I. Leibovitch; D. Selva; R.A. Goldberg; T.J. Sullivan; P. Saeed; G. Davis; J.D. McCann; A. Mcnab; J. Rootman
Objective: To present the clinical features and management outcome in a large series of patients with periocular and orbital amyloidosis. Design: Retrospective, noncomparative, interventional case series. Patients: All patients diagnosed with periocular and orbital amyloidosis in 6 oculoplastic and
Alan Y Ho
Full Text Available Alan Y Ho, Anastasia DimitropoulosDepartment of Psychology, Case Western Reserve University, Cleveland, OH, USAAbstract: Prader–Willi syndrome (PWS is a complex neurodevelopmental disorder caused by an abnormality on the long arm of chromosome 15 (q11–q13 that results in a host of phenotypic characteristics, dominated primarily by hyperphagia and insatiable appetite. Characteristic behavioral disturbances in PWS include excessive interest in food, skin picking, difficulty with a change in routine, temper tantrums, obsessive and compulsive behaviors, and mood fluctuations. Individuals with PWS typically have intellectual disabilities (borderline to mild/moderate mental retardation and exhibit a higher overall behavior disturbance compared to individuals with similar intellectual disability. Due to its multisystem disorder, family members, caregivers, physicians, dieticians, and speech-language pathologists all play an important role in the management and treatment of symptoms in an individual with PWS. This article reviews current research on behavior and cognition in PWS and discusses management guidelines for this disorder.Keywords: Prader–Willi syndrome; neurodevelopment, hyperphagia, disability
Bouali, Sofiene; Maatar, Nidhal; Bouhoula, Asma; Abderrahmen, Khansa; Said, Imed Ben; Boubaker, Adnen; Kallel, Jalel; Jemel, Hafedh
Purpose: The spinal epidural angiolipomas are rare expansive processes made of mature lipomatous and angiomatous elements. They often have a benign character. Their etiology, pathogenesis remains uncertain, and it is a cause of spinal cord compression. The magnetic resonance imaging is the most important neuroradiological examination. Histological examination is the only examination to confirm the diagnosis. Surgery is the treatment of choice. Methods: A retrospective study of all patients operated on for a spinal epidural angiolipoma at the Department of Neurosurgery at the National Institute of Neurology of Tunis between January 2000 and December 2014 (15 years) was performed. The aim of this study is to describe the clinical, radiological, histological characteristics and the treatment of this tumor. Results: A total of nine patients were operated from January 01, 2000 to November 30, 2014. The average age of our patients was 51 years with ages that ranged from 29 to 65 with a male predominance. The period between onset of symptoms and diagnosis ranged from 24 months with an average 12 months. Posterior localization of the tumor was seen in all patients. Surgical resection was performed for all cases. The postoperative course has been satisfactory, with a complete recovery of neurological functions in all patients. Conclusions: The spinal epidural angiolipomas is rare expansive process causing spinal cord compression. Treatment is exclusively surgical resection. The functional outcome of spinal epidural angiolipomas is particularly favorable with a complete neurological recovery is if the patient was quickly operated.
Bouali, Sofiene; Maatar, Nidhal; Bouhoula, Asma; Abderrahmen, Khansa; Said, Imed Ben; Boubaker, Adnen; Kallel, Jalel; Jemel, Hafedh
Purpose: The spinal epidural angiolipomas are rare expansive processes made of mature lipomatous and angiomatous elements. They often have a benign character. Their etiology, pathogenesis remains uncertain, and it is a cause of spinal cord compression. The magnetic resonance imaging is the most important neuroradiological examination. Histological examination is the only examination to confirm the diagnosis. Surgery is the treatment of choice. Methods: A retrospective study of all patients operated on for a spinal epidural angiolipoma at the Department of Neurosurgery at the National Institute of Neurology of Tunis between January 2000 and December 2014 (15 years) was performed. The aim of this study is to describe the clinical, radiological, histological characteristics and the treatment of this tumor. Results: A total of nine patients were operated from January 01, 2000 to November 30, 2014. The average age of our patients was 51 years with ages that ranged from 29 to 65 with a male predominance. The period between onset of symptoms and diagnosis ranged from 24 months with an average 12 months. Posterior localization of the tumor was seen in all patients. Surgical resection was performed for all cases. The postoperative course has been satisfactory, with a complete recovery of neurological functions in all patients. Conclusions: The spinal epidural angiolipomas is rare expansive process causing spinal cord compression. Treatment is exclusively surgical resection. The functional outcome of spinal epidural angiolipomas is particularly favorable with a complete neurological recovery is if the patient was quickly operated. PMID:27695535
Rodriguez-Manero, M.; Namdar, M.; Sarkozy, A.; Casado-Arroyo, R.; Ricciardi, D.; Asmundis, C. de; Chierchia, G.B.; Wauters, K.; Rao, J.Y.; Bayrak, F.; Malderen, S. Van; Brugada, P.
Atrial fibrillation (AF) can be the first manifestation of latent Brugada syndrome (BS). The aim of our study was to assess the prevalence of AF as the first clinical diagnosis in patients with BS and their demographic and clinical characteristics and diagnosis management in a large cohort of patien
Miravitlles, Marc; Murio, Cristina; Tirado-Conde, Gema; Levy, Gur; Muellerova, Hana; Soriano, Joan B; Ramirez-Venegas, Alejandra; Ko, Fanny WS; Canelos-Estrella, Byron; Giugno, Eduardo; Bergna, Miguel; Chérrez, Ivan; Anzueto, Antonio
Aims Data on differences in clinical characteristics and management of COPD in different countries and settings are limited. We aimed to characterize the profile of patients with COPD in a number of countries and their treatment in order to evaluate adherence to recommendations of international guidelines. Method This was an observational, international, cross-sectional study on patients with physician-diagnosed COPD. Demographic and clinical characteristics, risk factors, and treatment were collected by their physician via an internet web-based questionnaire developed for the study. Results A total of 77 investigators from 17 countries provided data on 833 patients. The countries with the highest number of patients included were: Argentina (128), Ecuador (134), Spain (162), and Hong Kong (153). Overall, 79.3% were men and 81% former smokers, with a mean FEV1 = 42.7%, ranging from 34.3% in Hong Kong to 58.8% in Ecuador. Patients reported a mean of 1.6 exacerbations the previous year, with this frequency being significantly and negatively correlated with FEV1(%) (r = −0.256; p < 0.0001). Treatment with short-acting bronchodilators and theophyllines was more frequent in Ecuador and Hong Kong compared with Spain and Argentina, and in patients belonging to lower socioeconomic levels (p < 0.0001 for all comparisons). Inadequacy of treatment with inhaled corticosteroids and theophyllines was high, with significant differences among countries. Conclusions Differences in the clinical characteristics and management of COPD were significant across countries. Adherence to international guidelines appears to be low. Efforts should be made to disseminate and adapt guidelines to the socioeconomic reality of different settings. PMID:19281096
FENG Zhi-chun; SHI Yun; DONG Jian-ying; ZHENG Tian; LI Jing-ya; LU Li-li; LIU Jing-jing; LIANG Jing; ZHANG Hao
Background Respiratory distress syndrome (RDS) is one of the most common causes of neonatal respiratory failure and neonatal death, however, its clinical characteristics are very different from premature RDS, and these characteristics have not been well documented as yet. This study was to investigate the pathogenesis, clinical characteristics and management strategies of RDS in full-term neonates, with the aim of developing a working protocol for improving the outcome in full-term neonates with RDS.Methods A total of 125 full-term infants with RDS were enrolled in this study. Their clinical and laboratory data were collected for analyzing the characteristics of full-term neonatal RDS.Results (1) The 125 cases included 94 male and 31 female infants, vaginal delivery occurred in 80 cases and cesarean section in 45 cases. (2) The onset time of RDS was (3.11±3.59) hours after birth. (3)The possible reasons included severe perinatal infections in 63 patients, elective cesarean section in 34 cases, severe birth asphyxia in 12 patients,meconium aspiration syndrome in 9 patients, pulmonary hemorrhage in 4 patients and matemal diabetes in 3 patients. (4)Complications included multiple organ system failure (MOSF) in 49 patients, persistent pulmonary hypertension of newborn (PPHN) in 25 patients, acute renal failure in 18 patients, severe hyperkalemia in 25 patients, severe metabolic acidosis in 6 cases, severe myocardial injury in 9 cases, pulmonary hemorrhage in 3 cases, disseminated intravascular coagulation in 14 patients and shock in 12 patients.(5) Four patients died, the mortality was therefore 3.2% with the main cause of septicemia complicating of MOSF, but their prognosis was improved while comprehensive treatment measures including early mechanical ventilation and broad spectrum antibiotics were taken into account.Conclusions RDS is not an uncommon disease in full-term infants and is associated with a higher mortality, its clinical characteristics are very
Rodríguez-Mañero, Moisés; Namdar, Mehdi; Sarkozy, Andrea; Casado-Arroyo, Rubén; Ricciardi, Danilo; de Asmundis, Carlo; Chierchia, Gian-Battista; Wauters, Kristel; Rao, Jayakeerthi Y; Bayrak, Fatih; Van Malderen, Sophie; Brugada, Pedro
Atrial fibrillation (AF) can be the first manifestation of latent Brugada syndrome (BS). The aim of our study was to assess the prevalence of AF as the first clinical diagnosis in patients with BS and their demographic and clinical characteristics and diagnosis management in a large cohort of patients. The patient group consisted of 611 patients with BS. The data from those with a diagnosis of AF previous to the identification of BS were analyzed (n = 35). Eleven cases were unmasked after the initiation of a class I antiarrhythmic drug and one during the establishment of general anesthesia. In the remaining population, BS was diagnosed using an ajmaline test performed mainly because of younger age in patients with lone AF (n = 13), previous syncope or sudden cardiac death (n = 3), or a clinical history of sudden cardiac death in the family (n = 5). The mean patient age was 49 ± 15 years, 21 were male patients, 14 had a family history of sudden death, 15 had had previous syncope, and 4 had survived cardiac arrest. Concomitant electrical disorder was found in 13 patients. Remarkably, 21 patients had normal findings on the baseline electrocardiogram. In conclusion, AF could be one of the first clinical manifestations of latent BS in a considerable number of patients. This identification is crucial because the treatment of these patients is subject to relevant changes. The ajmaline test plays an essential role, mainly in young patients with a family history of sudden death, despite having normal findings on a baseline electrocardiogram. PMID:23206922
Full Text Available Objective: To determine the risk factors, clinical characteristics, surgical management and outcome of pseudoaneurysm secondary to iatrogenic or traumatic vascular injury. Methods: This was a cross-sectional study being performed in department of cardiovascular and thoracic surgery skims soura during a 4-year period. We included all the patients referring to our center with primary diagnosis of pseudoaneurysm. The pseudoaneurysm was diagnosed with angiography and color Doppler sonography. The clinical and demographic characteristics were recorded and the risk factors were identified accordingly. Patients with small swelling (less than 5-cm and without any complication were managed conservatively. They were followed for progression and development of complications in relation to swelling. Others underwent surgical repair and excision. The outcome of the patients was also recorded. Results: Overall we included 20 patients with pseudoaneurysm. The mean age of the patients was 42.1±0.6 years. Among them there were 11 (55% men and 9 (45% women. Nine (45% patients with end stage renal disease developed pseudoaneurysm after inadvertent femoral artery puncture for hemodialysis; two patients after interventional cardiology procedure; one after femoral embolectomy; one developed after fire arm splinter injury and one formed femoral artery related pseudoaneurysm after drainage of right inguinal abscess. The most common site of pseudoaneurysm was femoral artery followed by brachial artery. Overall surgical intervention was performed in 17 (85% patients and 3 (15% were managed conservatively. Conclusion: End stage renal disease is a major risk factor for pseudoaneurysm formation. Coagulopathy, either therapeutic or pathological is also an important risk factor. Patients with these risk factors need cannulation of venous structures for hemodialysis under ultrasound guide to prevent inadvertent arterial injury. Patients with end stage renal disease who
Thomsen, Frederik B; Mikkelsen, Marta K; Hansen, Rikke B;
BACKGROUND: The Danish Cancer Registry holds information on all prostate cancers (PCa) cases, including diagnostic TNM. However, stratification according to contemporary risk classification is not possible because histopathological grading and prostate-specific antigen (PSA) level are not registe......BACKGROUND: The Danish Cancer Registry holds information on all prostate cancers (PCa) cases, including diagnostic TNM. However, stratification according to contemporary risk classification is not possible because histopathological grading and prostate-specific antigen (PSA) level...... are not registered. The objective of the study was to report clinical characteristics and primary management of men diagnosed with PCa from a primary referral center in Denmark. MATERIAL AND METHODS: Records on all men diagnosed with PCa at the Department of Urology, Frederiksberg Hospital, 1 January 2007 - 31...... December 2013, were reviewed. Clinical characteristics and primary treatment were recorded. The National Comprehensive Cancer Network risk group classification was used. RESULTS: A total of 1934 men with a median age of 69 years (interquartile range 65-75) were diagnosed with PCa in the study period...
Full Text Available Patients affected by psychotic disorders are more likely to develop high rates of co-morbidities , such as obesity, type 2 diabetes, dyslipidemias, hypertension, metabolic syndrome, myocardial infarction, stroke etc. in the long-term. These morbidities have a significant impact on the life-expectancy of these patients. Patients with chronic psychoses show a two- to three-fold increased risk of death mostly from cardiovascular and metabolic diseases. Although there may be an independent link between schizophrenia and metabolic conditions, the cardio-metabolic risk is mostly related to an unhealthy lifestyle and the usage of antipsychotic agents (especially Second Generation Antipsychotics or atypical even when these remain effective treatments in the management of major psychoses. Recently many international organizations have developed screening and monitoring guidelines for the control of modifiable risk factors in order to reduce the rate of co-morbidity and mortality among patients affected by schizophrenia. This paper is a review of current knowledge about the metabolic issues of patients affected by schizophrenia and describes clinical characteristics and medical management strategies for such conditions.
Richards, Michael D; Wong, Agnes
Infantile nystagmus syndrome (INS) is an important clinical diagnosis because it is a common presenting sign of many ocular, neurologic, and systemic diseases. Although INS has been studied for more than a century, its diagnosis and treatment remains a challenge to clinicians because of its varied manifestations and multiple associations, and its pathogenesis continues to rouse considerable scientific debate. Fueled by these challenges, recent basic research and clinical investigations have provided new insights into INS. New genetic discoveries and technological advances in ocular imaging have refined our understanding of INS subtypes and offer new diagnostic possibilities. Unexpected surgical outcomes have led to new understanding of its pathogenesis based on novel hypothesized pathways of ocular motor control. Comparative studies on nonhuman visual systems have also informed models of the neural substrate of INS in humans. This review brings together the classic profile of this disorder with recent research to provide an update on the clinical features of INS, an overview of the current theories on how and why INS develops, and a practical approach to the diagnosis and management of INS.
Park, Soyoung; Choi, Kyoung Ho; Oh, Youngmin; Lee, Hae-Kook; Kweon, Yong-Sil; Lee, Chung Tai; Lee, Kyoung-Uk
Case management interventions for suicide attempters aimed at helping adjust their social life to prevent reattempts have high nonparticipation and dropout rates. We analyzed the clinical characteristics of the group who refused to participate in the suicide prevention program in Korea. A total of 489 patients with a suicide attempt who visited Uijeongbu St. Mary's Hospital, the Catholic University of Korea, from December 2009 to December 2013 were analyzed. All patients were divided into the participation group (n = 262) and the refusal group (n = 227) according to their participation in the case management program. Demographic and clinical characteristics of each group were examined. Results showed that the refusal group had low risks for suicide in terms of risk factors related with psychopathologies and presenting suicide behavior. That is, the refusal group had less patients with co-morbid medical illnesses and more patients with mild severity of depression compared to the participation group. However, the refusal group had more interpersonal conflict, more isolation of social integrity, and more impaired insight about suicide attempt. The results suggest that nonparticipation in the case management program may depend upon the patient's impaired insight about the riskiness of suicide and lack of social support.
Cherukuri, Harika; Pramoda, K.; Rohini, D.; Thunga, Girish; Vijaynarayana, K; Sreedharan, N.; Varma, Muralidhar; Pandit, Vinay
Herbicide poisoning is most common method of suicide in India and it is associated with high morbidity and mortality. Among different herbicidal poisonings the most predominantly found poisonings are paraquat and glyphosate. These compounds are highly toxic and their poisonings require proper management techniques. High fatality is seen in these cases which are mainly due to its inherent toxicity and lack of effective treatment. Common symptoms of these poisonings includes gastrointestinal co...
Full Text Available Abstract Background Adequate surgery still remains the only curative treatment of chordoma. Interesting clinical data on advanced disease with molecularly targeted therapies were reported. Methods We described the clinical outcome of a series of chordoma patients followed at Regina Elena National Cancer Centre of Rome from 2004 to 2008. Results Twenty-five consecutive patients with sacral (11 patients, spine (13 patients, and skull base (1 patient chordoma went to our observation. Six patients (24% had primary disease, 14(56% a recurrent disease, and 5(20% a metastatic spreading. Surgery was the primary option for treatment in 22 out of 25 patients. Surgical margins were wide in 5 (23% and intralesional in 17(77% patients; 3 out of 4 in-house treated patients obtained wide margins. After first surgery, radiotherapy (protons or high-energy photons were delivered to 3 patients. One out of the 5 patients with wide margins is still without evidence of disease at 20 months from surgery; 2 patients died without evidence of disease after 3 and 36 months from surgery. Sixteen out of 17 (94% patients with intralesional margins underwent local progression at a median time of 18 months with a 2-year local progression-free survival of 47%. The 5-year metastasis-free survival rate was 78.3%. Seventeen patients with locally advanced and/or metastatic disease expressing platelet-derived growth factor receptor (PDGFR β were treated with imatinib mesylate. A RECIST stabilization of the disease was the best response observed in all treated cases. Pain relief with reduction in analgesics use was obtained in 6 out of 11 (54% symptomatic patients. The 5- and 10-year survival rates of the entire series of patients were 76.7 and 59.7%, respectively. Conclusions Despite progress of surgical techniques and the results obtained with targeted therapy, more effort is needed for better disease control. Specific experience of the multidisciplinar therapeutic team is
Hou-Quan Tao; Jing-Xia Zhang; Shou-Chun Zou
AIM: To study clinical characteristics and management of patients with early severe acute pancreatitis (ESAP).METHODS: Data of 297 patients with severe acute pancreatitis (SAP) admitted to our hospital within 72 h after onset of symptoms from January 1991 to June 2003 were reviewed for the occurrence and development of early severe acute pancreatitis (ESAP). ESAP was defined as presence of organ dysfunction within 72 h after onset of symptoms. Sixtynine patients had ESAP, 228 patients without organ dysfunction within 72 h after onset of symptoms had SAR The clinical characteristics, incidence of organ dysfunction during hospitalization and prognosis between ESAP and SAP were compared.RESULTS: Impairment degree of pancreas (Balthazar CT class) in ESAP was more serious than that in SAP (5.31±0.68 vs 3.68±0.29, P＜0.01). ESAP had a higher mortality than SAP (43.4% vs 2.6%, P＜0.01), and a higher incidence of hypoxemia (85.5% vs 25%, P＜0.01), pancreas infection (15.9% vs7.5% , P＜0.05), abdominal compartment syndrome (ACS) (78.3% vs 23.2%, P＜0.01) and multiple organ dysfunction syndrome (MODS)(78.3% vs 10.1%, P＜0.01). In multiple logistic regression analysis, the main predisposing factors to ESAP were higher APACHE Ⅱ score, Balthazar CT class, MODS and hypoxemia.CONCLUSION: ESAP is characterised by MODS, severe pathological changes of pancreas, early hypoxemia and abdominal compartment syndrome. Given the poor prognosis of ESAP, these patients should be treated in specialized intensive care units with special measures such as close supervision, fluid resuscitation, improvement of hypoxemia, reduction of pancreatic secretion, elimination of inflammatory mediators, prevention and treatment of pancreatic infections.
Kleibl, Zdenek; Kristensen, Vessela N
The presence of breast cancer in any first-degree female relative in general nearly doubles the risk for a proband and the risk gradually increases with the number of affected relatives. Current advances in molecular oncology and oncogenetics may enable the identification of high-risk individuals with breast-cancer predisposition. The best-known forms of hereditary breast cancer (HBC) are caused by mutations in the high-penetrance genes BRCA1 and BRCA2. Other genes, including PTEN, TP53, STK11/LKB1, CDH1, PALB2, CHEK2, ATM, MRE11, RAD50, NBS1, BRIP1, FANCA, FANCC, FANCM, RAD51, RAD51B, RAD51C, RAD51D, and XRCC2 have been described as high- or moderate-penetrance breast cancer-susceptibility genes. The majority of breast cancer-susceptibility genes code for tumor suppressor proteins that are involved in critical processes of DNA repair pathways. This is of particular importance for those women who, due to their increased risk of breast cancer, may be subjected to more frequent screening but due to their repair deficiency might be at the risk of developing radiation-induced malignancies. It has been proven that cancers arising from the most frequent BRCA1 gene mutation carriers differ significantly from the sporadic disease of age-matched controls in their histopathological appearances and molecular characteristics. The increased depth of mutation detection brought by next-generation sequencing and a better understanding of the mechanisms through which these mutations cause the disease will bring novel insights in terms of oncological prevention, diagnostics, and therapeutic options for HBC patients. PMID:27318168
Kleibl, Zdenek; Kristensen, Vessela N
The presence of breast cancer in any first-degree female relative in general nearly doubles the risk for a proband and the risk gradually increases with the number of affected relatives. Current advances in molecular oncology and oncogenetics may enable the identification of high-risk individuals with breast-cancer predisposition. The best-known forms of hereditary breast cancer (HBC) are caused by mutations in the high-penetrance genes BRCA1 and BRCA2. Other genes, including PTEN, TP53, STK11/LKB1, CDH1, PALB2, CHEK2, ATM, MRE11, RAD50, NBS1, BRIP1, FANCA, FANCC, FANCM, RAD51, RAD51B, RAD51C, RAD51D, and XRCC2 have been described as high- or moderate-penetrance breast cancer-susceptibility genes. The majority of breast cancer-susceptibility genes code for tumor suppressor proteins that are involved in critical processes of DNA repair pathways. This is of particular importance for those women who, due to their increased risk of breast cancer, may be subjected to more frequent screening but due to their repair deficiency might be at the risk of developing radiation-induced malignancies. It has been proven that cancers arising from the most frequent BRCA1 gene mutation carriers differ significantly from the sporadic disease of age-matched controls in their histopathological appearances and molecular characteristics. The increased depth of mutation detection brought by next-generation sequencing and a better understanding of the mechanisms through which these mutations cause the disease will bring novel insights in terms of oncological prevention, diagnostics, and therapeutic options for HBC patients.
Woo, Jennifer A; Leonard N Chen; Bhagat, Aditi; Oermann, Eric K; Kim, Joy S; Moures, Rudy; Yung, Thomas; Lei, Siyuan; Collins, Brian T.; Kumar, Deepak; Suy, Simeng; Dritschilo, Anatoly; Lynch, John H.; Sean P Collins
Purpose: Stereotactic body radiation therapy (SBRT) is increasingly utilized as primary treatment for clinically localized prostate cancer. While acute post-SBRT urinary symptoms are well recognized, the late genitourinary toxicity of SBRT has not been fully described. Here, we characterize the clinical features of late urinary symptom flare and recommend conservative symptom management approaches that may alleviate the associated bother. Methods: Between February 2008 and August 2011, 216...
Atrial fibrillation can be categorized into nonpermanent and permanent atrial fibrillation. There is less information on permanent than on nonpermanent atrial fibrillation patients. This analysis aimed to describe the characteristics and current management, including the proportion of patients with successful atrial fibrillation control, of these atrial fibrillation subsets in a large, geographically diverse contemporary sample.
Zhou Hua; Jiang Liang; Wei Feng; Yu Miao; Wu Fengliang; Liu Xiaoguang; Liu Zhongjun
Background Chordomas of the upper cervical spine are rare and present unique surgical challenge.This study aimed to describe the clinical characteristics and surgical management of patients with chordomas of the upper cervical spine.Methods Twenty-one patients with chordomas of the upper cervical spine who were treated in Peking University Third Hospital from January 1999 to October 2012 were retrospectively analyzed.Survival was calculated by the Kaplan-Meier method and was compared between groups using the log-rank test.Results The postoperative diagnosis was classical chordoma in 20 cases and chondroid chordoma in one case.The mean operative time was 9.5 hours (range 6-17 hours),and the mean blood loss was 2 812 ml (range 700-4 800 ml).There were two postoperative deaths.Unilateral vertebral artery ligation was performed in six patients,cervical nerve roots were cut in six patients,and the external branch of the superior laryngeal nerve was repaired after being cut in one case.Two patients developed postoperative velopharyngeal incompetence,and loosening of the occipitocervical screws was observed in one patient.The recurrence rate was 66.7％ (10/15) after a mean follow-up period of 46.8 months (range 14-150 months).The 5-and 10-year overall survival rates were (39.8±13.1)％ and (31.9±12.7)％,respectively.There was a significant difference in survival rate between patients who underwent surgery and those who did not.Conclusion In spite of the high rates of recurrence and complications after surgical treatment of chordomas of the upper cervical spine,intralesional resection combined with adjuvant radiotherapy remains the optimal treatment to prolong survival.
Jan Murin; Lisa Naditch-Brûlé; Sandrine Brette; Chern-En Chiang; James O'Neill; P Gabriel Steg
BACKGROUND: Atrial fibrillation can be categorized into nonpermanent and permanent atrial fibrillation. There is less information on permanent than on nonpermanent atrial fibrillation patients. This analysis aimed to describe the characteristics and current management, including the proportion of patients with successful atrial fibrillation control, of these atrial fibrillation subsets in a large, geographically diverse contemporary sample. METHODS AND RESULTS: Data from RealiseAF, an interna...
Full Text Available Objectives: We sought to describe the demographics, clinical characteristics, management and outcomes of patients in Oman with acute heart failure (AHF as part of the Gulf aCute heArt failuRe rEgistry (CARE project. Methods: Data were analyzed from 988 consecutive patients admitted with AHF to 12 hospitals in Oman between 14 February and 14 November 2012. Results: The mean age of our patients was 63±12 years. Over half (57% were male and 95% were Omani citizens. Fifty-seven percent of patients presented with acute decompensated chronic heart failure (ADCHF while 43% had new-onset AHF. The primary comorbid conditions were hypertension (72%, coronary artery disease (55%, and diabetes mellitus (53%. Ischemic heart disease (IHD, hypertensive heart disease, and idiopathic cardiomyopathy were the most common etiologies of AHF in Oman. The median left ventricular ejection fraction of the cohort was 36% (27–45% with 56% of the patients having heart failure with reduced ejection fraction (< 40%. Atrial fibrillation was seen in 15% of patients. Acute coronary syndrome (ACS and non-compliance with medications were the most common precipitating factors. At discharge, angiotensin converting enzyme inhibitors and beta-blockers were prescribed adequately, but aldosterone antagonists were under prescribed. Within 12-months follow-up, one in two patients were rehospitalized for AHF. In-hospital mortality was 7.1%, which doubled to 15.7% at three months and reached 26.4% at one-year post discharge. Conclusions: Oman CARE was the first prospective multicenter registry of AHF in Oman and showed that heart failure (HF patients present at a younger age with recurrent ADCHF and HF with reduced ejection fraction. IHD was the most common etiology of HF with a low prevalence of AHF, but a high prevalence of acute coronary syndrome and non-compliance with medications precipitating HF. A quarter of patients died at one-year follow-up even though at discharge medical
Mansfield Richard J
Full Text Available Abstract Background Although shoulder pain is a commonly encountered problem in primary care, there are few studies examining its presenting characteristics and clinical management in this setting. Methods We performed secondary data analysis of 692 office visits for shoulder pain collected through the National Ambulatory Medical Care Survey (Survey years 1993–2000. Information on demographic characteristics, history and place of injury, and clinical management (physician order of imaging, physiotherapy, and steroid intraarticular injection were examined. Results Shoulder pain was associated with an injury in one third (33.2% (230/692 of office visits in this population of US primary care physicians. Males, and younger adults (age ≤ 52 more often associated their shoulder pain with previous injury, but there were no racial differences in injury status. Injury-related shoulder pain was related to work in over one-fifth (21.3% (43/202 of visits. An x-ray was performed in 29.0% (164/566 of office visits, a finding that did not differ by gender, race, or by age status. Other imaging (CT scan, MRI, or ultrasound was infrequently performed (6.5%, 37/566. Physiotherapy was ordered in 23.9% (135/566 of visits for shoulder pain. Younger adults and patients with a history of injury more often had physiotherapy ordered, but there was no significant difference in the ordering of physiotherapy by gender or race. Examination of the use of intraarticular injection was not possible with this data set. Conclusion These data from the largest sample of patients with shoulder pain presenting to primary care settings offer insights into the presenting characteristics and clinical management of shoulder pain at the primary care level. The National Ambulatory Medical Care Survey is a useful resource for examining the clinical management of specific symptoms in U.S. primary care offices.
Bradley, John S; Peacock, Georgina; Krug, Steven E; Bower, William A; Cohn, Amanda C; Meaney-Delman, Dana; Pavia, Andrew T
Anthrax is a zoonotic disease caused by Bacillus anthracis, which has multiple routes of infection in humans, manifesting in different initial presentations of disease. Because B anthracis has the potential to be used as a biological weapon and can rapidly progress to systemic anthrax with high mortality in those who are exposed and untreated, clinical guidance that can be quickly implemented must be in place before any intentional release of the agent. This document provides clinical guidance for the prophylaxis and treatment of neonates, infants, children, adolescents, and young adults up to the age of 21 (referred to as "children") in the event of a deliberate B anthracis release and offers guidance in areas where the unique characteristics of children dictate a different clinical recommendation from adults.
Ozlem Yonem; Yusuf Bayraktar
Caroli's syndrome is characterized by multiple segmental cystic or saccular dilatations of intrahepatic bile ducts associated with congenital hepatic fibrosis. The clinical features of this syndrome reflect both the characteristics of congenital hepatic fibrosis such as portal hypertension and that of Caroli's disease named as recurrent cholangitis and cholelithiasis. The diagnosis depends on both histology and imaging methods which can show the communication between the sacculi and the bile ducts. Treatment consists of symptomatic treatment of cholangitis attacks by antibiotics, some endoscopic,radiological and surgical drainage procedures and surgery. Liver transplantation seems the ultimate treatment for this disease. Prognosis is fairly good unless recurrent cholangitis and renal failure develops.
Pan, Heng-Chih; Wu, Pei-Chen; Wu, Vin-Cent; Yang, Ya-Fei; Huang, Tao-Min; Shiao, Chih-Chung; Chen, Te-Chuan; Tarng, Der-Cherng; Lin, Jui-Hsiang; Yang, Wei-Shun; Sun, Chiao-Yin; Lin, Chan-Yu; Chu, Tzong-Shinn; Wu, Mai-Szu; Wu, Kwan-Dun; Chen, Yung-Chang; Huang, Chiu-Ching
Acute kidney injury (AKI) is a common complication in hospitalized patients. The International Society of Nephrology implemented the "0 by 25" initiative aimed at preventing deaths from treatable AKI worldwide by 2025 and conducted a global snapshot survey in 2014. We joined in the project and conducted this study to compare the epidemiology, risk factors, and prognosis between patients with pure AKI and those with acute-on-chronic kidney disease (ACKD). In this study, we prospectively collected demographic parameters and data on clinical characteristics, baseline comorbidities, management, and outcomes of 201 AKI patients in 18 hospitals in Taiwan from September 2014 to November 2014. The in-hospital mortality rate was 16%. AKI was mostly attributed to sepsis (52%). Multivariate logistic regression indicated that oliguria was a positive independent predictor of in-hospital mortality, whereas preexisting CKD and exposure to nephrotoxic agents were negative independent predictors. The prevalence of vasopressor use, intensive care unit care, and mortality were significantly higher in pure AKI patients than in ACKD patients. Moreover, serum creatinine (SCr) levels significantly increased within 7 days after AKI diagnosis in nonsurvivors but not in survivors in the pure AKI group. By contrast, SCr levels were persistently lower in nonsurvivors than in survivors in the ACKD group during the same period. We thus determined that the prognosis of ACKD patients differed from that of pure AKI patients. Considering the CKD history in the future AKI staging system may improve prognosis prediction. PMID:27684854
Hoa L Nguyen
Full Text Available BACKGROUND: Cardiovascular disease is one of the leading causes of morbidity and mortality in Vietnam. We conducted a pilot study of Hanoi residents hospitalized with acute myocardial infarction (AMI at the Vietnam National Heart Institute in Hanoi. The objectives of this observational study were to examine sex differences in clinical characteristics, hospital management, in-hospital clinical complications, and mortality in patients hospitalized with an initial AMI. METHODS: The study population consisted of 302 Hanoi residents hospitalized with a first AMI at the largest tertiary care medical center in Hanoi in 2010. RESULTS: The average age of study patients was 66 years and one third were women. Women were older (70 vs. 64 years and were more likely than men to have had hyperlipidemia previously diagnosed (10% vs. 2%. During hospitalization, women were less likely to have undergone percutaneous coronary intervention (PCI compared with men (57% vs. 74%, and women were more likely to have developed heart failure compared with men (19% vs. 10%. Women experienced higher in-hospital case-fatality rates (CFRs than men (13% vs. 4% and these differences were attenuated after adjustment for age and history of hyperlipidemia (OR: 2.64; 95% CI: 1.01, 6.89, and receipt of PCI during hospitalization (OR: 2.09; 95% CI: 0.77, 5.09. CONCLUSIONS: Our pilot data suggest that among patients hospitalized with a first AMI in Hanoi, women experienced higher in-hospital CFRs than men. Full-scale surveillance of all Hanoi residents hospitalized with AMI at all Hanoi medical centers is needed to confirm these findings. More targeted and timely educational and treatment approaches for women appear warranted.
Full Text Available Clinical chorioamnionitis continues to contribute to fetal and maternal morbidity and mortality. Significant advances have been made in the last 20 years in understanding the pathophysiologic processes leading to chorioamnionitis. This review addresses the history, incidence, pathophysiology, host defenses, risk factors, diagnosis, and maternal and neonatal management of clinically evident chorioamnionitis. After a detailed review of the physiologic processes leading to clinical chorioamnionitis and sepsis, we present a modern management scheme designed to optimize perinatal outcome for both mother and fetus.
Batista, Pollyanna Barros; Bertollo, Eny Maria Goloni; Costa, Danielle de Souza; Eliam, Lucas; Cunha, Karin Soares Gonçalves; Cunha-Melo, José Renan; Darrigo Junior, Luiz Guilherme; Geller, Mauro; Gianordoli-Nascimento, Ingrid Faria; Madeira, Luciana Gonçalves; Mendes, Hérika Martins; Miranda, Débora Marques de; Mata-Machado, Nikolas Andre; Morato, Eric Grossi; Pavarino, Érika Cristina; Pereira, Luciana Baptista; Rezende, Nilton Alves de; Rodrigues, Luíza de Oliveira; Sette, Jorge Bezerra Cavalcanti
Part 1 of this guideline addressed the differential diagnosis of the neurofibromatoses (NF): neurofibromatosis type 1 (NF1), neurofibromatosis type 2 (NF2) and schwannomatosis (SCH). NF shares some features such as the genetic origin of the neural tumors and cutaneous manifestations, and affects nearly 80 thousand Brazilians. Increasing scientific knowledge on NF has allowed better clinical management and reduced rate of complications and morbidity, resulting in higher quality of life for NF patients. Most medical doctors are able to perform NF diagnosis, but the wide range of clinical manifestations and the inability to predict the onset or severity of new features, consequences, or complications make NF management a real clinical challenge, requiring the support of different specialists for proper treatment and genetic counseling, especially in NF2 and SCH. The present text suggests guidelines for the clinical management of NF, with emphasis on NF1. PMID:26083891
Burns, Martha S
Agnosia is a neurological recognition deficit that affects a single modality. Visual agnosias include pure object agnosia, prosopagnosia, akinetopsia, and pure alexia. Auditory agnosias include pure word deafness, phonagnosia, and pure sound agnosia. New neuroimaging tools have permitted scientists to better understand the loci of lesions that cause various agnosias and from that knowledge to develop theories about the processing networks that contribute to perception and recognition in each modality. These research data, in turn, inform the rehabilitation process. By utilizing current knowledge about neuroprocessing networks, clinical professionals can differentially diagnose agnosias from aphasia and other cognitive deficits. Practical approaches to treatment of agnosia will follow once the diagnosis is established.
Del Brutto, Oscar H
Neurocysticercosis is the most common helminthic disease of the nervous system and a leading cause of acquired epilepsy worldwide. Differences in the number and location of lesions as well as in the severity of the immune response against the parasites, makes neurocysticercosis a complex disease. Therefore, a single therapeutic approach is not expected to be useful in every patient. Introduction of cysticidal drugs - praziquantel and albendazole - have changed the prognosis of thousands of patients with neurocysticercosis. While pioneer trials of therapy were flawed by a poor design, recent studies have shown that cysticidal drugs results in disappearance of lesions and clinical improvement in most cases. Nevertheless, some patients with parenchymal neurocysticercosis may be left with remaining cysts and may develop recurrent seizures after therapy, and many patients with subarachnoid cysts may need repeated courses of therapy. In addition, not all forms of the disease benefit from cysticidal drugs.
Yamauchi, Mika; Sugimoto, Toshitsugu
As men are less likely than women to develop osteoporosis, male osteoporosis remains poorly understood. However, elderly men have a clearly reduced bone mineral density and increased risk for fractures. In Japan, one in four patients with osteoporosis is male. Male osteoporosis is associated with not only reduction in androgen, but also estrogen, and differs from postmenopausal osteoporosis in that decreased bone formation is involved and that age-related changes in cortical bone structure and perforation of the trabeculae of cancellous bone are unlikely to occur. The proportion of secondary osteoporosis is higher for men than women;therefore, differential diagnosis is important in the diagnosis of male osteoporosis. In addition, it is recommended that bone mineral density be measured at the femoral neck or total hip in men. Men have a worse prognosis following fractures than women, and management of male osteoporosis is highly important for extending healthy life expectancy. PMID:27346307
Li, Ming; And Others
Reports a study that examined the characteristics that enable graduate sport management programs to achieve their objectives. Surveys of sport management educators found they agreed on 11 characteristics that indicated a sport management program's effectiveness. Respondents believed an effective program should produce sport managers, not…
Williams, David M; Gallagher, Maire; Handley, Joel; Stephens, Jeffrey W
Hyponatraemia is the most common electrolyte disorder seen in clinical practice and the consequences can range from minor symptoms to life-threatening complications including seizures and cardiorespiratory distress. These effects occur as a result of fluid shifts due to deranged serum tonicity and subsequent cerebral oedema. The appropriate assessment and management of patients with hyponatraemia is not always achieved in clinical practice, which is partly related to challenges in teaching with limited clinical guidance. Recently, the European Society of Endocrinology, European Society of Intensive Care Medicine and European Renal Association-European Dialysis and Transplant Association produced clinical practice guidelines to focus on appropriate investigation and management of these patients. Within this manuscript, we highlight the key points from these guidelines, which are most pertinent to doctors of all specialties to improve the care of patients with this common electrolyte disorder. PMID:27044859
Lennard-Jones, J E
First, it is important to find out whether the patient is complaining of infrequent defaecation, excessive straining at defaecation, abdominal pain or bloating, a general sense of malaise attributed to constipation, soiling, or a combination of more than one symptom. Second, one must decide if there is a definable abnormality as a cause of the symptom(s). Is the colon apparently normal or is its lumen widened (megacolon)? Is the upper gut normal or is there evidence of neuropathy or myopathy? Is the ano-rectum normal or is there evidence of a weak pelvic floor, mucosal prolapse, major rectocele, an internal intussusception or solitary rectal ulcer? Is there any systemic component such as hypothyroidism, hypercalcaemia, neurological or psychiatric disorder or relevant drug therapy? Choice of treatment will depend on this clinical evaluation. The range of treatments available is: Reassurance and stop current treatment: Patients with a bowel obsession may take laxatives or rectal preparations regularly without need. Increase dietary fibre: Most cases of 'simple' constipation respond to increased dietary fibre, possibly with an added supplement of natural bran. Toilet training and altered routine of life: Young people particularly may need to recognise the call to stool and alter their daily routine to permit and encourage regular defaecation. Medicinal bulking agent: Ispaghula, methyl cellulose, concentrated wheat germ or bran, and similar preparations are useful when patients with a normal colon find it difficult to take adequate dietary fibre. These preparations increase the bulk of stool and soften its consistency. They may be useful for those patients with the constipated form of irritable bowel syndrome.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8234432
Smith, G. Scott; Wetzstein, Michael E.; Douce, G. Keith
Considering pest management in terms of a set of technology characteristics allows an investigation of various pest-management characteristics and how they relate to a total pest-management package. Employing restricted and unrestricted least squares in this investigation indicates the unique impact individual pest-management characteristics exert on net returns. A Stein-rule estimator is also employed in assessing this impact.
B.A. Kirwan (Bridget Anne)
textabstractThe aim of this thesis is to show how clinical trial conduct can be managed while respecting the underlying scientific principles. Chapter 2 describes the main results of PICO (PImobendan in COngestive heart failure), a trial which investigated a positive inotropic agent in patients with
The spill pleural is a frequent entity in congestive heart failure. The congestive heart failure, is probable that the cause more common of pleural spill, an analysis of the spill causes is made, the pathology is revised from the clinical point of view, highlighting the most excellent characteristics in each entity and an cytological analysis is made
The radiologist plays a crucial role in identifying and narrowing the differential diagnosis of intracranial infections. A thorough understanding of the intracranial compartment anatomy and characteristic imaging findings of specific pathogens, as well incorporation of the clinical information, is essential to establish correct diagnosis. Specific types of infections have certain propensities for different anatomical regions within the brain. In addition, the imaging findings must be placed in the context of the clinical setting, particularly in immunocompromised and human immunodeficiency virus (HIV)-positive patients. This paper describes and depicts infections within the different compartments of the brain. Pathology-proven infectious cases are presented in both immunocompetent and immunocompromised patients, with a discussion of the characteristic findings of each pathogen. Magnetic resonance spectroscopy (MRS) characteristics for several infections are also discussed
Ozgur Harmanci; Yusuf Bayraktar
Idiopathic portal hypertension is one of the interesting causes of portal hypertension. Even in very developed medical centers, this disorder is still one of the most important misdiagnoses of clinical practice. To inexperienced physicians, presenting esophageal varices and upper gastrointestinal bleeding usually prompt an unfortunate diagnosis of cirrhosis. A heterogenous clinical presentation and progression of this disorder should be recognized by physicians, and management should be directed towards some specific problems confined to this disorder. Although a genetic basis and other factors are implicated in its pathogenesis, exact underlying mechanism(s) is (are) unknown. In this review, we discuss the heterogeneity of idiopathic portal hypertension, its etiopathogenesis, clinical presentation and management issues. With the expectation of an excellent prognosis, a practicing gastroenterologist should be aware that "not all varices mean cirrhosis".
Information for researchers about developing, reporting, and managing NCI-funded cancer prevention clinical trials. Protocol Information Office The central clearinghouse for clinical trials management within the Division of Cancer Prevention.Read more about the Protocol Information Office. | Information for researchers about developing, reporting, and managing NCI-funded cancer prevention clinical trials.
Objective: To analyse the clinical characteristics of the radiation pneumonia, sum the experience and the basis of the radiation pneumonia for its prevention and treatment. Method: Twenty three cases with radiation pneumonia from 1991 to 1998 were retrospectively analysed. Its clinical manifestation, chest X-ray, thoracic CT and blood routine were evaluated. Result: The acute manifestation was fever, cough, dyspnea, and the chronic manifestation was cough and insufficiency of pulmonary function. Conclusion: The prevention of radiation pneumonia is more important, high dose cortical steroids and antibiotics were prescribed during the acute stage and the chronic radiation pneumonia is irreversible
Alavi Darazam, Ilad; Shamaei, Masoud; Mobarhan, Mandana; Ghasemi, Shahin; Tabarsi, Payam; Motavasseli, Masoud; Mansouri, Davood
Nocardiosis has been reported increasingly in recent two decades, probably due to improvement in isolation of the organism and increased burden of immune compromised patients. Nocardia occasionally has been reported in healthy people. A case series of definitive Nocardiosis (2002 to 2010), clinical characteristics, underlying diseases, immune status and in-patient outcome were studied in a tertiary referral center. Twenty one patients with definite diagnosis of Nocardiosis were studied. 17 ca...
Kales, A; Soldatos, C R; Caldwell, A B; Kales, J D; Humphrey, F J; Charney, D S; Schweitzer, P K
Fifty adults with either a present or past complaint of somnambulism were evaluated to determine the development and clinical course of their disorder as well as their personality patterns. Generally, when sleepwalking was outgrown, its onset was before age 10 years and its termination before age 15 years. Current sleepwalkers, compared with past sleepwalkers, started sleepwalking at a later age, had a higher frequency of events, and had episodes earlier in the night. Their episodes were also characterized by more intense clinical manifestations. Furthermore, current sleepwalkers demonstrated high levels of psychopathology, whereas past sleepwalkers had essentially normal psychological patterns. Specifically, the current sleepwalkers showed active, outwardly directed behavioral patterns, suggestive of difficulties in handling aggression. The clinical application of these findings is discussed and practical recommendations are given for the evaluation and management of sleepwalking. PMID:7447621
妊娠期高血压疾病是产科最常见的病种,可导致孕产妇和围产儿妊娠结局不良.早发型重度子痫前期是妊娠期高血压疾病的一个特殊亚型,其主要特征是孕产妇并发症多,围产儿死亡率高,且其并发症发病早,病情重,严重威胁着孕产妇和围产儿的安全.早期预测并鉴别围产儿并发症有助于监测患者病情严重程度,指导临床处理.但目前尚无被证明很确切的早发型重度子痫前期的产前预测方法,精确预测其发生风险仍然是一个挑战.既往有早发型重度子痫前期病史的女性再次妊娠时,其再发早发型重度子痫前期的风险增高,其它不良妊娠并发症发生率也增高.故期待治疗在临床处理中意义重大.该文综合其最新研究进展作以综述.%Hypertensive disorders complicating pregnancy are the most common disorders in pregnancy and are associated with adverse maternal and perinatal outcomes. Early onset severe preeclampsia (ES-PE) is a specific subtype of hypertensive disorders complicating pregnancy. It is characterized by high incidence rates of maternal complications and high perinatal mortality, and early onset and severe complications, so it threatens safty of the pregnant women and the perineonate severely. Early prediction and identification of complications are helpful to monitor severity of the disease and guide clinical treatment. But no confirmed and more definite predicting method of ES-PE before labor is found, and preciously predicting the risk of developing the disease remains a challenge. The women who had a previous history of ES-PE had an increased replase risk of the disease and increased incidence rates of adverse pregnancy complications and outcomes in their subsequent pregnancies. So expectant management which improves perinatal outcomes is very important in clinical treatment. In this article, we reviewed progress in research on ES-PE.
Gotts, Jeffrey E; Matthay, Michael A
Sepsis, severe sepsis, and septic shock represent increasingly severe systemic inflammatory responses to infection. Sepsis is common in the aging population, and it disproportionately affects patients with cancer and underlying immunosuppression. In its most severe form, sepsis causes multiple organ dysfunction that can produce a state of chronic critical illness characterized by severe immune dysfunction and catabolism. Much has been learnt about the pathogenesis of sepsis at the molecular, cell, and intact organ level. Despite uncertainties in hemodynamic management and several treatments that have failed in clinical trials, investigational therapies increasingly target sepsis induced organ and immune dysfunction. Outcomes in sepsis have greatly improved overall, probably because of an enhanced focus on early diagnosis and fluid resuscitation, the rapid delivery of effective antibiotics, and other improvements in supportive care for critically ill patients. These improvements include lung protective ventilation, more judicious use of blood products, and strategies to reduce nosocomial infections. PMID:27217054
Rostomyan, Liliya; Daly, Adrian F; Beckers, Albert
Acromegaly and pituitary gigantism are very rare conditions resulting from excessive secretion of growth hormone (GH), usually by a pituitary adenoma. Pituitary gigantism occurs when GH excess overlaps with the period of rapid linear growth during childhood and adolescence. Until recently, its etiology and clinical characteristics have been poorly understood. Genetic and genomic causes have been identified in recent years that explain about half of cases of pituitary gigantism. We describe these recent discoveries and focus on some important settings in which gigantism can occur, including familial isolated pituitary adenomas (FIPA) and the newly described X-linked acrogigantism (X-LAG) syndrome.
Rostomyan, Liliya; Daly, Adrian F; Beckers, Albert
Acromegaly and pituitary gigantism are very rare conditions resulting from excessive secretion of growth hormone (GH), usually by a pituitary adenoma. Pituitary gigantism occurs when GH excess overlaps with the period of rapid linear growth during childhood and adolescence. Until recently, its etiology and clinical characteristics have been poorly understood. Genetic and genomic causes have been identified in recent years that explain about half of cases of pituitary gigantism. We describe these recent discoveries and focus on some important settings in which gigantism can occur, including familial isolated pituitary adenomas (FIPA) and the newly described X-linked acrogigantism (X-LAG) syndrome. PMID:26585365
Objective To analyze the clinic characteristics of varicella zoster myocarditis and to determine the diagnostic value of serum cardiac troponin I (cTnI ) on the disease. Methods Information of 58 hospitalized patients with varicella zoster was collected, and the incidence of varicella zoster myocarditis and clinic characteristics (ECG, cTnI, age and sex distribution, etc. ) were analyzed respectively. Results It was found that 36.2% of the patients developed myocarditis. The old and female persons were much more susceptible to varicella zoster myocarditis. All patients had responsive ECG manifestations, and the abnormal ST-T changes were more common than other ECG abnormalities. CTnI remained higher than normal and had significant diagnostic value. Most of the patients had good prognosis, only a few patients lasted a long time and even progressed into cardiomyopathy. Nearly all the patients came to see dermatologists when they felt ill initially. That would lead to more misdiagnosis. Conclusion Infection of varicella zoster can complicate myocarditis, we must pay more attention to the patients who suffer from varicella zoster especially in the aged and female; cTnI is an important and effective index for diagnosis of varicella zoster myocarditis.
Takahashi, Yoshinobu; Makino, Keishi; Nakamura, Hideo; Hide, Takuichiro; Yano, Shigetoshi; Kamada, Hajime; Kuratsu, Jun-Ichi
Cerebellar glioblastomas (GBMs) are rare, with neither their pathogenesis nor prognosis being completely understood. The present study aimed to clarify the clinical characteristics of cerebellar GBMs by comparison with supratentorial GBMs, focusing particularly on the pathogenesis. The clinical factors between cerebellar (n=10) and supratentorial (n=216) GBMs were compared. Additionally, p53 and epidermal growth factor receptor (EGFR) levels were investigated in six patients by immunostaining as well as the isocitrate dehydrogenase 1 (IDH1) status of five patients by direct sequencing. Eight males and two females participated in the present study, the mean age at diagnosis was 56.6 years and the range 37-75 years. Four patients presented with hydrocephalus and one with brainstem involvement, and two patients were diagnosed with neurofibromatosis type 1. Two patients had previously received radiotherapy, eight patients received postoperative radiotherapy and seven chemotherapy. The mean Karnofsky performance status (KPS) score was lower in patients with cerebellar GBMs compared to those with supratentorial GBM; however, the survival times did not differ between the two groups. All of the cases of six cerebellar GBMs were p53‑positive and EGFR‑negative, as detected by immunostaining, consistent with secondary GBM. However, no IDH1 mutations were detected in any of the five cases of cerebellar GBMs analyzed, indicating that these tumors were not of the secondary type. The KPS score with cerebellar GBMs may be lower due to hydrocephalus, which was ameliorated by surgery but may have impacted the survival rate. It was confirmed that cerebellar GBMs were identical to supratentorial GBMs with respect to its clinical features, with the possible exception of the KPS score. The present study's genetic analyses indicated that cerebellar GBMs may develop via a pathway different from that of either primary or secondary GBM. PMID:25199771
闫桂森; 杨征; 张骥; 朱振华
Objective To investigate the characteristics, therapeutic effects, and prognosis of cases with traumatic dislocations of the hip in children. Methods From January 1990 to December 2006, 27 pa-tients with traumatic hip dislocations were entered in the study, including 19 males and 8 females with an average age of 10.2 years (range, 2.5-14.4 years). Sixteen cases were caused by high-energy trauma, and 11 occurred during daily activities. 25 patients were diagnosed to have a posterior dislocation, and direction of the dislocation was not clear in 2 cases for spontaneous reduction. The diagnosis in one case was initially missed, possibly due to a combination of femur shaft fracture. The duration between injury and reduction was 1-9 h in 24 cases and over 24 h in the other 3. Twenty-one cases were treated by closed reduction, and 6 by open reduction. Of 6 cases with open reduction, 3 cases had osteoehondral fragments, 2 glenoid labrum tear and incarceration, 1 intra-articular incarceration. All the cases were immobilized with spica cast after reduc-tion for 4-6 weeks, and avoided weight-bearing for 3 months. Results The ratio of boys to girls was 2.4:1, and 48 percent of the patients aged under ten. There was significant difference between the age of high- and low-energy trauma. All patients were followed up for an average of 3.6 years (range, 2.4-8.3 years). Accord-ing to Thompson and Epstein's criterion, clinical results were excellent in 24, good in 2, fair in 1. At final follow-up four had femoral head necrosis and three developed residual coxa magna, all of them were high-en-ergy trauma. There was high risk of femoral head necrosis in the group which reduction was delayed over 24 h. Conclusion The trauma energy caused hip dislocation is lower in childhood, the combined injury was few. Closed reduction was usually easy to achieve with few complications. If central reduction was failed, open reduction should be performed. The results were satisfactory of which
Full Text Available Management is leading, administering resources, and achieving the goals and objectives that have been set. In the Chilean health care system, management can be subdivided in three main levels – macro-management, meso-management and micro-management. Managing health care is also about epidemiological changes, information and technology innovations, patient groups demanding better services, but mostly about a huge escalation in costs that is not necessarily substantiated by evidence on more efficiency in health outcomes.Clinical management is more than a management tool. It is a cultural change that will provide new values to professional practice and to the organization as a whole. However, clinical management demands more commitment on behalf of the human teams that need to learn how to lead and to be led. These teams will be called upon to help in the decision-making process for the betterment of the institution.
Full Text Available Ozlem Balci Ophthalmology Department, Kolan Hospitalium Group, Istanbul, Turkey Purpose: To evaluate the clinical characteristics of patients with conjunctivochalasis (CCh. Methods and materials: This retrospective study enrolled 30 subjects diagnosed with conjunctivochalasis. Complete ophthalmic examination, including visual acuity assessment, slit-lamp examination, applanation tonometry, dilated funduscopy, tear break-up time, Schirmer 1 test, and fluorescein staining were performed in all patients. Age, sex, laterality, ocular history, symptoms, and clinical findings were recorded. Results: The study included 50 eyes from 30 cases. Ages ranged from 45 to 80 years, with a mean age of 65±10 years. CChs grading were as follows: 30 (60% eyes with grade 1 CCh; 15 (30% eyes with grade 2 CCh; and five (10% eyes with grade 3 CCh. CCh was located in the inferior bulbar conjunctiva in 45 (90% eyes, and in the remaining five (10% CCh was located in the superior bulbar conjunctiva. Ten (33.3% patients had no symptoms. Dryness, eye pain, redness, blurry vision, tired eye feeling, and epiphora were the symptoms encountered in the remaining twenty (63.6% patients. Altered tear meniscus was noted in all cases. The mean tear break-up time was 7.6 seconds. The mean Schirmer 1 test score was 7 mm. Pinguecula was found in ten patients. Conclusion: Dryness, eye pain, redness, blurry vision, and epiphora were the main symptoms in patients with CCh. Dryness, eye pain, and blurry vision were worsened during downgaze and blinking. So CCh should be taken into consideration in the differential diagnosis of chronic ocular irritation and epiphora. Keywords: ocular irritation, epiphora, dryness, eye pain, blurry vision
Cheng, Zhuo; Li, Xiaofeng; Ding, Jin
Liver cancer is an aggressive malignant disease with a poor prognosis. Patients with liver cancer are usually diagnosed at an advanced stage and thus miss the opportunity for surgical resection. Chemotherapy and radiofrequency ablation, which target tumor bulk, have exhibited limited therapeutic efficacy to date. Liver cancer stem cells (CSCs) are a small subset of undifferentiated cells existed in liver cancer, which are considered to be responsible for liver cancer initiation, metastasis, relapse and chemoresistance. Elucidating liver CSC characteristics and disclosing their regulatory mechanism might not only deepen our understanding of the pathogenesis of liver cancer but also facilitate the development of diagnostic, prognostic and therapeutic approaches to improve the clinical management of liver cancer. In this review, we will summarize the recent advances in liver CSC research in terms of the origin, identification, regulation and clinical correlation.
