Sample records for clinical characteristics management

  1. Clinical characteristics and management of melanoma families

    NARCIS (Netherlands)

    Rhee, Jasper Immanuel van der


    Being a member of a melanoma family is a major risk factor for cutaneous malignant melanoma. In this thesis clinical characteristics and management of melanoma families are discussed. In the first part of the thesis clinical and histological characteristics of melanoma (patients) from families with

  2. Clinical management of behavioral characteristics of Prader–Willi syndrome

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    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

  3. Spinal epidural angiolipomas: Clinical characteristics, management and outcomes (United States)

    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

  4. Prevalence, clinical characteristics and management of atrial fibrillation in patients with Brugada syndrome

    NARCIS (Netherlands)

    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

  5. Geographic differences in clinical characteristics and management of COPD: the EPOCA study (United States)

    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

  6. Clinical characteristics, diagnosis and management of respiratory distress syndrome in full-term neonates

    Institute of Scientific and Technical Information of China (English)

    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

  7. Characteristics of Pseudoaneurysms in Southern India; Risk Analysis, Clinical Profile, Surgical Management and Outcome

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    Hafeezulla Lone


    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

  8. Metabolic Issues in patients affected by Schizophrenia:Clinical characteristics and Medical Management

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    Antonio eVentriglio


    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.

  9. Clinical characteristics and primary management of patients diagnosed with prostate cancer between 2007 and 2013

    DEFF Research Database (Denmark)

    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...... 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...

  10. Impulse control disorders: updated review of clinical characteristics and pharmacological management

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    Jon E Grant


    Full Text Available Impulse control disorders (ICDs are characterized by urges and behaviors that are excessive and/or harmful to oneself or others and cause significant impairment in social and occupational functioning, as well as legal and financial difficulties. ICDs are relatively common psychiatric conditions, yet are poorly understood by the general public, clinicians, and individuals struggling with the disorder. Although ICD treatment research is limited, studies have shown ICDs may respond well to pharmacological treatment. This article presents a brief overview about the clinical characteristics of ICDs and pharmacological treatment options for individuals with ICDs.

  11. Inner Ear Disease and Benign Paroxysmal Positional Vertigo: A Critical Review of Incidence, Clinical Characteristics, and Management

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    M. Riga


    Full Text Available Background. This study is a review of the incidence, clinical characteristics, and management of secondary BPPV. The different subtypes of secondary BPPV are compared to each other, as well as idiopathic BPPV. Furthermore, the study highlights the coexistence of BPPV with other inner ear pathologies. Methods. A comprehensive search for articles including in the abstract information on incidence, clinical characteristics, and management of secondary BPPV was conducted within the PubMed library. Results. Different referral patterns, different diagnostic criteria used for inner ear diseases, and different patient populations have led to greatly variable incidence results. The differences regarding clinical characteristics and treatment outcomes may support the hypothesis that idiopathic BPPV and the various subtypes of secondary BPPV do not share the exact same pathophysiological mechanisms. Conclusions. Secondary BPPV is often under-diagnosed, because dizziness may be atypical and attributed to the primary inner ear pathology. Reversely, a limited number of BPPV patients may not be subjected to a full examination and characterized as idiopathic, while other inner ear diseases are underdiagnosed. A higher suspicion index for the coexistence of BPPV with other inner ear pathologies, may lead to a more integrated diagnosis and consequently to a more efficient treatment of these patients.

  12. Infantile nystagmus syndrome: clinical characteristics, current theories of pathogenesis, diagnosis, and management. (United States)

    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.

  13. 47,XXY Klinefelter syndrome: clinical characteristics and age-specific recommendations for medical management. (United States)

    Aksglaede, Lise; Link, Katarina; Giwercman, Aleksander; Jørgensen, Niels; Skakkebaek, Niels E; Juul, Anders


    47,XXY (Klinefelter syndrome) is the most frequent sex chromosomal disorder and affects approximately one in 660 newborn boys. The syndrome is characterized by varying degrees of cognitive, social, behavioral, and learning difficulties and in adulthood additionally primary testicular failure with small testes, hypergonadotropic hypogonadism, tall stature, and eunuchoid body proportions. The phenotype is variable ranging from "near-normal" to a significantly affected individual. In addition, newborns with Klinefelter syndrome generally present with a normal male phenotype and the only consistent clinical finding in KS is small testes, that are most often not identified until after puberty. Decreased awareness of this syndrome among health professionals and a general perception that all patients with 47,XXY exhibit the classic textbook phenotype results in a highly under-diagnosed condition with up to 75% of the patients left undetected. Typically, diagnosis is delayed with the majority of patients identified during fertility workup in adulthood, and only 10% of patients diagnosed prior to puberty. Early detection of this syndrome is recommended in order to offer treatment and intervention at the appropriate ages and stages of development for the purpose of preventing osteopenia/osteoporosis, metabolic syndrome, and other medical conditions related to hypogonadism and to the XXY as well as minimizing potential learning and psychosocial problems. The aim of this review is to present the clinical aspects of XXY and the age-specific recommendations for medical management. © 2013 Wiley Periodicals, Inc.

  14. Clinical Characteristics of the Suicide Attempters Who Refused to Participate in a Suicide Prevention Case Management Program. (United States)

    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.

  15. Characteristics and clinical management of acute pulmonary embolism in real world: findings from TUSCAN-PE study

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    Luca Masotti


    Full Text Available Acute pulmonary embolism (PE remains one of the leading causes of mortality and morbidity in cardiovascular setting. Despite much information about clinical aspects and recommendations or clinical guidelines is available from literature, few data exist about the management of PE in real world of internal medicine scenario. Therefore the aim of the present study was to report on characteristics and management of PE patients admitted in this setting. TUSCAN-PE study was a multicenter, observational, retrospective, cohort study aimed to analyze data of PE patients admitted in Internal Medicine wards of Tuscany. Each center was invited to submit anonymously data of at least ten patients consecutively discharged for acute PE in 2012. Data were referred to demographic, clinical, instrumental, prognostic and therapeutic characteristics. A total of 452 patients from 28 Tuscan centers (60.2% F, with mean age 76.01±12.34 years, were enrolled. A total of 87% of patients was admitted from Emergency Department, but only 65.2% of patients with diagnosis of PE. Around one third of diagnoses of PE was performed by internists. In 14.8% of diagnoses was incidental. In 86% of patients, diagnosis was performed by computer tomography pulmonary angiography. Overall mortality was 9.5%, 5.75% being PE-related. Main risk factors enclosed recent respiratory tract infections (55.3%, immobility (42.25%, recent hospital admissions (33.6% and cancer (30.3%. In 65.8% of patients, PE was associated with deep vein thrombosis. 16.6% of patients had a shock index ≥1 and 84.75% simplified pulmonary embolism severity index (PESI score ≥1. A number of 51.5% of patients presented echocardiographic right heart dysfunction, 50.6% and 55.9% of patients presented increased values of troponins and natriuretic peptides, respectively. The following percentage, 6.5%, 71.1% and 22.4%, were defined as high, intermediate and low risk according to the European Society of Cardiology (ESC

  16. Management of headache disorders: design of a randomised clinical trial screening for prognostic patient characteristics

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    Vaes Peter H


    Full Text Available Abstract Background Treatment of headache disorders is not always optimal. Patients are treated in multiple ways, and the lack of scientific arguments for referral and the insufficient implementation of guidelines result in unclear treatment strategies. The coexistence of headache and neck pain can lead to the referral to a musculoskeletal physiotherapist. This treatment can only be successful if an underlying cervical segmental dysfunction is present. In such cases a physical treatment can be a valuable option that should be considered. The aim of this study is to identify prognostic therapeutic patient characteristics and to increase the number of correct physiotherapy referrals. Methods/design This trial is designed to identify patient characteristics which can influence the prognosis of the patient. Patients with recurrent headache and co-existent neck pain are recruited via a multicenter setup. After screening for eligibility, subjects are tested at baseline and randomly allocated to one of two treatment groups. Testing includes the administering of questionnaires (a Headache Diagnosis Questionnaire, Headache Inventory List and the Headache Impact Test (HIT-6 and physical tests (Thermal Stimuli, Manual Cervical Spine Examination and Pressure Algometry. Treatment groups are a usual care group (UC administered by the General Practitioner (GP and a usual care plus musculoskeletal physiotherapy treatment group (UCMT. UC is based on the Dutch GP Guideline for Headache. UCMT consists of the UC plus a combination of exercises and spinal cervical mobilisations. Follow-up measurements consist of the completion of the Headache Inventory List, the HIT-6 and scoring of the global perceived effect (GPE. The latter allowing the distinction between responders (positive effect and non-responders (no effect or worse. Logistic regression analysis will be used to identify the specific patient characteristics of the responders and the non-responders. The

  17. Clinical characteristics and management of patients with early acute severe pancreatitis:Experience from a medical center in China

    Institute of Scientific and Technical Information of China (English)

    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.

  18. Clinical Characteristics and Surgical Management of Patients with Temporal Lobe Gangliogliomas

    Institute of Scientific and Technical Information of China (English)

    Huanchang Shi; Ding Lei; Baiyong Mao; Sanzhong Li


    OBJECTIVE To review the clinical features and surgical treatment for patients with temporal lobe gangliogliomas.METHODS Patients with temporal lobe gangliogliomas who underwent resection of temporal lobe tumors, confirmed by surgical pathology, seen between September 1998 and November 2004 at the West China hospital, were selected. Medical records were reviewed for age at diagnosis,age at onset of seizures, delay between seizure onset and tumor diagnosis, types and frequencies of seizures, EEG results, extent of surgery,and pathologic diagnosis. The follow-up periods varied from 12 to 60months (mean 30 months).RESULTS Eighteen patients were identified, including 14 males and 4females. Age at operation ranged from 4 years to 34 years (mean 17.6years). All patients underwent at least one surgical procedure. Fifteen tumors were classified as WHO Grade Ⅰ lesions, and 3 as WHO Grade Ⅱ lesions. None of patients experienced a tumor recurrence. Among the patients, 85% had complete and sustained seizure relief.CONCLUSION Complex partial seizures and auras were the common presenting symptom of these patients. The follow-up suggested good relief from the seizures after surgery and a low risk for tumor recurrence and malignant progression.

  19. Women at high risk of breast cancer: Molecular characteristics, clinical presentation and management. (United States)

    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.

  20. Clinical Characteristics, Management, and Outcome of 22 Cases of Primary Hypophysitis

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    Sun Mi Park


    Full Text Available BackgroundPrimary hypophysitis causes varying degrees of endocrine dysfunction and mass effect. The natural course and best treatment have not been well established.MethodsMedical records of 22 patients who had been diagnosed with primary hypophysitis between January 2001 and March 2013 were retrospectively reviewed. Based on the anatomical location, we classified the cases as adenohypophysitis (AH, infundibuloneurohypophysitis (INH, and panhypophysitis (PH. Clinical presentation, endocrine function, pathologic findings, magnetic resonance imaging findings, and treatment courses were reviewed.ResultsAmong 22 patients with primary hypophysitis, 81.8% (18/22 had involvement of the posterior pituitary lobe. Two patients of the AH (2/3, 66.6% and three patients of the PH (3/10, 30% groups initially underwent surgical mass reduction. Five patients, including three of the PH (3/10, 33.3% group and one from each of the AH (1/3, 33.3% and INH (1/9, 11.1% groups, initially received high-dose glucocorticoid treatment. Nearly all of the patients treated with surgery or high-dose steroid treatment (9/11, 82% required continuous hormone replacement during the follow-up period. Twelve patients received no treatment for mass reduction due to the absence of acute symptoms and signs related to a compressive mass effect. Most of them (11/12, 92% did not show disease progression, and three patients recovered partially from hormone deficiency.ConclusionDeficits of the posterior pituitary were the most common features in our cases of primary hypophysitis. Pituitary endocrine defects responded less favorably to glucocorticoid treatment and surgery. In the absence of symptoms related to mass effect and with the mild defect of endocrine function, it may not require treatment to reduce mass except hormone replacement.

  1. Clinical characteristics, management, and control of permanent vs. nonpermanent atrial fibrillation: insights from the RealiseAF survey.

    LENUS (Irish Health Repository)

    Murin, Jan


    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.

  2. Clinical characteristics and management of late urinary symptom flare following stereotactic body radiation therapy for prostate cancer

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    Jennifer Ai-Lian Woo


    Full Text Available Purpose: Stereotactic body radiotherapy (SBRT is increasingly utilized as primary treatment for localized prostate cancer (PCa. The late GU toxicity of SBRT has not been fully described. We characterize the clinical features of late urinary symptom flare (LUSF and recommend conservative management approaches.Methods: Between Feb.08-Aug.11, 216 men with PCa were treated definitively with SBRT at GUH. Treatment was delivered using the CyberKnife (35 Gy-36.25 Gy in 5 fractions. The prevalence of CTC-graded toxicities and medication usage were assessed at each follow-up visit. Patient-reported symptoms were assessed using the AUA symptom score and the EPIC-26 at 1, 3, 6, 9, 12, 18 and 24 months. LUSF was defined as an increase in the AUA score of ≥ 5 points above baseline with a degree of severity in the moderate to severe range. The relationship between the occurrence of flare and pretreatment characteristics were examined.Results: Of the 216 patients, 29 (13.4% experienced a late transient increase in the AUA score that met the criteria for LUSF. Among flare patients, median age was 66 yrs compared to 70 for those without flare (p = 0.007. In patients who experienced flare, CTC toxicities peaked at 9-18 months, and alpha-antagonist utilization peaked at 18 months (85% before decreasing at 24 months. The EPIC urinary summary score of flare patients transiently declined between 6 months and 18 months before returning to baseline at two years post-SBRT. Clinically significant increases in frequency, weak stream and dysuria were seen at 12 months post-SBRT. Among flare patients, 42.9% felt that urination was a moderate to big problem at 12 months following SBRT.Conclusions: In this study, we characterize LUSF following SBRT. LUSF is a constellation of symptoms including frequency/urgency, weak stream and dysuria that transiently occurs 6-18 months post-SBRT. The maintenance of prophylactic alpha-antagonists may limit the bother associated with this

  3. [Management in clinical nutrition]. (United States)

    Alvarez, J; Monereo, S; Ortiz, P; Salido, C


    Terms such as management, costs, efficacy, efficiency, etc. that are so common in the discourse of managers are now beginning to appear in the vocabulary of clinicians. Management in Clinical Nutrition is an innovative aspect of interest among health-care professionals dealing with the needs of undernourished patients or those at risk of malnutrition. The basic goal of this paper is to show that the tools for clinical management of hospitals are applicable to such a multidisciplinary and complex speciality as clinical nutrition and also to propose the measures needed to improve our information systems and optimize management in this field. The very concept of hospitals has changed, as has their activity, over the years. Hospitals are nowadays no longer just a charitable institution but has become a service company, a public utility for the promotion of good health and they have to be managed in accordance with criteria of efficacy, efficiency, equity and quality. The concepts of Evidence-Based Medicine (EBM) and Cost-Effective Medicine (CEM) are of evident importance in the different ways of managing health-care services. Good clinical practice is the combination of EBM and CEM. This review defines the various cost studies of fundamental importance when taking decisions in hospital management and analyzes such clinical management tools as analytical accounting, Minimum Hospital Database Set (MHDS) and encoding systems, among others, thus facilitating an analysis of the usefulness of data in clinical nutrition management systems. Finally, after reviewing some specific examples, measures are proposed to optimize current information systems. The medical staff and those of us responsible for Nutrition Units operate in hospitals as part of a centralized service transferring information to the various departments where the patient is physically located (Surgery, Internal Medicine, Digestive, ICU, etc.). One of the priority goals in micro-management and middle management

  4. Patient characteristics and clinical management of patients with shoulder pain in U.S. primary care settings: Secondary data analysis of the National Ambulatory Medical Care Survey

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    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.

  5. Characteristics and clinical management of patients admitted to cholera wards in a regional referral hospital during the 2012 epidemic in Sierra Leone

    Directory of Open Access Journals (Sweden)

    Alexander Blacklock


    Full Text Available Background and objectives: In 2012, Sierra Leone suffered a nationwide cholera epidemic which affected the capital Freetown and also the provinces. This study aims to describe the characteristics and clinical management of patients admitted to cholera isolation wards of the main referral hospital in the Northern Province and compare management with standard guidelines. Design: All available clinical records of patients from the cholera isolation wards were reviewed retrospectively. There was no active case finding. The following data were collected from the clinical records after patients had left the ward: date of admission, demographics, symptoms, dehydration status, diagnoses, tests and treatments given, length of stay, and outcomes. Results: A total of 798 patients were admitted, of whom 443 (55.5% were female. There were 18 deaths (2.3%. Assessment of dehydration status was recorded in 517 (64.8% of clinical records. An alternative or additional diagnosis was made for 214 patients (26.8%. Intravenous (IV fluids were prescribed to 767 patients (96.1%, including 95% of 141 patients who had documentation of being not severely dehydrated. A history of vomiting was documented in 92.1% of all patients. Oral rehydration solution (ORS was given to 629 (78.8% patients. Doxycycline was given to 380 (47.6% patients, erythromycin to 34 (4.3%, and other antibiotics were used on 247 occasions. Zinc was given to 209 (26.2%. Discussion: This retrospective study highlights the need for efforts to improve the quality of triage, adherence to clinical guidance, and record keeping. Conclusions: Data collection and analysis of clinical practices during an epidemic situation would enable faster identification of those areas requiring intervention and improvement.

  6. Pediatric anthrax clinical management. (United States)

    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.

  7. Clinical Characteristics of Labyrinthine Concussion


    Choi, Mi Suk; Shin, See-Ok; Yeon, Je Yeob; Choi, Young Seok; Kim, Jisung; Park, Soo Kyoung


    Background and Objectives Inner ear symptoms like hearing loss, dizziness or tinnitus are often developed after head trauma, even in cases without inner ear destruction. This is also known as labyrinthine concussion. The purpose of this study is to determine the clinical manifestations, characteristics of audiometry and prognostic factors of these patients. Materials and Methods We reviewed the medical records of the 40 patients that had been diagnosed as labyrinthine concussion from 1996 to ...

  8. Nurse manager characteristics and skills: curriculum implications. (United States)

    Dienemann, J; Shaffer, C


    If one accepts the premise that all nurses need knowledge of management and leadership, then schools of nursing need to design their curriculum to provide administrative content and learning experiences to adequately prepare nurses for leadership positions. This study assays the opinions of nurse unit managers about the relative importance of different characteristics and skills in effective job performance. A sample of 73 unit managers from six hospitals and two community health agencies ranked human relations and communication skills as most important. Nursing knowledge and clinical skills were ranked second. Experienced managers thought political savvy and business or management skills were more important than did novice managers. The results of this study are discussed in relation to curriculum issues in nursing management at both the baccalaureate and the graduate level.

  9. Clinical characteristics of Caroli's syndrome

    Institute of Scientific and Technical Information of China (English)

    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.

  10. Is there a sex effect in colon cancer? Disease characteristics, management, and outcomes in routine clinical practice (United States)

    Quirt, J.S.; Nanji, S.; Wei, X.; Flemming, J.A.; Booth, C.M.


    Introduction The incidence of colon cancer varies by sex. Whether women and men show differences in extent of disease, treatment, and outcomes is not well described. We used a large population-based cohort to evaluate sex differences in colon cancer. Methods Using the Ontario Cancer Registry, all cases of colon cancer treated with surgery in Ontario during 2002–2008 were identified. Electronic records of treatment identified use of surgery and adjuvant chemotherapy. Pathology reports for a random 25% sample of all cases were obtained, and disease characteristics, treatment, and outcomes in women and men were compared. A Cox proportional hazards model was used to identify factors associated with overall (os) and cancer-specific survival (css). Results The study population included 7249 patients who underwent resection of colon cancer; 49% (n = 3556) were women. Stage of disease and histologic grade did not vary by sex. Compared with men, women were more likely to have right-sided disease (55% vs. 44%, p ≤ 0.001). Surgical procedure and lymph node yield did not differ by sex. Adjuvant chemotherapy was delivered to 18% of patients with stage ii and 64% of patients with stage iii disease; when adjusted for patient- and disease-related factors, use of adjuvant chemotherapy was similar for women and men [relative risk: 0.99; 95% confidence interval (ci): 0.94 to 1.03]. Adjusted analyses demonstrated that os [hazard ratio (hr): 0.80; 95% ci: 0.75 to 0.86] and css (hr: 0.82; 95% ci: 0.76 to 0.90) were superior for women compared with men. Conclusions Long-term survival after colon cancer is significantly better for women than for men, which is not explained by any substantial differences in extent of disease or treatment delivered.

  11. Clinical characteristics and management stratege of acute abdomen in elderly patients%老年急腹症临床特点与治疗对策

    Institute of Scientific and Technical Information of China (English)



    Objective To investigate the clinical characteristics and management stratege of acute abdomen in elderly patients. Methods The clinical data of 375 cases of acute abdomen in elderly patients between January 2000 and March 2011 in surgery department of Wuhu the fifth people's hospital were analyzed retrospectively. Results The incidence of actue abdomen is high in elderly patients and with multiple complications. Early diagnosis is difficult,so misdiagnosis happening easily. 363 cases (96. 8% ) were cured, and 12 cases(3. 2% ) died. Conclusion Acute abdomen is not contraindication for operation in elderly patients. Early diagnosis,active preparation before operation,good clinical decision and prevention of postoperative complications are the key for acute abdomen in elderly patients.%目的 探讨老年急腹症的临床特点及治疗策略.方法 回顾性分析我院普外科2000年1月~2011年3月收治的375例老年急腹症临床资料.结果 老年急腹症发病率高,早期诊断困难,易发生误诊,且并发症多.治愈363例(96.8%),死亡12例(3.2%).结论 老年急腹症并不是手术的绝对禁忌.早期诊断,积极的术前准备,及时恰当的临床决策,预防并发症的发生是老年急腹症治疗的关键.

  12. A nationwide survey of clinical characteristics, management, and outcomes of acute kidney injury (AKI) - patients with and without preexisting chronic kidney disease have different prognoses. (United States)

    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.

  13. Sex differences in clinical characteristics, hospital management practices, and in-hospital outcomes in patients hospitalized in a Vietnamese hospital with a first acute myocardial infarction.

    Directory of Open Access Journals (Sweden)

    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.

  14. Sport Management Graduate Programs: Characteristics of Effectiveness. (United States)

    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…

  15. Clinical medication error characteristics analysis and safety management countermeasures%临床给药错误特性分析及安全管理对策

    Institute of Scientific and Technical Information of China (English)

    周月华; 王青云; 林丽华


    目的:探讨如何避免给药错误的发生,研究相应防范管理对策,提高临床给药安全的管理质量。方法回顾本院2010-2012年护理不良事件系统上报的111起给药错误,对给药错误类型、原因、特点等进行分析。结果给药错误前3位为遗漏、患者身份识别错误、药物名称错误,分别占22.52%,20.72%,19.82%;给药错误的前3位原因为查对不认真、未遵守操作流程、沟通不良,分别占21.62%,16.22%,14.41%;年限低于5年的护士给药错误发生率占62.86%,10年以上者发生率占16.19%;1 d中给药错误发生的3个高峰时段为10:00-11:59、8:00-9:59、16:00-17:59。结论护理管理人员应根据护士给药错误的原因与特点制定针对性防范措施,加强护士责任心教育,改善工作环境,改革护理人员的排班模式,加强薄弱环节管理,加强护士培训与考核,规范科室药品管理等措施,提高给药安全。%Objective To discuss how to avoid medication errors , and research relevant preventive management strategies so as to improve the quality of clinical drug safety management .Methods Analyzed the types, causes and features of medication errors by reviewing 111 reported nursing adverse events about the medicine mistakes between 2010 and 2012 .Results The top three sorts of medication were omittance (22.52%), patients identification errors(20.72%) and drug name errors(19.82%), and the top three cause were no seriously check ( 21.62%), no complying with operation ( 16.22%) and poor communication (14.41%).Medication error rates of nurses with less 5 work years was 62.86%,and that nurses with more than 10 work years was 16.19%.The top three medication error time slots were 10:00-11:59(25.23%), 8:00-9:59(19.82%) and 16:00-17:59 (13.51%).Conclusions Nursing manager should formulate the pertinence preventive measures according to the reasons and

  16. Impact of diabetes mellitus on clinical characteristics, management, and in-hospital outcomes in patients with acute myocardial infarction (from the NCDR). (United States)

    Rousan, Talla A; Pappy, Reji M; Chen, Anita Y; Roe, Matthew T; Saucedo, Jorge F


    Patients with diabetes mellitus (DM) presenting with acute myocardial infarction (AMI) have worse outcomes versus those without DM. Comparative contemporary data in patients presenting with AMI with insulin-requiring diabetes mellitus (IRDM), noninsulin-requiring diabetes mellitus (NIRDM), and newly identified DM (hemoglobin A1C level >6.5%) versus patients without DM are limited. This observational study from the National Cardiovascular Data Registry (NCDR) Acute Coronary Treatment and Intervention Outcomes Network-Get with the Guidelines (ACTION Registry-GWTG consisted of 243,861 patients with AMI from 462 US sites identified from January 2007 to March 2011 entered into the registry. Clinical characteristics, management, and in-hospital outcomes were analyzed. Patients with DM with non-ST-segment elevation myocardial infarction (NSTEMI; n = 53,094, 35%) were less likely to undergo diagnostic angiography or revascularization, whereas those with ST-segment elevation myocardial infarction (STEMI) (n = 21,507, 23%) were less likely to undergo reperfusion therapy compared with patients without DM. There was an increased adjusted risk of in-hospital mortality in the DM group in both the NSTEMI (odds ratio [OR] 1.14, 95% confidence interval [CI] 1.06 to 1.22) and STEMI (OR 1.17, 95% CI 1.07 to 1.27) population. In patients with DM, the risk-adjusted in-hospital mortality was higher in patients with IRDM than those with NIRDM in the NSTEMI group (OR 1.12, 95% CI 1.01 to 1.24) but not in the STEMI group (OR 1.12, 95% CI 0.95 to 1.32). Newly diagnosed patients with DM presenting with AMI had similar unadjusted in-hospital outcomes compared with patients without DM. In conclusion, patients with DM presenting with AMI have a higher mortality risk than patients without DM. In patients with DM, those with IRDM presenting with NSTEMI had an increased mortality than those with NIRDM.

  17. Modern Management of Clinical Chorioamnionitis

    Directory of Open Access Journals (Sweden)

    Thomas Westover


    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.

  18. Clinical management of agnosia. (United States)

    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.

  19. [Controlling in clinical management]. (United States)

    Bähr, K; Ellinger, K


    Managers of industrial enterprises strive continually to improve the efficiency of production, distribution and service for their customers in order to be able to compete on the market. In socially orientated non-profit-organisations this is not universe practice. Relating to section 17 Abs. 1 KHG and section 13 BPfIV of German social legislation hospital charges are refunded only, if the hospital is working efficiently and economically. Controlling is a tool to achieve these goals. Controlling coordinates the flow of information for planning and evaluation. Strategic and operative controlling are closely interrelated: Strategic controlling is directed towards new and promising activities, operative controlling supports decision--making--including future-oriented aspects-by providing and condensing information. Controlling is definitely not intended to dictate or "command" any action. Its object is to serve as an instrument or tool supporting result-oriented planning, regulating and evaluation.

  20. Clinical management of neurocysticercosis. (United States)

    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.





    The article reveals main management styles practiсed by managers all over the world. The author considers key characteristics of management styles, conditions of their using. The paper analyzes cultural differences in management styles in the West and in the East.

  2. [Clinical characteristics of male osteoporosis]. (United States)

    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.

  3. Socio-demographic psychosocial and clinical characteristics of participants in e-HealthyStrides©: an interactive ehealth program to improve diabetes self-management skills. (United States)

    Pemu, Priscilla E; Quarshie, Alexander Q; Josiah-Willock, R; Ojutalayo, Folake O; Alema-Mensah, Ernest; Ofili, Elizabeth O


    Diabetes self-management (DSM) training helps prevent diabetic complications. eHealth approaches may improve its optimal use. The aims were to determine a) acceptability of e-HealthyStrides© (an interactive, Internet-based, patient-driven, diabetes self-management support and social networking program) among Morehouse Community Physicians' Network diabetics; b) efficacy for DSM behavior change c) success factors for use of e-HealthyStrides©. Baseline characteristics of pilot study participants are reported. Of those approached, 13.8% agreed to participate. Among participants, 96% were Black, 77% female; age 56±9.2 years; education: 44% college or higher and 15% less than 12th grade; 92.5% with home computers. Over half (51%) failed the Diabetes Knowledge Test. Nearly half (47%) were at goal A1C; 24% at goal blood pressure; 3% at goal LDL cholesterol level. Median (SD) Diabetes Empowerment Scale score = 3.93 (0.72) but managing psychosocial aspects = 3.89 (0.89) scored lower than other domains. There was low overall confidence for DSM behaviors. Assistance with healthy eating was the most frequently requested service. Requestors were more obese with worse A1C than others. Chronic care delivery scored average with high scores for counseling and problem solving but low scores for care coordination and follow up.