Cheng, Zhuo; Li, Xiaofeng; Ding, Jin
Liver cancer is an aggressive malignant disease with a poor prognosis. Patients with liver cancer are usually diagnosed at an advanced stage and thus miss the opportunity for surgical resection. Chemotherapy and radiofrequency ablation, which target tumor bulk, have exhibited limited therapeutic efficacy to date. Liver cancer stem cells (CSCs) are a small subset of undifferentiated cells existed in liver cancer, which are considered to be responsible for liver cancer initiation, metastasis, relapse and chemoresistance. Elucidating liver CSC characteristics and disclosing their regulatory mechanism might not only deepen our understanding of the pathogenesis of liver cancer but also facilitate the development of diagnostic, prognostic and therapeutic approaches to improve the clinical management of liver cancer. In this review, we will summarize the recent advances in liver CSC research in terms of the origin, identification, regulation and clinical correlation. PMID:26272183
Bethea, Jane; Makki, Sophia; Gray, Steve; MacGregor, Vanessa; Ladhani, Shamez
In England and Wales, meningococcal disease caused by group W has historically been associated with outbreaks of disease among travellers to high-risk countries. Following a large outbreak associated with travel to the Hajj in 2000, the number of cases declined and, in 2008, only 19 laboratory-confirmed cases were identified nationally. In 2013, in the East Midlands region of England, eight cases of meningococcal disease caused by this serogroup were recorded, compared with six from 2011 to 2012. To explore this further, data for all cases with a date of onset between 1 January 2011 and 31 December 2013 were collected. Data collected included geographical location, clinical presentation and outcome. Fourteen cases were identified; two died as a result of their illness and two developed long-term health problems. No commonality in terms of geographical location, shared space or activities was identified, suggesting that group W is circulating endemically with local transmission. Clinical presentation was variable. Half presented with symptoms not typical of a classical meningococcal disease, including two cases of cellulitis, which may have implications for clinicians, in terms of timely identification and treatment, and public health specialists, for offering timely antibiotic chemoprophylaxis to close contacts. PMID:27336327
Ikegami, H; Sumiyoshi, T; Ishizuka, N; Ueda, M; Inaba, T; Hosoda, S; Aomi, S; Endo, M; Hashimoto, A; Koyanagi, H
Increases in pancreatic enzyme levels after cardiovascular surgery were studied, and their clinical characteristics evaluated. The subjects were 128 patients who had undergone cardiovascular surgery (65 patients after valve replacement, 32 after coronary bypass surgery and 31 after aortic artificial graft replacement). The pancreatic enzyme (serum amylase and lypase) levels were monitored serially before and after operation, and amylase fractions were measured at their peaks. The relationships of the peak lypase level with underlying cardiac diseases, background factors, factors related to surgery, factors related to the extracorporeal circulation, presence or absence of symptoms, and treatments were examined. The amylase level exhibited biphasic changes consisting of a peak in which salivary glands amylase (S type) was dominant and a peak in which pancreatic amylase (P type) was dominant. The second peak coincided with the peak lypase and occurred mostly 3 to 10 days after operation. The peak lypase level exceeded the normal range in 78% of all the patients. It exceeded 564 U/l, 4 times the normal value in 28% of the patients, many of whom were symptomatic. So, we recommended that these cases should be treated as "postoperative pancreatitis". A high peak lypase level showed a significant correlation with the history of gallbladder and pancreatic diseases and diabetes mellitus among the background factors and emergency operation and the use of IABP among the surgery-related factors.(ABSTRACT TRUNCATED AT 250 WORDS)
Correia-Sá, Inês; Rodrigues-Pereira, Pedro; Marques, Marisa
Implants from Poly Implant Prothése (PIP), the French manufacturer, showed increased risk of implant rupture and silicone leakage through the shell. Concerns also exist about the potential irritant behavior of silicone gel filler in these implants. This report presents the clinical, histologic, and microbiologic characteristics of a capsule and a siliconoma from a patient with a ruptured PIP implant. A 41-year-old woman submitted to breast augmentation in 2005 with PIP silicone gel implants presented with a recent history of progressive asymmetric breast enlargement and an enlarged lymph node on her right axilla. No capsular contracture was observed. A breast ultrasonography showed intra- and extracapsular ruptures of the right implant. The woman underwent explantation. Histologic analysis of the breast capsules showed a thin capsule with a chronic, mild inflammatory response. Microbiologic analysis showed no bacterial agent. The irritant behavior of the PIP silicone gel previously described was not able to produce capsular contracture or an exuberant inflammatory reaction. Studies to evaluate the potential risks of the silicone gel and to define the hazards for women implanted with those prostheses are urgently needed. PMID:23943050
Wong, SH; Ng, KF; Chen, PP
Since it was first introduced more than 30 years ago, clinical simulation has become a popular tool for medical training, particularly in crisis management. The modern high-fidelity patient simulator consists of a whole-body mannequin with integrated electronic patient monitoring; it is controlled by computers capable of simulating numerous clinical scenarios and patient characteristics, and reacting to various interventions appropriately. Simulator training is theoretically superior to conve...
Del Rosso, James Q; Harper, Julie C; Graber, Emmy M; Thiboutot, Diane; Silverberg, Nanette B; Eichenfield, Dawn Zhang; Eichenfield, Lawrence F
Acne presenting in adult women is commonly encountered in clinical practice. Many affected women have had acne during their teenaged years, have tried several therapies in the past, and are seeking effective treatment. Others are frustrated by the inexplicable emergence of acne as an adult when they never had it as a teenager. Both groups seek an explanation of why they have acne, are often psychosocially affected by its effects on appearance and self-esteem, and all are wanting effective and safe treatment. Clinicians are encouraged to connect favorably with each patient through careful history and physical examination and to consider underlying causes of androgen excess. Practical approaches to examination and laboratory evaluation are discussed. PMID:26682286
Del Rosso, James Q; Harper, Julie C; Graber, Emmy M; Thiboutot, Diane; Silverberg, Nanette B; Eichenfield, Dawn Zhang; Eichenfield, Lawrence F
Acne presenting in adult women is commonly encountered in clinical practice. Many affected women have had acne during their teenaged years, have tried several therapies in the past, and are seeking effective treatment. Others are frustrated by the inexplicable emergence of acne as an adult when they never had it as a teenager. Both groups seek an explanation of why they have acne, are often psychosocially affected by its effects on appearance and self-esteem, and all are wanting effective and safe treatment. Clinicians are encouraged to connect favorably with each patient through careful history and physical examination and to consider underlying causes of androgen excess. Practical approaches to examination and laboratory evaluation are discussed.
Yen, Miaofen; Fang, Szu-Ting
Everything is changing in our daily life. The ancient Chinese philosopher, Sun Tzu, said "The art of war teaches us to rely not on the likelihood of the enemy's not coming, but on our own readiness to receive him". In the challenging environment of today, nursing administrators should prepare themselves by developing a range of skills to face the changing world. This article introduces Chinese and Western leadership theories and suggests eight key characteristics of successful leaders in health care. Equipped with these characteristics, nursing leaders should be able to collaborate with other professionals in their organization to manage any crisis. Success in crisis management also enhances an organization's general potential to succeed in this competitive world.
Even though it is firmly established that statins are the cornerstone of management of dyslipidemias, several controversies still exist in this area. In the present review, the most pertinent controversies in lipid management are discussed and the current evidence is summarized. Treatment with statins increases the risk for type 2 diabetes mellitus (T2DM) but this increase appears to be small and outweighed by the benefits of statins on cardiovascular disease prevention. Accordingly, statin treatment-associated T2DM should not affect management decisions. In patients who cannot achieve low-density lipoprotein cholesterol (LDL-C) targets despite treatment with the maximum tolerated dose of a potent statin, adding ezetimibe appears to be the treatment of choice. Finally, patients who achieved LDL-C targets with a statin but have elevated triglyceride levels appear to have increased cardiovascular risk and adding fenofibrate appears to reduce this risk. Even though additional large randomized controlled trials are unlikely to be performed with the existing lipid-lowering agents, mechanistic, genetic and epidemiological studies, as well as careful analyses of the existing trials will provide further insights in these controversial issues and will allow the optimization of the management of dyslipidemia aiming at further reductions in cardiovascular morbidity.
Chongjin Feng; Junbing Guo; Yong Chen
OBJECTIVE To analyse the clinical characteristics of malignant granuloma(MG) and evaluate its treatment.METHODS From March 1985 to May 1998, 101 cases of malignant granuloma were treated with radiation (RT) alone or radiotherapy followed by chemotherapy or chemotherapy followed by radiotherapy. For chemotherapy, a CCNU, COMP (CTX, VCR, MTX, PDN) or CHOP (CTX,ADM, VCR, PDN) regimen was given. Radiation was directed through the anterior field of the nose mainly for nasal and paranasal sinus malignant granuloma, and through the faciocervical field for malignant granuloma of Walderyer's ring or for patients with cervical lymphadenectasis. Total dose was 45-65 Gy over 5-6 weeks.RESULTS The overall 3-year, 5-year and 10-year survival rates were 78.2%, 56.1% and 39.7% respectively. The 5-year survival rate was: RT group 60.3%, RT + CHOP or CHOP + RT group 64.7% (P ＞0.05), RT +CCNU group 40%, and RT + COMP group 33.3%. The 5-year survival rates of patients with one involved focus and more than 2 involved foci were 75.6%(34/45) and 39.3% (22/56) (P＜0.001). The 5-year survival rates of patients with or without body symptoms were 39.6% (18/48) and 67.9%(36/53) (P＜0.05). The 5-year survival rate of the 50-60 Gy group and the ＜50Gy group were 60.1% (40/66) and 20% (1/5)(P ＜0.05). The local and regional recurrence rate was 20.8 % (21/101 ).CONCLUSION Radiotherapy alone should be the treatment of choice for patients with one site involvement and without body symptoms. Radiation fields should be large enough to include the potentially involved sites. The recommended dose is 50-60 Gy over 5-6 weeks. It is suggested that patients with more than 2 foci involvement and those with body symptoms should receive the combination therapy.
Roelofsen, Thijs; van Ham, Maaike A; de Hullu, Joanne A; Massuger, Leon F
Uterine papillary serous carcinoma (UPSC) is an aggressive variant of endometrial cancer. Owing to its rarity, most clinicians are unfamiliar with the clinical aspects and management of UPSC. Furthermore, little prospective evidence exists regarding how best to treat this subset of patients. In anticipation of prospective clinical trials, this article summarizes the latest results of various clinical management options in the different substages of UPSC, with a special focus on the effects of cytoreductive surgery, comprehensive surgical staging and different adjuvant treatment options in relation to recurrence rate and survival outcome. PMID:21166512
Sharff, Katie A; Richards, Eric P; Townes, John M
Septic arthritis is a rheumatologic emergency as joint destruction occurs rapidly and can lead to significant morbidity and mortality. Accurate diagnosis can be particularly challenging in patients with underlying inflammatory joint disease. This review outlines the risk factors for septic arthritis and summarizes the causative bacterial organisms. We highlight advances in antibiotic management with a focus on new drugs for methicillin-resistant Staphylococcus aureus (MRSA) and discuss the use of adjunctive therapies for treatment of septic arthritis in adults.
Pollyanna Barros Batista
Full Text Available Part 1 of this guideline addressed the differential diagnosis of the neurofibromatoses (NF: neurofibromatosis type 1 (NF1, neurofibromatosis type 2 (NF2 and schwannomatosis (SCH. NF shares some features such as the genetic origin of the neural tumors and cutaneous manifestations, and affects nearly 80 thousand Brazilians. Increasing scientific knowledge on NF has allowed better clinical management and reduced rate of complications and morbidity, resulting in higher quality of life for NF patients. Most medical doctors are able to perform NF diagnosis, but the wide range of clinical manifestations and the inability to predict the onset or severity of new features, consequences, or complications make NF management a real clinical challenge, requiring the support of different specialists for proper treatment and genetic counseling, especially in NF2 and SCH. The present text suggests guidelines for the clinical management of NF, with emphasis on NF1.
Ortlieb, Evan; Pearce, Daniel L.
A literacy clinic is an ideal setting where research and exploration often lead to breakthroughs in reading remediation; that information can then be transferred to classroom instruction (Morris, 2003). Although it is clear that literacy clinics should be structured around what works for their student populations, there remains ambiguity…
Mulholland, Carlen; Martin, Malissa
Context: Characteristics of a model clinical instructor (CI) continue to be defined. However, certain characteristics are still unknown. Objective: To more fully define and describe quality clinical instruction by examining the impact of employment status, years of experience as a certified athletic trainer (AT), and employment setting on athletic…
Weiler, Catherine R; Butterfield, Joseph
Mast cell sarcoma is a disorder that results in abnormal mast cells as identified by morphology, special stains, and in some publications, c-kit mutation analysis. It affects animal species such as canines more commonly than humans. In humans it is a very rare condition, with variable clinical presentation. There is no standard therapy for the disorder. It can affect any age group. It is occasionally associated with systemic mastocytosis and/or urticaria pigmentosa. The prognosis of mast cell sarcoma in published literature is very poor in humans.
Szczęch, Justyna; Rutka, Maja; Samotij, Dominik; Zalewska, Agnieszka; Reich, Adam
Introduction Lupus erythematosus (LE) shows a wide variety of clinical manifestations, skin involvement being one of the most important. Aim To analyze the clinical presentation of cutaneous variants of lupus erythematosus in terms of skin lesion spectrum and extracutaneous involvement. Material and methods A total of 64 patients with cutaneous LE (CLE) were included. The study was based on the “Core Set Questionnaire” developed by the European Society of Cutaneous Lupus Erythematosus (EUSCLE...
Aller, T A
Myopia has been increasing in prevalence throughout the world, reaching over 90% in some East Asian populations. There is increasing evidence that whereas genetics clearly have an important role, the type of visual environment to which one is exposed to likely influences the onset, progression, and cessation of myopia. Consequently, attempts to either modify the environment or to reduce the exposure of the eye to various environmental stimuli to eye growth through the use of various optical devices are well under way at research centers around the globe. The most promising of current treatments include low-percentage atropine, bifocal soft contact lenses, orthokeratology, and multifocal spectacles. These methods are discussed briefly and are then categorized in terms of their expected degree of myopia progression control. A clinical strategy is presented for selecting the most effective treatment for the appropriate type of patient at the optimal stage of refractive development to achieve the maximum control of myopia progression. PMID:24357844
Edward L Krawitt
Autoimmune hepatitis (AIH) is a chronic hepatitis of unknown etiology which can progress to cirrhosis.Its clinical manifestations are highly variable and sometimes follow a fluctuating course.Diagnosis is based on characteristic histologic,clinical,biochemical and serological findings. Anti-inflammatory/immunosuppressive treatment frequently induces remission but long-term maintenance therapy is often required. Liver transplantation is generally successful in patients with decompensated cirrhosis unresponsive to or intolerant of medical therapy.
José Roque Nodal Arruebarrena
Full Text Available Clinical Practice Guidelines for Potential Donors Management. It has been defined as the patient in Glasgow coma with scale higher or equal to 8 who doesn´t present contradictions for transplant (possible donor and who has been diagnosed of encephalic death. This document reviews and updates concepts, lists indications and contraindications for different organs donation, clinical assessment of the donor and its treatment. It includes assessment guidelines focused on the most important aspects to be accomplished.
Meyer, Raquel M; O'Brien-Pallas, Linda; Doran, Diane; Streiner, David; Ferguson-Paré, Mary; Duffield, Christine
Increasing role complexity has intensified the work of managers in supporting healthcare teams. This study examined the influence of front-line managers' characteristics and scope of responsibility on teamwork. Scope of responsibility considers the breadth of the manager's role. A descriptive, correlational design was used to collect cross-sectional survey and administrative data in four acute care hospitals. A convenience sample of 754 staff completed the Relational Coordination Scale as a measure of teamwork that focuses on the quality of communication and relationships. Nurses (73.9%), allied health professionals (14.7%) and unregulated staff (11.7%) worked in 54 clinical areas, clustered under 30 front-line managers. Data were analyzed using hierarchical linear modelling. Leadership practices, clinical support roles and compressed operational hours had positive effects on teamwork. Numbers of non-direct report staff and areas assigned had negative effects on teamwork. Teamwork did not vary by span, managerial experience, worked hours, occupational diversity or proportion of full-time employees. Large, acute care teaching hospitals can enable managers to foster teamwork by enhancing managers' leadership practices, redesigning the flow or reporting structure for non-direct reports, optimizing managerial hours relative to operational hours, allocating clinical support roles, reducing number of areas assigned and, potentially, introducing co-manager models.
Dinkelspiel, Helen E.; Wright, Jason D.; Lewin, Sharyn N.; Herzog, Thomas J.
Although the contemporary management of endometrial cancer is straightforward in many ways, novel data has emerged over the past decade that has altered the clinical standards of care while generating new controversies that will require further investigation. Fortunately most cases are diagnosed at early stages, but high-risk histologies and poorly differentiated tumors have high metastatic potential with a significantly worse prognosis. Initial management typically requires surgery, but the ...
Hatfield, Elizabeth; Dicks, Elizabeth; Parfrey, Patrick
Large, integrated multidisciplinary teams have become recognized as an efficient means by which to drive innovation and discovery in clinical research. This chapter describes how to budget and fund these large studies and effectively manage the large, often dispersed teams involved. Sources of funding are identified; budget development, justification, reporting, financial governance, and accountability are described; in addition to the creation and management of the multidisciplinary team that will implement the research plan. PMID:19160746
KENDALL, Philip C.; Compton, Scott N.; Walkup, John T.; Birmaher, Boris; Albano, Anne Marie; Sherrill, Joel; Ginsburg, Golda; Rynn, Moira; McCracken, James; Gosch, Elizabeth; Keeton, Courtney; Bergman, Lindsey; Sakolsky, Dara; Suveg, Cindy; Iyengar, Satish
Reports the characteristics of a large, representative sample of treatment seeking anxious youth (N =488). Participants, aged 7–17 years (mean 10.7 yrs), had a principal DSM-IV diagnosis of separation anxiety disorder (SAD), generalized anxiety disorder (GAD), or social phobia (SP). Although youth with a co-primary diagnosis for which a different disorder-specific treatment would be indicated (e.g., major depressive disorder, substance abuse) were not included, there were few other exclusion ...
Njoroge, Sarah W
Clinical laboratory tests play an integral role in medical decision-making and as such must be reliable and accurate. Unfortunately, no laboratory tests or devices are foolproof and errors can occur at pre-analytical, analytical and post-analytical phases of testing. Evaluating possible conditions that could lead to errors and outlining the necessary steps to detect and prevent errors before they cause patient harm is therefore an important part of laboratory testing. This can be achieved through the practice of risk management. EP23-A is a new guideline from the CLSI that introduces risk management principles to the clinical laboratory. This guideline borrows concepts from the manufacturing industry and encourages laboratories to develop risk management plans that address the specific risks inherent to each lab. Once the risks have been identified, the laboratory must implement control processes and continuously monitor and modify them to make certain that risk is maintained at a clinically acceptable level. This review summarizes the principles of risk management in the clinical laboratory and describes various quality control activities employed by the laboratory to achieve the goal of reporting valid, accurate and reliable test results. PMID:24982831
Parano, E; Lovelace, R E
Hypotonia is a common occurrence in pediatrics, especially in the neonatal period. The hypotonic neonate represents a diagnostic challenge for the general pediatrician because hypotonia may be caused by a lesion at any level in the neuraxis: (1) central nervous system (CNS), (2) peripheral nerves (PN), (3) neuromuscular junction, or (4) muscles. Distinguishing among these pathologies is a particularly arduous task. This review will discuss the clinical approach to neonatal hypotonia with emphasis on disorders of the peripheral nervous system and muscle, and the importance of the electrophysiological study as a diagnostic test.
Full Text Available G Simonetti, P Gaviani, A Botturi, A Innocenti, E Lamperti, A Silvani Neurooncology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy Abstract: Oligodendrogliomas represent the third most common type of glioma, comprising 4%–15% of all gliomas and can be classified by degree of malignancy into grade II and grade III, according to WHO classification. Only 30% of oligodendroglial tumors have anaplastic characteristics. Anaplastic oligodendroglioma (AO is often localized as a single lesion in the white matter and in the cortex, rarely in brainstem or spinal cord. The management of AO is deeply changed in the recent years. Maximal safe surgical resection followed by radiotherapy (RT was considered as the standard of care since paramount findings regarding molecular aspects, in particular co-deletion of the short arm of chromosome 1 and the long arm of chromosome 19, revealed that these subsets of AO, benefit in terms of overall survival (OS and progression-free survival (PFS, from the addition of chemotherapy to RT. Allelic losses of chromosomes 1p and 19q occur in 50%–70% of both low-grade and anaplastic tumors, representing a strong prognostic factor and a powerful predictor of prolonged survival. Several other molecular markers have potential clinical significance as IDH1 mutations, confirming the strong prognostic role for OS. Malignant brain tumors negatively impacts on patients' quality of life. Seizures, visual impairment, headache, and cognitive disorders can be present. Moreover, chemotherapy and RT have important side effects. For these reasons, “health-related quality of life” is becoming a topic of growing interest, investigating on physical, mental, emotional, and social well-being. Understanding the impact of medical treatment on health-related quality of life will probably have a growing effect both on health care strategies and on patients. Keywords: anaplastic oligodendroglioma, radiotherapy, chemotherapy
Oligodendrogliomas represent the third most common type of glioma, comprising 4%–15% of all gliomas and can be classified by degree of malignancy into grade II and grade III, according to WHO classification. Only 30% of oligodendroglial tumors have anaplastic characteristics. Anaplastic oligodendroglioma (AO) is often localized as a single lesion in the white matter and in the cortex, rarely in brainstem or spinal cord. The management of AO is deeply changed in the recent years. Maximal safe surgical resection followed by radiotherapy (RT) was considered as the standard of care since paramount findings regarding molecular aspects, in particular co-deletion of the short arm of chromosome 1 and the long arm of chromosome 19, revealed that these subsets of AO, benefit in terms of overall survival (OS) and progression-free survival (PFS), from the addition of chemotherapy to RT. Allelic losses of chromosomes 1p and 19q occur in 50%–70% of both low-grade and anaplastic tumors, representing a strong prognostic factor and a powerful predictor of prolonged survival. Several other molecular markers have potential clinical significance as IDH1 mutations, confirming the strong prognostic role for OS. Malignant brain tumors negatively impacts on patients’ quality of life. Seizures, visual impairment, headache, and cognitive disorders can be present. Moreover, chemotherapy and RT have important side effects. For these reasons, “health-related quality of life” is becoming a topic of growing interest, investigating on physical, mental, emotional, and social well-being. Understanding the impact of medical treatment on health-related quality of life will probably have a growing effect both on health care strategies and on patients
Gutiérrez López, Cristina; Mauriz, Jose L; Culebras, Jesús M
Nowadays, balanced scorecards have updated traditional management systems in the business sector. In this way, Kaplan and Norton propose performance measurement through several perspectives with a logical sequence: internal processes and learning impact client services, so that financial performance is affected. The aim of the present paper is to analyze the main characteristics of balanced scorecard when it is applied to non-for-profit companies and, specifically to the health sector in the clinical nutrition field. This model improves the economic vision of management with clinical indicators that represent healthcare professional's perspective. The balanced scorecard would allow a proper monitoring and tracking system for the main healthcare indicators. This contributes to a better control in comparison with standards that are associated with adequate quality assistance. Owing to the role of management accounting and cost calculations, the definition of healthcare professionals as clients or users, and clinical results relevance, it is necessary to adapt the balanced scorecard to the specific characteristics of the clinical field, redefining both perspectives and indicators. PMID:26262746
Gutiérrez López, Cristina; Mauriz, Jose L; Culebras, Jesús M
Nowadays, balanced scorecards have updated traditional management systems in the business sector. In this way, Kaplan and Norton propose performance measurement through several perspectives with a logical sequence: internal processes and learning impact client services, so that financial performance is affected. The aim of the present paper is to analyze the main characteristics of balanced scorecard when it is applied to non-for-profit companies and, specifically to the health sector in the clinical nutrition field. This model improves the economic vision of management with clinical indicators that represent healthcare professional's perspective. The balanced scorecard would allow a proper monitoring and tracking system for the main healthcare indicators. This contributes to a better control in comparison with standards that are associated with adequate quality assistance. Owing to the role of management accounting and cost calculations, the definition of healthcare professionals as clients or users, and clinical results relevance, it is necessary to adapt the balanced scorecard to the specific characteristics of the clinical field, redefining both perspectives and indicators.
Bossley, C.J.; Saglani, S; Kavanagh, C.; Payne, D.N.R.; Wilson, N; Tsartsali, L.; Rosenthal, M; Balfour-Lynn, I M; Nicholson, A.G.; Bush, A
This study describes the clinical characteristics and corticosteroid responsiveness of children with difficult asthma (DA). We hypothesised that complete corticosteroid responsiveness (defined as improved symptoms, normal spirometry, normal exhaled nitric oxide fraction (FeNO) and no bronchodilator responsiveness (BDR
Collins-Yoder, Angela Smith
Angioedema (AE) is a unique clinical presentation of an unchecked release of bradykinin. The origin of this clinical presentation can be either genetic or acquired. The outcome within the patient is subcutaneous swelling of the lower layers of the epidermis. Symptoms are most often localized to the upper airway or the gastrointestinal tract. A typical course resolves in 5 to 7 days, but in some patients, the clinical manifestations exist up to 6 weeks. Hereditary AE is rare and genetically linked, and typically, the patient has episodes for many years before diagnosis. Episodes of acquired AE may be drug induced, triggered by a specific allergen, or idiopathic. Angioedema can elicit the need for critical care interventions, for advanced airway management, or unnecessary abdominal surgery. The treatment for these patients is evolving as new pharmacological agents are developed. This article addresses subtypes of AE, triggers, pharmacology, and information for interdisciplinary team planning of individualized case management. PMID:27258954
Ahmed Farag Elhassanien
Full Text Available Background: ADEM, although relatively uncommon, is probably under-recognized. Objectives: To spotlight the clinical profile and therapeutic outcome of children with ADEM. Materials and Methods: This is a prospective study of patients with ADEM who were admitted to the Pediatric Departments in Aladan and Alfarawanya Hospitals in Kuwait, from January 2009 to January 2011. Clinical, microbiological and radiological data were analyzed. Results: Of 48 patients presented with acute neurological symptoms and signs, 21 patients fulfilled criteria for ADEM. 80.95% of cases were presenting in winter and spring, 57% of patients had a history of upper respiratory tract illness. The commonest presentations were motor deficits, convulsions and altered consciousness. CSF virology studies showed herpes simplex virus (HSV and Epstein-Barr virus (EBV (3 patients whereas nasal and nasopharyngeal swab showed evidence of influenza H1N1 virus (1 patient. Brain MRI was performed in all patients and revealed multiple hyperintense supratentorial brain lesions on T2/FLAIR images. 85.7% of patients had cortical and/or subcortical white matter lesions which were bilateral and asymmetric in location and size. Conclusion: ADEM although rare must be considered in children with acute onset of neurological signs and symptoms and must be distinguished from any acute neurological insult.
Full Text Available Objective To explore the clinical characteristics of intractable asthma,and to provide new knowledge for diagnosis and treatment of the disease.Methods Forty one patients with intractable asthma,admitted to the Institute of Respiratory Disease,Xinqiao Hospital of Third Military Medical University from Jan.2009 to Dec.2010,were included in present study.Spirometry tests were performed for all the 41 patients.Cell classification and counting were done in the induced sputum of 37 patients,and 34 patients underwent high-resolution chest computed tomography(HRCT.Results Incomplete reversibility of airflow obstruction(FEV1/FVC 0.03 of the total cells,13(35.1% and increased neutrophils( > 0.61 of total cells,6(16.2% showed increased both eosinophils and neutrophils,and only that of one patient showed normal percentage of the eosinophils and neutrophils.Chest HRCT of 34 patients showed thickening of bronchial wall in visible segment in 28 cases(82.3%,and in 22 cases(64.7% thickening of bronchial wall in secondary segments was accompanied with narrowed bronchus lumen,cylindrical bronchiectasis was predominant in 7 patients,and centrilobular emphysema was seen in 5 patients.Conclusion Airway remodeling,incomplete reversibility of airflow obstruction,airway inflammation appear to be the major clinical characteristics of intractable asthma.Combined use of chest HRCT,spirometry test,and cellular analysis of induced sputum may be helpful for identifying intractable asthma,and they provide the basis for individualized strategies to manage the disease.
Jin-huan WANG; Liu, Bo-Ji; Xu, Hui-Xiong; Sun, Li-ping; Li, Dan-Dan; Guo, Le-Hang; Liu, Lin-Na; Xu, Xiao-Hong
Objectives: To investigate the clinical, pathological, and sonographic characteristics of unexpected gallbladder carcinoma (UGC). Methods: Of 5424 patients who had undergone cholecystectomy from December 2006 to October 2013, 54 patients with primary gallbladder carcinomas confirmed by pathological diagnosis were identified. The patients were divided into two groups: diagnosed before operation (n=34) and UGC groups (n=20), of whom the clinical, pathological, and sonographic characteristics we...
Kales, J D; Kales, A; Soldatos, C R; Caldwell, A B; Charney, D S; Martin, E D
The development and clinical course of night terrors and the personality patterns of patients with this disorder were evaluated in 40 adults who had a current complaint of night terrors. Compared with a group of adult sleepwalkers, the patients with night terrors had a later age of onset for their disorder, a higher frequency of events, and an earlier time of night for the occurrence of episodes. Both groups had high levels of psychopathology, with higher values for the night terror group. This sleepwalkers showed active, outwardly directed behavioral patterns, whereas the night terror patients showed an inhibition of outward expressions of aggression and a predominance of anxiety, depression, tendencies obsessive-compulsive/, and phobicness. Although night terrors and sleepwalking in childhood seem to be related primarily to genetic and developmental factors, their persistence and especially their onset in adulthood are found to be related more to psychological factors. PMID:7447622
Bjerregaard, Asger; Laing, Ingrid A; Backer, Vibeke;
BACKGROUND AND OBJECTIVE: Airway eosinophilia is associated with an increased risk of asthma exacerbations; however, the impact on the severity of exacerbations is largely unknown. We describe the sputum inflammatory phenotype during asthma exacerbation and correlate it with severity and treatment...... response. METHODS: Patients presenting to hospital with an asthma exacerbation were recruited during a 12-month period and followed up after 4 weeks. Induced sputum was collected at both visits. Patients underwent spirometry, arterial blood gas analysis, fractional exhaled nitric oxide analysis, white...... with a sensitivity of 86% and a specificity of 70%. CONCLUSION: Our findings suggest that eosinophilic asthma exacerbations may be clinically more severe than NEEs, supporting the identification of these higher risk patients for specific interventions....
Espinola-Zavaleta, Nilda; Játiva-Chávez, Silvio; Muñoz-Castellanos, Luis; Zamora-González, Carlos
Seven patients with scimitar syndrome underwent retrospective clinical and echocardiographic examination. The findings were: respiratory infection with dyspnea on moderate exercise in 90%, scimitar sign in four (57%), dextrocardia in five (71%), and interatrial septal defect in five (71%), one of whom had patent ductus arteriosus. Overall, two patients had patent ductus arteriosus: one also had aortic coarctation and the other, a bicuspid aortic valve. Dilation of the right cavities was found in five (71%) and blunt edge in five (71%). In two patients, anomalous drainage was into the right atrium; in another two, into the inferior vena cava; and in three, towards the junction of the right atrium and the inferior vena cava. In three patients, drainage was obstructed. Six patients with cardiac abnormalities proceeded to surgery. Scimitar syndrome is a rare entity. In the large majority of patients (86%), diagnosis and follow-up can be performed echocardiographically.
Full Text Available Clinical Data Management (CDM is a critical phase in clinical research, which leads to generation of high-quality, reliable, and statistically sound data from clinical trials. This helps to produce a drastic reduction in time from drug development to marketing. Team members of CDM are actively involved in all stages of clinical trial right from inception to completion. They should have adequate process knowledge that helps maintain the quality standards of CDM processes. Various procedures in CDM including Case Report Form (CRF designing, CRF annotation, database designing, data-entry, data validation, discrepancy management, medical coding, data extraction, and database locking are assessed for quality at regular intervals during a trial. In the present scenario, there is an increased demand to improve the CDM standards to meet the regulatory requirements and stay ahead of the competition by means of faster commercialization of product. With the implementation of regulatory compliant data management tools, CDM team can meet these demands. Additionally, it is becoming mandatory for companies to submit the data electronically. CDM professionals should meet appropriate expectations and set standards for data quality and also have a drive to adapt to the rapidly changing technology. This article highlights the processes involved and provides the reader an overview of the tools and standards adopted as well as the roles and responsibilities in CDM.
Roseli Saraiva Moreira Bittar; Eliane Maria Dias von Söhsten Lins
INTRODUCTION: Persistent postural-perceptual dizziness is the dizziness that lasts for over three months with no clinical explanation for its persistence. The patient's motor response pattern presents changes and most patients manifest significant anxiety. OBJECTIVE: To evaluate the clinical characteristics of patients with persistent postural and perceptual dizziness. METHODS: statistical analysis of clinical aspects of patients with persistent postural-perceptual dizziness. RESULTS: 81 pati...
Mullikin, Trey C; Rajkumar, S Vincent; Dispenzieri, Angela; Buadi, Francis K; Lacy, Martha Q; Lin, Yi; Dingli, David; Go, Ronald S; Hayman, Suzanne R; Zeldenrust, Steven R; Russell, Stephen J; Lust, John A; Leung, Nelson; Kapoor, Prashant; Kyle, Robert A; Gertz, Morie A; Kumar, Shaji K
A single monoclonal protein typically characterizes monoclonal gammopathies, but a small proportion may have more than one M protein identifiable. In the setting of symptomatic multiple myeloma (MM), the development of a new monoclonal protein following therapy is associated with better outcomes. As for the precursor conditions, monoclonal gammopathy undetermined significance (MGUS) and smoldering multiple myeloma (SMM), there is limited information on the impact of a second monoclonal protein on the disease course, including progression and response to treatment. The outcomes of patients with MGUS and SMM with more than one monoclonal protein, after identifying 539 patients with biclonal proteins on electrophoresis and/or immunofixation, were reported. About 22 of 393 patients with MGUS/biclonal gammopathy of undetermined significance (BGUS) progressed to SMM (6), MM (11), AL (3), or WM (2), and 5 of 16 patients with biclonal SMM progressed to MM. The rate of progression for BGUS was approximately 1% per year, which is similar to MGUS with one monoclonal protein. The median estimated time of progression of biclonal SMM was 2.6 years; similar to monoclonal SMM. For patients with biclonal MM, both M spikes responded to treatment and, upon relapse, the original dominant M protein remained dominant as the disease progressed. In conclusion, the presence of a second monoclonal protein does not appear to affect the progression of precursor states and suggests multiple monoclonal proteins do not clinically impact one another in the course of the disease. Am. J. Hematol. 91:473-475, 2016. © 2016 Wiley Periodicals, Inc. PMID:26840395
Myrick, Karen M
Ankle sprains are a common occurrence and are frequently either undertreated or overtreated. With the incidence estimated at more than 3 million a year and at a rate of 2.15/1,000 in the United States alone, this is an orthopaedic injury that providers should be acutely aware of and successfully able to evaluate and treat. This clinical feature will provide a thorough review of the mechanism of injury, the history and physical examination, and the classification and management of these injuries. Clinical red flags are discussed. PMID:25233201
Bradyarrhythmias are common clinical findings consisting of physiologic and pathologic conditions (sinus node dysfunction and atrioventricular [AV] conduction disturbances). Bradyarrhythmias can be benign, requiring no treatment; however, acute unstable bradycardia can lead to cardiac arrest. In patients with confirmed or suspected bradycardia, a thorough history and physical examination should include possible causes of sinoatrial node dysfunction or AV block. Management of bradycardia is based on the severity of symptoms, the underlying causes, presence of potentially reversible causes, presence of adverse signs, and risk of progression to asystole. Pharmacologic therapy and/or pacing are used to manage unstable or symptomatic bradyarrhythmias. PMID:27484658
Moracco, J C
Stress and burnout is a prevalent feature of the helping profession. The toll that these phenomena take on the individual can be devastating. This article explains the stress reaction from an appraisal model and discusses how the clinic can initiate a stress reduction strategy. A three point intervention plan is recommended. Strategies for changing the occupational environment, individual characteristics, and coping mechanisms constitute three points in a comprehensive plan.
Renato Wendell Damasceno
Full Text Available ABSTRACTLife expectancy is increasing in most countries. With increasing age, many individuals may develop involutional ophthalmic diseases, such as eyelid aging. Dermatochalasis, ptosis, ectropion, and entropion are common disorders in middle-aged and older adults. This review outlines the pathophysiology and clinical management of these involutional eyelid disorders. Recently, a decrease in elastic fibers with ultrastructural abnormalities and an overexpression of elastin-degrading enzymes have been demonstrated in involutional ectropion and entropion. This may be the consequence of local ischemia, inflammation, and/or chronic mechanical stress. Eyelid aging with progressive loss of tone and laxity may affect the ocular surface and adnexal tissues, resulting in different clinical symptoms and signs. Surgical management depends on the appropriate correction of the underlying anatomical defect.
Pollyanna Barros Batista; Eny Maria Goloni Bertollo; Danielle de Souza Costa; Lucas Eliam; Karin Soares Gonçalves Cunha; José Renan Cunha-Melo; Luiz Guilherme Darrigo Junior; Mauro Geller; Ingrid Faria Gianordoli-Nascimento; Luciana Gonçalves Madeira; Hérika Martins Mendes; Débora Marques Miranda; Nikolas Andre Mata-Machado; Eric Grossi Morato; Érika Cristina Pavarino
Part 1 of this guideline addressed the differential diagnosis of the neurofibromatoses (NF): neurofibromatosis type 1 (NF1), neurofibromatosis type 2 (NF2) and schwannomatosis (SCH). NF shares some features such as the genetic origin of the neural tumors and cutaneous manifestations, and affects nearly 80 thousand Brazilians. Increasing scientific knowledge on NF has allowed better clinical management and reduced rate of complications and morbidity, resulting in higher quality of life for NF ...
Mehta, S; Zenilman, J; Erbelding, E
Objectives: There is a lack of information describing levels of patient satisfaction among patients seeking sexually transmitted diseases (STD) care in a public clinic setting. We sought to identify patient, provider, and clinic characteristics associated with patient satisfaction within public STD clinics.
［1］Kokstein Z, Balatka J, Horacek J. ECG changes in children with acute myocarditis[J]. Sb Ved Pr Lek Fak Karlovy Univerzity Hradci Kralove Suppl, 1990, 33(4): 373-379.［2］Rich R, McErlean M. Complete heart block in a child with varicella[J]. Am J Emerg M, 1993, 11(6): 602-605.［3］Sobrino MJM, Lopez PF, Cisneros JM, et al. Thoracic pain as early clinical manifestation of myocarditis caused by varicella [J]. Med Clin Barc,1992, 99(6): 236-237.［4］Teravanichpong S, Chuangsuwanich T. Fatal varicella in a healthy girl[J]. J Med Assoc Thai, 1990, 73(11): 648-651.［5］Amral FT, Bestetti RB, Araujo RC, et al. Transient atroventricular conduction disordor: a potential cause of sudden death in myocarditis due to varicella[J]. Arq Bras Cardiol, 1989, 53(2): 129-131.［6］Lorber A, Zonis Z, Maisuls E, et al. The scale of myocardial involvement in varicella myocarditis[J]. Int J Cardiol,1988, 20(2): 257-262.［7］Ettedgui JA, Ladusans E, Bamford M. Complete heart block as a complication of varicella[J]. Int J Cardiol, 1987, 14(3): 362-365.［8］Waagner DC, Murphy TV. Varicella myocarditis[J]. Pediatr Infect Dis J, 1990, 9(5): 360-363.［9］Rivera CF, Omar M, Aliaga ML, et al. Varicella complicated by pericarditis and pneumonia [J]. An Med Interna, 1996, 13(3): 130-132.［10］Civico RF, Omar M, Martinez LA, et al. Varicella complicated by pericarditis and pneumonia [J]. An Med Interna, 1996, 13(3): 130-132.［11］Bachli E, Kagi MK, Krause M. Visceral and neurological complications in varicella infections of adults [J]. Schweiz Med Wochenschr, 1996, 126(11): 440-446.［12］Senellart F, Bozio A, Sassolas F, et al. Varicella myocarditis and junctional ectopic tachycardia [J]. Pediatrie Bucur, 1991, 46(3): 267-270.［13］Straus S, Ostrove J, Inchauspe G, et al. Varicella- zoster virus infections[J]. Ann Intern Med,1988, 108: 221-237.［14］Tsintsof A, Delprado WJ, Keogh AM. Varicella zoster myocarditis progressing to cardiomyopathy and cardiac
Sas, David J; Becton, Lauren J; Tutman, Jeffrey; Lindsay, Laura A; Wahlquist, Amy H
While the incidence of pediatric kidney stones appears to be increasing, little is known about the demographic, clinical, laboratory, imaging, and management variables in this patient population. We sought to describe various characteristics of our stone-forming pediatric population. To that end, we retrospectively reviewed the charts of pediatric patients with nephrolithiasis confirmed by imaging. Data were collected on multiple variables from each patient and analyzed for trends. For body mass index (BMI) controls, data from the general pediatrics population similar to our nephrolithiasis population were used. Data on 155 pediatric nephrolithiasis patients were analyzed. Of the 54 calculi available for analysis, 98 % were calcium based. Low urine volume, elevated supersaturation of calcium phosphate, elevated supersaturation of calcium oxalate, and hypercalciuria were the most commonly identified abnormalities on analysis of 24-h urine collections. Our stone-forming population did not have a higher BMI than our general pediatrics population, making it unlikely that obesity is a risk factor for nephrolithiasis in children. More girls presented with their first stone during adolescence, suggesting a role for reproductive hormones contributing to stone risk, while boys tended to present more commonly at a younger age, though this did not reach statistical significance. These intriguing findings warrant further investigation. PMID:26467033
Chipchase Lucinda S
Full Text Available Abstract Background During clinical placements, clinical educators facilitate student learning. Previous research has defined the skills, attitudes and practices that pertain to an ideal clinical educator. However, less attention has been paid to the role of student readiness in terms of foundational knowledge and attitudes at the commencement of practice education. Therefore, the aim of this study was to ascertain clinical educators’ views on the characteristics that they perceive demonstrate that a student is well prepared for clinical learning. Methods A two round on-line Delphi study was conducted. The first questionnaire was emailed to a total of 636 expert clinical educators from the disciplines of occupational therapy, physiotherapy and speech pathology. Expert clinical educators were asked to describe the key characteristics that indicate a student is prepared for a clinical placement and ready to learn. Open-ended responses received from the first round were subject to a thematic analysis and resulted in six themes with 62 characteristics. In the second round, participants were asked to rate each characteristic on a 7 point Likert Scale. Results A total of 258 (40.56% responded to the first round of the Delphi survey while 161 clinical educators completed the second (62.40% retention rate. Consensus was reached on 57 characteristics (six themes using a cut off of greater than 70% positive respondents and an interquartile deviation IQD of equal or less than 1. Conclusions This study identified 57 characteristics (six themes perceived by clinical educators as indicators of a student who is prepared and ready for clinical learning. A list of characteristics relating to behaviours has been compiled and could be provided to students to aid their preparation for clinical learning and to universities to incorporate within curricula. In addition, the list provides a platform for discussions by professional bodies about the role of placement
To determine the frequency of dengue as a cause of fever and compare the clinical and haematological characteristics of Dengue-probable and Dengue-proven cases. All patients with age above 14 years, who were either hospitalized or treated in medical outdoor clinic due to acute febrile illness, were evaluated for clinical features of Dengue Fever (DF), Dengue haemorrhagic fever (DHF) and Dengue Shock Syndrome (DSS). Patients showing typical clinical features and haematological findings suggestive of Dengue fever (As per WHO criteria) were evaluated in detail for comparison of probable and confirmed cases of Dengue fever. All other cases of acute febrile illness, not showing clinical features or haematological abnormalities of Dengue fever, were excluded. The clinical and laboratory features were recorded on SPSS 11.0 programme and graded where required, for descriptive and statistical analysis. Out of 5200 patients with febrile illness, 107 (2%) presented with typical features of DF, 40/107 (37%) were Dengue-proven while 67/107 (63%) were Dengue-probable. Out of Dengue-proven cases, 38 were of DF and 2 were of DHF. Day 1 temperature ranged from 99-105 degreeC (mean 101 degree C). Chills and rigors were noticed in 86 (80%), myalgia in 67%, headache in 54%, pharyngitis in 35%, rash in 28%, and bleeding manifestations in 2% cases. Hepatomegaly in 1(0.5%), lymphadenopathy in 1 (0.5%) and splenomegaly in 12 (11.2%) cases. Leucopoenia (count 40 U/L in 57% cases. Frequency of clinically suspected dengue virus infection was 107 (2%), while confirmed dengue fever cases were 40 (0.8%) out of 5200 fever cases. Fever with chills and rigors, body aches, headache, myalgia, rash, haemorrhagic manifestations, platelet count, total leukocyte count, and ALT, are parameters to screen the cases of suspected dengue virus infection, the diagnosis cannot be confirmed unless supported by molecular studies or dengue specific IgM. (author)
Andréa Eduardo M.; Atié Jacob; Maciel Washington A.; Oliveira Jr Nilson A. de; Camanho Luiz Eduardo; Belo Luís Gustavo; Carvalho Hecio Affonso de; Siqueira Leonardo; Saad Eduardo; Venancio Ana Claudia
OBJECTIVE: To assess the clinical, electrocardiographic, and electrophysiologic characteristics of patients (pt) with intra-His bundle block undergoing an electrophysiologic study (EPS). METHODS: We analyzed the characteristics of 16 pt with second-degree atrioventricular block and symptoms of syncope or dyspnea, or both, undergoing conventional EPS. RESULTS: Intra-His bundle block was documented in 16 pt during an EPS. In 15 (94%) pt, the atrioventricular block was recorded in sinus rhythm; ...
Objective To investigate the clinical characteristics of patients infected with human adenovirus type 7 and to provide guidance for early diagnosis and timely control of the outbreak.Methods A total of 301 patients infected with the human adenoviruses who were quarantined in hospital from December 2012 to February 2013 were observed.Epidemiological questionnaires were used to collect data of clinical features of the disease including
McClure, R J; Newell, S J; Edwards, S
A study was carried out to identify the characteristics of children who do not attend appointments at general outpatient clinics. Over six months, 359 children who had an appointment at a general clinic were studied using a questionnaire given to parents (74% response rate) and by inspection of case notes. Based on their first appointment in the study period, children were divided into 'attenders' (n = 262) and 'non-attenders' (n = 97) for analysis. Non-attenders were significantly more likel...
Saeed Ahmed; Patompong Ungprasert; Supawat Ratanapo; Tanveer Hussain; Riesenfeld, Erik P.
Background: Takotsubo cardiomyopathy (TC) or transient left ventricular apical ballooning syndrome is an acute cardiac syndrome characterized by transient wall motion abnormalities extending beyond a single epicardial vessel in the absence of significant obstructive coronary artery disease. Aim: This study was to describe the clinical characteristics of TC in North America. Materials and Methods: We identified 10 patients who met the Mayo Clinic criteria for TC using our Electronic Medical Re...
Full Text Available Mycoplasma pneumonia is a common respiratory pathogen that produces diseases of varied severity ranging from mild upper respiratory tract infection to severe atypical pneumonia. Apart from respiratory tract infections, this organism is also responsible for producing a wide spectrum of non-pulmonary manifestations including neurological, hepatic, cardiac diseases, hemolytic anemia, polyarthritis and erythema multiforme. This review focuses on molecular taxonomy, biological characteristics, epidemiology, clinical presentation, radiology and various laboratory tools in diagnosis, differential diagnosis, treatment and prevention of mycoplasma pneumonia.
Levin, Roger P
Simply having excellent clinical skills is not enough to enable you to achieve practice goals. In the end, people will validate the quality of the practice based on the way you and your team communicate. It is amazing to realize how much impact we have on other individuals, based purely on what we say. A well-groomed dentist and staff possessing very attractive features and beautiful teeth almost invariably will work in the practice's favor. However, these traits, powerful as they may be, are incomplete without the ability to say the right thing at the right time. In the practice, the easiest way to ensure consistently excellent communication is to use clinical and management scripts. Nothing you do in your practice will equal the impact of what you say because it affects patient perceptions of quality and overall customer service experiences. Your goal is to have all routine communications in the practice turned into written scripts within 6 months. PMID:15637966
杨志晓; 林庆; 吴希如; 熊晖; 张月华; 包新华; 姜玉武; 吴晔; 王爽; 常杏芝; 秦炯
Objective : To investigate and analyze the clinical manifestations , classification , therapeutic approaches and follow-up of myasthenia gravis ( MG) in children in order to improve its management and prognosis. Methods : Clinical information of 135 children with MG, who were diagnosed between January 1993 to January 2008 , were collected and retrospectively analyzed. And prospective following-up of these patients were conducted. Results : Among the 135 cases, 59 were males and 76 females, giving the ratio of M/F around 1:1.3. Totally, 115 cases (85. 2％ ) were type Ⅰ MG ( ocular type) , of which only 4.2％developed to generalized type during the subsequent clinical course. Type Ⅱ MG ( generalized type ) was found in 18 cases ( 13.4％ ) and tpye Ⅲ MG in two cases(1.5％ ). The onset age ranged from 5 month to 15 years, with 50. 3％ before three years and 80. 7％ before seven years. Upper respiratory tract infection was presented in 26. 7％ (36/135) of the sick children before the onset of MG. Among the 106 children being followed up, recurrence of the disease identified in 50.9％ and the number of relapse ranged from 1 to 9. Altogether, 40. 19％ (43/106) of the cases were positive for anti-acetylcholine receptor antibodies (AchR-Ab) on the initial examination, and the AchR-Ab postitive rate showed no difference among different clinical subtypes and states. However, during the follow-up, 53％ (9/17) of the recurrent cases, who were negative at the first onset, turned to be positive, and 37. 97％ (30/79) were positive for repetitive nerve stimulation in electromyogram test. There were 71 ％ (45/63) of all the cases showed reduced levels of CD4 + and/or CD3 + and/or CD8 + . Thymus proliferation was found in 5. 93％ ( 8/135 ) through CT scan and thymoma in 1. 48％ ( 2/135 ) . Steroids and anti-cholinesterase administration were effective in most cases with good prognosis. Conclusion: Childhood MG, mainly type Ⅰ , is relatively common in China, with
Doherty, Leo; Mutlu, Levent; Sinclair, Donna; Taylor, Hugh
Uterine fibroids (leiomyomata) are extremely common lesions that are associated with detrimental effects including infertility and abnormal uterine bleeding. Fibroids cause molecular changes at the level of endometrium. Abnormal regulation of growth factors and cytokines in fibroid cells may contribute to negative endometrial effects. Understanding of fibroid biology has greatly increased over the last decade. Although the current armamentarium of Food and Drug Administration-approved medical therapies is limited, there are medications approved for use in heavy menstrual bleeding that can be used for the medical management of fibroids. Emergence of the role of growth factors in pathophysiology of fibroids has led researchers to develop novel therapeutics. Despite advances in medical therapies, surgical management remains a mainstay of fibroid treatment. Destruction of fibroids by interventional radiological procedures provides other effective treatments. Further experimental studies and clinical trials are required to determine which therapies will provide the greatest benefits to patients with fibroids. PMID:24819877
Doherty, Leo; Mutlu, Levent; Sinclair, Donna; Taylor, Hugh
Uterine fibroids (leiomyomata) are extremely common lesions that are associated with detrimental effects including infertility and abnormal uterine bleeding. Fibroids cause molecular changes at the level of endometrium. Abnormal regulation of growth factors and cytokines in fibroid cells may contribute to negative endometrial effects. Understanding of fibroid biology has greatly increased over the last decade. Although the current armamentarium of Food and Drug Administration-approved medical therapies is limited, there are medications approved for use in heavy menstrual bleeding that can be used for the medical management of fibroids. Emergence of the role of growth factors in pathophysiology of fibroids has led researchers to develop novel therapeutics. Despite advances in medical therapies, surgical management remains a mainstay of fibroid treatment. Destruction of fibroids by interventional radiological procedures provides other effective treatments. Further experimental studies and clinical trials are required to determine which therapies will provide the greatest benefits to patients with fibroids.
Quality and integrity of clinical trials and associated data management is a basis on the scientific and rightly assessments of drug safety and efficacy. While both normalization and standardization of clinical trial procedures assure quality of clinical trials and the relevant data processes, they will drive and improve the efficiency and reliability of real-world deliverables in clinical trials in turn. Currently, the comprehensive standards and practices of clinical trials and associated data management are globally established better, and US and EMA have enacted and implemented adequate guidances and regulations well. China is in the initial stage of development of relevant regulations regarding clinical trials and associated data management. This review will focus on the above-mentioned global regulations and standards of clinical data management in the views of good clinical data management standpoints, making references to improve the Chinese regulative system of clinical data management. PMID:26911040
Ho, Effie; Yao, Chen; Zhang, Zi-bao; Liu, Yu-xiu
Source data and its source documents are the foundation of clinical research. Proper source data management plays an essential role for compliance with regulatory and GCP requirements. Both paper and electronic source data co-exist in China. Due to the increasing use of electronic technology in pharmaceutical and health care industry, electronic data source becomes an upcoming trend with clear advantages. To face new opportunities and to ensure data integrity, quality and traceability from source data to regulatory submission, this document demonstrates important concepts, principles and best practices during managing source data. It includes but not limited to: (1) important concepts of source data (e.g., source data originator, source data elements, source data identifier for audit trail, etc.); (2) various modalities of source data collection in paper and electronic methods (e.g., paper CRF, EDC, Patient Report Outcomes/eCOA, etc.); (3) seven main principles recommended in the aspect of data collection, traceability, quality standards, access control, quality control, certified copy and security during source data management; (4) a life cycle from source data creation to obsolete is used as an example to illustrate consideration and implementation of source data management. PMID:26911026
Lam, Carolyn S P; McEntegart, Margaret; Claggett, Brian;
BACKGROUND: We examined the association of sex with clinical characteristics and outcomes in patients following myocardial infarction (MI) in the Valsartan in Acute Myocardial Infarction Trial (VALIANT). METHODS AND RESULTS: A total of 4570 women and 10 133 men with heart failure (HF), left ventr...
This report presents a subset of data collected from the American Association for Marriage and Family Therapy (AAMFT) Practice Research Network project conducted in 2002. A sample of 47 clinical members of AAMFT who indicated they practiced in a rural community provided descriptive information on demographic characteristics, training, clinical…
Khanakova, N A; Sheremet, N L; Loginova, A N; Chukhrova, A L; Poliakov, A V
The article presents a review of literature on hereditary optic neuropathies: Leber mitochondrial hereditary optic neuropathy, autosomal dominant and autosomal recessive optic neuropathies, X-linked optic atrophy. Clinical and molecular genetic characteristics are covered. Isolated optic neuropathies, as well as hereditary optic disorders, being a part of a complex syndromic disease are described.
Objective: To determine the clinical and biochemical characteristics of children with Juvenile Idiopathic Arthritis (JIA) at a tertiary care centre in Karachi, Pakistan. Study Design: A descriptive study. Place and Duration of Study: Paediatric Rheumatology Clinic of The Aga Khan University Hospital (AKUH), Karachi, from January 2008 to December 2011. Methodology: Clinical and laboratory profile and outcome of children less than 15 years of age attending the Paediatric Rheumatology Clinic of the Aga Khan University, Karachi with the diagnosis of Juvenile Idiopathic Arthritis according to International League against Rheumatism were studied. These children were classified into different types of JIA; their clinical and laboratory characteristics, response to therapy and outcome was evaluated. Results: Sixty eight patients satisfying the criteria of International League against Rheumatism (ILAR) for Juvenile Idiopathic Arthritis were enrolled during the study period of four consecutive years, their age ranged from 9 months to 15 years. Mean age at onset was 6.45 +- 4.03 years while mean age at diagnosis was 7.60 +- 3.93 years. Polyarticular was the most predominant subtype with 37 (54%) patients, out of these, 9 (24%) were rheumatoid factor positive. An almost equal gender predisposition was observed. Fever and arthritis were the most common presenting symptoms, with only 2 patients presenting with uveitis. Conclusion: The clinico-biochemical characteristics of JIA at the study centre showed a pattern distinct with early onset of disease, high frequency of polyarticular type and a higher rheumatoid factor (QRA) and ANA positivity in girls. (author)
Kucera, Tomas; Sponer, Pavel [Charles University in Prague, Faculty of Medicine and University Hospital in Hradec Kralove, Department of Orthopaedic Surgery, Hradec Kralove (Czech Republic); Brtkova, Jindra [Charles University in Prague, Faculty of Medicine and University Hospital in Hradec Kralove, Department of Diagnostic Radiology, Hradec Kralove (Czech Republic); Ryskova, Lenka [Charles University in Prague, Faculty of Medicine and University Hospital in Hradec Kralove, Department of Clinical Microbiology, Hradec Kralove (Czech Republic); Popper, Eduard [Charles University in Prague, Faculty of Medicine and University Hospital in Hradec Kralove, Department of Rehabilitation, Hradec Kralove (Czech Republic); Frank, Martin [Charles University in Prague, Faculty of Medicine and University Hospital in Hradec Kralove, Department of Surgery, Hradec Kralove (Czech Republic); Kucerova, Marie [Regional Hospital in Pardubice, Department of Neurosurgery, Hradec Kralove (Czech Republic)
The purpose of the present study was to evaluate the role of diagnostic tools and management options for patients with pyogenic sacroiliitis, including potential complications. This retrospective study included 16 patients with pyogenic sacroiliitis who were admitted to a single orthopaedic centre between 2007 and 2012. The following data were collected: demographics, history, radiography, magnetic resonance images (MRI), biological data, type of pathogenic agent, abscess formation, type of management, and clinical outcome. Our study demonstrated that only one-fifth of the patients with lumbogluteal or hip pain had established diagnoses of suspected pyogenic sacroiliitis upon admission. MRIs confirmed this diagnosis in all cases. MRI examinations revealed joint fluid in the sacroiliac joint and significant oedema of the adjacent bone and soft tissues. In 12 of the 16 cases, erosions of the subchondral bone were encountered. Contrast-enhanced MRI revealed that 9 patients had abscesses. All patients received antibiotic therapy. Antibiotic treatment was only successful in 9 cases. The other 7 patients underwent computed tomography (CT)-guided abscess drainage. Drainage was sufficient for 4 patients, but 3 patients required open surgery. One patient required sacroiliac arthrodesis. The clinical outcomes included minimal disability (n = 10), moderate disability (n = 5), and full disability (n = 1) of the spine. Contrast-enhanced MRI is mandatory for a reliable diagnosis. Abscess formation was observed in approximately half of the MRI-diagnosed sacroiliitis cases and required minimally invasive drainage under CT guidance or frequently open surgery. (orig.)