  4. Clinical Trials Management | Division of Cancer Prevention (United States)

    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.

  5. Intracranial Infections: Clinical and Imaging Characteristics

    Energy Technology Data Exchange (ETDEWEB)

    Foerster, B.R.; Thurnher, M.M.; Malani, P.N.; Petrou, M.; Carets-Zumelzu, F.; Sundgren, P.C. [Dept. of Radiology, and Divisions of Infectious Diseases and G eriatric Medicine, Dept. of Internal Medicine, Univ. of Michigan Medical Center, Ann Arbor, MI (United States)


    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.

  6. Clinical characteristics of idiopathic portal hypertension

    Institute of Scientific and Technical Information of China (English)

    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".

  7. Hereditary angioedema: imaging manifestations and clinical management. (United States)

    Gakhal, Mandip S; Marcotte, Gregory V


    Hereditary angioedema is a genetic disorder typically related to insufficient or dysfunctional C1-esterase inhibitor. Patients present with episodic swelling of various body parts, such as the face, neck, bowel, genitals, and extremities. Acute or severe symptoms can lead to patients presenting to the emergency room, particularly when the neck and abdominopelvic regions are affected, which is often accompanied by radiologic imaging evaluation. Patients with hereditary angioedema can pose a diagnostic challenge for emergency department physicians and radiologists at initial presentation, and the correct diagnosis may be missed or delayed, due to lack of clinical awareness of the disease or lack of its consideration in the radiologic differential diagnosis. Timely diagnosis of hereditary angioedema and rapid initiation of appropriate therapy can avoid potentially life-threatening complications. This article focuses on the spectrum of common and characteristic acute imaging manifestations of hereditary angioedema and provides an update on important recent developments in its clinical management and treatment.

  8. Clinical characteristics of fulminant hepatitis in pregnancy

    Institute of Scientific and Technical Information of China (English)

    Xiao-Mao Li; Lin Ma; Yue-Bo Yang; Zhong-Jie Shi; Shui-Sheng Zhou


    AIM: To investigate the clinical characteristics of fulminant hepatitis in pregnancy.METHODS: We compared and analyzed the etiology,clinical characteristics, and laboratory examinations of 25 cases of fulminant hepatitis in pregnancy and 30 cases of fulminant hepatitis not in pregnancy.RESULTS: HBV infection and chronic fulminant hepatitis were most common both in the pregnant and in the non-pregnant groups. Jaundice, digestive tract symptoms,increase of bilirubin and thrombinogen activity were the main manifestations. The incidence of hepatic encephalopathy (HE) and hepato-renal syndrome (HRS) was significantly different between the two groups. The incidence of preterm labor, dead fetus and neonatal asphyxia was high.CONCLUSION: Fulminant hepatitis is likely to occur in late pregnancy with more severe complications, which significantly influences maternity, perinatal fetus, and newborn.

  9. 早发型重度子痫前期的特点和临床处理%Clinical characteristics and management of early onset severe preeclampsia

    Institute of Scientific and Technical Information of China (English)

    刘慧英; 何晓宇


    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.

  10. Describing the characteristics, treatment pathways, outcomes, and costs of people with persistent noncancer pain managed by community pain clinics and generating an indicative estimate of cost-effectiveness: feasibility study protocol

    Directory of Open Access Journals (Sweden)

    AlAujan S


    Full Text Available Shiekha AlAujan,1 Saja AlMazrou,1 Roger D Knaggs,1,2 Rachel A Elliott11Division for Social Research in Medicines and Health, The School of Pharmacy, University of Nottingham, Nottingham, UK; 2Pharmacy Department and Pain Management Service, Nottingham University Hospitals NHS Trust, Nottingham, UKBackground: Low back pain (LBP and fibromyalgia (FM, also known as chronic widespread pain (CWP, are highly prevalent chronic painful conditions that have substantial impact on patients, health care systems, and society. Diagnosis is complex and management strategies are associated with various levels of evidence for effectiveness and cost-effectiveness. Multidisciplinary pain services have been shown to be effective in some settings and therefore are recommended by clinical practice guidelines as a rational treatment option to manage these patients. Knowing that these services are resource intensive, evidence is needed to demonstrate their cost-effectiveness. This study aims to describe the management of patients with LBP and FM in two community pain clinics to derive an indicative estimate of cost-effectiveness compared with standard practice.Methods: This is a prospective observational multicenter study, using patient-level data. The data from this study will be combined with modelling of the long-term economic impact of community pain clinics in treating people with LBP and FM. Newly referred patients with LBP and FM who provide written consent will be included. We will collect data on functional disability, pain intensity, quality of life, and health resource utilization. Follow-up data at the 3- and 6-month points will be collected by patient-completed questionnaires and health care contact diaries. Health care resource use from diaries will be compared with patient electronic records to assess the agreement between these recording methods. Patient cohort characteristics, treatment pathways, resource use, and outcomes derived from this study will

  11. [New antiepileptic drugs: characteristics and clinical applications]. (United States)

    Ohtsuka, Yoko


    New antiepileptic drugs (AEDs) that have been used in many other countries for more than 10 years have only recently became available for use in Japan. Gabapentin, topiramate, lamotrigine and levetiracetam were licensed for use in Japan between 2006 and 2010. Stiripentol for Dravet syndrome and rufinamide for Lennox-Gastaut syndrome were also approved in 2012 and 2013 as orphan drugs. Clinical trials of other new AEDs such as oxcarbazepine, vigabatrin, lacosamide, and perampanel are in progress. In this review, the general characteristics of the new AEDs are discussed with regards to their effectiveness, tolerability, drug interaction, safety and mechanisms of action. The effectiveness, of the new AEDs compared with established AEDs is also discussed. Clinical applications of the new AEDs, focusing on gabapentin, topiramate, lamotrigine and levetiracetam are also discussed based on our domestic experience as well as overseas reports.

  12. Pituitary gigantism: Causes and clinical characteristics. (United States)

    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.

  13. Clinical characteristics and surgical management in A-pattern exotropia%A型外斜视的临床表现和手术治疗

    Institute of Scientific and Technical Information of China (English)

    董宁; 刘陇黔; 李平惠


    AIM: To survey the pathogenesis, clinical characteristics and surgical treatment for the correction of A-pattern exotropia.METHODS: The case history and surgical effect of 62 A-pattern exotropia in 1825 strabismus were studied. The superior oblique muscles weakening or the horizontal muscles procedures were performed in all patients according to the dysfunction of the superior oblique muscles, horizontal deviation, with or without binocular vision. Follow-up after surgery was 6-18months with mean duration of 9 months.RESULTS: A-pattern exotropia accounts for 3.4% of all strabismus. A-pattern exotropia accounts for 21.2% of A-V syndrome. After surgery, 52 cases got alignment, 56 cases gained A-sign correction and 54 cases recovered binocular vision.CONCLUSION: A-pattern exotropia is a common type in strabismus, its etiology is mainly oblique muscle dysfunction.Different surgical procedures should be selected according to overaction degrees of oblique muscle and binocular vision function, which can acquire the satisfied results.%目的:探讨A型外斜视的病因、临床特征、手术治疗方法及疗效.方法:分析自1995-01/2003-12收治的1 825例斜视中62例A型外斜视病例的病历资料及治疗效果.所有患者依据是否伴有上斜肌功能过强、原位水平斜视及双眼视觉功能情况行上斜肌部分肌腱切除术或断腱术和/或水平直肌手术,术后随访时间6~18(平均9)mo.结果:A型外斜视占同期斜视患者3.4%.在同期所有的A-V征中,A-外斜占21.2%;术后眼位恢复正位52例(83.9%),A征消失56例(90.4%),术后54例获得立体视功能(包括术前3例存在立体视功能患者).结论:A型外斜视是一种较常见的斜视类型,发病原因以斜肌功能异常为主,常合并水平斜视,应依据是否伴有斜肌功能异常及双眼视情况,选择不同的手术方式,可获得满意的术后效果.

  14. Gender differences in Parkinson's disease: clinical characteristics and cognition. (United States)

    Miller, Ivy N; Cronin-Golomb, Alice


    More men than women are diagnosed with Parkinson's disease (PD), and a number of gender differences have been documented in this disorder. Examples of clinical characteristics that appear in men more often than women include rigidity and rapid eye movement behavior disorder, whereas more women than men exhibit dyskinesias and depression. Differences between men and women in cognition have not been extensively examined, though there are reports of deficits in men in aspects of cognition that contribute to activities of daily living, in verbal fluency, and in the recognition of facial emotion, and deficits in women in visuospatial cognition. Side of disease onset may interact with gender to affect cognitive abilities. One possible source of male-female differences in the clinical and cognitive characteristics of PD is the effect of estrogen on dopaminergic neurons and pathways in the brain. This effect is not yet understood, as insight into how the fluctuation of estrogen over the lifetime affects the brain is currently limited. Further attention to this area of research will be important for accurate assessment and better management of PD. Attention should also be directed to multiple covariates that may affect clinical characteristics and cognition. Knowledge about differences in the presentation of PD symptoms in men and women and about the pathophysiology underlying those differences may enhance the accuracy and effectiveness of clinical assessment and treatment of the disease.

  15. Clinic Characteristics of Varicella Zoster Myocarditis

    Institute of Scientific and Technical Information of China (English)


    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.

  16. Sydenham's chorea: clinical and evolutive characteristics

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    Maria Teresa Ramos Ascensão Terreri


    Full Text Available CONTEXT: During the last 12 years we have observed an increase in the frequency of Sydenham's chorea in our country. We have observed that some of our patients have presented recurrence of the chorea despite regular treatment with benzathine penicillin. OBJECTIVE: The aim of our study was to evaluate clinical and evolutive characteristics of Sydenham's chorea in a group of patients followed in our Pediatric Rheumatology Unit. TYPE OF STUDY: Retrospective study. SETTING: Section of Pediatric Rheumatology - Discipline of Allergy, Clinical Immunology and Rheumatology - Department of Pediatrics - UNIFESP - EPM. PARTICIPANTS: Two hundred and ninety patients with rheumatic fever followed between 1986 and 1999. METHODS: We reviewed the records of 290 patients with rheumatic fever followed between 1986 and 1999. All patients were diagnosed according to the revised Jones criteria (1992. We included 86 patients that presented Sydenham's chorea as one of the major criteria (one or more attacks and evaluated their clinical and evolutive characteristics as well the treatment. RESULTS: Fifty-five patients were girls and 31 were boys. The mean age at onset was 9.7 years and mean follow-up period was 3.6 years. The 86 Sydenham's chorea patients presented 110 attacks of chorea. We observed isolated chorea in 35% of the patients, and 25 (29% presented one or more recurrences. We included only 17 of the 25 patients for further analysis, with a total of 22 recurrences of which 14 were attacks of chorea, because it was not possible to precisely detect the interval between attacks in the other patients. The approximate interval between the attacks ranged from 4 to 96 months. In 71% of the patients there was no failure in the secondary prophylaxis with benzathine penicillin, which was performed every 3 weeks. CONCLUSION: Despite the regular use of secondary benzathine penicillin prophylaxis, children with rheumatic fever have a high risk of Sydenham's chorea

  17. Clinical management of hereditary colorectal cancer syndromes. (United States)

    Vasen, Hans F A; Tomlinson, Ian; Castells, Antoni


    Hereditary factors are involved in the development of a substantial proportion of all cases of colorectal cancer. Inherited forms of colorectal cancer are usually subdivided into polyposis syndromes characterized by the development of multiple colorectal polyps and nonpolyposis syndromes characterized by the development of few or no polyps. Timely identification of hereditary colorectal cancer syndromes is vital because patient participation in early detection programmes prevents premature death due to cancer. Polyposis syndromes are fairly easy to recognize, but some patients might have characteristics that overlap with other clinically defined syndromes. Comprehensive analysis of the genes known to be associated with polyposis syndromes helps to establish the final diagnosis in these patients. Recognizing Lynch syndrome is more difficult than other polyposis syndromes owing to the absence of pathognomonic features. Most investigators therefore recommend performing systematic molecular analysis of all newly diagnosed colorectal cancer using immunohistochemical methods. The implementation in clinical practice of new high-throughput methods for molecular analysis might further increase the identification of individuals at risk of hereditary colorectal cancer. This Review describes the clinical management of the various hereditary colorectal cancer syndromes and demonstrates the advantage of using a classification based on the underlying gene defects.

  18. Basic concepts and definitions of clinical management

    Directory of Open Access Journals (Sweden)

    Angélica Román


    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.

  19. Clinical Characteristics of Fuchs’ Uveitis Syndrome

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    Pınar Çakar Özdal


    Full Text Available Objectives: To evaluate the clinical and demographic properties of Fuchs’ uveitis syndrome (FUS in Turkish patients. Materials and Methods: The medical records of 161 patients with FUS followed in the Uveitis Division of Ulucanlar Eye Hospital between 1996 and 2014 were respectively reviewed. The mean age at diagnosis, sex, the number of affected eyes, follow-up period, clinical findings at presentation, complications during the follow-up period, medical and surgical treatments, and best corrected visual acuity at the initial and final visits were recorded. Results: The study included 171 eyes of 161 patients diagnosed with FUS. Of the patients, 94 (58.4% were female and 67 (41.6% were male. The mean age at presentation was 35.2±11.0 (11-65 years. The mean follow-up period was 23.5±32.8 (2-216 months. Ten (6.2% patients had bilateral involvement. The most common symptoms at presentation were decreased visual acuity or blurred vision in 63 (39.1% and floaters in 19 (11.8% patients. Clinical findings at presentation included diffuse small, round, white keratic precipitates in 128 (74.8% eyes, anterior chamber reaction in 82 (47.9%, vitreous cells in 122 (71.3%, heterochromia in 47 (27.4% and iris nodules in 32 (18.7% eyes. During the follow-up period, elevated intraocular pressure occured in 31 (18.1% eyes and the most common complication was cataract development (89 eyes, 52.0%. Conclusion: Heterochromia was observed in 27.4% of patients in our study. However, the diffuse small, round keratic precipitates, low-grade anterior chamber reaction and varying degrees of vitreous reaction are more common clinical characteristics that are helpful in making the diagnosis.

  20. Clinical Characteristics of Fuchs’ Uveitis Syndrome (United States)

    Nalçacıoğlu, Pınar; Çakar Özdal, Pınar; Şimşek, Mert


    Objectives: To evaluate the clinical and demographic properties of Fuchs’ uveitis syndrome (FUS) in Turkish patients. Materials and Methods: The medical records of 161 patients with FUS followed in the Uveitis Division of Ulucanlar Eye Hospital between 1996 and 2014 were respectively reviewed. The mean age at diagnosis, sex, the number of affected eyes, follow-up period, clinical findings at presentation, complications during the follow-up period, medical and surgical treatments, and best corrected visual acuity at the initial and final visits were recorded. Results: The study included 171 eyes of 161 patients diagnosed with FUS. Of the patients, 94 (58.4%) were female and 67 (41.6%) were male. The mean age at presentation was 35.2±11.0 (11-65) years. The mean follow-up period was 23.5±32.8 (2-216) months. Ten (6.2%) patients had bilateral involvement. The most common symptoms at presentation were decreased visual acuity or blurred vision in 63 (39.1%) and floaters in 19 (11.8%) patients. Clinical findings at presentation included diffuse small, round, white keratic precipitates in 128 (74.8%) eyes, anterior chamber reaction in 82 (47.9%), vitreous cells in 122 (71.3%), heterochromia in 47 (27.4%) and iris nodules in 32 (18.7%) eyes. During the follow-up period, elevated intraocular pressure occured in 31 (18.1%) eyes and the most common complication was cataract development (89 eyes, 52.0%). Conclusion: Heterochromia was observed in 27.4% of patients in our study. However, the diffuse small, round keratic precipitates, low-grade anterior chamber reaction and varying degrees of vitreous reaction are more common clinical characteristics that are helpful in making the diagnosis. PMID:27800260

  1. Clinical Characteristics of Marfan Syndrome in Korea (United States)

    Lim, A Young; Song, Ju Sun; Kim, Eun Kyoung; Jang, Shin Yi; Chung, Tae-Young; Choi, Seung-Hyuk; Sung, Kiick; Huh, June; Kang, I-Seok; Choe, Yeon Hyeon; Ki, Chang-Seok


    Background and Objectives Marfan syndrome (MFS) is a connective tissue disorder with autosomal dominant inheritance and a highly variable clinical spectrum. However, there are limited data available on the clinical features of Korean patients with MFS. The aim of the present study was to describe the clinical characteristics and outcomes of Korean patients with MFS. Subjects and Methods We included all patients who were diagnosed with MFS between January 1995 and May 2015 at a single tertiary medical center. Patients with an MFS-related disorder including MASS phenotype (myopia, mitral valve prolapse, borderline and non-progressive aortic root dilatation, skeletal findings, and striae), mitral valve prolapse syndrome, and ectopia lentis syndrome were excluded. A total of 343 Korean patients aged ≥15 years who satisfied the revised Ghent nosology were included. Results The mean patient age at diagnosis was 35.9±12.6 years and 172 (50.1%) patients were male. Median follow-up duration was 52.8 months. A total of 303 patients (88.6%) had aortic root dilatation with Z score ≥2 or aortic root dissection. Ectopia lentis was relatively less common (163 patients, 55.1%) and systemic score ≥7 was found in 217 patients (73.8%). Among 219 probands, a family history of MFS was present in 97 patients (44.5%) and sporadic cases in 121 patients (55.5%). Among the 157 probands who underwent genetic analysis, 141 (89.8%) had an FBN1 mutation associated with aortic root aneurysm/dissection. Aortic dissection (AD) or intramural hematoma (IMH) was identified in 110 patients (32.1%). Among the 221 patients without AD or IMH, descending aortic aneurysms were identified in 19 patients (8.6%). Two hundred thirteen patients (62%) underwent cardiovascular surgery of any type. Eight patients died during follow-up. Conclusion We described the clinical characteristics and outcomes of Korean MFS patients. Cardiovascular manifestations were commonly detected and FBN1 mutation was present

  2. [Eight characteristics of leaders in crisis management]. (United States)

    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.

  3. Ovarian fibroma--clinical and histopathological characteristics. (United States)

    Sivanesaratnam, V; Dutta, R; Jayalakshmi, P


    Twenty-three cases of ovarian fibroma, comprising 3% of all benign tumors seen over a 20-year period, were analyzed. It was unilateral in all cases affecting more commonly the left ovary (70%). Whilst a majority of cases (77%) were encountered in the reproductive age group, the tumor was rare before the second decade. Only in 13% of cases was ascitis clinically detectable. This was not influenced by the size and weight (average of 9.3 x 10.8 x 11.1 cm and 959 g, respectively) of the tumors; a smooth-surfaced tumor was, however, associated with a greater amount of peritoneal fluid. Varying degrees of calcification in some tumors are detectable on ultrasonography and occasionally on abdominal radiography. The classical Meig's Syndrome was seldom encountered. The histopathological features, diagnostic problems and management are discussed.

  4. Psychogenic tics: clinical characteristics and prevalence

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    Janik, Piotr


    Full Text Available Aim. Clinical characteristics and the prevalence of psychogenic tics (PT Methods. 268 consecutively examined patients aged 4 to 54 years (221 men, 47 females; 134 children, 134 adults with tic phenotype: Gilles de la Tourette syndrome (GTS, n = 255, chronic motor tics (n = 6, chronic vocal tics (n = 1, transient tics (n = 1, tics unclassified (n = 2, PT (n = 5 were analyzed. The diagnosis of tic disorders was made on the DSM-IV-TR criteria and mental disorders by psychiatrists. Results. PT were found in 5 patients (1.9%, aged 17 to 51 years, four men and one woman. The phenotype included vocalizations and complex movements. In none of the patients simple motor facial tics, inability to tic suppress, unchanging clinical pattern, peak severity from the beginning of the disease, lack of concern about the disease were present. The absence of premonitory urges, regression in unexpected positions, and the presence of atypical for GTS mental disorders were found in two persons. PT occurred in three persons in whom organic tics were present in childhood. Pharmacological treatment and psychotherapy were unsuccessful. In two persons spontaneous resolution occurred, in two patients the tics persist, in one person the course of PT is unknown. Conclusions. PT are rare and may occur in patients with organic tics. The most typical features of PT are: early onset in adulthood, lack of simple motor tics, inability to tic suppress. The diagnosis is established if a few atypical symptoms for organic tics occur.

  5. Status report from the American Acne & Rosacea Society on medical management of acne in adult women, part 1: overview, clinical characteristics, and laboratory evaluation. (United States)

    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.

  6. Characteristics of liver cancer stem cells and clinical correlations. (United States)

    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.

  7. Clinical and morphological characteristics of cutaneous melanoma. (United States)

    Balaban, Jagoda; Ninković Baroš, Djuka; Grujić, Dragana; Starović, Dragana; Ćelić, Milanka


    The incidence of cutaneous melanoma has increased significantly worldwide over the last several decades. The aim of this study is to determine clinical and morphology characteristics of primary melanoma, since some of them are important prognostic factors. This retrospective study included 172 patients. The data were collected by the Consulting team for malignant skin tumors in the Banja Luka Clinical Centre from 2009 to 2011. We did not use dermoscopy as a diagnostic tool in our investigation. We determined that melanoma occurs equally commonly in both sexes, in women in the sixth decade and the seventh in men. The most common sub-type was nodular melanoma (59.5%, P<0.05), followed by superficial spreading (27.8%) and acral lentiginous melanoma (11.4%). The most common localization was on the back in men (34.3%) and on the legs in women (P<0.05). More than half of our patients (55.8%) had melanoma thickness from 1.0 to 4.0 mm, and 38% had a melanoma thicker than 4.0 mm. The average Breslow thickness is 4.6 mm. More women than men had melanoma thicker than 4 mm (P<0.05). Spread of the primary tumor localization was found in 31.4% of patients, more frequently in men than in women (P<0.05). In most cases it was abstraction of lymph nodes (P<0.05). The average thickness of the melanoma in our patients is much higher than the average in the world and the countries of Europe. The results of this study indicate a need for better unique regional registry in this part of Bosnia and Herzegovina and improvement of preventive measures in the early diagnosis of melanoma.

  8. Clinical characteristics of patients with conjunctivochalasis

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    Balci O


    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

  9. [Clinical characteristics of pancreatitis after cardiovascular surgery]. (United States)

    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)

  10. Mesenchymal stem cells: characteristics and clinical applications.

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    Sylwia Bobis


    Full Text Available Mesenchymal stem cells (MSCs are bone marrow populating cells, different from hematopoietic stem cells, which possess an extensive proliferative potential and ability to differentiate into various cell types, including: osteocytes, adipocytes, chondrocytes, myocytes, cardiomyocytes and neurons. MSCs play a key role in the maintenance of bone marrow homeostasis and regulate the maturation of both hematopoietic and non-hematopoietic cells. The cells are characterized by the expression of numerous surface antigens, but none of them appears to be exclusively expressed on MSCs. Apart from bone marrow, MSCs are located in other tissues, like: adipose tissue, peripheral blood, cord blood, liver and fetal tissues. MSCs have been shown to be powerful tools in gene therapies, and can be effectively transduced with viral vectors containing a therapeutic gene, as well as with cDNA for specific proteins, expression of which is desired in a patient. Due to such characteristics, the number of clinical trials based on the use of MSCs increase. These cells have been successfully employed in graft versus host disease (GvHD treatment, heart regeneration after infarct, cartilage and bone repair, skin wounds healing, neuronal regeneration and many others. Of special importance is their use in the treatment of osteogenesis imperfecta (OI, which appeared to be the only reasonable therapeutic strategy. MSCs seem to represent a future powerful tool in regenerative medicine, therefore they are particularly important in medical research.

  11. Clinical characteristics of high grade foveal hypoplasia. (United States)

    Park, Kyung-Ah; Oh, Sei Yeul


    To report clinical characteristics of high grade foveal hypoplasia. Patients with foveal hypoplasia of grade 3 or 4 on spectral domain optical coherence tomography according to a previously published scheme were enrolled. All patients underwent a full ophthalmologic assessment including visual acuity testing, slit lamp biomicroscopy, fundus examination, and evaluation of ocular alignment. The underlying causes of foveal hypoplasia were identified as albinism in five patients and aniridia in six patients. The mean logMAR visual acuity was 0.57 ± 0.24 (range 0.22-1.00) in the right eyes and 0.58 ± 0.21 (range 0.30-1.00) in the left eyes. On fundus examination in patients with albinism, two patients showed marked transparency, one patient showed moderate transparency, and two patients showed minimal transparency. Among six patients with aniridia, five patients showed normal macular pigmentation without macular reflex and one patient showed decreased macular pigmentation with no macular reflex. Patients with high grade macular hypoplasia tended to have poor visual acuities; however, the range of visual acuity was quite variable. Other factors associated with underlying disease could be the reason of this variability. Therefore, careful consideration should be given when assessing visual prognosis in foveal hypoplasia using optical coherence tomography.

  12. Theory, Practice and Characteristics of Management in Serbia

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    Svetlana Vukotic


    Full Text Available The paper analyses management and manager's characteristics which determine the success of organisations. For Serbian managers the only constant is change. The paper deals with this aspect in 3 segments: general characteristics in international and domestic context, the influence for national culture on the characteristics of managers and the characteristics of managers in times of change. The focus of our paper is on theory and practice of management in Serbia, a country that went through significant political, economic and social changes in the postsocialistic period, but which is already transforming in every aspect including educating managers for contemporary and future work challenges.

  13. Short Bowel Syndrome: clinical management


    Loris Pironi; Mariacristina Guidetti; Elisabetta Lanzoni; Caterina Pazzeschi; Catia Corsini


    The management of a case of intestinal failure due to Short Bowel Syndrome (SBS) is described. Patients’ care needs an expert multidisciplinary approach. Published data have demonstrated that the lack of a specialist staff is a risk factor for patients’ death. The creation of networks linking non-specialist doctors with dedicated centers is recommended.

  14. Clinical controversies in lipid management. (United States)

    Tziomalos, K


    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.

  15. Boundary spanning by nurse managers: effects of managers' characteristics and scope of responsibility on teamwork. (United States)

    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.

  16. Clinical management of septic arthritis. (United States)

    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.

  17. Neurofibromatosis: part 2 – clinical management

    Directory of Open Access Journals (Sweden)

    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.

  18. Herbal Hepatotoxicity: Clinical Characteristics and Listing Compilation. (United States)

    Frenzel, Christian; Teschke, Rolf


    Herb induced liver injury (HILI) and drug induced liver injury (DILI) share the common characteristic of chemical compounds as their causative agents, which were either produced by the plant or synthetic processes. Both, natural and synthetic chemicals are foreign products to the body and need metabolic degradation to be eliminated. During this process, hepatotoxic metabolites may be generated causing liver injury in susceptible patients. There is uncertainty, whether risk factors such as high lipophilicity or high daily and cumulative doses play a pathogenetic role for HILI, as these are under discussion for DILI. It is also often unclear, whether a HILI case has an idiosyncratic or an intrinsic background. Treatment with herbs of Western medicine or traditional Chinese medicine (TCM) rarely causes elevated liver tests (LT). However, HILI can develop to acute liver failure requiring liver transplantation in single cases. HILI is a diagnosis of exclusion, because clinical features of HILI are not specific as they are also found in many other liver diseases unrelated to herbal use. In strikingly increased liver tests signifying severe liver injury, herbal use has to be stopped. To establish HILI as the cause of liver damage, RUCAM (Roussel Uclaf Causality Assessment Method) is a useful tool. Diagnostic problems may emerge when alternative causes were not carefully excluded and the correct therapy is withheld. Future strategies should focus on RUCAM based causality assessment in suspected HILI cases and more regulatory efforts to provide all herbal medicines and herbal dietary supplements used as medicine with strict regulatory surveillance, considering them as herbal drugs and ascertaining an appropriate risk benefit balance.