The purpose of the present study was to evaluate the role of diagnostic tools and management options for patients with pyogenic sacroiliitis, including potential complications. This retrospective study included 16 patients with pyogenic sacroiliitis who were admitted to a single orthopaedic centre between 2007 and 2012. The following data were collected: demographics, history, radiography, magnetic resonance images (MRI), biological data, type of pathogenic agent, abscess formation, type of management, and clinical outcome. Our study demonstrated that only one-fifth of the patients with lumbogluteal or hip pain had established diagnoses of suspected pyogenic sacroiliitis upon admission. MRIs confirmed this diagnosis in all cases. MRI examinations revealed joint fluid in the sacroiliac joint and significant oedema of the adjacent bone and soft tissues. In 12 of the 16 cases, erosions of the subchondral bone were encountered. Contrast-enhanced MRI revealed that 9 patients had abscesses. All patients received antibiotic therapy. Antibiotic treatment was only successful in 9 cases. The other 7 patients underwent computed tomography (CT)-guided abscess drainage. Drainage was sufficient for 4 patients, but 3 patients required open surgery. One patient required sacroiliac arthrodesis. The clinical outcomes included minimal disability (n = 10), moderate disability (n = 5), and full disability (n = 1) of the spine. Contrast-enhanced MRI is mandatory for a reliable diagnosis. Abscess formation was observed in approximately half of the MRI-diagnosed sacroiliitis cases and required minimally invasive drainage under CT guidance or frequently open surgery. (orig.)
Nielsen, Jacob Steendahl; Boer, Harry; Lindgren, Peter
excellent Lean managers have? Based on an assessment done by a panel of Lean experts composed from 26 different Danish companies, this paper presents a profile description of an excellent Lean manager, which encompasses 16 different personality traits. A comparison with the average Dane shows some important...
Uyeki, Timothy M.; Mehta, Aneesh K.; Davey, Richard T.; Liddell, Allison M.; Wolf, Timo; Vetter, Pauline; Schmiedel, Stefan; Grünewald, Thomas; Jacobs, Michael; Arribas, Jose R.; Evans, Laura; Hewlett, Angela L.; Brantsaeter, Arne B.; Ippolito, Giuseppe; Rapp, Christophe; Hoepelman, Andy I M; Gutman, Julie
Background Available data on the characteristics of patients with Ebola virus disease (EVD) and clinical management of EVD in settings outside West Africa, as well as the complications observed in those patients, are limited. METHODS We reviewed available clinical, laboratory, and virologic data fro
Full Text Available Listeria monocytogenes causes foodborne illnesses through consumption of ready-to-eat foods. Although 135-201annual listeriosis cases have been estimated in Japan, the details regarding the clinical isolates such as infection source, virulence level, and other genetic characteristics, are not known. In order to uncover the trends of listeriosis in Japan and use the knowledge for prevention measures to be taken, the genetic characteristics of the past human clinical isolates needs to be elucidated. For this purpose, multilocus tandem-repeat sequence analysis (MLTSA and multi-virulence-locus sequence typing (MVLST were used in this study. The clinical isolates showed a variety of genetically distant genotypes, indicating they were from sporadic cases. However, the MVLST profiles of 7 clinical isolates were identical to those of epidemic clone (EC I isolates, which have caused several serious outbreaks in other countries, suggesting the possibility that they have strong virulence potential and originated from a single outbreak. Moreover, 6 Japanese food isolates shared their genotypes with ECI isolates, indicating that there may be risks for listeriosis outbreak in Japan. This is the first investigational study on genetic characteristics of Japanese listeriosis isolates. The listeriosis cases happened in the past are presumably sporadic, but it is still possible that some isolates with strong virulence potential have caused listeriosis outbreaks, and future listeriosis risks also exist.
Karlsson, Christer; Sköld, Martin
This paper explores the clinical approach to management research and positions it in relation to other similar approaches. It achieves this by pointing out the most important historical milestones in the development of such approaches. The literature on the approach is mapped, including...... that on the most adjacent approaches, in order to characterize and position the different approaches. Field or application data are used to identify how the approach has been used and developed in publications in major journals in the field. After the introduction, which presents the brief characteristics...... of the approaches, the paper discusses the research issues to which clinical research is relevant and how the research framework should be designed, then practical issues relating to how to approach the study objects, the design of the research instruments, and the conducting of the field research. Finally...
Brown, William Virgil; Garg, Abhimanyu; Gorden, Phillip; Shamburek, Robert
Lipodystrophy comes in several forms, some involving the complete failure to develop adipose tissue and others with a partial absence in various bodily distributions. All appear to have a major genetic basis, and all involve a high frequency of lipoprotein disorders. High triglycerides and low high-density lipoprotein cholesterol are the usual findings that raise interesting questions as to how such abnormalities characteristic of obesity can be caused by genetic variants that produce a paucity of adiposity. We are learning to link some specific genetic variants that seem causal and to manage these disorders in more effective ways. We are joined by 3 experts who have been leaders in the study of the clinical presentation, genetics, abnormal physiology, and the management of lipodystrophy in recent years. They are Drs Abhimanyu Garg from the University of Texas Southwestern, Phillip Gorden of the National Institute of Diabetes, Digestive and Kidney Diseases, and Robert Shamburek of the National Heart, Lung and Blood Institute. PMID:27578101
Torad, Faisal A; Hassan, Elham A
Salivary mucocele is one of the causes of submandibular swelling in dogs and is due to a collection of mucoid saliva that has leaked from a damaged salivary gland. The purpose of this case series report was to describe the clinical and ultrasonographic characteristics of confirmed salivary mucoceles in 13 dogs admitted to the Faculty of Veterinary Medicine at Cairo University. The final diagnosis of salivary mucocele was based on aspirate cytology for all dogs and additional surgical excision for seven dogs. For dogs admitted from 2 weeks to 1 month from the onset of clinical signs, the cervical mucocele appeared as a round echogenic structure with a large volume of central anechoic content. The wall was a clearly identified hyperechoic structure surrounding the gland. For dogs admitted between 1 to 2 months from the onset of clinical signs, the volume of anechoic material appeared less than that seen in the acute cases. The overall appearance of the salivary mucocele was heterogenous. For dogs admitted after 2 months from the onset of clinical signs, the salivary mucocele appeared grainy or mottled, with a heterogenous appearance and a further decrease in anechoic content. For one dog that presented after 3 months from the onset of clinical signs, the salivary mucocele was hard on palpation and appeared hyperechoic with distal acoustic shadowing. Findings from this study indicated that ultrasonographic characteristics of salivary mucoceles in dogs vary depending on the chronological stage of the disease. PMID:23442204
Full Text Available Infection is a major cause of morbidity and mortality among patients admitted in intensive care units (ICUs. The application of the principles and the practice of Clinical Microbiology for ICU patients can significantly improve clinical outcome. The present article is aimed at summarising the strategic and operational characteristics of this unique field where medical microbiology attempts to venture into the domain of direct clinical care of critically ill patients. The close and strategic partnership between clinical microbiologists and intensive care specialists, which is essential for this model of patient care have been emphasized. The article includes discussions on a variety of common clinical-microbiological problems faced in the ICUs such as ventilator-associated pneumonia, blood stream infections, skin and soft tissue infection, UTI, infection control, besides antibiotic management.
黄晓娇; 陈漠水; 邢波; 林德洪; 杜子军; 吴淼; 陆士娟
目的 探讨冠状动脉支架内血栓形成病例的临床特点、治疗方法及其原因.方法 分析4例PCI治疗后发生支架内血栓的患者的临床资料,分析发生支架内血栓的临床特征及血栓形成原因.结果 4例患者中,急性血栓1例,亚急性血栓1例,迟发晚期血栓2例.4例均再次行PCI术,再通血管,症状消失.其发生与多重危险因素、复杂病变、停用抗血小板药物等有关.结论 冠状动脉支架植入术后有发生支架内血栓的可能,应引起重视.再次PCI治疗是首选治疗方法.%Objective To analyze the clinical characteristics of stent thrombosis (ST) after percutaneous coronary intervention (PCI) and investigate the possible cause and risk factors of ST. Methods Analyze the clinical characteristics and cause of the 4 patients with ST after PCI. Results There were 1 patient suffered from acute ST, 1 patient suffered from sub-acute ST, and 2 patients suffered from very late ST. All the patients discharged after successful emergency PCI. The reasons related to ST including of the multiple risk facters, the complicated lesion. the imcomplete treatment of anti-thrombu. Conclusion Stent thrombosis may occur after PCI, and special attention must be paid. The optimal therapy is the emergency PCI.
Kyrle, Paul Alexander; Binder, Konrad; Eichinger, Sabine; Függer, Reinhold; Gollackner, Bernd; Hiesmayr, J Michael; Huber, Kurt; Lang, Wielfried; Perger, Peter; Quehenberger, Peter; Roithinger, Franz X; Schmaldienst, Sabine; Weltermann, Ansgar; Domanovits, Hans
Dabigatran, a direct thrombin inhibitor, is licensed for the prevention of venous thromboembolism after knee and hip replacement, the prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation and for the treatment of acute venous thromboembolism. As dabigatran has a favourable benefit-risk profile, it is being increasingly used. Dabigatran differs from vitamin K antagonists as regards its pharmacological characteristics and its impact on certain laboratory tests, and also in the lack of a direct antagonist that can reverse dabigatran-induced anticoagulation. In emergency settings such as acute bleeding, emergency surgery, acute coronary syndrome, thrombolysis for ischaemic stroke or overdosing, specific strategies are required. A working group of experts from various disciplines has developed strategies for the management of dabigatran-treated patients in emergency settings. PMID:25138549
Wahl, Astrid K; Robinson, Hilde S; Langeland, Eva; Larsen, Marie H; Krogstad, Anne-Lene; Moum, Torbjørn
Knowledge of illness perception may aid the identification of groups of patients with a higher risk of coping poorly with the demands of their illness. This study aims to investigate associations between illness perception, clinical characteristics, patient knowledge, quality of life and subjective health in persons with psoriasis. The present study was based on cross-sectional data from patients awaiting climate therapy in Gran Canaria. We included 254 eligible patients (74%) who completed a questionnaire including the revised Illness Perception Questionnaire, the Psoriasis Knowledge Questionnaire, and the Dermatological Life Quality Index. Disease severity was measured using the Psoriasis Area and Severity Index. Several statistically significant associations between clinical characteristics, knowledge and various illness perception dimensions were found. Illness perception was also significantly related to disease-specific quality of life and subjective health. These findings contradict previous findings, which suggested that objective disease factors are not relevant to illness perception in psoriasis.
Full Text Available Mohammed Rigi,1 Sumayya J Almarzouqi,2 Michael L Morgan,2 Andrew G Lee2–4 1Robert Cizik Eye Clinic, University of Texas, 2Department of Ophthalmology, Houston Methodist Hospital, Blanton Eye Institute, 3Baylor College of Medicine, 4Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medical College, Houston, UTMB Galveston, UT MD Anderson Cancer Center, Houston, TX, The University of Iowa Hospitals and Clinics, Iowa City, IA, USA Abstract: Papilledema is optic disc swelling due to high intracranial pressure. Possible conditions causing high intracranial pressure and papilledema include intracerebral mass lesions, cerebral hemorrhage, head trauma, meningitis, hydrocephalus, spinal cord lesions, impairment of cerebral sinus drainage, anomalies of the cranium, and idiopathic intracranial hypertension (IIH. Irrespective of the cause, visual loss is the feared morbidity of papilledema, and the main mechanism of optic nerve damage is intraneuronal ischemia secondary to axoplasmic flow stasis. Treatment is directed at correcting the underlying cause. In cases where there is no other identifiable cause for intracranial hypertension (ie, IIH the available options include both medical and surgical modalities. Weight loss and diuretics remain the mainstays for treatment of IIH, and surgery is typically reserved for patients who fail, are intolerant to, or non-compliant with maximum medical therapy. Keywords: papilledema, intracranial hypertension, idiopathic intracranial hypertension, epidemiology, papilledema management, papilledema etiology, acetazolamide, optic nerve sheath fenestration, ventriculoperitoneal shunt, lumboperitoneal shunt, venous sinus stenting
Li; Coucke, Philippe; Qian,, S.J..; Huang, Yi-Rong; Gu, Da-Zhong; Mirimanoff, René-Olivier; Yu, Zi-Hao
Purpose: To analyze the clinical characteristics, prognosis, and treatment outcome of pelvic cryptorchid seminoma (PCS), and to determine whether whole abdominal-pelvic irradiation for Stage I disease is necessary. Methods and Materials: From 1958 to 1991,60 patients with PCS were treated at the Cancer Hospital of Chinese Academy of Medical Sciences, Beijing. They presented with a lower abdominal mass and showed a predominance for the right side. A high proportion of patients with...
Özlem Abakay; Abdurrahman Abakay; Abdullah Çetin Tanrıkulu; Fatih Meteroğlu; Cengizhan Sezgi; Hadice Selimoğlu Şen; Ayşe Dallı; Mehmet Kabak
Objectives: The clinical characteristics and treatment resultsof patients diagnosed with sarcoidosis was investigatedin Dicle University Medical Faculty Hospital.Materials and methods: A total of 39 patients were includeddiagnosed with sarcoidosis between 01 January2008 and31 December 2011.Demographic data, laboratoryfindings, spirometric test data, diagnostic methodsand treatment regimens for the study were recorded form.According to pulmonary function test results of patients,61.5% were nor...
Francesco Martines; Daniela Bentivegna; Fabiola Di Piazza; Enrico Martines; Vincenzo Sciacca; Gioacchino Martinciglio
Objective. 312 tinnitus sufferers were studied in order to analyze: the clinical characteristics of tinnitus; the presence of tinnitus-age correlation and tinnitus-hearing loss correlation; the impact of tinnitus on subjects' life and where possible the etiological/predisposing factors of tinnitus. Results. There is a slight predominance of males. The highest percentage of tinnitus results in the decades 61–70. Of the tinnitus sufferers, 197 (63.14%) have a hearing deficit (light hearing loss...
Javed, Saba; Javed, Syed A; Mays, Rana M; Tyring, Stephen K.
Skin cancer in darker skin is associated with considerable morbidity and mortality. We sought to assess the clinical characteristics of cutaneous malignancy amongst Hispanic skin cancer patients and compare them to age-matched non-Hispanic Caucasians. In this retrospective study, 150 Hispanic skin cancer patients were identified from electronic medical records and age-matched to 150 non-Hispanic Caucasian controls with skin cancer. The incidence of actinic keratoses (AKs) in Hispanic skin c...
The effectiveness of direct media employed for promoting marketing, service and sales management conferences and institutes was analyzed. Direct mail was the preferred media for program promotion for business clientele. Three enrollment tables illustrate the effectiveness of different media by program area and course type. (EM)
Ageno, W.; Riva, N.; Schulman, S.; Bang, S.-M.; Sartori, M.T.; Grandone, E.; Beyer, J.; Pasca, S.; Di Minno, D.; Duce, R.; Malato, A.; Santoro, R.; Poli, D.; Verhamme, P.; Passamonti, S.; Kamphuisen, P.; Alatri, A.; Becattini, C.; Bucherini, E.; Piana, A.; De Stefano, V.; Vidili, G.; Bazzan, M.; Di Nisio, M.; Dentali, F.; Martinelli, I.; Barillari, G.; Poggio, R.; Colaizzo, D.; Vaccarino, A.
Background Splanchnic vein thrombosis (SVT) is a challenging disease. The aim of this international registry was to describe the characteristics of a large cohort of patients with SVT and their management in clinical practice. Patients and Methods Consecutive patients with objectively diagnosed SVT
Advanced and controlled drug delivery systems are important for clinical disease management. In this review the most important new systems which have reached clinical application are highlighted. Microbiologically controlled drug delivery is important for gastrointestinal diseases like ulcerative co
Emine Elvan Taşğın; Göknur Kalkan; Hatice Meral Ekşioğlu; Güler Vahaboğlu
Objective: To evaluate the epidemiologic characteristics of the pediatric patients with psoriazis applied to our outpatients' clinic and compare these data with the literature. Methods: The study population consisted of 37 patients younger than 16 years with the diagnosis of psoriazis in dermatology outpatient clinic between May 2009 and December 2010. The patients were evaluated with regard to age, gender, age of onset of the disease, duration of the disease, the presence of accompanying ...
Full Text Available The objective of this paper is to provide a global perspective of the operational risk from a banking societies’ viewpoint. We describe the main regulations and settlements in the field and examine the various approaches of the operational banking risk. The paper presents the need of banks to managing operational risk. We study comparatively for a banking society the capital charge for covering the operational risk under the basic indicator approach and under the standardized approach. We present a case study of implementing current capital requirements at the level of a Romanian banking society. From the theoretical approach and from the description of quantifying of operational banking risk, the results of this study insist on the importance of measuring of operational banking risk and identifies major issues that need to be considered to improve the managing operational banking risk.
Grignard, Sophie; Bourguignon, Jean-Pierre; Born, Michel; Mairiaux, Philippe; Vandoorne, Chantal
This study evaluates the actions taken by obese adolescents in an attempt to lose weight in relation to changes in weight. Particular emphasis is put on the context surrounding the management process. Thirty one obese adolescents aged 14-18 participated in this study. The adolescents answered a written questionnaire, took a body-size dissatisfaction test and were interviewed. Their family physicians were interviewed by telephone. Quantitative data concerned changes in weight and body-size dis...
Adela Socol; Leonardo Badea
The objective of this paper is to provide a global perspective of the operational risk from a banking societies’ viewpoint. We describe the main regulations and settlements in the field and examine the various approaches of the operational banking risk. The paper presents the need of banks to managing operational risk. We study comparatively for a banking society the capital charge for covering the operational risk under the basic indicator approach and under the standardize...
Windfuhr, Jochen P; Toepfner, Nicole; Steffen, Gregor; Waldfahrer, Frank; Berner, Reinhard
In 2013, a total of 84,332 patients had undergone extracapsular tonsillectomies (TE) and 11,493 a tonsillotomy (TT) procedure in Germany. While the latter is increasingly performed, the number of the former is continually decreasing. However, a constant number of approximately 12,000 surgical procedures in terms of abscess-tonsillectomies or incision and drainage are annually performed in Germany to treat patients with a peritonsillar abscess. The purpose of this part of the clinical guideline is to provide clinicians in any setting with a clinically focused multi-disciplinary guidance through the surgical treatment options to reduce inappropriate variation in clinical care, improve clinical outcome and reduce harm. Surgical treatment options encompass intracapsular as well as extracapsular tonsil surgery and are related to three distinct entities: recurrent episodes of (1) acute tonsillitis, (2) peritonsillar abscess and (3) infectious mononucleosis. Conservative management of these entities is subject of part I of this guideline. (1) The quality of evidence for TE to resolve recurrent episodes of tonsillitis is moderate for children and low for adults. Conclusions concerning the efficacy of TE on the number of sore throat episodes per year are limited to 12 postoperative months in children and 5-6 months in adults. The impact of TE on the number of sore throat episodes per year in children is modest. Due to the heterogeneity of data, no firm conclusions on the effectiveness of TE in adults can be drawn. There is still an urgent need for further research to reliably estimate the value of TE compared to non-surgical therapy of tonsillitis/tonsillo-pharyngitis. The impact of TE on quality of life is considered as being positive, but further research is mandatory to establish appropriate inventories and standardized evaluation procedures, especially in children. In contrast to TE, TT or comparable procedures are characterized by a substantially lower postoperative
Rehman, Sajjad ur
Reports results of a study which compared the treatment of selected characteristics of the reviewing literature of management in professional and trade journals. The characteristics examined included lag time, review length, descriptive or analytic nature of reviews, positive or negative evaluations, and affiliation of the reviewer. (CLB)
This thesis was a research into the characteristics of an effective service industry manager, the influencing rationales behind the identified characteristics and the variation in the effectiveness of the identified characteristics in various service organizations. The research was conducted through observation of four service organizations ranging from the retails store represented by Marks and Spencer (M&S), telecommunication as represented by Vodafone Outlet, Hospitality as represented by ...
Management is leading, administering resources, and achieving the goals and objectives that have been set. In the Chilean health care system, management can be subdivided in three main levels – macro-management, meso-management and micro-management. Managing health care is also about epidemiological changes, information and technology innovations, patient groups demanding better services, but mostly about a huge escalation in costs that is not necessarily substantiated by evidence on more eff...
Søndergaard, Kathrine Lærke; Almli, Line Floan
In this paper we examine what characterizes family firms’ decisions when it comes to having a family member being the CEO or the chairman of the board of the company. We define this as family management, which is the dependent variable in our research. This variable has four non-ordered mutually exclusive values; family CEO, family chairman of the board, family CEO and family chairman of the board, and neither family CEO nor family chairman of the board. Using data from the Center for Corpora...
Antônio Paulo Machado Gomes
This article aimed to investigate whether corporate governance uses tax management to increase companies' performance. The objective was checking whether corporate governance characteristics, such as remuneration paid to the executive board, segregation between Chairman and CEO, and the independence and composition of the Board of Directors, influence tax management in Brazilian companies. At the same time, it aimed to identify whether the preceding tax management is reflected on the subseque...
Antônio Paulo Machado Gomes
Full Text Available This article aimed to investigate whether corporate governance uses tax management to increase companies' performance. The objective was checking whether corporate governance characteristics, such as remuneration paid to the executive board, segregation between Chairman and CEO, and the independence and composition of the Board of Directors, influence tax management in Brazilian companies. At the same time, it aimed to identify whether the preceding tax management is reflected on the subsequent tax management. To do this, a sample of 355 Brazilian companies listed on the BM&FBOVESPA between 2008 and 2014 was used, in order to find out whether their corporate governance characteristics influenced tax management, something identified by calculating ETR, CashETR, and BTD. As a result, it was found (i that the remuneration paid to executives may be regarded as a characteristic influencing tax management in Brazilian firms, and (ii that the preceding tax management influences the future tax management. In addition, it was found that Brazilian companies do not rule out tax management benefits, since the average effective rate in the sample under analysis was 25%, and it is statistically lower than the nominal rate of taxes on earnings in Brazil, which is 34%.
Shen, Tong; Liu, Yan
With worldwide improvements in the regulations of international and domestic clinical trial conductions, the quality of clinical trials and trial data management are receiving a great deal of attention. To ensure the quality of clinical trials, maintain business flexibilities and effectively utilize internal and external resources, the outsourcing model is used in the management of clinical data in operation of pharmaceutical companies. The essential criteria of a successful outsourcing mode in clinical trial are selection of qualified contract research organizations (CRO); establishment of appropriate outsourcing model, and generation of effective quality control systems to ensure the authenticity, integrity and accuracy of the clinical trial data. PMID:26911050
Shen, Tong; Liu, Yan
With worldwide improvements in the regulations of international and domestic clinical trial conductions, the quality of clinical trials and trial data management are receiving a great deal of attention. To ensure the quality of clinical trials, maintain business flexibilities and effectively utilize internal and external resources, the outsourcing model is used in the management of clinical data in operation of pharmaceutical companies. The essential criteria of a successful outsourcing mode in clinical trial are selection of qualified contract research organizations (CRO); establishment of appropriate outsourcing model, and generation of effective quality control systems to ensure the authenticity, integrity and accuracy of the clinical trial data.
Smed, Marie; Getz, Kenneth A.
, although both academic and independent sites generate the same level of knowledge, academic sites share more of this knowledge with sponsor companies. This study suggests new strategies that sponsors can leverage to drive greater transfer of clinical research knowledge into clinical practice and ultimately...... on to sponsor companies and may ultimately assist in positioning new products and driving commercialization success. This study evaluates site characteristics that influence the acquisition and sharing of knowledge gained through clinical trial experience. The impact of 2 central site characteristics...... on the process of translating drug experience is assessed: site location (North America/rest of the world) and site type or setting (academic/independent). The results show that investigative sites located outside North America generate and share more knowledge than those within North America. Furthermore...
Bai, Li; Zhang, Xu-Sheng; Wang, Bin; Xiao-ming CHENG; Zhang, Qiao; Hua-ping CHEN; Ma, Qian-li; Zou, Li-Guang; Wang, Chang-Zheng
Objective To explore the clinical characteristics of intractable asthma,and to provide new knowledge for diagnosis and treatment of the disease.Methods Forty one patients with intractable asthma,admitted to the Institute of Respiratory Disease,Xinqiao Hospital of Third Military Medical University from Jan.2009 to Dec.2010,were included in present study.Spirometry tests were performed for all the 41 patients.Cell classification and counting were done in the induced sputum of 37 patients,and 34...
Mustafa Arıca; Roza Zelal Abdioğlu; Ruken Azizoğlu Anlı; Sibel Yorgancılar
Background and Design: In this study, our aim was to determine clinical and the demographical characteristics of the patients with alopecia areata in our region.Materials and Metods: In the study, 100 patients who received alopecia areata diagnosis with ages raging from 2 to 52 and who applied to the polyclinic of ………… Medical Faculty Dermatology Department between October and November 2009 were evaluated.Results: Of 100 patients included into the study 44 (44%) were female and 56 (56%) male....
Roseli Saraiva Moreira Bittar
Full Text Available INTRODUCTION: Persistent postural-perceptual dizziness is the dizziness that lasts for over three months with no clinical explanation for its persistence. The patient's motor response pattern presents changes and most patients manifest significant anxiety. OBJECTIVE: To evaluate the clinical characteristics of patients with persistent postural and perceptual dizziness. METHODS: statistical analysis of clinical aspects of patients with persistent postural-perceptual dizziness. RESULTS: 81 patients, average age: 50.06 ± 12.16 years; female/male ratio: 5.7/1; main reasons for dizziness: visual stimuli (74%, body movements (52%, and sleep deprivation (38%. The most prevalent comorbidities were hypercholesterolemia (31%, migraine headaches (26%, carbohydrate metabolism disorders (22% and cervical syndrome (21%. DHI, State-Trait Anxiety Inventory - Trait, Beck Depression Inventory, and Hospital Anxiety and Depression Scale questionnaires were statistically different (p < 0.05 when compared to controls. 68% demonstrated clinical improvement after treatment with serotonin reuptake inhibitors. CONCLUSION: Persistent postural-perceptual dizziness affects more women than men, with a high associated prevalence of metabolic disorders and migraine. Questionnaires help to identify the predisposition to persistent postural-perceptual dizziness. The prognosis is good with adequate treatment.
Francisco J. Labrador
Full Text Available The objectives of this study are to describe the most common characteristics of patients receiving psychological treatment and the treatments administered. We analyzed a sample of 856 patients at the University Psychology Clinic of the Complutense University of Madrid. Five diagnostic categories accounted for 78.4% of demand: anxiety disorders (31.9%, no diagnosis (15.4%, other problems requiring clinical attention (14.2%, mood disorders (9.5% and adaptive disorders (7.4%. A total of 17.7% presented a comorbid diagnosis and 49.3% had received treatment previously. The mean of assessment and treatment sessions was 3.5 and 12.7, respectively. The most commonly applied techniques included psychoeducation (95.1%, cognitive restructuring (74.8%, relaxation (74.4%, and control of internal dialogue (68.1%.Of the patients that had finished contact with the clinic, 68.3% were a therapeutic success. We discuss the generalization of the results and the implications for the profession and clinical practice.
Full Text Available Clinical cases are primary and vital evidence for Traditional Chinese Medicine (TCM clinical research. A great deal of medical knowledge is hidden in the clinical cases of the highly experienced TCM practitioner. With a deep Chinese culture background and years of clinical experience, an experienced TCM specialist usually has his or her unique clinical pattern and diagnosis idea. Preserving huge clinical cases of experienced TCM practitioners as well as exploring the inherent knowledge is then an important but arduous task. The novel system ISMAC (Intelligent System for Management and Analysis of Clinical Cases in TCM is designed and implemented for customized management and intelligent analysis of TCM clinical data. Customized templates with standard and expert-standard symptoms, diseases, syndromes, and Chinese Medince Formula (CMF are constructed in ISMAC, according to the clinical diagnosis and treatment characteristic of each TCM specialist. With these templates, clinical cases are archived in order to maintain their original characteristics. Varying data analysis and mining methods, grouped as Basic Analysis, Association Rule, Feature Reduction, Cluster, Pattern Classification, and Pattern Prediction, are implemented in the system. With a flexible dataset retrieval mechanism, ISMAC is a powerful and convenient system for clinical case analysis and clinical knowledge discovery.
Anıl Gülsel Bahalı
Full Text Available Background and Design: The purpose of this study was to obtain data that may provide an insight into the etiopathogenesis of recurrent aphtous stomatitis (RAS by the way of analysing the sociodemographic and clinical characteristics of patients who had been diagnosed with RAS. Materials and Metods: The patients, who were diagnosed with RAS in the dermatology outpatient clinic, between May 2007 and May 2010, were evaluated retrospectively. The data including sociodemografic and clinical characteristics, and treatment options were recorded. Results: A hundred patients (68 women, 32 men were included in this study. The average age was 40±13.6 years. RAS was more common in patients with middle-income and low education. The most common type of RAS was minor aphtous ulcers (88%. The lesions were most frequently seen on the lateral side of the tongue (34% and cheek (34%. Sixty percent of patients had a positive family history. Some factors such as biting (12%, tooth brushing (18%, dental disease presence (82%, food (39%, menstruation (10.3%, stress (76%, iron deficiency (16.7%, vitamin B12 deficiency (22.4%, low serum ferritin levels (18%, and seasonal variability (32% showed positive correlation with RAS. A negative correlation was found between RAS and smoking. Forty-nine percent of patients had used alternative therapies in addition to drug therapy. The most frequently used alternative method was consumption of sumac (26.5%. Conlucions: In contrast to the literature, our study found that RAS is started in the third decade of life and, approximately 50% of patients prefered alternative treatment methods, particularly sumac. Nowadays, discussions about the etiopathogenesis of RAS continue. In this study, we found that different sociodemographic and clinical factors may be associated with the etiopathogenesis of the disease. Our study will be followed by further studies using prospective design to identify the the etiopathogenesis of RAS.
Lin, Blossom Yen-Ju; Yeh, Ying-Chen; Lin, Wen-Hung
This study examines the relationship between job characteristics and job outcomes of pharmacists in hospital, clinic, and community pharmacies in Taiwan. The structured questionnaires covered the items of job characteristics, job outcomes, and demographics of pharmacists, and were distributed between Feb 2004 and April 2004. Two hundred and ninety-eight pharmacists responded. Data were analyzed descriptively, and univariate analyses, factor analysis, and multiple regression analyses were used. It found the more enriched the job, the greater the job satisfaction and less intention to leave. And community pharmacists reported greater job enrichment and job satisfaction and less intention to leave than did hospital and clinic pharmacists. It suggests pharmacy managers could recognize the needs of pharmacists to redesign and enrich their work arrangements. PMID:17622026
Guler, A; Guler, Y; Acar, E; Aung, S M; Efe, S C; Kilicgedik, A; Karabay, C Y; Barutcu, S; Tigen, M K; Pala, S; İzgi, A; Esen, A M; Kirma, C
Recently, longitudinal stent deformation (LSD) has been reported increasingly. Even though the reported cases included almost all stent designs, most cases were seen in the Element™ stent design (Boston Scientific, Natick, MA, USA). It is considered that stent design, lesion and procedural characteristics play a role in the etiology of LSD. Yet, the effect of LSD on long-term clinical outcomes has not been studied well. Element stents implanted between January 2013 and April 2015 in our hospital were examined retrospectively. Patients were grouped into two according to the presence of LSD, and their clinical, lesion and procedural characteristics were studied. Twenty-four LSD's were detected in 1812 Element stents deployed in 1314 patients (1.83 % of PCI cases and 1.32 % of all Element stents). LMCA lesions (16.7 % vs 1.6 %, p LSD than in cases without it. In addition, the number of stents, stent inflation pressure and the use of post-dilatation were significantly different between the two groups. Two patients had an adverse event during the follow-up period. LSD is a rarely encountered complication, and is more common in complex lesions such as ostial, bifurcation and LMCA lesions. The use of extra-support guiding catheter, extra-support guidewires and low stent inflation pressure increases the occurrence of LSD. Nevertheless, with increased awareness of LSD and proper treatment, unwanted long-term outcomes can be successfully prevented. PMID:27198891
Full Text Available Introduction: The aim of this study is was to evaluate the clinical features of cases with diagnosis of spinal muscular atrophy (SMA. Materials and Methods: Thirty-eight pediatric patients were evaluated retrospectively. All patients were followed in the Pediatric Neurology Department of Erciyes University Faculty of Medicine. The diagnosis of patients had been confirmed by genetic analysis of homozygous deletions of survival motor neuron 1 gene. Detailed history, newborn symptoms, nutritional characteristics, initial complaints, physical examination, concomitant pathologies, genetic characteristics, and treatment modalities were investigated in all patients. Results: The study population consisted of 19 boys (50% and 19 girls (50%. The mean age of patients was 26.9±25.7 months (range: 3-96 months. The mean follow-up period was 12.2±13.3 months (range: 2-48 months. According to SMA classification, 22 patients (57.8% were type 1, 8 patients (21.1% were type 2, and 8 patients were (21.1% type 3. Neonatal respiratory distress, age at early diagnosis, nutritional problems, and recurrent lung diseases were detected as poor prognostic factors. Conclusions: SMA is a neuromuscular disease that requires multidisciplinary approach to medical care. There is a wide range of clinical severity. Identification of poor prognostic factors will help in terms of guiding close monitoring and timely treatments of children with SMA.
Nguyen Quang Tan
This paper discusses the problems associated with the development of information management systems clinics. Presentation model of the system, which is based on a platform of technology cloud computing IBM SmartCloud and mobile phones. Giving the composition and structure of the clinics information management system that successfully support for user in managing patient information, medical history of the patients, the images for the diagnosis, prescriptions.
Kim, Go-Woon; Park, Jang-Hee; Kwon, Oh-Joon; Kim, Dong Hyun
Background and Objectives The epidermoid cyst is a common benign disease of the skin caused by inflammation of hair cortex follicles and proliferation of epidermal cells within the dermis or superficial subcutaneous tissue. The purpose of this study was to investigate the characteristics of epidermoid cysts of the external auditory canal (EAC) by analyzing the clinical and radiologic features. Subjects and Methods The clinical records were retrospectively reviewed for patients diagnosed with epidermoid cyst of the EAC from March 2004 to December 2013. The epidermoid cysts were diagnosed clinically by endoscopy and microscopy examinations and by temporal bone CT images, and were confirmed by histopathologic examination. Characteristics of epidermoid cysts in bony EAC and cartilaginous EAC were compared. Results Eight patients had an epidermoid cyst in the bony EAC and nine patients had one in the cartilaginous EAC. Swelling and otalgia were common symptoms, but 47% of cysts were found incidentally. The mean age of patients was 49.6 years (age range, 26-67 years) in the bony EAC cases and 26.1 years (age range, 6-57 years) in the cartilaginous EAC cases. The mean size of the epidermoid cyst was 3.50 mm (size range, 2-7 mm) in the bony EAC cases and 9.55 mm (size range, 2-20 mm) in the cartilaginous EAC cases. Conclusions Comparison of epidermoid cysts of the bony EAC and the cartilaginous EAC revealed that epidermoid cysts of the bony EAC is usually found incidentally, arose in older patients and had smaller size. PMID:27144232
Levinton, Paula H.; Dunning, Tessa F.E.
Information requirements of mental health providers are sufficiently different from those of other health care managers to warrant a different approach to the development of management information systems (MIS). Advances in computer technology and increased demands for fiscal accountability have led to developing integrated mental health information systems (MHIS) that support clinical and management requirements.
Cediel, N.; Fraser, C G; Deom, A.; Josefsson, L.; Worth, H. G. J.; Zinder, O.
Trainees in laboratory medicine must develop skills in laboratory management. Guidelines are detailed for laboratory staff in training, directors responsible for staff development and professional bodies wishing to generate material appropriate to their needs. The syllabus delineates the knowledge base required and includes laboratory planning and organization, control of operations, methodology and instrumentation, data management and statistics, financial management, clinical use of tests, ...
Allet, Marion; Hudon, Marek
In recent years, development practice has seen that microfinance institutions (MFIs), beyond their financial and social objectives, start considering their environmental bottom line. Yet, little is known on the characteristics of institutions involved in environmental management. For the first time, this paper empirically identifies the characteristics of these ‘green’ MFIs on a sample of 160 microfinance institutions worldwide. Basing our analysis on various econometric tests, we find that l...
Bessenyei, Beáta; Nagy, Andrea; Szakszon, Katalin; Mokánszki, Attila; Balogh, Erzsébet; Ujfalusi, Anikó; Tihanyi, Mariann; Novák, László; Bognár, László; Oláh, Éva
Craniosynostosis, the premature closure of cranial sutures, is a common craniofacial disorder with heterogeneous etiology and appearance. The purpose of this study was to investigate the clinical and molecular characteristics of craniosynostoses in Hungary, including the classification of patients and the genetic analysis of the syndromic forms. Between 2006 and 2012, 200 patients with craniosynostosis were studied. Classification was based on the suture(s) involved and the associated clinical features. In syndromic cases, genetic analyses, including mutational screening of the hotspot regions of the FGFR1, FGFR2, FGFR3, and TWIST1 genes, karyotyping and FISH study of TWIST1, were performed. The majority (88%) of all patients with craniosynostosis were nonsyndromic. The sagittal suture was most commonly involved, followed by the coronal, metopic, and lambdoid sutures. Male, twin gestation, and very low birth weight were risk factors for craniosynostosis. Syndromic craniosynostosis was detected in 24 patients. In 17 of these patients, Apert, Crouzon, Pfeiffer, Muenke, or Saethre-Chotzen syndromes were identified. In one patient, multiple-suture craniosynostosis was associated with achondroplasia. Clinical signs were not typical for any particular syndrome in six patients. Genetic abnormalities were detected in 18 syndromic patients and in 8 relatives. In addition to 10 different, known mutations in FGFR1,FGFR2 or FGFR3, one novel missense mutation, c.528C>G(p.Ser176Arg), was detected in the TWIST1 gene of a patient with Saethre-Chotzen syndrome. Our results indicate that detailed clinical assessment is of paramount importance in the classification of patients and allows indication of targeted molecular testing with the highest possible diagnostic yield. PMID:26289989
Jiao, Jocelyn M; So, Eric; Jebakumar, Jebakaran; George, Mary Catherine; Simpson, David M; Robinson-Papp, Jessica
Chronic pain is common in HIV, but incompletely characterized, including its underlying etiologies, its effect on healthcare utilization, and the characteristics of affected patients in the HIV primary care setting. These data are needed to design and justify appropriate clinic-based pain management services. Using a clinical data warehouse, we analyzed one year of data from 638 patients receiving standard-of-care antiretroviral therapy in a large primary care HIV clinic, located in the Harlem neighborhood of New York City. We found that 40% of patients carried one or more chronic pain diagnoses. The most common diagnoses were degenerative musculoskeletal disorders (eg, degenerative spinal disease and osteoarthritis), followed by neuropathic pain and headache disorders. Many patients (16%) had multiple chronic pain diagnoses. Women, older patients, and patients with greater burdens of medical illness, and psychiatric and substance use comorbidities were disproportionately represented among those with chronic pain diagnoses. Controlling for overall health status, HIV patients with chronic pain had greater healthcare utilization including emergency department visits and radiology procedures. In summary, our study demonstrates the high prevalence of chronic pain disorders in the primary care HIV clinic. Colocated interventions for chronic pain in this setting should not only focus on musculoskeletal pain but also account for complex multifaceted pain syndromes, and address the unique biopsychosocial features of this population. Furthermore, because chronic pain is prevalent in HIV and associated with increased healthcare utilization, developing clinic-based pain management programs could be cost-effective.
This report describes the geotechnical, geochemical and environmental characteristics of fine-grained uranium tailings (slimes) which may influence both short- and long-term management of slime-enriched uranium tailings impoundments. Properties of slimes are compared and contrasted with those of sand tailings using field and laboratory data primarily from naturally segregated tailings in the Elliot Lake area, Ontario and Northern Saskatchewan uranium-bearing regions of Canada. Key management considerations are included
Patients with fibromyalgia experience chronic widespread pain, with associated symptoms of fatigue, sleep disturbance and memory problems. There are many therapies which may be helpful in managing the symptoms of fibromyalgia; however, these often require a process of trial and error to establish optimum management using a combination of pharmacological and non-pharmacological approaches. Nurses can support patients with fibromyalgia using a biopsychosocial approach to symptom management. Understanding the nature of fibromyalgia and management options will enable nurses to deliver holistic patient-centred care. PMID:27682568
Patients with fibromyalgia experience chronic widespread pain, with associated symptoms of fatigue, sleep disturbance and memory problems. There are many therapies which may be helpful in managing the symptoms of fibromyalgia; however, these often require a process of trial and error to establish optimum management using a combination of pharmacological and non-pharmacological approaches. Nurses can support patients with fibromyalgia using a biopsychosocial approach to symptom management. Understanding the nature of fibromyalgia and management options will enable nurses to deliver holistic patient-centred care.
Shunchang Han; Chuanqiang Pu; Qiuping Gui; Xusheng Huang; Senyang Lang; Weiping Wu; Peifu Wang
BACKGROUND: The clinical manifestations of Wernicke encephalopathy(WE) are atypical and short of effective auxiliary examination means. The effects of magnetic resonance imaging (MRI) in the diagnosis of WE have been reported suecessively. But its imageological detection needs to be further investigated.OBJECTIVE: To analyze the eharacteristics of clinical manifestations, skull MRI examination and pathological results in patients with WE.DESTGN: Retrospective analysis.SETTTNG: The General Hospital of Chinese PLA.PARTTCTPANTS: Ten patients of WE admitted to the Department of Neurology, General Hospital of Chinese PLA were recruited. Among them, five patients were diagnosed pathologically after death. Their pathological changes accorded with the pathological characteristics of WE. The other 5 patients were diagnosed clinically before death. Their pathological changes accorded with clinical and imageological manifestations and had definite reaction to the treatment of thiamine. Ten patients, 7 males and 3 females, were aged (47±13) years ranging from 33 to 73 years. Their disease courses averaged 6 weeks ranging from 3 to 10 weeks. They all were non-alcoholics. Four patients developed WE after acute pancreatitis, two patients after the recurrence of gastric cancer, two patients after cholecystectomy, one patient after hepatitis medicamentosa, one patient after Alzheimer disease. Informed consents were obtained from all the patients and their relatives.METHODS: After admission, clinical manifestations of patients were observed and recorded. Five patients underwent skull MRI examination and their detected results were recorded. Five dead patients underwent autopsy and brain pathological examinations. Neuropathological examination involved cerebrum, cerebellum and brain stem.MATN OUTCOME MEASURES: Clinical manifestations, MRI examination results, pathological analysis results and prognosis of all the patients.RESULTS: Ten patients with WE were involved in the final
Stoffel, Elena M; Erichsen, Rune; Frøslev, Trine;
BACKGROUND AND AIMS: Colonoscopy provides incomplete protection from colorectal cancer (CRC), but determinants of post-colonoscopy CRC are not well understood. We compared clinical features and molecular characteristics of CRCs diagnosed at different time intervals after a previous colonoscopy....... METHODS: We performed a population-based, cross-sectional study of incident CRC cases in Denmark (2007-2011), categorized as post-colonoscopy or detected during diagnostic colonoscopy (in patients with no prior colonoscopy). We compared prevalence of proximal location and DNA mismatch repair deficiency (d......MMR) in CRC tumors, relative to time since previous colonoscopy, using logistic regression and cubic splines to assess temporal variation. RESULTS: Of 10,365 incident CRCs, 725 occurred after colonoscopy examinations (7.0%). These were more often located in the proximal colon (odds ratio [OR], 2.34; 95% CI, 1...
Kim, Ga-Yeon; Jeon, Jae-Sik
Candida spp. is an invasive infectious fungus, a major risk factor that can increase morbidity and mortality in hospitalized patients. In this study, 2,508 Candida spp. were isolated from various clinical specimens collected from university hospitals from July 2011 to October 2014. They were identified in order to determine isolation frequencies and characteristics by specimen, gender, age group, year, season, and month. The strain-specific isolation rate of Candida spp. is in the order of Candida albicans (1,218 strains, 48.56%), Candida glabrata (416 strains, 16.59%), Candida utilis (305 strains, 12.16%), Candida tropicalis (304 strains, 12.12%), and Candida parapsilosis (116 strains, 4.63%) and these five species accounted for more than 94% of the total strains. Of the specimens, Candida spp. were most frequently isolated from urine-catheter, followed by urine-voided, blood, sputum, other, open pus, vaginal discharge, Tip, ear discharge, bronchial aspiration and bile, in that order. Looking at the age distribution, the detection rate of patients in their 60s and older was significantly higher at 75.8% (1,900/2,508). The detection rate of patients in their 20s and younger was shown to be very low at 2.55% (64/2,508). By year, the detection rate of non-albicans Candida spp. showed a tendency to gradually increase each year compared with C. albicans. As isolation of Candida spp. from clinical samples at the specie level can vary depending on characteristics of the patient, sample, season, etc., continual studies are required. PMID:27433120
Kim, Ga-Yeon; Jeon, Jae-Sik; Kim, Jae Kyung
Candida spp. is an invasive infectious fungus, a major risk factor that can increase morbidity and mortality in hospitalized patients. In this study, 2,508 Candida spp. were isolated from various clinical specimens collected from university hospitals from July 2011 to October 2014. They were identified in order to determine isolation frequencies and characteristics by specimen, gender, age group, year, season, and month. The strain-specific isolation rate of Candida spp. is in the order of Candida albicans (1,218 strains, 48.56%), Candida glabrata (416 strains, 16.59%), Candida utilis (305 strains, 12.16%), Candida tropicalis (304 strains, 12.12%), and Candida parapsilosis (116 strains, 4.63%) and these five species accounted for more than 94% of the total strains. Of the specimens, Candida spp. were most frequently isolated from urine-catheter, followed by urine-voided, blood, sputum, other, open pus, vaginal discharge, Tip, ear discharge, bronchial aspiration and bile, in that order. Looking at the age distribution, the detection rate of patients in their 60s and older was significantly higher at 75.8% (1,900/2,508). The detection rate of patients in their 20s and younger was shown to be very low at 2.55% (64/2,508). By year, the detection rate of non-albicans Candida spp. showed a tendency to gradually increase each year compared with C. albicans. As isolation of Candida spp. from clinical samples at the specie level can vary depending on characteristics of the patient, sample, season, etc., continual studies are required.
Tresch, D D; Sims, F H; Duthie, E H; Goldstein, M D; Lane, P S
Little is known concerning the specific clinical characteristics of patients in persistent vegetative states (PVS). Fifty-one patients from four nursing homes, approximately 3% of the total patients, were identified as being in a PVS. The mean age of the patients was 64.8 +/- 3.2 years (range, 19 to 96 years) and the mean duration of the PVS was 3.3 +/- 5.0 years (range, 1 to 16.8 years), with 13 patients' PVS being longer than 5 years. Cerebrovascular accidents and dementia were the most common causes of the PVS, accounting for 32 of the cases (63%). In the younger patients cerebral trauma secondary to motor vehicle accidents was the most common cause. All 51 patients were fed via tube feeding and 35 patients had urinary catheters (75%). All patients were receiving daily medications, with greater than 50% taking daily vitamins. Over 30% were taking digitalis and/or diuretics and over 32% were taking H2 blockers. Transfer of patients to an acute care hospital was not uncommon, with 31 patients (61%) requiring 63 acute care hospitalizations during their stay in the nursing home. As expected, infections were the most common reason for acute care hospitalization, although 15 of the patients were hospitalized for surgical procedures. Another common problem encountered by the patients was pressure sores, with 78% of patients requiring specific therapy for at least one pressure sore. Surprisingly, only 27 (53%) of 51 patients had a specific resuscitation status designation in the medical chart, and neither presence of a chart designation nor specific resuscitation order was related to the patient's age or the cause or duration of PVS. From these data it would appear that clinical characteristics of patients in PVS are variable. Some patients are young, others are old. The cause varies from cerebrovascular accidents to cerebral trauma. Survival may be prolonged; complications are not uncommon, with some patients requiring acute care hospitalization. PMID:2025140
MEI Yu; AO Ying-fang; WANG Jian-quan; MA Yong; ZHANG Xin; WANG Jia-ning; ZHU Jing-xian
Background Clinical features of anterior cruciate ligament (ACL) injury are important for its prevention,diagnosis and treatment.However,few studies have reported such data,especially in China.The purpose of this study was to describe the clinical characteristics of ACL injury on a large cohort.Methods Between 1993 and 2007,a total of 4355 ACL deficient inpatients (612 athletes and 3743 non-athletes) were registered.Data were collected using a special database system.And the distributions of characteristics in different groups were compared and analyzed statistically.Results All subjects were confirmed with ACL tear during surgery.Statistical analysis revealed that the percentage of females in Athlete Group was significantly higher than that in Non-athlete Group (56.05％ vs.24.95％,P＜0.001).This study also found that sports trauma was the main cause of ACL tears.Soccer,basketball,judo,wrestling and track and field were the five most responsible activities for athletes.The average injury time for athletes was significantly shorter than that for non-athletes (413.3 days vs.717.5 days,P＜0.001).Three thousand nine hundred and eight cases were ordered ACL reconstruction (76.04％ single-bundle,18.30％ double-bundle).Three hundred and forty-five patients (7.92％)were combined with other ligaments injuries,2667 (61.24％) were found with various grades of cartilage lesions,and 3377 (77.54％) were found with meniscal injury.Conclusions Sports trauma was the main cause of ACL tears in China,and reconstruction had become the principal surgical choice.In order to restore knee joint stability and reduce the incidence of cartilage and meniscal injury,patienttailored ACL reconstruction should be suggested at the right moment.
Savas Yakan; Cemil Caliskan; Ozer Makay; Ali Galip Denecl; Mustafa Ali Korkut
AIM: To evaluate 20 adults with intussusception and to clarify the cause, clinical features, diagnosis, and management of this uncommon entity.METHODS: A retrospective review of patients aged >18 years with a diagnosis of intestinal intussusception between 2000 and 2008. Patients with rectal prolapse,prolapse of or around an ostomy and gastroenterostomy intussusception were excluded.RESULTS: There were 20 cases of adult intussusception.Mean age was 47.7 years. Abdominal pain, nausea,and vomiting were the most common symptoms. The majority of intussusceptions were in the small intestine (85%). There were three (15%) cases of colonic intussusception. Enteric intussusception consisted of five jejunojejunal cases, nine ileoileal, and four cases of ileocecal invagination. Among enteric intussusceptions,14 were secondary to a benign process, and in one of these, the malignant cause was secondary to metastatic lung adenocarcinoma. All colonic lesions were malignant. All cases were treated surgically.
Cho, Jeong Yeon [Dept. of Radiology, Seoul National University College of Medicine, Seoul (Korea, Republic of); Lee, Young Ho [Dept. of Radiology, Cheil General Hospital and Women' s Healthcare Center, Kwandong University College of Medicine, Seoul (Korea, Republic of)
The incidence of fetal tumors has been increased due to generalization of prenatal evaluation and improvement of imaging techniques. The early detection of a fetal tumor and understanding of its imaging features are very important for fetal, maternal, and neonatal care. Ultrasonography is usually used for the detection and differential diagnosis of fetal tumors, and magnetic resonance imaging is increasingly being used as a complementary study. Many fetal tumors have different clinical and imaging features compared with pediatric tumors. Although several fetal tumors may mimic other common anomalies, some specific imaging features may carry early accurate diagnosis of fetal tumors, which may alter the prenatal management of a pregnancy and the mode of delivery, and facilitate immediate postnatal treatment.
The growing emphasis on off-site and off-shore clinical data management activities mandates a paramount need for adequate solutions geared toward on-time, quality deliverables. The author has been leading large teams that have been involved in successful global clinical data management endeavors. While each study scenario is unique and has to be approached as such, there are several elements in defining strategy and team structure in global clinical data management that can be applied univers...
Full Text Available Objective: In this study, we aimed to evaluate clinical and laboratory characteristics of patients with Kawasaki disease (KD in Konya region of Turkey. Methods: The hospital records of patients who were hospitalized with the diagnosis of KD in the Pediatrics Clinics of Konya Training and Research Hospital between May 2010 and June 2012 were reviewed retrospectively. Results: Seven cases were found to have the diagnosis of KD, two of whom were incomplete KD. Oropharynx changes were the most common (100% feature in our patients. Five (71% patients had bulbar conjunctivitis. Three (43% patients had erythema at the site of BCG inoculation. Adenopathy was present in all of our patients with the classical form. A desquamation was observed in one case at the seventh day of fever. No cardiac manifestation was seen. Elevated erythrocyte sedimentation rate and thrombocytosis were present in all patients. All of the patients were received intravenous immunoglobulin in the first ten days of the fever. Conclusion: KD should be considered as a possible diagnosis in any child presenting with prolonged fever. BCG reaction can be attributed as a diagnostic criterion for incomplete form of the disease especially in countries where BCG vaccination is routinely performed. Early treatment is essential to prevent cardiovascular complications.
Nentwich, Martin M; Bordón, M; di Martino, D Sánchez; Campuzano, A Ruiz; Torres, W Martínez; Laspina, F; Lichi, S; Samudio, M; Farina, N; Sanabria, Rosa R; de Kaspar, Herminia Mino
To describe the clinical and epidemiological characteristics of patients with severe infectious keratitis in Asunción, Paraguay between April 2009 and September 2011. All patients with the clinical diagnosis of severe keratitis (ulcer ≥2 mm in size and/or central location) were included. Empiric treatment consisted of topical antibiotics and antimycotics; in cases of advanced keratitis, fortified antibiotics were used. After microbiological analysis, treatment was changed if indicated. In total 48 patients (62.5 % males, 25 % farmers) were included in the analysis. A central ulcer was found in 81.3 % (n = 39). The median delay between onset of symptoms and time of first presentation at our institution was 7 days (range 1-30 days). Fungal keratitis was diagnosed in 64.5 % (n = 31) of patients, of which Fusarium sp. (n = 17) was the most common. Twenty-one patients (43.8 %) reported previous trauma to the eye. The globe could be preserved in all cases. While topical therapy only was sufficient in most patients, a conjunctival flap was necessary in six patients suffering from fungal keratitis. The high rate of fungal keratitis in this series is remarkable, and microbiological analysis provided valuable information for the appropriate treatment. In this setting, one has to be highly suspicious of fungal causes of infectious keratitis.
Pyometra is a common disease of female dogs. In Sweden, where approximately 90% of the dog population is intact (not neutered), nearly 25% of all female dogs are diagnosed with the disease before 10 years of age. In certain high-risk breeds, this risk of developing pyometra exceeds 50%. Various clinical signs associated with the genital tract as well as with systemic disease are present in dogs with pyometra. A frequent and serious consequence of the uterine infection is endotoxaemia and progression into the systemic inflammatory response syndrome (SIRS), or sepsis, and the disease is then regarded as a medical emergency. Acute phase proteins and inflammatory markers associated with SIRS and with the outcome as measured by length of hospitalization have been identified in blood samples. Recently, the inflammatory response in infected uterine tissue during pyometra has been more closely explored. The expression of many genes associated with chemokines, cytokines, inflammatory cell extravasation, anti-bacterial action, the complement system and innate immune responses and also a large panel of proteases are upregulated in the uterine tissue in pyometra. Products of certain upregulated genes may be detected systemically and used for diagnostic or prognostic purposes provided that tests are developed in the future. More knowledge of the complex local and systemic inflammatory response in pyometra may allow identification of novel disease biomarkers or future targets for treatment. In this article, clinical as well as molecular characteristics of the disease are reviewed. PMID:23279529
Full Text Available Abstract Background Clinical trial and epidemiological studies need high quality biospecimens from a representative sample of participants to investigate genetic influences on treatment response and disease. Obtaining blood biospecimens presents logistical and financial challenges. As a result, saliva biospecimen collection is becoming more frequent because of the ease of collection and lower cost. This article describes an assessment of saliva biospecimen samples collected through the mail, trial participant demographic and behavioral characteristics, and their association with saliva and DNA quantity and quality. Methods Saliva biospecimens were collected using the Oragene® DNA Self-Collection Kits from participants in a National Cancer Institute funded smoking cessation trial. Saliva biospecimens from 565 individuals were visually inspected for clarity prior to and after DNA extraction. DNA samples were then quantified by UV absorbance, PicoGreen®, and qPCR. Genotyping was performed on 11 SNPs using TaqMan® SNP assays and two VNTR assays. Univariate, correlation, and analysis of variance analyses were conducted to observe the relationship between saliva sample and participant characteristics. Results The biospecimen kit return rate was 58.5% among those invited to participate (n = 967 and 47.1% among all possible COMPASS participants (n = 1202. Significant gender differences were observed with males providing larger saliva volume (4.7 vs. 4.5 ml, p = 0.019, samples that were more likely to be judged as cloudy (39.5% vs. 24.9%, p 0.21, P Conclusion Findings from this study show that demographic and behavioral characteristics of smoking cessation trial participants have significant associations with saliva and DNA metrics, but not with the performance of TaqMan® SNP or VNTR genotyping assays. Trial registration COMPASS; registered as NCT00301145 at clinicaltrials.gov.
Lei Kong; Nn Santiago; Tian-Quan Han; Sheng-Dao Zhang
AIM: To investigate the clinical characteristics and prognostic factors of a consecutive series of patients with severe acute pancreatitis (SAP).METHODS: Clinical data of SAP patients admitted to our hospital from January 2003 to January 2004 were retrospectively reviewed. Collected data included the age, gender, etiology,length of hospitalization, APACHE Ⅱ score at admission,local and organ/systemic complications of the patients.RESULTS: Of the 268 acute pancreatitis patients, 94 developed SAP. The mean age of SAP patients was 52 years, the commonest etiology was cholelithiasis (45.7%), the mean length of hospitalization was 70 d, the mean score of APACHE Ⅱ was 7.7. Fifty-four percent of the patients developed necrosis, 25% abscess, 58% organ/systemic failure. A total of 23.4% (22/94) of the SAP patients died. Respiratory failure was the most common organ clysfunction (90.9%) in deceased SAP patients, followed by cardiovascular failure (86.4%),renal failure (50.0%). In the SAP patients, 90.9% (20/22)developed multiple organ/systemic failures. There were significant differences in age, length of hospitalization,APACHE Ⅱ score and incidences of respiratory failure, renal failure, cardiovascular failure and hematological failure between deceased SAP patients and survived SAP patients.By multivariate logistic regression analysis, independent prognostic factors for mortality were respiratory failure,cardiovascular failure and renal failure.CONCLUSION: SAP patients are characterized by advanced age, high APACHE Ⅱ score, organ failure and their death is mainly due to multiple organ/systemic failures. In patients with SAP, respiratory, cardiovascular and renal failures can predict the fatal outcome and more attention should be paid to their clinical evaluation.