  19. Herbal Hepatotoxicity: Clinical Characteristics and Listing Compilation

    Directory of Open Access Journals (Sweden)

    Christian Frenzel


    Full Text Available Herb induced liver injury (HILI and drug induced liver injury (DILI share the common characteristic of chemical compounds as their causative agents, which were either produced by the plant or synthetic processes. Both, natural and synthetic chemicals are foreign products to the body and need metabolic degradation to be eliminated. During this process, hepatotoxic metabolites may be generated causing liver injury in susceptible patients. There is uncertainty, whether risk factors such as high lipophilicity or high daily and cumulative doses play a pathogenetic role for HILI, as these are under discussion for DILI. It is also often unclear, whether a HILI case has an idiosyncratic or an intrinsic background. Treatment with herbs of Western medicine or traditional Chinese medicine (TCM rarely causes elevated liver tests (LT. However, HILI can develop to acute liver failure requiring liver transplantation in single cases. HILI is a diagnosis of exclusion, because clinical features of HILI are not specific as they are also found in many other liver diseases unrelated to herbal use. In strikingly increased liver tests signifying severe liver injury, herbal use has to be stopped. To establish HILI as the cause of liver damage, RUCAM (Roussel Uclaf Causality Assessment Method is a useful tool. Diagnostic problems may emerge when alternative causes were not carefully excluded and the correct therapy is withheld. Future strategies should focus on RUCAM based causality assessment in suspected HILI cases and more regulatory efforts to provide all herbal medicines and herbal dietary supplements used as medicine with strict regulatory surveillance, considering them as herbal drugs and ascertaining an appropriate risk benefit balance.

  20. Pharmacological characteristics and clinical application of trans-dermal fentanyl in cancer pain management%芬太尼透皮贴剂治疗癌痛的药理特点及其临床应用

    Institute of Scientific and Technical Information of China (English)

    程志祥(综述); 王科明(审校)


    Cancer pain seriously affects the quality of life of patients and could disturb normal cancer treatment. Therefore, ap-propriate drugs should be chosen to control the pain. Transdermal fentanyl is a type of potent opioid that is widely used in controlling moderate and severe cancer pains. This paper reviews the pharmacological characteristics of transdermal fentanyl and its clinical appli-cation in cancer pain management.%癌痛严重影响患者的生存质量,有时影响正常的肿瘤治疗,因而选择合适的药物控制癌痛至关重要。芬太尼透皮贴剂是一种强阿片类药物,临床上广泛应用于中重度癌痛的治疗,尤其适合一些特别的人群,本文对芬太尼透皮贴剂在癌痛治疗中的药理特点及临床应用进行综述。

  1. Mast cell sarcoma: clinical management. (United States)

    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.

  2. [Cellulitis: clinical manifestations and management]. (United States)

    Blum, C-L; Menzinger, S; Genné, D


    Cellulitis is an acute bacterial non-necrotizing dermal-hypodermal infection predominantly affecting the lower limbs. It is characterised by a circumscribed erythema with a raised border and fever. The predisposing factors are skin wounds, edema from any cause and systemic factors (diabetes, immunosuppression). The diagnosis is clinical and the most common complication is recurrence. Other complications include local abscess, fasciitis and bacteremia. The germ is rarely identified. The majority of infections (85%) is due to group A beta-hemolytic streptococcus. The treatment of cellulitis consists of an association of an antibiotic with rest of the concerned area.

  3. Clinical practice guidelines in patient management

    Directory of Open Access Journals (Sweden)

    Santosh Kumar


    Full Text Available Efforts have always been made to evolve certain prin-ciples to reduce the variability in the management of patients and make medical care more appropriate. These efforts have become almost a movement since 1980s as evidenced in the development of clinical practice guide-lines in all medical disciplines. This article describes the need for clinical practice guidelines and their de-velopment methods and qualities. Advantages and limi-tations of clinical practice guidelines are enumerated. The salient features of various available clinical prac-tice guidelines in urology are also described.

  4. Clinical Characteristics and Treatment of Malignant Granuloma

    Institute of Scientific and Technical Information of China (English)

    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.

  5. Characteristics and Roles of Literacy Clinic Directors (United States)

    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…

  6. Clinical Practice Guidelines for Potential Donors Management

    Directory of Open Access Journals (Sweden)

    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.

  7. Clinical Review: Emergency management of acute poisoning

    Directory of Open Access Journals (Sweden)

    D.J. van Hoving


    The aim of this commissioned review was to establish concise guidelines for the initial management of the acutely poisoned patient in the Emergency Centre. The American Academy of Clinical Toxicology and the European Association of Poisons Centres and Clinical Toxicologists are the international leaders in the field of toxicology and the guidelines in their position papers were generally followed. Most of the dosage regimes are according to the South African Medicines Formulary.

  8. Clinical features and management of autoimmune hepatitis

    Institute of Scientific and Technical Information of China (English)

    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.

  9. Clinical Characteristics of Fuchs’ Uveitis Syndrome



    Objectives: To evaluate the clinical and demographic properties of Fuchs’ uveitis syndrome (FUS) in Turkish patients. Materials and Methods: The medical records of 161 patients with FUS followed in the Uveitis Division of Ulucanlar Eye Hospital between 1996 and 2014 were respectively reviewed. The mean age at diagnosis, sex, the number of affected eyes, follow-up period, clinical findings at presentation, complications during the follow-up period, medical and surgical treatments, and best cor...

  10. Clinical Characteristics of Fuchs’ Uveitis Syndrome



    Objectives: To evaluate the clinical and demographic properties of Fuchs’ uveitis syndrome (FUS) in Turkish patients. Materials and Methods: The medical records of 161 patients with FUS followed in the Uveitis Division of Ulucanlar Eye Hospital between 1996 and 2014 were respectively reviewed. The mean age at diagnosis, sex, the number of affected eyes, follow-up period, clinical findings at presentation, complications during the follow-up period, medical and surgical treatments, and...

  11. Clinical challenges in the management of osteoporosis

    Directory of Open Access Journals (Sweden)

    Sheryl F Vondracek


    Full Text Available Sheryl F Vondracek1, Paul Minne2, Michael T McDermott31Department of Clinical Pharmacy, University of Colorado at Denver and Health Sciences Center, Denver, CO, USA; 2Amgen Medical Affairs, Denver, CO, USA; 3Director of the Endocrine and Diabetes Practice, Department of Medicine, University of Colorado at Denver and Health Sciences Center, Denver, CO, USAAbstract: While knowledge regarding the diagnosis and treatment of osteoporosis has expanded dramatically over the last few years, gaps in knowledge still exist with guidance lacking on the appropriate management of several common clinical scenarios. This article uses fictional clinical scenarios to help answer three challenging questions commonly encountered in clinical practice. The first clinical challenge is when to initiate drug therapy in a patient with low bone density. It is estimated that 34 million Americans have low bone density and are at a higher risk for low trauma fractures. Limitations of using bone mineral density alone for drug therapy decisions, absolute risk assessment and evidence for the cost-effectiveness of therapy in this population are presented. The second clinical challenge is the prevention and treatment of vitamin D deficiency. Appropriate definitions for vitamin D insufficiency and deficiency, the populations at risk for low vitamin, potential consequences of low vitamin D, and how to manage a patient with low vitamin D are reviewed. The third clinical challenge is how to manage a patient receiving drug therapy for osteoporosis who has been deemed a potential treatment failure. How to define treatment failure, common causes of treatment failure, and the approach to the management of a patient who is not responding to appropriate osteoporosis therapy are discussed.Keywords: osteoporosis, osteopenia, bisphosphonate, vitamin D, dual-energy X-ray absorptiometry

  12. Risk Management in the Clinical Laboratory (United States)

    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


    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.

  14. Clinical management of grade III oligodendroglioma

    Directory of Open Access Journals (Sweden)

    Simonetti G


    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

  15. 儿童甲型H1N1流感的现状、临床特点及处理%Current situation, clinical characteristics and management of human swine influenza A H1N1) in children

    Institute of Scientific and Technical Information of China (English)

    覃肇源; 陈丽植; 张玲


    目前在全球呈现大流行趋势的甲型H1N1流感病毒是具备高度传染性的病毒,儿童和年轻成年人是主要易患人群,其临床表现相对轻微,但仍有部分病例因出现严重并发症而需要住院治疗.儿童,尤其是小于5岁者,是此次甲型H1N1流感流行中较易成为重症病例的高危人群,容易发生严重并发症,尤其是伴有慢性呼吸道、心血管疾病及免疫缺陷的儿童可能面临更大的死亡危险.神经氨酸酶抑制剂奥司他韦和扎那米韦是目前推荐使用的用于预防和治疗的抗病毒药物.疫苗被认为是控制流行的有效手段.%Human swine influenza A (H1N1) is a highly transmissible infectious disease, which has spreaded globally and represented a continuous pandemic threat. The novel virus has predominantly affected the children and young adults. Clinical manifestations generally appear mild, but there are still many patients with severe complications leading to hospitalization. According to the current reports, the mortality in the early stages of the pandemic appears no more than seasonal influenza A . Children (especially less than 5years) are considered to be at higher risk of infection and complications. Pediatric patients with a underlying significant chronic disease such as chronic respiratory disease,cardiovascular disease and immunodeficiency disease, are at a higher risk of death. The neuraminidase inhibitors Oseltamivir and Zanamivir are effective for prophylaxis and treatment. Effective vaccines are regarded to be crucial for the control of influenza pandemics. This review focuses on the epidemiological situation, clinical characteristics and management of human swine influenza A (H1N1), so as to provide practical advice for clinicians.

  16. Clinical characteristics and current treatment of glaucoma. (United States)

    Cohen, Laura P; Pasquale, Louis R


    Glaucoma is a neurodegenerative disorder in which degenerating retinal ganglion cells (RGC) produce significant visual disability. Clinically, glaucoma refers to an array of conditions associated with variably elevated intraocular pressure (IOP) that contributes to RGC loss via mechanical stress, vascular abnormalities, and other mechanisms, such as immune phenomena. The clinical diagnosis of glaucoma requires assessment of the ocular anterior segment with slit lamp biomicroscopy, which allows the clinician to recognize signs of conditions that can produce elevated IOP. After measurement of IOP, a specialized prismatic lens called a gonioscope is used to determine whether the angle is physically open or closed. The structural manifestation of RGC loss is optic nerve head atrophy and excavation of the neuroretinal rim tissue. Treatment is guided by addressing secondary causes for elevated IOP (such as inflammation, infection, and ischemia) whenever possible. Subsequently, a variety of medical, laser, and surgical options are used to achieve a target IOP.

  17. Data management in clinical research: An overview

    Directory of Open Access Journals (Sweden)

    Binny Krishnankutty


    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.

  18. Clinical characteristics of 41 patients with intractable asthma

    Directory of Open Access Journals (Sweden)

    Li BAI


    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.

  19. Neonatal peripheral hypotonia: clinical and electromyographic characteristics. (United States)

    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.

  20. Candidiasis: pathogenesis, clinical characteristics, and treatment. (United States)

    Appleton, S S


    Candida organisms live on the skin and mucous membranes of up to 75 percent of the population. They can live commensally without causing harm or can change to an aggressive form and invade tissue, causing both acute and chronic disease in the host. Oropharyngeal candidiasis manifests clinically as acute pseudomembranous, acute atrophic, chronic atrophic, chronic hypertrophic/hyperplastic, and angular cheilitis. Systemic infection leading to candidemia can be devastating and cause up to a 60 percent mortality rate in medical or post-surgical intensive care wards. Oral nystatin, clotrimazole, and fluconazole usually provide appropriate therapy; although resistance to medications is increasing, particularly in immunocompromised hosts.

  1. Hydatidiform mole clinical and pathological characteristics


    Pacheco D., José; Instituto de Patología, UNMSM; Instituto de Medicina Legal; Alegre, Jaime; Hospital Nacional Dos de Mayo, Lima, Perú; Paniagua, Gissela; Instituto de Patología de la UNMSM


    Objective: To determine clinical and pathological findings in hydatidiform mole. Design: Descriptive retrospective study. Material and methods: All cases de molar pregnancy attended at Dos de Mayo National Hospital (HNDM) between 1998 and 2001 were reviewed. Results: Twenty-four cases of hydatidiform mole were attended; mean age was 26,4 years ± 6,4 and gestational age 13,1 weeks ± 3,3. Past history only showed 1 and 3 cases of hyperemesis gravidarum and previous abortions, respectively; 18 p...

  2. Acute demyelinating encephalomyelitis: Clinical characteristics and outcome

    Directory of Open Access Journals (Sweden)

    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.

  3. Workshop report: Schistosomiasis vaccine clinical development and product characteristics. (United States)

    Mo, Annie X; Colley, Daniel G


    A schistosomiasis vaccine meeting was organized to evaluate the utility of a vaccine in public health programs, to discuss clinical development paths, and to define basic product characteristics for desirable vaccines to be used in the context of schistosomiasis control and elimination programs. It was concluded that clinical evaluation of a schistosomiasis vaccine is feasible with appropriate trial design and tools. Some basic Preferred Product Characteristics (PPC) for a human schistosomiasis vaccine and for a veterinary vaccine for bovine use were also proposed.

  4. Clinical characteristics of 297 newly diagnosed Chinese HIV / AIDS patients

    Institute of Scientific and Technical Information of China (English)



    Objective To determine the clinical characteristics of HIV infected patients in China in order to improve early recognition and diagnosis of AIDS.Methods A total of297 newly diagnosed HIV/AIDS patients were enrolled in Peking Union Medical College Hospital(PUMCH)from January 2001 to December 2012,including 19 patients of primary phase,115 of asymptomatic phase and 163 of AIDS phase.Clinical characteristics of these patients were retrospectively analyzed.Results Two hundred and

  5. Eyelid aging: pathophysiology and clinical management

    Directory of Open Access Journals (Sweden)

    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.

  6. Clinical characteristics of roxatidine acetate: a review. (United States)

    Dammann, H G; de Looze, S M; Bender, W; Labs, R


    Pharmacodynamic studies revealed that 150 mg of roxatidine acetate were optimal in suppressing gastric acid secretion, and that a single bedtime dose of 150 mg was more effective than a dose of 75 mg twice daily in terms of inhibiting nocturnal acid secretion. When administered orally as a capsule containing a granule formulation, the drug displayed modified-release properties, which led to a sustained suppression of gastric acid secretion. Clinical trials revealed that roxatidine acetate, 75 mg twice daily and 150 mg at night, was highly effective in healing duodenal and gastric ulcers and in reducing ulcer pain, over 4, 6, and 8 weeks of therapy. A steady reduction in diameter was observed in those ulcers not completely healed during therapy. The single bedtime dose regimen, while producing the same degree of healing as the divided daily dose during controlled clinical trials, may be of greater value in therapeutic use owing to improved patient compliance. In all efficacy criteria (cure, reduction in ulcer size, and pain relief) there was no significant difference between roxatidine acetate in a total daily dose of 150 mg, ranitidine in a total daily dose of 300 mg, and cimetidine in a total daily dose of 800 mg. Prevention of gastric and duodenal ulcer relapse was achieved by roxatidine acetate, 75 mg at night for 6 months, in about 70% of patients, as determined in open, pilot studies--a rate comparable to those reported for cimetidine and ranitidine. Roxatidine acetate shares with ranitidine an improved safety profile when compared with cimetidine. Human pharmacology studies and short-term and long-term clinical trials have all shown that roxatidine acetate is an exceptionally well tolerated compound, without the antiandrogenic activity and interference with hepatic drug metabolism which have characterized cimetidine treatment. A reason for the improved safety profile of roxatidine acetate may be its greater potency than cimetidine (six times less potent) and

  7. Clinical Practice Guidelines for Convulsive Condition Management

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    Victor Rene Navarro Machado


    Full Text Available Clinical Practice Guidelines for Convulsive Condition Management. It has been redefined as the occurrence of two or more successive convulsions without conscience recuperation between them; or the occurrence of convulsive uninterrupted activity for more than 5 minutes, including focal crisis. This document includes a review and update of conceptual, etiological and classification aspects for diagnosis and treatment, stressing the various therapy trends. It includes assessment guidelines focused on the most important aspects to be accomplished.

  8. Managing stress and burnout in clinical gerontology. (United States)

    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.

  9. Huntington's disease: clinical characteristics, pathogenesis and therapies. (United States)

    Nakamura, Ken; Aminoff, Michael J


    Huntington's disease is a devastating disorder with no known cure. The disease results from an expanded sequence of CAG repeats in the huntingtin gene and leads to a movement disorder with associated cognitive and systemic deficits. Huntington's disease is diagnosed by genetic testing and disease progression can be followed with a variety of imaging modalities. The accumulation of aggregated huntingtin with associated striatal degeneration is evident at autopsy. The pathophysiology of Huntington's disease remains unknown, although protein aggregation, excitotoxicity, deficits in energy metabolism, transcriptional dysregulation and apoptosis may all be involved. Current pharmacologic therapy for Huntington's disease is limited and exclusively symptomatic. However, the disease is being heavily researched, and a wide range of disease-modifying therapies is currently under development. The efficacy of these therapies is being evaluated in transgenic models of Huntington's disease and in preliminary clinical trials.

  10. Clinical characteristics of eosinophilic asthma exacerbations

    DEFF Research Database (Denmark)

    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....

  11. [Clinical and echocardiographic characteristics of scimitar syndrome]. (United States)

    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.

  12. Clinical characteristics and treatment outcomes of severe ulcerative colitis

    Institute of Scientific and Technical Information of China (English)



    Objective To explore the clinical characteristics and medicine treatment of patients with severe ulcerative colitis(UC),the efficacy of rescue treatment in patients with glucocorticoid(GCS)resistant severe UC,and the clinical risk factors in patients with GCS-refractory severe UC.Methods From January 2001 to December 2012,

  13. Clinical characteristics of patients with persistent postural-perceptual dizziness


    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...

  14. Clinical and behavioral characteristics in FG syndrome. (United States)

    Graham, J M; Superneau, D; Rogers, R C; Corning, K; Schwartz, C E; Dykens, E M


    FG syndrome is a rare X-linked recessive form of mental retardation, first described by Opitz and Kaveggia in 1974. Based on over 50 reported cases, FG syndrome is associated with agenesis of the corpus callosum, minor facial anomalies (high, broad forehead with frontal cowlick, ocular hypertelorism, down-slanted palpebral fissures, and small cupped auricles), relative macrocephaly, broad thumbs and halluces, and prominent fetal fingertip pads. Affected individuals manifest neonatal hypotonia and severe constipation, which usually resolves during mid-childhood. The hypotonia with joint hyperlaxity evolves into spasticity with joint contractures in later life. Affability, hyperactivity, and excessive talkativeness are noted frequently in patients with FG syndrome. Recently, we described three additional families (six additional patients) with FG syndrome who support the localization of a gene for the FG syndrome in chromosome region Xq12-q21 [Graham JM Jr, Tackels D, Dibbern K, Superneau D, Rodgers C, Corning K, Schwartz CE. 1998. Am J Med Genet 80:145-156.]. Using these same families and one additional sporadic case of FG syndrome, we compared behavioral and personality characteristics of 6 FG boys with other boys with syndromic and nonsyndromic mental retardation: eight with Down syndrome, seven with Prader-Willi syndrome, eight with nonspecific mental retardation, and 13 with Williams syndrome. Using the Vineland Adaptive Behavior Scales, the Reiss Personality Profiles, and the Achenbach Child Behavior Checklist, parents were asked to characterize the behavior and personality of their boys from ages 4 to 10 years. When compared with Williams syndrome, the FG boys had fewer internalizing behaviors and were significantly less anxious and withdrawn but had similar socially oriented, attention-seeking behaviors. On the Reiss Profile, FG boys were also quite similar to Williams syndrome boys. On the Vineland Scales, FG boys demonstrated significant relative strengths

  15. [Master documentation and records in the clinical data management]. (United States)

    Sun, Hua-long; Xu, Gang; Li, Wei; Wei, Zhao-hui; Ding, Li


    This list of clincal data management documentation is to ensure standardized and adequate archival of trial documents and records in clinical data management, which is applicable to all of phase I-IV clinical trials.

  16. Characteristics of Veterans Health Administration chiropractors and chiropractic clinics. (United States)

    Lisi, Anthony J; Goertz, Christine; Lawrence, Dana J; Satyanarayana, Preeti


    Chiropractic services have been delivered on station at select Veterans Health Administration (VHA) medical facilities since late 2004. No published data describing the characteristics of VHA chiropractic physicians (chiropractors) and chiropractic clinics exist at a national level. This study was designed to examine elements of the structures of chiropractic services in VHA settings. Web-based survey methods were used to question all chiropractors in VHA facilities (N = 36). Data were obtained from 33 providers, yielding a 91.6% response rate. Most respondents were full-time VHA employees, while others were part-time employees or contractors. Differences were found in prior training, integrated practice, and academic or research experience. Of the respondents, 88% ranked low back pain as the most common patient complaint seen in practice and 79% ranked cervical pain the second most common complaint. Of the new patient consultations, 67.6% originated from primary care, 9.4% from pain management, and 6.2% from physiatry. Most respondents were similar in their reported use of diagnostic and therapeutic procedures, but their reported rates of participation in various facility activities were different. Further work is needed for researchers and policy makers to more fully understand the integration and delivery of chiropractic services in VHA settings.

  17. Clinic Characteristics of Varicella Zoster Myocarditis

    Institute of Scientific and Technical Information of China (English)

    FANG; Wu-wang


    [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

  18. Trauma-associated tinnitus: audiological, demographic and clinical characteristics.

    Directory of Open Access Journals (Sweden)

    Peter M Kreuzer

    Full Text Available BACKGROUND: Tinnitus can result from different etiologies. Frequently, patients report the development of tinnitus after traumatic injuries. However, to which extent this specific etiologic factor plays a role for the phenomenology of tinnitus is still incompletely understood. Additionally, it remains a matter of debate whether the etiology of tinnitus constitutes a relevant criterion for defining tinnitus subtypes. OBJECTIVE: By investigating a worldwide sample of tinnitus patients derived from the Tinnitus Research Initiative (TRI Database, we aimed to identify differences in demographic, clinical and audiological characteristics between tinnitus patients with and without preceding trauma. MATERIALS: A total of 1,604 patients were investigated. Assessment included demographic data, tinnitus related clinical data, audiological data, the Tinnitus Handicap Inventory, the Tinnitus Questionnaire, the Beck Depression Inventory, various numeric tinnitus rating scales, and the World Health Organisation Quality of Life Scale (WHOQoL. RESULTS: Our data clearly indicate differences between tinnitus patients with and without trauma at tinnitus onset. Patients suffering from trauma-associated tinnitus suffer from a higher mental burden than tinnitus patients presenting with phantom perceptions based on other or unknown etiologic factors. This is especially the case for patients with whiplash and head trauma. Patients with posttraumatic noise-related tinnitus experience more frequently hyperacousis, were younger, had longer tinnitus duration, and were more frequently of male gender. CONCLUSIONS: Trauma before tinnitus onset seems to represent a relevant criterion for subtypization of tinnitus. Patients with posttraumatic tinnitus may require specific diagnostic and therapeutic management. A more systematic and - at best - standardized assessment for hearing related sequelae of trauma is needed for a better understanding of the underlying pathophysiology and

  19. Clinical characteristics and follow-up management of 135 children with myasthenia gravis%135例儿童重症肌无力患者的临床特点及其治疗后随访

    Institute of Scientific and Technical Information of China (English)

    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

  20. Total quality management in clinical virology laboratories. (United States)

    Tibbets, M W; Gomez, R; Kannangai, R; Sridharan, G


    The diagnostic laboratories in India are progressively promoting higher standards and are moving towards accreditation and international acceptance. Hence, the concept of "Quality" will need to be understood and implemented. Total quality management (TQM) in a laboratory is an integrated program involving all laboratory staff and management. TQM is a framework to operate and it is aiming for integration, consistency, increase in efficiency and a continuous drive for improvement. A well structured clinical virology service will include serology setup, cell culture facility and capacity for molecular diagnosis. The quality of results from the laboratory is significantly influenced by many pre-analytical and post-analytical factors which needed attention. The end goal of the TQM should be to provide the best care possible for the patient.

  1. Uterine fibroids: clinical manifestations and contemporary management. (United States)

    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.

  2. Characteristics of student preparedness for clinical learning: clinical educator perspectives using the Delphi approach

    Directory of Open Access Journals (Sweden)

    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

  3. Pyogenic sacroiliitis: diagnosis, management and clinical outcome

    Energy Technology Data Exchange (ETDEWEB)

    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.)

  4. Hepatitis A: clinical manifestations and management. (United States)

    Jeong, Sook-Hyang; Lee, Hyo-Suk


    Due to improved living conditions and subsequent changes in hepatitis A epidemiology, the disease burden of hepatitis A is increasing in many regions. Recently, Korea has faced a large, community-wide outbreak of hepatitis A, which has prompted a vaccination program. The clinical spectrum of hepatitis A virus infection ranges from asymptomatic infection to fulminant hepatitis. Clinical manifestations depend on the age of the host: less than 30% of infected young children are symptomatic, while about 80% of infected adults manifest severe hepatitis with remarkably elevated serum aminotransferases. Fulminant hepatitis is rare, with a reported incidence from 0.015 to 0.5%. Atypical manifestations include relapsing hepatitis and prolonged cholestasis, and complicated cases with acute kidney injury have been reported. Extrahepatic manifestations, such as autoimmune hemolytic anemia, aplastic anemia, pure red cell aplasia, pleural or pericardial effusion, acute reactive arthritis, acute pancreatitis, acalculous cholecystitis, mononeuritis, and Guillain-Barré syndrome, have been rarely reported. Management of hepatitis A includes general supportive care, and critical decisions regarding liver transplantation await further studies on prognostic predictors. Fundamental management of hepatitis A is active vaccination. However, a vaccination program should be adapted to the regional situation, according to differing epidemiology and disease burden.

  5. Personality characteristics of excellent lean managers

    DEFF Research Database (Denmark)

    Nielsen, Jacob Steendahl; Boer, Harry; Lindgren, Peter


    , and analytical tools. However, many companies struggle with developing a CI culture and DNA. Reasons for this can be many but the authors of this paper believe that one of the main reasons is the mindset and personality of the Lean managers. This paper addresses the question: Which personality traits should...

  6. Supply chain management in the clinical laboratory. (United States)

    McHugh, Thomas M


    Between 15 and 45 percent of a clinical laboratory's operating budget is spent on supplies. Given the size of this expenditure, laboratory managers must pay close attention to the supply chain and develop effective strategies to manage their inventory. Areas that need analysis include the carrying cost of supplies, the cost to generate a purchase order, methods to efficiently count supplies on hand, processes to ensure that lot number items are used before their expiration, and detailed analysis of the inventory. At the University of California-San Francisco Medical Center, we investigated options to manage our inventory and implemented a computerized system. The system required modifications to existing practices, which initially seemed unwieldy. However, after a relatively short learning curve, the improvement to operations has been significant, with a reduction in wasted reagents, fewer staff hours used to count supplies, and the ability to provide prompt analysis of the inventory for audits and discussions with administration. Focusing on the supply chain has allowed us to reduce inventory expenses by approximately 8 percent, reduce waste, given us a more focused understanding of our operations, and provided us with the ability to analyze our inventory easily.

  7. Clinical management of ebola virus disease in the United States and Europe

    NARCIS (Netherlands)

    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

  8. Characteristics of Managing Operational Banking Risk

    Directory of Open Access Journals (Sweden)

    Adela Socol


    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.

  9. Baseline characteristics and management of patients with splanchnic vein thrombosis: Results of an international registry

    NARCIS (Netherlands)

    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

  10. Clinical characteristics of cervicogenic-related dizziness and vertigo. (United States)

    Yacovino, Dario A; Hain, Timothy C


    Cervical vertigo has long been a controversial entity and its very existence as a medical entity has advocates and opponents. Supporters of cervical vertigo claim that its actual prevalence is underestimated due to the overestimation of other diagnostic categories in clinics. Furthermore, different pathophysiological mechanisms have been attributed to cervical vertigo. Here the authors discuss the clinical characteristics of rotational vertebral artery vertigo, postwhiplash vertigo, proprioceptive cervical vertigo, and cervicogenic vertigo of old age. A clinical entity named subclinical vertebrobasilar insufficiency appears in the context of cervical osteoarticular changes. Migraine-associated vertigo may explain why some patients suffering from cervical pain have vertigo while others do not.