Aganovic, Damir; Prcic, Alen; Kulovac, Benjamin; Hadziosmanovic, Osman
Objectives: To determine the optimal medication for the treatment of renal colic using evidence based medicine (EBM) parameters (RR, ARR, NNT, NNH, ARI, RRI). Sample and Methodology: During 2010, an ITT study was conducted on 400 outpatients of the Sarajevo University Clinical Center Urology Clinic in order to investigate renal colic pain relief drugs. Each group consisting of 100 patients was administered either Metamizol amp. i.v., or Diclofenac amp. i.m., or Butylscopolamine amp. i.v., whi...
João Manoel Silva
Full Text Available Introduction: Intensive care mortality of HIV-positive patients has progressively decreased. However, critically ill HIV-positive patients with sepsis present a worse prognosis. To better understand this condition, we propose a study comparing clinical, etiological and inflammatory data, and the hospital course of HIV-positive and HIV-negative patients with severe sepsis or septic shock. Methods: A prospective observational study enrolling patients with severe sepsis or septic shock associated or not with HIV infection, and admitted to intensive care unit (ICU. Clinical, microbiological and inflammatory parameters were assessed, including C-reactive protein (CRP, procalcitonin (PCT, interleukin-6, interleukin-10 and TNF-α. Outcome measures were in-hospital and six-month mortality. Results: The study included 58 patients with severe sepsis/septic shock admitted to ICU, 36 HIV-positive and 22 HIV-negative. All HIV-positive patients met the criteria for AIDS (CDC/2008. The main foci of infection in HIV-positive patients were pulmonary and abdominal (p=0.001. Fungi and mycobacteria were identified in 44.4% and 16.7% of HIV-positive patients, respectively. In contrast, the main etiologies for sepsis in HIV-negative patients were Gram-negative bacilli (36.4% and Gram-positive cocci (36.4% (p=0.001. CRP and PCT admission concentrations were lower in HIV-positive patients (130 vs. 168 mg/dL p=0.005, and 1.19 vs. 4.06 ng/mL p=0.04, respectively, with a progressive decrease in surviving patients. Initial IL-10 concentrations were higher in HIV-positive patients (4.4 pg/mL vs. 1.0 pg/mL, p=0.005, with moderate accuracy for predicting death (area under receiver-operating characteristic curve =0.74. In-hospital and six-month mortality were higher in HIV-positive patients (55.6 vs. 27.3% p=0.03, and 58.3 vs. 27.3% p=0.02, respectively. Conclusions: The course of sepsis was more severe in HIV-positive patients, with distinct clinical, etiological and
Full Text Available Objective: The aim of this study is to present a comprehensive profile of clinical and psychosocial characteristics of children with psychogenic nonepileptic seizures and to assess the short-term outcome of these patients. Materials and Methods: The subjects were consecutive cases of children with a diagnosis of nonepileptic seizures (N=17, mean age = 10.7 years, S.D. = 1.26 and two groups of control groups matched on age and sex: true seizure group and healthy controls. All the children were recruited from the out-patient services of the Department of Pediatrics of a tertiary care teaching hospital in North India. Detailed history taking and clinical examination was done in the case of every child. A standard 18 channel EEG was done in all the children and a video EEG was done in 12 cases of children with nonepileptic seizures. The Childhood Psychopathology Measurement Schedule (CPMS and Life Events Scale for Indian Children (LESIC were used to measure the children′s emotional and behavioral functioning at home, and the number of life events and the stress associated with these events in the preceding year and the year before that. Short-term outcome was examined three to six months after the diagnosis of nonepileptic seizures was made. Results: Unresponsiveness without marked motor manifestations was the most common "ictal" characteristic of the nonepileptic seizures. Pelvic thrusting, upper and lower limb movements, head movements, and vocalization were observed in less than one-third of the patients. Increased psychosocial stress and significantly higher number of life events in the preceding year were found to characterize children with nonepileptic seizures, as compared to the two control groups. The nonepileptic seizures and true seizures groups had a higher proportion of children with psychopathology scores in the clinically significant maladjustment range, as compared to those in the healthy control group. A majority of the patients
WEI Wen-bin; JIE Ying; MO Jing; LI Bin
Background Neurofibroma is a kind of benign neoplasm that derives from nervous tissues.Though this tumor is the most common types in the peripheral nervous system,it is rarely seen in the choroid and easy to be misdiagnosed of choroidal melanoma.The aim of this study was to review the clinical features of neurofibroma of the choroid in the Chinese race.Methods A retrospective case series design was used.Two male and one female patients diagnosed with choroidal neurofibroma in Beijing Tongren Eye Center were included in this study.The clinical histories were abstracted from the patients' medical records.Routine eye examinations including visual acuity,intraocular pressure,slit lamp and ophthalmoscope were performed.Auxiliary examinations included fluorescein fundus angiography (FFA),AB-ultrasound scan,color doppler imaging (CDI),and magnetic resonance imaging (MRI).Local resection of the tumors was performed and the specimens underwent pathological examinations.Results The tumors were of yellow-pink color with pigmentation on the surface.CDI showed arterial blood signals in the tumor and MRI showed high-intensity in the T1-weighted image and a slightly increased intensity in the T2-weighted image.FFA and indocyaninegreen angiography demonstrated the tumors were of hypofluorescence at early stage and hyperfluorescence with prominent leakage at late stage.The pathological examination confirmed the tumors were choroidal neurofibroma.After 5-10-year follow-up,there were no recurrences of the tumors and the retinas were well attached.Conclusions Choroidal neurofibroma is difficult to be diagnosed clinically and pathological confirmation is important.These tumors can be managed conservatively by local resection.
Janssens, Peter; Arnaud, Laurent; Galicier, Lionel; Mathian, Alexis; Hie, Miguel; Sene, Damien; Haroche, Julien; Veyssier-Belot, Catherine; Huynh-Charlier, Isabelle; Grenier, Philippe A; Piette, Jean-Charles; Amoura, Zahir
Lupus enteritis is a rare and poorly understood cause of abdominal pain in patients with systemic lupus erythematosus (SLE). In this study, we report a series of 7 new patients with this rare condition who were referred to French tertiary care centers and perform a systematic literature review of SLE cases fulfilling the revised ACR criteria, with evidence for small bowel involvement, excluding those with infectious enteritis. We describe the characteristics of 143 previously published and 7 new cases. Clinical symptoms mostly included abdominal pain (97%), vomiting (42%), diarrhea (32%) and fever (20%). Laboratory features mostly reflected lupus activity: low complement levels (88%), anemia (52%), leukocytopenia or lymphocytopenia (40%) and thrombocytopenia (21%). Median CRP level was 2.0 mg/dL (range 0-8.2 mg/dL). Proteinuria was present in 47% of cases. Imaging studies revealed bowel wall edema (95%), ascites (78%), the characteristic target sign (71%), mesenteric abnormalities (71%) and bowel dilatation (24%). Only 9 patients (6%) had histologically confirmed vasculitis. All patients received corticosteroids as a first-line therapy, with additional immunosuppressants administered either from the initial episode or only in case of relapse (recurrence rate: 25%). Seven percent developed intestinal necrosis or perforation, yielding a mortality rate of 2.7%. Altogether, lupus enteritis is a poorly known cause of abdominal pain in SLE patients, with distinct clinical and therapeutic features. The disease may evolve to intestinal necrosis and perforation if untreated. Adding with this an excellent steroid responsiveness, timely diagnosis becomes primordial for the adequate management of this rare entity.
罗爱伦; 郭向阳; 易杰; 任洪智; 黄宇光; 叶铁虎
Objective To investigate clinical features of pheochromocytoma and summarize experiences of anesthetic management during the perioperative period. Methods Two hundred and fifty eight patients who were diagnosed with pheochromocytoma in our hospital were reviewed retrospectively for clinical features. According to different preoperative pharmalogical preparations, perioperative mortalities were analyzed in three periods (Period 1: January 1955-December 1975; Period 2: January 1976-December 1994; Period 3: January 1995-July 2001). In Period 3, hemodynamic changes in the patients undergoing different anesthetic methods were analyzed. Results About 5.8% (15/258) of pheochromocytoma was an integral part of multiple endocrine neoplasia (MEN) type Ⅱ or mixed type. Sixty percent (149/249) of the patients who had undergone surgery possessed evidence of catecholamine cardiac toxicity preoperatively. Impaired glucose tolerance was found in 59% (147/249) of the patients before surgery. Perioperative mortality was significantly decreased from 8% (5/60) in Period 1 to 1.2% (1/75) in Period 2 (P<0.01). No perioperative deaths occurred in Period 3. The volume infused during the operation was significantly higher both in the epidural anesthesia group (3474 ml±624 ml, P<0.01) and in the epidural plus general anesthesia group (3654 ml±475 ml, P<0.01) than in the general anesthesia group (2534 ml±512 ml). There were favorable hemodynamic characteristics in patients before removal of the tumor in the epidural anesthesia group and in the epidural plus general anesthesia group, as compared with the general anesthesia group. Conclusions A positive surgical outcome of the excision of pheochromocytoma depends on multiple factors, including careful assessment of potential vital organ damage before surgery and restoration of blood volume by establishing α-blockade preoperatively, meticulous anesthetic management of patients during surgery, and appropriate circulatory support after
Weitzel, William D.; And Others
Available from: American Medical Association, 535 N. Dearborn Street, Chicago, Illinois 60610 The professional literature relevant to child incest cases is reviewed, and four questions related to clinical management are examined. (Author)
Fenn, Paul; Egan, Tom
This paper explores this theme – the inter-relationship between good governance, financial incentives and clinical risk management – and presents evidence gleaned from views expressed by key decision takers within the NHS.
Sunil Somnath Patil
Conclusions: There is need of setting menopausal clinics and centres to help women with symptoms and signs of estrogen deprivation. Counseling and education are main treatment modalities. [Int J Reprod Contracept Obstet Gynecol 2016; 5(3.000: 757-761
Croen, L.A.; Shaw, G.M. [California Birth Defects Monitoring Program, Emeryville, CA (United States); Lammer, E.J. [Children`s Hospital, Oakland, CA (United States)
Holoprosencephaly is a brain defect resulting from incomplete cleavage of the embryonic forebrain. It involves forebrain and facial malformations that can range from mild to severe. The epidemiology of holoprosencephaly is largely unknown. Published prevalence estimates have been derived from clinic-based case series, and suggested risk factors for holoprosencephaly have been identified in case reports, without confirmation from systematically conducted population-based studies. Using data from a population-based birth defects registry in California, we described the epidemiologic and clinical characteristics of cytogenetically and phenotypically distinct types of holoprosencephaly. A total of 121 cases was identified among a cohort of 1,035,386 live births and fetal deaths. The prevalence of holoprosencephaly was 1.2 per 10,000 births (95% confidence interval 1.0-1.4 per 10,000). Of all cases, 41% (50/121) had a chromosomal abnormality, most commonly Trisomy 13. Among the 71 cytogenetically apparently normal cases, 18 had recognizable syndromes and the remaining 53 were of unknown cause. Among the cytogenetically abnormal cases, females had a greater risk than males (odds ratio = 2.3, 95% confidence interval [1.2, 4.4]). Among the cytogenetically normal cases, increased risks were observed among Hispanic whites (OR = 1.8 [0.9, 3.6]) and cases whose mother was born in Mexico (OR = 2.2 [1.0, 4.5]). Approximately 46% of all cases had alobar holoprosencephaly, the most severe form of the forebrain malformation. The facial phenotype did not strongly predict the severity of the brain defect; however, severity was inversely correlated with length of survival. This study is the first to present findings based on such a large population-based series of infants/fetuses affected by holoprosencephaly, and demonstrates the importance of investigating the component subgroups of this rare phenotype. 47 refs., 7 tabs.
Esra; Kardes; Betul; Ilkay; Sezgin; Akcay; Kansu; Bozkurt; Cihan; Unlu; Gurkan; Erdogan; Gulunay; Akcali
·AIM: To describe the clinical characteristics of Turkish patients with intermediate uveitis(IU) and to investigate the effect of clinical findings and complications on final visual acuity(VA).·METHODS: We retrospectively analyzed the medical records of patients with IU who had at least 6mo of follow-up and were older than 16 y.· RESULTS: A total of 78 eyes of 45 patients were included in the study and the mean follow-up period was19.4mo. The mean age at the time of presentation was42.9s. Systemic disease associations were found in17.7% of cases; sarcoidosis(8.8%) and multiple sclerosis(6.6%) were the most common diseases. Recurrence rate(odds ratio=45.53; 95%CI: 2.181-950.58), vitritis equals to or more than 3+ cells(odds ratio =57.456; 95%CI: 4.154-794.79) and presenting with VA less than 20/40(odds ratio =43.81; 95% CI: 2.184-878.71) were also found as high risk factors for poor final VA. At the last follow-up examination, 67.9% of eyes had VA of 20/40 or better.·CONCLUSION: IU is frequently seen at the beginning of the fourth decade of life. The disease is most commonly idiopathic in adult Turkish patients. Patients with severe vitritis at presentation and patients with frequent recurrences are at high risk for poor visual outcome.
Full Text Available Objectives: The clinical characteristics and treatment resultsof patients diagnosed with sarcoidosis was investigatedin Dicle University Medical Faculty Hospital.Materials and methods: A total of 39 patients were includeddiagnosed with sarcoidosis between 01 January2008 and31 December 2011.Demographic data, laboratoryfindings, spirometric test data, diagnostic methodsand treatment regimens for the study were recorded form.According to pulmonary function test results of patients,61.5% were normal pattern, 30.8% were restrictive patternand 7.7% were obstructive pattern.Results: Of the 39 patients 15.4% male, 84.6% werefemale. The mean age was 39.5±13.1 years for males,females 44.8±14.0 years. All patients of was 17.9%stage 1, 66.7% stage 2, 10.3% stage 3 and 5.1% stage4. 61.5% were symptomatic, 38.5% were asymptomatic.Methods of diagnosis of the patients examined, 25.6% ofpatients bronchoscopic biopsy procedures, 74.4% of patientssurgical biopsy procedures. Of the 56.4% patientshad received corticosteroid treatment, 5.1% patients hadreceived corticosteroid + methotrexate treatment, 38.5%were followed up without the pharmacological treatment.Pharmacological treatment in the group complete at thetime of the study 20.5% concluded the treatment of theperson. Patients who treatment ending 8.4 months hadused pharmacological treatment.Conclusions: Interstitial lung diseases which are prevalentamong patients with sarcoidosis diagnosed by examiningthe clinical features, differential diagnosis and treatmentmay be possible detection of potential problems. JClin Exp Invest 2012; 3 (3: 363-367Key words: Sarcoidosis diagnosis, treatment
Smith, Steven C.; Gronseth, Darren L.
In order for research programs at academic medical centers and universities to survive and thrive in the increasingly challenging economic, political and regulatory environment, successful transformation is extremely important. Transformation and quality management techniques are increasingly well established in medical practice organizations. In…
Full Text Available Background and Aims: Infection with hepatitis A virus is still one of the most common causes of hepatitis worldwide. The clinical manifestation of acute hepatitis A (AHA in adults can vary greatly, ranging from asymptomatic infection to severe and fulminant hepatitis. The aim of this study was to describe the demographic, clinical characteristics, laboratory features and hospital outcome of adult patients with AHA over a consecutive period of 4 years within an area from Eastern European country. Methods: Two hundred and two adult patients diagnosed with AHA were retrospective, observational and analytic analized over a period of 4 years. Based on prothrombin time less than 50, the study group was stratified in medium (79.2% and severe forms (20.8%. We investigated the clinical, laboratory and epidemiological features. Statistical analysis were applied to compare the medium and severe forms of AHA. Results: Most patients (72.7% were younger than 40 years. The main symptoms included: dyspepsia (72.07%, jaundice (86.63%, asteno-adynamia (86.72%, and flu-like symptoms (53.46%. The hemorrhagic cutaneous-mucous manifestations (6.93% associated with the severe forms of AHA (OR =12.19, 95%CI -3.59 - 41.3, p =0.001. We found statistically significant differences for PT (p <0.001, INR (p <0.001, TQ (p <0.001, ALAT (p <0.001, ASAT (p <0.001, ALP (p <0.001 and platelets (p =0.009 between severe and medium AHA forms. We found that TQ, INR, ALAT and ASAT have the highest diagnostic values, statistically significant (p <0.05 for severe AHA forms with AUC (0.99, 0.99, 0.72, 0.70 at values of sensitivity (95%, 90.5%, 89%, 95% and specificity (98%, 99%, 88%,94%. Conclusions Medium severity AHA forms were found in most of the study group patients (79.2%. The severe AHA forms were associated with hemorrhagic cutaneous-mucous manifestations (OR =12.19, p =0.001. The univariate analysis proved a negatively statistically significant correlation between IP and ALAT
Kanai, Chieko; Iwanami, Akira; Ota, Haruhisa; Yamasue, Hidenori; Matsushima, Eisuke; Yokoi, Hideki; Shinohara, Kazuyuki; Kato, Nobumasa
Diagnosis of Asperger's Syndrome (AS) in adults is difficult, and clinical sample-based studies that systematically illustrate the clinical characteristics of adult AS patients are needed so that appropriate treatment can be provided. Here we examined the clinical characteristics of AS in 112 adults (median age, 28.0 years [range, 18-52]; 71 men…
Mao, Zhiguo; Chong, Jiehan; Ong, Albert C M
The first clinical descriptions of autosomal dominant polycystic kidney disease (ADPKD) go back at least 500 years to the late 16 (th) century. Advances in understanding disease presentation and pathophysiology have mirrored the progress of clinical medicine in anatomy, pathology, physiology, cell biology, and genetics. The identification of PKD1 and PKD2, the major genes mutated in ADPKD, has stimulated major advances, which in turn have led to the first approved drug for this disorder and a fresh reassessment of patient management in the 21 (st) century. In this commentary, we consider how clinical management is likely to change in the coming decade. PMID:27594986
Repullo, Jose Ramón; Oteo, Luis Angel
Portfolio methodology is widely applied to training, particularly in medical education and for medical trainees. Some Spanish Institutions (National University of Distance Learning and National School of Public Health) are using a seven dimension Portfolio in the field of Clinical Management, which could be used as conceptual framework and checklist for building up different documents for planning, programming and evaluating the new experiences of Clinical Units based on clinical management initiatives. This paper describe the Portfolio in short, takes into consideration its potential use, and concludes addressing the relevance of good governance and accountability for the medical professionalism. PMID:25688529
Desrochers, André; Francoz, David
Synovial fluid, ultrasound, and radiographic imaging are common diagnostic tools for septic arthritis. Mycoplasma septic arthritis is suspected in calves with clinical signs of otitis and pneumonia. Commonly affected joints are carpus, stifle, and tarsus. Treatment strategy must include long-term antibiotics, anti-inflammatories, and joint lavage. Knowledge of communication and boundaries for commonly affected joints is essential to perform joint lavage and arthrotomy.
Vriend J; Corkum P
Jennifer Vriend1, Penny Corkum21Clinical Psychology PhD Program, Dalhousie University, Halifax, Nova Scotia, Canada; 2Department of Psychology, Dalhousie University, Halifax, Nova Scotia, CanadaAbstract: Behavioral insomnia is highly prevalent, affecting approximately 25% of children. It involves difficulties initiating and maintaining sleep and frequently results in inadequate sleep, leading to an array of negative effects for both the child and the child’s family. In this paper, w...
Pumarino, H; Oviedo, S; Michelsen, H; Campino, C
50 patients with autonomous growth hormone excess (48 with adult acromegaly and 2 with gigantism) were studied between 1966 to 1986 (2.38 pts/year). Characteristic clinical presentation, an increase in growth hormone (GH) uninhibited by glucose, and/or hyperphosphemia and hyperhydroxiprolinuria were present in all patients. No cases of hypercalcemia were recorded. Phosphemia was increased in 55.8%, alkaline phosphatases in 61.7%, calciuria in 26.9% and hydroxyprolinuria in 74.2% of the patients. Basal GH was over 5 ng/ml (89.9 DS +/- 170.9) in 42 pts, and in 37 was not suppressed after glucose administration, 38% had an increased (paradoxical response) and 62% a flat response (less than 50% change of basal values). TRH test was performed in 14 patients, 8 presented an increase in GH titer. Hyperprolactinemia was seen in 4 of 12 patients in whom this hormone was measured. The size of the sella turcica was increased in 93%, and although the larger sellar size correlated to higher levels of GH, correlation was not significant. 20% of the pts had rheumatological disease, 14% goiter, 12% cardiac disease, 26.5% had diastolic hypertension and 4% renal lithiasis (hypercalciuric pts). 38% had hyperglycemia with a diabetic glucose tolerance test and 18% had non-diabetic abnormal glucose tolerance test. PMID:1844771
Pereira, Wildéa Lice de Carvalho Jennings; Reiche, Edna Maria Vissoci; Kallaur, Ana Paula; Kaimen-Maciel, Damacio Ramón
The aim of this study was to review the epidemiological and clinical characteristics of neuromyelitis optica (NMO) and the immunopathological mechanisms involved in the neuronal damage. NMO is an inflammatory demyelinating autoimmune disease of the central nervous system that most commonly affects the optic nerves and spinal cord. NMO is thought to be more prevalent among non-Caucasians and where multiple sclerosis (MS) prevalence is low. NMO follows a relapsing course in more than 80-90% of cases, which is more commonly in women. It is a complex disease with an interaction between host genetic and environmental factors and the main immunological feature is the presence of anti-aquaporin 4 (AQP4) antibodies in a subset of patients. NMO is frequently associated with multiple other autoantibodies and there is a strong association between NMO with other systemic autoimmune diseases. AQP4-IgG can cause antibody-dependent cellular cytotoxicity (ADCC) when effector cells are present and complement-dependent cytotoxicity (CDC) when complement is present. Acute therapies, including corticosteroids and plasma exchange, are designed to minimize injury and accelerate recovery. Several aspects of NMO pathogenesis remain unclear. More advances in the understanding of NMO disease mechanisms are needed in order to identify more specific biomarkers to NMO diagnosis.
Full Text Available Human rhinovirus (HRV is a leading cause of acute respiratory infection (ARI in young children and infants worldwide and has a high impact on morbidity and mortality in this population. Initially, HRV was classified into two species: HRV-A and HRV-B. Recently, a species called HRV-C and possibly another species, HRV-D, were identified. In Mexico, there is little information about the role of HRV as a cause of ARI, and the presence and importance of species such as HRV-C are not known. The aim of this study was to determine the clinical characteristics and genetic variability of HRV in Mexican children. Genetic characterization was carried out by phylogenetic analysis of the 5′-nontranslated region (5′-NTR of the HRV genome. The results show that the newly identified HRV-C is circulating in Mexican children more frequently than HRV-B but not as frequently as HRV-A, which was the most frequent species. Most of the cases of the three species of HRV were in children under 2 years of age, and all species were associated with very mild and moderate ARI.
Nagao, Miki; Saito, Takashi; Doi, Shoichi; Hotta, Gou; Yamamoto, Masaki; Matsumura, Yasufumi; Matsushima, Aki; Ito, Yutaka; Takakura, Shunji; Ichiyama, Satoshi
Ocular candidiasis is a major complication of Candida bloodstream infection (BSI). This study was performed to reveal the clinical characteristics of ocular candidiasis. Of the 220 patients with Candida BSI, 204 cases received ophthalmology consultations between January 2005 and December 2011 at 2 teaching hospitals. Fifty-four (26.5%) cases had findings consistent with the diagnosis of ocular candidiasis. Of these 54 cases, 43 (79.6%) were diagnosed within 7 days after a positive blood culture. Among ocular candidiasis cases, more cases were due to Candida albicans (P =0.034 odds ratio [OR]; 3.68 95% confidence interval [CI] 1.11-12.2) and had higher β-d-glucan values (P = 0.001 OR; 9.99 95% CI 2.60-21.3). We need to consider fundoscopic examination to be performed within the first 7 days of therapy, especially for those patients who have C. albicans BSIs and higher β-d-glucan values. Additionally, follow-up fundoscopic examination should be considered before stopping therapy for high-risk patients.
Manigandan, D; Bharanidharan, G; Aruna, P; Devan, K; Elangovan, D; Patil, Vikram; Tamilarasan, R; Vasanthan, S; Ganesan, S
The fundamental dosimetric characteristics of commercially available metal oxide semiconductor field effect transistor (MOSFET) detectors were studied for clinical electron beam irradiations. MOSFET showed excellent linearity against doses measured using an ion chamber in the dose range of 20-630cGy. MOSFET reproducibility is better at high doses compared to low doses. The output factors measured with the MOSFET were within +/-3% when compared with those measured with a parallel plate chamber. From 4 to 12MeV, MOSFETs showed a large angular dependence in the tilt directions and less in the axial directions. MOSFETs do not show any dose-rate dependence between 100 and 600MU/min. However, MOSFETs have shown under-response when the dose per pulse of the beam is decreased. No measurable effect in MOSFET response was observed in the temperature range of 23-40 degrees C. The energy dependence of a MOSFET dosimeter was within +/-3.0% for 6-18MeV electron beams and 5.5% for 4MeV ones. This study shows that MOSFET detectors are suitable for dosimetry of electron beams in the energy range of 4-18MeV. PMID:19128995
Sobkowski, D A; Maquera, V
A practical application of a neurology case management healthcare delivery mode results in increased access to specialty providers, shorter follow-up periods, and improved continuity of medical care. The program described in the following sections was developed at a naval hospital for the ongoing evaluation of therapeutic schemes to optimize headache therapy and, 1 year after implementation, shows improvement in patient outcomes and resource use. PMID:9192570
Full Text Available Leslie A Sadownik University of British Columbia, Department of Obstetrics and Gynecology, Vancouver, BC, Canada Abstract: Chronic vulvar pain or discomfort for which no obvious etiology can be found, ie, vulvodynia, can affect up to 16% of women. It may affect girls and women across all age groups and ethnicities. Vulvodynia is a significant burden to society, the health care system, the affected woman, and her intimate partner. The etiology is multifactorial and may involve local injury or inflammation, and peripheral and or central sensitization of the nervous system. An approach to the diagnosis and management of a woman presenting with chronic vulvar pain should address the biological, psychological, and social/interpersonal factors that contribute to her illness. The gynecologist has a key role in excluding other causes for vulvar pain, screening for psychosexual and pelvic floor dysfunction, and collaborating with other health care providers to manage a woman's pain. An important component of treatment is patient education regarding the pathogenesis of the pain and the negative impact of experiencing pain on a woman's overall quality of life. An individualized, holistic, and often multidisciplinary approach is needed to effectively manage the woman's pain and pain-related distress. Keywords: vulvodynia, diagnosis, treatment, etiology, sexual pain disorder, dyspareunia, vestibulodynia, assessment, treatment, multidisciplinary
Electronic medical record (EMR) system has been widely used in clinical practice. Instead of traditional record system by hand writing and recording, the EMR makes big data clinical research feasible. The most important feature of big data research is its real-world setting. Furthermore, big data research can provide all aspects of information related to healthcare. However, big data research requires some skills on data management, which however, is always lacking in the curriculum of medical education. This greatly hinders doctors from testing their clinical hypothesis by using EMR. To make ends meet, a series of articles introducing data management techniques are put forward to guide clinicians to big data clinical research. The present educational article firstly introduces some basic knowledge on R language, followed by some data management skills on creating new variables, recoding variables and renaming variables. These are very basic skills and may be used in every project of big data research.
Full Text Available Abstract Background There has been an increased interest in recruiting health professionals with a clinical background to management positions in health care. We know little about the factors that influence individuals’ decisions to engage in management. The aim of this study is to explore clinicians’ journeys towards management positions in hospitals, in order to identify potential drivers and barriers to management recruitment and development. Methods We did a qualitative study which included in-depth interviews with 30 clinicians in middle and first-line management positions in Norwegian hospitals. In addition, participant observation was conducted with 20 of the participants. The informants were recruited from medical and surgical departments, and most had professional backgrounds as medical doctors or nurses. Interviews were analyzed by systemic text condensation. Results We found that there were three phases in clinicians’ journey into management; the development of leadership awareness, taking on the manager role and the experience of entering management. Participants’ experiences suggest that there are different journeys into management, in which both external and internal pressure emerged as a recurrent theme. They had not anticipated a career in clinical management, and experienced that they had been persuaded to take the position. Being thrown into the position, without being sufficiently prepared for the task, was a common experience among participants. Being left to themselves, they had to learn management “on the fly”. Some were frustrated in their role due to increasing administrative workloads, without being able to delegate work effectively. Conclusions Path dependency and social pressure seems to influence clinicians’ decisions to enter into management positions. Hospital organizations should formalize pathways into management, in order to identify, attract, and retain the most qualified talents. Top managers
Casal Román, Manuel
The tuberculosis is one of the most important and mortal diseases of the world. The microbiological confirmatory diagnosis and the microbiological therapeutic orientation are fundamental nowadays in the tuberculosis in AIDS and in the Resistant tuberculosis. They are described throughout the time by the classic Microbiology: From 1882 to final 20th century (130 years). With the modern current Microbiology: In the beginning of the 21st century (20-30 years). And as will be done with the future Microbiology: From the years 2020-30. The important advances are outlined in the modern and future clinical microbiology, for the control of the Tuberculosis.
Root Kustritz, Margaret V
Average gestation length in domestic cats is 65.6 days, with a range of 52-74 days. Average reported litter size is 4.0 kittens per litter; litter size is not correlated with number of matings in a given estrus. Superfecundation is common in domestic cats; superfetation never has been definitively proven to occur. Eclampsia may occur during pregnancy in queens, with non-specific clinical signs. Ectopic pregnancy and uterine torsion have been reported. Pregnancy loss may be due to infectious causes, including bacteria, viruses or protozoa, or non-infectious causes, such as hypoluteoidism and chromosome errors. PMID:16620942
Malik, Asma; Hayat, Ghazala; Kalia, Junaid S; Guzman, Miguel A
Idiopathic inflammatory myopathies (IIM) are a group of chronic, autoimmune conditions affecting primarily the proximal muscles. The most common types are dermatomyositis (DM), polymyositis (PM), necrotizing autoimmune myopathy (NAM), and sporadic inclusion body myositis (sIBM). Patients typically present with sub-acute to chronic onset of proximal weakness manifested by difficulty with rising from a chair, climbing stairs, lifting objects, and combing hair. They are uniquely identified by their clinical presentation consisting of muscular and extramuscular manifestations. Laboratory investigations, including increased serum creatine kinase (CK) and myositis specific antibodies (MSA) may help in differentiating clinical phenotype and to confirm the diagnosis. However, muscle biopsy remains the gold standard for diagnosis. These disorders are potentially treatable with proper diagnosis and initiation of therapy. Goals of treatment are to eliminate inflammation, restore muscle performance, reduce morbidity, and improve quality of life. This review aims to provide a basic diagnostic approach to patients with suspected IIM, summarize current therapeutic strategies, and provide an insight into future prospective therapies. PMID:27242652
Intindola, Melissa; Rogers, Sean; Flinchbaugh, Carol; Della Pietra, Doug
Purpose - The purpose of this paper is to explore the links between various characteristics of hospital administration and the utilization of classes of volunteer resource management (VRM) practices. Design/methodology/approach - This paper uses original data collected via surveys of volunteer directors in 122 hospitals in five Northeastern and Southern US states. Findings - Structural equation modeling results suggest that number of paid volunteer management staff, scope of responsibility of the primary volunteer administrator, and hospital size are positively associated with increased usage of certain VRM practices. Research limitations/implications - First, the authors begin the exploration of VRM antecedents, and encourage others to continue this line of inquiry; and second, the authors assess dimensionality of practices, allowing future researchers to consider whether specific dimensions have a differential impact on key individual and organizational outcomes. Practical implications - Based on the findings of a relationship between administrative characteristics and the on-the-ground execution of VRM practice, a baseline audit comparing current practices to those VRM practices presented here might be useful in determining what next steps may be taken to focus investments in VRM that can ultimately drive practice utilization. Originality/value - The exploration of the dimensionality of volunteer management adds a novel perspective to both the academic study, and practice, of volunteer management. To the authors' knowledge, this is the first empirical categorization of VRM practices.
Intindola, Melissa; Rogers, Sean; Flinchbaugh, Carol; Della Pietra, Doug
Purpose - The purpose of this paper is to explore the links between various characteristics of hospital administration and the utilization of classes of volunteer resource management (VRM) practices. Design/methodology/approach - This paper uses original data collected via surveys of volunteer directors in 122 hospitals in five Northeastern and Southern US states. Findings - Structural equation modeling results suggest that number of paid volunteer management staff, scope of responsibility of the primary volunteer administrator, and hospital size are positively associated with increased usage of certain VRM practices. Research limitations/implications - First, the authors begin the exploration of VRM antecedents, and encourage others to continue this line of inquiry; and second, the authors assess dimensionality of practices, allowing future researchers to consider whether specific dimensions have a differential impact on key individual and organizational outcomes. Practical implications - Based on the findings of a relationship between administrative characteristics and the on-the-ground execution of VRM practice, a baseline audit comparing current practices to those VRM practices presented here might be useful in determining what next steps may be taken to focus investments in VRM that can ultimately drive practice utilization. Originality/value - The exploration of the dimensionality of volunteer management adds a novel perspective to both the academic study, and practice, of volunteer management. To the authors' knowledge, this is the first empirical categorization of VRM practices. PMID:27119392
Emine Elvan Taşğın
Full Text Available Objective: To evaluate the epidemiologic characteristics of the pediatric patients with psoriazis applied to our outpatients' clinic and compare these data with the literature. Methods: The study population consisted of 37 patients younger than 16 years with the diagnosis of psoriazis in dermatology outpatient clinic between May 2009 and December 2010. The patients were evaluated with regard to age, gender, age of onset of the disease, duration of the disease, the presence of accompanying diseases, family history, clinical features, and triggering factors. Results: Of 37 pediatric patients with psoriazis evaluated in this study, 21 were girls and 16 were boys. The ages of the patients ranged between 2 and 15 years. 32.4% of the patients had family history. Plaque (59.45% of the patients, guttate (29.7% of the patients and pustular (10.8% of the patientstypes of psoriazis were determined. The psoriazis lesions involved most frequently the hairy skin (73% and the disease generally originated from this region. Ungual involvement was determined in 27% of the patients. None of the patients had psoriatic arthritis. Conclusion: Our study might contribute to generate epidemiological data's about the pediatric patients with psoriazis in our population.
Wang, Yi-Gao; Zhao, Lin-Yong; Liu, Chuan-Qi; Pan, Si-Cheng; Chen, Xiao-Long; Liu, Kai; Zhang, Wei-Han; Yang, Kun; Chen, Xin-Zu; Zhang, Bo; Chen, Zhi-Xin; Chen, Jia-Ping; Zhou, Zong-Guang; Hu, Jian-Kun
Abstract Primary gastric lymphoma (PGL) is the most common extranodal non-Hodgkin lymphoma. This retrospective study aimed to analyze the clinical characteristics, prognostic factors, and roles of different treatment modalities in patients with PGL. From January 2003 to November 2014, 165 patients who were diagnosed with PGL at West China Hospital were enrolled in this study. The clinical features, treatment, and follow-up information were analyzed. In this study, diffuse large B-cell lymphoma (DLBCL) (108, 65.5%) and mucosa-associated lymphoid tissue (MALT) lymphoma (52, 31.5%) were two predominant histological subtypes. One-year and 5-year overall survival (OS) rates of all patients were 95.2% and 79.5%, respectively; in whom 110 (66.7%) underwent surgery, 110 (66.7%) received chemotherapy, 12 (7.3%) received radiotherapy, and 10 (6.1%) received Helicobacter pylori eradication. And 75 patients (45.5%) were treated with at least 2 different types of therapies. Elevated lactic dehydrogenase (LDH) levels, poor performance status (PS), advanced stage, International Prognostic Index (IPI) score ≥3, conservative treatment, and high-grade histological subtype were associated with worse prognosis in univariate analysis. Cox regression analysis showed that LDH levels, PS, staging, and histological subtype were independent predictors of survival outcomes. In the DLBCL type, 5-year OS was significantly better in the surgically treated group (80.1%) than that of patients conservatively treated (49.8%) (P = 0.001). Surgical treatment had almost no impact on OS in the MALT type than conservative treatment (P = 0.597). The proportion of patients received conservative treatment increased from 4.5% in period 1 to 51.7% in period 4. High LDH levels, poor PS, advanced staging, and malignant pathological type at diagnosis are significantly associated with poor OS. Our data suggest that surgery is superior in prognosis over conservative treatment in the DLBCL type, but not
Full Text Available Jennifer Vriend1, Penny Corkum21Clinical Psychology PhD Program, Dalhousie University, Halifax, Nova Scotia, Canada; 2Department of Psychology, Dalhousie University, Halifax, Nova Scotia, CanadaAbstract: Behavioral insomnia is highly prevalent, affecting approximately 25% of children. It involves difficulties initiating and maintaining sleep and frequently results in inadequate sleep, leading to an array of negative effects for both the child and the child’s family. In this paper, we describe a variety of empirically supported behavioral interventions for insomnia from infancy through adolescence. We explore how biological, cognitive, and psychosocial developmental changes contribute to behavioral insomnia and how these changes may affect sleep and behavioral interventions. We also discuss barriers that prevent families from accessing interventions, including why many empirically-supported behavioral interventions are overlooked by health care providers.Keywords: sleep, behavioral insomnia, treatment, infants, children, adolescents
Christgen, Matthias; Steinemann, Doris; Kühnle, Elna; Länger, Florian; Gluz, Oleg; Harbeck, Nadia; Kreipe, Hans
Infiltrating lobular breast cancer (ILBC) is the most common special breast cancer subtype. This review provides a comprehensive description of ILBC characteristics, including epidemiology, clinical features, molecular genetics and histomorphology. Twenty detailed supplemental data tables guide through primary data of more than 200 original studies. Meta-analyses indicate that ILBC is at least twice as common in the Western world as it is in other geographic regions. ILBC is over-represented in so-called interval carcinomas and in primary metastatic breast cancer. ILBC is also associated higher age, higher pT stage and hormone receptor (ER/PR) positivity. Pathological complete response rates after neoadjuvant chemotherapy are low, ranging between 0% and 11%. Positive resection margins after breast-conserving surgery are comparatively frequent and 17% to 65% of patients undergo a second surgical intervention. Depending on the morphological stringency in the diagnosis of ILBC, lack of E-cadherin expression is observed in 55% to 100% of cases. CDH1/E-cadherin mutation detection rates vary between 12% and 83%. Various additional molecular factors, including PIK3CA, TP53, FOXA1, FGFR1, ZNF703 and BCAR4, have been implicated in ILBC or progression of lobular carcinoma in situ (LCIS) to invasive cancer and are discussed in detail. Eight instructive figure plates recapitulate the histomorphology of ILBC and its variants. Furthermore, we draw attention to rarely addressed histological details, such as two-sided nuclear compression and fat-avoiding growth at the invasion front. Last but not least, we discuss future translational research directions and emphasize the concept of synthetic lethality, which promises new options for targeted ILBC therapy.
Ming-Jun Xin; Hong Chen; Bin Luo; Jia-Bang Sun
AIM: To investigate the etiology and clinical characteristics of severe acute pancreatitis (SAP) in elderly patients (≥60 years of age).METHODS: We reviewed retrospectively all the SAP cases treated in Xuanwu Hospital in Beijing between 2000 and 2007.RESULTS: In 169 patients with SAP, 94 were elderly and 16 died.Biliary and idiopathic etiologies were the first two causes that accounted for over 90% of SAP in the elderly.Biliary, hyperlipemic and alcoholic etiologies were the first three causes in the young.The proportion of comorbidity of cholelithiasis, biliary infection, hypertension and coronary heart disease in the aged was significantly higher than that in their young partners.The scores of APACHE Ⅱ and Ranson were also significantly higher in the elderly except the CT score.Organ failures were more common in the elderly, but the local pancreatic complications were not different between the two groups.Mortality of the aged was correlated with the severity of SAP, multiple co-morbidity and incidence of multiple organ dysfunction syndrome (NODS).NODS was the main cause of death.CONCLUSION: The etiology of SAP in the elderly is quite different from that in the young.Biliary and unknown factors are main causes in the aged.The elderly are subject to major organ failures but there is no difference in the occurrence of local pancreatic complications between the elderly and the young.It is crucial to monitor and improve the functions of major organs so as to prevent MODS in the aged with SAP.
Severe acute pancreatitis (SAP) develops in about 25% of patients with acute pancreatitis (AP). Severity of AP is linked to the presence of systemic organ dysfunctions and/or necrotizing pancreatitis pathomorphologically.Risk factors determining independently the outcome of SAP are early multi-organ failure, infection of necrosis and extended necrosis (＞ 50%). Up to one third of patients with necrotizing pancreatitis develop in the late course infection of necroses. Morbidity of SAP is biphasic, in the first week strongly related to early and persistence of organ or multi-organ dysfunction. Clinical sepsis caused by infected necrosis leading to multi-organ failure syndrome (MOFS) occurs in the later course after the first week. To predict sepsis, MOFS or deaths in the first 48-72 h, the highest predictive accuracy has been objectified for procalcitonin and IL-8; the SepsisRelated Organ Failure Assessment (SOFA)-score predicts the outcome in the first 48 h, and provides a daily assessment of treatment response with a high positive predictive value. Contrast-enhanced CT provides the highest diagnostic accuracy for necrotizing pancreatitis when performed after the first week of disease. Patients who suffer early organ dysfunctions or at risk of developing a severe disease require early intensive care treatment. Early vigorous intravenous fluid replacement is of foremost importance. The goal is to decrease the hematocrit or restore normal cardiocirculatory functions.Antibiotic prophylaxis has not been shown as an effective preventive treatment. Early enteral feeding is based on a high level of evidence, resulting in a reduction of local and systemic infection. Patients suffering infected necrosis causing clinical sepsis, pancreatic abscess or surgical acute abdomen are candidates for early intervention. Hospital mortality of SAP after interventional or surgical debridement has decreased in high volume centers to below 20%.
Eliza David Remona
Full Text Available Clinical laboratory tests ensure approximately 70% of the medical decisions, so that the time until the release of the results and its accuracy are critical for the diagnosis and the efficiency of the treatment . Risk management involves both the anticipation of what could happen erroneous and the assessment of errors’ frequency as well as the consequences or the severity of the effects caused by it, and finally to decide what can be done in order to reduce the risk to an acceptable clinical level. For this reason, organizations should not see the risk management as a compliance issue, but as an integral part of the decision-making process. EP23-A is a guideline of CLSI that introduces the risk management principles in the clinical laboratory and encourages the laboratories to develop plans of risk management which are addressed to the risks of each laboratory. EP18-A2 proposes 2 techniques for identifying and controlling the errors in the laboratory: FMEA (Failure Mode and Effects Analysis and FRACAS (Failure Reporting, Analysis and Corrective Action System. The European Committee of Experts and Management of Safety and Quality in Health Care proposed to use the quality indicators to identify the critical stages of each process, thus being possible to assess continuously the medical processes with the aim of identifying the errors when they occur. This review summarizes the principles of the risk management in the clinical laboratory, thus it can achieve its aims to report valid, accurate and reliable test results
The Tokyo Metropolitan external quality assessment (EQA) program has revealed some serious problems in private independent microbiology laboratories in Tokyo since 1982. The poor performance in the EQA surveys closely related to poor laboratory managements, the type of training, experience of the medical technologists or technicians, and supervisory ability of the consultant physicians in independent laboratories. Social factors impede the reform of the quality assurance of clinical microbiology. Such factors include poor infrastructure of continuing education for small private laboratories, closure of the central clinical laboratories in the hospitals and outsourcing of laboratory tests due to restructuring in response to economic problems, and limited numbers of certified clinical pathologists of the Japan Society of Clinical Pathology (JSCP). Therefore, the Tokyo Metropolitan EQA Scheme is still confidential and its main role is educational. Good two way communication between participants and the organizers' clinical pathologists is essential, if the quality of laboratory tests is to be improved. The new JSCP edition of the postgraduate training requirement in clinical pathology includes "Laboratory Administration and Management". Good laboratory management(GLM) is an increasingly important component of good laboratory practice. The practice activities of clinical pathologists must include general management in addition to exercising there specialized knowledge in medicine and technology. Whereas leadership of a good clinical pathologist provides the direction of where a good laboratory is going, good management provides the steps of how to get there. And I believe quality system models from business and industry may provide us with strong guidance to build a quality system for the good laboratory that will endure into the next century. PMID:9528335
Love, R M
Several hundred different species of bacteria are present in the human intraoral environment. Bacterial penetration of root canal dentin occurs when bacteria invade the root canal system. These bacteria may constitute a reservoir from which root canal reinfection may occur during or after endodontic treatment. The learning objective of this article is to review endodontic microbiology, update readers on the role of bacteria in pulp and periapical disease, and discuss the principles of management of infected root canal dentin. Complete debridement, removal of microorganisms and affected dentin, and chemomechanical cleansing of the root canal are suggested as being the cornerstones of successful endodontic therapy, followed by intracanal medication to remove residual bacteria, when required.
Diabetes is a global health problem, with a challenging epidemiology. It is one of the major health problems affecting countries around the world, particularly the UK (World Health Organization [WHO], 2006; Department of Health [DH], 2006b). It is also a growing public health threat in the US (Mokdad et al, 2001). As a result, diabetes has become an important public health issue, prompting the WHO and International Diabetes Federation (IDF) to adopt the theme 'Diabetes for Everyone' for World Diabetes Day 2006. In 2007, on World Diabetes Day, the United Nations also launched its 'Living with Diabetes at School' campaign, in response to the growing diabetes 'epidemics' (Diabetes UK, 2007). This article provides an overview of diabetes mellitus and its acute- and long-term management, including definition, aetiology, pathophysiology, classification, signs, symptoms and complications. The role of the nurse in providing patient-centred care for people with diabetes is emphasized.
Inada, Masanori; Sato, Mayumi; Yoneyama, Akiko
This paper discusses a knowledge management system for clinical laboratories. In the clinical laboratory of Toranomon Hospital, we receive about 20 questions relevant to laboratory tests per day from medical doctors or co-medical staff. These questions mostly involve the essence to appropriately accomplish laboratory tests. We have to answer them carefully and suitably because an incorrect answer may cause a medical accident. Up to now, no method has been in place to achieve a rapid response and standardized answers. For this reason, the laboratory staff have responded to various questions based on their individual knowledge. We began to develop a knowledge management system to promote the knowledge of staff working for the laboratory. This system is a type of knowledge base for assisting the work, such as inquiry management, laboratory consultation, process management, and clinical support. It consists of several functions: guiding laboratory test information, managing inquiries from medical staff, reporting results of patient consultation, distributing laboratory staffs notes, and recording guidelines for laboratory medicine. The laboratory test information guide has 2,000 records of medical test information registered in the database with flexible retrieval. The inquiry management tool provides a methos to record all questions, answer easily, and retrieve cases. It helps staff to respond appropriately in a short period of time. The consulting report system treats patients' claims regarding medical tests. The laboratory staffs notes enter a file management system so they can be accessed to aid in clinical support. Knowledge sharing using this function can achieve the transition from individual to organizational learning. Storing guidelines for laboratory medicine will support EBM. Finally, it is expected that this system will support intellectual activity concerning laboratory work and contribute to the practice of knowledge management for clinical work support
Inada, Masanori; Sato, Mayumi; Yoneyama, Akiko
This paper discusses a knowledge management system for clinical laboratories. In the clinical laboratory of Toranomon Hospital, we receive about 20 questions relevant to laboratory tests per day from medical doctors or co-medical staff. These questions mostly involve the essence to appropriately accomplish laboratory tests. We have to answer them carefully and suitably because an incorrect answer may cause a medical accident. Up to now, no method has been in place to achieve a rapid response and standardized answers. For this reason, the laboratory staff have responded to various questions based on their individual knowledge. We began to develop a knowledge management system to promote the knowledge of staff working for the laboratory. This system is a type of knowledge base for assisting the work, such as inquiry management, laboratory consultation, process management, and clinical support. It consists of several functions: guiding laboratory test information, managing inquiries from medical staff, reporting results of patient consultation, distributing laboratory staffs notes, and recording guidelines for laboratory medicine. The laboratory test information guide has 2,000 records of medical test information registered in the database with flexible retrieval. The inquiry management tool provides a methos to record all questions, answer easily, and retrieve cases. It helps staff to respond appropriately in a short period of time. The consulting report system treats patients' claims regarding medical tests. The laboratory staffs notes enter a file management system so they can be accessed to aid in clinical support. Knowledge sharing using this function can achieve the transition from individual to organizational learning. Storing guidelines for laboratory medicine will support EBM. Finally, it is expected that this system will support intellectual activity concerning laboratory work and contribute to the practice of knowledge management for clinical work support.
Waite, Polly; Creswell, Catharine
Background Reports of the clinical characteristics of children and adolescents with anxiety disorders are typically based on community populations or from clinical samples with exclusion criterion applied. Little is known about the clinical characteristics of children and adolescents routinely referred for treatment for anxiety disorders. Furthermore, children and adolescents are typically treated as one homogeneous group although they may differ in ways that are clinically meaningful. Method...
Airway foreign bodies may cause suffocation and pneumonia. Therefore, accurate diagnosis and expeditious removal are needed. However, we sometimes experience difficulty in removing foreign bodies from the airway by bronchoscopy. We examined the clinical characteristics of 15 cases of foreign body managed in our institute over the past 19 years, and evaluated characteristic difficulties during bronchoscopic removal. The mean age of cases was 58 years. Four patients had dementia as their underlying disease. Episodes of aspiration occurred in 10 patients. Dental foreign bodies were seen in 9 patients (60%). Chest X-ray films detected foreign bodies in 11 patients (73%), and chest computed tomography identified them in all patients. Alligator forceps and basket forceps were mainly used for removal. Fogarty forceps were also used in combination with the above in 2 patients. The foreign body was removed during the first procedure in 12 patients; however, further procedures were needed (20%) in the remaining 3 patients: using different bronchoscopic techniques, tracheotomy and surgical resection, respectively. The characteristics of these 3 cases were as follows; granulation forming around a sharp foreign body obstructing the bronchus for a prolonged period, inability of the patient to lie still due to dementia, and tracheal stenosis after tracheotomy. Characteristic difficulties during bronchoscopic removal were granulation around the foreign body, inability of the patient to lie still, and tracheal stenosis. When difficulties in bronchoscopic removal are expected, it is necessary to prepare a variety of devices in advance. (author)
Khairat, Saif; Craven, Catherine; Gong, Yang
Clinical communication failures are considered the leading cause of medical errors . The complexity of the clinical culture and the significant variance in training and education levels form a challenge to enhancing communication within the clinical team. In order to improve communication, a comprehensive understanding of the overall communication process in health care is required. In an attempt to further understand clinical communication, we conducted a thorough methodology literature review to identify strengths and limitations of previous approaches . Our research proposes a new data collection method to study the clinical communication activities among Intensive Care Unit (ICU) clinical teams with a primary focus on the attending physician. In this paper, we present the first ICU communication instrument, and, we introduce the use of database management system to aid in discovering patterns and associations within our ICU communications data repository. PMID:22874366
Khairat, Saif; Craven, Catherine; Gong, Yang
Clinical communication failures are considered the leading cause of medical errors . The complexity of the clinical culture and the significant variance in training and education levels form a challenge to enhancing communication within the clinical team. In order to improve communication, a comprehensive understanding of the overall communication process in health care is required. In an attempt to further understand clinical communication, we conducted a thorough methodology literature review to identify strengths and limitations of previous approaches . Our research proposes a new data collection method to study the clinical communication activities among Intensive Care Unit (ICU) clinical teams with a primary focus on the attending physician. In this paper, we present the first ICU communication instrument, and, we introduce the use of database management system to aid in discovering patterns and associations within our ICU communications data repository.
Galli, Elena; Neri, Iria; Ricci, Giampaolo; Baldo, Ermanno; Barone, Maurizio; Belloni Fortina, Anna; Bernardini, Roberto; Berti, Irene; Caffarelli, Carlo; Calamelli, Elisabetta; Capra, Lucetta; Carello, Rossella; Cipriani, Francesca; Comberiati, Pasquale; Diociaiuti, Andrea; El Hachem, Maya; Fontana, Elena; Gruber, Michaela; Haddock, Ellen; Maiello, Nunzia; Meglio, Paolo; Patrizi, Annalisa; Peroni, Diego; Scarponi, Dorella; Wielander, Ingrid; Eichenfield, Lawrence F
The Italian Consensus Conference on clinical management of atopic dermatitis in children reflects the best and most recent scientific evidence, with the aim to provide specialists with a useful tool for managing this common, but complex clinical condition. Thanks to the contribution of experts in the field and members of the Italian Society of Pediatric Allergology and Immunology (SIAIP) and the Italian Society of Pediatric Dermatology (SIDerP), this Consensus statement integrates the basic principles of the most recent guidelines for the management of atopic dermatitis to facilitate a practical approach to the disease. The therapeutical approach should be adapted to the clinical severity and requires a tailored strategy to ensure good compliance by children and their parents. In this Consensus, levels and models of intervention are also enriched by the Italian experience to facilitate a practical approach to the disease.
Neitch, Shirley M; Meadows, Charles; Patton-Tackett, Eva; Yingling, Kevin W
Every day, patients with dementia, their families, and their physicians face the enormous challenges of this pervasive life-changing condition. Seeking help, often grasping at straws, victims, and their care providers are confronted with misinformation and myths when they search the internet or other sources. When Persons with Dementia (PWD) and their caregivers believe and/or act on false information, proper treatment may be delayed, and ultimately damage can be done. In this paper, we review commonly misunderstood issues encountered in caring for PWD. Our goal is to equip Primary Care Practitioners (PCPs) with accurate information to share with patients and families, to improve the outcomes of PWD to the greatest extent possible. While there are innumerable myths about dementia and its causes and treatments, we are going to focus on the most common false claims or misunderstandings which we hear in our Internal Medicine practice at Marshall Health. We offer suggestions for busy practitioners approaching some of the more common issues with patients and families in a clinic setting. PMID:27025116
Neitch, Shirley M; Meadows, Charles; Patton-Tackett, Eva; Yingling, Kevin W
Every day, patients with dementia, their families, and their physicians face the enormous challenges of this pervasive life-changing condition. Seeking help, often grasping at straws, victims, and their care providers are confronted with misinformation and myths when they search the internet or other sources. When Persons with Dementia (PWD) and their caregivers believe and/or act on false information, proper treatment may be delayed, and ultimately damage can be done. In this paper, we review commonly misunderstood issues encountered in caring for PWD. Our goal is to equip Primary Care Practitioners (PCPs) with accurate information to share with patients and families, to improve the outcomes of PWD to the greatest extent possible. While there are innumerable myths about dementia and its causes and treatments, we are going to focus on the most common false claims or misunderstandings which we hear in our Internal Medicine practice at Marshall Health. We offer suggestions for busy practitioners approaching some of the more common issues with patients and families in a clinic setting.
Wilson, Don P; McNeal, Catherine; Blackett, Piers
During the last 50 years, it has become evident that atherosclerosis originates in childhood. Although cardiovascular disease (CVD) events are rare in children, autopsy data and imaging studies have documented subclinical disease in association with measurable risk factors during childhood. When present at a young age, risk factors track into adulthood and have been associated with a moderate to high risk of future CVD. As such, the ability to identify this vulnerable population creates the opportunity to prevent the development of risk factors and future CVD events with effective management of genetic and acquired risk factors. In 2011, the National Heart, Lung, and Blood Institute Expert Panel published comprehensive guidelines summarizing the current evidence and providing developmentally appropriate recommendations for screening, treatment, and follow-up of children and adults younger than 21 years at risk for premature CVDs such as myocardial infarction and stroke. In addition to screening individuals with a family history of hypercholesterolemia and/or premature CVD, the Expert Panel recommended universal screening of all children between 9 and 11 years of age and then again between 17 and 21 years of age. Although the recommendation for universal screening, regardless of general health or the presence/absence of risk factors of CVD, is not without controversy, this review serves to create awareness among healthcare providers, elected officials, and the lay public about the burden of CVD, the opportunity for prevention, and the benefits of early and effective therapeutic intervention with lifestyle changes and lipid-lowering medications.
Full Text Available The growing emphasis on off-site and off-shore clinical data management activities mandates a paramount need for adequate solutions geared toward on-time, quality deliverables. The author has been leading large teams that have been involved in successful global clinical data management endeavors. While each study scenario is unique and has to be approached as such, there are several elements in defining strategy and team structure in global clinical data management that can be applied universally. In this article, key roles, practices, and high-level procedures are laid out as a road map to ensure success with the model.
West, D A; Balas, E A; West, T D
In addition to providing comparable and verifiable evidence regarding outcomes, clinical trials could also serve as sources of accurate and replicable financial information. Trial reports that identify expenses associated with effective diagnostic and therapeutic interventions enable cost controls. Standardized cost calculations could help clinicians and administrators identify more efficient health care technologies. Unfortunately, relatively few published trials include economic analyses and when they do, data are incomplete. Based on analyses of 97 clinical trial reports, this article proposes a standard costing format. Health care financial managers have the costing expertise necessary to implement and interpret standardized cost calculations for clinical trials. With the active involvement of financial managers, a standard costing format for clinical trials can be achieved. PMID:10961828
Chen, Feng; Sun, Hua-long; Shen, Tong; Yu, Hao
A perfect clinical trial must nave a solid study design, strict conduction, complete quality control, non-interference of statistical result, and acceptable risk-benefit ratio. To reach the target, the quality control (QC) should be performed from the study design to conduction, from the analysis to conclusion. We discuss the relationship between data management and biostatistics from the statistical point of view, and emphasize the importance of the statistical concept and methods in the improvement of data quality in clinical data management.
The main objective with this project has been to develop a tool for close to-the-clinic health-care management, based upon ways of measuring which are interpretable both by profession-als as well as by patients. This would be a tool that collects and compiles data related to the dental health situation, permitting an overview of a dental clinic, and thus facilitating the management of dental-health improvements. This thesis is based upon four different studies. The first st...
Full Text Available Edward D Nicol1,21Department of Cardiology, Royal Brompton Hospital and Harefield NHS Trust, London, United Kingdom; 2Clinical Leadership Academy, School of Medicine, Keele University, Staffordshire, United KingdomAbstract: The National Health Service (NHS is one of the UKs most cherished but political public institutions, providing healthcare, free at the point of delivery. The English NHS must make £20bn efficiency savings in the next 3 years whilst in the midst of fundamental structural change outlined in the government's Health and Social Care Bill. This paper will explore the history of leadership and management in the NHS; the evolution of clinical leadership; national strategies to improve NHS clinical and managerial leadership and Lord Darzi's pivotal NHS review. It defines the kind of leadership and management required for today's NHS, looking to overcome some of the main challenges such as improving healthcare quality whilst making efficiency savings and engaging grass roots workers to deliver sustainable, long term improvements. Finally this manuscript makes suggestions as to where future investment is required to improve clinical leadership and management in the NHS.Keywords: clinical leadership, healthcare management, national health service
Longo, M Anne; Roussel, Linda; Pennington, Sandra L; Hoying, Cheryl
Patricia Benner applied the Dreyfus Model of Skill Acquisition to describe and interpret skill acquisition and clinical judgment in nursing practice. Operational definitions for the 5 levels of her original Novice to Expert Theory were used by the study participants in a large Midwestern pediatric hospital to self-identify their level of practice. The frontline clinical managers of these direct care registered nurses (RNs) used the same tool to rate their direct reports. The aim of this portion of a larger study was to determine if the clinical manager's perception of their direct reports was the same as that of the RNs. The results of this study are being used by one study unit's clinical managers as the basis for implementing the Hersey and Blanchard Situational Leadership Model. The clinical managers work with their direct reports depending on the level of practice and the details of the task to be performed. One example is creating therapeutic relationships with each other and with families to ensure a safe environment for all.
Chen, Zhao-hua; Huang, Qin; Deng, Ya-zhong; Zhang, Yue; Xu, Yu; Yu, Hao; Liu, Zong-fan
Data quality management system is essential to ensure accurate, complete, consistent, and reliable data collection in clinical research. This paper is devoted to various choices of data quality metrics. They are categorized by study status, e.g. study start up, conduct, and close-out. In each category, metrics for different purposes are listed according to ALCOA+ principles such us completeness, accuracy, timeliness, traceability, etc. Some general quality metrics frequently used are also introduced. This paper contains detail information as much as possible to each metric by providing definition, purpose, evaluation, referenced benchmark, and recommended targets in favor of real practice. It is important that sponsors and data management service providers establish a robust integrated clinical trial data quality management system to ensure sustainable high quality of clinical trial deliverables. It will also support enterprise level of data evaluation and bench marking the quality of data across projects, sponsors, data management service providers by using objective metrics from the real clinical trials. We hope this will be a significant input to accelerate the improvement of clinical trial data quality in the industry.
Longo, M Anne; Roussel, Linda; Pennington, Sandra L; Hoying, Cheryl
Patricia Benner applied the Dreyfus Model of Skill Acquisition to describe and interpret skill acquisition and clinical judgment in nursing practice. Operational definitions for the 5 levels of her original Novice to Expert Theory were used by the study participants in a large Midwestern pediatric hospital to self-identify their level of practice. The frontline clinical managers of these direct care registered nurses (RNs) used the same tool to rate their direct reports. The aim of this portion of a larger study was to determine if the clinical manager's perception of their direct reports was the same as that of the RNs. The results of this study are being used by one study unit's clinical managers as the basis for implementing the Hersey and Blanchard Situational Leadership Model. The clinical managers work with their direct reports depending on the level of practice and the details of the task to be performed. One example is creating therapeutic relationships with each other and with families to ensure a safe environment for all. PMID:23934257
The physical, chemical and antibacterial properties of saliva provide protection to human dentition against dental diseases, Therefore, salivary deficiency has to be managed carefully. The causes of saliva deficiency are many and varied. It is worth mentioning that saliva flow rate is normally affected by physiologic condition, such as eating, resting, sleeping, cold or hot season etc. In this paper the protective role of saliva, etiologiy of saliva deficiency and its clinical management are discussed. (author
Gomes, Christiane Maria Moreira; Giraldo, Paulo César; Gomes, Francis de Assis Moraes; Amaral, Rose; Passos, Mauro Romero Leal; Gonçalves, Ana Katherine da Silveira
Female genital ulcer is a disease that affects a large number of women, and its etiologic diagnosis can be difficult. The disease may increase the risk of acquiring HIV. Genital ulcer may be present in sexually transmitted diseases (STD)--syphilis, chancroid, genital herpes, donovanosis, lymphogranuloma venereum; and other non-STD disorders (NSTD)--Behçet's syndrome, pemphigus, Crohn's disease, erosive lichen planus and others. This study evaluated the clinical-histopathologic-microbiologic characteristics of female genital ulcers. A cross-sectional descriptive prospective study was conducted during a six-month period to investigate the first 53 women without a definitive diagnosis, seeking medical care for genital ulcers at a genital infections outpatient facility in a university hospital. A detailed and specific history was taken, followed by a dermatologic and gynecologic examination. In addition to collecting material from the lesions for microbiologic study, a biopsy of the ulcer was performed for histopathologic investigation. The average age of the patients was 32.7 years, 56.6% had junior high school education and higher education. The most frequent etiology was herpetic lesion, followed by auto-immune ulcers. At the time of their first consultation, around 60% of the women were using inadequate medication that was inconsistent with the final diagnosis. Histologic diagnosis was conclusive in only 26.4% of the patients (14/53). Cure was obtained in 99% of the cases after proper therapy. The female genital ulcers studied were equally distributed between sexually transmitted and non-sexually transmitted causes. Herpes was the most frequent type of genital ulcer, affecting women indiscriminately, mostly between the ages of 20 and 40 years. The etiologic diagnosis of herpetic ulcers is difficult to make even when various diagnostic methods are applied. It is imperative that NSTD should be included in the differential diagnoses of female genital ulcers. The
Christiane Maria Moreira Gomes
Full Text Available Female genital ulcer is a disease that affects a large number of women, and its etiologic diagnosis can be difficult. The disease may increase the risk of acquiring HIV. Genital ulcer may be present in sexually transmitted diseases (STD - syphilis, chancroid, genital herpes, donovanosis, lymphogranuloma venereum and other non-STD disorders (NSTD - Behçet's syndrome, pemphigus, Crohn's disease, erosive lichen planus and others. This study evaluated the clinical-histopathologic-microbiologic characteristics of female genital ulcers. A cross-sectional descriptive prospective study was conducted during a six-month period to investigate the first 53 women without a definitive diagnosis, seeking medical care for genital ulcers at a genital infections outpatient facility in a university hospital. A detailed and specific history was taken, followed by a dermatologic and gynecologic examination. In addition to collecting material from the lesions for microbiologic study, a biopsy of the ulcer was performed for histopathologic investigation. The average age of the patients was 32.7 years, 56.6% had junior high school education and higher education. The most frequent etiology was herpetic lesion, followed by auto-immune ulcers. At the time of their first consultation, around 60% of the women were using inadequate medication that was inconsistent with the final diagnosis. Histologic diagnosis was conclusive in only 26.4% of the patients (14/53. Cure was obtained in 99% of the cases after proper therapy. The female genital ulcers studied were equally distributed between sexually transmitted and non-sexually transmitted causes. Herpes was the most frequent type of genital ulcer, affecting women indiscriminately, mostly between the ages of 20 and 40 years. The etiologic diagnosis of herpetic ulcers is difficult to make even when various diagnostic methods are applied. It is imperative that NSTD should be included in the differential diagnoses of female
Martha Torres Narváez
Full Text Available This article describes the knowledge management practices derived from clinical research, and some hospitals and academic institutions in Colombia. The profile of these institutions and the variables involved in knowledge management and research are presented. Objective: Exploring the practices that some Colombian institutions have to build or strengthen their capacity to con-duct clinical research. Materials and methods: We conducted an exploratory study by consulting a convenience sample, the use of specific practices in knowledge management. In a documentary analysis on knowledge management. The information was obtained of primary sources by semi-structured interview applied to selected key players. Results: In the institutions that participated in the study, it was observed as determinants in knowledge management: structure and strategic management, intellectual capital, technological resources, and the continuity and sustainability of the processes. Conclusion: Include research processes in services delivery institutions is criti¬cal to improving the quality of health care and encourage their intellectual capital. Colombia has institutions working with determination to the generation of knowledge from clinical practice.
Fatemeh Ghorbanalizadeh Ghaziani
Full Text Available The purpose of study was comparison of conflict management strategies of physical education office managers based on their some demographic characteristics. All of managers of physical education office of Mazandaran (n = 15 and Guilan (n = 16 province and their assistant [(n = 15 and (n =16 respectively] response to Putnam and Wilson’s “organizational communication conflict instrument (OCCI”.Analysis showed that Mazandaran’s and Guilan’s managers and their assistant hadn’t differences together in conflict management strategies, and using cooperation strategy significantly as first preference, and using compromise, dominance, accommodation, and avoidance strategies as second preference in conflicts resolution; and demographic variables (age, work duration, interaction of age and work duration, study proof, study branch, interaction of study proof and study branch hadn’t effect on conflict management strategies preferences. In conclusion, however there were no significant difference between conflict management strategies preference of Mazandaran’s and Guilan’s managers and their assistant; but, it is important that the preference of both Mazandaran’s and Guilan’s managers is cooperation suggesting that the managers use good decision making and appropriate styles for resolution of employees’ problems in offices.
Objective To investigate clinical characteristics and outcome of patients with liver cirrhosis complicated with diabetes,and to explore the differences of clinical characteristics and prognosis between hepatogenous diabetes (HD) and type 2 diabetes mellitus (T2DM) .Methods From November 2010 to April 2012,246 patients with liver cirrhosis were collected and divided into liver cir-
O'Neil, Kelly A.; Podell, Jennifer L.; Benjamin, Courtney L.; Kendall, Philip C.
Research indicates that depression and anxiety are highly comorbid in youth. Little is known, however, about the clinical and family characteristics of youth with principal anxiety disorders and comorbid depressive diagnoses. The present study examined the demographic, clinical, and family characteristics of 200 anxiety-disordered children and…
Goom, Thomas S H; Malliaras, Peter; Reiman, Michael P; Purdam, Craig R
Synopsis Proximal hamstring tendinopathy (PHT) typically manifests as deep buttock pain at the hamstring common origin. Both athletic and nonathletic populations are affected by PHT. Pain and dysfunction are often long-standing and limit sporting and daily functions. There is limited evidence regarding diagnosis, assessment, and management; for example, there are no randomized controlled trials investigating rehabilitation of PHT. Some of the principles of management established in, for example, Achilles and patellar tendinopathy would appear to apply to PHT but are not as well documented. This narrative review and commentary will highlight clinical aspects of assessment and management of PHT, drawing on the available evidence and current principles of managing painful tendinopathy. The management outline presented aims to guide clinicians as well as future research. J Orthop Sports Phys Ther 2016;46(6):483-493. Epub 15 Apr 2016. doi:10.2519/jospt.2016.5986. PMID:27084841
Amit Kumar Mishra, Smita Panda, Prakash Chandra Panda
Full Text Available Introduction: In INDIA almost 20000 people die (40% of world death each year from rabies. Most of these deaths could be prevented by post exposure prophylaxis with wound washing, rabies immunoglobulin & vaccination. Local wound management alone can reduce viral load by up to 80%. Objective: To study self-wound management practices in animal exposure patients before attending a tertiary level ARV clinic. Methodology: Data regarding wound management was collected by individual interview of patients attending the ARV clinic during OCT 2011 to MAR 2012. The data collected in the form of a questionnaire. Analysis of data was done in the Department Of Community Medicine, V.S.S. Medical College, Burla. Results: Total 493 cases of animal exposure were attended during the study period. Most common biting animal was dog (94.5%. 31% of cases were under the age of 10 years & 23% belongs to the age of 10-19 years. Male to female ratio was 3:1. Most of the cases (91% were of category III exposure. Immediate management of wound was practiced by 63-77% of cases before visiting ARV clinic; only 2% wash the wound with running water & soap for 15 minutes. 39% of cases applied Dettol/savlon at the wound side & other 38% applied turmeric, red chilli, kerosene, Band-Aid & ghee locally. Most cases (61% reported to ARV clinic within 24hours.
Eindhoven, GB; Dercksen, B; Regtien, JG; Borg, PAJ; Wierda, JMKH
Difficult airway management represents a challenge in anaesthesia. In the last decades airway difficulty awareness has improved as a result of better anticipation and decision-making. Airway algorithms and protocols have a more prominent role in training and in clinical anaesthesia practice. In addi
Hulse, Nathan C; Galland, Joel; Borsato, Emerson P
In this manuscript, we present an overview of the clinical knowledge management strategy at Intermountain Healthcare in support of our electronic medical record systems. Intermountain first initiated efforts in developing a centralized enterprise knowledge repository in 2001. Applications developed, areas of emphasis served, and key areas of focus are presented. We also detail historical and current areas of emphasis, in response to business needs.
Smet, P.A.G.M. de; Floor-Schreudering, A.; Bouvy, M.L.; Wensing, M.J.P.
Clinical risk management offers a systematic approach to minimize healthcare-related risks by paying attention to: (1) risk identification and assessment; (2) develop notment and execution of risk reduction strategies; (3) evaluation of risk reduction strategies. This paper reviews these key areas f
Molar incisor hypomineralisation (MIH) is a common developmental condition resulting in enamel defects in first permanent molars and permanent incisors. It presents at eruption of these teeth. Early diagnosis is essential since rapid breakdown of tooth structure may occur, giving rise to acute symptoms and complicated treatment. The purpose of this article is to review MIH and illustrate its clinical management in young children.
P. Boffano; C. Gallesio; F. Roccia; B. van den Bergh; T. Forouzanfar
Purpose: The aims of this study were to assess the clinical outcomes of patients with anterior bifocal mandibular fractures and to discuss the management of this peculiar type of trauma. Methods: From the systematic computer-assisted database that has continuously recorded patients hospitalized with
The university hospitals of Geneva are the largest consortium of public hospitals in Switzerland. This organization is born in 1995, after a political decision to merge the seven public and teaching hospitals of the Canton of Geneva. From an information technologies perspective, it took several years to reach a true unified vision of the complete organization. The clinical information system is deployed in all sites covering in- and outpatient cares. It is seen as the cornerstone of information management and flow in the organization, for direct patient care and decision support, but also for the management to drive, improve and leverage the activities, for better efficiency, quality and safety of care, but also to drive processes. As the system has become more important for the organization, it has required progressive changes in its governance. The high importance of interoperability and use of formal representation has become a major challenge in order to be able to reuse clinical information for real-time care and management activities, and for secondary usage such as billing, resource management, strategic planning and clinical research. This paper proposes a short overview of the tools allowing to leverage the management for physicians, nurses, human resources and hospital governance.
Soil fertility management (SFM) has important implications for sustaining agricultural development and food self-sufifciency. Better understanding the determinants of farmers’ SFM can be a great help to the adoption of effective SFM practices. Based on a dataset of 315 plots collected from a typical rice growing area of South China, this study applied statistical method and econometric models to examine the impacts of land characteristics on farmers’ SFM practices at plot scale. Main results showed that in general land characteristics affected SFM behaviors. Securer land tenure arrangements facilitated effective practices of SFM through more diversiifed and more soil-friendly cropping pattern choices. Plot size signiifcantly reduced the intensities of phosphorus and potassium fertilizer application. Given other factors, 1 ha increase in plot size might reduce 3.0 kg ha-1 P2O5 and 1.8 kg ha-1 K2O. Plots far from the homestead were paid less attention in terms of both chemical fertilizers and manure applications. Besides, plots with better quality were put more efforts on management by applying more nitrogen and manure, and by planting green manure crops. Signiifcant differences existed in SFM practices between the surveyed villages with different socio-economic conditions. The ifndings are expected to provide important references to the policy-making incentive for improving soil quality and crop productivity.
Katz, Ofrat Beyar; Brenner, Benjamin; Horowitz, Netanel A
Inflammation and coagulation are known to affect each other in many ways. Vasculitis represents a group of disorders where blood vessels (small, medium, large or variable) are infiltrated with inflammatory cells. Accumulating evidence in the literature suggests both clinical and physiological association between vasculitis and thrombosis. Vasculitis-associated thrombosis involves arteries and veins, and a tight connection has been reported between the activity of vasculitis and the appearance of thrombosis. Pathophysiology of these relations is complex and not completely understood. While thrombophilic factors are associated with vasculitis, it remains unclear whether a true association with clinical thrombosis is present. Furthermore, several factors leading to hemostasis, endothelial injury and induction of microparticles were described as possibly accounting for thrombosis. Management of thrombosis in vasculitis patients is challenging and should be further assessed in randomized controlled studies. The current review describes clinical manifestations, pathogenesis and management of thrombosis associated with different vasculitides.
Mincik, Jozef; Urban, Daniel; Timkova, Silvia
Root resorption is a pathological process involving loss of hard dental tissues. It may occur as a consequence of dental trauma, orthodontic treatment, and bleaching, and occasionally it accompanies periodontal disease. Although the mechanism of resorption process is examined in detail, its etiology is not fully understood. Wide open apical foramen is more difficult to manage and the root canal may often overfill. In this report we present two cases of root resorption and describe means for its clinical management. We conclude that useful measure of a success or failure in managing root resorption is the persistence of the resorption process. It is a clear sign of an active ongoing inflammatory process and shows the clinical need for retreatment. PMID:27648314
Root resorption is a pathological process involving loss of hard dental tissues. It may occur as a consequence of dental trauma, orthodontic treatment, and bleaching, and occasionally it accompanies periodontal disease. Although the mechanism of resorption process is examined in detail, its etiology is not fully understood. Wide open apical foramen is more difficult to manage and the root canal may often overfill. In this report we present two cases of root resorption and describe means for its clinical management. We conclude that useful measure of a success or failure in managing root resorption is the persistence of the resorption process. It is a clear sign of an active ongoing inflammatory process and shows the clinical need for retreatment.
Full Text Available Root resorption is a pathological process involving loss of hard dental tissues. It may occur as a consequence of dental trauma, orthodontic treatment, and bleaching, and occasionally it accompanies periodontal disease. Although the mechanism of resorption process is examined in detail, its etiology is not fully understood. Wide open apical foramen is more difficult to manage and the root canal may often overfill. In this report we present two cases of root resorption and describe means for its clinical management. We conclude that useful measure of a success or failure in managing root resorption is the persistence of the resorption process. It is a clear sign of an active ongoing inflammatory process and shows the clinical need for retreatment.
Full Text Available Objective To discuss the clinical features of the patients suffering from cervical cancer who visited Daping Hospital affiliated to Third Military Medical University in recent 10 years. Methods The clinical data of the patients who were pathologically diagnosed as invasive cervical cancer in Daping Hospital of TMMU from Jan. 2004 to Dec. 2013 were retrospectively analyzed. They were divided into different age groups and analyzed according to age, clinical features, pathological type, and surgical approach. Results Clinical data of 950 patients with invasive cervical cancer were reviewed in this study. The mean age of the patients was 46.9 years. The clinical features, pathological type, and surgical approaches were different in different age groups. Analysis of the age structure of the patients, the onset age of cervical cancer seemed to increase year by year. Conclusion The clinical features of cervical cancer are diversity in different age, and the strategy for controlling its development should be varied according to age. DOI: 10.11855/j.issn.0577-7402.2015.03.09
The department of Energy (DOE) views as one of its most challenging problems the minimization, management, and cleanup of waste materials generated from Departmental operations. The challenges for the DOE have striking similarities to the environmental restoration and waste management challenges associated with energy production and the mining and mineral processing industries. Their challenges relate to uranium mining and the resulting mill tailings; decontamination and decommissioning of facilities; processing of nuclear materials and production of weapons components. Add to this the challenge of environmental restoration solutions for waste disposal practices of the past. The fundamental goal of the DOE is to ensure that risks to human health and safety and to the environment posed by the department's past, present, and future operations are either eliminated to reduced to prescribed levels by the year 2019. To achieve this goal they must be able to assess environmental and health impacts resulting from the low concentrations of contaminants. This paper presents an overview of the causes, characteristics, and cures for these environmental restoration and waste management issues
Ozdal, Pinar Cakar; Berker, Nilufer; Tugal-Tutkun, Ilknur
Pars planitis is an idiopathic chronic intermediate uveitis which predominantly affects children and adolescents, and accounts for 5-26.7% of pediatric uveitis. Although an autoimmune process with a genetic predisposition has been suggested, its etiology still remains unknown. The most common presenting symptoms are floaters and blurred vision. Diffuse vitreous cells, haze, snowballs and snowbanks are typical findings of pars planitis. Peripheral retinal vasculitis, optic disc edema and anterior segment inflammation are other well-known findings. Although pars planitis is known to be a benign form of uveitis in most cases, it may become a potentially blinding disease due to complications including cataract, cystoid macular edema, vitreous opacities and optic disc edema. Cystoid macular edema is the most common cause of visual morbidity. Band keratopathy, epiretinal membrane formation, vitreous condensation, neovascularizations, vitreous hemorrhage, retinal detachment, cyclitic membranes, glaucoma and amblyopia may develop as a consequence of the chronic course of the disease. Exclusion of infectious and non-infectious causes which may present with intermediate uveitis is of utmost importance before starting treatment. Treatment of pars planitis has been a controversial issue. There is no consensus specifically for treatment of cases with minimal inflammation and relatively good visual acuity. However, current experience shows that pars planitis may cause severe inflammation and needs an aggressive treatment. A stepladder approach including corticosteroids, immunosupressive agents, anti-tumor necrosis factor-alpha and pars plana vitrectomy and/or laser photocoagulation is the most commonly used method for treatment of pars planitis. Adequate control of inflammation and prompt detection of associated complications are crucial in order to improve the overall prognosis of the disease. PMID:27051493
Full Text Available Colleen Doyle,1–3 David Dunt,2 David Ames,1 Suganya Selvarajah11National Ageing Research Institute, Royal Melbourne Hospital Royal Park Campus, Parkville, Victoria, Australia; 2Centre for Health Policy, Programs and Economics, University of Melbourne, Parkville, Victoria, Australia; 3Australian Catholic University, Fitzroy, Victoria, AustraliaBackground: There is good evidence for the positive benefits of pulmonary rehabilitation (PR in the prevention of hospital admissions, lower mortality, and improved health-related quality of life. There is also increasing evidence about the impact of PR on mental health and, in particular, mood disorders. We aimed to identify how depression in chronic obstructive pulmonary disease (COPD patients in Victoria, Australia, is being managed in PR, to identify the prevalence of depressive symptoms among COPD patients who attend PR, and to determine whether patients with depressive symptoms or anxiety symptoms dropped out of PR early.Method: Of 61 PR clinics, 44 were invited and 22 agreed to participate. Telephone interviews were conducted to see how depression and anxiety in COPD patients were being recognized and managed in these clinics. A total of 294 questionnaires were distributed to patients by clinic coordinators to determine the prevalence of anxiety/depression, as measured by the Hospital Anxiety and Depression Scale. Coordinators were contacted to provide information on whether respondents dropped out of rehabilitation early or continued with their treatment at 2–4 months post program.Results: Seven clinics were not aware of local guidelines on assessment/treatment/management of mood. Four clinics did not use any screening tools or other aids in the recognition and management of depression and/or anxiety. Overall, eight clinics participating in this study requested advice on suitable screening tools. The patient survey indicated that the mean depression score on the Hospital Anxiety and Depression
Ignacio López H. Marco Mendoza E. Consuelo Rodríguez M. Lesly Álvarez C
Full Text Available Introduction : Diabetes mellitus (DM has a national prevalence near 4.2% and the worldwide fluctuates between 2 and 5%. The complications are caused by poor metabolic control and hence also by the poor management of cardiovascular risk factors (CVRF, hence the importance of managing and reducing the CVRF, the main objective of control programs for DM. AIM: To characterize clinically to patients with DM2 who were cared for in the agenda of cardiovascular CESFAM Chiguay (commune of Chiguayante, region of Bio Bio during the first 9 months of 2008. PATIENT and method S: Observational descriptivestudy, non-probability sampling a retrospective study was observational and descriptive, reviewing the ballots of each tabcontrol chronic clinic patients enrolled in the program Cardiovascular(VCP from January to September 2008 in CESFAM “Chiguay.” Results : The study included 332 patients, of whom 67.77% were women and 32.23% men. Average age was 63.6 years. 47.59% were obese. 49.39% had a HbA1c levels at about 7%. 21.69% had an “optimal” control of LDL. 56.93% had blood pressure poorly controlled. Discussion : The most noticeable clinical and epidemiological characteristics of the diabetes type 2 found in our study were late aged dominance in females and obese. Almost 80% of the cases had higher levels of LDL and only around a half had good metabolic control, with HbA1c under7%. This could be explained because the studied subjects belongedmostly to a low socioeconomic status, which would lead to unbalanced diet, poor adherence to the treatment and poor understanding of their pathology.
Mathura, Venkatarajan S; Rangareddy, Mahendiranath; Gupta, Pankaj; Mullan, Michael
Clinical trials involve multi-site heterogeneous data generation with complex data input-formats and forms. The data should be captured and queried in an integrated fashion to facilitate further analysis. Electronic case-report forms (eCRF) are gaining popularity since it allows capture of clinical information in a rapid manner. We have designed and developed an XML based flexible clinical trials data management framework in .NET environment that can be used for efficient design and deployment of eCRFs to efficiently collate data and analyze information from multi-site clinical trials. The main components of our system include an XML form designer, a Patient registration eForm, reusable eForms, multiple-visit data capture and consolidated reports. A unique id is used for tracking the trial, site of occurrence, the patient and the year of recruitment. Availability http://www.rfdn.org/bioinfo/CTMS/ctms.html. PMID:21670796
Zhao, J J; Liberman, A
In ancillary or laboratory utilization management, the roles of pathologists have not been explored fully in managed care systems. Two possible reasons may account for this: pathologists' potential contributions have not been defined clearly, and effective measurement of and reasonable compensation for the pathologist's contribution remains vague. The responsibilities of pathologists in clinical practice may include clinical pathology and laboratory services (which have long been well-defined and are compensated according to a resource-based relative value system-based coding system), laboratory administration, clinical utilization management, and clinical research. Although laboratory administration services have been compensated with mechanisms such as percentage of total service revenue or fixed salary, the involvement of pathologists seems less today than in the past, owing to increased clinical workload and time constraints in an expanding managed care environment, especially in community hospital settings. The lack of financial incentives or appropriate compensation mechanisms for the services likely accounts for the current situation. Furthermore, the importance of pathologist-driven utilization management in laboratory services lacks recognition among hospital administrators, managed care executives, and pathologists themselves, despite its potential benefits for reducing cost and enhancing quality of care. We propose a financial compensation model for such services and summarize its advantages.
Tsapakis, Evangelia M; Dimopoulou, Trisevgeni; Tarazi, Frank I
Overwhelming research evidence suggests that the negative symptoms of schizophrenia (NSS) contribute more to impaired quality of life and poor functioning than positive symptoms, and that NSS, including affective flattening, alogia and avolition are present in at least one-fifth of patients diagnosed with schizophrenia. Despite this, management of NSS continues to be a major clinical unmet need as treatment with current antipsychotic medication seems to reach at best modest efficacy. A critical review of the current pharmacological, non-pharmacological and psychosocial treatments available for NSS is presented here, using data retrieved from the MEDLINE/PUBMED, the Cochrane Database of Systematic Reviews and the ClinicalTrials.gov databases. An early and accurate diagnosis using selective scales is essential for documentation and monitoring of change in NSS according to treatment response. Typical and atypical antipsychotic drugs, showed modest efficacy in managing NSS. Conflicting results were obtained with the use of glycinergic neuromodulators, anticholinergics, antidepressants, anticonvulsants, psychostimulants, modafinil and 5-HT3 receptor antagonists. Moreover, non-pharmacological therapies including psychological therapies have failed to address NSS effectively. At present, it appears that the best effective approach for clinical management of NSS is achieved by complementing drug therapy with psychosocial therapies. Continuing basic and clinical research for the understanding of the genetic, behavioral and neural basis of NSS should yield novel pharmacotherapies with superior efficacy, tolerability and long-term maintenance for improved treatment of NSS.
Full Text Available Alcohol withdrawal is commonly encountered in general hospital settings. It forms a major part of referrals received by a consultation-liaison psychiatrist. This article aims to review the evidence base for appropriate clinical management of the alcohol withdrawal syndrome. We searched Pubmed for articles published in English on pharmacological management of alcohol withdrawal in humans with no limit on the date of publication. Articles not relevant to clinical management were excluded based on the titles and abstract available. Full-text articles were obtained from this list and the cross-references. There were four meta-analyses, 9 systematic reviews, 26 review articles and other type of publications like textbooks. Alcohol withdrawal syndrome is a clinical diagnosis. It may vary in severity. Complicated alcohol withdrawal presents with hallucinations, seizures or delirium tremens. Benzodiazepines have the best evidence base in the treatment of alcohol withdrawal, followed by anticonvulsants. Clinical institutes withdrawal assessment-alcohol revised is useful with pitfalls in patients with medical comorbidities. Evidence favors an approach of symptom-monitored loading for severe withdrawals where an initial dose is guided by risk factors for complicated withdrawals and further dosing may be guided by withdrawal severity. Supportive care and use of vitamins is also discussed.
Shchelochkov, Oleg A; Cheung, S W; Lupski, J R
Genomic disorders have been increasingly recognized as a significant source of clinically relevant phenotypes largely fostered by advances in technologies for genome-wide analyses. Molecular and clinical studies of copy number variants involving chromosome 17 began with locus-specific studies of Charcot-Marie-Tooth disease type 1A (CMT1A, OMIM #118220) and hereditary neuropathy with liability to pressure palsies (HNPP, OMIM #162500), which laid the foundation for the paradigm of duplication/deletion and gene-dosage for our understanding of genomic disorders. With the clinical introduction of high-resolution array comparative genomic hybridization (aCGH) the number of recognized genomic disorders including microduplications has been increasing rapidly. A relatively high proportion of disease-associated copy number variants map to chromosome 17. This may result from its unique structural features, such as relative abundance of segmental duplications and interspersed repetitive elements, high gene content, and the presence of dosage-sensitive genes. These genomic rearrangements are mediated by diverse mechanisms including Non-Allelic Homologous Recombination (NAHR), Non-Homologous End-Joining (NHEJ), and Fork Stalling and Template Switching (FoSTeS). We provide specific examples of chromosome 17 microduplications with the emphasis on their phenotype, specific clinical features aiding in their diagnosis, and counseling. PMID:20425816
Mahoney, Emery B.; Perfect, Michelle M.; Edwinson, Roxanne M.
The ratio of internship applicants to internship positions listed in the online directory of the Association of Psychology Postdoctoral and Internship Centers (APPIC) is estimated at 1.23:1. In 2014a, approximately 14% of all students who participated in the match were not placed. Although the internship crisis impacts students in clinical,…
are among the first stem cell types to be introduced in the clinic. Several studies have demonstrated the possible use of MSC in systemic transplantation for systemic diseases, local implantation for local tissue defects, as a vehicle for genes in gene therapy protocols or to generate transplantable tissues...
Kolar, Dusan; Hechtman, Lily; Francoeur, Emmett; Paterson, Jodi
Abstract. This study explores whether the child psychiatry ADHD clinic and the pediatric ADHD clinic serve different population of patients regarding the patient characteristics, severity of ADHD symptoms and comorbid disorders, thereby testing the efficacy of a triage system set up to direct patients referred for Attention Deficit Disorder symptoms to the appropriate clinics. Charts of 163 children and adolescents treated in two clinical settings were analyzed with regard to demographic char...
Eliza David Remona; Minodora Dobreanu
Clinical laboratory tests ensure approximately 70% of the medical decisions, so that the time until the release of the results and its accuracy are critical for the diagnosis and the efficiency of the treatment . Risk management involves both the anticipation of what could happen erroneous and the assessment of errors’ frequency as well as the consequences or the severity of the effects caused by it, and finally to decide what can be done in order to reduce the risk to an acceptable clinic...
Strickler, David Charles
In this Open Forum a psychiatric health care consumer recounts his experience with his state's requirement to hold case management meetings outside of the clinic. Over time, the author found that meeting elsewhere amounted to being put on public display, and he felt embarrassed and powerless to change the situation. Requiring people with psychiatric disorders to meet outside a clinical setting may violate the Health Insurance Portability and Accountability Act and human rights. This New Hampshire state policy needs to be changed because it undermines treatment and reinforces the stigma that many consumers already feel because of their disability.
Full Text Available Background: The epidemiology and management of skin infections in nursing homes has not been adequately described. We reviewed the characteristics, diagnosis and treatment of skin infections among residents of nursing homes to identify opportunities to improve antibiotic use. Methods: A retrospective study involving 12 nursing homes in the Denver metropolitan area. For residents at participating nursing homes diagnosed with a skin infection between July 1, 2013 and June 30, 2014, clinical and demographic information was collected through manual chart review.Results: Of 100 cases included in the study, the most common infections were non-purulent cellulitis (n=55, wound infection (n=27, infected ulcer (n=8, and cutaneous abscess (n=7. In 26 cases, previously published minimum clinical criteria for initiating antibiotics (Loeb criteria were not met. Most antibiotics (n=52 were initiated as a telephone order following a call from a nurse, and 41 patients were not evaluated by a provider within 48 hours after initiation of antibiotics. Nearly all patients (n=95 were treated with oral antibiotics alone. The median treatment duration was 7 days (interquartile range [IQR] 7-10; 43 patients received treatment courses of ≥ 10 days.Conclusions: Most newly diagnosed skin infections in nursing homes were non-purulent infections treated with oral antibiotics. Antibiotics were initiated by telephone in over half of cases, and lack of a clinical evaluation within 48 hours after starting antibiotics was common. Improved diagnosis through more timely clinical evaluations and decreasing length of therapy are important opportunities for antibiotic stewardship in nursing homes.
Sunita J. Ramanand; Balasaheb B Ghongane; Jaiprakash B Ramanand; Milind H Patwardhan; Ghanghas, Ravi R.; Jain, Suyog S
Background: Polycystic ovary syndrome (PCOS) is common diagnosis in women presenting with infertility. All the dimensions of PCOS have not been completely explored. Many studies have tried to characterize the exact presentation of the disease. In this study we studied clinical features of PCOS in Indian women to characterize different phenotypes of this syndrome. Prevalence of acanthosis nigricans (AN) as surrogate marker of insulin resistance, obesity, hirsutism and hypothyroidism in PCOS wo...
Kim, Joo Dong; Han, Young Seok; Choi, Dong Lak
Purpose Groove pancreatitis is a rare specific form of chronic pancreatitis that extends into the anatomical area between the pancreatic head, the duodenum, and the common bile duct, which are referred to as the groove areas. We present the diagnostic modalities, pathological features and clinical outcomes of a series of symptomatic patients with groove pancreatitis who underwent pancreaticoduodenectomy. Methods Six patients undergoing pancreaticoduodenectomy between May 2006 and May 2009 due...
Barbers, Richard G.; Papanikolaou, Ilias C.; Michael N. Koss; Ashish Patel ,; Elton Katagihara; Maggie Arenas; Khalid Chan; Azen, Colleen G.; Sharma, Om P.
Background. Inflammation and remodeling are integral parts of asthma pathophysiology. We sought to describe the clinical and pathologic features of near fatal asthma exacerbation (NFE). Methods. Bronchial biopsies were collected prospectively from NFE I subjects. Another NFE II group and a moderate severity exacerbation control group (ME II) were retrospectively identified—no biopsies obtained. Results. All NFE II ( = 9 ) subjects exhibited remodeling and significant inflammation (eosinophi...
Tishchenko D.V.; Matveeva O.V.; Chernenkov Yu.V.; Maslyakova G.N.; Bucharskaya A.B.
The research goal is to determine clinical, endoscopic and morphological signs of chronic duodenitis in children. Materials and methods: The diagnostic value of molecular markers has been revealed by immunohistochemical research of biopsy. It has been received from endoscopic examination of 32 children aged from 3 to 17 years old with chronic duodenitis. Morphometric investigation of markers expression has been ca...
Sarafraz, Alireza; Chamani, Mojtaba; Derakhshandeh, Hossein
Background Inadequate epidemiologic investigations of the paranasal sinuses malignancies prompted this retrospective study with special emphasis on a major group of 111 tumors. Material and Methods Clinical records of 111 patients with histologically confirmed malignant tumors of the paranasal sinuses were investigated retrospectively from April 2000 to January 2012. Collection of data included demographic information, clinical manifestations, treatment plans, and histopathology of the tumor. Results There were 69 (62.16%) male and 42 (37.83%) female patients (male-to-female ratio of 1.6:1), with a median age of 49±12.2 years (range 21 to 88 years). A high level of occurrence was noticed in the fifth (26.3%) decade of life. The most frequent histological types were squamous cell carcinoma (43.5%) and adenoid cystic carcinoma (19%). Among clinical manifestations, nasal obstruction was the most frequent followed by diplopia, and facial swelling. Fifty three patients (47.74%) were treated with combined approach of surgery and radiation therapy. Conclusions Paranasal sinuses malignancies are rare conditions with nonspecific symptoms which make early diagnosis of the lesions more challenging. The optimal therapeutic protocol for patients suffering from these tumors is still a somewhat controversial entity and requires further studies. Key words:Paranasal sinuses, malignancy, surgery,radiotherapy. PMID:27475693
Khalifa, Mohamed; Alswailem, Osama
Clinical Decision Support Systems have been shown to increase quality of care, patient safety, improve adherence to guidelines for prevention and treatment, and avoid medication errors. Such systems depend mainly on two types of content; the clinical information related to patients and the medical knowledge related to the specialty that informs the system rules and alerts. At King Faisal Specialist Hospital and Research Center, Saudi Arabia, the Health Information Technology Affairs worked on identifying best strategies and recommendations for successful CDSS knowledge management. A review of literature was conducted to identify main areas of challenges and factors of success. A qualitative survey was used over six months' duration to collect opinions, experiences and suggestions from both IT and healthcare professionals. Recommendations were categorized into ten main topics that should be addressed during the development and implementation of CDSS knowledge management tools in the hospital. PMID:26152955
@@ This article summarizes the major new findings on clinical management for benign prostatic hyperplasia (BPH) that were presented at the annual meeting of the American Urological Association (AUA) in May 2008.The management of symptomatic BPH has been changed significantly over the last decade in response to the availability of new treatment options.Prior to the 1980s,open prostatectomy was the only widely accepted intervention for BPH.Since then,the advent of new medical therapies for BPH and the introduction of a range of minimally invasive therapies have provided for men with lower urinary tract symptoms (LUTS) secondary to BPH.1 In this year's AUA meeting,several new findings were reported in the filed of BPH which involved epidemiology,clinical progression,drug therapy and new technologies in surgical therapy of BPH.
Acute radiation-induced esophagitis includes all clinical symptoms (odynophagia, dysphagia) occurring within 90 days after thoracic irradiation start. Its severity can be graded using RTOG and CTCAE scales. The clinical risk factors are: age, female gender, initial performance status, pre-therapeutic body mass index, pre-therapeutic dysphagia, tumoral and nodal stage, delivered dose, accelerated hyperfractionated radiotherapy, concomitant association of chemotherapy to radiotherapy and response to the treatment. The dosimetric parameters predictive of esophagitis are: mean dose, V20 Gy, V30 Gy, V40 Gy, V45 Gy and V50 Gy. Amifostine is the only drug to have a proven radioprotective efficacy (evidence level C, ESMO recommendation grade III). The medical management of esophagitis associates a diet excluding irritant food, medication against gastroesophageal reflux, analgesic treatment according to the WHO scale and management of dehydration and de-nutrition by enteral feeding. (authors)
This report has described how the Midwest Compact region's low-level radioactive waste characteristics were determined and has provided assessments of several key characteristics of the waste. Sources of the data used and comments on the validity and uncertainty of both the raw information and the region-wide estimates that have been generated are indicated. The contents and organization of the computerized Midwest Data Base are also presented. This data base is a resource for rational development of the Midwest Compact's Regional Management Plan. The value of the level of detail contained in Midwest Data Base is demonstrated in its use to analyze the viability of LLW treatment alternatives in other aspects of the regional management plan (RAE86). 10 refs., 7 figs., 13 tabs
Hulse, Nathan C; Galland, Joel; Borsato, Emerson P
In this manuscript, we present an overview of the clinical knowledge management strategy at Intermountain Healthcare in support of our electronic medical record systems. Intermountain first initiated efforts in developing a centralized enterprise knowledge repository in 2001. Applications developed, areas of emphasis served, and key areas of focus are presented. We also detail historical and current areas of emphasis, in response to business needs. PMID:23304309
Cassiano Kuchenbecker Rösing; Walter Loesche
Halitosis is an unpleasant condition that causes social restraint. Studies worldwide indicate a high prevalence of moderate halitosis, whereas severe cases are restricted to around 5% of the populations. The etiological chain of halitosis relates to the presence of odoriferous substances in exhaled air, especially the volatile sulphur compounds (VSC) produced by bacteria. The organoleptic diagnosis is the gold standard and clinical management includes oral approaches, especially periodontal t...
Nicola Tambasco; Simone Simoni; Erica Marsili; Elisa Sacchini; Donatella Murasecco; Gabriela Cardaioli; Aroldo Rossi; Paolo Calabresi
In Parkinson's disease, one of the most troublesome dilemmas is the treatment of levodopa-induced dyskinesia. After a few years, chronic treatment with levodopa is associated with the development of dyskinesias. Strategies to delay or to reduce dyskinesias are based on the change of levodopa dosing or the early use of dopamine agonists. Dopamine agonists with different pharmacological profile are available. Our paper was aimed to analyse the clinical impact and the management of dyskinesias w...
Finster, Molly; Clark, Corrie; Schroeder, Jenna; Martino, Louis
Geothermal power plants use geothermal fluids as a resource and create waste residuals as part of the power generation process. Both the geofluid resource and the waste stream are considered produced fluids. The chemical and physical nature of produced fluids can have a major impact on the geothermal power industry and can influence the feasibility of geothermal power development, exploration approaches, power plant design, operating practices, and the reuse or disposal of residuals. In general, produced fluids include anything that comes out of a geothermal field and that subsequently must be managed on the surface. These fluids vary greatly depending on the geothermal reservoir being harnessed, power plant design, and the life cycle stage in which the fluid exists, but generally include water and fluids used to drill geothermal wells, fluids used to stimulate wells in enhanced geothermal systems, and makeup and/or cooling water used during operation of a geothermal power plant. Additional geothermal-related produced fluids include many substances that are similar to waste streams from the oil and gas industry, such as scale, flash tank solids, precipitated solids from brine treatment, hydrogen sulfide, and cooling-tower-related waste. This review paper aims to provide baseline knowledge on specific technologies and technology areas associated with geothermal power production. Specifically, this research focused on the management techniques related to fluids produced and used during the operational stage of a geothermal power plant; the vast majority of which are employed in the generation of electricity. The general characteristics of produced fluids are discussed. Constituents of interest that tend to drive the selection of treatment technologies are described, including total dissolved solids, noncondensable gases, scale and corrosion, silicon dioxide, metal sulfides, calcium carbonate, corrosion, metals, and naturally occurring radioactive material. Management
Rupsa C. Boelig
Full Text Available Objective. To describe the demographic and clinical characteristics of HIV-infected individuals and HIV-affected couples who were referred for preconception counseling (PCC at a large urban US-based HIV clinic. Methods. Electronic medical records were reviewed for HIV-infected individuals and HIV-affected couples. Medical, reproductive, surgical, psychosocial, and family history data were abstracted. Univariate analyses were done. Results. There were 8 single HIV-infected women and 100 HIV-affected couples who underwent PCC. HIV-infected women were older (mean age 35 years versus 32 years, P=0.06, were more likely to smoke (23% versus 0%, P<0.01, and had more medical comorbidities (57% versus 33%, P=0.04 than HIV-uninfected women. The majority of couples were serodiscordant (77%, and of these couples, 32% had a detectable plasma viral load and 33% report inconsistent condom use. Conclusions. HIV-infected women have a number of medical and psychosocial issues, including those related to HIV that may increase the risk of adverse pregnancy outcomes and HIV perinatal and sexual transmission. PCC is an important intervention to optimize maternal management to improve perinatal outcomes and minimize transmission risks.
Trusov, V.V.; Zelenin, A.A.; Dundua, M.G. (Izhevskij Meditsinskij Inst. (USSR))
A comparative characteristic of the methods for radioimmunological and immunofermental control of supporting therapy is given and the mechanisms of digoxin tolerance in cases of treatment of 89 patients with circulatory insufficiency are investigated. Pharmacokinetic parameters were calculated on the basis of bilocular mathematical model following the intravenous injection of 0.5 mg of digoxin. The absence of substantial differences in the methods under consideration is shown but a certain preference is given to the method of immunofermental analysis as it is convenient to be used for the daily control of the glycoside level in case of supporting therapy and investigations of the preparation pharmacokinetics.
Price, Jack F; Jeewa, Aamir; Denfield, Susan W
Cardiomyopathies are diseases of the heart muscle, a term introduced in 1957 to identify a group of myocardial diseases not attributable to coronary artery disease. The definition has since been modified to refer to structural and or functional abnormalities of the myocardium where other known causes of myocardial dysfunction, such as systemic hypertension, valvular disease and ischemic heart disease, have been excluded. In this review, we discuss the pathophysiology, clinical assessment and therapeutic strategies for hypertrophic, dilated and hypertrophic cardiomyopathies, with a particular focus on aspects unique to children.
Dental clinic include dental pulp disease, dental, orthodontic repair and others. This work is precise and meticulous.And the course of treatment and follow-up time is longer, the number of patients is much more. Patients need spend much time to wait,and need pay for high cost of this. Patients would inevitably have negative emotions, under the influence of many factors. The doctors and nurses could use mental nursing to establish a good relationship between doctors and patients, and create...
Full Text Available Five patients with sporadic Creutzfeldt-Jakob disease (sCJD presented rapidly progressive dementia which were subacute onset from 1 to 4 months. Among these cases, periodic synchronous discharge (PSD of electroencephalography (EEG was seen in 2 patients. Besides, 4 patients obtained positive results in cerebrospinal fluid (CSF analysis for 14-3-3 protein. The cranial MRI examination showed symmetrical or asymmetrical colored-ribbon-shaped high signals in cerebral cortex or basal ganglia by diffusion weighted imaging (DWI, suggesting that DWI had high sensitivity and specificity for the diagnosis of sCJD as a preferred method in the clinical examination of sCJD.
Full Text Available Along with the reform of medical system, medical education in China is also undergoing great changes. Due to the special characteristics of medical education, it differs from other educational characteristics. It carries with the characteristics of clinical practice on the basis distributed learning, physical and mental development along with ages, enrollment expansion and medical requirement, and standardization training for resident doctors. So, ideological and political education of clinical graduates showed many new characteristics. First, medical ethics education is the basic step, combined with the related disciplines of medical humanity connotation. Second, flexible and diversified form of ideological and political education on the basis of medical work is necessary. Third, establish a system of ideological and political education for clinical graduates, to build up new education concept, and to develop ideological and political education activities for clinical graduates in depth.
Objective To investigate the clinical characteristics of gastroesophageal reflux disease (GERD) in several endoscopy centers of Northwest China.Methods From September 2008 to September 2009,a questionnaire survey was carried out in the endoscopy centers of four hospitals
A. van Samkar
In this thesis, we describe the clinical characteristics, etiology, treatment and outcome of zoonotic bacterial meningitis. Each chapter describes meningitis patients infected by a specific zoonotic pathogen, such as Streptococcus equi, Streptococcuis suis, Capnocytophaga canimorsus, Campylobacter f
Objective Restrictive cardiomyopathy(RCM) is rare in children,and little is known about the molecular basis of RCM.The aim of this study was to investigate the clinical and myopathological characteristics and to detect
Sunita J Ramanand
Full Text Available Background: Polycystic ovary syndrome (PCOS is common diagnosis in women presenting with infertility. All the dimensions of PCOS have not been completely explored. Many studies have tried to characterize the exact presentation of the disease. In this study we studied clinical features of PCOS in Indian women to characterize different phenotypes of this syndrome. Prevalence of acanthosis nigricans (AN as surrogate marker of insulin resistance, obesity, hirsutism and hypothyroidism in PCOS women have been simultaneously studied. Materials and Methods: Present work is a non comparative cross-sectional open label study carried out over a period of 18 months in an endocrinology hospital in western Maharashtra, India. Results and Conclusion: Authors conclude that PCOS occurs both in obese and non-obese women; AN and hirsutism occur in equal proportion of patients. AN is correlated with obesity. Hormonal dysfunctions in PCOS manifested together or independently. PCOS women can be sub grouped based on clinical features suggestive of endocrinological malfunctions and can be investigated accordingly for selection of appropriate treatment modalities.
Full Text Available The aim of this study was to compare clinical and laboratory findings of women with or without uterine leiomyoma.Study group consisted of 82 women with uterine leiomyoma and the control group comprised 42 healthy women. Women’s age, gravity, parity, blood groups, pattern of menstrual cycles, complaints at presentation, fertility, ultrasonographical findings, surgical operations and thyroid function tests were evaluated.There were no significant differences in blood group distribution, gravity, parity and thyroid function test results between the patients and the control subjects (P>0.05. A significant difference was found in the complaints at presentation between two groups (P<0.001. Mentrual cycles irregularity was more frequently found in the patients compared with the controls (57.3% vs. 42.9%, respectively, P=0.009. Although no infertile woman was found in the control group, 8.5% of patients were found to have infertility. The sensitivity of ultrasonography was found to be 97.6%. Except for the existence of higher infertility rate and the menstrual cycles irregularities, no significant difference was found in the clinical and laboratory findings between women with or without uterine leiomyoma. Therefore, physical examination and imaging methods are remained as the most important diagnostic tools for uterine leiomyoma.
Gribova, N P; Galitskaia, O S
A clinical-electroneuromyographical study of 40 children (32 (80%) of them aged from 12 to 17 years, mean age 13,9+/-1,8 years, and 8 (20%) - from 1 to 8 years, mean age 4,4+/-2,1 years) were studied in the acute period of facial nerve paralysis (FNP). Six (15%) children had FNP in the anamnesis. Among precipitating factors were the cold exposure the day before disease onset (20 (50%) patients), symptoms of flu (13 (32,5%) patients) and psycho-emotional tension (3 (7,5%) patients). No precipitation was noted in 4 (10%) children. The degree of muscle paresis was 81,9+/-7% that corresponded to clinical stages III-IV according to K. Rosler. An electroneuromyographical analysis of motor ortho- and antidromic response to the facial nerve stimulation on the side of paresis and on the contralateral side in patients and controls revealed the presence of proximal axon- and myelinopathy of facial nerve with the involvement of its own motorneurons and brain stem interneurons. The maintenance of wink reflex and F-wave blocks in the period over 3 weeks are prognostically unfavorable factors for restoration of mimic muscle function in the early stage of disease.
Full Text Available Objective: to study the causes and clinical manifestations of disease in children referred for hospitalization in children infectious diseases hospital in Saratov with a diagnosis of «acute flaccid paralysis». Material and methods: 157 children with the diagnosis on admission of the guide «acute flaccid paralysis». Conducted clinical examination and laboratory tests included a general analysis of cerebrospinal fluid, urine, virological examination of nasal swabs and faeces, with the definition of a serological ELISA method and RPHA immunoglobulins to influenza, rubella, and enterovirus, immunological study of blood, cerebrospinal fluid PCR, electromyography of the affected limbs. Results. 77 patients (49% with the disease associated with the violation of the musculoskeletal system were registered. In the other cases revealed polyneuropathy was not of poliovirus etiology. Etiological nature of the disease could be explained by 54% of patients. In 37 (46% patients the diagnosis was formulated in accordance with the severity of paralysis. One child was diagnosed with a vaccine-associated poliomyelitis. Conclusion. The diagnosis of «acute flaccid paralysis» used as administered requires a detailed interpretation in a hospital.
Kassardjian, Charles D; Macdonald, R Loch; Munoz, David G
Intracranial hemangioblastomas are benign vascular tumors. The peak age of incidence is between 20 to 50 years. Hemangioblastomas rarely occur in patients over the age of 65. To our knowledge there is no review of the prevalence and clinical features in an elderly population. We reviewed our 12 year experience with intracranial hemangioblastomas, and characterized the clinical features of hemangioblastomas in patients over the age of 65. We present a 72-year-old man with a cerebellar mass initially thought to be a metastasis as an illustrative case. We reviewed our pathology database and identified all patients with a histopathologically confirmed diagnosis of hemangioblastoma over the last 12 years in a large tertiary adult hospital; all patients were over the age of 18. Of all cases of hemangioblastoma in the last 12 years, six of 77 (7.7%) occurred in patients over the age of 65. All were cerebellar in location, and none were associated with von-Hippel Lindau disease. Hemangioblastomas are uncommon, but not rare, in patients over the age of 65, and should be included in the differential diagnosis of patients presenting with gait ataxia and a cerebellar lesion in this age group. PMID:24629394
Full Text Available BACKGROUND: Pulmonary hypertension (PH is associated with increased mortality and morbidity. It is frequently associated with cardiopulmonary diseases that are prevalent in African Americans (AAs. However, the prevalence or determinants of PH in the AA population is not known. METHODS: We conducted a cross-sectional study to estimate the prevalence of PH (defined as trans-tricuspid gradient ≥ 35 mm Hg and associated clinical characteristics in AAs using the Jackson Heart Study cohort (n=3,282 who underwent echocardiography and had a measurable trans-tricuspid regurgitant jet. Echocardiography is frequently used for screening for PH despite its limitations in estimating accurate PA systolic pressures. Overall and age-adjusted gender-specific prevalence were estimated and modified Poisson regression was used to identify independent clinical, spirometric, and echocardiographic characteristics associated with PH. RESULTS: The mean age of the study population was 56.1 ± 12.6 years with 67.5% female. The prevalence of PH was 6.8%, with higher prevalence in female AAs (age-adjusted prevalence: Men 4.9%, 95% CI 3.6-6.2%; Women 7.7%, 95% CI 6.6-8.8%. Pulmonary hypertension prevalence increased with age (Prevalence Ratio: 10.0, 95%CI 4.0-25.1, >65 versus <45 years old, presence of obesity, higher pulse pressure, diabetes, obstructive or restrictive spirometry pattern, and severe left heart valvular disease. Also, PH was significantly associated with left atrial size and left ventricular ejection fraction. CONCLUSIONS: Pulmonary hypertension is prevalent in AAs, more in women than in men. The identified cardiopulmonary risk factors that increase the prevalence of PH may assist in diagnosis and management of these at-risk subjects in the AA population.
Aguilera, Paula; Malvehy, Josep; Carrera, Cristina; Palou, Josep; Puig-Butillé, Joan Anton; Alòs, Llúcia; Badenas, Celia; Puig, Susana
Background About 6 to 14% of melanoma cases occur in a familial setting. Germline mutations in CDKN2A are detected in 20 to 40% of melanoma families. Objective To characterise the clinical and histopathological characteristics of familial melanoma thus providing more information to clinicians and contribute to the understanding of the genetic-environment interplay in the pathogenesis of melanoma. Methods Clinical, histological and immunohistochemical characteristics of 62 familial melanomas w...
Objective To explore the clinical characteristics and prognostic value of monosomal karyotype(MK)patients in adult acute myeloid leukemia(AML).Methods We retrospectively studied 45 patients of MK+in newly-diagnosed adult AML in our center from Oct 2000 to Dec2012.Clinical characteristics,cytogenetic data and prognostic features were analyzed in the cohort of MK+patients.Results MK was found in 45 patients(19.0%)
Richard G. Barbers
Full Text Available Background. Inflammation and remodeling are integral parts of asthma pathophysiology. We sought to describe the clinical and pathologic features of near fatal asthma exacerbation (NFE. Methods. Bronchial biopsies were collected prospectively from NFE I subjects. Another NFE II group and a moderate severity exacerbation control group (ME II were retrospectively identified—no biopsies obtained. Results. All NFE II (=9 subjects exhibited remodeling and significant inflammation (eosinophilic, neutrophilic. NFE II group (=37 had a significant history of prior intubation and inhaled corticosteroids usage compared to ME II group (=41. They also exhibited leukocytosis, eosinophilia, and longer hospitalization days. Conclusions. Remodeling, eosinophilic, and neutrophilic inflammation were observed in NFE. NFE is associated with prior intubation and inhaled corticosteroids usage.