  11. Management Reviewing Literature: An Evaluation of Selected Characteristics. (United States)

    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)

  12. Knowledge Creation in Clinical Product Development Management Research

    DEFF Research Database (Denmark)

    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...

  13. Demographic, clinical and radiological characteristics of seronegative spondyloarthritis Egyptian patients: A rheumatology clinic experience in Mansoura

    Directory of Open Access Journals (Sweden)

    Adel Abdelsalam


    Conclusion: The demographic, clinical and radiological characteristics of Egyptian SpA patients are comparable to those from other countries except for the lower prevalence of extra-articular manifestations.

  14. Sex differences in clinical characteristics and outcomes after myocardial infarction

    DEFF Research Database (Denmark)

    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...

  15. Characteristics and Clinical Practices of Rural Marriage and Family Therapists (United States)

    Morris, James


    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…

  16. [Hereditary optic neuropathies: clinical and molecular genetic characteristics]. (United States)

    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.

  17. Clinical and demographic characteristics of 165 patients with lichen planus

    Directory of Open Access Journals (Sweden)

    Bilge Bülbül Şen


    Full Text Available Objective: Lichen planus (LP, is a papulosquamous inflammatory disease, which involves the skin, mucous membranes, nails and scalp. The incidence varies according to geographical regions. In this study, it was aimed to detect the clinical and demographic characteristics of the patients with LP who have been under follow-up at our clinic. Methods: One hundred sixty five patients, who were diagnosed as LP in our clinic between 2010 and 2013, were enrolled to the study. The age, gender, disease duration, time of onset of disease, characteristics of involvement, associated systemic diseases, laboratory findings and treatment were recorded retrospectively. Results: In our study, 0.6% of all patients admitted to our clinic were diagnosed as LP. A total of 165 patients included in the study, 92 women (56% and 73 men (44%, respectively. Patients’ ages ranged 8-78 (mean 44.7±16.7. Disease duration ranged from 1 month to 20 years (mean 15.6±29.7. One hundred thirty four patients (81.2% had skin involvement, 51 (31% had oral mucosal involvement, and 15 (9% had genital involvement. Five (4.5% of 111 patients with viral hepatitis tests were positive for hepatitis C virus. Hepatitis B virus positivity was seen in 4 (4% patients. Conclusion: There is a need for further studies with more patients to better understand the epidemiological, clinical and pathological characteristics of LP. We believe that our study will contribute to the determination of our country’s data.

  18. Endophthalmitis: Pathogenesis, clinical presentation, management, and perspectives

    Directory of Open Access Journals (Sweden)

    M Kernt


    Full Text Available M Kernt, A KampikDepartment of Ophthalmology, Ludwig Maximilian University, Munich, GermanyAbstract: Endophthalmitis is a rare but sight-threatening complication that can occur after ocular surgery or trauma or as a consequence of systemic infection. To optimize visual outcome, early diagnosis and treatment are essential. Over recent decades, advances in hygienic standards, improved microbiologic and surgical techniques, development of powerful antimicrobial drugs, and the introduction of intravitreal antibiotic therapy have led to a decreased incidence and improved management of endophthalmitis. However, endophthalmitis still represents a serious clinical problem. This review focuses on current principles and techniques for evaluation and treatment of endophthalmitis. In addition, it addresses recent developments regarding antimicrobial treatment and prophylaxis of infectious endophthalmitis.Keywords: endophthalmitis, intravitreal, antibiotics, victrectomy, moxifloxacin, voriconazole, caspofungin

  19. Clinical suspicion and parathyroid carcinoma management

    Directory of Open Access Journals (Sweden)

    Fabio Luiz de Menezes Montenegro

    Full Text Available CONTEXT AND OBJECTIVE: Adequate management of parathyroid carcinoma apparently relates to the surgeon’s ability to identify it at the first operation. The objective of this paper was to evaluate the role of clinical suspicion in the management of parathyroid carcinoma. DESIGN AND SETTING: Retrospective analysis of parathyroid carcinoma patients treated in Department of Head and Neck Surgery, Faculdade de Medicina da Universidade de São Paulo. METHODS: Cross-sectional study of 143 patients who underwent surgery from 1995 to 2000, due to hyperparathyroidism. These cases were reviewed to ascertain whether preoperative and intraoperative suspicion of parathyroid carcinoma were helpful during the operation, and which factors demonstrated the suspicion of cancer best. RESULTS: Among 66 patients with primary hyperparathyroidism there were four cases of parathyroid carcinoma (6.1%, and one case was found in secondary hyperparathyroidism (1.3%. Palpable nodules were found in five patients with primary hyperparathyroidism, four of them with parathyroid carcinoma. Preoperative levels of calcium in primary hyperparathyroidism with cancer patients varied from 12.0 mg/dl to 18.2 mg/dl. Two patients had gross macroscopic spread of the tumor to adjacent structures. Except for one patient, with extensive disease, tumors were resected en bloc. In secondary hyperparathyroidism, parathyroid carcinoma was found in a fifth mediastinal gland. One atypical adenoma was observed. CONCLUSIONS: High levels of calcium, palpable tumors and adherence to close structures are more common in parathyroid carcinoma. These clinical signs may be helpful for decision-making during parathyroid surgery.

  20. Clinical and practical considerations in the pharmacologic management of narcolepsy. (United States)

    Thorpy, Michael J; Dauvilliers, Yves


    Despite published treatment recommendations and the availability of approved and off-label pharmacologic therapies for narcolepsy, the clinical management of this incurable, chronic neurologic disorder remains challenging. While treatment is generally symptomatically driven, decisions regarding which drug(s) to use need to take into account a variety of factors that may affect adherence, efficacy, and tolerability. Type 1 narcolepsy (predominantly excessive daytime sleepiness with cataplexy) or type 2 narcolepsy (excessive daytime sleepiness without cataplexy) may drive treatment decisions, with consideration given either to a single drug that targets multiple symptoms or to multiple drugs that each treat a specific symptom. Other drug-related characteristics that affect drug choice are dosing regimens, tolerability, and potential drug-drug interactions. Additionally, the patient should be an active participant in treatment decisions, and the main symptomatic complaints, treatment goals, psychosocial setting, and use of lifestyle substances (ie, alcohol, nicotine, caffeine, and cannabis) need to be discussed with respect to treatment decisions. Although there is a lack of narcolepsy-specific instruments for monitoring therapeutic effects, clinically relevant subjective and objective measures of daytime sleepiness (eg, Epworth Sleepiness Scale and Maintenance of Wakefulness Test) can be used to provide guidance on whether treatment goals are being met. These considerations are discussed with the objective of providing clinically relevant recommendations for making treatment decisions that can enhance the effective management of patients with narcolepsy.

  1. [CAP quality management system in clinical laboratory and its issue]. (United States)

    Tazawa, Hiromitsu


    The CAP (College of American Pathologists) was established in 1962 and, at present, CAP-accredited laboratories include about 6000 institutions all over the world, mainly in the U.S. The essential purpose of CAP accreditation is high quality reservation and improvement of clinical laboratory services for patient care, and is based on seven points, listed below. (1) Establishment of a laboratory management program and laboratory techniques to assure accuracy and improve overall quality of laboratory services. (2) Maintenance and improvement of accuracy objectively by centering on a CAP survey. (3) Thoroughness in safety and health administration. (4) Reservation of the performance of laboratory services by personnel and proficiency management. (5) Provision of appropriate information to physicians, and contribution to improved quality of patient care by close communication with physicians (improvement in patient care). (6) Reduction of running costs and personnel costs based on evidence by employing the above-mentioned criteria. (7) Reduction of laboratory error. In the future, accreditation and/or certification by organizations such as CAP, ISO, etc., may become a requirement for providing any clinical laboratory services in Japan. Taking the essence of the CAP and the characteristics of the new international standard, ISO151589, into consideration, it is important to choose the best suited accreditation and/or certification depending of the purpose of clinical laboratory.

  2. Emergency thoracic ultrasound and clinical risk management

    Directory of Open Access Journals (Sweden)

    Interrigi MC


    Full Text Available Maria Concetta Interrigi,1 Francesca M Trovato,2,3 Daniela Catalano,3,4 Guglielmo M Trovato3,5 1Accident and Emergency Department, Ospedale Cannizzaro, Catania, 2Accident and Emergency Department, Ospedale Civile, Ragusa, 3Department of Clinical and Experimental Medicine, The School of Medicine, University of Catania, 4Postgraduate School of Clinical Ultrasound, Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Policlinico, University of Catania, 5Postgraduate School of e-Learning and ICT in Health Sciences, The School of Medicine, University of Catania, Catania, Italy Purpose: Thoracic ultrasound (TUS has been proposed as an easy-option replacement for chest X-ray (CXR in emergency diagnosis of pneumonia, pleural effusion, and pneumothorax. We investigated CXR unforeseen diagnosis, subsequently investigated by TUS, considering its usefulness in clinical risk assessment and management and also assessing the sustainability of telementoring. Patients and methods: This observational report includes a period of 6 months with proactive concurrent adjunctive TUS diagnosis telementoring, which was done using freely available smartphone applications for transfer of images and movies. Results: Three hundred and seventy emergency TUS scans (excluding trauma patients were performed and telementored. In 310 cases, no significant chest pathology was detected either by CXR, TUS, or the subsequent work-up; in 24 patients, there was full concordance between TUS and CXR (ten isolated pleural effusion; eleven pleural effusion with lung consolidations; and three lung consolidation without pleural effusion; in ten patients with lung consolidations, abnormalities identified by CXR were not detected by TUS. In 26 patients, only TUS diagnosis criteria of disease were present: in 19 patients, CXR was not diagnostic, ie, substantially negative, but TUS detected these conditions correctly, and these were later confirmed by computed

  3. Papilledema: epidemiology, etiology, and clinical management

    Directory of Open Access Journals (Sweden)

    Rigi M


    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

  4. Genetic characteristics of Japanese clinical Listeria monocytogenes isolates.

    Directory of Open Access Journals (Sweden)

    Satoko Miya

    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.

  5. Clinical microbiology in the intensive care unit: Strategic and operational characteristics

    Directory of Open Access Journals (Sweden)

    Bhattacharya S


    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.

  6. Change in MSW characteristics under recent management strategies in Taiwan. (United States)

    Chang, Yu-Min; Liu, Chien-Chung; Hung, Chao-Yang; Hu, Allen; Chen, Shiao-Shing


    Reduction and recycling initiatives such as producer responsibility and pay-as-you-throw are being implemented in Taiwan. This paper presents a study assessing the impact of recently implemented municipal solid waste (MSW) reduction and recycling management strategies on the characteristics of waste feedstock for incineration in Taiwan. Through the periodic sampling of two typical MSW incineration plants, proximate and ultimate analyses were conducted according to standard methods to explore the influence of MSW reduction and recycling management strategies on incineration feed waste characteristics. It was observed that the annual amount of MSW generated in 2005 decreased by about 10% compared to 2003 and that the characteristics of MSW have changed significantly due to recent management strategies. The heating value of the MSW generated in Taiwan increased yearly by about 5% after program implementation. A comparison of the monthly variations in chemical concentrations indicated that the chlorine content in MSW has changed. This change results from usage reduction of PVC plastic due to the recycling fund management (RFM) program, and the food waste as well as salt content reduction due to the total recycling for kitchen garbage program. This achievement will improve the reduction of dioxin emissions from MSW incineration. In summary, management strategies must be conducted in tandem with the global trend to achieve a zero-waste-discharge country. When implementing these strategies and planning for future MSW management systems, it is important to consider the changes that may occur in the composition and characteristics of MSW over time.

  7. Advanced and controlled drug delivery systems in clinical disease management

    NARCIS (Netherlands)

    Brouwers, JRBJ


    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

  8. Clinical characteristics associated with illness perception in psoriasis. (United States)

    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.



    Miller, Ivy N.; Cronin-Golomb, Alice


    More men than women are diagnosed with Parkinson's disease (PD), and a number of gender differences have been documented in this disorder. Examples of clinical characteristics that appear in men more often than women include rigidity and rapid eye movement behavior disorder, whereas more women than men exhibit dyskinesias and depression. Differences between men and women in cognition have not been extensively examined, though there are reports of deficits in men in aspects of cognition that c...

  10. Clinical and laboratory characteristics of Achromobacter xylosoxidans infection.



    Achromobacter xylosoxidans was isolated from six patients. The organism causes opportunistic infections in patients who are compromised. A. xylosoxidans is a catalase- and oxidase-positive, motile, gram-negative rod that oxidizes xylose and glucose. The organism exists in a water environment and may be confused with Pseudomonas species. Unlike pseudomonas, achromobacter has peritrichous flagella. The clinical and laboratory characteristics of A. xylosoxidans are presented.

  11. Clinical presentation and management of congenital ptosis

    Directory of Open Access Journals (Sweden)

    Marenco M


    Full Text Available Marco Marenco,1,* Ilaria Macchi,2,* Iacopo Macchi,3 Emilio Galassi,4 Mina Massaro-Giordano,5 Alessandro Lambiase1 1Department of Sense Organs, University of Rome “Sapienza”, 2Department of Ophthalmology, Campus Bio-Medico University of Rome, Rome, 3Department of Ophthalmology, University of Catania, Catania, 4Ophthalmic Clinic, Department of Ophthalmology, University of L’Aquila, L’Aquila, Italy; 5Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA *These authors contributed equally to this work Abstract: Congenital ptosis is a rare condition characterized by lower positioning of the upper eyelid that is present at birth and is a clinical condition that is persistent if not treated. It may be unilateral or bilateral and may be associated with other ocular disorders or systemic conditions, including Marcus Gunn, Horner, and Duane syndromes. It is a benign condition but causes functional, cosmetic, and psychological problems in children. However, not all patients need to undergo surgery, and usually only patients at risk of amblyopia need a prompt surgical correction, while in other cases, surgery can be postponed. The grade of ptosis, the eyelid function, and the amblyopic risk are the parameters that affect the ophthalmologist’s decision on timing of surgery and the surgical technique to be used. In fact, there are several types of surgical techniques to correct a congenital ptosis, although very often more than one is needed to obtain an acceptable result. This paper reviews the causes of congenital ptosis and associated diseases. Particular emphasis is given to surgical management and different procedures available to correct the upper eyelid anomaly and avoid permanent damage to visual function. Keywords: ptosis, extraocular muscle development, neurologic dysfunction, surgical approach

  12. Emergency thoracic ultrasound and clinical risk management (United States)

    Interrigi, Maria Concetta; Trovato, Francesca M; Catalano, Daniela; Trovato, Guglielmo M


    Purpose Thoracic ultrasound (TUS) has been proposed as an easy-option replacement for chest X-ray (CXR) in emergency diagnosis of pneumonia, pleural effusion, and pneumothorax. We investigated CXR unforeseen diagnosis, subsequently investigated by TUS, considering its usefulness in clinical risk assessment and management and also assessing the sustainability of telementoring. Patients and methods This observational report includes a period of 6 months with proactive concurrent adjunctive TUS diagnosis telementoring, which was done using freely available smartphone applications for transfer of images and movies. Results Three hundred and seventy emergency TUS scans (excluding trauma patients) were performed and telementored. In 310 cases, no significant chest pathology was detected either by CXR, TUS, or the subsequent work-up; in 24 patients, there was full concordance between TUS and CXR (ten isolated pleural effusion; eleven pleural effusion with lung consolidations; and three lung consolidation without pleural effusion); in ten patients with lung consolidations, abnormalities identified by CXR were not detected by TUS. In 26 patients, only TUS diagnosis criteria of disease were present: in 19 patients, CXR was not diagnostic, ie, substantially negative, but TUS detected these conditions correctly, and these were later confirmed by computed tomography (CT). In seven patients, even if chest disease was identified by CXR, such diagnoses were significantly modified by ultrasound, and CT confirmed that TUS was more appropriate. The overall respective individual performances of CXR and TUS for the diagnosis of a pleural–pulmonary disease in emergency are good, with accuracy >95%. Conclusion About 20% of pneumonia cases were detectable only by CXR and 20% only by TUS and not by CXR; ie, about 40% of patients may have been misdiagnosed if, by chance, only one of the two tools had been used. The concurrent use of TUS and CXR increases the overall sensitivity and

  13. The Influence of Top Management Team Characteristics on BPD Performance

    Directory of Open Access Journals (Sweden)

    Joy Elly Tulung


    Full Text Available Based on ”upper echelons theory”, this paper investigates the relation between top management team composition and BPD performance. For top management team characteristics, we employ age, level of education, background of education, gender, and functional background, while for measured the BPD performance we employ return on asset (ROA, return on equity (ROE, capital adequacy ratio (CAR, net interest margin (NIM, loan to deposit ratio (LDR, non-performing loan (NPL and operation expenses to operation income (BOPO. The results show that all characteristics have positive significant influences on BPD performance.

  14. Clinical presentation and management of congenital ptosis (United States)

    Marenco, Marco; Macchi, Ilaria; Macchi, Iacopo; Galassi, Emilio; Massaro-Giordano, Mina; Lambiase, Alessandro


    Congenital ptosis is a rare condition characterized by lower positioning of the upper eyelid that is present at birth and is a clinical condition that is persistent if not treated. It may be unilateral or bilateral and may be associated with other ocular disorders or systemic conditions, including Marcus Gunn, Horner, and Duane syndromes. It is a benign condition but causes functional, cosmetic, and psychological problems in children. However, not all patients need to undergo surgery, and usually only patients at risk of amblyopia need a prompt surgical correction, while in other cases, surgery can be postponed. The grade of ptosis, the eyelid function, and the amblyopic risk are the parameters that affect the ophthalmologist’s decision on timing of surgery and the surgical technique to be used. In fact, there are several types of surgical techniques to correct a congenital ptosis, although very often more than one is needed to obtain an acceptable result. This paper reviews the causes of congenital ptosis and associated diseases. Particular emphasis is given to surgical management and different procedures available to correct the upper eyelid anomaly and avoid permanent damage to visual function. PMID:28280295

  15. [Basic considerations during outsourcing of clinical data management services]. (United States)

    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.

  16. ISMAC: An Intelligent System for Customized Clinical Case Management and Analysis

    Directory of Open Access Journals (Sweden)

    Mingyu You


    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.


    Directory of Open Access Journals (Sweden)



    Full Text Available BACKGROUND AND OBJECTIVES: Choledocholithiasis complicates the working and management of cholelithiasis necessitating additional diagnostic procedures, increasing morbidity and mortality. CBD stone generally remain asymptomatic but when symptoms start appearing, cause a lot of suffering. There are various treatment modalities available presently. The objective of our study was to study the incidence, various modes of clinical presentations and different modalities of treatment in common bile duct stones. MATERIALS AND METHODS: 35 Patients were prospectively studied from July 2012 to June 2014 as in-patients in Victoria Hospital. RESULTS: CBD stones occurred predominantly in elderly females and presented from subclinical jaundice to complications in the form of biliary pancreatitis and cholangitis. USG abdomen with LFT was able to diagnose majority of the CBD stones preoperatively. Per operative cholangiogram was used selectively in case USG was inconclusive, ERCP was used in patients presenting with severe obstructive jaundice, pancreatitis, cholangitis, minimal CBD ductal dilation. Open exploration was the main focus with a wide variety of procedures performed according to specific indications. CONCLUSION: CBD was more common in elderly female patients probably due to neglected gall bladder stones. CBD stones can occur from occult asymptomatic stones only with altered LFT to symptomatic presentation in the form of cholangitis, pancreatitis. USG abdomen was inexpensive and easily available imaging modality to diagnose CBD stones with per operative cholangiogram being needed in minority of the cases. While ERCP was good in treating complications of CBD stones and early stages of the disease; the more advanced stage of the disease with gross CBD ductal dilation and multiple stones open CBD exploration were more productive.

  18. Risk management in clinical practice. Part 10. Periodontology. (United States)

    Baker, P; Needleman, I


    A sizeable proportion of patients in clinical practice will have some form of periodontal disease and most of these patients can be well managed in primary care. Unfortunately, dento-legal claims regarding inappropriate periodontal care are increasing rapidly and are now one of the most common reasons for litigation in dentistry. In this paper we will look at aspects of contemporary management of periodontal disease in clinical practice and offer guidance for examination, management and referral.

  19. Clinical and Management Requirements for Computerized Mental Health Information Systems


    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.

  20. Diabetes quality management in care groups and outpatient clinics

    NARCIS (Netherlands)

    Campmans-Kuijpers, M.J.E.


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

  1. Clinical and Molecular Characteristics of Post-Colonoscopy Colorectal Cancer

    DEFF Research Database (Denmark)

    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...

  2. Characteristics of leadership that influence clinical learning: a narrative review. (United States)

    Walker, Rachel; Cooke, Marie; Henderson, Amanda; Creedy, Debra K


    Leadership has been consistently implied in fostering clinical learning. However there is a lack of clarity about the form leadership should take. Limited quantitative research indicated a narrative approach to review literature from a broad perspective. A framework to guide the synthesis was developed to ensure a rigorous review process. Preliminary reading and review of papers using search terms nursing and leadership and clinical learning and learning culture narrowed the inclusion criteria to 245 papers published between 2000 and 2010. Given the diversity of the papers' focus, aim and context, a refined screening process justified the inclusion of twenty-six papers in the review. A critical appraisal of these peer-reviewed quantitative, qualitative and commentary papers identified factors/elements integral to effective leadership. Across the literature leadership was discussed in relation to two broad themes: influence of leadership on organisational learning and development and; influence of leadership on undergraduate clinical education. The factors central to leadership emerged as transformative principles, the role of the nurse unit/ward manager, collaboration and relationship building and role-modelling. The review has raised some suggestions for future research aimed at examining the impact of a leadership capacity building intervention that supports clinical learning.

  3. Clinical characteristics of patients with persistent postural-perceptual dizziness

    Directory of Open Access Journals (Sweden)

    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.

  4. Clinical characteristics of early- and late-onset gout (United States)

    Zhang, Bingqing; Fang, Weigang; Zeng, Xuejun; Zhang, Yun; Ma, Ya; Sheng, Feng; Zhang, Xinlei


    Abstract A retrospective cross-sectional study using data from an outpatient clinic in China was conducted to investigate the clinical features of early-onset gout patients. All patients diagnosed with gout were asked about clinical characteristics of their gout and comorbid diseases. Patients presenting with acute flares were asked about common triggers before the flare. “Early-onset” gout was defined as onset of gout before 40 years and “late-onset” as onset ≥40 years. Major joint involvement, flare frequency before presentation, the cumulative number of involved joints, proportions of tophi complications at presentation, flare triggers, as well as any metabolic, cardiovascular, cerebrovascular, and renal comorbidities, were compared between the 2 groups. A total of 778 gout patients were enrolled in this study, including 449 (57.7%) in the early-onset group and 329 (42.3%) in the late-onset group. Compared with the late-onset gout patients, the early-onset gout patients had a higher proportion of ankle/mid-foot involvement (62.8% vs 48.2%, P gout patients had fewer metabolic, cardiovascular, cerebrovascular, or renal complications. Early- and late-onset gout patients had different clinical features. Early-onset seems to be influenced more by lifestyle, while late-onset patients have more complications because of comorbidities. PMID:27893683

  5. Sociodemographic and clinical characteristics of patients with recurrent aphthous stomatitis

    Directory of Open Access Journals (Sweden)

    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.

  6. The influence of job characteristics on job outcomes of pharmacists in hospital, clinic, and community pharmacies. (United States)

    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.

  7. Fibromyalgia: clinical features, diagnosis and management. (United States)

    Walker, Jennie


    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.

  8. Clinical features and management of Hadronyche envenomation in man. (United States)

    Miller, M K; Whyte, I M; White, J; Keir, P M


    Using case reports and a review of the literature, the clinical features of envenomation by the genus of Australian funnel web spiders known as Hadronyche, are characterised. Five cases are reported here, including the first life-threatening envenomation by Hadronyche species 14 (the Port Macquarie funnel web). Two severe envenomations by Hadronyche cerberea (the Southern Tree funnel web) and one each by Hadronyche formidabilis (the Northern Tree funnel web) and Hadronyche infensa (the Darling Downs funnel web) are also described. The clinical experience of the authors' provided the five cases described in detail one of which has previously been reported in brief. Eight cases of Hadronyche envenomation from the literature (Medline 1966-1998 and Embase 1980-1998) were analysed in order to draw comparisons between this syndrome and the well described envenomation syndrome of Atrax robustus (the Sydney funnel web). Reports of funnel web spider antivenom use to Commonwealth Serum Laboratories (CSL) between 1995 and June 1998 were also examined. The biology of these dangerous spiders, their geographic distribution, venom characteristics and management issues are addressed. It is concluded that bites from at least six Hadronyche species have produced a life-threatening envenomation syndrome clinically indistinguishable from that of Atrax robustus. Atrax robustus derived antivenom is effective although antivenom requirements may be greater than for Atrax envenomation. Antivenom supplies are limited and sufficient stocks to treat a severe envenomation are unlikely to be found in any one institution. Pressure-immobilisation first aid is effective in delaying onset of envenomation, may enhance local inactivation of venom and early removal can result in rapid clinical deterioration.

  9. Kikuchi-Fujimoto disease: Clinical and laboratory characteristics and outcome

    Directory of Open Access Journals (Sweden)

    P S Rakesh


    Full Text Available Introduction: Kikuchi-Fujimoto disease is an uncommon disorder with worldwide distribution, characterized by fever and benign enlargement of the lymph nodes, primarily affecting young adults. Awareness about this disorder may help prevent misdiagnosis and inappropriate investigations and treatment. The objective of the study was to evaluate the clinical and laboratory characteristics of histopathologically confirmed cases of Kikuchi′s disease from a tertiary care center in southern India. Materials and Methods: Retrospective analysis of all adult patients with histopathologically confirmed Kikuchi′s disease from January 2007 to December 2011 in a 2700-bed teaching hospital in South India was done. The clinical and laboratory characteristics and outcome were analyzed. Results: There were 22 histopathologically confirmed cases of Kikuchi′s disease over the 5-year period of this study. The mean age of the subjects′ was 29.7 years (SD 8.11 and majority were women (Male: female- 1:3.4. Apart from enlarged cervical lymph nodes, prolonged fever was the most common presenting complaint (77.3%. The major laboratory features included anemia (54.5%, increased erythrocyte sedimentation rate (31.8%, elevated alanine aminotransferase (27.2% and elevated lactate dehydrogenase (LDH (31.8%. Conclusion: Even though rare, Kikuchi′s disease should be considered in the differential diagnosis of young individuals, especially women, presenting with lymphadenopathy and prolonged fever. Establishing the diagnosis histopathologically is essential to avoid inappropriate investigations and therapy.

  10. Clinical Characteristics of Cases with Spinal Muscular Atrophy

    Directory of Open Access Journals (Sweden)

    Mehmet Canpolat


    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.

  11. Clinical characteristics affecting motor recovery and ambulation in stroke patients (United States)

    Yetisgin, Alparslan


    [Purpose] To describe the clinical characteristics affecting motor recovery and ambulation in stroke patients. [Subjects and Methods] Demographic and clinical characteristics of 53 stroke patients (31 M, 22 F), such as age, gender, etiology, hemiplegic side, Brunnstrom stage, functional ambulation scale scores, history of rehabilitation, and presence of shoulder pain and complex regional pain syndrome were evaluated. [Results] The etiology was ischemic in 79.2% of patients and hemorrhagic in 20.8%. Brunnstrom hand and upper extremity values in females were lower than in males. Complex regional pain syndrome was observed at a level of 18.9% in all patients (more common in females). Brunnstrom hand stage was lower in complex regional pain syndrome patients than in those without the syndrome. Shoulder pain was present in 44.4% of patients. Brunnstrom lower extremity values and functional ambulation scale scores were higher in rehabilitated than in non-rehabilitated cases. [Conclusion] Brunnstrom stages of hand and upper extremity were lower and complex regional pain syndrome was more common in female stroke patients. Shoulder pain and lower Brunnstrom hand stages were related to the presence of complex regional pain syndrome. PMID:28265142

  12. Clinical and diagnostic characteristics of hyperprolactinemia in childhood and adolescence. (United States)

    Catli, Gonul; Abaci, Ayhan; Bober, Ece; Büyükgebiz, Atilla


    Pituitary adenoma is the most common cause of hyperprolactinemia, which is a rare endocrine disorder encountered in pediatric patient care. Epidemiological and clinical information about hyperprolactinemia in childhood and adolescence is limited. Clinical signs of hyperprolactinemia are very heterogeneous. In girls, disturbances in menstrual function and galactorrhea may be seen, whereas in boys, headache, visual disturbances, delayed pubertal development and hypogonadism are often present. Owing to the ease of ordering a serum prolactin measurement, an evidence-based, cost-effective approach to the management of this endocrine disorder is required. Before a diagnosis of hyperprolactinemia is made, drug use, renal insufficiency, hypothyroidism, and parasellar tumors should be excluded. The main objectives of treatment are normalization of prolactin level, adenoma shrinkage, and recovery from clinical signs related to hyperprolactinemia. In patients with microadenoma, invasive or non-invasive macroadenoma, and even in patients with visual field defects, dopamine agonists are the first-line treatment. Surgical treatment is indicated in patients who are unresponsive or intolerant to medical treatment or who have persistent neurological signs. Radiotherapy should be considered as a supportive treatment for patients in whom surgery fails or medical response is not achieved.

  13. Clinical characteristics of Takotsubo cardiomyopathy in North America

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    Saeed Ahmed


    Full Text Available 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 Records. We also conducted a systematic review of case series of TC that were done in North America by searching the MEDLINE database. We identified 11 case series that met our eligibility criteria. Results: Our systematic review included 620 patients. Chest pain and ST segment elevation were the cardinal features of this syndrome, but the prevalence was lower than in the European and Asian cohort (50% and 39% as compared with 80% and 70%, respectively. Classic precipitating emotional or physical stress was described in > 80% of patients. Cardiac biomarkers were found to be elevated in >90% of our patients. Conclusions : TC is a worldwide problem and clinical presentation appears to be similar in North American, European, and Asian countries. However, fewer patients in our cohort presented with typical chest pain and electrocardiography (ECG changes, which might suggest ethnic variations in the syndrome or perhaps a more aggressive diagnostic approach in North American countries.

  14. Chronic pain disorders in HIV primary care: clinical characteristics and association with healthcare utilization. (United States)

    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.

  15. Conventional crop management effects on soil organic matter characteristics



    International audience; A Mediterranean soil affected by long-term crop management systems was evaluated to identify the best indicators of its quality. Selected characteristics included total soil organic carbon (TOC), light fraction carbon (LFC), acid hydrolyzable and water-soluble carbohydrates carbon (AHG-C and WSC-C), phenolic carbon (PC), mineralizable carbon (Q), microbial biomass carbon (MB-C) and metabolic quotients (qCO$_2$ and qD). Soil samples were taken under natural grass (NG), ...

  16. Clinical features of pheochromocytoma and perioperative anesthetic management

    Institute of Scientific and Technical Information of China (English)

    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

  17. Lupus enteritis: from clinical findings to therapeutic management. (United States)

    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.

  18. Laparoscopic Surgical Management and Clinical Characteristics of Ovarian Dermoid Cysts%卵巢皮样囊肿临床特点和腹腔镜手术治疗效果分析

    Institute of Scientific and Technical Information of China (English)



    Objective:To analyze the clinical characteristics of ovarian dermoid cysts and to evaluate the efficacy and safety of laparoscopic surgery for ovarian fibromas.Method:We reviewed the records of 63 consecutive women who underwent laparoscopic or laparotomic surgeries and whose final histopathological diagnoses were ovarian mature cystic teratomas in Heze Municiple Hospital,Gynaecology from 2014 to 2015[laparoscopic surgery (n=29,the observation group), laparotomy(n=34,the control group)],correlated clinical indexes of two groups were compared.Result:76.2% of the infections showed no symptom.However,three patients showed positive results when they performed uterine myoma scan,and 1 case has been detected when she did the ectopic pregnancy scan.23.8% of the infections felt obvious abdominal pains,including 5 cases who suffered torsion of the pedicle of ovarin cyst.17.5% were in peri-menopasusal,76.2% were in growth season and 6.3% were teenagers. There were 14.2% who had ovary cyst on both sides,42.9% on the left and 42.9% on the right.We discovered 5 cases who had torsion of the pedicle of ovarian cyst,had tumor body size roughly around 10.4 cm.The median of CA125 was 16.60 U/mL,the median of CA199 was 17.75 U/mL.The observation group had the advantages of shorter hospital stay and less intraoperatve blood soss and faster return of bowel activities compared to the control group(P6 cm,the risk of torsion is raising.CA125 and CA199 don’t raise in ovarian dermoid cysts.Laparoscopic surgery for ovarian dermoid cysts is efficacy and safety.%目的:研究卵巢皮样囊肿的临床特点和评估腹腔镜手术治疗的安全性和有效性。方法:回顾性分析63例进行开腹或腹腔镜手术的的卵巢皮样囊肿患者的临床资料[腹腔镜治疗组29例(观察组),开腹手术组34例(对照组)],分析其临床特点,比较两组患者手术时间、住院时间、肿瘤直径、术中失血量、囊液外溢率、肠功能恢复时间

  19. Clinical Management of Father-Daughter Incest. A Critical Reexamination (United States)

    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)

  20. Hospital administrative characteristics and volunteer resource management practices. (United States)

    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.

  1. The characteristics of railway service disruption: implications for disruption management. (United States)

    Golightly, D; Dadashi, N


    Rail disruption management is central to operational continuity and customer satisfaction. Disruption is not a unitary phenomenon - it varies by time, cause, location and complexity of coordination. Effective, user-centred technology for rail disruption must reflect this variety. A repertory grid study was conducted to elicit disruption characteristics. Construct elicitation with a group of experts (n = 7) captured 26 characteristics relevant to rail disruption. A larger group of operational staff (n = 28) rated 10 types of rail incident against the 26 characteristics. The results revealed distinctions such as business impact and public perception, and the importance of management of the disruption over initial detection. There were clear differences between those events that stop the traffic, as opposed to those that only slow the traffic. The results also demonstrate the utility of repertory grid for capturing the characteristics of complex work domains. Practitioner Summary: The aim of the paper is to understand how variety in rail disruption influences socio-technical design. It uses repertory grid to identify and prioritise 26 constructs, and group 10 disruption types, identifying critical factors such as whether an incident stops or merely slows the service, and business reputation.

  2. Outcomes of a Nurse-Managed Diabetes Foot Clinic (United States)


    Managed Diabetes Foot Clinic 5b. GRANT NUMBER HU0001-04-1-TS10 5c. PROGRAM ELEMENT NUMBER N/A 6. AUTHOR(S) 5d. PROJECT NUMBER N04-017...measured outcomes of a nurse-managed diabetes foot clinic on foot wound rates, health care costs, and changes in health status in adults with...assignment by risk. All received diabetic - foot self-care education and foot assessment. Controls were seen very three months. Treatment participants

  3. Clinical manifestation, imageological and pathological characteristics of Wernicke encephalopathy

    Institute of Scientific and Technical Information of China (English)

    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

  4. Fatal tumors: prenatal ultrasonographic findings and clinical characteristics

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    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.

  5. Community-acquired Acinetobacter baumannii: clinical characteristics, epidemiology and pathogenesis. (United States)

    Dexter, Carina; Murray, Gerald L; Paulsen, Ian T; Peleg, Anton Y


    Community-acquired Acinetobacter baumannii (CA-Ab) is a rare but serious cause of community-acquired pneumonia in tropical regions of the world. CA-Ab infections predominantly affect individuals with risk factors, which include excess alcohol consumption, diabetes mellitus, smoking and chronic lung disease. CA-Ab pneumonia presents as a surprisingly fulminant course and is characterized by a rapid onset of fever, severe respiratory symptoms and multi-organ dysfunction, with a mortality rate reported as high as 64%. It is unclear whether the distinct clinical syndrome caused by CA-Ab is because of host predisposing factors or unique bacterial characteristics, or a combination of both. Deepening our understanding of the drivers of overwhelming CA-Ab infection will provide important insights into preventative and therapeutic strategies.

  6. Isolation Frequency Characteristics of Candida Species from Clinical Specimens. (United States)

    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.

  7. Clinical characteristics of 4355 patients with anterior cruciate ligament injury

    Institute of Scientific and Technical Information of China (English)

    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.

  8. Quality management systems and clinical outcomes in Dutch nursing homes.

    NARCIS (Netherlands)

    Wagner, C.; Klein Ikkink, K.; Wal, G. van der; Spreeuwenberg, P.; Bakker, D.H. de; Groenewegen, P.P.


    The objective of the article is to explore the impact quality management systems and quality assurance activities in nursing homes have on clinical outcomes. The results are based on a cross-sectional study in 65 Dutch nursing homes. The management of the nursing homes as well as the residents (N =

  9. Quality management systems and clinical outcomes in Dutch nursing homes

    NARCIS (Netherlands)

    Wagner, Cordula; Klein Ikkink, Karen; Wal, Gerrit van der; Spreeuwenberg, Peter; Bakker, Dinny Herman de; Groenewegen, Peter Paulus


    The objective of the article is to explore the impact quality management systems and quality assurance activities in nursing homes have on clinical outcomes. The results are based on a cross-sectional study in 65 Dutch nursing homes. The management of the nursing homes as well as the residents (N= 1

  10. Transforming Research Management Systems at Mayo Clinic (United States)

    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…

  11. Clinical risk management of herb-drug interactions.

    NARCIS (Netherlands)

    Smet, P.A.G.M. de


    The concomitant use of conventional and herbal medicines can lead to clinically relevant herb-drug interactions. Clinical risk management offers a systematic approach to minimize the untoward consequences of these interactions by paying attention to: (i) risk identification and assessment; (ii) deve

  12. Pathophysiology and Japanese clinical characteristics in Marfan syndrome. (United States)

    Fujita, Daishi; Takeda, Norifumi; Imai, Yasushi; Inuzuka, Ryo; Komuro, Issei; Hirata, Yasunobu


    Marfan syndrome is an autosomal dominant heritable disorder of the connective tissue, caused by mutations of the gene FBN1, which encodes fibrillin-1, a major component of the microfibrils of the extracellular matrix. Fibrillin-1 interacts with transforming growth factor-β (TGF-β), and dysregulated TGF-β signaling plays a major role in the development of connective tissue disease and familial aortic aneurysm and dissection, including Marfan syndrome. Losartan, an angiotensin II blocker, has the potential to reduce TGF-β signaling and is expected to be an additional therapeutic option. Clinical diagnosis is made using the Ghent nosology, which requires comprehensive patient assessment and has been proven to work well, but evaluation of some of the diagnostic criteria by a single physician is difficult and time-consuming. A Marfan clinic was established at the University of Tokyo Hospital in 2005, together with cardiologists, cardiac surgeons, pediatricians, orthopedists, and ophthalmologists in one place, for the purpose of speedy and accurate evaluation and diagnosis of Marfan syndrome. In this review, we discuss the recent progress in diagnosis and treatment of Marfan syndrome, and the characteristics of Japanese patients with Marfan syndrome.

  13. Clinical and epidemiological characteristics of infectious keratitis in Paraguay. (United States)

    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.

  14. Clinical and laboratory characteristics of children with Kawasaki disease

    Directory of Open Access Journals (Sweden)

    Fatih Akın


    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.

  15. The demographic and clinical characteristics of leprosy in Saudi Arabia. (United States)

    Alotaibi, Mohammad H; Bahammam, Salman A; Ur Rahman, Saeed; Bahnassy, Ahmed A; Hassan, Imad S; Alothman, Adel F; Alkayal, Abdulkareem M


    Leprosy is a chronic disease caused by Mycobacterium leprae. Although the occurrence of leprosy has declined in Saudi Arabia, it has not yet been eradicated. To our knowledge, this descriptive retrospective study is the first to assess the clinical presentation of leprosy at the time of diagnosis in Saudi Arabia. All study subjects were leprosy patients admitted to Ibn Sina hospital, the only referral hospital for leprosy in Saudi Arabia, between January 2000 and May 2012. A total of 164 subjects, the majority of whom (65%) were between 21 and 50 years of age, were included, and the male-to-female ratio was 2.8:1. Of these 164 patients, 63% were Saudis, and 77% of all admitted patients were from the western region. Lepromatous leprosy was observed most frequently (33%), and 31% of cases had a positive history of close contact with leprosy. At the time of diagnosis, 84% of all subjects presented with skin manifestation. The prevalence of neurological deficit at the time of diagnosis was 87%. Erythema nodosum leprosum (E.N.L.) developed in only 10% of all subjects. Further studies are needed to determine the clinical characteristics pertaining to each type of leprosy in the region, and training courses in caring for and diagnosing patients with leprosy should be organized for health workers.

  16. Clinical trial participant characteristics and saliva and DNA metrics

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    Richards Julie


    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

  17. Clinical characteristics and treatment of neurofibroma of the choroid

    Institute of Scientific and Technical Information of China (English)

    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.

  18. Clinical characteristics and prognostic factors of severe acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    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.

  19. Menopausal syndrome: clinical presentation and management

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    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

  20. Claudin-Low Breast Cancer; Clinical & Pathological Characteristics (United States)

    Dias, Kay; Dvorkin-Gheva, Anna; Hallett, Robin M.; Wu, Ying; Hassell, John; Pond, Gregory R.; Levine, Mark; Whelan, Tim; Bane, Anita L.


    Claudin-low breast cancer is a molecular type of breast cancer originally identified by gene expression profiling and reportedly associated with poor survival. Claudin-low tumors have been recognised to preferentially display a triple-negative phenotype, however only a minority of triple-negative breast cancers are claudin-low. We sought to identify an immunohistochemical profile for claudin-low tumors that could facilitate their identification in formalin fixed paraffin embedded tumor material. First, an in silico collection of ~1600 human breast cancer expression profiles was assembled and all claudin-low tumors identified. Second, genes differentially expressed between claudin-low tumors and all other molecular subtypes of breast cancer were identified. Third, a number of these top differentially expressed genes were tested using immunohistochemistry for expression in a diverse panel of breast cancer cell lines to determine their specificity for claudin-low tumors. Finally, the immunohistochemical panel found to be most characteristic of claudin-low tumors was examined in a cohort of 942 formalin fixed paraffin embedded human breast cancers with >10 years clinical follow-up to evaluate the clinico-pathologic and survival characteristics of this tumor subtype. Using this approach we determined that claudin-low breast cancer is typically negative for ER, PR, HER2, claudin 3, claudin 4, claudin 7 and E-cadherin. Claudin-low tumors identified with this immunohistochemical panel, were associated with young age of onset, higher tumor grade, larger tumor size, extensive lymphocytic infiltrate and a circumscribed tumor margin. Patients with claudin-low tumors had a worse overall survival when compared to patients with luminal A type breast cancer. Interestingly, claudin-low tumors were associated with a low local recurrence rate following breast conserving therapy. In conclusion, a limited panel of antibodies can facilitate the identification of claudin-low tumors

  1. Sepsis in AIDS patients: clinical, etiological and inflammatory characteristics

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    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

  2. Clinical and psychosocial characteristics of children with nonepileptic seizures

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    Chinta Sri


    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

  3. Etiology, diagnosis, and clinical management of vulvodynia

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    Sadownik LA


    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

  4. Data management by using R: big data clinical research series. (United States)

    Zhang, Zhongheng


    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.

  5. Clinical management of behavioral insomnia of childhood


    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...

  6. Clinical management of septic arthritis in cattle. (United States)

    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.

  7. Clinical management of the mandibular molars. (United States)

    Canut, J A


    The complex variety of clinical problems posed by the lower molars requires maximum care in diagnosis and in treatment planning. In this article several therapeutic solutions to these problems are presented. The need to treat positional anomalies of the second molars and to control their drifting in cases of bracing and mandibular insertion, may be an effective auxillary means of treatment of those malocclusions in which lengthening of the dental bracing zones is indicated.

  8. Clinical characteristics and prognostic impact of bacterial infection in hospitalized patients with alcoholic liver disease. (United States)

    Park, Jin Kyoung; Lee, Chang Hun; Kim, In Hee; Kim, Seon Min; Jang, Ji Won; Kim, Seong Hun; Kim, Sang Wook; Lee, Seung Ok; Lee, Soo Teik; Kim, Dae-Ghon


    Bacterial infection is an important cause of death in patients with liver cirrhosis. The aim of this study was to investigate the clinical characteristics and prognostic impact of bacterial infection in hospitalized patients with alcoholic liver disease (ALD). We retrospectively analyzed data from 409 patients consecutively admitted to a tertiary referral center with ALD diagnosis. Of a total of 544 admissions, 133 (24.4%) cases presented with bacterial infection, of which 116 were community-acquired whereas 17 were hospital-acquired. The common types of infection were pneumonia (38%), biliary tract infection (17%), soft tissue infection (12%), and spontaneous bacterial peritonitis (9%). Diabetes, serum Na patients with ALD. Overall 30-day and 90-day mortalities in patients with bacterial infection were significantly (P patients with ALD. A thorough evaluation at admission or on clinical deterioration is required to detect possible infection with prompt management.

  9. Clinical management of pregnancy in cats. (United States)

    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.

  10. [The modern microbiology in the clinical managing]. (United States)

    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.

  11. Ventricular arrhythmias. Clinical recognition and management. (United States)

    Nestico, P F; DePace, N L; Morganroth, J


    The recognition that patients at high risk for sudden cardiac death can be identified raises our enthusiasm to eliminate some of these risk factors and thus our hope to prevent sudden cardiac death. Although this effect is yet to be shown in cooperative, well-controlled clinical trials, data exist to suggest that this result will be achieved. Thus, the use of antiarrhythmic agents in chronic ventricular ectopy, particularly in patients with left ventricular dysfunction, seems to be warranted, and new and more potent agents to be used for this end will be available in the future.

  12. Clinical characteristics and perinatal outcome of fetal hydrops (United States)

    Yeom, Wonkyung; Paik, E Sun; An, Jung-Joo; Oh, Soo-young; Roh, Cheong-Rae; Kim, Jong-Hwa


    Objective To investigate the clinical characteristics of fetal hydrops and to find the antenatal ultrasound findings predictive of adverse perinatal outcome. Methods This is a retrospective study of 42 women with fetal hydrops who delivered in a tertiary-referral center from 2005 to 2013. Fetal hydrops was defined as the presence of fluid collection in ≥2 body cavities: ascites, pleural effusion, pericardial effusion, and skin edema. Predictor variables recorded included: maternal characteristics, gestational age at diagnosis, ultrasound findings, and identifiable causes. Primary outcome variables analyzed were fetal death and neonatal death. Results The mean gestational age at diagnosis was 29.3±5.4 weeks (range, 18 to 39 weeks). The most common identifiable causes were cardiac abnormality (10), followed by syndrome (4), aneuploidy (3), congenital infection (3), twin-to-twin transfusion syndrome (3), non-cardiac anormaly (2), chorioangioma (2), inborn errors of metabolism (1), and immune hydrops by anti-E antibody isoimmunization (1). Thirteen cases had no definite identifiable causes. Three women elected termination of pregnancy. Fetal death occurred in 4 cases. Among the 35 live-born babies, only 16 survived (54.0% neonatal mortality rate). Fetal death and neonatal mortality rate was not significantly associated with Doppler velocimetry indices or location of fluid collection, but increasing numbers of fluid collection site was significantly associated with a higher risk of neonatal death. Conclusion The incidence of fetal hydrops in our retrospective study was 24.4 per 10,000 deliveries and the perinatal mortality rate was 61.9% (26/42). The number of fluid collection sites was the significant antenatal risk factor to predict neonatal death. PMID:25798421

  13. Clinical characteristics of intermediate uveitis in adult Turkish patients

    Institute of Scientific and Technical Information of China (English)

    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.

  14. Holoprosencephaly: Epidemiologic and clinical characteristics of a California population

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    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.

  15. Air Embolism: Diagnosis, Clinical Management and Outcomes

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    Colin J. McCarthy


    Full Text Available Air embolism is a rare but potentially fatal complication of surgical procedures. Rapid recognition and intervention is critical for reducing morbidity and mortality. We retrospectively characterized our experience with air embolism during medical procedures at a tertiary medical center. Electronic medical records were searched for all cases of air embolism over a 25-year period; relevant medical and imaging records were reviewed. Sixty-seven air embolism cases were identified; the mean age was 59 years (range, 3–89 years. Ninety-four percent occurred in-hospital, of which 77.8% were during an operation/invasive procedure. Vascular access-related procedures (33% were the most commonly associated with air embolism. Clinical signs and symptoms were related to the location the air embolus; 36 cases to the right heart/pulmonary artery, 21 to the cerebrum, and 10 were attributed to patent foramen ovale (PFO. Twenty-one percent of patients underwent hyperbaric oxygen therapy (HBOT, 7.5% aspiration of the air, and 63% had no sequelae. Mortality rate was 21%; 69% died within 48 hours. Thirteen patients had immediate cardiac arrest where mortality rate was 53.8%, compared to 13.5% (p = 0.0035 in those without. Air emboli were mainly iatrogenic, primarily associated with endovascular procedures. High clinical suspicion and early treatment are critical for survival.

  16. [Knowledge management system for laboratory work and clinical decision support]. (United States)

    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.

  17. [Job satisfaction of nurses in the clinical management units]. (United States)

    Martínez Lara, Concepción; Praena Fernández, Juan Manuel; Gil García, Eugenia


    Clinical Management Unit (CMU) is currently set in the Andalusian health institutions as the model reference management. This management model aims to make all healthcare professionals a powerful idea: the best performance of health resources is performed to drive clinical practice using the least number of diagnostic and therapeutic resources. The CMU not only aims at saving money, in the Clinical Management Agreement [1] are measured all the dimensions that make up the UGC: research, training, clinical process, the portfolio of services, objectives, financial management and indicators to control and security. The CMU is to transfer more responsibilities to Health Care Professionals, involving them in the management of the Unit. The CMU sets new approaches that directly affect health professionals and presents advantages and disadvantages for the Doctors and the Nurses, involved in achieving excellence in care work. Nurse Practitioners shows expectant before the changes are generated in health institutions and appears a discussion of skills derived from the CMU. Some Nurses believe that the bur, den of care to which they are subjected in public institutions has increased since the onset of the CMU and yet others believe that they are motivated and rewarded for the results obtained with this model of management. In health institutions, some professionals are more motivated than others and this is found in the outcome of health care activity [2]. Given the positive and negative perceptions that arise in the CMU Professional Nurses, it is considered appropriate to focus the objective of this work in the search for factors that influence job satisfaction of nurses in the CMU. There are few studies about the CMU [3] but are absent when linked with nursing, so the pursuit of scientific knowledge related to nursing management model based on Clinical and Quality Care can lead to establish new concepts around the nursing profession, a profession in which major changes are

  18. Acute Viral Hepatitis A – Clinical, Laboratory and Epidemiological Characteristics

    Directory of Open Access Journals (Sweden)

    Melinda HORVAT


    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

  19. Clinical characteristics of zinc phosphide poisoning in Thailand (United States)

    Trakulsrichai, Satariya; Kosanyawat, Natcha; Atiksawedparit, Pongsakorn; Sriapha, Charuwan; Tongpoo, Achara; Udomsubpayakul, Umaporn; Rittilert, Panee; Wananukul, Winai


    Objective The objectives of this study were to describe the clinical characteristics and outcomes of poisoning by zinc phosphide, a common rodenticide in Thailand, and to evaluate whether these outcomes can be prognosticated by the clinical presentation. Materials and methods A 3-year retrospective cohort study was performed using data from the Ramathibodi Poison Center Toxic Exposure Surveillance System. Results In total, 455 poisonings were identified. Most were males (60.5%) and from the central region of Thailand (71.0%). The mean age was 39.91±19.15 years. The most common route of exposure was oral (99.3%). Most patients showed normal vital signs, oxygen saturation, and consciousness at the first presentation. The three most common clinical presentations were gastrointestinal (GI; 68.8%), cardiovascular (22.0%), and respiratory (13.8%) signs and symptoms. Most patients had normal blood chemistry laboratory results and chest X-ray findings at presentation. The median hospital stay was 2 days, and the mortality rate was 7%. Approximately 70% of patients underwent GI decontamination, including gastric lavage and a single dose of activated charcoal. In all, 31 patients were intubated and required ventilator support. Inotropic drugs were given to 4.2% of patients. Four moribund patients also received hyperinsulinemia–euglycemia therapy and intravenous hydrocortisone; however, all died. Patients who survived and died showed significant differences in age, duration from taking zinc phosphide to hospital presentation, abnormal vital signs at presentation (tachycardia, low blood pressure, and tachypnea), acidosis, hypernatremia, hyperkalemia, in-hospital acute kidney injury, in-hospital hypoglycemia, endotracheal tube intubation, and inotropic requirement during hospitalization (P<0.05). Conclusion Zinc phosphide poisoning causes fatalities. Most patients have mild symptoms, and GI symptoms are the most common. Patients who present with abnormal vital signs or

  20. Clinical management of infected root canal dentin. (United States)

    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.

  1. Management of diabetes mellitus in clinical practice. (United States)

    Lawal, Muili

    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.

  2. Clinical Characteristics of Adults with Asperger's Syndrome Assessed with Self-Report Questionnaires (United States)

    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…

  3. Clinical management of behavioral insomnia of childhood

    Directory of Open Access Journals (Sweden)

    Vriend J


    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

  4. Clinical Characteristics and Genetic Variability of Human Rhinovirus in Mexico

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    Hilda Montero


    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.

  5. Epidemiological, clinical, and immunological characteristics of neuromyelitis optica: A review. (United States)

    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.

  6. Investigation of Tinnitus Patients in Italy: Clinical and Audiological Characteristics

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    Francesco Martines


    Full Text Available 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 in 37.18% of cases. The hearing impairment results of sensorineural type in 74.62% and limited to the high frequencies in 58.50%. The tinnitus is referred as unilateral in 59.93%, a pure tone in 66.99% and 10 dB above the hearing threshold in 37.7%. It is limited to high frequencies in 72.10% of the patients with sensorineural hearing loss (SNHL while the 88.37% of the patients with high-frequency SNHL have a high-pitched tinnitus (2=66.26;<.005. Conclusion. Hearing status and age represent the principal tinnitus related factors; there is a statistically significant association between high-pitched tinnitus and high-frequency SNHL. There is no significant correlation between tinnitus severity and tinnitus loudness confirming the possibility that neural connection involved in evoking tinnitus-related negative reactions are governed by conditioned reflexes.

  7. Clinical characteristics and risk factors of ocular candidiasis. (United States)

    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.

  8. Clinical characteristics and progression of liver abscess caused by toxocara

    Institute of Scientific and Technical Information of China (English)

    Kyung; Ho; Ha; Jung; Eun; Song; Byung; Seok; Kim; Chang; Hyeong; Lee


    AIM: To evaluate the clinical characteristics and progression of liver abscess caused by toxocara.METHODS: We retrospectively reviewed the medical records of patients with serum Ig G antibody to Toxocara canis and liver abscess diagnosed using abdominal computed tomography between February 2010 and February 2015. Among 84 patients exhibiting serum Ig G antibody to Toxocara canis, 34 patients were diagnosed with liver asbscess and treated with albendazole. A follow-up period of 1 year was conducted. RESULTS: Mean patient age was 53(34-79) years, with 26(76.5%) patients being male. Twenty-one(61.7%) patients were moderate or heavy drinkers, 23(67.6%) patients had a history of eating raw meat or liver and 6(17.6%) patients owned pet dogs or cats. Main patient symptoms consisted of right upper quadrant pain, fever, and fatigue; 18(52.9%) patients, however, presented with no symptoms. Lung involvement was detected in 444(11.7%) patients. The eosinophil count increased in 29(85.3%) patients at initial diagnosis, and decreased in most patients after albendazole treatment. The initial serum Ig E level increased in 25(73.5%) patients, but exhibited various response levels after albendazole treatment. Liver abscess formation improved in all patients.CONCLUSION: The liver abscess was improved with albendazole treatment.

  9. Ensuring on-time quality data management deliverables from global clinical data management teams

    Directory of Open Access Journals (Sweden)

    Zia Haque


    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.