A 9-month-old male infant was admitted to our hospital on the second day of cold like syndrome because of high fever, convulsion, coma, and decerebrate rigidity. Serum GOT, GPT, LDH, and CPK were markedly elevated. Serum ammonia was slightly increased, and hypoglycemia was present. The cerebrospinal fluid showed no pleocytosis, normal sugar content, but increased protein. Thus we made a diagnosis of clinical Reye syndrome according to the criteria by Yamashita, et al. A CT on the day of admission showed symmetrical low-density areas in the posterior fossa and the regions of thalamus. Ringed enhancements were seen around the areas of low density in the thalamus on the twenty-second hospital day. We consider that these lesions may represent the infarction due to obstruction of the thalamoperforant arteries caused by cerebral edema in the early stage of the disease. (author)
Kim, Jiyeon; Kim, Seong Hoon; Lim, Sung Chul; Kim, Woojun; Shon, Young-Min
Purpose To evaluate the evolution of nonlesional temporal lobe epilepsy (TLE-NL) in patients treated exclusively with antiepileptic drugs and to elucidate clinical phenotypes related to the prognosis of these patients. Methods Clinical, radiological, and electroencephalographic (EEG) findings in 84 patients with TLE-NL were reviewed. A good response group (GRG) and a poor response group (PRG) were defined if the duration of their seizure-free period was >1 year, or <1 year, respectively. Results There were 46 (54.8%) patients in the GRG and 38 (45.2%) patients in the PRG. The number of antiepileptic drugs administered was significantly lower in the GRG than that in the PRG (1.3±0.8 vs 2.8±1.0, respectively; P<0.05). The GRG had a significantly older age of onset than the PRG and a lower occurrence of initial precipitating events, such as febrile seizures, central nervous system infection, and head trauma (P<0.05). The prevalence of EEG abnormality, presence of aura, generalized seizures, and automatism was less frequently observed in the GRG (P<0.05). Multivariate analysis showed that the presence of automatism and initial precipitating events were significantly associated with a poor prognosis (P<0.05). Conclusion In contrast to the commonly assumed intractability of TLE, we found that more than 54% of patients with TLE-NL achieved a long seizure-free period. Older age at onset of TLE-NL was associated with a better prognosis. However, the presence of automatism and initial precipitating events were related to a poor prognosis. Future prospective studies with a much larger population are warranted. PMID:27555776
A. R. Bilalova
Full Text Available Purpose of the study. To carry out a comparative description of the clinical and biochemical parameters at patients with cirrhosis of an alcoholic genesis (CP-HGA and cirrhosis of mixed etiologies — CP-HGM (HСV+ alcohol.Materials and methods. The study involved 62 patients with cirrhosis of different etiologies, who carries out clinical, immunogenetic and biochemical studies.Results. Patients with the 3d genotype and low viral load were registered with cirrhosis of mixed etiologies (HСV+ alcohol. At the cirrhosis Class B for Child-Pugh basic data biochemical parameters were similar in patients with CP-HGA and CP-HGM, but ALT and AST activity, which are significantly higher than observed in patients with CP-HGM. At dismissal, ALT and GGT activities were detected significantly higher in patients with CP-HGM than the CP-HGA. At the cirrhosis Class C for Child-Pugh the baseline, reflecting cholestasis — is total bilirubin, GGT and alkaline phosphatase and were detected significantly higher in the CP-HGA, than with CP-HGM significantly reduced, and thore is no differences between the groups to be discharged from the hospital, in addition to the activity of GGT, which it remained significantly higher in the CP-HGA, than with CP-HGM. Cytolytic activity of enzymes (ALT, AST during the entire period of the disease was observed significantly higher normal values and did not depend on the CP etiology.Conclusion decision. The maximum rate of change of the basic biochemical parameters is observed in patients with cirrhosis of mixed etiologies Class B for Child-Pugh and at the cirrhosis of an alcoholic genesis — in patients with cirrhosis Class C.
Full Text Available Background: End-stage hypertrophic cardiomyopathy (HCM is complicated by substantial adverse events. However, few studies have focused on electrocardiographic features and their prognostic values in HCM. This study aimed to evaluate the clinical manifestations and prognostic value of electrocardiography in patients with end-stage HCM. Methods: End-stage HCM patients were enrolled from a total of 1844 consecutive HCM patients from April 2002 to November 2013 at Fuwai Hospital. Clinical data, including medical history, electrocardiography, and echocardiography, were analyzed. Cox hazards regression analysis was used to assess the risk factors for cardiovascular mortality. Results: End-stage HCM was identified in 99 (5.4% patients, averaged at 52 ± 16 years old at entry. Atrial fibrillation was observed in 53 patients and mural thrombus in 19 patients. During 3.9 ± 3.0 years of follow-up, embolic stroke, refractory heart failure, and death or transplantation were observed in 20, 39, and 51 patients, respectively. The incidence of annual mortality was 13.2%. Multivariate Cox hazards regression analysis identified New York Heart Association Class (NYHA III/IV at entry (hazard ratio [HR]: 1.99; 95% confidence interval [CI]: 1.05-3.80; P = 0.036, left bundle branch block (LBBB (HR: 2.80; 95% CI: 1.47-5.31; P = 0.002, and an abnormal Q wave (HR: 2.21; 95% CI: 1.16-4.23; P = 0.016 as independent predictors of cardiovascular death, in accordance with all-cause death and heart failure-related death. Conclusions: LBBB and an abnormal Q wave are risk factors of cardiovascular mortality in end-stage HCM and provide new evidence for early intervention. Susceptibility of end-stage HCM patients to mural thrombus and embolic events warrants further attention.
Positron emission tomography (PET) methodologies, which visualize in vivo biochemical, physiological and pharmacological processes, together with the availability of hybrid imaging modalities (PET with computer tomography (PET/CT) imaging), have revolutionized patient diagnosis, disease staging, disease management and therapy follow-up. These technologies have opened up fascinating possibilities for new non-invasive medical care and individualized patient management unlike those seen before in a clinical setting. There is immense global interest in PET, with accelerated investment in the clinical setting. The radiotracers used for PET are very different from conventional nuclear medicine radiopharmaceuticals. They have extremely short half-lives, which means that they have to be produced close to the clinical user. The time available for the labelling of PET molecules (including purification and quality control) is very limited, which presents new challenges and a need for more proficient systems to be established before clinical use. The busy and demanding nature of clinical settings adds to the complexities and creates a need for more robust quality management programmes. This publication focuses on clinical settings and was compiled following several IAEA Consultants Meetings and with the benefit of the contributions of individual experts. It aims to raise awareness of the issues involved and suggests ways of reducing risk. The purpose of these guidelines is to encourage a proactive approach to each aspect of parametric release and to propose practical test methods for each criterion for parametric acceptance, thereby helping end users to ensure the quality of PET products. It is hoped that these criteria will stimulate further cooperation among various countries worldwide in the development of a set of harmonized acceptance test criteria for PET systems and sensible quality assurance (QA) standards for all PET tracers. Many countries and IAEA Member States are
М.SH. JAMANTAYEVA; A.S. SUBHANBERDINA; N.E. DUNENBAYEV; D.M.SERGAZIYEV
The article reveals some clinical and social characteristics of women registered on a drug-abuse dispensary with mental and behavioral disorders due to use of drugs. The present study points to their influence on structural dynamic characteristics of social adaptation of patients. There are some comprehensive measures of medical and rehabilitative activities directed at outpatient drug treatment.
JIANG Ling-zhen; XIAO Yuan-chun
@@ Scalp Acupuncture and Daoyin Technique, which are summarized by Dr. KONG in the light of his long-term acupuncture practice, has been considered as one of the clinical diagnostic and treatment programs in Chinese medicine by the State Administration of Traditional Chinese Medicine. In this paper, the characteristics and clinical application of Scalp Acupuncture and Daoyin Technique are presented as follows.
Objective To investigate the clinical characteristics of MSBT(malignant small bowel tumors) .Methods Six hundred and twenty-five cases of MSBT were recruited in this study and their clinical records and information including age,gender,blood types,family history,personal
Newcorn, Jeffrey H.; Sutton, Virginia K.; Zhang, Shuyu; Wilens, Timothy; Kratochvil, Christopher; Emslie, Graham J.; D'Souza, Deborah N.; Schuh, Leslie M.; Allen, Albert J.
Objective: Understanding placebo response is a prerequisite to improving clinical trial methodology. Data from placebo-controlled trials of atomoxetine in the treatment of children and adolescents with attention-deficit/hyperactivity disorder (ADHD) were analyzed to identify demographic and clinical characteristics that might predict placebo…
Full Text Available Jiyeon Kim,1 Seong Hoon Kim,2 Sung Chul Lim,2 Woojun Kim,2 Young-Min Shon3 1Department of Neurology, Korea University Ansan Hospital, College of Medicine, Korea University, Ansan, 2Department of Neurology, Catholic Neuroscience Institute, College of Medicine, The Catholic University of Korea, Seocho-gu, 3Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea Purpose: To evaluate the evolution of nonlesional temporal lobe epilepsy (TLE-NL in patients treated exclusively with antiepileptic drugs and to elucidate clinical phenotypes related to the prognosis of these patients.Methods: Clinical, radiological, and electroencephalographic (EEG findings in 84 patients with TLE-NL were reviewed. A good response group (GRG and a poor response group (PRG were defined if the duration of their seizure-free period was >1 year, or <1 year, respectively.Results: There were 46 (54.8% patients in the GRG and 38 (45.2% patients in the PRG. The number of antiepileptic drugs administered was significantly lower in the GRG than that in the PRG (1.3±0.8 vs 2.8±1.0, respectively; P<0.05. The GRG had a significantly older age of onset than the PRG and a lower occurrence of initial precipitating events, such as febrile seizures, central nervous system infection, and head trauma (P<0.05. The prevalence of EEG abnormality, presence of aura, generalized seizures, and automatism was less frequently observed in the GRG (P<0.05. Multivariate analysis showed that the presence of automatism and initial precipitating events were significantly associated with a poor prognosis (P<0.05.Conclusion: In contrast to the commonly assumed intractability of TLE, we found that more than 54% of patients with TLE-NL achieved a long seizure-free period. Older age at onset of TLE-NL was associated with a better prognosis. However, the presence of automatism and initial precipitating events were related to a poor prognosis. Future prospective
Jo, Heui-Sug; Kim, Dong Ik; Chang, Sung-Goo; Shin, Ein-Soon; Oh, Moo-Kyung
This study introduces the Clinical practice guidelines (CPGs) appraisal system by the Korean Academy of Medical Sciences (KAMS). Quality management policies for CPGs vary among different countries, which have their own cultures and health care systems. However, supporting developers in guideline development and appraisals using standardized tools are common practices. KAMS, an organization representing the various medical societies of Korea, has been striving to establish a quality management system for CPGs, and has established a CPGs quality management system that reflects the characteristics of the Korean healthcare environment and the needs of its users. KAMS created a foundation for the development of CPGs, set up an independent appraisal organization, enacted regulations related to the appraisals, and trained appraisers. These efforts could enhance the ability of each individual medical society to develop CPGs, to increase the quality of the CPGs, and to ultimately improve the quality of the information available to decision-makers.
Terzić Dragica; Mijović Gordana; Dupanović Brankica; Drašković Nenad; Švirtlih Neda
Introduction Hepatitis E has many similarities in with hepatitis A concerning clinical picture, route of transmission and nonexistence of chronicity. Comparison of clinical and laboratory parameters of patients with hepatitis A and E to estimate characteristics of these diseases. Material and methods Total of 54 patients divided into two groups was investigated: 27 had hepatitis A, others had hepatitis E. Detailed history past, clinical examination, liver function tests and ultrasonography of...
Luo, Xin; YE, HUIJING; Ding, Yun-gang; Du, Yi; Yang, Huasheng
Background/aim: The aim of this study was to investigate the potential correlation between clinical characteristics and prognosis of patients with retinoblastoma (Rb). Materials and methods: This retrospective study included 314 Rb patients. Clinical data including laterality of eyes, sex, age, presenting signs, lag time, and survival were recorded and analyzed. Results: Leukocoria is the most common clinical presentation of Rb. Patients with isolated leukocoria had shorter lag time and e...
Pichichero, Michael E
The immunogenicity of polysaccharides as human vaccines was enhanced by coupling to protein carriers. Conjugation transformed the T cell-independent polysaccharide vaccines of the past to T cell-dependent antigenic vaccines that were much more immunogenic and launched a renaissance in vaccinology. This review discusses the conjugate vaccines for prevention of infections caused by Hemophilus influenzae type b, Streptococcus pneumoniae, and Neisseria meningitidis. Specifically, the characteristics of the proteins used in the construction of the vaccines including CRM, tetanus toxoid, diphtheria toxoid, Neisseria meningitidis outer membrane complex, and Hemophilus influenzae protein D are discussed. The studies that established differences among and key features of conjugate vaccines including immunologic memory induction, reduction of nasopharyngeal colonization and herd immunity, and antibody avidity and avidity maturation are presented. Studies of dose, schedule, response to boosters, of single protein carriers with single and multiple polysaccharides, of multiple protein carriers with multiple polysaccharides and conjugate vaccines administered concurrently with other vaccines are discussed along with undesirable consequences of conjugate vaccines. The clear benefits of conjugate vaccines in improving the protective responses of the immature immune systems of young infants and the senescent immune systems of the elderly have been made clear and opened the way to development of additional vaccines using this technology for future vaccine products. PMID:23955057
Full Text Available Mohammed A ZolalyDepartment of Pediatrics, College of Medicine, Taibah University, Al-Madinah Al-Munawarah, Kingdom of Saudi ArabiaBackground: The purpose of this study was to determine whether seizure susceptibility due to antihistamines is provoked in patients with febrile seizures.Methods: The current descriptive study was carried out from April 2009 to February 2011 in 250 infants and children who visited the Madinah Maternity and Children's Hospital as a result of febrile convulsions. They were divided into two groups according to administration of antihistamines at the onset of fever.Results: Detailed clinical manifestations were compared between patients with and without administration of antihistamines. The time from fever detection to seizure onset was significantly shorter in the antihistamine group than that in the nonantihistamine group, and the duration of seizures was significantly longer in the antihistamine group than in the nonantihistamine group. No significant difference was found in time from fever detection to seizure onset or seizure duration between patients who received a first-generation antihistamine and those who received a second-generation antihistamine.Conclusion: Due to their central nervous system effects, H1 antagonists should not be administered to patients with febrile seizures and epilepsy. Caution should be exercised regarding the use of histamine H1 antagonists in young infants, because these drugs could potentially disturb the anticonvulsive central histaminergic system.Keywords: antihistamine, nonantihistamine, histamine H1 antagonist, febrile seizures
Sahel, José-Alain; Marazova, Katia; Audo, Isabelle
Inherited retinal degenerations (IRDs) encompass a large group of clinically and genetically heterogeneous diseases that affect approximately 1 in 3000 people (>2 million people worldwide) (Bessant DA, Ali RR, Bhattacharya SS. 2001. Molecular genetics and prospects for therapy of the inherited retinal dystrophies. Curr Opin Genet Dev 11: 307-316.). IRDs may be inherited as Mendelian traits or through mitochondrial DNA, and may affect the entire retina (e.g., rod-cone dystrophy, also known as retinitis pigmentosa, cone dystrophy, cone-rod dystrophy, choroideremia, Usher syndrome, and Bardet-Bidel syndrome) or be restricted to the macula (e.g., Stargardt disease, Best disease, and Sorsby fundus dystrophy), ultimately leading to blindness. IRDs are a major cause of severe vision loss, with profound impact on patients and society. Although IRDs remain untreatable today, significant progress toward therapeutic strategies for IRDs has marked the past two decades. This progress has been based on better understanding of the pathophysiological pathways of these diseases and on technological advances.
K. Yu. Mukhin
Full Text Available Pseudo-Lennox syndrome (PLS, or atypical benign partial epilepsy of childhood, is a disease from a group of age-related epileptic encephalopathies with a phenomenon of continuous spike-wave activity during slow sleep, which manifests itself as frequent polymorphic focal motor and pseudogeneralized seizures, cognitive impairments, as well as regional and diffuse epileptiform activity on electroencephalogram (EEG by the morphology identical to that of benign epileptiform patterns of childhood. The disease was first described by J. Aicardi and J. J. Chevrie in 1982, based on a study of 7 cases. Its diagnostic complexity is the polymorphism of both epileptic seizures and EEG data, as well as low awareness of the syndrome among physicians and its absence in the international classification of epilepsies. The typical triad of seizures, which occurs in nearly 100 % of patients, encompasses focal motor paroxysms (identical to those as observed in Rolandic epilepsy, atypical absences, and atonic seizures. Seizures in PLS in its active period (generally up to 7–8 years are highly resistant to antiepileptic drugs. Only a few agents have been proven to be effective in PLS; these include valproates, succinimides, benzodiazepines, topiramate, and sulthiame. The frequency of seizures are noted to increase in patients with PLS treated with drugs, such as vigabatrin, gabapentin, lamotrigine, phenobarbital, or phenytoin. The author considers in detail the history of studies of the disease, clinical manifestations, diagnostic criteria, therapeutic approaches, and prognosis.
Chae Young Yeo
Full Text Available Purpose : Turner syndrome (TS is a disorder in which various anomalies can be accompanied, especially cardiovascular, renal, thyroid and auditory problems. The aim of this study is to identify the incidence of these disorders in patients with TS according to karyotype. Methods : We reviewed medical records of 90 patients with TS diagnosed by chromosomal analysis in 4 hospitals from Jan 1998 to Dec 2007. We evaluated these cases by prepared protocol of 4 medical problems. Results : The distribution of karyotype was 45,X (47.8%, mosaic pattern (34.4% and structural aberration group (17.8 %. Renal anomalies, cardiovascular anomalies, thyroid disorders and auditory problems are accompanied in 4.4%, 10.0 %, 11.1% and 5.6%, respectively. 45,X group had renal anomalies (7.0%, cardiovascular anomalies (18.6%, thyroid disorders (9.3% and auditory problems (11.6%. Mosaic group had renal anomalies (3.2%, thyroid disorders (12.9%, no cardiovascular anomalies and auditory problems. Structural aberration group had cardiovascular anomalies (6.3%, thyroid disorders (12.5% and no other 2 problems. Patients with 45,X group had a significant higher incidence of cardiovascular anomalies (P=0.025. Conclusion : Our results indicate that there are differences clinically according to karyotype of TS, especially in incidence of cardiovascular anomalies.
Full Text Available
The research goal is to determine clinical, endoscopic and morphological signs of chronic duodenitis in children. Materials and methods: The diagnostic value of molecular markers has been revealed by immunohistochemical research of biopsy. It has been received from endoscopic examination of 32 children aged from 3 to 17 years old with chronic duodenitis. Morphometric investigation of markers expression has been carried out by means of analyzing system of digital images of Mikrovizor medical uVizo-103. Results: The index of proliferation has been higher in cells of cover epithelium than in glands. The inductor expression of apoptosis Bax has been poorly expressed in both groups of patients. It has been proved that proliferative processes are predominant in this pathology. Conclusion: It has been found out that proliferation of significant activity in the cover epithelium accompanies the development of preatrophic processes in children with chronic duodenitis. The greater degree of regeneration has been marked in crypts.
Sahel, José-Alain; Marazova, Katia; Audo, Isabelle
Inherited retinal degenerations (IRDs) encompass a large group of clinically and genetically heterogeneous diseases that affect approximately 1 in 3000 people (>2 million people worldwide) (Bessant DA, Ali RR, Bhattacharya SS. 2001. Molecular genetics and prospects for therapy of the inherited retinal dystrophies. Curr Opin Genet Dev 11: 307-316.). IRDs may be inherited as Mendelian traits or through mitochondrial DNA, and may affect the entire retina (e.g., rod-cone dystrophy, also known as retinitis pigmentosa, cone dystrophy, cone-rod dystrophy, choroideremia, Usher syndrome, and Bardet-Bidel syndrome) or be restricted to the macula (e.g., Stargardt disease, Best disease, and Sorsby fundus dystrophy), ultimately leading to blindness. IRDs are a major cause of severe vision loss, with profound impact on patients and society. Although IRDs remain untreatable today, significant progress toward therapeutic strategies for IRDs has marked the past two decades. This progress has been based on better understanding of the pathophysiological pathways of these diseases and on technological advances. PMID:25324231
Both decreased insulin secretion and insulin resistance are two major factors of impaired glucose tolerance (IGT) in the elderly. Up to now, decreased lean body mass and relatively increased fat mass, so-called sarcopenia or sarcopenic obesity, contribute to insulin resistance in the elderly. However, recent reports indicate that muscle mitochondrial function is reduced in aging, and this age-associated decline in mitochondrial function contributes to insulin resistance in the elderly. In addition, exercise intervention to IGT in the elderly is more effective to reduce in the incidence of type 2 diabetes than in younger people. Exercise seems to improve insulin resistance through mitochondrial function by activating AMP-activated protein kinase(AMPK) and PPARgamma coactivator-1alpha (PGC-1alpha). Because cognitive impairment is a most crucial factor plunging into frailty in diabetic elderly, diabetic control would be very important in preventing cognitive decline as well as vascular events. However, comprehensive management of diabetes, including dyslipidemia and hypertension, might contribute to the prevention of declines in cognitive function in older diabetic patients. PMID:24397156
Renwick, Laoise; Stewart, Duncan; Richardson, Michelle; Lavelle, Mary; James, Karen; Hardy, Claire; Price, Owen; Bowers, Len
Aggression and violence are widespread in UK Mental Health Trusts, and are accompanied by negative psychological and physiological consequences for both staff and other patients. Patients who are younger, male, and have a history of substance use and psychosis diagnoses are more likely to display aggression; however, patient factors are not solely responsible for violence, and there are complex circumstances that lead to aggression. Indeed, patient-staff interactions lead to a sizeable portion of aggression and violence on inpatient units, thus they cannot be viewed without considering other forms of conflict and containment that occur before, during, and after the aggressive incident. For this reason, we examined sequences of aggressive incidents in conjunction with other conflict and containment methods used to explore whether there were particular profiles to aggressive incidents. In the present study, 522 adult psychiatric inpatients from 84 acute wards were recruited, and there were 1422 incidents of aggression (verbal, physical against objects, and physical). Cluster analysis revealed that aggressive incident sequences could be classified into four separate groups: solo aggression, aggression-rule breaking, aggression-medication, and aggression-containment. Contrary to our expectations, we did not find physical aggression dominant in the aggression-containment cluster, and while verbal aggression occurred primarily in solo aggression, physical aggression also occurred here. This indicates that the management of aggression is variable, and although some patient factors are linked with different clusters, these do not entirely explain the variation. PMID:26892149
Joint diabetes renal (JDR) clinics are recommended as the appropriate model of care to manage advanced diabetic-associated renal failure. We performed a retrospective review of clinical data and records of the first 60 patients who attended our service and their follow-up at 12 months.
Full Text Available Diabetes mellitus is a public health problem which leads to serious complications over time. Experimentally, many herbs have been recommended for treating diabetes. In most cases, however, the recommendations are based on animal studies and limited pieces of evidence exist about their clinical usefulness. This review focused on the herbs, the hypoglycemic actions of which have been supported by three or more clinical studies. The search was done in Google Scholar, Medline and Science Direct databases using the key terms diabetes, plants, herbs, glucose and patients. According to the clinical studies, Aegle marmelos, Allium cepa, Gymnema sylvestre, Momordica charantia, Ocimum sanctum, Nigella sativa, Ocimum sanctum, Panax quinquefolius, Salacia reticulate, Silybum marianum and Trigonella foenum-graecum have shown hypoglycemic and, in some cases, hypolipidemic activities in diabetic patients. Among them, Gymnema sylvestre, Momordica charantia, Silybum marianum and Trigonella foenum-graecum have acquired enough reputation for managing diabetes. Thus, it seems that physicians can rely on these herbs and advise for the patients to improve management of diabetes.
Tricarico, Pierfrancesco; Tardivo, Stefano; Sotgiu, Giovanni; Moretti, Francesca; Poletti, Piera; Fiore, Alberto; Monturano, Massimo; Mura, Ida; Privitera, Gaetano; Brusaferro, Silvio
Purpose - The European Union recommendations for patient safety calls for shared clinical risk management (CRM) safety standards able to guide organizations in CRM implementation. The purpose of this paper is to develop a self-evaluation tool to measure healthcare organization performance on CRM and guide improvements over time. Design/methodology/approach - A multi-step approach was implemented including: a systematic literature review; consensus meetings with an expert panel from eight Italian leader organizations to get to an agreement on the first version; field testing to test instrument feasibility and flexibility; Delphi strategy with a second expert panel for content validation and balanced scoring system development. Findings - The self-assessment tool - Clinical Assessment of Risk Management: an INtegrated Approach includes seven areas (governance, communication, knowledge and skills, safe environment, care processes, adverse event management, learning from experience) and 52 standards. Each standard is evaluated according to four performance levels: minimum; monitoring; outcomes; and improvement actions, which resulted in a feasible, flexible and valid instrument to be used throughout different organizations. Practical implications - This tool allows practitioners to assess their CRM activities compared to minimum levels, monitor performance, benchmarking with other institutions and spreading results to different stakeholders. Originality/value - The multi-step approach allowed us to identify core minimum CRM levels in a field where no consensus has been reached. Most standards may be easily adopted in other countries. PMID:27477931
Tricarico, Pierfrancesco; Tardivo, Stefano; Sotgiu, Giovanni; Moretti, Francesca; Poletti, Piera; Fiore, Alberto; Monturano, Massimo; Mura, Ida; Privitera, Gaetano; Brusaferro, Silvio
Purpose - The European Union recommendations for patient safety calls for shared clinical risk management (CRM) safety standards able to guide organizations in CRM implementation. The purpose of this paper is to develop a self-evaluation tool to measure healthcare organization performance on CRM and guide improvements over time. Design/methodology/approach - A multi-step approach was implemented including: a systematic literature review; consensus meetings with an expert panel from eight Italian leader organizations to get to an agreement on the first version; field testing to test instrument feasibility and flexibility; Delphi strategy with a second expert panel for content validation and balanced scoring system development. Findings - The self-assessment tool - Clinical Assessment of Risk Management: an INtegrated Approach includes seven areas (governance, communication, knowledge and skills, safe environment, care processes, adverse event management, learning from experience) and 52 standards. Each standard is evaluated according to four performance levels: minimum; monitoring; outcomes; and improvement actions, which resulted in a feasible, flexible and valid instrument to be used throughout different organizations. Practical implications - This tool allows practitioners to assess their CRM activities compared to minimum levels, monitor performance, benchmarking with other institutions and spreading results to different stakeholders. Originality/value - The multi-step approach allowed us to identify core minimum CRM levels in a field where no consensus has been reached. Most standards may be easily adopted in other countries.
To investigate the features of CT, ultrasonography and fundus fluorescein angiography(FFA) of morning glory syndrome, the data on CT, A/B-scan ultrasonography and fundus fluorescein angiography (FFA) were retrospectively analyzed in 8 cases of morning glory syndrome (MGS).Among those cases, 6 were examined with CT, 4 with FFA and 8 with A/B-scan ultrasonography.Results showed that the characteristics of CT, A/B-scan ultrasonography and FFA in MGS included:(1) The attachment spot of optic nerve became thin and vitreous body protruded to the posterior wall of eyeball with a spherical shape on CT image; (2) in the early period of FFA, hypofluorescence appeared on the optic, the abnormal arteriae and veins around the optic papilla were displayed clearly and in the late period, optic disc was stained with fluorescein; (3) on B-scan ultrasonogram, the vitreous cavity extended to the posterior pole and optic papilla, and projected to the basal part of muscle cones and thus the posterior part of vitreous cavity looked like an upside-down bottleneck. Sometimes the echogenic band of retinal detachment could also be seen. On A-scan ultrasonogram, both vitreous cavity and bottleneck showed no ultrasonic echoes and presented a base line without any evident wave crest. It is concluded that CT, A/B-scan ultrasonography and FFA could show the imageological features of MGS from different aspects, which helps clinicians to differentiate it from other diseases such as optic disc coloboma. CT and A/B-scan ultrasonography, in particular, are considered to be reliable imageological methods for the accurate diagnosis of MGS and are superior to the traditional techniques.
Adisasmita, Asri; Smith, Carl V; El-Mohandes, Ayman A E; Deviany, Poppy Elvira; Ryon, Judith J; Kiely, Michele; Rogers-Bloch, Quail; Gipson, Reginald F
This Indonesian study evaluates associations between near-miss status/death with maternal demographic, health care characteristics, and obstetrical complications, comparing results using retrospective and prospective data. The main outcome measures were obstetric conditions and socio-economic factors to predict near-miss/death. We abstracted all obstetric admissions (1,358 retrospective and 1,240 prospective) from two district hospitals in East Java, Indonesia between 4/1/2009 and 5/15/2010. Prospective data added socio-economic status, access to care and referral patterns. Reduced logistic models were constructed, and multivariate analyses used to assess association of risk variables to outcome. Using multivariate analysis, variables associated with risk of near-miss/death include postpartum hemorrhage (retrospective AOR 5.41, 95 % CI 2.64-11.08; prospective AOR 10.45, 95 % CI 5.59-19.52) and severe preeclampsia/eclampsia (retrospective AOR 1.94, 95 % CI 1.05-3.57; prospective AOR 3.26, 95 % CI 1.79-5.94). Associations with near-miss/death were seen for antepartum hemorrhage in retrospective data (AOR 9.34, 95 % CI 4.34-20.13), and prospectively for poverty (AOR 2.17, 95 % CI 1.33-3.54) and delivering outside the hospital (AOR 2.04, 95 % CI 1.08-3.82). Postpartum hemorrhage and severe preeclampsia/eclampsia are leading causes of near-miss/death in Indonesia. Poverty and delivery outside the hospital are significant risk factors. Prompt recognition of complications, timely referrals, standardized care protocols, prompt hospital triage, and structured provider education may reduce obstetric mortality and morbidity. Retrospective data were reliable, but prospective data provided valuable information about barriers to care and referral patterns. PMID:25656716
Kjellberg, S; Houltz, B K; Zetterström, O; Robinson, P D; Gustafsson, Per M
Suboptimal asthma control is common despite modern asthma therapy. The degree of peripheral airway involvement remains unclear and poor medication delivery to these regions might be a contributing reason for this failure in obtaining adequate symptom control. A cohort of 196 adults (median (range) age 44 (18-61) years, 109 females, 54 ex-smokers, six current smokers) with physician-diagnosed asthma were recruited from primary care. Subjects were characterized clinically by interviews, questionnaires, skin prick tests (SPT) and blood eosinophil counts. Lung function was assessed by spirometry, impulse oscillometry (IOS) and nitrogen multiple breath washout (N2 MBW). IOS assessed peripheral airway resistance (FDR, frequency dependence of resistance). N2 MBW assessed global ventilation inhomogeneity (LCI, lung clearance index), specific indices of peripheral airway function (Scond × VT and Sacin × VT; VT, tidal volume), and inter-regional inhomogeneity (specific ventilation ratio). Never-smoking healthy cohorts of 158 and 400 adult subjects provided local reference values for IOS and N2 MBW variables, respectively. Peripheral airway dysfunction was detected in 31% (FDR or specific ventilation ratio) to 47% (Scond x VT) of subjects. Risk factors for peripheral airway dysfunction were identified. Among subjects with low FEV1 and either positive smoking history and/or blood eosinophilia (>4.0%), 63% had abnormality across all peripheral airway outcomes, whilst only one subject was completely normal. Abnormal peripheral airway function was present in a large proportion of adult asthmatics at baseline. Reduced FEV1, a positive smoking history, and/or blood eosinophilia identified "a small airway asthma subtype" that might benefit from peripheral airway targeted therapy. PMID:27492518
information on clinical PET in oncology for nuclear medicine physicians, radiologists and clinical practitioners. Possible ideas for cost effectiveness of clinical PET in oncology are mentioned. The information is also intended to be useful in decision making to improve clinical management of cancer patients when allocating resources dedicated to the health care system. This is a critical issue that is important for the development of both clinical oncology and nuclear medicine in IAEA member states. The IAEA can be instrumental in the advancement of programmes which focus on the IAEA's coordinated research projects and technical cooperation project
Chen, Mu-Hong; Tsai, Shih-Jen
Panic disorder is commonly prevalent in the population, but the treatment response for panic disorder in clinical practice is much less effective than that in our imagination. Increasing evidence suggested existence of a chronic or remitting-relapsing clinical course in panic disorder. In this systematic review, we re-examine the definition of treatment-resistant panic disorder, and present the potential risk factors related to the treatment resistance, including the characteristics of panic disorder, other psychiatric and physical comorbidities, and psychosocial stresses. Furthermore, we summarize the potential pathophysiologies, such as genetic susceptibility, altered brain functioning, brain-derived neurotrophic factor, and long-term inflammation, to explain the treatment resistance. Finally, we conclude the current therapeutic strategies for treating treatment-resistant panic disorder from pharmacological and non-pharmacological views. PMID:26850787
Seyed Esmaeil Managheb
Full Text Available Compiling clinical guidelines is one of the requirements of family physician plan and classification of health care services.1 The high prevalence of type 2 diabetes can easily be seen in general practice so that 2.5% of referrals to general practitioners are due to diabetes. More than half of the patients with Type 2 diabetes are left undiagnosed and most of them suffer from its complications at the time of diagnosis. For example, 6.2% of patients suffer from diabetic retinopathy at the time of diagnosis.2 Most patients diagnosed with diabetes take more than one type of medication to treat the complications; about 60% take only oral medications, and 14 percent take oral medications and insulin.3 Although the principles of care for people with Type 2 diabetes is well known, there is a gap between the quality of care in general practice and optimal care so that up to 50% of patients’ condition are weakly controlled.4 Chronic care model for patients with chronic diseases explains the necessary measures to improve the care of people with chronic diseases. These elements include supporting disease management by the patients themselves, patient care, and support teams. Consultation and training are often done in general practice while it is usually a brief consultation about weight, medication or exercise. There is little evidence that mere printed texts are effective in controlling the disease. Extensive training programs are designed to develop self-management skills for diabetes control.4 The implementation of clinical guidelines in medical practice is a challenging task. But, a number of evidences have been shown to accelerate effective clinical guideline implementation and care improvement.5 Management of diabetes mellitus type 2 is shown in Figure 1.
Purpose/Objective: The course will be divided into three major topics: (1) Review of radiobiological principles as they apply to the radiotherapeutic management of skin carcinomas; (2) review of radiotherapeutic techniques including beam qualities, beam collimation, tissue dose profiles, and the relative indications of external beam irradiation vs. brachytherapy; (3) comprehensive review of the tumor biology of skin malignancies, including malignant melanoma, and of the relative indications for radiotherapeutic and/or surgical management. (1) Review of critical data which have led to currently applied principles of time-dose-volume concepts in the radiotherapeutic management of skin carcinomas. Emphasis will be placed on the relative importance of fraction size and overall treatment time on tumor control probability and acute and late normal tissue toxicity. (2) Considering that radiotherapy in the management of skin carcinomas is often used to minimize patient disfiguration and to preserve critical body functions (e.g. eye lids) the technical aspects of radiotherapy delivery are most critical. Careful evaluation of the extent of the lesions including evaluation of their depth of invasion will determine the quality of the radiation beams, orthovoltage and low energy electrons being the most useful. Beam harding for orthovoltage beams and secondary and tertiary (skin) collimation of appropriate electron beams are critical. For more extensive and deeply invasive lesions contour-shaping through customized bolus material is essential. Equally important is the familiarity with custom shielding of critical structures, such as eyes, ears, oral cavity and central nervous system structures. Brachytherapy applications in the treatment of skin carcinomas is limited but should be considered when implants with high dose uniformity can be constructed. (3) The discussion of clinical management will start with a discussion of properties and routes of spread of the diverse
Baelum, Vibeke; Hintze, Hanne; Wenzel, Ann;
in a low-caries population. METHODS: Each of four examiners independently examined preselected contacting interproximal surfaces in 53 dental students aged 20-37 years using a visual-tactile examination and bitewing radiography. The visual-tactile examination distinguished between noncavitated......OBJECTIVES: In clinical practice, a visual-tactile caries examination is frequently supplemented by bitewing radiography. This study evaluated strategies for combining visual-tactile and radiographic caries detection methods and determined their implications for clinical management decisions......-specificity) were calculated for each diagnostic strategy. RESULTS: Visual-tactile examination provided a true-positive rate of 34.2% and a false-positive rate of 1.5% for the detection of a cavity. The combination of a visual-tactile and a radiographic examination using the lesion in dentin threshold...
Clinical practice guidelines are key tools for the translation of scientific evidence into everyday patient care. Therefore guidelines can act as cornerstones of evidence based knowledge management in healthcare, if they are trustworthy, and its recommendations are not biased by authors' conflict of interests. Good medical guidelines should be disseminated by means of virtual (digital/electronic) health libraries - together with implementation tools in context, such as guideline based algorithms, check lists, patient information, a.s.f. The article presents evidence based medical knowledge management using the German experiences as an example. It discusses future steps establishing evidence based health care by means of combining patient data, evidence from medical science and patient care routine, together with feedback systems for healthcare providers. PMID:24326702
Grieve, A W; Davis, P; Dhillon, S; Richards, P; Hillebrandt, D; Imray, C H E
Frostbite is a thermal injury that can occur when temperatures drop low enough for tissue to freeze. On rewarming the tissues, an inflammatory process develops which is often associated with tissue loss. The extent of the tissue loss reflects the severity of the cold exposure and includes factors such as temperature, duration, wind chill, altitude, and systemic hypothermia. This review discusses the epidemiology, the pathophysiological processes involved, and the clinical management of frostbite injuries. Practical advice is given on both the field and hospital management and how to seek expert advice from remote situations. The review also discusses newer developments in frostbite treatment such as intra-vascular thrombolysis and adjunctive treatments such as the use of intravenous vasodilators. PMID:21465915
Clinical practice guidelines are key tools for the translation of scientific evidence into everyday patient care. Therefore guidelines can act as cornerstones of evidence based knowledge management in healthcare, if they are trustworthy, and its recommendations are not biased by authors' conflict of interests. Good medical guidelines should be disseminated by means of virtual (digital/electronic) health libraries - together with implementation tools in context, such as guideline based algorithms, check lists, patient information, a.s.f. The article presents evidence based medical knowledge management using the German experiences as an example. It discusses future steps establishing evidence based health care by means of combining patient data, evidence from medical science and patient care routine, together with feedback systems for healthcare providers.
Garzon, Alba C
The implementation of management systems in accordance with standards like ISO 9001:2008 (1,2) in the clinical laboratories has conferred and added value of reliability and therefore a very significant input to patient safety. As we know the ISO 9001:2008 (1) a certification standard, and ISO 15189:2012 (2) an accreditation standard, both, at the time have generated institutional memory where they have been implemented, the transformation of culture focused on correct execution, control and following, evidence needed and the importance of register.
Many types of dental abnormality can be observed in the anterior sectors, where they can cause genuine esthetic problems for our patients. While conventional prosthetic treatments offer the best solutions in terms of esthetic result and durability, they involve the sacrifice of significant quantities of mineralized dental material and cannot be undertaken before the periodontal tissues are mature. Other less invasive alternatives should be envisaged as transitional, or sometimes even permanent, solutions for the management of these anomalies in children and adolescents. This article discusses these options and presents a clinical case where composite resin veneers and microabrasion of the enamel were used to treat dental agenesis and enamel dysplasia. PMID:27498052
Cassiano Kuchenbecker Rösing
Full Text Available Halitosis is an unpleasant condition that causes social restraint. Studies worldwide indicate a high prevalence of moderate halitosis, whereas severe cases are restricted to around 5% of the populations. The etiological chain of halitosis relates to the presence of odoriferous substances in exhaled air, especially the volatile sulphur compounds (VSC produced by bacteria. The organoleptic diagnosis is the gold standard and clinical management includes oral approaches, especially periodontal treatment and oral hygiene instructions, including the tongue. When oral strategies are not successful, referral to physicians is warranted.
The implementation of management systems in accordance with standards like ISO 9001:2008 (1,2) in the clinical laboratories has conferred and added value of reliability and therefore a very significant input to patient safety. As we know the ISO 9001:2008 (1) a certification standard, and ISO 15189:2012 (2) an accreditation standard, both, at the time have generated institutional memory where they have been implemented, the transformation of culture focused on correct execution, control and following, evidence needed and the importance of register. PMID:27683495
Garzon, Alba C
The implementation of management systems in accordance with standards like ISO 9001:2008 (1,2) in the clinical laboratories has conferred and added value of reliability and therefore a very significant input to patient safety. As we know the ISO 9001:2008 (1) a certification standard, and ISO 15189:2012 (2) an accreditation standard, both, at the time have generated institutional memory where they have been implemented, the transformation of culture focused on correct execution, control and following, evidence needed and the importance of register. PMID:27683495
Singhal, Rajni; Brimble, K Scott
Patients with the nephrotic syndrome are at increased risk of developing venous and arterial thromboembolism, the most common of which is renal vein thrombosis. There are several unanswered or controversial issues relating to the nephrotic syndrome and thromboembolism, which include the mechanism of thromboembolism, and optimal diagnostic and anticoagulant management strategies. This review will discuss several of these issues: the epidemiology and clinical spectrum of thromboembolic disease occurring in patients with the nephrotic syndrome; the pathophysiology of the hypercoagulable state associated with the nephrotic syndrome; the diagnosis of renal vein thrombosis in the nephrotic syndrome; and the evidence for prophylactic and therapeutic anticoagulation strategies in such patients.
Full Text Available INTRODUCTION Hashimoto’s Thyroiditis is a well-known clinical condition affecting the thyroid gland predominantly in women during 4 th decade & is often under diagnosed due its wide spectrum of clinical features. It could present as a multinodular goitre, diffuse goitre, or as a solitary nodule with features of Hypothyroidism, Hyperthyroidism or Euthyroid state. AIMS 1. To detect HT by FNAC, Antibody titers finally by Histopathology of excised Thyroid gland. 2. To know its various clinical features. 3. To study Sex ratio & Age it affects. 4. Management i.e. by conservative or surgical. 5. Complications & malignant transformation including Lymphomas. MATERIALS & METHODS 60 patients were taken for 2 years’ period from March 2014 to Feb 2016 attending Government General Hospital-Nizamabad; Telangana State. OBSERVATIONS 56 case are females, 4 cases are males; common age is 30-39 yrs., >50 yrs.-2 cases. All cases presented with swelling in front of neck, only 5 had toxicity, 2 had obstructive symptoms. None had voice change. 36 Cases- 60% had MNG, 18 Cases- 30% diffuse goitre and 6 cases- 10%- solitary nodule. The Hypothyroid, Euthyroid & Hyperthyroid state here are 48%, 44% & 8% comparative to Fenn et al -44%, 47% and 7%, FNAC- was positive 90% here where as Lakshman Rao et al study has 77%. We had 80% Anti Thyroid Antibodies positivity, others shown 63% and 84%. MANAGEMENT All are put on Hormone-Thyroxine replacement or suppression therapy and all patients found to be clinically Euthyroid during follow up. All patients showed decrease in size of gland except those with MNG. 8 patients underwent surgery- Subtotal Thyroidectomy. Of these 6 were Colloid goiters, later on diagnosed as HT by final HPE. One case was operated for cosmetic reason and the other for obstructive symptoms which was noticed to be lymphoma after HPE.
Karen L. Hanson
Full Text Available Informationists at NYU Health Sciences Libraries (NYUHSL successfully applied for a NLM supplement to a translational research grant obtained by PIs in the NYU School of Medicine Department of Otolaryngology titled, “Clinical Management of Cochlear Implant Patients with Contralateral Hearing Aids”. The grant involves development of evidence-based guidelines for post-implant management of patients with bimodal cochlear implants. The PIs are also seeking to acquire new data sets to merge with grant-generated data. In light of the shifting data requirements, and the potential introduction of additional datasets, informationists will evaluate and restructure the data model and data entry tool. Report queries will be refined for the new data model and options for a query tool appropriate for users unfamiliar with query languages will be assessed and implemented. The services offered through this supplement represent the deepest and most detailed data management support offered by NYUHSL to date. The components of the supplement are being analyzed as a pilot of a broader offering of these data management services.
Walter W. Virkus
displaced bimalleolar fracture in insulin dependant middle aged woman; Man-agement of calcaneal fractures; Fixation technic for a displaced talar neck fracture in a patient in ER; Indica-tions for surgical treatment of metatarsal fractures; Bone grafting in acute fractures; Management of a nonunion of plated midshaft tibia fracture; Management of a child with a twisted ankle and normal x-rays; Assessment of com-partment syndrome in foot.The Section III is about “GENERAL FRACTURE CARE” including: Management of multiple orthopedic injuries and damage control orthopedics; Bone stimula-tion in nonunion; Indications for locking plates; Fractures requiring anatomic reduction.AUDIENCE: Mainly trauma fellows and practicing or-thopedists are the targeted audience of the book, but not only the basic knowledge for the orthopedic residents but also the expert advices for complicated and controversial cases pointing experienced surgeons widen the spectrum of audience. Also non-physician personnel may benefit the basic knowledge from brief answers given in a casual format.ASSESMENT: “Curbside Consultation in Fracture Man-agement:49 Clinical Questions” offering practical, brief, evidence based answers to frequently asked questions especially those have been often left controversial related with the treatment of fractures of upper and lower extrem-ity, pelvic fractures is a useful resource mainly for resi-dents, fellows and junior orthopedists. Casual format that mimics a “curbside” dialog of colleagues and also the rich illustrations by images and diagrams makes the advanced knowledge in the text easier to understand and learn. Questions are carefully chosen from a wide spectrum of subjects related to fracture management to form a unique reference including high and low energy trauma fractures, pediatric fractures, fractures in elderly, multiple orthope-dic injury, and general fracture care. Assessment of frac-tures and diagnostic approach, postoperative care and
Pacheco, José Márcio da Cunha; Gomes, Romeu
This paper analyses the decision making process for senior management in public hospitals that are a part of the National Health Service in Brazil (hereafter SUS) in relation to projects aimed at changing clinical management. The methodological design of this study is qualitative in nature taking a hermeneutics-dialectics perspective in terms of results. Hospital directors noted that clinical management projects changed the state of hospitals through: improving their organizations, mobilizing their staff in order to increase a sense of order and systemizing actions and available resources. Technical rationality was the principal basis used in the decision making process for managers. Due to the reality of many hospitals having fragmented organizations, this fact impeded the use of aspects related to rationality, such as economic and financial factors in the decision making process. The incremental model and general politics also play a role in this area. We concluded that the decision making process embraces a large array of factors including rational aspects such as the use of management techniques and the ability to analyze, interpret and summarize. It also incorporates subjective elements such as how to select values and dealing with people's working experiences. We recognized that management problems are wide in scope, ambiguous, complex and do not come with a lot of structure in practice. PMID:27557021
Pacheco, José Márcio da Cunha; Gomes, Romeu
This paper analyses the decision making process for senior management in public hospitals that are a part of the National Health Service in Brazil (hereafter SUS) in relation to projects aimed at changing clinical management. The methodological design of this study is qualitative in nature taking a hermeneutics-dialectics perspective in terms of results. Hospital directors noted that clinical management projects changed the state of hospitals through: improving their organizations, mobilizing their staff in order to increase a sense of order and systemizing actions and available resources. Technical rationality was the principal basis used in the decision making process for managers. Due to the reality of many hospitals having fragmented organizations, this fact impeded the use of aspects related to rationality, such as economic and financial factors in the decision making process. The incremental model and general politics also play a role in this area. We concluded that the decision making process embraces a large array of factors including rational aspects such as the use of management techniques and the ability to analyze, interpret and summarize. It also incorporates subjective elements such as how to select values and dealing with people's working experiences. We recognized that management problems are wide in scope, ambiguous, complex and do not come with a lot of structure in practice.
The term masked hypertension phenomenon was first described by the late Professor Thomas Pickering and is commonly defined as having a normal clinic blood pressure (BP) but an elevated "out of office" reading. In the main these elevated readings have been provided through ambulatory blood pressure monitoring (ABPM) but sometimes home BP monitoring is used. It is now largely accepted that ABPM gives a better classification of risk than clinic BP. Thus the elevated ABPM levels should relate to higher cardiovascular risk and it follows that these people might be regarded as being genuinely hypertensive and at higher cardiovascular risk. The problem for clinical practice is how to identify and manage these subjects. The phenomenon should be suspected in subjects who have had an elevated clinic BP at some time, in young subjects with normal or normal-high clinic BP who have early left ventricular hypertrophy, in subjects with a family history of hypertension in both parents, patients with multiple risks for cardiovascular disease and perhaps diabetic patients. It appears to be more prevalent in subjects of male gender, with younger age, higher heart rate, obesity or high cholesterol levels and in smokers. Those with masked hypertension are at higher risk of events such as stroke and have a higher prevalence of target organ damage, for example, nephropathy. In conclusion most of the debate around this topic relates to its reliable identification. Given the higher ambulatory readings there is an increases cardiovascular risk making this diagnosis important. This article is protected by copyright. All rights reserved.
San-Jun Cai; Ye Xu; Guo-Xiang Cai; Peng Lian; Zu-Qing Guan; Shan-Jing Mo; Meng-Hong Sun; Qi Cai; Da-Ren Shi
AIM: To study the clinical characteristics of hereditarynonpolyposis colorectal cancer (HNPCC) in the Chinesepopulation and discuss the identification and managementof the patients with HNPCC.METHODS: A series of 140 patients with colorectal cancers(CRC) and HNPCC associated tumors from 30 families fulfillingthe Amsterdam criteria were analyzed.RESULTS: A total of 118 patients had CRC. Average age atdiagnosis of the first CRC was 45.7 years, 56.8 % and 23.4 %of the first CRC were located proximal to the splenic flexureand in the rectum respectively. Twenty-three (19.5 %) hadsynchronous and metachronous CRC. Twenty-seven patientswere found to have extracolonic tumors. Gastric carcinomawas the most common tumor type in our series (44.4 %).CONCLUSION: The frequency of HNPCC was 2.6 % in ourseries of patients. The main features are an excess of earlyonset with a propensity to involve the proximal colon, andhigh frequency of multiple foci. Management and surveillancefor these patients should be different from sporadic CRC.Contrary to American and European reports, gastric cancerseems more frequent than endometrial cancer in Chinese.It is necessary to formulate a new HNPCC criterion forChinese patients.
Amorin-Woods Lyndon G
Full Text Available Abstract Background A definitive diagnosis in chiropractic clinical practice is frequently elusive, yet decisions around management are still necessary. Often, a clinical impression is made after the exclusion of serious illness or injury, and care provided within the context of diagnostic uncertainty. Rather than focussing on labelling the condition, the clinician may choose to develop a defendable management plan since the response to treatment often clarifies the diagnosis. Discussion This paper explores the concept and elements of defensive problem-solving practice, with a view to developing a model of agile, pragmatic decision-making amenable to real-world application. A theoretical framework that reflects the elements of this approach will be offered in order to validate the potential of a so called '3-Questions Model'; Summary Clinical decision-making is considered to be a key characteristic of any modern healthcare practitioner. It is, thus, prudent for chiropractors to re-visit the concept of defensible practice with a view to facilitate capable clinical decision-making and competent patient examination skills. In turn, the perception of competence and trustworthiness of chiropractors within the wider healthcare community helps integration of chiropractic services into broader healthcare settings.
There are a large number of ideas concerning the systematization of clinical laboratory management. Therefore many types of laboratory systems have been constructed. As our hospital is not large, we adopted a small scale laboratory system. In introducing it, we expected not only an increase in value-added labor productivity by automating laboratory tests, but also an improvement in technologist's cost awareness. Consequently, new system equipment has itself performed the former in many sections, but not the latter. Improvement in cost awareness was caused by the technologist's routine work in managing reagent and material stocks. We found that this soft-type systematization has been more important than the advanced hard-type system.
Wanderer, Jonathan P; Ehrenfeld, Jesse M
Clinical decision support (CDS) systems are being used to optimize the increasingly complex care that our health care system delivers. These systems have become increasingly important in the delivery of perioperative care for patients undergoing cardiac, thoracic, and vascular procedures. The adoption of perioperative information management systems (PIMS) has allowed these technologies to enter the operating room and support the clinical work flow of anesthesiologists and operational processes. Constructing effective CDS systems necessitates an understanding of operative work flow and technical considerations as well as achieving integration with existing information systems. In this review, we describe published examples of CDS for PIMS, including support for cardiopulmonary bypass separation physiological alarms, β-blocker guideline adherence, enhanced revenue capture for arterial line placement, and detection of hemodynamic monitoring gaps. Although these and other areas are amenable to CDS systems, the challenges of latency and data reliability represent fundamental limitations on the potential application of these tools to specific types of clinical issues. Ultimately, we expect that CDS will remain an important tool in our efforts to optimize the quality of care delivered.
Full Text Available Johannes Schiefer,1,* Cornelius J Werner,1,* Kathrin Reetz1,2 1Euregional Huntington Center, 2Jülich Aachen Research Alliance (JARA – Translational Brain Medicine, Department of Neurology, RWTH Aachen University, Aachen, Germany *These authors contributed equally to this work Abstract: This review focuses on clinical diagnosis and both pharmacological and nonpharmacological therapeutic options in early stages of the autosomal dominant inherited neurodegenerative Huntington's disease (HD. The available literature has been reviewed for motor, cognitive, and psychiatric alterations, which are the three major symptom domains of this devastating progressive disease. From a clinical point of view, one has to be aware that the HD phenotype can vary highly across individuals and during the course of the disease. Also, symptoms in juvenile HD can differ substantially from those with adult-onset of HD. Although there is no cure of HD and management is limited, motor and psychiatric symptoms often respond to pharmacotherapy, and nonpharmacological approaches as well as supportive care are essential. International treatment recommendations based on study results, critical statements, and expert opinions have been included. This review is restricted to symptomatic and supportive approaches since all attempts to establish a cure for the disease or modifying therapies have failed so far. Keywords: Neurodegeneration, clinical picture, early symptoms, therapy, treatment
Nanavati, R N; Mondkar, J A; Fernandez, A R; Raghavan, K R
Supportive breastfeeding policies in the hospital constitute the foundation for initiation of successful breastfeeding by mothers, constant reinforcement and support to all lactating mothers is however essential to maintain lactation. The objective, methodology and outcome of the Lactation Management Clinic which constitutes a hospital-based mother support group is described. The study was carried out over a period of 2 1/2 years and 519 mothers had attended this clinic. Analysis of the data revealed that at the time of the 1st visit to the clinic, 65.9% mothers had already started supplementary top feeds and the commonest reason encountered was mother's own assessment of inadequate milk seen in 73.6% mothers. Two-thirds (66.9%) of babies in our study were roomed in right from the first day of life, 75.3% of babies had received colostrum and 67.1% babies had not received any prelacteal feeds and yet faced problems at lactation. Mother and infant evaluation revealed no complications with 86.5% mothers and with 54.5% babies. Local breast problems were detected in 19.3% mothers. Faulty positioning was observed in 47.2% patients. Psychological support to mothers was the most important form of therapy given. Seventy eight per cent mothers practiced exclusive breastfeeding subsequently while 21.2% of mothers were partially successful in lactation. Only 3 mothers had lactation failure.
Full Text Available Abstract Background The National Comprehensive Cancer Network clinical practice guidelines in oncology-gastric cancer guidelines have been widely used to provide appropriate recommendations for the treatment of patients with gastric cancer. The aim of this study was to examine the adherence of surgical oncologists, medical oncologists, and radiation oncologists' to the recommended guidelines. Methods A questionnaire asking the treatment options for gastric cancer cases was sent to 394 Chinese oncology specialists, including surgical oncologists, medical oncologists, and radiation oncologists working in hospitals joined in The Western Cooperative Gastrointestinal Oncology Group of China. The questionnaire involved a series of clinical scenarios regarding the interpretation of surgery, neoadjuvant, adjuvant, and advanced treatment planning of gastric cancer. Results Analysis of 358 respondents (91% showed variations between each specialization and from the recommended guidelines in the management approaches to specific clinical scenarios. The majority of specialists admitted that less than 50% of patients received multidisciplinary evaluation before treatment. The participants gave different responses to questions involving adjuvant, neoadjuvant, and advanced settings, compared to the recommended guidelines. Conclusions These results highlight the heterogeneity of the treatment of gastric cancer. Surgical oncologists, medical oncologists, and radiation oncologists are not adhering to the recommended guidelines.
Landry, Bradford W; Fischer, Philip R; Driscoll, Sherilyn W; Koch, Krista M; Harbeck-Weber, Cynthia; Mack, Kenneth J; Wilder, Robert T; Bauer, Brent A; Brandenburg, Joline E
Chronic pain in children and adolescents can be difficult for a single provider to manage in a busy clinical setting. Part of this difficulty is that pediatric chronic pain not only impacts the child but also the families of these children. In this review article, we discuss etiology and pathophysiology of chronic pain, along with variables that impact the severity of chronic pain and functional loss. We review diagnosis and management of selected chronic pain conditions in pediatric patients, including headache, low back pain, hypermobility, chronic fatigue, postural orthostatic tachycardia syndrome, abdominal pain, fibromyalgia, and complex regional pain syndrome. For each condition, we create a road map that contains therapy prescriptions, exercise recommendations, and variables that may influence pain severity. Potential medications for these pain conditions and associated symptoms are reviewed. A multidisciplinary approach for managing children with these conditions, including pediatric pain rehabilitation programs, is emphasized. Lastly, we discuss psychological factors and interventions for pediatric chronic pain and potential complementary and alternative natural products and interventions. PMID:26568508
Schöbel, Martin; Stäubert, Sebastian; Löbe, Matthias; Meinel, Kirsti; Winter, Alfred
As a part of the introduction of a Clinical Trial Management System (CTMS) for an Academic Site Management Organization (SMO) we had to determine the requirements such a system has to meet. By performing extensive Requirements Engineering, we aimed at raising the success of the future system and the user satisfaction. Investigations revealed the existence of TORE (Task and Object-oriented Requirements Engineering), a task-driven approach for determining requirements on user interface- and information-intensive systems. In this paper, we present an adoption of this method for our purposes, resulting in a reasonable list of requirements for CTMS acquisition. PMID:27577390
Schöbel, Martin; Stäubert, Sebastian; Löbe, Matthias; Meinel, Kirsti; Winter, Alfred
As a part of the introduction of a Clinical Trial Management System (CTMS) for an Academic Site Management Organization (SMO) we had to determine the requirements such a system has to meet. By performing extensive Requirements Engineering, we aimed at raising the success of the future system and the user satisfaction. Investigations revealed the existence of TORE (Task and Object-oriented Requirements Engineering), a task-driven approach for determining requirements on user interface- and information-intensive systems. In this paper, we present an adoption of this method for our purposes, resulting in a reasonable list of requirements for CTMS acquisition.
Efsen, Anne Marie; Schultze, Anna; Post, Frank;
INTRODUCTION: Rates of both TB/HIV co-infection and multi-drug-resistant (MDR) TB are increasing in Eastern Europe (EE). Data on the clinical management of TB/HIV co-infected patients are scarce. Our aim was to study the clinical characteristics of TB/HIV patients in Europe and Latin America (LA...
Full Text Available Roger A Goldberg,1,2 Sabri Raza,1 Eric Walford,1 William J Feuer,1 Jeffrey L Goldberg1,3 1Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA; 2Tufts-New England Eye Center/Ophthalmic Consultants of Boston, Boston, MA, USA; 3Shiley Eye Center, University of California San Diego, San Diego, CA, USA Purpose: To review the patient and clinical characteristics of patients with Fuchs endothelial corneal dystrophy (FECD. Methods: Review of records for every patient who presented to the Bascom Palmer Eye Institute between 2003 and 2009 whose visit was coded for endothelial corneal dystrophy (International Classification of Diseases, Ninth Revision [ICD9] 371.57, bullous keratopathy (ICD9 371.23, or who underwent a corneal surgery with or without cataract extraction. Demographic, clinical, and ancillary testing data were collected from the time of presentation, diagnosis, and follow-up, and the use, timing, and type of surgical interventions was documented, with 6-month and final visual acuities recorded. Results: A total of 2,370 charts were included in this study, of which 966 patients had a diagnosis of FECD. Of these, 197 patients (21% received a corneal transplantation procedure. The surgery most often performed was penetrating keratoplasty with or without cataract extraction (66%, followed by endothelial keratoplasty with or without cataract extraction (34%. The risk factors for surgery include worse visual acuity at presentation (20/60 Snellen visual acuity in surgical patients versus 20/40 Snellen visual acuity in nonsurgical patients, P<0.001, greater average central corneal thickness (635 µm versus 592 µm, P<0.001, loss of visual acuity over time (two lines lost versus zero lines lost, P<0.001, increasing age (P<0.001, and male sex (P=0.008. Over half of patients (52% did not receive surgery despite poor vision. Conclusion: During this time period, FECD did not have a consistent pattern for management or treatment, and despite
Rosenbaum, Brooke E; Freitas, Derek; Nosal, Sarah C; Meydani, Ahou
An understanding of the burden of skin disease in the uninsured population is needed to address the unique barriers they face to access dermatologic care. We conducted a retrospective chart review of patients seen for skin conditions over three years at the New York City (NYC) Free Clinic, a weekly primary care clinic operated by the NYU School of Medicine and the Institute for Family Health. Main outcomes of this study were descriptive analyses of demographic characteristics, diagnoses, management strategies, and referral outcomes, as well as key factors influencing referral to a dermatologist and referral attendance. Diagnosis was a significant predictor of referral (ptravel distance had no significant association with non-attendance. While demand for dermatologic care by uninsured patients in NYC is high, referral non-attendance remains a substantial barrier to care. PMID:27180711
Jespersen, Kristina Risom; Bysted, Rune
’ characteristics are what lead to successful implementation of NPD. Managers’ characteristics affect the decision outcome. This study incorporates curiosity as a personal trait and NPD experience as a personal characteristic of the manager as moderating effects of the strategy implementation process of NPD. 131...... NPD managers of Scandinavia SBUs participated in the study. Data were analysed sing partial least squares regression. The study finds that managers influence the realised NPD strategy. NPD managers impose competence traps on strategy implementation. Curious NPD managers implementing aggressive...... identified inadequately developed information competences among NPD managers. The result shows the importance of analysing how personal characteristics facilitate or hinder NPD strategy implementation. The competitive advantage of NPD efforts relies on such an analysis....
Bae, Soon Ook; Lee, Gang Pyo; Seo, Han Gil; Oh, Byung-Mo; Han, Tai Ryoon
Objective To evaluate demographic characteristics of children with suspected dysphagia who underwent videofluoroscopic swallowing study (VFSS) and to identify factors related to penetration or aspiration. Methods Medical records of 352 children (197 boys, 155 girls) with suspected dysphagia who were referred for VFSS were reviewed retrospectively. Clinical characteristics and VFSS findings were analyzed using univariate and multivariate analyses. Results Almost half of the subjects (n=175, 49...
Aim: Our aim was to identify the characteristics of the patient that performed upper gastrointestinal endoscopy in a new established endoscopy unit of a state hospital. We want to present the spectrum of gastrointestinal diseases in our hospitals region. Material and Method: We analyzed patients upper endoscopy results according to age, sex, complaints, clinical characteristics, type of anesthesia, and the necessity of biopsy. We reviewed 256 patients data between 2013 December-2014 July. All...
CB Mithun; Paul T Antony; Christina M Mariaselvam; Vir S Negi
AimThe aim of this study was to determine the clinical characteristics and prevalence of HLA B27 in patients with psoriatic arthritis presenting to a tertiary care centre in South India. BackgroundAlthough the prevalence of psoriasis is high in India, there is paucity of data, especially on Ps A. Materials and methodsThis retrospective study included 141 patients satisfying the ClASsification criteria for Ps A (CASPAR). Demographic, clinical, and laboratory data of the patients were collected...
Han, Seung Chul; Kim, Man-Deuk; Jung, Dae Chul; Lee, Myungsu; Lee, Mu Sook; Park, Sung Il; Won, Jong Yun; Lee, Do Yun; Lee, Kwang Hun
Purpose Imaging features and clinical characteristics of degenerated leiomyoma in patients referred for uterine fibroid embolization (UFE) were analyzed to assess the incidence of degenerated leiomyoma. Materials and Methods Patients referred for UFE between 2008 and 2009 were retrospectively analyzed (n=276). Patients ranged in age from 27 to 51 years (mean 38.0 years). All patients underwent screening MRI with contrast enhancement. Medical histories and clinical symptoms were evaluated. Res...
Seyedeh Hajar Shahrami; Zahra Abbasi Ranjbar; Forozan Milani; Ehsan Kezem-Nejad; Afagh Hassanzadeh Rad; Seyedeh Fatemeh Dalil Heirat
Critical issue regarding to variation of findings based on different phenotypes led investigators to define whether they are distinct features or overlapping ones. Therefore, we aimed to investigate the association between diverse phenotypes of PCOS (Poly Cystic Ovary Syndrome) with clinical manifestations, anthropometric indices, and metabolic characteristics. This was a descriptive cross-sectional study conducted in 15-39 years old women with PCOS referred to infertility clinics in the nort...
T. Ch. Ogwueleka
Municipal solid waste management has emerged as one of the greatest challenges facing environmental protection agencies in developing countries. This study presents the current solid waste management practices and problems in Nigeria. Solid waste management is characterized by inefficient collection methods, insufficient coverage of the collection system and improper disposal. The waste density ranged from 280 to 370 kg/m3 and the waste generation rates ranged from 0.44 to 0.66 kg/capita/day....
Full Text Available Basapogu Sreeramulu,1 Naragani DVN Shyam,2 Pilla Ajay,1 Pathipaka Suman1 1Department of Prosthodontics, 2Department of Oral Pathology, Government Dental College and Hospital, Hyderabad, Telangana State, India Abstract: Papillon–Lefèvre syndrome (PLS is a rare autosomal recessive disorder, characterized by diffuse palmoplantar keratoderma and precocious aggressive periodontitis, leading to premature loss of deciduous and permanent dentition at a very young age. Various etiopathogenic factors are associated with the syndrome, like immunologic alterations, genetic mutations, and the role of bacteria. Dentists play a significant role in the diagnosis and management of PLS as there are characteristic manifestations like periodontal destruction at an early age and an early eruption of permanent teeth. Here, we are presenting an elaborate review of PLS, its etiopathogenesis, clinical presentation, and management options. Keywords: deciduous and permanent dentition, modified complete dentures, palmoplantar keratoderma, periodontitis
Rimo, Alexandra; Panbunyuen, Podjaman
This study investigates the effect of company characteristics on the working capital management. We employed quantitative method to examine the relationship between company characteristics and the cash conversion cycle as a measure of working capital management in Swedish listed companies. The company characteristics include profitability, operating cash flow, company size, sale growth, current ratio and debt ratio. The sample consists of 40 companies in the large cap investment segment liste...
O’Keefe, Maree; Wade, Victoria; McAllister, Sue; Stupans, Ieva; Miller, Jennifer; Burgess, Teresa; LeCouteur, Amanda; Starr, Linda
Background The aim of this project was to explore the process of change in a busy community dental clinic following a team development intervention designed to improve the management of student supervision during clinical placements. Methods An action research model was used. Seven members of a community dental clinic team (three dentists, two dental therapists, one dental assistant and the clinic manager), together with the university clinical placement supervisor participated in the team de...
Purpose/Objective: The course will be divided into three major topics: (1) Review of radiobiological principles as they apply to the radiotherapeutic management of skin carcinomas; (2) review of radiotherapeutic techniques including beam qualities, beam collimation, tissue dose profiles, and the relative indications of external beam irradiation vs. brachytherapy; (3) comprehensive review of the tumor biology of skin malignancies, including malignant melanoma, and of the relative indications for radiotherapeutic and/or surgical management. (1) Review of critical data which have lead to currently applied principles of time-dose-volume concepts in the radiotherapeutic management of skin carcinomas. Emphasis will be placed on the relative importance of fraction size and overall treatment time on tumor control probability and acute and late normal tissue toxicity. (2) Considering that radiotherapy in the management of skin carcinomas is often used to minimize patient disfiguration and to preserve critical body functions (e.g. eye lids) the technical aspects of radiotherapy delivery are most critical. Careful evaluation of the extent of the lesions including evaluation of their depth of invasion will determine the quality of the radiation beams, orthovoltage and low energy electrons being the most useful. Beam harding for orthovoltage beams and secondary and tertiary (skin) collimation of appropriate electron beams are critical. For more extensive and deeply invasive lesions contour-shaping through customized bolus material is essential. Equally important is the familiarity with custom shielding of critical structures, such as eyes, ears, oral cavity and central nervous system structures. Brachytherapy applications in the treatment of skin carcinomas is limited but should be considered when implants with high dose uniformity can be constructed. (3) The discussion of clinical management will start with a discussion of tumor biological properties of the diverse malignant
Full Text Available Lead poisoning is a historic universal disease. Acute or chronic lead exposure may cause reversible or even permanent damages in human beings. Environmental lead exposure is a global health concern in children. Occupational lead poisoning is still a health issue, particularly in developing countries. During the last decades, new methods and medications have been advocated for the prevention and treatment of lead poisoning. This review deals mainly with recent developments in the management of lead poisoning. Sources of lead exposure are introduced, and methods for the primary prevention of lead poisoning are discussed. Details for the screening of adults and children are also explained to serve as a practical guideline for the secondary prevention. Standard chelation therapy in different groups and up-to-date less toxic new medications for the treatment of lead poisoning are finally discussed. Our published clinical research on the therapeutic effects of garlic tablets in mild to moderate occupational lead poisoning will also be discussed.
Nur Azah Hamzaid
Full Text Available This paper addressed student perceptions and opinion of the problem based learning method, as well as the empirically collected data on students' learning outcomes on a Biomedical Engineering course, i.e. Management and Clinical Engineering. Pure lecture delivery with absence of practical intervention was deemed insufficient to provide appropriate means to achieve the course objectives. Therefore, a Mock Company assignment was introduced in this course as a problem based learning application aimed to aid the achievement of the program outcome while improving the attainment of the course objectives. The students were divided into groups to form individual mock company. Each mock company formed their organization post for each member, and came up with a business plan for a new project to be presented for fund approval by the panels, made up of the course instructors and invited lecturers from the clinical engineering industry and hospital practitioners. The company discussion progress and performance were monitored by the instructors through the formal university e- learning platform throughout the semester with occasional response and suggestions. The panels identified the expected lack of business and management knowledge but this was counteracted by the reasonably successful business plan produced independently by all companies’ At the end of the semester, through questionnaires, 69.6% of the 56 students agreed that this mock company assignment was useful in achieving the course objectives and should be conducted in the following years. Students who performed weakly in this assignment also demonstrated lower performance in all evaluations including by traditional means (p = 0.01, although there were no direct associations amongst the problem-based and the traditional evaluations (r <0.66. The students’ responses also reflected their readiness to perform more independent learning approaches, despite them expressing the lack of clear scope
Full Text Available Amena SadiyaLifestyle Clinic, Rashid Centre for Diabetes and Research, Ministry of Health, Ajman, United Arab EmiratesAbstract: Diabetic gastroparesis (DGP, or slow emptying of the stomach, is a well-established complication of diabetes mellitus and is typically considered to occur in individuals with long-standing type 1 and type 2 diabetes mellitus. Clinical consequences of DGP include induction of gastrointestinal (GI symptoms (early satiety, abdominal distension, reflux, stomach spasm, postprandial nausea, vomiting, alteration in drug absorption, and destabilization of glycemic control (due to mismatched postprandial glycemic and insulin peaks. Effective nutritional management not only helps in alleviating the symptoms, but also in facilitating better glycemic control. Although there have been no evidence-based guidelines pertaining to the nutrition care process of the DGP, the current dietary recommendations are based on expert opinions or observational studies. The dietary management of gastroparesis needs to be tailored according to the severity of malnutrition and kind of upper GI symptom by changing the volume, consistency, frequency, fiber, fat, and carbohydrates in the meal. Small frequent meals, using more liquid calories, reducing high fat or high fiber, consuming bezoar forming foods, and adjusting meal carbohydrates based on medications or insulin helps in improving the upper GI symptoms and glycemic control. Enteral nutrition can be an option for patients who fail to stabilize their weight loss, or for those who cannot gain weight with oral feedings, while total parenteral nutrition is rarely necessary for the patient with gastroparesis.Keywords: diabetic gastroparesis, delayed gastric emptying, diabetes mellitus, bezoar, GI symptoms, glycemic control
Full Text Available Asthma is the most common chronic disease affecting children in industrialized countries but it is greatly underdiagnosed in preschool children. In these patients, who are not able to collaborate in the execution of spirometry tests, it is possible to use interrupter resistance (Rint technique. The aim of our study is to assess Rint utility in asthma management when integrated with clinical evaluation in preschool children. Data from 35 preschool children with recurrent wheezing and/or cough were collected. Case history, physical examination, in vitro and in vivo allergy testing were investigated. According to the presence or absence of symptoms in intercritical period they were divided into two groups, asymptomatic (A and symptomatic (B. To assess respiratory function we used baseline and post-bronchodilator Rint. In group A (asymptomatic baseline Rint was normal in 78,9% of children and increased in 21,1%. After bronchodilator (BD administration there was a significant response in 52,6% of patients. In group B (symptomatic baseline Rint was normal in 81,3% of children and increased in 18,7%. After bronchodilator administration there was a significant response in 56,3% of patients. Our results confirm that baseline Rint cannot be used to discriminate between healthy and sick children, therefore it is necessary to perform this test after administration of BD. In our patients, a significant response to BD permitted to objectify the discomfort of symptomatic children and to report a state of subclinical bronchial obstruction and/or bad perceptions of the severity of bronchospasm in asymptomatic ones, allowing to confirm previous therapeutic choices in some cases and to suggest different therapeutic strategies in others. Therefore, bronchodilator response measured by Rint should be systematically studied and further assessed in conjunction with clinical outcomes, in order to implement asthma management in children unable to produce reliable
Ohmann, Christian; Kuchinke, Wolfgang; Canham, Steve;
A recent survey has shown that data management in clinical trials performed by academic trial units still faces many difficulties (e.g. heterogeneity of software products, deficits in quality management, limited human and financial resources and the complexity of running a local computer centre...... a standard specifying the requirements for high quality GCP-compliant data management in multinational clinical trials....
Plochg, T.; Arah, O.A.; Botje, D.; Thompson, C.A.; Klazinga, N.S.; Wagner, C.; Mannion, R.; Lombarts, K.
Objective: Clinical management is hypothesized to be critical for hospital management and hospital performance. The aims of this study were to develop and validate professional involvement scales for measuring the level of clinical management by physicians and nurses in European hospitals. Design: T
Kikuchi, Masao; Wickman, Larysa; Hodgin, Jeffrey B; Wiggins, Roger C
Chronic kidney disease culminating in end-stage kidney disease is a major public health problem costing in excess of $40 billion per year with high morbidity and mortality. Current tools for glomerular disease monitoring lack precision and contribute to poor outcome. The podocyte depletion hypothesis describes the major mechanisms underlying the progression of glomerular diseases, which are responsible for more than 80% of cases of end-stage kidney disease. The question arises of whether this new knowledge can be used to improve outcomes and reduce costs. Podocytes have unique characteristics that make them an attractive monitoring tool. Methodologies for estimating podocyte number, size, density, glomerular volume and other parameters in routine kidney biopsies, and the rate of podocyte detachment from glomeruli into urine (podometrics) now have been developed and validated. They potentially fill important gaps in the glomerular disease monitoring toolbox. The application of these tools to glomerular disease groups shows good correlation with outcome, although data validating their use for individual decision making is not yet available. Given the urgency of the clinical problem, we argue that the time has come to focus on testing these tools for application to individualized clinical decision making toward more effective progression prevention.
Nivesh H Sewlall
Full Text Available In 2008 a nosocomial outbreak of five cases of viral hemorrhagic fever due to a novel arenavirus, Lujo virus, occurred in Johannesburg, South Africa. Lujo virus is only the second pathogenic arenavirus, after Lassa virus, to be recognized in Africa and the first in over 40 years. Because of the remote, resource-poor, and often politically unstable regions where Lassa fever and other viral hemorrhagic fevers typically occur, there have been few opportunities to undertake in-depth study of their clinical manifestations, transmission dynamics, pathogenesis, or response to treatment options typically available in industrialized countries.We describe the clinical features of five cases of Lujo hemorrhagic fever and summarize their clinical management, as well as providing additional epidemiologic detail regarding the 2008 outbreak. Illness typically began with the abrupt onset of fever, malaise, headache, and myalgias followed successively by sore throat, chest pain, gastrointestinal symptoms, rash, minor hemorrhage, subconjunctival injection, and neck and facial swelling over the first week of illness. No major hemorrhage was noted. Neurological signs were sometimes seen in the late stages. Shock and multi-organ system failure, often with evidence of disseminated intravascular coagulopathy, ensued in the second week, with death in four of the five cases. Distinctive treatment components of the one surviving patient included rapid commencement of the antiviral drug ribavirin and administration of HMG-CoA reductase inhibitors (statins, N-acetylcysteine, and recombinant factor VIIa.Lujo virus causes a clinical syndrome remarkably similar to Lassa fever. Considering the high case-fatality and significant logistical impediments to controlled treatment efficacy trials for viral hemorrhagic fever, it is both logical and ethical to explore the use of the various compounds used in the treatment of the surviving case reported here in future outbreaks
Hammoudeh, Mohammed; Al Rayes, Hanan; Gado, Kamel; Shirazy, Khalid; Deodhar, Atul
Data on spondyloarthritis (SpA) from the Middle East are sparse and the management of these diseases in this area of the world faces a number of challenges, including the relevant resources to enable early diagnosis and referral and sufficient funds to aid the most appropriate treatment strategy. The objective was to report on the characteristics, disease burden, and treatment of SpA in the Middle East region and to highlight where management strategies could be improved, with the overall aim of achieving better patient outcomes. This multicenter, observational, cross-sectional study collected demographic, clinical, laboratory, and treatment data on 169 consecutive SpA patients at four centers (Egypt, Kuwait, Qatar, and Saudi Arabia). The data collected presents the average time from symptom onset to diagnosis along with the presence of comorbidities in the region and comparisons between treatment with NSAIDs and biologics. In the absence of regional registries of SpA patients, the data presented here provide a rare snapshot of the characteristics, disease burden, and treatment of these patients, highlighting the management challenges in the region. PMID:26793241
Kornecki, A.; Daneman, A.; Navarro, O.; Connolly, B.; Manson, D.; Alton, D.J. [Toronto Univ., ON (Canada); Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, ON (Canada)
Background. To analyze the spectrum of clinical features, management and outcome of children with documented spontaneous reduction of intussusception (SROI). Materials and methods. Review of records of 50 children (33 boys, 17 girls; age range 11 days-15 years; mean age 4 years) with documented SROI, in whom intussusception was initially diagnosed by sonography (US) in 44, air enema in 2, and computed tomography in 4, in the 6-year period 1992-1998. Results. Symptoms suggestive of intussusception were present in 21 (3 of whom had Henoch-Schoenlein purpura and 4 had previous ileocolic intussusception reduced by air enema). Intussusception was an incidental finding in the other 29, in 28 of whom the finding was in the small bowel. Intussusception was limited to the small bowel in 43 and was ileocolic in 7. SROI was usually documented on US. Laparotomy performed in only 4 showed no evidence of intussusception or pathologic lead point. Outcome in all patients was favorable. Conclusions. SROI may present in symptomatic or asymptomatic children and occurs more commonly than previously reported. These intussusceptions are usually short-segment, small-bowel intussusceptions with no recognizable lead point. In asymptomatic patients, conservative observation is warranted. Intervention should be dictated by the clinical findings in symptomatic patients. (orig.)
Berg, Jonathan S; Potocki, Lorraine; Bacino, Carlos A
Details on the phenotypic consequences of genomic microdeletions and microduplications are rapidly emerging in the wake of increased utilization of high-resolution methods for the detection of genomic copy number variants (CNVs). Due to their recent discovery, the complete phenotypic characterization of these syndromes is still in progress. For practicing clinicians, this unprecedented molecular diagnostic capability has in many cases outpaced our ability to convey conclusive information regarding these conditions to patients and family members. In particular, genomic microduplication syndromes are frequently associated with variable phenotypes and incomplete penetrance, leading to difficulty in counseling regarding the potential future consequences of a given microduplication. In this review, we have attempted to provide an initial set of recommendations for the management of patients with recurrent microduplication syndromes. We summarize the clinical information for microduplications of 14 different genomic regions and provide a framework for clinical evaluation and anticipatory guidance in these conditions. It is our expectation that these preliminary guidelines will be revised further for each microduplication syndrome as more information becomes available.
Full Text Available Nasopharyngeal tuberculosis (NPTB is a noteworthy disease especially in its worldwide spread of the Mycobacterium infection. Although NPTB has been identified in less than one percent of TB cases, recent multiple case reports indicate an either increased awareness or incidence of this disease. The most helpful diagnostic tool is an uncomplicated nasopharyngeal biopsy. However, NPTB is usually ignored because it has varied clinical manifestations and similar presentations with other more common head and neck diseases. Furthermore, the most common presenting symptom is cervical lymphadenopathy mimicking nasopharyngeal carcinoma, a more common and serious disease. Treatment outcomes of NPTB are good in both HIV-positive or HIV-negative patients. In addition, pulmonary tuberculosis association was reported in wide range between 8.3% and 82% which should be considered in a treatment program. In conclusion, early diagnosis and management in NPTB can be achieved by (1 increased awareness of this disease, (2 improvement in knowledge regarding clinical manifestations, and (3 improvement of diagnostic techniques.
Quetglas, Iris M; Moeini, Agrin; Pinyol, Roser; Llovet, Josep M
Molecular profiling of hepatocellular carcinoma (HCC) is enabling the advancement of novel approaches to disease diagnosis and management. Accurate prognosis prediction in HCC is specially critical. Clinical staging systems for HCC support clinical decision-making (e.g., BCLC algorithm) might be complemented by molecular-based information in the near future. Molecular signatures derived from tumour and non-tumour samples are associated with patient recurrence an outcome. Single nucleotide polymorphisms have been linked with HCC development. Next generation sequencing studies have brought to light the genomic diversity of this disease. Gens recurrently altered in HCC and susceptible to be targeted belong to signalling pathways including telomere maintenance, cell cycle, chromatin remodelling, Wnt/beta-catenin, RAS/RAF/MAPK and PI3K/AKT/mTOR pathways. Oncogenic loops are unknown but might include some of the already discovered aberrations. Despite the intratumoral heterogeneity observed in HCC tumours, studies including large number of samples can identify key genetic drivers and contribute to the development of novel treatments and a personalized medicine. PMID:25260311
Diabetic gastroparesis (DGP), or slow emptying of the stomach, is a well-established complication of diabetes mellitus and is typically considered to occur in individuals with long-standing type 1 and type 2 diabetes mellitus. Clinical consequences of DGP include induction of gastrointestinal (GI) symptoms (early satiety, abdominal distension, reflux, stomach spasm, postprandial nausea, vomiting), alteration in drug absorption, and destabilization of glycemic control (due to mismatched postprandial glycemic and insulin peaks). Effective nutritional management not only helps in alleviating the symptoms, but also in facilitating better glycemic control. Although there have been no evidence-based guidelines pertaining to the nutrition care process of the DGP, the current dietary recommendations are based on expert opinions or observational studies. The dietary management of gastroparesis needs to be tailored according to the severity of malnutrition and kind of upper GI symptom by changing the volume, consistency, frequency, fiber, fat, and carbohydrates in the meal. Small frequent meals, using more liquid calories, reducing high fat or high fiber, consuming bezoar forming foods, and adjusting meal carbohydrates based on medications or insulin helps in improving the upper GI symptoms and glycemic control. Enteral nutrition can be an option for patients who fail to stabilize their weight loss, or for those who cannot gain weight with oral feedings, while total parenteral nutrition is rarely necessary for the patient with gastroparesis.
Diabetic gastroparesis (DGP), or slow emptying of the stomach, is a well-established complication of diabetes mellitus and is typically considered to occur in individuals with long-standing type 1 and type 2 diabetes mellitus. Clinical consequences of DGP include induction of gastrointestinal (GI) symptoms (early satiety, abdominal distension, reflux, stomach spasm, postprandial nausea, vomiting), alteration in drug absorption, and destabilization of glycemic control (due to mismatched postprandial glycemic and insulin peaks). Effective nutritional management not only helps in alleviating the symptoms, but also in facilitating better glycemic control. Although there have been no evidence-based guidelines pertaining to the nutrition care process of the DGP, the current dietary recommendations are based on expert opinions or observational studies. The dietary management of gastroparesis needs to be tailored according to the severity of malnutrition and kind of upper GI symptom by changing the volume, consistency, frequency, fiber, fat, and carbohydrates in the meal. Small frequent meals, using more liquid calories, reducing high fat or high fiber, consuming bezoar forming foods, and adjusting meal carbohydrates based on medications or insulin helps in improving the upper GI symptoms and glycemic control. Enteral nutrition can be an option for patients who fail to stabilize their weight loss, or for those who cannot gain weight with oral feedings, while total parenteral nutrition is rarely necessary for the patient with gastroparesis. PMID:23055757
Full Text Available Abstract Background Clinical risk management (CRM plays a crucial role in enabling hospitals to identify, contain, and manage risks related to patient safety. So far, no instruments are available to measure and monitor the level of implementation of CRM. Therefore, our objective was to develop an instrument for assessing CRM in hospitals. Methods The instrument was developed based on a literature review, which identified key elements of CRM. These elements were then discussed with a panel of patient safety experts. A theoretical model was used to describe the level to which CRM elements have been implemented within the organization. Interviews with CRM practitioners and a pilot evaluation were conducted to revise the instrument. The first nationwide application of the instrument (138 participating Swiss hospitals was complemented by in-depth interviews with 25 CRM practitioners in selected hospitals, for validation purposes. Results The monitoring instrument consists of 28 main questions organized in three sections: 1 Implementation and organizational integration of CRM, 2 Strategic objectives and operational implementation of CRM at hospital level, and 3 Overview of CRM in different services. The instrument is available in four languages (English, German, French, and Italian. It allows hospitals to gather comprehensive and systematic data on their CRM practice and to identify areas for further improvement. Conclusions We have developed an instrument for assessing development stages of CRM in hospitals that should be feasible for a continuous monitoring of developments in this important area of patient safety.
Full Text Available Nazema Y Siddiqui, Autumn L EdenfieldDivision of Urogynecology and Reconstructive Surgery, Duke University Medical Center, Durham, NC, USAAbstract: Pelvic organ prolapse is highly prevalent, and negatively affects a woman’s quality of life. Women with bothersome prolapse may be offered pessary management or may choose to undergo corrective surgery. In choosing the most appropriate surgical procedure, there are many factors to consider. These may include the location(s of anatomic defects, the severity of prolapse symptoms, the activity level of the woman, and concerns regarding the durability of the repair. In many instances, women and their surgeons are challenged to weigh the risks and benefits of native tissue versus mesh-augmented repairs. Though mesh-augmented repairs may offer better durability, they are also associated with unique complications, such as mesh erosion. Furthermore, newer surgical techniques of mesh placement via abdominal or vaginal routes may result in different outcomes compared to traditional techniques. Biologic grafts may also be considered to improve durability of a surgical repair, while avoiding potential complications of synthetic mesh. In this article, we review many of the clinical challenges that gynecologic surgeons face in the surgical management of vaginal prolapse. Furthermore, we review data that can help guide decision making when treating women with pelvic organ prolapse.Keywords: pelvic organ prolapse, vaginal prolapse, surgery, sacrocolpopexy, sacrospinous ligament fixation, transvaginal mesh, uterosacral ligament suspension
Full Text Available ABSTRACT: BACKGROUND: Incisional hernia, by definition represents a breakdown or loss of continuity of a fascial closure. Surgical management of incision al hernias has evolved over the last century. This study was performed to review clinical profile and management of incisional hernia in our institute. AIMS AND OBJECTIVES: To analyze the etiopathogenesis of incisional hernia with respect to patient variab le factors, types of surgical intervention. MATERIALS AND METHODS: This a prospective study conducted at our institute between February 2009 and January 2011(24 months. 100 patients were included and followed up for immediate post - operative complications. OBSERVATIONS AND RESULTS: Incisional hernia was found to occur more often in 31 - 40yr age group,and mostly in females. Most commonly occurred following gynecological operations, lower abdominal incisions, post operative wound infection. Most patients notic ed the incisional hernia only 1 to 5 years after the index surgery. Laparoscopic hernioplasty was the most commonly performed surgery. CONCLUSION: In Incisional hernias the choice of operative technique is crucial Incisional hernias occur more often in fem ales as they are more likely to undergo lower abdominal surgeries. Mesh repair is considered superior to anatomical repair alone and we recommend Laparoscopic Hernioplasty as the first line of treatment. KEYWORDS : Incisional hernia, ventral hernia, post op erative hernia, mesh repair,Laparoscopic Hernioplasty
O'Connor, Ayrn; Ruha, Anne-Michelle
Bark scorpion envenomation is potentially life threatening in children and traditionally treated with antivenom (AV). We sought to describe the clinical course, management, complications and outcome of children with severe scorpion envenomation treated with supportive care during a period when AV was unavailable. A retrospective chart review was performed, all children presenting to a referral hospital between September 1, 2004 and July 31, 2006 with severe scorpion envenomation not receiving AV, were included. A standardized data abstraction form was used to record time of symptom onset, time to healthcare facility (HCF), clinical findings, treatment, complications, and length of stay. Eighty-eight patients were included with mean age of 3.7 years (0.33-12). Mean time to symptom onset was 20 min (0-130) and mean time to HCF was 79 min (10-240). Incidence of clinical manifestations include: neuromuscular agitation, 100 %; opsoclonus, 97 %; hypersalivation, 81 %; tachycardia, 82 %; hypertension, 49 %; vomiting, 38 %; fever, 28 %; respiratory distress, 33 %; and hypoxia, 18 %. Complications included rhabdomyolysis in 18 (20 %) and aspiration in 12 (13 %) patients. Intubation was required in 24 % of patients. The most frequently used agents to control symptoms were benzodiazepines (98 %) followed by opioids (69 %). Intravenous fluids were given to 84 %. Mean length of stay was 29 h (range, 6-73 h). There were no deaths. In addition to the classic findings of neuromuscular hyperactivity, opsoclonus, and hypersalivation, a high incidence of hyperadrenergic findings and respiratory compromise are noted in this series. A significant number of patients required mechanical ventilation. Benzodiazpines and opioids were the most common medications used to control symptoms. PMID:22562239
Objective To investigate the incidence of gastroenteropancreatic neuroendocrine neoplasm(GEP-NEN) in Chengdu City in 2010 and summarize clinical characteristics of GEP-NEN. Methods The incidence of GEP-NEN was estimated with the data in 2010 from the
Narges Karimi; Athena Sharifi; Ashraf Zarvani; Hamed Cheraghmakani
Context: Chronic inflammatory demyelinating polyradiculopathy (CIDP) is an acquired and autoimmune neuropathy, characterized by a chronic, rapidly progressive, symmetric weakness. In children, abnormal gait is as a first symptom of muscle weakness. Evidence Acquisition: The diagnosis of CIDP is on the basis of clinical characteristics, electrodiagnostic that shows the severity of the disease, lumbar puncture and spine magnetic res...
Nguyen, Ly; Arganza, Girlyn F.; Huang, Larke N.; Liao, Qinghong; Nguyen, Hoang T.; Santiago, Rolando
This study examined the psychiatric diagnoses and clinical characteristics of the 981 Asian American children enrolled in the first phase of the Comprehensive Community Mental Health Services for Children and Their Families Program. Asian Americans were less likely than non-Asian Americans to receive diagnoses of depression and ADHD and more…
Yang, P.; Zhang, Z.; Zhou, H.; Li, B.; Huang, X.; Gao, Y.; Zhu, L.; Ren, Y.; Klooster, J.; Kijlstra, A.
Purpose: To address the clinical pattern and characteristics of uveitis in a tertiary center for uveitis in China and compare the similarity and difference in the distribution of uveitis entities between China and other countries. Methods: A retrospective study was performed on the patients with uve
Velkers, F C; van de Graaf-Bloois, L; Wagenaar, J A; Westendorp, S T; van Bergen, M A P; Dwars, R M; Landman, W J M; Wagenaar, Jaap
BACKGROUND: Enterococcus hirae-associated endocarditis, characterized by a peak in mortality during the second week of the grow-out, and occasionally lameness, was diagnosed at Dutch broiler farms. OBJECTIVES: Field cases were studied to increase knowledge on clinical and pathological characteristic
Velkers, F.C.; Graaf-Blois, Van de L.; Wagenaar, J.A.; Westendorp, S.T.; Bergen, Van M.A.P.; Dwars, R.M.; Landman, W.J.M.
Background: Enterococcus hirae-associated endocarditis, characterized by a peak in mortality during the second week of the grow-out, and occasionally lameness, was diagnosed at Dutch broiler farms. Objectives: Field cases were studied to increase knowledge on clinical and pathological characteristic
Objective To investigate the drug resistance of My-coplasma pneumoniae among children with community-acquired pneumonia (CAP) ,and to explore the clinical and radiological characteristics of and the role of azithromycin in the treatment of of macrolide-resistant (MR) Mycoplasma pneumoniae pneumonia.Methods Cases of CAP in children (n=179) were prospectively enrolled in
Objective To explore the clinical characteristics of pulse wave velocity,arterial compliance and cardiovascular risk factors in elderly patients with type 2 diabetes mellitus.Methods A total of 363 patients were selected and divided into 4 groups:diabetic group,diabetic
Migliaccio, Americo A.; Halmagyi, G. Michael; McGarvie, Leigh A.; Cremer, Phillip D.
We report four patients with the syndrome of cerebellar ataxia with bilateral vestibulopathy (CABV) and, using search coil oculography, we validate its characteristic clinical sign, namely impairment of the visually enhanced vestibulo-ocular reflex (VVOR) or doll's head reflex. In our four patients, CABV began in the sixth decade of life; they are…
Objective To investigate the clinical characteristics,peripheral insulin sensitivity,andβ-cell function in patients with ketosis-prone diabetes(KPD).Methods Thirty-one patients with newly diagnosed ketosis-prone diabetes were admitted to West China Hospital from January2004 to December 2009.They were divided into 2 groups according to
Richmond, Bert O.; And Others
Administered the Clinical Analysis Questionnaire and the What I Think and Feel test to 159 male prisoners. Participants reported low levels of anxiety and an absence of debilitating personality characteristics, suggesting the absence of a criminal personality that is a separate and distinct type of personality. (JAC)
Maarbjerg, Stine; Wolfram, Frauke; Gozalov, Aydin;
and severe NVC. METHODS: Clinical characteristics were prospectively collected from consecutive TN patients using semi-structured interviews in a cross-sectional study design. We evaluated 3.0 Tesla MRI blinded to the symptomatic side. RESULTS: We included 135 TN patients. Severe NVC was more prevalent...
Miller, J L
Organized and efficient systems that are responsive to the needs of the medical group, hospital and management services organization are at the heart of successful integrated healthcare systems. Unfortunately, selecting the right systems solution can be a time-consuming and difficult process, at best. The problems are many. First, not all management services organizations look alike. Some are limited in scope and function. Others offer an expansive menu of services to the participating groups and physicians. Second, the level of sophistication of clinic or MSO personnel evaluating systems varies. Often, hospital systems personnel with little experience in the practice management arena are assigned the job of evaluating practice systems. Third, the budget for a data processing system may be limited. The process of forming an MSO and organizing a group without walls may be very expensive. Unless adequate budgeting is done in advance, only limited funds may be left for investment in systems. Lastly, identifying viable systems which are available can be an arduous undertaking. Literally, hundreds of possible systems are available. Unfortunately, few sources offer comprehensive information on each system suitable for proper evaluation. This has led many organizations to strategically design and develop their own physician network solutions and options using such applications as 4th generation data base language. According to Mick Bassell of Partners in HealthCare, a systems consulting group in San Rafael, CA., "a request for proposal process is usually the best way to identify systems that meet the group's needs, weaknesses and strengths. This should be done before vendors are asked to supply information about various computer systems. Developing a good RFP is a building process for both the MSO and group which will help them to jointly identify, organize and prioritize system requirements."
Farias, Michael; Jenkins, Kathy; Lock, James; Rathod, Rahul; Newburger, Jane; Bates, David W.; Safran, Dana G.; Friedman, Kevin; Greenberg, Josh
Variability in medical practice in the United States leads to higher costs without achieving better patient outcomes. Clinical practice guidelines, which are intended to reduce variation and improve care, have several drawbacks that limit the extent of buy-in by clinicians. In contrast, standardized clinical assessment and management plans (SCAMPs) offer a clinician-designed approach to promoting care standardization that accommodates patients’ individual differences, respects providers’ clinical acumen, and keeps pace with the rapid growth of medical knowledge. Since early 2009 more than 12,000 patients have been enrolled in forty-nine SCAMPs in nine states and Washington, D.C. In one example, a SCAMP was credited with increasing clinicians’ rate of compliance with a recommended specialist referral for children from 19.6 percent to 75 percent. In another example, SCAMPs were associated with an 11–51 percent decrease in total medical expenses for six conditions when compared with a historical cohort. Innovative tools such as SCAMPs should be carefully examined by policy makers searching for methods to promote the delivery of high-quality, cost-effective care. PMID:23650325
To investigate the difference of biochemical characteristics on gsp-positive and gsp-negative growth hormone (GH)-secreting pituitary tumors, 18 GH-secreting pituitary tumors were examined for their clinical characteristics and gsp oncogenes. All patients received the pituitary function combinative stimulating test. It was found that there were no difference in the sex, age, tumor size, course of disease and plasma basal GH levels with gsp- positive and gsp-negative patients. The plasma levels of PRL were increased in most patients (11/18), and the plasma levels of TSH in gsp-positive patients were higher than those in gsp-negative patients (P<0.05). There was no significant difference in the responses to pituitary combinative stimulating test in gsp-positive and gsp-negative patients. It was concluded that there was little difference in the clinical biochemical characteristics of gsp-positive with gsp-negative GH-secreting pituitary tumors.
Sorbye, Halfdan; Pfeiffer, Per; Cavalli-Björkman, Nina;
oncological consideration at 3 hospitals in Scandinavia covering defined populations were registered consecutively during 2003 to 2006. Clinical trial enrollment, patient characteristics, and treatment were recorded prospectively, and the follow-up was complete. RESULTS: Palliative chemotherapy was initiated...... was then only 2.1 months. The median survival for all 760 nonresectable mCRC patients was 10.7 months. CONCLUSIONS: mCRC patients enrolled into clinical trials differ in characteristics from patients receiving chemotherapy outside protocol and have better survival, even when given the same treatment. Although......BACKGROUND: Trial accrual patterns were examined to determine whether metastatic colorectal cancer (mCRC) patients enrolled in trials are representative of a general cancer population concerning patient characteristics and survival. METHODS: A total of 760 mCRC patients referred for their first...
Todisco, Gabriele; Manshouri, Taghi; Verstovsek, Srdan; Masarova, Lucia; Pierce, Sherry A; Keating, Michael J; Estrov, Zeev
Chronic lymphocytic leukemia (CLL) and myeloproliferative neoplasms (MPN) may occur concomitantly. However, little is known about the pathobiological characteristics and interaction between the neoplastic clones in these rare cases of coinciding malignancies. We retrospectively examined the clinical and biological characteristics of 13 patients with concomitant CLL and MPN--eight primary myelofibrosis (PMF), three essential thrombocytosis (ET), and two polycythemia vera (PV)--who presented to our institution between 1998 and 2014, and tested all patients for MPN-specific aberrations, such as JAK2, MPL and CALR mutations. Along with epidemiological and molecular characterization of this rare condition, we found that JAK2 mutation can be detected 9 years prior to PMF diagnosis, suggesting that PMF clinical phenotype may require several years to develop and CLL/MPN clinical co-occurrence might be sustained by common molecular events. Some features of these patients suggest that pathobiologies of these diseases might be intertwined. PMID:26402369
Tiago Machado Guerreiro
Full Text Available Restless legs syndrome (RLS is a neurological disorder that responds to dopaminergic drugs, indicating a common pathophysiology with Parkinson's disease (PD. The prevalence of RLS was estimated in a group of PD patients and its clinical and biochemical characteristics were analysed. Forty-eight patients with PD were evaluated into two groups, with and without RLS. Clinical characteristics assessed in both groups were age, gender, duration of PD, Hoehn and Yahr, and Schwab and England scales. Laboratory variables such as hemoglobin, s-iron, s-ferritin and creatinine were obtained. The prevalence of RLS was 18.75%. No significant differences regarding clinical variables and biochemical parameters were observed. The high prevalence of RLS found in PD patients suggests the concept of a common etiological link and it seems that secondary causes did not play a central role in the pathophysiology of RLS in this group of parkinsonian patients.
Jaan Sidorov; Franz Joseph Fisher; Sabrina Girolami; Otto Wolke
Objective: To describe the cost savings achieved in a health maintenance organization (HMO)-sponsored primary care-based case management and disease management programs. Methods: The HMO-sponsored programs recruited patients in the primary care setting and relied on clinical guidelines and HMO-employed patient education nurses and case management nurses. Total per member per month (PMPM) charges for medical services and changes in selected clinical outcomes before and after entry into HMO-spo...
Chang, Sho-Fang; Hsieh, Ping-Jung; Chen, Hui-Fang
The study explores the perceptions of physicians and hospital managers regarding the key success factors (KSFs) of a clinical knowledge management system (CKMS). It aims to eliminate the perception gap and gain more insights for a successful CKMS.A survey was conducted in four medical centers in Taiwan. A total of 340 questionnaires, including 15 for hospital managers and 70 for physicians in each hospital, were administered. The effective response rates are 78.3% and 56.1% respectively. Partial least square (PLS) were used to analyze the data.The results identified six KSFs of CKMS including system software and hardware, knowledge quality, system quality, organizational factors, user satisfaction, and policy factors. User satisfaction and policy factors have direct effects on perceived CKMS performance. Knowledge quality is regarded as an antecedent to user satisfaction, while system quality is the antecedent to both user satisfaction and policy factors. System software and hardware was supported only by managers, and organizational factors were supported only by physicians.Among the factors, this study highlighted the policy factor. Besides, the study provides hospital managers additional insights into physician requirements for organizational support. Third, more physician participation and involvement are recommended when introducing and developing a CKMS. PMID:26444813
Tao Wang; Wei Huang; Yong Zhang
Background:Both lower urinary tract dysfunction and urinary symptoms are prevalent in patients with multiple sclerosis (MS).Although the significance of identifying and treating urinary symptoms in MS is currently well-known,there is no information about the real prevalence and therapeutic effect of urinary symptoms in patients with MS.The purpose of this study was to analyze the major symptoms and urodynamic abnormalities,and observe the therapeutic effect in different MS characteristics.Methods:We enrolled 126 patients with urological dysfunction who were recruited between July 2008 and January 2015 in Beijing Tian Tan Hospital,Capital Medical University and conducted overactive bladder system score (OABSS),urodynamic investigation,and expanded disability status scale (EDSS).Changes of urinary symptoms and urodynamic parameters were investigated.Results:Urgency was the predominant urinary symptom,and detrusor overactivity was the major bladder dysfunction.There was a positive correlation between EDSS and OABSS.Clinically isolated syndrome (CIS) had lowest EDSS and OABSS.CIS exhibited significant improvements in OABSS,maximum urinary flow rate (Qmax),and bladder volume at the first desire to voiding and maximum bladder volume after the treatment (P ＜ 0.05).Relapsing-remitting MS showed significant improvements in the OABSS,Qmax,and bladder volume at the first desire to voiding,maximum bladder volume and bladder compliance after the treatment (P ＜ 0.05).Progressive MS exhibited significant increase in the bladder volume at the first desire to voiding,the detrusor pressure at maximum flow rate (PdetQmax),and bladder compliance after the treatment (P ＜ 0.05).Conclusions:Urodynamic parameters examined are important in providing an accurate diagnosis,guiding management decisions of MS.Early and effective treatment may improve the bladder function and the quality of life at the early stages of MS.
Very few studies from Pakistan have examined the profile of patients seen by psychiatrists in general hospital. The aim of this research is to describe the clinical and demographic characteristics of patients referred to the psychiatric unit of a general hospital over a one year period. Methods: This cross-sectional study was conducted at the Ayub Teaching Hospital, Abbottabad, from January 1st to December 31st 2012. All patients being referred to psychiatry were included in the study over one year period. The information was recorded on a structured questionnaire and analysed the data using SPSS-19.0. Results: Out of the 105 patients referred to the psychiatric unit, 74 (72.3%) were females. A total of 69 (68.5%) patients were married. More than half were uneducated and only number 4 (3%) patients had university qualification. Housewives made up 64.4% of the patient population followed by students (11%). Majority 55 (53%) had less than Rs. 5000/ monthly income. About 30% patients were shifted to psychiatry ward while, nearly one tenth were discharged. In 35% cases the psychiatrist was asked to help in the management, while in 50% cases only opinion was sought. Aggressive and threatening behaviour was source of concern in majority of patients for the primary team while 34% exhibited suicidal behaviour. Depression was most frequent diagnosis in 45 43% patients, followed by conversion disorder 19 (17%) and delirium 16 (14%). Conclusion: The rate of psychiatric referrals is dismal with only one third of the patients being transferred to the psychiatric ward. The major psychiatric diagnosis was depression. Patients with aggressive and threatening behaviour were more frequently referred. (author)
Full Text Available Purpose: Along with mutual funds’ scale and quantity expanding for our country, it is common for fund management companies hiring new managers or the original fund managers mobilizing from one to another. The high liquidity of fund managers makes different managers regroup to manage the funds that belong to the same fund management company in each fund year. The characteristics of these different management team will influence the fund performance, and also affect the earnings of the fund management company and portfolio investors. The purpose of this paper is as follows. First, evaluating the effect of management team characteristics on portfolio characteristics: risk, performance, and extremity. Second, testing the hypothesis that the ranking of mid-year performance have effect on investment style extremity and research what relationship exists between this phenomenon and management team characteristics in depth.Design/methodology/approach: On the analysis of the relationships between the management team characteristics and portfolio characteristics, a series of OLS regressions is run where the time series regression model (the factor model and cross-sectional regression are included based on using the STATA, EVIEWS and MATLAB. The validity and practicability of the model will be verified in the paper. All of the above are aimed at achieving portfolio optimization and realizing the maximization of the interests of fund management companies and investors.Findings: The main findings are as follows. Teams with more doctors or MBA (CPA and CFA hold more risky portfolios, while teams with long team tenure hold less. More members and large gender diversity have negative effect on performance, and the opposite is age diversity. Teams with more members and long tenure tend to hold less extreme style decisions, but age diversity is related to more. Besides, tournament hypothesis does exist in China investment funds industry especially when the
BACKGROUND: Carpal tunnel syndrome (CTS) is diagnosed mainly according to clinical symptoms, physical sign and neurodiagnostic laboratory examination. The therapeutic effect of conservative management and surgical operation in treating CTS need to be further observed and evaluated. OBJECTIVE: To analyze the clinical characteristics, neurophysiological grade and outcome in patients with CTS.DESIGN: Retrospective case-analysis.SETTING: Department of Neurology, First Affiliated Hospital, Medical College, Xi'an Jiaotong University. PARTICIPANTS: Totally 161 patients with suspected CTS from National Neuroscience Institute of Singapore referred to the Neurodiagnostic Laboratory for the confirmatory testing between January and September 2002. The involved patients, 137 male and 24 female, were aged 21-85 years. METHODS:①The condition of diabetes mellitus complicated by abnormal thyroid function was observed.②The effect on predominant hand, and paraesthesia were observed.③Neuroelectrophysiological studies were performed and the results were graded into mild, moderate and severe CTS according to the American Association of Electrodiagnostic Medicine (AAEM) criteria.④Conservative management and surgical intervention were followed up 3 months later, and symptoms and physical sign basically disappeared, and function was basically recovered, which indicated that disease condition improved.MAIN OUTCOME MEASURES:①Condition of CTS complicated by metabolic disease;②Effects on predominant hand and paraesthesia;③Electrophysiological grading; ④Prognosis.RESULTS: Totally 161 patients participated in the final analysis.①Condition of CTS complicated by metabolic disease: Among 161 patients, 17.4% (28/161) were documented to have diabetes mellitus and 7(4.3%) had hypothyroidism.②Effects on predominant hand and paraesthesia: Dominant hand involvement was present in 134 patients (83.2%) and more than 75% had onset of symptoms in the dominant hand. Sensory symptoms like
Maciukiewicz, Malgorzata; Pawlak, Joanna; Kapelski, Pawel; Łabędzka, Magdalena; Skibinska, Maria; Zaremba, Dorota; Leszczynska-Rodziewicz, Anna; Dmitrzak-Weglarz, Monika; Hauser, Joanna
Schizophrenia (SCH) is a complex, psychiatric disorder affecting 1 % of population. Its clinical phenotype is heterogeneous with delusions, hallucinations, depression, disorganized behaviour and negative symptoms. Bipolar affective disorder (BD) refers to periodic changes in mood and activity from depression to mania. It affects 0.5-1.5 % of population. Two types of disorder (type I and type II) are distinguished by severity of mania episodes. In our analysis, we aimed to check if clinical and demographical characteristics of the sample are predictors of symptom dimensions occurrence in BD and SCH cases. We included total sample of 443 bipolar and 439 schizophrenia patients. Diagnosis was based on DSM-IV criteria using Structured Clinical Interview for DSM-IV. We applied regression models to analyse associations between clinical and demographical traits from OPCRIT and symptom dimensions. We used previously computed dimensions of schizophrenia and bipolar affective disorder as quantitative traits for regression models. Male gender seemed protective factor for depression dimension in schizophrenia and bipolar disorder sample. Presence of definite psychosocial stressor prior disease seemed risk factor for depressive and suicidal domain in BD and SCH. OPCRIT items describing premorbid functioning seemed related with depression, positive and disorganised dimensions in schizophrenia and psychotic in BD. We proved clinical and demographical characteristics of the sample are predictors of symptom dimensions of schizophrenia and bipolar disorder. We also saw relation between clinical dimensions and course of disorder and impairment during disorder. PMID:26646576
Full Text Available OBJECTIVES: Septic pulmonary embolism caused by a Klebsiella (K. pneumoniae liver abscess is rare but can cause considerable morbidity and mortality. However, clinical information regarding this condition is limited. This study was conducted to elucidate the full disease spectrum to improve its diagnosis and treatment. METHOD: We reviewed the clinical characteristics, imaging findings, and clinical courses of 14 patients diagnosed with septic pulmonary embolism caused by a K. pneumoniae liver abscess over a period of 9 years. RESULTS: The two most prevalent symptoms were fever and shortness of breath. Computed tomography findings included a feeding vessel sign (79%, nodules with or without cavities (79%, pleural effusions (71%, peripheral wedge-shaped opacities (64%, patchy ground-glass opacities (50%, air bronchograms within a nodule (36%, consolidations (21%, halo signs (14%, and lung abscesses (14%. Nine (64% of the patients developed severe complications and required intensive care. According to follow-up chest radiography, the infiltrates and consolidations were resolved within two weeks, and the nodular opacities were resolved within one month. Two (14% patients died of septic shock; one patient had metastatic meningitis, and the other had metastatic pericarditis. CONCLUSION: The clinical presentations ranged from insidious illness with fever and respiratory symptoms to respiratory failure and septic shock. A broad spectrum of imaging findings, ranging from nodules to multiple consolidations, was detected. Septic pulmonary embolism caused by a K. pneumoniae liver abscess combined with the metastatic infection of other vital organs confers a poor prognosis.
Full Text Available OBJECTIVE: 1. to evaluate the impact of blunt abdominal trauma on the Solid abdominal viscera’s, hollow viscera’s, mesentery and Retroperitoneal structures and various modes of presentation in early diagnosis. 2. To evaluate various modalities of management and complications. BACKGROUND DATA: Blunt abdominal trauma is one of the most common injuries caused mainly by road traffic accidents. They are usually not obvious. Hence, often missed unless, strong suspicion. In view of increasing number of motor vehicles and consequently road traffic accidents, this study has been chosen to study the cases of injury to solid organs in blunt abdominal trauma. MATERIAL AND METHODS: This is a prospective study of blunt injury abdomen during the period from September 2010 to September 2013. Number of cases studied is 100. Data were collected from the Patients by their clinical history, examination and appropriate investigations. Post-operative follow-up was done to note for complications. Documentation of patients, which included, identification, history, clinical findings, diagnostic test, operative findings, operative procedures, complications during the stay in the hospital and during subsequent follow-up period, were all recorded on a proforma specially prepared. The decision for operative or non-operative management depended on the outcome of the Hemodynamic status and Computed Tomography. RESULTS: The majority of the patients belonged to 11 to 20 years age group, followed by 21-30 years age group. 91 cases were males, with females accounting for only about 9 cases. 74 patients were operated and 26 patients were subjected for non- operative management. Road traffic accident was responsible for 62% of blunt abdominal trauma cases, while fall from heights accounted for 27% of cases and blow with blunt object was responsible for 11% of injuries. Majority of the patients presented with abdominal pain (90% and abdominal tenderness (82%. Average latent
郑家驹; 史晓华; 褚行琦; 贾黎明; 王风鸣
Background An increasing incidence of Crohn' s disease has been found in China in recent years.Our study has been focused on evaluating the diversity of the clinical manifestations of Crohn' s disease in order to improve early diagnostic accuracy and therapeutic efficacy.Methods Thirty patients with active Crohn's disease were enrolled and their clinical data, including diagnostic and therapeutic results, were analyzed. Endoscopy combined with histological examination of biopsy specimens provided characteristic features of the disease. Transabdominal bowel sonography (TABS) was used for detecting intestinal complications. Nutritional supportive therapy was given to 20 subjects with active cases of the disease.Results Most patients were young adults with a higher proportion of females to males (ratio: 1.14:1). The disease affects any segment or a combination of segments along with the alimentary tract(from the mouth to the anus). In this study, the colon and small bowel were the major sites involved.Recurrent episodes of abdominal pain in the right lower quadrant and watery diarrhea were the most common symptoms. Granulomas were identifiable in nearly one-third (30.8%) of all biopsy specimens. In moderate cases of the disease, remission was achieved more quickly through the use of oral prednisone therapy than with SASP or 5-ASA. Beneficial effects on the host' s nutritional status were observed. Immunosuppressives were used on an individual basis and showed variable therapeutic effects. Sixteen patients had surgery due to intestinal obstruction or failure to respond to drug therapies. Rapid improvement after surgery was reported. Conclusion Endoscopy (with biopsy) and TABS were both crucial procedures for diagnosis. SASP(or 5-ASA) and prednisone were effective as inductive therapies. Azathioprine has demonstrable benefits after induction therapy with prednisone. Surgery, as an alternative treatment, provided another effective choice in selected patients.
Huang, Qin; Wang, Jun
Although the importance of clinical data is drawing more attention in drug development in China, the clinical data management is not good enough in the clinical trials right now. With the development of internet and progress of information technology, especially with the setup of the state innovation strategy for drug development, it is necessary and urgent to improve the clinical data quality. Good data quality is the primary basis of technical evaluation of drug at the marketing authorization. So Center for Drug Evaluation of CFDA has made some endeavors to enhance data management in the clinical trials in recent years. This article is focused on these aspects of data managment.
Huang, Qin; Wang, Jun
Although the importance of clinical data is drawing more attention in drug development in China, the clinical data management is not good enough in the clinical trials right now. With the development of internet and progress of information technology, especially with the setup of the state innovation strategy for drug development, it is necessary and urgent to improve the clinical data quality. Good data quality is the primary basis of technical evaluation of drug at the marketing authorization. So Center for Drug Evaluation of CFDA has made some endeavors to enhance data management in the clinical trials in recent years. This article is focused on these aspects of data managment. PMID:26911033
Babalhavaeji, Fahimeh; Farhadpoor, Mohammad Reza
Purpose: This article examines characteristics of the external environment of library and information centres of Islamic Azad University in Iran, focusing on perceived environmental uncertainty and perceived source accessibility and quality, and their impacts on the amount of scanning and the frequency of information source use. Methods: This…
Ozyurt, I. Burak; Keator, David B.; Wei, Dingying; Fennema-Notestine, Christine; Pease, Karen R.; Bockholt, Jeremy; Grethe, Jeffrey S.
Managing vast datasets collected throughout multiple clinical imaging communities has become critical with the ever increasing and diverse nature of datasets. Development of data management infrastructure is further complicated by technical and experimental advances that drive modifications to existing protocols and acquisition of new types of research data to be incorporated into existing data management systems. In this paper, an extensible data management system for clinical neuroimaging s...