  10. Clinical characteristics of patients with gender identity disorder at a Japanese gender identity disorder clinic. (United States)

    Okabe, Nobuyuki; Sato, Toshiki; Matsumoto, Yosuke; Ido, Yumiko; Terada, Seishi; Kuroda, Shigetoshi


    The aim of this study was to examine the clinical characteristics of patients with gender identity disorder (GID) at a GID clinic in Japan. A total of 603 consecutive patients were evaluated at the GID clinic using clinical information and results of physical and neurological examinations. Using DSM-IV criteria, 579 patients (96.0%) were diagnosed with GID. Four patients were excluded for transvestic fetishism, eight for homosexuality, five for schizophrenia, three for personality disorders, and four for other psychiatric disorders. Among the GID patients, 349 (60.3%) were the female-to-male (FTM) type, and 230 (39.7%) were the male-to-female (MTF) type. Almost all FTM-type GID patients started to feel discomfort with their sex before puberty and were sexually attracted to females. The proportion of FTM patients who had experienced marriage as a female was very low, and very few had children. Therefore, FTM-type GID patients seem to be highly homogeneous. On the other hand, various patterns of age at onset and sexual attraction existed among MTF patients. Among the MTF-type GID patients, 28.3% had married as males and 18.7% had sired children. Thus, MTF-type GID patients seem to be more heterogeneous.

  11. Severe acute pancreatitis: Clinical course and management

    Institute of Scientific and Technical Information of China (English)


    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%.

  12. Do Land Characteristics Affect Farmers’ Soil Fertility Management?

    Institute of Scientific and Technical Information of China (English)

    Tan Shu-hao


    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.


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    Full Text Available Incisional hernia follows operations on the anterolateral abdominal wall. It is a diffuse extrusion of peritoneum and abdominal contents through a weak scar due to the failure of the lines of closure of the abdominal wall following laparotomy. The incidence of incisional hernia varies widely in different series published and is at least 10% as shown in longterm follow-up studies. Clarification regarding the type of mesh and its positioning and operative methods of open surgery and laparoscopic repair needs to be addressed. In addition to surgical closure techniques, patient's risk factors also influence surgical outcome following wound closure. RESULTS Age, gender and risk factors such as diabetes, Hypertension, Anaemia, Obesity, COPD and Type of previous incision contribute to the development of primary and recurrent incisional hernia. Although complete prevention of development of incisional hernia is not possible, repair of hernia by replacement of simple suture technique with that of mesh reinforcement has shown better longterm results and patient satisfaction. CONCLUSION For management of incisional hernia, the available evidence has been favourable for good quality long term results with mesh repair techniques.

  14. Pediatric dyslipidemia: recommendations for clinical management. (United States)

    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.

  15. Hemorrhoids: From basic pathophysiology to clinical management

    Institute of Scientific and Technical Information of China (English)

    Varut Lohsiriwat


    This review discusses the pathophysiology,epidemiology,risk factors,classification,clinical evaluation,and current non-operative and operative treatment of hemorrhoids.Hemorrhoids are defined as the symptomatic enlargement and distal displacement of the normal anal cushions.The most common symptom of hemorrhoids is rectal bleeding associated with bowel movement.The abnormal dilatation and distortion of the vascular channel,together with destructive changes in the supporting connective tissue within the anal cushion,is a paramount finding of hemorrhoids.It appears that the dysregulation of the vascular tone and vascular hyperplasia might play an important role in hemorrhoidal development,and could be a potential target for medical treatment.In most instances,hemorrhoids are treated conservatively,using many methods such as lifestyle modification,fiber supplement,suppositorydelivered anti-inflammatory drugs,and administration of venotonic drugs.Non-operative approaches include sclerotherapy and,preferably,rubber band ligation.An operation is indicated when non-operative approaches have failed or complications have occurred.Several surgical approaches for treating hemorrhoids have been introduced including hemorrhoidectomy and stapled hemorrhoidopexy,but postoperative pain is invariable.Some of the surgical treatments potentially cause appreciable morbidity such as anal stricture and incontinence.The applications and outcomes of each treatment are thoroughly discussed.

  16. Dementia Care: Confronting Myths in Clinical Management. (United States)

    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.

  17. Representing clinical communication knowledge through database management system integration. (United States)

    Khairat, Saif; Craven, Catherine; Gong, Yang


    Clinical communication failures are considered the leading cause of medical errors [1]. 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 [2]. 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.

  18. [Relationship of statistics and data management in clinical trials]. (United States)

    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.

  19. Improving clinical leadership and management in the NHS

    Directory of Open Access Journals (Sweden)

    Nicol ED


    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

  20. The frontline clinical manager identifying direct reports' level of practice. (United States)

    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.

  1. [Clinical trial data management and quality metrics system]. (United States)

    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.

  2. Clinical characteristics of foot ulceration in people with chronic gout. (United States)

    Rome, Keith; Erikson, Kathryn; Otene, Cynthia; Sahid, Hazra; Sangster, Karyn; Gow, Peter


    Gout is the most common form of inflammatory arthritis and it has an affliction to the foot. Foot involvement in gout has been linked to foot pain, impairment and disability. There has been limited research on the effect of ulceration on foot pain, impairment, disability and health-related quality of life in patients already living with gout. The aim of the study was to describe the wound characteristics and the effect on foot pain, disability and health-related quality of life in patients with foot ulceration associated with gout. Participants were recruited from rheumatology clinics in Auckland, New Zealand. All the current foot ulceration sites and wound characteristics were recorded using the TIME wound assessment tool. The outcome measures included general pain, patient global assessment scale, foot pain, disability and impairment. Participants completed the Cardiff Wound Impact Schedule to assess the effect of ulcers on health-related quality of life. Sensory loss, vibrational thresholds and ankle brachial pressure index were collated to assess for lower limb arterial disease. Six participants were predominantly older men with a long duration of gout, high rates of obesity and co-morbidities such as hypertension, hyperlipidaemia, diabetes and cardiovascular disease. The mean (SD) duration of the foot ulcers was 4 (2) months. The majority of foot ulcers observed were 0·5 cm(2) or smaller superficial thickness with surrounding callus. Partial thickness and full-thickness ulcers were also observed. Two patients presented with ulcers on multiple sites. There was only one case of infection. Gouty tophi were evident in most of the wounds. The dorsal aspect of the third toe was found to ulcerate in most cases. Moderate scores of foot pain, disability, impairment and health-related quality of life were observed. Most participants wore shoes deemed as poor. Foot ulceration in gout is chronic and multiple ulcers can occur with the potential of leading to delayed

  3. The application of disease management to clinical trial designs. (United States)

    Puterman, Jared; Alter, David A


    The utilization of disease management (DM) as a minimum standard of care is believed to facilitate pronounced benefits in overall patient outcome and cost management. Randomized clinical trials remain the gold standard evaluative tool in clinical medicine. However, the extent to which contemporary cardiovascular clinical trials incorporate DM components into their treatment or control arms is unknown. Our study is the first to evaluate the extent to which clinical trials incorporate DM as a minimum standard of care for both the intervention and control groups. In total, 386 clinical trials published in 3 leading medical journals between 2003 and 2006 were evaluated. For each study, elements related to DM care, as defined using the American Heart Association Taxonomy, were abstracted and characterized. Our results demonstrate that while the application of DM has increased over time, only 3.4% of the clinical trials examined incorporated all 8 DM elements (and only 11% of such trials incorporated 4 DM elements). A significant association was found between study year and the inclusion of more than 3 elements of DM (chi(2) = 10.10 (3); p = 0.018). In addition, associations were found between study objective and DM criteria, as well as between cohort type and domains described. Our study serves as a baseline reference for the tracking of DM within, and its application to, randomized clinical trials. Moreover, our results underscore the need for broader implementation and evaluation of DM as a minimum care standard within clinical trial research.

  4. Epidemiology and clinical management of tuberculosis in children in Canada


    Shaun K Morris; Demers, Anne-Marie; Lam, Ray; Pell, Lisa G; Giroux, Ryan JP; Kitai, Ian


    Although often regarded as a foreign disease, latent tuberculosis or tuberculosis disease will be encountered in many clinical situations by the Canadian child health practitioner. There are key differences between tuberculosis in children and adults. In the present article, the changing epidemiology of tuberculosis in children in Canada and around the world, the pathogenesis of infection, diagnostic tests, and clinical management of childhood latent tuberculosis and tuberculosis disease are ...

  5. Visual height intolerance and acrophobia: clinical characteristics and comorbidity patterns. (United States)

    Kapfhammer, Hans-Peter; Huppert, Doreen; Grill, Eva; Fitz, Werner; Brandt, Thomas


    The purpose of this study was to estimate the general population lifetime and point prevalence of visual height intolerance and acrophobia, to define their clinical characteristics, and to determine their anxious and depressive comorbidities. A case-control study was conducted within a German population-based cross-sectional telephone survey. A representative sample of 2,012 individuals aged 14 and above was selected. Defined neurological conditions (migraine, Menière's disease, motion sickness), symptom pattern, age of first manifestation, precipitating height stimuli, course of illness, psychosocial impairment, and comorbidity patterns (anxiety conditions, depressive disorders according to DSM-IV-TR) for vHI and acrophobia were assessed. The lifetime prevalence of vHI was 28.5% (women 32.4%, men 24.5%). Initial attacks occurred predominantly (36%) in the second decade. A rapid generalization to other height stimuli and a chronic course of illness with at least moderate impairment were observed. A total of 22.5% of individuals with vHI experienced the intensity of panic attacks. The lifetime prevalence of acrophobia was 6.4% (women 8.6%, men 4.1%), and point prevalence was 2.0% (women 2.8%; men 1.1%). VHI and even more acrophobia were associated with high rates of comorbid anxious and depressive conditions. Migraine was both a significant predictor of later acrophobia and a significant consequence of previous acrophobia. VHI affects nearly a third of the general population; in more than 20% of these persons, vHI occasionally develops into panic attacks and in 6.4%, it escalates to acrophobia. Symptoms and degree of social impairment form a continuum of mild to seriously distressing conditions in susceptible subjects.

  6. Lobular breast cancer: Clinical, molecular and morphological characteristics. (United States)

    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.

  7. Severe acute pancreatitis in the elderly: Etiology and clinical characteristics

    Institute of Scientific and Technical Information of China (English)

    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.

  8. The clinical characteristics of 169 cases of severe fever with thrombocytopenia syndrome

    Institute of Scientific and Technical Information of China (English)



    Objective To analyze the clinical characteristics of severe fever with thrombocytopenia syndrome(SFTS) so as to improve the recognition of the emerging infectious disease. Methods A retrospective analysis was performed upon clinical manifestations,laboratory test results and

  9. Human computer interaction issues in Clinical Trials Management Systems. (United States)

    Starren, Justin B; Payne, Philip R O; Kaufman, David R


    Clinical trials increasingly rely upon web-based Clinical Trials Management Systems (CTMS). As with clinical care systems, Human Computer Interaction (HCI) issues can greatly affect the usefulness of such systems. Evaluation of the user interface of one web-based CTMS revealed a number of potential human-computer interaction problems, in particular, increased workflow complexity associated with a web application delivery model and potential usability problems resulting from the use of ambiguous icons. Because these design features are shared by a large fraction of current CTMS, the implications extend beyond this individual system.

  10. Pediatric Traumatic Brain Injury: Characteristic Features, Diagnosis, and Management (United States)

    ARAKI, Takashi; YOKOTA, Hiroyuki; MORITA, Akio


    Traumatic brain injury (TBI) is the leading cause of death and disability in children. Pediatric TBI is associated with several distinctive characteristics that differ from adults and are attributable to age-related anatomical and physiological differences, pattern of injuries based on the physical ability of the child, and difficulty in neurological evaluation in children. Evidence suggests that children exhibit a specific pathological response to TBI with distinct accompanying neurological symptoms, and considerable efforts have been made to elucidate their pathophysiology. In addition, recent technical advances in diagnostic imaging of pediatric TBI has facilitated accurate diagnosis, appropriate treatment, prevention of complications, and helped predict long-term outcomes. Here a review of recent studies relevant to important issues in pediatric TBI is presented, and recent specific topics are also discussed. This review provides important updates on the pathophysiology, diagnosis, and age-appropriate acute management of pediatric TBI. PMID:28111406

  11. Trial analytics--a tool for clinical trial management. (United States)

    Bose, Anindya; Das, Suman


    Prolonged timelines and large expenses associated with clinical trials have prompted a new focus on improving the operational efficiency of clinical trials by use of Clinical Trial Management Systems (CTMS) in order to improve managerial control in trial conduct. However, current CTMS systems are not able to meet the expectations due to various shortcomings like inability of timely reporting and trend visualization within/beyond an organization. To overcome these shortcomings of CTMS, clinical researchers can apply a business intelligence (BI) framework to create Clinical Research Intelligence (CLRI) for optimization of data collection and analytics. This paper proposes the usage of an innovative and collaborative visualization tool (CTA) as CTMS "add-on" to help overwhelm these deficiencies of traditional CTMS, with suitable examples.

  12. Evolution in clinical knowledge management strategy at Intermountain Healthcare. (United States)

    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.

  13. A Semantic Web-based System for Managing Clinical Archetypes. (United States)

    Fernandez-Breis, Jesualdo Tomas; Menarguez-Tortosa, Marcos; Martinez-Costa, Catalina; Fernandez-Breis, Eneko; Herrero-Sempere, Jose; Moner, David; Sanchez, Jesus; Valencia-Garcia, Rafael; Robles, Montserrat


    Archetypes facilitate the sharing of clinical knowledge and therefore are a basic tool for achieving interoperability between healthcare information systems. In this paper, a Semantic Web System for Managing Archetypes is presented. This system allows for the semantic annotation of archetypes, as well for performing semantic searches. The current system is capable of working with both ISO13606 and OpenEHR archetypes.

  14. Clinical outcomes of surgical management of anterior bilateral mandibular fractures

    NARCIS (Netherlands)

    Boffano, P.; Gallesio, C.; Roccia, F.; van den Bergh, B.; Forouzanfar, T.


    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

  15. Molar incisor hypomineralisation: clinical management of the young patient.

    LENUS (Irish Health Repository)

    Daly, Dympna


    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.


    Directory of Open Access Journals (Sweden)

    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.

  17. Clinical information systems: cornerstone for an efficient hospital management. (United States)

    Lovis, Christian


    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.

  18. Clinical Management of Two Root Resorption Cases in Endodontic Practice

    Directory of Open Access Journals (Sweden)

    Jozef Mincik


    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.

  19. Geothermal Produced Fluids: Characteristics, Treatment Technologies, and Management Options

    Energy Technology Data Exchange (ETDEWEB)

    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

  20. Thrombosis in vasculitic disorders-clinical manifestations, pathogenesis and management. (United States)

    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.

  1. Clinical guidelines for the management of craniofacial fibrous dysplasia

    Directory of Open Access Journals (Sweden)

    Lee JS


    Full Text Available Abstract Fibrous dysplasia (FD is a non-malignant condition caused by post-zygotic, activating mutations of the GNAS gene that results in inhibition of the differentiation and proliferation of bone-forming stromal cells and leads to the replacement of normal bone and marrow by fibrous tissue and woven bone. The phenotype is variable and may be isolated to a single skeletal site or multiple sites and sometimes is associated with extraskeletal manifestations in the skin and/or endocrine organs (McCune-Albright syndrome. The clinical behavior and progression of FD may also vary, thereby making the management of this condition difficult with few established clinical guidelines. This paper provides a clinically-focused comprehensive description of craniofacial FD, its natural progression, the components of the diagnostic evaluation and the multi-disciplinary management, and considerations for future research.

  2. Genital ulcers in women: clinical, microbiologic and histopathologic characteristics. (United States)

    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

  3. Genital ulcers in women: clinical, microbiologic and histopathologic characteristics

    Directory of Open Access Journals (Sweden)

    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

  4. Pathologists' roles in clinical utilization management. A financing model for managed care. (United States)

    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.

  5. Clinical characteristics of 42 patients with cardiac amyloidosis

    Institute of Scientific and Technical Information of China (English)



    Objective To characterize the clinical features of patients with cardiac amyloidosis(CA).Methods Totally42 patients with CA admitted to Guangdong General Hospital since 2008 were included and retrospectively analyzed in the present study.CA was confirmed by abdomen and endocardium biopsy examination.Clinical manifestations,electrocardiogram and echocardiography were collected for the evaluation.Results Several clinic features are common in CA.In the present study,37 cases

  6. Pars planitis: Epidemiology, clinical characteristics, management and visual prognosis

    Directory of Open Access Journals (Sweden)

    Pinar Cakar Ozdal


    Full Text Available 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.

  7. Managing mood disorders in patients attending pulmonary rehabilitation clinics

    Directory of Open Access Journals (Sweden)

    Selvarajah S


    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

  8. Clinical characteristics,prognosis and indicators of glucose metabolism of liver cirrhosis complicated with diabetes

    Institute of Scientific and Technical Information of China (English)



    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-

  9. Trigeminal neuralgia--a prospective systematic study of clinical characteristics in 158 patients

    DEFF Research Database (Denmark)

    Maarbjerg, Stine; Gozalov, Aydin; Olesen, Jes


    OBJECTIVE: To prospectively describe the clinical characteristics of classical trigeminal neuralgia (TN) in a standardized manner. BACKGROUND: TN is a rare disease and most clinicians only see a few patients. There is a lack of prospective systematic studies of the clinical characteristics of TN...

  10. Clinical management of negative symptoms of schizophrenia: An update. (United States)

    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 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.

  11. Clinical management of alcohol withdrawal: A systematic review

    Directory of Open Access Journals (Sweden)

    Shivanand Kattimani


    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.

  12. CliniProteus: A flexible clinical trials information management system (United States)

    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 PMID:21670796

  13. Utilization of lean management principles in the ambulatory clinic setting. (United States)

    Casey, Jessica T; Brinton, Thomas S; Gonzalez, Chris M


    The principles of 'lean management' have permeated many sectors of today's business world, secondary to the success of the Toyota Production System. This management method enables workers to eliminate mistakes, reduce delays, lower costs, and improve the overall quality of the product or service they deliver. These lean management principles can be applied to health care. Their implementation within the ambulatory care setting is predicated on the continuous identification and elimination of waste within the process. The key concepts of flow time, inventory and throughput are utilized to improve the flow of patients through the clinic, and to identify points that slow this process -- so-called bottlenecks. Nonessential activities are shifted away from bottlenecks (i.e. the physician), and extra work capacity is generated from existing resources, rather than being added. The additional work capacity facilitates a more efficient response to variability, which in turn results in cost savings, more time for the physician to interact with patients, and faster completion of patient visits. Finally, application of the lean management principle of 'just-in-time' management can eliminate excess clinic inventory, better synchronize office supply with patient demand, and reduce costs.

  14. Chronic pelvic ischemia: etiology, pathogenesis, clinical presentation and management. (United States)

    Kapoor, H; Gupta, E; Sood, A


    Overactive bladder (OAB) and bladder pain syndrome (BPS) although common, are vaguely defined and difficult to diagnose and manage etiologies of storage-type lower urinary tract symptoms (LUTS). The lack of optimal management options is a direct consequence of deficient understanding of the pathophysiologic mechanisms underlying these conditions. These conditions are especially prevalent in females, and cumulative contemporary epidemiological, clinical and laboratory evidence implicates ischemia as one of the key players in the pathophysiologic foundation of both these disorders. Taken together they make up "the" diagnostic as well as therapeutic black-hole in urologic practice. Much akin to chronic ischemic heart disease, chronic ischemia-reperfusion has been shown to cause degenerative changes at cellular and subcellular level in the bladder mucosa, smooth muscle fibers, and vesical neural and microvascular structures leading to a hypersensitive, hyperactive bladder initially, which with time invariably progresses into a failed, fibrotic and pressurized bladder. Diagnosis and management of these diseases are currently symptom focused and remains a source of much frustration. Consideration of role of ischemia connotates hope and could lead to a paradigm shift in the management of these patients with a completely new therapeutic armamentarium attacking the pathology itself. The aim of the current review is to provide a clinical thought perspective on the etiology/pathophysiology of chronic pelvic ischemia and its role as a precursor to the aforementioned conditions, and shed some light upon the potential management strategies to consider.

  15. Case reports and clinical guidelines for managing radix entomolaris (United States)

    Thomas, Bejoy J.; Nishad, A.; Paulaian, Benin; Sam, Jonathan Emil


    Knowledge about the external and internal anatomy of the tooth is essential for successful dental practice. Anomalies in the tooth are often encountered which poses difficulties in dental treatments. As like any other tooth, mandibular first molars are also prone for anatomic malformations. One such anatomic variation is the presence of extra root distolingually. This distolingual root is called radix entomolaris (RE). The presence of an additional root can lead to difficulties during endodontic therapy. This article is a report of two cases describing the management of the first mandibular molars with an RE and clinical guidelines for its management. PMID:27829770

  16. Clinical Characteristics of the Causes of Plantar Heel Pain


    Yi, Tae Im; Lee, Ga Eun; Seo, In Seok; Huh, Won Seok; Yoon, Tae Hee; Kim, Bo Ra


    Objective The objectives of this study were to investigate the causes of plantar heel pain and find differences in the clinical features of plantar fasciitis (PF) and fat pad atrophy (FPA), which are common causes of plantar heel pain, for use in differential diagnosis. Method This retrospective study analyzed the medical records of 250 patients with plantar heel pain at the Foot Clinic of Rehabilitation Medicine at Bundang Jesaeng General Hospital from January to September, 2008. Results The...

  17. Clinical guidelines in the management of prosthetic joint infection. (United States)

    Minassian, Angela M; Osmon, Douglas R; Berendt, Anthony R


    Clinical practice guidelines for the diagnosis and management of prosthetic joint infection have been produced by a range of organizations. Guidelines stress the importance of multi-disciplinary working and of adopting a methodical approach. This includes careful assessment of the patient's surgical, medical and psychosocial problems, rational investigation, a decision-making framework for surgery and targeted, sometimes prolonged, use of intravenous or highly bioavailable oral antibiotics. Despite limited high-quality evidence, adoption of clinical guidelines can improve practice by reducing variation and by establishing conditions for the subsequent conduct of multicentre studies or systematic reviews.

  18. Requiring case management meetings to be conducted outside the clinic. (United States)

    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.

  19. Analysis of clinical characteristics of 950 cases of cervical cancer

    Directory of Open Access Journals (Sweden)

    Shu-li ZHU


    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

  20. Clinical Characteristics of patients with Diabetes Mellitus 2 of Family Health Center Chiguay.

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    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.

  1. Clinical Characteristics of Bowel Obstruction in Southern Iran; Results of a Single Center Experience

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    Majid Akrami


    Full Text Available Objective: To determine the epidemiological, clinical, laboratory characteristics as well as outcome of 411 patients with bowel obstruction in Southern Iran. Methods: This was a cross-sectional study being performed in Shahid Faghihi hospital of Shiraz between 2006 and 2012. We reviewed the medical charts of the 411 patients with initial diagnosis of bowel obstruction who were admitted to our center during the study period. The patients’ demographic, clinical and laboratory findings as well as their management and outcome was recorded in data gathering forms. The data were then analyzed according to the outcome and clinical characteristics. Results: Among the 411 patients with initial diagnosis of bowel obstruction, 253 (61.5% were men and 158 (38.5% were women. The mean age of the patients was 48.2±19.7 years. Besides, 73.6% were observed and 26.4% were operated. Those who were operated had those who underwent operation had significantly lower frequency of obstipation (28.1% vs. 71.9%; p=0.045 and abdominal distention (32.3% vs. 67.7%; p=0.007. Intraoperative findings included adhesion band formation in 50 (48.1%, mass 18 (17.3%, and hernia 7 (6.7%. We found that the frequency of malignancy was significantly higher in those who were managed conservatively compared to those undergoing operation (64.3% vs. 35.7%; p=0.042. The mean hospital stay was significantly higher in those who underwent operation (8.1±7.5 vs. 2.6±2.2 days; p=0.035. Conclusion: The results of this study demonstrates although some signs and symptoms, such as abdominal pain, vomiting, abdominal tenderness, abdominal distention, and obstipation, were more common among the patients with bowel obstruction, they were not sensitive and specific enough for definite diagnosis. Due to the lack of positive predictive value of clinical signs and symptoms in diagnosis of bowel obstruction, a reasonable and logical modality is needed for bowel obstruction diagnosis with better

  2. Clinical Decision Support Knowledge Management: Strategies for Success. (United States)

    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.

  3. Glucose: archetypal biomarker in diabetes diagnosis, clinical management and research. (United States)

    Krentz, Andrew J; Hompesch, Marcus


    The clinical utility of diabetes biomarkers can be considered in terms of diagnosis, management and prediction of long-term vascular complications. Glucose satisfies all of these requirements. Thresholds of hyperglycemia diagnostic of diabetes reflect inflections that confer a risk of developing long-term microvascular complications. Degrees of hyperglycemia (impaired fasting glucose, impaired glucose tolerance) that lie below the diagnostic threshold for diabetes identify individuals at risk of progression to diabetes and/or development of atherothrombotic cardiovascular disease. Self-measured glucose levels usefully complement hemoglobin A1c levels to guide daily management decisions. Continuous glucose monitoring provides detailed real-time data that is of value in clinical decision making, assessing response to new diabetes drugs and the development of closed-loop artificial pancreas technology.

  4. Gluteal Tendinopathy: Integrating Pathomechanics and Clinical Features in Its Management. (United States)

    Grimaldi, Alison; Fearon, Angela


    Synopsis Gluteal tendinopathy is now believed to be the primary local source of lateral hip pain, or greater trochanteric pain syndrome, previously referred to as trochanteric bursitis. This condition is prevalent, particularly among postmenopausal women, and has a considerable negative influence on quality of life. Improved prognosis and outcomes in the future for those with gluteal tendinopathy will be underpinned by advances in diagnostic testing, a clearer understanding of risk factors and comorbidities, and evidence-based management programs. High-quality studies that meet these requirements are still lacking. This clinical commentary provides direction to assist the clinician with assessment and management of the patient with gluteal tendinopathy, based on currently limited available evidence on this condition and the wider tendon literature and on the combined clinical experience of the authors. J Orthop Sports Phys Ther 2015;45(11):910-922. Epub 17 Sep 2015. doi:10.2519/jospt.2015.5829.

  5. Immunological Landscape and Clinical Management of Rectal Cancer

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    Elísabeth ePérez-Ruiz


    Full Text Available The clinical management of rectal cancer and colon cancer differs due to increased local relapses in rectal cancer. However, the current molecular classification does not differentiate rectal cancer and colon cancer as two different entities. In recent years, the impact of the specific immune microenvironment in cancer has attracted renewed interest, and is currently recognized as one of the major determinants of clinical progression in a wide range of tumors. In colorectal cancer, the density of lymphocytic infiltration is associated with better overall survival. Due to the need for biomarkers of response to conventional treatment with chemoradiotherapy in rectal tumors, the immune status of rectal cancer emerges as a useful tool to improve the management of patients.

  6. Current clinical management strategies for benign prostatic hyperplasia

    Institute of Scientific and Technical Information of China (English)

    ZHANG Xiang-hua


    @@ 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.

  7. Clinical governance--bridging management and clinical approaches to quality in the UK. (United States)

    Freedman, Danielle B


    Clinical governance has, for the first time, placed the quality of healthcare as a direct responsibility of the Chief Executive and therefore the board of all NHS Trusts (Hospital), community providers and primary care trusts (general practitioners). The foundation for clinical governance was set out in the Department of Health Publication 'A first class service-quality in the new NHS' [Department Of Health, A First Class Service: Quality in the New NHS, London, HMSO, 1998]. Much of this had been precipitated by the Bristol cardiac surgery case and other series of medical disasters in the UK relating to cervical screening, breast screening, psychiatric care and pathological misdiagnoses. This new responsibility of clinical governance involves guaranteeing quality through a number of processes, many of which are currently in use and should be familiar to any clinician or manager. They include clinical effectiveness and optimisation of clinical care, clinical risk management, learning from complaints, professional development, good quality clinical data systems and involvement of patients and carers. This duty is equal to the other statutory responsibilities of NHS organisations, which are of financial probity, accountability and ensuring value for public money on behalf of the taxpayer.

  8. Assessing biocomputational modelling in transforming clinical guidelines for osteoporosis management. (United States)

    Thiel, Rainer; Viceconti, Marco; Stroetmann, Karl


    Biocomputational modelling as developed by the European Virtual Physiological Human (VPH) Initiative is the area of ICT most likely to revolutionise in the longer term the practice of medicine. Using the example of osteoporosis management, a socio-economic assessment framework is presented that captures how the transformation of clinical guidelines through VPH models can be evaluated. Applied to the Osteoporotic Virtual Physiological Human Project, a consequent benefit-cost analysis delivers promising results, both methodologically and substantially.