Full Text Available Julieta Trinks,1,2 María Laura Hulaniuk,1 María Ana Redal,1,3 Diego Flichman2,4 1Instituto de Ciencias Básicas y Medicina Experimental, Hospital Italiano de Buenos Aires, 2National Scientific and Technical Research Council, 3Instituto Universitario del Hospital Italiano de Buenos Aires, 4Cátedra de Virología, Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Buenos Aires, Argentina Abstract: Hepatitis C virus (HCV was identified for the first time more than 20 years ago. Since then, several studies have highlighted the complicated aspects of this viral infection in relation to its worldwide prevalence, its clinical presentation, and its therapeutic response. Recently, two landmark scientific breakthroughs have moved us closer to the successful eradication of chronic HCV infection. First, response rates in treatment-naïve patients and in prior non-responders to pegylated-interferon-α and ribavirin therapy are increasing as a direct consequence of the development of direct-acting antiviral drugs. Secondly, the discovery of single-nucleotide polymorphisms near the interleukin 28B gene significantly related to spontaneous and treatment-induced HCV clearance represents a milestone in the HCV therapeutic landscape. The implementation of this pharmacogenomics finding as a routine test for HCV-infected patients has enhanced our understanding of viral pathogenesis, has encouraged the design of ground-breaking antiviral treatment regimens, and has become useful for pretreatment decision making. Nowadays, interleukin 28B genotyping is considered to be a key diagnostic tool for the management of HCV-infected patients and will maintain its significance for new combination treatment schemes using direct-acting antiviral agents and even in interferon-free regimens. Such pharmacogenomics insights represent a challenge to clinicians, researchers, and health administrators to transform this information into knowledge with the aim of
Ralandison, S; Rafalimanana, E; Rakotonirainy, H; Rabenja, R
Developed countries issue recommendations regarding healthcare that aren't constantly appropriate for emergent countries. We suggest some remarks concerning rheumatology in Madagascar, taking account of scientific data, medical ethics, equality and equity. We have studied the minimal cost of care of medical conditions found in our hospital department if we were to follow international recommendations for their management. Then, we have estimated treatment expenses as a percentage of the SMIC (Malagasy minimum monthly salary). Out of 517 patients examined yearly, we have found 62.8% osteoarthritis cases, 6.3% rheumatoid arthritis (RA), and 4,2% septic arthritis. Therefore, the first month of treatment for an arthritis of the knee would absorb 147.3% of the SMIC; diagnosis and treatment of a case of septic arthritis would take up 1762.8% of the minimum wage, and a case of RA without biotherapy would require 175%. According to the American College of Rheumatology criteria which are used as a reference, the treatment of an arthritis of the knee would take only 23% of the SMIC. Caring for septic arthritis would demand 57.5% of the SMIC and while it would yield more arguments for diagnosis such as clinical examination, CRP, and Gram coloration on joint liquid aspiration. We can proceed to RA diagnosis with an acceptable security through precise clinical examination, blood cell count, ESR, CRP, rheumatoid factor and radiography. This means 56% of the SMIC. From this 517 patients, our suggestions would reduce the expense by 35,850% of the SMIC per year. The allocation of such funds onto the treatment of complicated forms of rheumatism would be fair. By refining and evaluating these suggestions, we would come up with appropriate recommendations for emergent countries.
Vogeser, Michael; Seger, Christoph
Thanks to highly specific analyte detection and potentially complete compensation for matrix variables based on the principle of stable isotope derivative internal standardisation, mass spectrometry methods allow the development of diagnostic tests of outstanding analytical quality. However, these features per se do not guarantee reliability of tests. A wide range of factors can introduce analytical errors and inaccuracy due to the extreme complexity of the methods involved. Furthermore, it can be expected that the application patterns of MS methods in diagnostic laboratories will change substantially during the coming years - with presumably less specialised laboratories implementing mass spectrometry. Introduction of highly automated test solutions by manufacturers will require some trade-off between operation convenience, sample throughput and analytical performance. Structured and careful quality and risk management is therefore crucial to translate the analytical power of mass spectrometry into actionable and reliable results for individual patients' care and to maintain the degree of reliability that is expected from MS methods in clinical pathology. This reflection review discusses whether particular quality assurance tools have to be applied for MS-based diagnostic tests and whether these tools are different from those applied for optical- and affinity-based standard tests. Both pre-implementation strategies and surveillance of assays with assessment of metadata in routine testing are addressed. The release of the CLSI guideline C62-A in 2014 was a substantial achievement in this context because it addresses a wide spectrum of relevant issues in quality assurance of mass spectrometry-based clinical tests. However, the translation of this best practice document into individual laboratory settings is likely to be heterogeneous.
Roerink, M.E.; Meijering, R.; Bosch, M.; Galan, B.E. de; Crevel, R. van
BACKGROUND: As HIV management has become more successful during the past years, non-communicable diseases have become more prevalent among HIV-infected individuals. As a result, more HIV-infected patients die of cardiovascular diseases, with diabetes being one of the main risk factors. This study ev
Windfuhr, Jochen P; Toepfner, Nicole; Steffen, Gregor; Waldfahrer, Frank; Berner, Reinhard
More than 120,000 patients are treated annually in Germany to resolve repeated episodes of acute tonsillitis. Therapy is aiming at symptom regression, avoidance of complications, reduction in the number of disease-related absences in school or at work, increased cost-effectiveness and improved quality of life. The purpose of this part of the guideline is to provide clinicians in any setting with a clinically focused multi-disciplinary guidance through different conservative treatment options in order to reduce inappropriate variation in clinical care, improve clinical outcome and reduce harm. Surgical management in terms of intracapsular as well as extracapsular tonsillectomy (i.e. tonsillotomy) is the subject of part II of this guideline. To estimate the probability of tonsillitis caused by β-hemolytic streptococci, a diagnostic scoring system according to Centor or McIsaac is suggested. If therapy is considered, a positive score of ≥3 should lead to pharyngeal swab or rapid test or culture in order to identify β-hemolytic streptococci. Routinely performed blood tests for acute tonsillitis are not indicated. After acute streptococcal tonsillitis, there is no need to repeat a pharyngeal swab or any other routine blood tests, urine examinations or cardiological diagnostics such as ECG. The determination of the antistreptolysin O-titer (ASLO titer) and other antistreptococcal antibody titers do not have any value in relation to acute tonsillitis with or without pharyngitis and should not be performed. First-line therapy of β-hemolytic streptococci consists of oral penicillin. Instead of phenoxymethylpenicillin-potassium (penicillin V potassium), also phenoxymethlpenicillin-benzathine with a clearly longer half-life can be used. Oral intake for 7 days of one of both the drugs is recommended. Alternative treatment with oral cephalosporins (e.g. cefadroxil, cefalexin) is indicated only in cases of penicillin failure, frequent recurrences, and whenever a more
Leikin, J B; Krantz, A J; Zell-Kanter, M; Barkin, R L; Hryhorczuk, D O
Hallucinogenic drugs are unique in that they produce the desired hallucinogenic effects at what are considered non-toxic doses. The hallucinogenic drugs can be categorised into 4 basic groups: indole alkaloid derivatives, piperidine derivatives, phenylethylamines and the cannabinols. The drugs reviewed include lysergic acid diethylamide (LSD), phencyclidine (PCP), cocaine, amphetamines, opiates, marijuana, psilocybin, mescaline, and 'designer drugs.' Particularly noteworthy is that each hallucinogen produces characteristic behavioural effects which are related to its serotonergic, dopaminergic or adrenergic activity. Cocaine produces simple hallucinations, PCP can produce complex hallucinations analogous to a paranoid psychosis, while LSD produces a combination of hallucinations, pseudohallucinations and illusions. Dose relationships with changes in the quality of the hallucinatory experience have been described with amphetamines and, to some extent, LSD. Flashbacks have been described with LSD and alcohol. Management of the intoxicated patient is dependent on the specific behavioural manifestation elicited by the drug. The principles involve differentiating the patient's symptoms from organic (medical or toxicological) and psychiatric aetiologies and identifying the symptom complex associated with the particular drug. Panic reactions may require treatment with a benzodiazepine or haloperidol. Patients with LSD psychosis may require an antipsychotic. Patients exhibiting prolonged drug-induced psychosis may require a variety of treatments including ECT, lithium and l-5-hydroxytryptophan.
Lomboy, Jason R; Coward, Robert M
A varicocele is an abnormal dilatation and tortuosity of the veins of the spermatic cord. Although varicoceles are common in the general population and are frequently found on routine physical examinations, they represent the most common correctable cause of male factor infertility. Varicoceles are also often incidental findings on imaging studies, particularly scrotal ultrasound. Importantly, not all varicoceles should be treated equally (or at all), and basic guidelines on the evaluation and indications for treatment of adult varicoceles should be reviewed before counseling and treatment. A semen analysis should be obtained for any male patient of reproductive age considering intervention. The adolescent varicocele is managed much differently than the adult varicocele and remains a source of controversy. This review describes the clinical presentation and the evaluation of adult and pediatric varicoceles, and provides guidance on their diagnosis and workup. It also describes options for surgical repair and the success and complication rates associated with each surgical approach, ultimately supporting microsurgical subinguinal varicocele repair as the current surgical standard. PMID:27582602
Hsiang-Tsai Chiang; Mei-Chih Lin
The paper examines cognition from the viewpoint of internal management teams of private universities against satisfaction with school performance, applying the SEM model. Empirical results show that the boardâ€™s operational effectiveness and attendance rate for internal important meetings held on campus have a significantly positive relationship with implementing effectiveness and satisfaction with school administrative performance. The satisfaction with school administrative performance and...
Acid sulfate soils(ASS) are widely distributod in Australia.This has only been recognised recently when intensive research on ASS has been done in this county.This paper reviews aspects concerning a )the distribution and acid potential,b) controls on acidic status,and c) problems and management of ASS problems from ASS exist but insufficient attention was paid to them.
Self-management is an essential component of disease management that involves collaboration between patients and healthcare providers to ensure patient engagement in behaviors that help control or reduce the impact of their disease. The self-management model assists patients in gaining skills to manage their disease and, more importantly, in gaining the confidence to apply these skills on a day-to-day basis. The key processes in self-management are goal selection, information collection and i...
Han, Su-Hyun; Choi, Hye-Yeon; Kim, Jeong-Min; Park, Kwang-Ryul; Youn, Young Chul; Shin, Hae-Won
Viral meningitis is the most common cause of aseptic meningitis. Use of the polymerase chain reaction (PCR) has increased the ability to determine the etiology of viral meningitis. This study used PCR analysis to evaluate the etiology of aseptic meningitis in 177 previously healthy adults over a 5-year period, as well as analyzing the clinical characteristics, cerebrospinal fluid (CSF) findings, and prognosis according to each etiology. The most frequent cause of aseptic meningitis was enterovirus (EV), followed by varicella zoster virus (VZV). Patients with EV meningitis were significantly younger than those with VZV meningitis. The percentage of lymphocytes in white blood cell counts and protein concentrations in the CSF differed significantly among patients with EV, VZV and meningitis of undetermined etiology. Younger age and lower percentage of lymphocyte and protein level in CSF analysis may be suggestive of EV meningitis. Further prospective studies are warranted to identify the correlations between the clinical characteristics and the etiologies of meningitis.
Fulcheri, M; Bertone, E; Barzega, G
In this paper the authors analyse transexualism from a psychopathological, nosographic and clinical point of view. The re-examine the theories on the subjects elaborated by a number of authors and describe the clinical characteristics of the syndrome, paying special attention to problems relating to differential diagnosis. Moreover, they present the results ofa study carried out in a personal series of cases. The sample studied included 11 male transsexual subjects. The latter were evaluated through psychiatric interview and a questionnaire aimed at obtaining information on the following topics: the subjects' social and affective relations; their childhood experience; their perception and acceptance of themselves; the meaning, characteristics, localisation and experience of sexual pleasure. The results are discussed and compared with those of national and international literature on this subjects. PMID:7643729
Thereza Maria Magalhães Moreira
Full Text Available Objective To analyze the association between socioeconomic situation, clinical characteristics referred and the family history of cardiovascular disease, with the Self-perceived health of young adults education and their implications for clinical characteristics observed. Method Analytical study conducted with 501 young adults who are students in countryside city in the Brazilian Northeast. We used binary logistic regression. Results The final model explained 83.3% of the self-perceived positive health, confirming the association of Self-perceived health with male, residence in the community, have excellent/very good lifestyle and does not have or do not know that there are cases of stroke in the family. Conclusion Health perception was often optimistic, being important to identify devices to be worked closer to their perception of their actual health condition, increasing the effectiveness of health promotion activities undertaken by professionals.
Shand, Beatriz; Goicochea, Maria Teresa; Valenzuela, Raul;
BACKGROUND: Data on the characteristics of Medication Overuse Headache (MOH) in Latin American (LA) are scarce. Here we report the demographic and clinical features of the MOH patients from Argentina and Chile enrolled in the multinational COMOESTAS project in the period 2008-2010. METHODS: The LA...... population was formed by 240 MOH subjects, 110 from Chile and 130 from Argentina, consecutively attending the local headache centres. In each centre, specifically trained neurologist interviewed and confirmed the diagnosis according to the ICHD-II criteria. A detailed history was collected on an electronic......, where it affects mostly women, in the most active decades of life. Some differences emerge as regards the demographic and clinical characteristics of MOH in this population as compared to Europe or Northern America. What seems more worrying about MOH in Argentina and Chile is that most patients overuse...
Lee, Tae Kyung; LaBrie, Richard A.; Grant, Jon E.; Kim, Suck Won; Shaffer, Howard J.
This paper reports the underlying structure of the demographic and clinical characteristics of level 3 (i.e., pathological) Korean casino gamblers. The participants reported their gambling behavior and clinical characteristics known to be associated with gambling problems (e.g., alcohol use problems, eating disorders, depression, anxiety, and…
Objective To analyze the clinical characteristics and prognosis of the patients with gastric mucosa-associated lymphoid tissue(MALT) lymphoma. Methods The clinical characteristics and prognostic factors of 103 gastric MALT lymphoma patients admitted to our hospital from April 2001 to August 2011 were
Samson, Harland E.
Developed out of a concern for the role postsecondary education should play in middle management development, this report presents an exploratory study of those factors influencing the nature and characteristics of middle management in the retail department store. The research involved personal interviews with retail department store executives…
The purpose of this study is to examine apparel manufacturers' inventory performance, which is one of the major performance indicators of supply chain management (SCM) with the consideration of company characteristics. The objectives of the study are (a) to identify the level of SCM activities of apparel manufacturers, (b) to examine the differences of apparel manufacturers' characteristics (i.e., product characteristic, production system, fabric suppliers, retail customers) according to the ...
This research was conducted on 209 respondents in the field of tourism and hospitality. The aim of the research was to determine the necessary leadership characteristics and skills of a modern tourism and hospitality manager, as leader of the organization or team in it. For the purposes of the survey questionnaire was used to ascertain the views and opinions of the respondents in terms of categories: psychological characteristics, personality, social characteristics, skills for establishing g...
DeVito, Nicholas; Henderson, Evita; Han, Gang; Reed, Damon; Marilyn M Bui; Lavey, Robert; Robinson, Lary; Zager, Jonathan S.; Gonzalez, Ricardo J; Sondak, Vernon K.; Letson, G. Douglas; Conley, Anthony
Solitary fibrous tumor (SFT) is a mesenchymal neoplasm of fibrous origin. The 2013 WHO classification of soft tissue tumors defines malignant forms as hypercellular, mitotically active (>4 mitosis/10 high-power fields), with cytological atypia, tumor necrosis, and/or infiltrative margins. With an IRB-approved protocol, we investigated patient records and clinicopathologic data from our Sarcoma Database to describe the clinical characteristics of both benign and malignant SFT. All pathology sp...
Specht, Matt W.; Woods, Douglas W; Piacentini, John; Scahill, Lawrence; Wilhelm, Sabine; Peterson, Alan L.; Chang, Susanna; Kepley, Hayden; Deckersbach, Thilo; Flessner, Christopher; Brian A. Buzzella; McGuire, Joseph F.; Levi-Pearl, Sue; Walkup, John T.
The clinical characteristics and rates of co-occurring psychiatric conditions in youth seeking treatment for a chronic tic disorder (CTD) were examined. Children and adolescents (N = 126) with a primary CTD diagnosis were recruited for a randomized controlled treatment trial. An expert clinician established diagnostic status via semi-structured interview. Participants were male (78.6%), Caucasians (84.9%), mean age 11.7 years (SD = 2.3) with moderate-to-severe tics who met criteria for Touret...
Dimitriadis, Konstantin; Leonhardt, Miriam; Yu-Wai-Man, Patrick; Kirkman, Matthew Anthony; Korsten, Alex; De Coo, Irenaeus F; Chinnery, Patrick Francis; Klopstock, Thomas
Background: Leber's hereditary optic neuropathy (LHON) is a mitochondrial disease that typically causes bilateral blindness in young men. Here we describe the clinical and molecular characteristics of 20 patients with disease onset after the age of 50 years (late onset-LHON). Methods: From a cohort of 251 affected and 277 unaffected LHON carriers, we identified 20 patients with onset of visual loss after the age of 50 years. Using structured questionnaires, data including basic demographic de...
Full Text Available Abstract Background The tcdA-negative variant (A-B+ of Clostridium difficile is prevalent in East Asian countries. However, the risk factors and clinical characteristics of A-B+C. difficile infections (CDI are not clearly documented. The objective of this study was to investigate these characteristics. Methods From September 2008 through January 2010, the clinical characteristics, medication history and treatment outcomes of CDI patients were recorded prospectively. Toxin characterization and antibiotic susceptibility tests were performed on stool isolates of C. difficile. Results During the study period, we identified 22 cases of CDI caused by tcdA-negative tcdB-positive (A-B+ strains and 105 cases caused by tcdA-positive tcdB-positive (A+B+ strains. There was no significant difference in disease severity or clinical characteristics between the two groups. Previous use of clindamycin and young age were identified as significant risk factors for the acquisition of A-B+ CDI (OR = 4.738, 95% CI 1.48–15.157, p = 0.009 and OR = 0.966, 95% CI 0.935–0.998, p = 0.038, respectively in logistic regression. Rates of resistance to clindamycin were 100% and 69.6% in the A-B+ and A+B+ isolates, respectively (p = 0.006, and the ermB gene was identified in 17 of 21 A-B+ isolates (81%. Resistance to moxifloxacin was also more frequent in the A-B+ than in the A+B+ isolates (95.2% vs. 63.7%, p = 0.004. Conclusions The clinical course of A-B+ CDI is not different from that of A+B+ CDI. Clindamycin use is a significant risk factor for the acquisition of tcdA-negative variant strains.
Denton, Christopher P; Krieg, Thomas; Guillevin, Loic;
OBJECTIVES: The Digital Ulcers Outcome (DUO) Registry was designed to describe the clinical and antibody characteristics, disease course and outcomes of patients with digital ulcers associated with systemic sclerosis (SSc). METHODS: The DUO Registry is a European, prospective, multicentre......, observational, registry of SSc patients with ongoing digital ulcer disease, irrespective of treatment regimen. Data collected included demographics, SSc duration, SSc subset, internal organ manifestations, autoantibodies, previous and ongoing interventions and complications related to digital ulcers. RESULTS...
Hwang, Jin Kyung; Park, Seung-Jung; On, Young Keun; Kim, June Soo; Park, Kyoung-Min
Background and Objectives Frequent ventricular premature complexes (VPCs) increase the risk of cardiomyopathy (CMP). However, most data regarding VPCs have been obtained from Western population and in-hospital patient-based studies. The objective of this study was to define the clinical characteristics and features of idiopathic VPCs in the Korean population. Subjects and Methods We investigated subjects undergoing transthoracic echocardiography and documented VPC burdens >1% by Holter monito...
Choudhary, Gaurav; Jankowich, Matthew; Wu, Wen-Chih
Background Pulmonary hypertension (PH) is associated with increased mortality and morbidity. It is frequently associated with cardiopulmonary diseases that are prevalent in African Americans (AAs). However, the prevalence or determinants of PH in the AA population is not known. Methods We conducted a cross-sectional study to estimate the prevalence of PH (defined as trans-tricuspid gradient ≥ 35 mm Hg) and associated clinical characteristics in AAs using the Jackson Heart Study cohort (n=3,28...
Kyoung Huh; Mi Kyeong Woo; Jung Rim Yoon; Gyu Hong Shin; Myoung Jae Chey; Mi Jung Park
Purpose : Vitamin D deficiency rickets is a significant public health problem that results from insufficient exposure to sunlight and inadequate vitamin D supplementation. The purpose of this study is to identify the clinical characteristics of vitamin D deficiency rickets in infants. Methods : Data of 35 infants diagnosed as vitamin D deficiency rickets at Sanggye-Paik Hospital, Seoul, Korea, from March 2007 to May 2009 were reviewed. Children with plasma 25-hydroxyvitamin D levels&...
Karlsen, Randi V; Larsen, Signe B; Christensen, Jane;
associations between socio-demographic or clinical characteristics and PSA testing without clinical indication. Material and methods. In the Danish Diet, Cancer and Health Cohort, we identified 1051 men with PC diagnosed in 1993-2008. Diagnostic and clinical characteristics were obtained from medical records......, and socio-demographic information was retrieved from administrative registers. We used general logistic regression analysis to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for associations between socio-demographic or clinical characteristics and PSA testing without clinical indication. Cox......Background. Social differences in prostate cancer (PC) incidence and mortality might be related to testing for prostate-specific antigen (PSA). Although routine PSA screening is not recommended in Denmark, testing without clinical indication increased during the past decade. We evaluated...
Full Text Available Context An intraductal oncocytic papillary neoplasm is a rare pancreatic tumor which was first described by Adsay et al. in 1996. It has been defined as a new subgroup of IPMN. Case report We report the case of a 76-year-old woman who presented with nausea. Imaging studies revealed a cystic mass in the body of the pancreas. She underwent a successful distal pancreatectomy and splenectomy, and has subsequently remained well. Microscopically, the cyst was lined by columnar epithelium similar to pancreatic duct epithelium, and the nodular projection consisted of arborizing papillary structures, lined by plump cells with abundant eosinophilic cytoplasm. These eosinophilic cells were immunohistochemically positively stained with anti-mitochondrial antibody. The cellular atypism was mild and the proliferating index was low, compatible with adenoma of an intraductal oncocytic papillary neoplasm. Although no ovarian type stroma was identified, in our case, no communication to main pancreatic duct (located in the pancreatic body and rapid growth by intracystic hemorrhage were clinical characteristics of a mucinous cystic neoplasm, but not IPMN. Conclusion With only 17 cases reported to date, the clinical and pathological details of an intraductal oncocytic papillary neoplasm are still unclear. We herein add one case with different characteristics from those of the past reports. To our knowledge, this is the first case report of an intraductal oncocytic papillary neoplasm with the clinical characteristics of a mucinous cystic neoplasm.
Pandis, Nikolaos; Polychronopoulou, Argy; Madianos, Phoebus; Makou, Margarita; Eliades, Theodore
The objective of this article was to record reporting characteristics related to study quality of research published in major specialty dental journals with the highest impact factor (Journal of Endodontics, Journal of Oral and Maxillofacial Surgery, American Journal of Orthodontics and Dentofacial Orthopedics; Pediatric Dentistry, Journal of Clinical Periodontology, and International Journal of Prosthetic Dentistry). The included articles were classified into the following 3 broad subject categories: (1) cross-sectional (snap-shot), (2) observational, and (3) interventional. Multinomial logistic regression was conducted for effect estimation using the journal as the response and randomization, sample calculation, confounding discussed, multivariate analysis, effect measurement, and confidence intervals as the explanatory variables. The results showed that cross-sectional studies were the dominant design (55%), whereas observational investigations accounted for 13%, and interventions/clinical trials for 32%. Reporting on quality characteristics was low for all variables: random allocation (15%), sample size calculation (7%), confounding issues/possible confounders (38%), effect measurements (16%), and multivariate analysis (21%). Eighty-four percent of the published articles reported a statistically significant main finding and only 13% presented confidence intervals. The Journal of Clinical Periodontology showed the highest probability of including quality characteristics in reporting results among all dental journals. PMID:21605830
Objective: To summarize the clinical characteristics of idiopathic pulmonary fibrosis (IPF). Methods: The clinical characteristics of twenty-eight cases diagnosed as IPF between 1991 and 2006 were studied retrospectively. Results: Most IPF patients had an insidious onset of progressive dyspnea and non-productive cough. Inspiratory crackles and finger clubbing were also noted in most patients. The most impressive appearance of their radiography was peripheral reticular and nodular opacities, distributed largely at the lung bases. Pulmonary function test showed restrictive impairment and impaired oxygen diffusion. The arterial blood gas analysis revealed type I respiratory failure. One IPF case was complicated with lung cancer. The symptoms of fifteen cases(71.4%) were relieved under the therapy with glucocorticoid. Seven patients died as yet in our group and the middle duration was 24 months. Conclusions: The diagnosis of IPF relies mostly on the clinical characteristics, radiography, pulmonary function test, blood gas analysis and exclusion of other ILD. Atypical cases need lung biopsy to do further the diagnosis. Therapy with glucocorticoid may be effective in some cases. Prognosis in IPF cases complicated with lung cancer is poor. (authors)
Gałkiewicz, Dominika Paula
This study provides a comprehensive overview of the use of credit default swaps by U.S. corporate bond funds and analyzes in detail whether certain characteristics of managers, in addition to the fundamentals of a fund, determine how their use these credit derivatives. Results suggest that a manager's education, age, experience, and skill are positively correlated with a fund's CDS holdings. In particular, managers holding a master's degree or educated at prestigious universities prefer using...
Kresse, Timothy M.; Hays, Phillip D.; Merriman, Katherine R.; Gillip, Jonathan A.; Fugitt, D. Todd; Spellman, Jane L.; Nottmeier, Anna M.; Westerman, Drew A.; Blackstock, Joshua M.; Battreal, James L.
Sixteen aquifers in Arkansas that currently serve or have served as sources of water supply are described with respect to existing groundwater protection and management programs, geology, hydrologic characteristics, water use, water levels, deductive analysis, projections of hydrologic conditions, and water quality. State and Federal protection and management programs are described according to regulatory oversight, management strategies, and ambient groundwater-monitoring programs that currently (2013) are in place for assessing and protecting groundwater resources throughout the State.
Brasso, Klaus; Friis, S; Juel, K;
We studied the need for hospital care of patients 74 years old or younger with clinically localized prostate cancer managed by deferred endocrine therapy.......We studied the need for hospital care of patients 74 years old or younger with clinically localized prostate cancer managed by deferred endocrine therapy....
Franklin, Ruth H.
As part of a Geriatric Education and Health Management program, a model nurse-managed free clinic has been established at an urban senior center by faculty and students of the University of New Mexico College of Nursing. Funded by a 3-year grant from the Department of Health and Human Services, the weekly clinic is based on Orem's self-care theory…
Guarnieri, Biancamaria; Cerroni, Gianluigi; Sorbi, Sandro
In 2004, in Genoa (Italy), the Italian Dementia Research Association (SINDem) was born. The first congress of this new scientific society took place in Rome in 2006. SINDem soon recognized the importance to investigate sleep problems in cognitive decline and created a national "sleep study group "composed by neurologists and sleep specialists. In 2012, The SINDem study group, in close relationship with the Italian Association of sleep medicine (AIMS), published the study "Prevalence of sleep disturbances in mild cognitive impairment and dementing disorders: a multicenter Italian clinical cross-sectional study on 431 patients ", confirming the high prevalence of sleep disturbances in a wide Italian population of persons with cognitive decline. The study was supported by a grant from the Italian Minister of Health and was conducted with the fundamental contribution of the Italian National Research Center (CNR). In 2014, the same group published the paper "Recommendations of the Sleep Study Group of the Italian Dementia Research Association (SINDem) on clinical assessment and management of sleep disorders in individuals with mild cognitive impairment and dementia: a clinical review". The recommendations are wide and directed to professionals (neurologists but not exclusively) to try to establish uniform levels of care, promote collaborative studies into areas of uncertainty, and define the qualitative characteristics of Dementia Reference Centers about sleep disturbances. PMID:26742676
Full Text Available Elena Pischik,1,2 Raili Kauppinen,11Porphyria Research Unit, Division of Endocrinology, Department of Medicine, University Central Hospital of Helsinki, Helsinki, Finland; 2Department of Neurology, Consultative and Diagnostic Centre with Polyclinics, St Petersburg, Russia Abstract: Acute intermittent porphyria (AIP is due to a deficiency of the third enzyme, the hydroxymethylbilane synthase, in heme biosynthesis. It manifests with occasional neuropsychiatric crises associated with overproduction of porphyrin precursors, aminolevulinic acid and porphobilinogen. The clinical criteria of an acute attack include the paroxysmal nature and various combinations of symptoms, such as abdominal pain, autonomic dysfunction, hyponatremia, muscle weakness, or mental symptoms, in the absence of other obvious causes. Intensive abdominal pain without peritoneal signs, acute peripheral neuropathy, and encephalopathy usually with seizures or psychosis are the key symptoms indicating possible acute porphyria. More than fivefold elevation of urinary porphobilinogen excretion together with typical symptoms of an acute attack is sufficient to start a treatment. Currently, the prognosis of the patients with AIP is good, but physicians should be aware of a potentially fatal outcome of the disease. Mutation screening and identification of type of acute porphyria can be done at the quiescent phase of the disease. The management of patients with AIP include following strategies: A, during an acute attack: 1 treatment with heme preparations, if an acute attack is severe or moderate; 2 symptomatic treatment of autonomic dysfunctions, polyneuropathy and encephalopathy; 3 exclusion of precipitating factors; and 4 adequate nutrition and fluid therapy. B, during remission: 1 exclusion of precipitating factors (education of patients and family doctors, 2 information about on-line drug lists, and 3 mutation screening for family members and education about precipitating factors in
Maarbjerg, Stine; Gozalov, Aydin; Olesen, Jes;
= .043. It affected solely the second and/or third trigeminal branch in 109 (69%) while the first branch alone was affected in only 7 (4%). Notably, 78 (49%) had concomitant persistent pain in addition to paroxysmal stabbing pain. Autonomic symptoms were present in 48 (31%). Patients who had...... not undergone surgery for TN had sensory abnormalities in 35 (29%). CONCLUSIONS: This, the first study in a series of papers focusing on the clinical, radiological, and etiological aspects of TN, revealed that the symptomatology of TN includes a high percentage of concomitant persistent pain, autonomic symptoms......, and sensory abnormalities. These findings offer new insights to the prevailing clinical impression of the clinical characteristics in TN....
Full Text Available Idiopathic inflammatory myopathies (IIM are traditionally identified as a group of disorders that target skeletal muscle due to autoimmune dysfunction. The IIM can be divided into subtypes based on certain clinical characteristics, and several classification schemes have been proposed. The predominant diagnostic criteria for IIM is the Bohan and Peter criteria, which subdivides IIM into primary polymyositis (PM, primary dermatomyositis (DM, myositis with another connective tissue disease, and myositis associated with cancer. However, this measure has been criticised for several reasons including lack of specific criteria to help distinguish between muscle biopsy findings of PM, DM, and immune-mediated necrotising myopathy, as well as the lack of identification of cases of overlap myositis (OM. Because of this issue, other classification criteria for IIM have been proposed, which include utilising myositis-associated antibodies and myositis-specific antibodies, as well as overlap features such as Raynaud’s phenomenon, polyarthritis, oesophageal abnormalities, interstitial lung disease, small bowel abnormalities such as hypomotility and malabsorption, and renal crises, amongst others. Indeed, the identification of autoantibodies associated with certain clinical phenotypes of myositis, in particular connective tissue disease-myositis overlap, has further helped divide IIM into distinct clinical subsets, which include OM and overlap syndromes (OS. This paper reviews the concepts of OM and OS as they pertain to IIM, including definitions in the literature, clinical characteristics, and overlap autoantibodies.
Solid waste management (SWM) is a multidimensional challenge faced by urban authorities, especially in developing countries like Bangladesh. We investigated per capita waste generation by residents, its composition, and the households' attitudes towards waste management at Rahman Nagar Residential Area, Chittagong, Bangladesh. The study involved a structured questionnaire and encompassed 75 households from five different socioeconomic groups (SEGs): low (LSEG), lower middle (LMSEG), middle (MSEG), upper middle (UMSEG) and high (HSEG). Wastes, collected from all of the groups of households, were segregated and weighed. Waste generation was 1.3 kg/household/day and 0.25 kg/person/day. Household solid waste (HSW) was comprised of nine categories of wastes with vegetable/food waste being the largest component (62%). Vegetable/food waste generation increased from the HSEG (47%) to the LSEG (88%). By weight, 66% of the waste was compostable in nature. The generation of HSW was positively correlated with family size (rxy = 0.236, p xy = 0.244, p xy = 0.671, p < 0.01) of the households. Municipal authorities are usually the responsible agencies for solid waste collection and disposal, but the magnitude of the problem is well beyond the ability of any municipal government to tackle. Hence dwellers were found to take the service from the local waste management initiative. Of the respondents, an impressive 44% were willing to pay US$0.3 to US$0.4 per month to waste collectors and it is recommended that service charge be based on the volume of waste generated by households. Almost a quarter (22.7%) of the respondents preferred 12-1 pm as the time period for their waste to be collected. This study adequately shows that household solid waste can be converted from burden to resource through segregation at the source, since people are aware of their role in this direction provided a mechanism to assist them in this pursuit exists and the burden is distributed according to the
Sudulagunta, Sreenivasa Rao
Full Text Available Introduction: Guillain-Barré syndrome (GBS is a fulminant polyradiculoneuropathy that is acute, frequently severe and autoimmune in nature. Etiology of GBS is incompletely understood, prognosis is usually good with early detection and prompt treatment. This retrospective study was done to evaluate clinical profile, epidemiological, laboratory, and electrodiagnostic features of patients with GBS and mode of management, complications and prognostic factors.Methods: Data of 1,166 patients admitted with GBS or presented to outpatient department (previous medical records with GBS between January 2003 and January 2014 were analyzed. Results: No difference in genders noted. Around 35% of patients are above 50 years of age. Poor control of diabetes with mean HbA of 8.1 ± 2.11 is found on analysis. Seasonal occurrence in GBS is prominent in winter 484 (41.50% and mechanically ventilated were 449 (38.50% patients. 48 (4.11% deaths were attributed to GBS. Neurological analysis revealed cranial nerve involvement in 407 (34.90% patients, facial palsy in 401 (34.39% and ataxia in 88 (7.54% patients. Most patients in plasma exchange group belonged to the lower socio-economic status. Mean cerebrospinal fluid (CSF protein levels was (n=962 113.8 ± 11.8 mg/dl. Conduction block determined indirectly by absent H-reflex was noted in 891 (90.64% patients. No difference in complications and outcome is found in treatment regimens of intravenous immunoglobulin (IVIG and plasma exchange.Conclusion: Seasonal occurrence predominantly in winter is noted. Peak flow test may be a predictor of assessing requirement of mechanical ventilation and prognosis. Conduction block is the major abnormality noted in electrophysiological studies and proximal nerve segment assessing with Erb’s point stimulation has high predictive value. IVIG treatment is more expensive but is associated with less duration of hospital stay.
Full Text Available Brand allows for market offer to be identified and differentiated from the competitive offers. The very essence of brand is based not only on potential sales figures, but on the philosophy that makes it posssible for a customer to identify with the brand. Faced with the plenty of market offers customers undoubtedly prefer well-known companies and brands, thus minimizing risk and time consuming activities of gaining futher knowledge concerning alternative offers. The consumers often wonder whether the branded goods are more worth from the other, similar goods without any famous trademarks. There are many questions and theories but only one is undeniable: one should never doubt the companies that invest great amount of assets, ideas, talents, love and risk, intend to risk previously stated items with bad design, services or products’ quality. Brand building in textile industry differs from branding of market offers targeting general public. Branding in textile industry requires more focused approach. Fashion companies are facing with bigger challenges when fighting to attract and keep new consumers who are offered new products and markets. In order to create strong brand, it is necessary to possess expert planning and long-term capital investment. Successful brand is actually an excellent product or service, with creatively designed and conducted marketing. Branding has become marketing’s priority, because successful brands achieve higher prices and gain over loyalty, and attract both consumers and financiers. Marketing agents of the successful 21st century brands must be extremely efficient in strategic brand management, which assumes implementation of marketing activities and programmes in order to build brands, as well as brand management to increase its value. Brands and its value must be regarded and recognized as strategic capital.
Full Text Available Introduction: Despite recent advances in the management of HIV infection and increased access to treatment, prevention, care and support, the HIV/AIDS epidemic continues to be a major global health problem, with sub-Saharan Africa suffering by far the greatest humanitarian, demographic and socio-economic burden of the epidemic. Information on HIV/AIDS clinical care and established cohorts’ characteristics in the Central Africa region are sparse. Methods: A survey of clinical care resources, management practices and patient characteristics was undertaken among 12 adult HIV care sites in four countries of the International Epidemiologic Databases to Evaluate AIDS Central Africa (IeDEA-CA Phase 1 regional network in October 2009. These facilities served predominantly urban populations and offered primary care in the Democratic Republic of Congo (DRC; six sites, secondary care in Rwanda (two sites and tertiary care in Cameroon (three sites and Burundi (one site. Results: Despite some variation in facility characteristics, sites reported high levels of monitoring resources, including electronic databases, as well as linkages to prevention of mother-to-child HIV transmission programs. At the time of the survey, there were 21,599 HIV-positive adults (median age=37 years enrolled in the clinical cohort. Though two-thirds were women, few adults (6.5% entered HIV care through prevention of mother-to-child transmission services, whereas 55% of the cohort entered care through voluntary counselling and testing. Two-thirds of patients at sites in Cameroon and DRC were in WHO Stage III and IV at baseline, whereas nearly all patients in the Rwanda facilities with clinical stage information available were in Stage I and II. WHO criteria were used for antiretroviral therapy initiation. The most common treatment regimen was stavudine/lamivudine/nevirapine (64%, followed by zidovudine/lamivudine/nevirapine (19%. Conclusions: Our findings demonstrate the
Azadmanjir, Zahra; Torabi, Mashallah; Safdari, Reza; Bayat, Maryam; Golmahi, Fatemeh
Introduction: management challenges of clinical laboratories are more complicated for educational hospital clinical laboratories. Managers can use tools of business intelligence (BI), such as information dashboards that provide the possibility of intelligent decision-making and problem solving about increasing income, reducing spending, utilization management and even improving quality. Critical phase of dashboard design is setting indicators and modeling causal relations between them. The pa...
Full Text Available Background and Design: Behçet’s disease (BD is a multisystem inflammatory disorder that is an important cause of morbidity worldwide. In this study, we aimed to investigate the clinical and demographic characteristics of Turkish patients diagnosed with BD. Materials and Methods: We retrospectively evaluated the hospital records of patients with BD who attended the Dermatoveneorology Department at the GATA Haydarpaşa Teaching and Research Hospital between 2001 and 2012. One hundred eighty-two male patients who met the diagnostic criteria of the International Study Group for BD were included in the study. The clinical and demographic characteristics, including symptoms and age at onset, systemic symptoms, duration of the disease and initial signs were recorded. Results: The ages of the 182 male patients included in the study varied from 20 to 53. The mean age at disease onset was 20.59±4.55 years. The leading clinical features were aphthous ulcers (100% followed by genital ulcers (86.8% and papulopustular lesions (80.3%. The pathergy test was positive in 57.3% of the patients. Ocular involvement was present in 527%, vascular involvement in 22.5%, and neurological manifestations was found in 7.1% of the patients. Joint involvement was reported in 18.1% of the subjects. Only 0.5% had genitourinary involvement. There was no relationship of BD with the age at onset and disease duration. Conclusion: We assume that the present study will contribute to the data on demographic and clinical characteristics of especially male BD patients in Turkey
Full Text Available Clinical characteristics associated with isolation of Borrelia burgdorferi sensu lato from skin have not been fully evaluated. To gain insight into predictors for a positive EM skin culture, we compared basic demographic, epidemiologic, and clinical data in 608 culture-proven and 501 culture-negative adult patients with solitary EM. A positive Borrelia spp. skin culture was associated with older age, a time interval of >2 days between tick bite and onset of the skin lesion, EM ≥ 5 cm in diameter, and location of the lesion on the extremities, whereas several other characteristics used as clinical case definition criteria for the diagnosis of EM (such as tick bite at the site of later EM, information on expansion of the skin lesion, central clearing were not. A patient with a 15-cm EM lesion had almost 3-fold greater odds for a positive skin culture than patients with a 5-cm lesion. Patients with a free time interval between the tick bite and onset of EM had the same probability of a positive skin culture as those who did not recall a tick bite (OR=1.02; however, the two groups had >3-fold greater odds for EM positivity than patients who reported a tick bite with no interval between the bite and onset of the lesion. In conclusion, several yet not all clinical characteristics used in EM case definitions were associated with positive Borrelia spp. skin culture. The findings are limited to European patients with solitary EM caused predominantly by B. afzelii but may not be valid for other situations.
Becker, Inga; Gjergji-Lama, Voltisa; Romer, Georg; Möller, Birgit
Given the increasing demand for counselling in gender dysphoria in childhood in Germany, there is a definite need for empirical data on characteristics and developmental trajectories of this clinical group. This study aimed to provide a first overview by assessing demographic characteristics and developmental trajectories of a group of gender variant boys and girls referred to the specialised Gender Identity Clinic in Hamburg. Data were extracted from medical charts, transcribed and analysed using qualitative content analysis methods. Categories were set up by inductive-deductive reasoning based on the patients' parents' and clinicians' information in the files. Between 2006 and 2010, 45 gender variant children and adolescents were seen by clinicians; 88.9% (n = 40) of these were diagnosed with gender identity disorder (ICD-10). Within this group, the referral rates for girls were higher than for boys (1:1.5). Gender dysphoric girls were on average older than the boys and a higher percentage of girls was referred to the clinic at the beginning of adolescence (> 12 years of age). At the same time, more girls reported an early onset age. More girls made statements about their (same-sex) sexual orientation during adolescence and wishes for gender confirming medical interventions. More girls than boys revealed self-mutilation in the past or present as well as suicidal thoughts and/or attempts. Results indicate that the presentation of clinically referred gender dysphoric girls differs from the characteristics boys present in Germany; especially with respect to the most salient age differences. Therefore, these two groups require different awareness and individual treatment approaches. PMID:25296510
Zhou, Li; Fan, Songqing; Liang, Qingchun; Peng, Yating; Zong, Dandan; Ouyang, Ruoyun
To explore the clinical characteristics, imaging manifestation, diagnosis and treatment for histoplasmosis and to improve therapeutic level, we retrospectively analyzed the clinical data of 8 patients with biopsy-confirmed histoplasmosis from 2004 to 2014 in the Second Xiangya Hospital of Central South University and reviewed relevant literatures. The main clinical symptoms of histoplasmosis included fever, cough, expectoration, chest pain, blood-stained sputum, lymphadenectasis, etc. The major lung imaging features were mass, node or pneumonia-like performance. No case was diagnosed as histoplasimosis firstly. Four patients whose imaging manifestations were focal pulmonary lesion received lobectomy of lung lesions or wedge resection. Clinical and imaging manifestations in 3 patients, who treated with amphotericin B or its liposomal, itraconazole or fluconazole, were improved. The clinical symptoms and imaging findings of histoplasmosis are nonspecific. It is easy for the physicians to misdiagnose histoplasmosis as bacterial infection, lung cancer, tuberculosis lymphoma, etc. Therefore, it is significant and necessary to carry out multiple biopsies combined with multiple etiological examinations for patients with difficult diagnosis.
Wang, Hao; Wang, Chunmei
An overview of the municipal solid waste (MSW) management in Beijing, a city with a resident population of about 19.61 million in 2010, is presented in the article. Economic development and population growth have resulted in a MSW generation increase from 2.96 million tons in 2000 to 6.20 million tons in 2007, fluctuating to 6.35 million tons in 2010. The components of MSW over the past decade are characterized by increasing food and paper contents, and a decreasing ash content. The percentage of food waste, the main putrescible component, increased steadily from 45.77% in 2002 to 66.98% in 2010. Combustible materials, such as plastic, paper, textile, wood and food waste, accounted for 94.66% of MSW in 2008. There are 15 landfill sites, 2 incinerators and 2 composting plants in Beijing, with a total designed capacity of 15,380 tons/day in 2010. The main waste disposal technology used in Beijing is landfill, which accounts for 92.27% of the total designed capacity in 2008 and 78.54% in 2009. The designed capacity of the existing disposal plants cannot cope with the actual quantity of waste generation, resulting in overloading and premature closure of landfill sites. Solid waste incineration has been given priority in technology development and financial support over other disposal methods.
The options for antithrombotic therapy have recently been expanded, facilitating optimal tailored treatment. Dual antiplatelet therapy with aspirin and an approved adenosine diphosphate P2Y12 receptor antagonist is recommended for the management of patients with acute coronary syndromes (ACS). However, there are a number of controversies: which P2Y12 inhibitor to choose; how long should antiplatelet therapy be used so as to prevent thrombotic events and minimize bleeding risks; whether to use drug-eluting (DES) or bare-metal stents (BMS) and how to manage the individual variability in response to clopidogrel. Clopidogrel in combination with aspirin has been the standard dual antiplatelet regimen for ACS. The new, more potent P2Y12 inhibitors, prasugrel and ticagrelor, have shown improved antithrombotic effects compared with clopidogrel in patients with ACS (with or without ST-segment elevation myocardial infarction) in landmark trials, even if they were associated with an increased risk of major bleeding. Different pharmacogenetic and pharmacodynamic characteristics may explain, in part, the different pharmacologic and clinical responses to these antiplatelet agents. Importantly, both clopidogrel and prasugrel are prodrugs, i.e., they need to be converted in vivo into active metabolites that selectively and irreversibly bind the P2Y12 receptor. Unlike clopidogrel, however, common functional cytochrome P450 genetic variants do not affect prasugrel active metabolite levels or inhibition of platelet aggregation. In contrast, ticagrelor is not a prodrug (i.e., does not require hepatic metabolism to exert its antiplatelet effect) and represents the first oral P2Y12 receptor antagonist that is reversibly bound. Similar to prasugrel, ticagrelor achieves greater and more rapid inhibition of platelet function than clopidogrel. Evidence suggests that the new P2Y12 antagonists may offer improved antithrombotic effects compared with clopidogrel in selected patients for the
Abubakari, Abdul-Razak; Cousins, Rosanna; Thomas, Cecil; Sharma, Dushyant; Naderali, Ebrahim K
Self-management is critical if people with diabetes are to minimise their risk of macrovascular and microvascular complications, yet adherence to self-management recommendations is suboptimal. Understanding the predictors of optimal diabetes self-management in specific populations is needed to inform effective interventions. This study investigated the role of demographic and clinical characteristics, illness perceptions, and self-efficacy in explaining adherence to self-management recommendations among people with poorly controlled diabetes in North West of England. Illness perceptions and self-efficacy data were collected using validated questionnaires and clinical data were obtained from hospital records. Correlations were used to investigate bivariate relationships between independent variables and self-management, and multiple regression techniques were used to determine demographic and psychosocial predictors of self-management. Various demographic and clinical characteristics were associated with adherence to self-management recommendations. In particular, employment status explained 11% of the variation in adherence to foot care whilst diabetes treatment category explained 9% of exercise and 21% of the variations in SMBG recommendations. Also, 22% and 8% of the variations in overall self-management were explained by illness perceptions and self-efficacy beliefs, respectively. Illness perceptions and self-efficacy beliefs of people with poorly controlled diabetes are important predictors of their self-management behaviours and could potentially guide effective interventions.
Lehmann, Sylvain; Hoofnagle, Andrew; Hochstrasser, Denis; Brede, Cato; Glueckmann, Matthias; Cocho, José A; Ceglarek, Uta; Lenz, Christof; Vialaret, Jérôme; Scherl, Alexander; Hirtz, Christophe
Proteomics studies typically aim to exhaustively detect peptides/proteins in a given biological sample. Over the past decade, the number of publications using proteomics methodologies has exploded. This was made possible due to the availability of high-quality genomic data and many technological advances in the fields of microfluidics and mass spectrometry. Proteomics in biomedical research was initially used in 'functional' studies for the identification of proteins involved in pathophysiological processes, complexes and networks. Improved sensitivity of instrumentation facilitated the analysis of even more complex sample types, including human biological fluids. It is at that point the field of clinical proteomics was born, and its fundamental aim was the discovery and (ideally) validation of biomarkers for the diagnosis, prognosis, or therapeutic monitoring of disease. Eventually, it was recognized that the technologies used in clinical proteomics studies [particularly liquid chromatography-tandem mass spectrometry (LC-MS/MS)] could represent an alternative to classical immunochemical assays. Prior to deploying MS in the measurement of peptides/proteins in the clinical laboratory, it seems likely that traditional proteomics workflows and data management systems will need to adapt to the clinical environment and meet in vitro diagnostic (IVD) regulatory constraints. This defines a new field, as reviewed in this article, that we have termed quantitative Clinical Chemistry Proteomics (qCCP).
Jian-Wen Chen; Li Zhao; Feng Zhang; Lan Li; Yu-Hang Gu; Jing-Yuan Zhou; Hui Zhang
Background:Spinocerebellar ataxias (SCAs) are a group ofneurodegenerative disorders that primarily cause the degeneration in the cerebellum,spinal cord,and brainstem.We study the clinical characteristics,radiological features and gene mutation in Chinese families with SCAs.Methods:In this study,we investigated 10 SCAs Chinese families with SCA1,SCA3/Machado-Joseph disease (MJD),SCA7,SCAB.There were 27 people who were genetically diagnosed as SCA,of which 21 people showed clinical symptoms,and 6 people had no clinical phenotype that we called them presymptomatic patients.In addition,3 people with cerebellar ataxia and cataracts were diagnosed according to the Harding diagnostic criteria but failed to be recognized as SCAs on genetic testing.Clinical characteristic analyses of each type of SCAs and radiological examinations were performed.Results:We found that SCA3/MJD was the most common subtype in Han population in China,and the ratio of the pontine tegmentum and the posterior fossa area was negatively correlated with the number of cytosine-adenine-guanine (CAG) repeats;the disease duration was positively correlated with the International Cooperative Ataxia Rating Scale score;and the CAG repeats number of abnormal alleles was negatively correlated with the age of onset.Conclusions:Collectively our study is a systematic research on SCAs in China,which may help for the clinical diagnosis and prenatal screening of this disease,and it may also aid toward better understanding of this disease.
Simmons, Cameron P; McPherson, Kirsty; Van Vinh Chau, Nguyen; Hoai Tam, D T; Young, Paul; Mackenzie, Jason; Wills, Bridget
This review describes and commentates on recent advances in the understanding of dengue pathogenesis and immunity, plus clinical research on vaccines and therapeutics. We expand specifically on the role of the dermis in dengue virus infection, the contribution of cellular and humoral immune responses to pathogenesis and immunity, NS1 and mechanisms of virus immune evasion. Additionally we review a series of therapeutic intervention trials for dengue, as well as recent clinical research aimed at improving clinical diagnosis, risk prediction and disease classification.
Full Text Available Stéphanie Guey,1,3 Elisabeth Tournier-Lasserve,1,2 Dominique Hervé,1,3 Manoelle Kossorotoff4 1Inserm UMR-S1161, Université Paris 7 Denis Diderot, Sorbonne Paris Cité, Paris, France; 2AP-HP, Groupe hospitalier Lariboisière-Saint-Louis, Service de génétique neurovasculaire, Paris, France; 3Service de Neurologie, Centre de Référence des maladies Vasculaires Rares du Cerveau et de l'Œil (CERVCO, Groupe Hospitalier Saint-Louis Lariboisière-Fernand Widal, Assistance Publique-Hôpitaux de Paris, Paris, France; 4Pediatric Neurology Department, French Center for Pediatric Stroke, University Hospital Necker-Enfants Malades, AP-HP Assistance publique-Hôpitaux de Paris, Paris, France Abstract: Moyamoya angiopathy is characterized by a progressive stenosis of the terminal portion of the internal carotid arteries and the development of a network of abnormal collateral vessels. This chronic cerebral angiopathy is observed in children and adults. It mainly leads to brain ischemic events in children, and to ischemic and hemorrhagic events in adults. This is a rare condition, with a marked prevalence gradient between Asian countries and Western countries. Two main nosological entities are identified. On the one hand, moyamoya disease corresponds to isolated moyamoya angiopathy, defined as being “idiopathic” according to the Guidelines of the Research Committee on the Pathology and Treatment of Spontaneous Occlusion of the Circle of Willis. This entity is probably multifactorial and polygenic in most patients. On the other hand, moyamoya syndrome is a moyamoya angiopathy associated with an underlying condition and forms a very heterogeneous group with various clinical presentations, various modes of inheritance, and a variable penetrance of the cerebrovascular phenotype. Diagnostic and evaluation techniques rely on magnetic resonance imaging (MRI, magnetic resonance angiography (MRA conventional angiography, and cerebral hemodynamics measurements
Full Text Available Objectives: There is significant evidence that psychotherapy is a pivotal treatment for persons diagnosed with Axis I clinical psychiatric conditions; however, a psychotherapy service has only recently been established in the Omani health care system. This study aimed to investigate the sociodemographic and clinical characteristics of attendees at a psychotherapy clinic at a tertiary care hospital. Methods: An analysis was carried out of 133 new referrals to the Psychotherapy Service at Sultan Qaboos University Hospital, a tertiary care hospital. Results: The majority of referrals were females (59%, aged 18–34 years, employed (38%, had ≤12 years of formal education (51%, and were single (54%. A total of 43% were treated for anxiety disorders (including obsessive compulsive disorder, while 22% were treated for depression. A total of 65% were prescribed psychotropic medications. The utilisation of the Psychotherapy Service and its user characteristics are discussed within the context of a culturally diverse Omani community which has unique personal belief systems such as in supernatural powers (Jinn, contemptuous envy (Hassad, evil eye (Ain and sorcery (Sihr which are often used to explain the aetiology of mental illness and influence personal decisions on utilising medical and psychological treatments. Conclusion: Despite the low number of referrals to the Psychotherapy Service, there is reason to believe that psychotherapy would be an essential tool to come to grips with the increasing number of mental disorders in Oman.
WANG Lei; ZHANG Mao-zhi; ZHANG Wei; ZHAO Shang-feng; ZHAO Ji-zong; JIA Jin-xiu
Background Tumor involving the septum pellucidum is uncommon. Surgery as the main therapeutic procedure for this lesion is a challenge to neurosurgeons. We analyzed the clinical characteristics and pathological features of septum pellucidum tumor in 41 patients and compared the curative effects of frontal transcortical, trans-sulcal and interhemispheric transcallosal approaches. Methods Clinical characteristics and the pathological features of septum pellucidum tumor were investigated retrospectively in 41 patients. The differences in postoperative residual rates, extents of tumors and resection of normal brain tissues after use of the three approaches in these patients were analyzed statistically. Results Septum pellucidum tumor is more likely to attack young or middle-aged persons. The tumor mainly presents itself as a central neurocytoma or cerebral low-grade glioma in pathology and manifests as intracranial hypertension clinically. No difference was found in the extent of tumor resection but significant difference in the extent of normal brain tissue resection and in postoperative disability rate among the three approaches. The transcortical approach brought about the most serious injury to brain tissue and the highest disability rate, Whereas the frontal transcallosal approach the lightest injury and the lowest disability rate. The injury to brain tissue and the disability rate brought about by the front trans-sulcus approach were between the above two approaches. Conclusions Operation is still regarded the major treatment for septum pellucidum tumor. Transcallosal and trans-sulcus approaches are fit with the concept of minimally invasive surgery, and transcallosal approach is the first choice for septum pellucidum tumor.
Banducci, Anne N; Dahne, Jennifer; Magidson, Jessica F; Chen, Kevin; Daughters, Stacey B; Lejuez, C W
In the United States, substance users who voluntarily (VO) elect to receive treatment and substance users who are court-mandated (CM) to receive treatment typically obtain care within the same facilities. Little is known about the clinical characteristics that differentiate these individuals. The current study provides rates of specific DSM-IV Axis I and Axis II psychiatric and substance use disorders, comorbidities, childhood trauma, motivation, and other clinical and demographic characteristics as a function of referral status, among individuals in residential substance use treatment (463 participants, M age=43.3; 69.7% male; 88.4% African American). Participants were interviewed and diagnosed using the Structure Clinical Interview for DSM-IV and the Diagnostic Interview for Personality Disorders. Within our sample, VO individuals, as compared to CM individuals had significantly higher rates of psychiatric disorders (68.7% versus 55.2%, respectively), including mood disorders, major depressive disorder, generalized anxiety disorder, and borderline personality disorder. Additionally, they were significantly more likely to have alcohol dependence (43.0% versus 20.8%) and cocaine dependence (66.5% versus 48.9%). Elevated rates of comorbidities and childhood abuse were also observed among VO individuals, while motivation did not differ as a function of referral status. Overall, VO individuals appeared to have more severe problems than their CM counterparts which may suggest that they require more intensive or different types of treatment. PMID:23380487
Kent-Man Chu; Ka-Fai Kwok; Simon Law; Kam-Ho Wong
AIM: To assess the clinical characteristics of Helicobacterpylori(H pylori) negative duodenal ulcer.METHODS: Patients with an endoscopic diagnosis of duodenal ulcer between 1996 and 2002 were included in the present study. Patients were considered to be negative for Hpylori, if both histological examination and rapid urease test of biopsy specimens were negative. A comparison was made between patients with H pyloripositive and negative duodenal ulcers.RESULTS: A total of 1 343 patients were studied. Their mean age was 54.7±0.5 years. There was a male preponderance (M:F = 2.5:1). Three hundred and ninetyeight patients (29.6%) did not have H pylori infection. The annual proportion of patients with H pylori negative duodenal ulcers increased progressively from 1996 to2002. On multivariate analysis, patients with H pylorinegative duodenal ulcer were more likely to be older, have concomitant medical problem, pre-existing malignancy, recent surgery, underlying sepsis, or taken non-steroidal anti-inflammatory drugs. In terms of clinical presentations, patients with H pylori negative duodenal ulcer were more likely to present with bleeding, multiple ulcers and larger ulcers.CONCLUSION: The proportion of patients with H pylori negative duodenal ulcers is on the rise because of a continued drop in incidence of H pylori positive duodenalulcers in recent years. Such patients have distinct clinical characteristics and it is important to ascertain the H pylori status before starting eradication therapy.
Vlcek, B; Spurny, F
The contribution of the high LET particles to dosimetric and microdosimetric characteristics of 150 and 205 MeV clinical proton beams was experimentally studied using track etched detectors. Secondary heavy charged particles produced from nuclear interactions and degraded protons at the Bragg peak region are particles with high LET. The method of the LET spectra measurement with track etched detectors allows one to determine the contribution of high LET particles to dosimetric characteristics of clinical proton beams: absorbed dose, equivalent dose and the value of the Relative Biological Effectiveness (RBE). Track detectors were irradiated in the various depth of clinical proton beams with the primary energies of 150 and 205 MeV. The LET spectra between 10 and 700 keV/m were measured by means of CR-39 track etched detectors and the automatic optical image analyzer LUCIA-II. The relative contribution of the high LET particles to absorbed dose increases from several per cent at the beam entrance to several ten...