  9. Bipolar affective disorder and creativity: implications and clinical management. (United States)

    Andreasen, N C; Glick, I D


    Research on the relationship between creativity and mental illness is summarized, and studies documenting a relationship in writers between creativity and affective illness (particularly bipolar illness) are described. Writers have a high prevalence of affective illness, and both affective illness and creativity have increased frequency in their first-degree relatives. The clinical management of the creative individual is challenging. In general, creative individuals are most productive when their affective symptoms are under good control.

  10. Management of sepsis: from evidence to clinical practice

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    Riccardo Gerloni


    Full Text Available Sepsis is one of the leading causes of death in hospitalized patients and its management involves a lot of specialist. Internist is required to demonstrate his competence since the beginning when the diagnosis is not so easy to be clarified. A rapid clinical suspicion permits a prompt management of the patient that means important mortality reduction. However, it is essential to understand the source of infection and echography represents a rapid, economic, useful and widespread tool with whom Internist should become more and more confident. The following review is a practical guide to manage septic patients according to the most recent literature, underlining aspects of antibiotic therapy, hemodynamic stabilization and supportive therapy. To limit sepsis mortality, a valid Internist should be culturally prepared and especially able to cooperate with other specialists, because a strong enemy requires a strong team.

  11. Clinical applications of magnets on cardiac rhythm management devices. (United States)

    Jacob, Sony; Panaich, Sidakpal S; Maheshwari, Rahul; Haddad, John W; Padanilam, Benzy J; John, Sinoj K


    The growing indications for permanent pacemaker and implantable cardioverter defibrillator (ICD) implantation have increased the number of patients with these cardiac rhythm management devices (CRMDs). Cardiac rhythm management devices occasionally perform inappropriately in response to electromagnetic interference (e.g. surgical electrocautery) or lead noise over-sensing (e.g. lead fracture). Temporary reprogramming of the CRMDs using device programmers can prevent these untoward device responses. However, these programmers are device manufacturer specific and require technically qualified personnel to operate. This could cause delayed patient care and increased use of resources in certain clinical situations. Alternatively, clinical magnets, when appropriately positioned over the device site, can change the pacing to an asynchronous mode in pacemakers and suspend tachycardia therapies in ICDs. Although readily available, clinical magnets have not been widely used for this purpose, perhaps due to the unfamiliarity with the variable responses of CRMDs to magnet application. This article provides a comprehensive overview of the current literature on the mechanism of action and the specific responses of various CRMDs to clinical magnets.

  12. Clinical utility of ivabradine in cardiovascular disease management: current status

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    Rosano GMC


    Full Text Available Giuseppe MC Rosano,1,2 Cristiana Vitale,1,2 Ilaria Spoletini,1 Maurizio Volterrani11Department of Medical Sciences, IRCCS San Raffaele Pisana, Rome, Italy; 2Cardiovascular and Cell Sciences Research Institute, St George's University of London, London, UK Abstract: Ivabradine is a selective antagonist of the funny channels with anti-anginal and anti-ischemic properties, approved for the treatment of coronary artery disease (CAD and heart failure (HF. It provides pure heart rate reduction, reducing the diastolic depolarization slope, without altering hemodynamic parameters. This review summarizes the current knowledge on the efficacy of ivabradine in patients with cardiovascular diseases, with a particular focus on its role in the clinical management of patients with CAD and HF. There is consistent evidence that ivabradine is effective in reducing angina pectoris symptoms and myocardial ischemia. At approved doses ivabradine is safe, improves exercise tolerance, and reduces heart rate. Available data from clinical trials support its use in the management of patients with stable CAD and chronic HF. Recent studies have cast doubt on the safety of non-approved high doses of ivabradine for the treatment of patients with CAD and without clinical HF, but have shown no concerns on the doses approved for clinical use. Keywords: ivabradine, coronary artery disease, heart failure, angina pectoris, exercise performance

  13. Pulmonary contusion: an update on recent advances in clinical management. (United States)

    Cohn, Stephen M; Dubose, Joseph J


    Pulmonary contusion is a common finding after blunt chest trauma. The physiologic consequences of alveolar hemorrhage and pulmonary parenchymal destruction typically manifest themselves within hours of injury and usually resolve within approximately 7 days. Clinical symptoms, including respiratory distress with hypoxemia and hypercarbia, peak at about 72 h after injury. The timely diagnosis of pulmonary contusion requires a high degree of clinical suspicion when a patient presents with trauma caused by an appropriate mechanism of injury. The clinical diagnosis of acute parenchymal lung injury is usually confirmed by thoracic computed tomography, which is both highly sensitive in identifying pulmonary contusion and highly predictive of the need for subsequent mechanical ventilation. Management of pulmonary contusion is primarily supportive. Associated complications such as pneumonia, acute respiratory distress syndrome, and long-term pulmonary disability, however, are frequent sequelae of these injuries.

  14. Clinical characteristics, diagnostic evaluation, and antibiotic prescribing patterns for skin infections in nursing homes

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    Norihiro Yogo


    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.

  15. Comparing School and Clinical Psychology Internship Applicant Characteristics (United States)

    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,…

  16. Clinical characteristics and outcome of intracerebral hemorrhage in young adults

    NARCIS (Netherlands)

    Rutten-Jacobs, L.C.A.; Maaijwee, N.A.M.M.; Arntz, R.M.; Schoonderwaldt, H.C.; Dorresteijn, L.D.A.; Dijk, E.J. van; Leeuw, F.E. de


    Data on determinants of prognosis after intracerebral hemorrhage (ICH) in young adults are scarce. Our aim was to identify clinical determinants of prognosis after ICH in adults aged 18-50. We investigated 98 consecutive patients with an ICH, aged 18-50 years, admitted to our hospital between 1980 a

  17. Hemifacial spasm: clinical characteristics of 321 Indian patients. (United States)

    Batla, Amit; Goyal, Chanchal; Shukla, Garima; Goyal, Vinay; Srivastava, Achal; Behari, Madhuri


    Hemifacial spasm (HFS) is a common neurological disorder characterized by involuntary tonic and clonic contractions of the muscles innervated by the facial nerve. We aimed to describe clinical features, common antecedents, triggers and relieving factors in patients with hemifacial spasm to study the correlation of hypertension and HFS, and to compare clinical features of primary and secondary cases of HFS. The data for the study were collected prospectively on a predesigned and pre-tested format at the first attendance in all consecutive HFS patients attending the movement disorders clinic of a tertiary teaching hospital in India. The demographic profile, HFS symptoms, antecedent illnesses and neurological examination were recorded and analyzed. Muscle power in individual muscles innervated by the facial nerve was tested carefully before botulinum toxin injection. Hemifacial spasm occurred in 7.14% (n = 582) of 8,151 cases registered at the movement disorders clinic from 1993 to 2010. Data of 321 patients were complete and were included in the study. Females constituted 49.22% (n = 158). The mean age the patients was 46.02 ± 11.82 years; ipsilateral ear clicking was observed in 22.74% cases. The most common aggravating factor was stress (44.86%), while the most common relieving factor was sleep (44.24%). Two hundred fifty-two patients (78.5%) had primary HFS. The severity of spasm correlated significantly with disease duration (p muscles (p < 0.001). We did not observe any correlation between HFS on the left side and hypertension, as has been reported earlier. This is one of the largest studies of HFS patients and the only one that prospectively assesses patients with HFS clinically on their first visit. Interesting observations of this study are lack of female preponderance, presence of clicking in the ipsilateral ear and facial weakness even prior to botulinum toxin injection.

  18. Trichomonas vaginalis: Diagnosis and Clinical Characteristics in Pregnancy


    R. Phillip Heine; James A. McGregor; Elisa Patterson; Deborah Draper; Janice French; Ward Jones


    Objective: The objectives of this study were to 1) determine the prevalance and characterize the symptomatology of Trichomonas vaginalis (TV) infection in pregnant women on entry into prenatal care in an inner-city population; 2) compare conventional microscopic methods vs. culture techniques in diagnosing TV in both symptomatic and asymptomatic pregnant patients; and 3) correlate wet mount microscopic and microbiologic characteristics of varying manifestations of trichomoniasis. Methods: One...

  19. Development of Quality Management Systems for Clinical Practice Guidelines in Korea. (United States)

    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.

  20. Preconception Counseling and Care in the Setting of HIV: Clinical Characteristics and Comorbidities

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    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.

  1. Abnormal echocardiography in patients with type 2 diabetes and relation to symptoms and clinical characteristics

    DEFF Research Database (Denmark)

    Jørgensen, Peter Godsk; Jensen, Magnus T; Mogelvang, Rasmus;


    OBJECTIVES: We aimed to determine the prevalence of echocardiographic abnormalities and their relation to clinical characteristics and cardiac symptoms in a large, contemporary cohort of patients with type 2 diabetes. RESULTS: A total of 1030 patients with type 2 diabetes participated...... with abnormal echocardiography along with dyspnoea and characteristic chest pain (p characteristics had sufficient sensitivity and specificity to accurately identify patients with abnormal echocardiography. CONCLUSION: Echocardiographic abnormalities...... are very common in outpatients with type 2 diabetes, but neither cardiac symptoms nor clinical characteristics are effective to identify patients with echocardiographic abnormalities....

  2. The clinical characteristics and MRI findings of acquired hepatocerebral degeneration

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    Xiao-yu DONG


    Full Text Available Acquired hepatocerebral degeneration (AHD is a rare chronic encephalopathy, and its etiology is usually correlated with cirrhosis and portal hypertension. In this study, clinical and radiological data of 326 patients with cirrhosis of the liver were retrospectively analyzed, among whom 11 patients were diagnosed as AHD, with the incidence of 3.37% . The most common neurological symptoms were static tremor (9 cases and ataxia (7 cases. Cerebral MRI showed T1WI hyperintensity in bilateral globus pallidus of all 11 patients. The lesions were also involved in bilateral thalamus (one case, tegment of midbrain (one case, bilateral posterior crus of internal capsule (one case and bilateral putamen (one case. Anti-Parkinson's disease drugs, such as levodopa and benserazide, had not presented satisfactory clinical effect. DOI: 10.3969/j.issn.1672-6731.2015.02.014

  3. [Minimal hepatic encephalopathy: characteristics, diagnosis and clinical implications]. (United States)

    Torre Delgadillo, Aldo; Guerrero-Hernández, Ignacio; Uribe, Misael


    The term minimal hepatic encephalopathy (MHE) refers to the subtle changes in cognitive function, electrophysiological parameters, cerebral neurochemical/neurotransmitter homeostasis, cerebral blood flow, metabolism, and fluid homeostasis that can be observed in patients with cirrhosis who have no clinical evidence of hepatic encephalopathy; the prevalence is as high as 84% in patients with hepatic cirrhosis. This cirrhosis complication is generally not perceived by physician, and diagnosis can only be made by neuropsychological tests and other especial measurements like evoked potentials and image studies like positron emission tomography. Diagnosis of minimal hepatic encephalopathy may have prognostic and therapeutic implications in cirrhotic patients. The present review pretends to explore the clinic, therapeutic, diagnosis and prognostic aspects of this complication.


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    M. Ghabace


    Full Text Available Chronic acquired demyelinating neuropathy (CADP is heterogeneous ill both clinical and laboratory features. This study was performed to define the clinical. clccuodiagnostic and histological findings. course and response 10 therapy in patients with CADI'. Thirty patients (20 men and 10 women with CADI' were studied. Diagnostic criteria were based on clinical presentation. clcctrophysiolcgical studies. cerebrospinal fluid (CSF protein level and sural nerve biopsy findings. Response 10 treatment was assessed by changes in average muscle score (A:vlS. Twenty-one patients conformed to the diagnostic criteria of chronic inflammatory demyelinating polyneuropathy (Cf Dl" and 9 to distal acquired demyelinating symmetric neuropathy (DADS. The course was monophasic in Cl (23~/~-, relapsing in I0 (40(~/;1 and chronic progressive in 8 (30':••;,: 4( 13°•'( had ucutc presentation with subsequent progression or relapsing course. Motor nerve conduction velocity (i"--INCV of less than 70°,-( and greater than 70'~;(, of normal were seen in 18 (60'~'; and 12 (40{~-;1 patients. respectively. Conduction block was observed in 14 (47(~/o and CSF protein levels WCl"C elevaled in 19 patients (66':--;. Demyelination was reported in 61(;--( and 58% of the biopsies performed in patients with MNCV <: 70'~";l and> 70'}'( of normal. respectively. The association between "•lNCV and histologic findings was no! significant. Twenty-one patients were treated with intravenous immunoglobulin (lVlg. Fifteen patients  83(;-{1 with ClDP had significant improvement in AfvlS following the iuitial fVlg treatment (P n.ol. This study highlights the heterogeneity of clinical and laboratory findings in C:"IP and the importance of early treatment.

  5. Clinical characteristics of pulmonary embolism with concomitant pneumonia. (United States)

    Cha, Seung-Ick; Choi, Keum-Ju; Shin, Kyung-Min; Lim, Jae-Kwang; Yoo, Seung-Soo; Lee, Jaehee; Lee, Shin-Yup; Kim, Chang-Ho; Park, Jae-Yong


    Although pneumonia is associated with an increased risk of venous thromboembolism, patients with pulmonary embolism and concomitant pneumonia are uncommon. The aim of the present study was to investigate the clinical features of pulmonary embolism with coexisting pneumonia. We retrospectively compared clinical, radiologic and laboratory parameters between patients with pulmonary embolism and concomitant pneumonia (pneumonia group) and those with unprovoked pulmonary embolism (unprovoked group), and then between the pneumonia group and those with pulmonary infarction (infarction group). Of 794 patients with pulmonary embolism, 36 (5%) had coexisting pneumonia and six (1%) had no provoking factor other than pneumonia. Stroke was significantly more common in the pneumonia group, than either the unprovoked group or the infarction group. In the pneumonia group, fever was significantly more common and serum C-reactive protein levels were significantly higher. By contrast, central pulmonary embolism and right ventricular dilation on computed tomography were significantly less frequent in the pneumonia group. In addition, an adverse outcome due to pulmonary embolism was less common in the pneumonia group than in either of the other two groups. The coexistence of pulmonary embolism and pneumonia is rarely encountered in clinical practice, especially without the presence of other factors that could provoke venous thromboembolism and is commonly associated with stroke. It is characterized by lower incidences of central pulmonary embolism and right ventricular dilation and by a lower rate of adverse outcomes due to pulmonary embolism itself.

  6. Clinical characteristics and presence of prolactinoma in women with hyperprolactinemia

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    López-Clavijo, Carlos Alberto


    Full Text Available Objectives: To clinically characterize women with hyperprolactinemia at InSer Pereira (Colombia and to determine the prevalence of prolactinoma. Methods: Retrospective description of 45 patients with hyperprolactinemia, and contrasted pituitary magnetic resonance (MR, between January 2008 and July 2013. Clinical manifestations, etiology, serum prolactin level, and MR findings were included. Results: The most frequent clinical manifestations were: infertility, galactorrhea, oligomenorrhea. There were 26 cases of prolactinoma (57.8 %, and 12 of idiopathic hyperprolactinemia (26.6 %. Out of the 26 prolactinomas, 23 were microadenomas (average size 5.1 mm; SD ± 3.2 mm. Average serum prolactin level was 74.05 ng/mL (SD ± 13.33 ng/mL. 78 % of patients with prolactinoma had serum prolactin level under 70.0 ng/mL. No significant association was found between serum prolactin level and the presence of prolactinoma. Conclusion: Prolactinomas are the main cause of hyperprolactinemia and they are found mostly with slight rise of serum prolactin. Pituitary MRI is recommended in patients with hyperprolactinemia, regardless of their prolactin level.

  7. Paranasal sinuses malignancies: A 12-year review of clinical characteristics (United States)

    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

  8. [Zhu Lian's characteristics and experiences in clinical practice of acupuncture and moxibustion]. (United States)

    Wei, Li fu; Pan, Xiaoria; Liu, Bing; Yue, Jin; Zhang, Lijian


    This paper aims at discussing the clinical characteristics and experiences of ZHU Lian, the renowned contemporary acupuncture master from the following three aspects: "characteristics of clinical manipulations and techniques", "thoughts on diagnosis and treatment" and "examples of clinical cases". The study has shown that ZHU Lian invented the slow insertion technique by rotating needle and the embedding needle technique, improved moxibustion technique with moxa roll and proposed the three keys on the treatment with acupuncture and moxibustion, as well as discovered new acupoints for treatment. The pioneering and distinguished achievements she con tributed play the great demonstrating and driving role in the development of clinical study and practice of acupuncture and moxibustion.

  9. Clinical and Molecular Characteristics of Non-Transfusion-Dependent Thalassemia in Kuwait. (United States)

    Adekile, Adekunle D; Azab, Asma F; Al-Sharida, Sondus I; Al-Nafisi, Bahia A; Akbulut, Nagihan; Marouf, Rajaa A; Mustafa, Nada Y


    Although not regularly transfused, patients with non-transfusion-dependent thalassemia (NTDT) are prone to iron overload and its complications. Their molecular, phenotypical and laboratory characteristics vary in different populations and there is a need to document local prevailing patterns. We have reviewed the records of our patients with NTDT in Kuwait and documented their clinical and molecular characteristics in addition to iron status [serum ferritin and liver magnetic resonance imaging (MRI) T2*], management and complications. There were 41 patients, made up of 20 with β-thalassemia intermedia (β-TI), 18 with Hb H (β4) disease and three with Hb E (HBB: c.79G > A)-β-thalassemia (Hb E-β-thal); their ages ranged from 3 to 36 years (mean 12.5 ± 7.7). While 18 (43.9%) had been transfused at least once, only three (7.3%) had been transfused on multiple occasions. Three patients had serum ferritin >500 ng/mL; while four of 38 had mild or moderate liver iron overload. Seven (35.0%) of the β-TI patients were managed with hydroxyurea (HU) with good response. Other complications included five patients with gallstones and one each of hypothyroidism and moyamoya. The most common mutations among the β-TI patients were IVS-II-1 (G > A) and IVS-I-6 (T > C), while among the Hb H patients, the Saudi α2-globin gene polyadenylation (polyA) (AATAAA > AATAAG) mutation was responsible for all cases either as homozygotes (61.1%) or compound heterozygotes with the α-thal-2 (-α(3.7)) allele (33.3%). Although the pattern of NTDT in Kuwaiti patients is generally mild, there is a need to follow them to adulthood as the complications are cumulative and more prevalent in this group.

  10. Clinical Assessment of Risk Management: an INtegrated Approach (CARMINA). (United States)

    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.

  11. Salivary Secretory Disorders, Inducing Drugs, and Clinical Management (United States)

    Miranda-Rius, Jaume; Brunet-Llobet, Lluís; Lahor-Soler, Eduard; Farré, Magí


    Background: Salivary secretory disorders can be the result of a wide range of factors. Their prevalence and negative effects on the patient's quality of life oblige the clinician to confront the issue. Aim: To review the salivary secretory disorders, inducing drugs and their clinical management. Methods: In this article, a literature search of these dysfunctions was conducted with the assistance of a research librarian in the MEDLINE/PubMed Database. Results: Xerostomia, or dry mouth syndrome, can be caused by medication, systemic diseases such as Sjögren's Syndrome, glandular pathologies, and radiotherapy of the head and neck. Treatment of dry mouth is aimed at both minimizing its symptoms and preventing oral complications with the employment of sialogogues and topical acting substances. Sialorrhea and drooling, are mainly due to medication or neurological systemic disease. There are various therapeutic, pharmacologic, and surgical alternatives for its management. The pharmacology of most of the substances employed for the treatment of salivary disorders is well-known. Nevertheless, in some cases a significant improvement in salivary function has not been observed after their administration. Conclusion: At present, there are numerous frequently prescribed drugs whose unwanted effects include some kind of salivary disorder. In addition, the differing pathologic mechanisms, and the great variety of existing treatments hinder the clinical management of these patients. The authors have designed an algorithm to facilitate the decision making process when physicians, oral surgeons, or dentists face these salivary dysfunctions. PMID:26516310

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

    DEFF Research Database (Denmark)

    Smed, Marie; Getz, Kenneth A.


    Investigative sites participating in clinical trials play an instrumental role in aiding market adoption. Site experiences in clinical research help physician investigators and research professionals gain familiarity with and exposure to investigational treatments. This knowledge may be passed on...

  13. Clinical disease presentation and ECG characteristics of LMNA mutation carriers (United States)

    Ollila, Laura; Nikus, Kjell; Holmström, Miia; Jalanko, Mikko; Jurkko, Raija; Kaartinen, Maija; Koskenvuo, Juha; Kuusisto, Johanna; Kärkkäinen, Satu; Palojoki, Eeva; Reissell, Eeva; Piirilä, Päivi; Heliö, Tiina


    Objective Mutations in the LMNA gene encoding lamins A and C of the nuclear lamina are a frequent cause of cardiomyopathy accounting for 5–8% of familial dilated cardiomyopathy (DCM). Our aim was to study disease onset, presentation and progression among LMNA mutation carriers. Methods Clinical follow-up data from 27 LMNA mutation carriers and 78 patients with idiopathic DCM without an LMNA mutation were collected. In addition, ECG data were collected and analysed systematically from 20 healthy controls. Results Kaplan-Meier analysis revealed no difference in event-free survival (death, heart transplant, resuscitation and appropriate implantable cardioverter-defibrillator therapy included as events) between LMNA mutation carriers and DCM controls (p=0.5). LMNA mutation carriers presented with atrial fibrillation at a younger age than the DCM controls (47 vs 57 years, p=0.003). Male LMNA mutation carriers presented with clinical manifestations roughly a decade earlier than females. In close follow-up non-sustained ventricular tachycardia was detected in 78% of LMNA mutation carriers. ECG signs of septal remodelling were present in 81% of the LMNA mutation carriers, 21% of the DCM controls and none of the healthy controls giving a high sensitivity and specificity for the standard ECG in distinguishing LMNA mutation carriers from patients with DCM and healthy controls. Conclusions Male LMNA mutation carriers present clinical manifestations at a younger age than females. ECG septal remodelling appears to distinguish LMNA mutation carriers from healthy controls and patients with DCM without LMNA mutations. PMID:28123761

  14. Best herbs for managing diabetes: a review of clinical studies

    Directory of Open Access Journals (Sweden)

    Ahmad Ghorbani


    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.

  15. Biomarkers for the clinical management of breast cancer: international perspective. (United States)

    Patani, Neill; Martin, Lesley-Ann; Dowsett, Mitch


    The higher incidence of breast cancer in developed countries has been tempered by reductions in mortality, largely attributable to mammographic screening programmes and advances in adjuvant therapy. Optimal systemic management requires consideration of clinical, pathological and biological parameters. Oestrogen receptor alpha (ERα), progesterone receptor (PgR) and human epidermal growth factor receptor 2 (HER2) are established biomarkers evaluated at diagnosis, which identify cardinal subtypes of breast cancer. Their prognostic and predictive utility effectively guides systemic treatment with endocrine, anti-HER2 and chemotherapy. Hence, accurate and reliable determination remains of paramount importance. However, the goals of personalized medicine and targeted therapies demand further information regarding residual risk and potential benefit of additional treatments in specific circumstances. The need for biomarkers which are fit for purpose, and the demands placed upon them, is therefore expected to increase. Technological advances, in particular high-throughput global gene expression profiling, have generated multi-gene signatures providing further prognostic and predictive information. The rational integration of routinely evaluated clinico-pathological parameters with key indicators of biological activity, such as proliferation markers, also provides a ready opportunity to improve the information available to guide systemic therapy decisions. The additional value of such information and its proper place in patient management is currently under evaluation in prospective clinical trials. Expanding the utility of biomarkers to lower resource settings requires an emphasis on cost effectiveness, quality assurance and possible international variations in tumor biology; the potential for improved clinical outcomes should be justified against logistical and economic considerations.

  16. Clinical Characteristics and Treatment of Cardiomyopathies in Children. (United States)

    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.

  17. Association between neurovascular contact and clinical characteristics in classical trigeminal neuralgia

    DEFF Research Database (Denmark)

    Maarbjerg, Stine; Wolfram, Frauke; Gozalov, Aydin


    BACKGROUND: Previous studies demonstrated that a severe neurovascular contact (NVC) causing displacement or atrophy of the trigeminal nerve is highly associated with classical trigeminal neuralgia (TN). There are no studies describing the association between the clinical characteristics of TN...

  18. Ideological and political education for clinical graduates on the basis of medical characteristics

    Directory of Open Access Journals (Sweden)

    Yun-chuan JING


    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.

  19. Clinical characteristics of patients with gastroesophageal reflux disease in several centers of Northwest China

    Institute of Scientific and Technical Information of China (English)



    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

  20. Clinical characteristics and genetic analysis of three pediatric patients with idiopathic restrictive cardiomyopathy

    Institute of Scientific and Technical Information of China (English)



    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

  1. Zoonotic bacterial meningitis in adults: clinical characteristics, etiology, treatment and outcome

    NARCIS (Netherlands)

    van Samkar, A.


    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

  2. Clinical characteristics of polycystic ovary syndrome in Indian women

    Directory of Open Access Journals (Sweden)

    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.

  3. Clinical and diagnostic characteristics of patients with suspected polyneuropathy

    Directory of Open Access Journals (Sweden)

    Mikhailova Е.V.


    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.

  4. Clinical and laboratory characteristics of women with uterine leiomiyoma

    Directory of Open Access Journals (Sweden)

    Özgür ÖZKUL


    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.

  5. [Clinical-electroneuromyographical characteristics of facial nerve paralysis in children]. (United States)

    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.

  6. Decision making and senior management: the implementation of change projects covering clinical management in SUS hospitals. (United States)

    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.

  7. Clinical characteristics and antimicrobial susceptibility of Bacillus cereus blood stream infections


    Ikeda, Mahoko; Yagihara,Yuka; Tatsuno, Keita; Okazaki, Mitsuhiro; Okugawa, Shu; Moriya, Kyoji


    Background Bacillus cereus is one of the pathogens causing nosocomial bloodstream infections (BSIs). However, few reports have documented the antimicrobial susceptibility and clinical characteristics of Bacillus cereus BSI and the importance of empirical therapy. The aim of this study was to investigate the clinical characteristics and antimicrobial susceptibility of B. cereus isolates from patients with BSI and to analyze the impact of appropriate empirical therapy on the outcome of patients...

  8. Monosomal karyotype among adult acute myeloid leukemia: clinical characteristic and prognostic analysis

    Institute of Scientific and Technical Information of China (English)



    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%)

  9. Clinical, Molecular, and Genetic Characteristics of PAPA Syndrome: A Review. (United States)

    Smith, Elisabeth J; Allantaz, Florence; Bennett, Lynda; Zhang, Dongping; Gao, Xiaochong; Wood, Geryl; Kastner, Daniel L; Punaro, Marilynn; Aksentijevich, Ivona; Pascual, Virginia; Wise, Carol A


    PAPA syndrome (Pyogenic Arthritis, Pyoderma gangrenosum, and Acne) is an autosomal dominant, hereditary auto-inflammatory disease arising from mutations in the PSTPIP1/CD2BP1 gene on chromosome 15q. These mutations produce a hyper-phosphorylated PSTPIP1 protein and alter its participation in activation of the "inflammasome" involved in interleukin-1 (IL-1β) production. Overproduction of IL-1β is a clear molecular feature of PAPA syndrome. Ongoing research is implicating other biochemical pathways that may be relevant to the distinct pyogenic inflammation of the skin and joints characteristic of this disease. This review summarizes the recent and rapidly accumulating knowledge on these molecular aspects of PAPA syndrome and related disorders.

  10. Clinical characteristics and prognostic factors for relapse in patients with polymyalgia rheumatica (PMR). (United States)

    Lee, Jung Hwa; Choi, Sang Tae; Kim, Jin Su; Yoon, Bo Young; Kwok, Seung-Ki; Kim, Hyun-Sook; Kim, Yun Sung; Song, Jung-Soo; Lee, Sang-Heon; Kim, Hae-Rim


    Polymyalgia rheumatica (PMR) is a common inflammatory disease of the elderly in western countries, but the prevalence is apparently different between races and countries. Until now, an epidemiologic study of PMR is limited in Korea. We retrospectively evaluated the clinical data of 78 patients with PMR who were treated in 5 tertiary hospitals, and analyzed initial laboratory data, symptoms, therapeutic responses, and prognostic factors for relapse 1 year after treatments. Sixty percent of patients had pain in both shoulder and hip girdles with 10.6 weeks of duration, 75.9 ± 32.7 mm/h of erythrocyte sedimentation rate (ESR), and 6.2 ± 6.4 mg/dl of C-reactive protein. The rate of relapse and remission at 1 year was 38.4 and 2.5 %, respectively. The rate of overall relapse was 46.1 %, and the relapse occurred mostly in a year, especially between 6 and 12 months after diagnosis. There were more female in relapse group (88.9 %, p = 0.037), and cumulative steroid dose of 1 year was significantly higher in relapse group (5.5 ± 2.7 vs. 4.4 ± 2.5 g, p = 0.018). Independent risk factors for relapse were initial CRP ≥ 2.5 mg/dl (OR 6.296, p = 0.047) and the use of hydroxychloroquine (OR 6.798, p = 0.035). Initial dosage or tapering speed of steroid did not influence on prognosis. In Korean patients with PMR, baseline clinical characteristics and relapse rate were similar to previous studies, but our patients accompanied no giant cell arteritis and showed lower remission rate as well as delayed therapeutic response and later occurrence of relapse. More aggressive management would be needed according to the clinical status of patients.

  11. Clinical Guide for Family Physicians to Manage Type 2 Diabetes

    Directory of Open Access Journals (Sweden)

    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.

  12. [Clinical practice guidelines and knowledge management in healthcare]. (United States)

    Ollenschläger, Günter


    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.

  13. Guidelines for the clinical management of familial adenomatous polyposis (FAP)

    DEFF Research Database (Denmark)

    Vasen, H.F.; Moslein, G.; Alonso, A.


    is the MUTYH gene and the inheritance is autosomal recessive. In April 2006 and February 2007, a workshop was organised in Mallorca by European experts on hereditary gastrointestinal cancer aiming to establish guidelines for the clinical management of FAP and to initiate collaborative studies. Thirty......-one experts from nine European countries participated in these workshops. Prior to the meeting, various participants examined the most important management issues according to the latest publications. A systematic literature search using Pubmed and reference lists of retrieved articles, and manual searches...... of relevant articles, was performed. During the workshop, all recommendations were discussed in detail. Because most of the studies that form the basis for the recommendations were descriptive and/or retrospective in nature, many of them were based on expert opinion. The guidelines described herein may...

  14. Informationist role: clinical data management in auditory research

    Directory of Open Access Journals (Sweden)

    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.

  15. Introduction to the special issue on advances in clinical and health-care knowledge management. (United States)

    Bali, Rajeev K; Feng, David Dagan; Burstein, Frada; Dwivedi, Ashish N


    Clinical and health-care knowledge management (KM) as a discipline has attracted increasing worldwide attention in recent years. The approach encompasses a plethora of interrelated themes including aspects of clinical informatics, clinical governance, artificial intelligence, privacy and security, data mining, genomic mining, information management, and organizational behavior. This paper introduces key manuscripts which detail health-care and clinical KM cases and applications.

  16. Near Fatal Asthma: Clinical and Airway Biopsy Characteristics

    Directory of Open Access Journals (Sweden)

    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.

  17. Causes and clinical characteristics of spontaneous intracerebral hemorrhage in children

    Directory of Open Access Journals (Sweden)

    Yan-ju MENG


    Full Text Available In this study, clinical data of 31 patients in childhood with spontaneous intracerebral hemorrhage (SICH were retrospectively analyzed. According to various imaging examinations (CT, MRI, CTA, MRA and DSA, 22 cases (70.97% had definite causes, including 9 cases (29.03% with intracranial arteriovenous malformation, 6 cases (19.35% with cavernous hemangioma, 3 cases (9.68% with hematopathy, 2 cases (6.45% with tumor apoplexy, one case (3.23% with intracranial aneurysm and one case (3.23% with moyamoya disease; 9 cases (29.03% had unclear causes. All cases were timely diagnosed and treated. Among all the patients, 23 cases (74.19% were cured with good prognosis, 6 cases (19.35% improved, and the other 2 cases (6.45% died. Therefore, primary diseases should be timely treated as hematoma was removed.

  18. Clinical characteristics and diagnostic imaging of cranial osteoblastoma. (United States)

    Pelargos, Panayiotis E; Nagasawa, Daniel T; Ung, Nolan; Chung, Lawrance K; Thill, Kimberly; Tenn, Stephen; Gopen, Quinton; Yang, Isaac


    Benign osteoblastoma is a rare, vascular, osteoid-forming bone tumor that occurs even less frequently in the cranial bones. Benign osteoblastoma of the cranium affects women slightly more often than men and typically presents in the first three decades of life. Although clinical presentation can vary depending on location, cranial osteoblastoma usually presents as a painful, non-mobile, subcutaneous mass or swelling. On CT scan, it generally presents as a well-demarcated, mixed lytic and sclerotic lesion, with enlarged diploe, thinning outer and/or inner tables, and varying degrees of calcification. It is hypo to isointense on T1-weighted MRI and has variable presentation on T2-weighted MRI. Gross total resection is the definitive treatment, while subtotal resection is utilized when it is necessary to preserve critical adjacent neurovascular structures.

  19. Case of clinical Reye syndrome presenting characteristic CT changes

    Energy Technology Data Exchange (ETDEWEB)

    Hino, Tamaki; Sai, Hoshun; Morikawa, Yuji; Mizuta, Ryuzo (Kyoto Second Red Cross Hospital (Japan)); Okuno, Takehiko


    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.

  20. Implications of caries diagnostic strategies for clinical management decisions

    DEFF Research Database (Denmark)

    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...

  1. Clinical features and management of hereditary spastic paraplegia

    Directory of Open Access Journals (Sweden)

    Ingrid Faber


    Full Text Available Hereditary spastic paraplegia (HSP is a group of genetically-determined disorders characterized by progressive spasticity and weakness of lower limbs. An apparently sporadic case of adult-onset spastic paraplegia is a frequent clinical problem and a significant proportion of cases are likely to be of genetic origin. HSP is clinically divided into pure and complicated forms. The later present with a wide range of additional neurological and systemic features. To date, there are up to 60 genetic subtypes described. All modes of monogenic inheritance have been described: autosomal dominant, autosomal recessive, X-linked and mitochondrial traits. Recent advances point to abnormal axonal transport as a key mechanism leading to the degeneration of the long motor neuron axons in the central nervous system in HSP. In this review we aim to address recent advances in the field, placing emphasis on key diagnostic features that will help practicing neurologists to identify and manage these conditions.

  2. Clinical management of acute diabetic Charcot foot in Denmark

    DEFF Research Database (Denmark)

    Jansen, Rasmus Bo; Svendsen, Ole Lander; Kirketerp-Møller, Klaus


    INTRODUCTION: Charcot foot is a severe complication to diabetes mellitus and treatment involves several different clinical specialities. Our objective was to describe the current awareness, knowledge and treatment practices of Charcot foot among doctors who handle diabetic foot disorders. METHODS......: This study is based on a questionnaire survey sent out to healthcare professionals, primarily doctors, working with diabetic foot ulcers and Charcot feet in the public sector of the Danish healthcare system. RESULTS: The survey obtained a 52% response rate. A temperature difference of > 2 °C between the two...... and treatment practices of acute diabetic Charcot foot at diabetes foot clinics in Denmark. The responders seem to follow the international recommendations and guidelines on management of the acute diabetic Charcot foot, despite a lack of Danish guidelines. FUNDING: none. TRIAL REGISTRATION: not relevant....

  3. Clinical decision support systems: data quality management and governance. (United States)

    Liaw, Siaw-Teng


    This chapter examines data quality management (DQM) and information governance (IG) of electronic decision support (EDS) systems so that they are safe and fit for use by clinicians and patients and their carers. This is consistent with the ISO definition of data quality as being fit for purpose. The scope of DQM & IG should range from data creation and collection in clinical settings, through cleaning and, where obtained from multiple sources, linkage, storage, use by the EDS logic engine and algorithms, knowledge base and guidance provided, to curation and presentation. It must also include protocols and mechanisms to monitor the safety of EDS, which will feedback into DQM & IG activities. Ultimately, DQM & IG must be integrated across the data cycle to ensure that the EDS systems provide guidance that leads to safe and effective clinical decisions and care.

  4. Clinical Characteristics and Prognosis of End-stage Hypertrophic Cardiomyopathy

    Directory of Open Access Journals (Sweden)

    Yan Xiao


    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.


    Directory of Open Access Journals (Sweden)

    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.

  6. Quality Management Systems in the Clinical Laboratories in Latin America (United States)


    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

  7. [Management of onychocryptosis in primary care: A clinical case]. (United States)

    Zavala Aguilar, K; Gutiérrez Pineda, F; Bozalongo de Aragón, E


    Onychocryptosis (ingrown toenail) is a condition commonly seen in Primary Care clinics. It is uncomfortable and restrictive for patients and has a high incidence in males between second and third decades of life. It is of unknown origin, with a number of predisposing triggering factors being involved. Treatment depends on the stage of the ingrown nail and the procedures may range from conservative to minor surgery that can be performed by the Primary Care physician in the health centre. We report the case of a 25-year onychocryptosis that did not respond to conservative management, and was extracted with partial matricectomy of the nail.

  8. Halitosis: an overview of epidemiology, etiology and clinical management. (United States)

    Rösing, Cassiano Kuchenbecker; Loesche, Walter


    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.

  9. Halitosis: an overview of epidemiology, etiology and clinical management

    Directory of Open Access Journals (Sweden)

    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.

  10. Thromboembolic complications in the nephrotic syndrome: pathophysiology and clinical management. (United States)

    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.

  11. Managing clinical research data: software tools for hypothesis exploration. (United States)

    Starmer, C F; Dietz, M A


    Data representation, data file specification, and the communication of data between software systems are playing increasingly important roles in clinical data management. This paper describes the concept of a self-documenting file that contains annotations or comments that aid visual inspection of the data file. We describe access of data from annotated files and illustrate data analysis with a few examples derived from the UNIX operating environment. Use of annotated files provides the investigator with both a useful representation of the primary data and a repository of comments that describe some of the context surrounding data capture.

  12. Quality Management Systems in the Clinical Laboratories in Latin America. (United States)

    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.


    Directory of Open Access Journals (Sweden)



    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.

  14. Complications and characteristics of patients referred to a joint diabetes renal clinic in Ireland.

    LENUS (Irish Health Repository)

    Thabit, H


    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.

  15. The clinical characteristics of 625 patients with malignant small bowel tumors

    Institute of Scientific and Technical Information of China (English)



    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

  16. Clinical Application and Characteristics of KONG's Scalp Acupuncture and Daoyin Technique

    Institute of Scientific and Technical Information of China (English)

    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.

  17. The characteristics and clinical manifestation of subjects with non-specific pattern of pulmonary function tests

    Institute of Scientific and Technical Information of China (English)



    Objective To analyze the characteristics of pulmonary function and the clinical significance of non-specific pattern(NSP).Methods A total of 1 933 pulmonary function tests of adult patients were analyzed,and those with NSP were selected.The pulmonary function test results,clinical diagnosis and radiological manifestations were

  18. [The clinical and molecular genetic characteristics of phenylketonuria patients in the Republic of Crimea]. (United States)

    Afanas'eva, N A; Bychkova, A M; Livshits, L A; Bariliak, I R


    The clinical and genetical characteristics of patients with phenylketonuria in the Crimean population is done in the present work. The comparison of clinical peculiarities of 28 patients, revealed by means of neonatal screening and that of 24 patients, the treatment of which was started late is presented. The prenatal diagnostics of 4 families with high phenylketonuria risk is conducted.

  19. Characteristics of Placebo Responders in Pediatric Clinical Trials of Attention-Deficit/Hyperactivity Disorder (United States)

    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…


    Directory of Open Access Journals (Sweden)

    D. R. Atakhodjayeva


    Full Text Available Background: Brucellosis is acute zoonotic, multi-systemic infection caused by Brucella bacteria kind. Brucellosis is met everywhere on all continents of the world, especially in the countries where livestock sector is developed. Nowadays in spite of significant success in the struggle against brucellosis this infection is a social problem. Brucellosis has specific clinical manifestations during various age periods. Problems interrelated with the study of the pathogenesis of brucellosis infection, particularly immune genesis, defining the progress and the outcome of the disease have great importance. Object of the research: to study peculiarities of the progress of acute brucellosis in children taking into account clinical-immunologic data. Materials and methods of the research: the research was based on the results of examinations of 23 children from 3 to 14 years old with brucellosis mostly living in endemic foci of the Republic of Uzbekistan. The diagnosis was defined based on epidemiologic anamnesis, clinical symptoms and laboratory data. All examined children got the analysis of detailed blood immunogramm. The corresponding data of 20 healthy children served to be controlling ones. Results and discussion: The analysis of epidemiologic anamnesis showed, that 78.3% of the examined patients with brucellosis were villagers keeping sheep, goats and cattle. In 73.9% cases source of infection was sheep and goats, 8.7% - cattle, and in 17.4% cases we could observe mixed type of infection. 78% of patients applied to hospital during prodromal period. Main complaints were weakness, frustration, headache, fatigue, bad appetite. These symptoms lasted not more than 3-5 days, after which there were symptoms of intoxication of organism with the rise of cardinal symptoms such as fever with chill (100%, arthalgia (69%, slight sweating (70%, hepato-lienal syndrome (68%. 32.9% of patients had tachycardia. Objective visual examination showed enlargement of

  1. Clinical characteristics of patients with benign nonlesional temporal lobe epilepsy

    Directory of Open Access Journals (Sweden)

    Kim J


    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

  2. Aggression on inpatient units: Clinical characteristics and consequences. (United States)

    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.

  3. Clinical Characteristics of Spinal Levobupivacaine: Hyperbaric Compared with Isobaric Solution

    Directory of Open Access Journals (Sweden)

    Vimolluck Sanansilp


    Full Text Available We performed a prospective, double-blinded study in 20 patients undergoing gynecologic surgery with lower abdominal incision, to investigate characteristics of intrathecal hyperbaric levobupivacaine compared with isobaric levobupivacaine. We randomly assigned them to receive 3 mL of either isobaric or hyperbaric 0.42% levobupivacaine intrathecally. We found that hyperbaric levobupivacaine, compared with isobaric levobupivacaine, spread faster to T10 level (2.8 ± 1.1 versus 6.6 ± 4.7 minutes, =0.039, reached higher sensory block levels at 5 and 15 minutes after injection (T8 versus L1, =0.011, and T4 versus T7, =0.027, resp., and had a higher peak level (T4 versus T8, =0.040. Isobaric levobupivacaine caused a wider range of peak levels (L1 to C8 compared with hyperbaric form (T7 to T2. The level of T4 or higher reached 90% in the hyperbaric group compared with 20% in the isobaric group (=0.005. Our results suggest that hyperbaric levobupivacaine was more predictable for sensory block level and more effective for surgical procedures with lower abdominal approach. Hyperbaric levobupivacaine seems to be suitable, but the optimal dosage needs further investigation.

  4. Clinical disease characteristics according to karyotype in Turner syndrome

    Directory of Open Access Journals (Sweden)

    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.

  5. Histamine H1 antagonists and clinical characteristics of febrile seizures

    Directory of Open Access Journals (Sweden)

    Zolaly MA


    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

  6. Clinical characteristics and current therapies for inherited retinal degenerations. (United States)

    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.

  7. Clinical and electrophysiological characteristics of neuropathy associated with Tangier disease. (United States)

    Zyss, Julie; Béhin, Anthony; Couvert, Philippe; Bouhour, Françoise; Sassolas, Agnès; Kolev, Ivan; Denys, Violaine; Vial, Christophe; Lacour, A; Carrié, Alain; Stojkovic, Tanya


    Tangier disease (TD) (OMIM#205400) is a rare autosomal recessive disorder resulting from mutations in the ABCA1 gene, leading to decreased levels of plasma high-density lipoproteins (HDL). Peripheral neuropathy is a common finding in this disease, and may present as relapsing/remitting mono/polyneuropathies or as syringomyelia-like neuropathy. We retrospectively analyzed four patients, and report here their clinical, biological, electrophysiological, imaging, and genetic findings. Three patients had a typical pseudosyringomyelic neuropathy including facial diplegia, but asymmetrical onset was observed in one patient who had first been misdiagnosed with Lewis-Sumner syndrome. Electrophysiological pattern was heterogeneous, showing both signs of demyelination and axonal degeneration. Truncating mutations of the ABCA1 gene, including two previously undescribed mutations, were constantly found. Atypical symptom onset and demyelinating features on electrophysiological examination can be misleading in case of pseudosyringomyelic neuropathy. These reports illustrate two different neurological phenotypes in TD, namely the pseudosyringomyelic type and the Lewis-Sumner-like type, and advocate for a systematic assessment of lipid profile including HDL cholesterol in demyelinating neuropathies.

  8. [Perspective for clinical laboratory management and its systematization--effects of the systematization of clinical laboratory management]. (United States)

    Ito, S


    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.

  9. Requirements on Clinical Trial Management Systems for Academic Site Management Organizations. (United States)

    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.

  10. Client satisfaction with a nurse-managed clinic. (United States)

    Pulliam, L


    To survive and thrive in today's competitive health-care market, health-care providers must evaluate outcomes of their services, including client satisfaction, then use this information to set standards. In the past, standards of care for the elderly were based on tradition rather than evaluation of their effect on outcomes (Thorsland, 1986). There are, therefore, few guidelines for evaluating outcomes of care in any setting and almost none for care of the elderly in nurse-managed centers. As a first step in evaluating client satisfaction in a nurse-managed clinic a focus group discussion was conducted with nine clients of the Nurse Education Link to Aged (NELA) Wellness Center. The focus group participants indicated that the Center had done an excellent job of meeting physical and emotional health needs of clients. Participants especially liked the location of the clinic in the apartment building where they live. Additional services requested by participants included programs for coping with depression and stress, alcoholism, and arthritis, and for increasing social interaction between men and women.

  11. Molar incisor hypomineralization: review and recommendations for clinical management. (United States)

    William, Vanessa; Messer, Louise B; Burrow, Michael F


    Molar incisor hypomineralization (MIH) describes the clinical picture of hypomineralization of systemic origin affecting one or more first permanent molars (FPMs) that are associated frequently with affected incisors. Etiological associations with systemic conditions or environmental insults during the child's first 3 years have been implicated. The complex care involved in treating affected children must address their behavior and anxiety, aiming to provide a durable restoration under pain-free conditions. The challenges include adequate anaesthesia, suitable cavity design, and choice of restorative materials. Restorations in hypomineralized molars appear to fail frequently; there is little evidence-based literature to facilitate clinical decisions on cavity design and material choice. A 6-step approach to management is described: (1) risk identification; (2) early diagnosis; (3) remineralization and desensitization; (4) prevention of caries and posteruption breakdown; (5) restorations and extractions; and (6) maintenance. The high prevalence of MIH indicates the need for research to clarify etiological factors and improve the durability of restorations in affected teeth. The purpose of this paper was to describe the diagnosis, prevalence, putative etiological factors, and features of hypomineralized enamel in molar incisor hypomineralization and to present a sequential approach to management.

  12. Epidemiology and clinical characteristics of traumatic brain injury in Lebanon (United States)

    Abou-Abbass, Hussein; Bahmad, Hisham; Ghandour, Hiba; Fares, Jawad; Wazzi-Mkahal, Rayyan; Yacoub, Basel; Darwish, Hala; Mondello, Stefania; Harati, Hayat; El Sayed, Mazen J.; Tamim, Hani; Kobeissy, Firas


    , epidemiological, clinical and translational research in this field in the future. PMID:27893670

  13. Current approach to masked hypertension: From diagnosis to clinical management.

    LENUS (Irish Health Repository)

    Dolan, Eamon


    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.

  14. Clinical presentation and management of mTOR inhibitor-associated stomatitis. (United States)

    de Oliveira, Marcio Augusto; Martins E Martins, Fabiana; Wang, Qian; Sonis, Stephen; Demetri, George; George, Suzanne; Butrynski, James; Treister, Nathaniel S


    Anti-cancer agents that inhibit the mTOR pathway are associated with a number of unique toxicities, with one of the most significant and potentially dose-limiting being stomatitis. The objective of this study was to report the clinical features and management outcomes of a series of cancer patients who developed painful mTOR inhibitor-associated stomatitis (mIAS). Seventeen cancer patients developed mIAS while being treated with everolimus- or ridaforolimus-containing protocols at the Dana-Farber Cancer Institute and were referred to the oral medicine clinic for evaluation and management. Clinical characteristics, toxicity management, and outcomes were summarized. In addition, the frequency and rationale for dose reductions and therapy discontinuation were assessed. The median duration of mTOR inhibitor therapy was 80 days (range 9-187 days). The median time to development of mouth ulcers was 10 days (range 4-25 days). Five patients required protocol-directed dose reductions due to grades 2 and 3 stomatitis and one patient discontinued cancer treatment due to mouth ulcers. Clinical improvement and pain relief was reported in 86.6% of patients following topical, intralesional, or systemic corticosteroid therapy, with side effects limited to secondary candidiasis (n=2). Mouth ulcers are a common and potentially dose limiting toxicity associated with the use of mTOR inhibitors in cancer treatment. This case series demonstrates that local and systemic corticosteroid therapy is an effective approach to managing patients with symptomatic mIAS. Prospective studies are necessary to evaluate the effectiveness of treatment and prevention strategies with the ultimate goal of improving overall cancer treatment outcomes.

  15. Clinical manifestations and managements in jellyfish envenomation A systematic review

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    Negar Taheri


    Full Text Available Background: The phylum Cnidarians have over nine thousand species that approximately, one hundred species are dangerous for humans. Annually, a large number of deaths were reported due to jellyfish stings. The manifestations depend on their species and kind of venoms, and include the local and systemic manifestations. A number of methods and compounds were used and under investigation for management of injuries with jellyfishes. Due to the lack of an integrated systematic review, the current study was done. Materials and Methods: The PubMed data bank was searched for the term “Jellyfish”. A total of 1677 papers were found. These papers were divided into three categories: medical, biomedical and biotechnological fields. The medical category was further divided into three subcategories comprising systemic manifestations, cutaneous manifestations and treatments for the stings of jellyfishes. The biomedical category was further subdivided into genomics, proteomics, and biology of venoms, mechanisms of actions and products of biomedical significance. In this part of systematic review, the medical aspects of injuries with jellyfishes were evaluated. Results: The clinical manifestations in jellyfish envenomation depend on their species and the nature of venoms. The most common clinical manifestations of jellyfish stings are cutaneous presentations like urticasia, erythema, swelling, vesicles and severe dermonectoric manifestations. Systemic manifestations were seen in the stings of box jellyfishes, Portuguese man-of-war and in Irukandji syndrome. The most common recommendations for jellyfish envenomation managements include decreasing the local effects of venom, prevention of the venomous nematocysts release, and Controlling of systemic reactions. Application of commercial vinegar (4 - 6% acetic acid, hot water immersion (HWI (42 ° C for 20 minutes, ice packs, sea water rinsing for inactivating nematocysts, administration of topical and parenteral

  16. Novel therapeutics in multiple sclerosis management: clinical applications. (United States)

    Leist, Thomas; Hunter, Samuel F; Kantor, Daniel; Markowitz, Clyde


    Multiple sclerosis (MS) affects an estimated 300,000 individuals in the United States. No cure exists and although there is a lack of consensus on management, strategies to modify disease course are available. These strategies involve initiating disease-modifying therapies that have been found to slow disease progression and prevent disability symptoms, thereby improving function for MS patients. The overall goal of early disease management is to intervene prior to irreversible neuronal destruction in order to delay disability progression and improve quality of life. Maintaining a lower level of disability for a longer period of time postpones and ultimately attempts to prevent reaching a level of immobility and irreversible disability. However, due to the complex nature of disease and its unique, individual patient course, no patient can be treated alike and no patient responds to therapy similarly. Therefore, MS research is continuous in its evolution of therapeutic development, focusing on neuroprotective effects and agents with distinctive mechanisms of action allowing for unique safety and efficacy profiles. Investigations include novel oral agents and monoclonal antibodies. Many of the approved agents also are continually being investigated in order to evaluate comparative data, the most appropriate means of implementing subsequent therapy upon failure, responsiveness to therapeutic agent when switched, and long-term safety and efficacy. This multimedia webcast educational activity will cover the current state of MS science, current therapies in MS, emerging treatments in clinical trials for MS as well as differences between physicians in diagnosis and management of MS and their evolving practices.

  17. The effect of management team characteristics on performance and style extremity of mutual fund portfolios

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    Liu Qiong


    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

  18. Clinical decision support for perioperative information management systems. (United States)

    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.

  19. Clinical diagnosis and management in early Huntington's disease: a review

    Directory of Open Access Journals (Sweden)

    Schiefer J


    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

  20. Clinical management of gastric cancer: results of a multicentre survey

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    Xu Feng


    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.

  1. Clinical characteristics, process of care and outcomes among Mexican, Hispanic and non-Hispanic white patients presenting with non-ST elevation acute coronary syndromes: Data from RENASICA and CRUSADE registries


    Sánchez-Diaz,Carlos Jerjes; García-Badillo,Edgar; Sánchez-Ramírez,Carlos Jerjes; Juárez,Úrsulo; Martínez-Sánchez,Carlos


    Introduction: Data regarding management characteristics of non-ST elevation acute coronary syndromes (NSTE ACS) in Mexican, Hispanic and Non- Hispanic white patients are scarce. Methods: We sought to describe the clinical characteristics, process of care, and outcomes of Mexicans, Hispanics and non-Hispanic whites presenting with NSTE ACS at Mexican and US hospitals. We compared baseline characteristics, resource use, clinical practice guidelines (CPGs) compliance and in-hospital mortality am...

  2. [The realization way and lean management about medical consumable material in clinical use]. (United States)

    Shang, Changhao; Cheng, Junpei; Xu, Hailin; Wang, Xiaoguang


    The medical consumable material management is an important part of logistic support in the management of hospital, but the hospital has many weak links in the management of supplies. This paper aims to explore the common problems (especially in clinical use) existing in the management of medical consumables and years of management experience in Changhai hospital's practice, then discusses lean management from the perspective of lean management

  3. A prospective study of the pathophysiology and clinical characteristics of pain in a palliative medicine population. (United States)

    Gutgsell, Terence; Walsh, Declan; Zhukovsky, Donna S; Gonzales, Francisco; Lagman, Ruth


    Comprehensive pain evaluation is requisite for optimal management. Few studies have evaluated pain syndromes and adequacy of associated analgesic regimens in one population. Available studies in cancer populations have focused on ambulatory patients or hospice-type inpatients. This study was designed to evaluate multiple characteristics of pain and adequacy of therapy in a broad spectrum of patients with advanced cancer presenting to a palliative medicine service. One hundred pain patients (95 with cancer) underwent a comprehensive pain evaluation consisting of history, physical examination, review of available diagnostics, and a pain assessment tool designed for routine clinical use. Seventy-one percent of 141 evaluable patients reported pain in the month before referral. In these 100 patients, 158 distinct sites of pain were reported, with 88 percent reporting a maximum of 2. Pain due to tumor was the most common cause (68 percent), and the most common pathophysiologic mechanism, somatic (52 percent). Pain was almost equally divided between continuous (48 percent) and intermittent (52 percent). Breakthrough pain occurred in 75 percent of continuous pains. Of these, 30 percent were exclusively incidental, 26percent nonincidental, and 16 percent due to end-of-dose failure. The remainder was of mixed etiology, but almost always with an incidental component. Of intermittent pain syndromes, 61 percent were incidental. On referral, analgesic dosing was inadequate and was compounded by use of regimens that typically did not meet peer-reviewed guidelines. Comprehensive studies rigorously evaluating characteristics of pain and response to treatment are a necessary first step toward more effective treatments for difficult pain syndromes.

  4. Measuring clinical management by physicians and nurses in European hospitals: development and validation of two scales.

    NARCIS (Netherlands)

    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

  5. Diabetes in patients with HIV: patient characteristics, management and screening

    NARCIS (Netherlands)

    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

  6. Information Source Characteristics and Environmental Scanning by Academic Library Managers (United States)

    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…

  7. Clinical Assessment and Management of Spondyloarthritides in the Middle East: A Multinational Investigation (United States)

    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

  8. Clinical use of placental hormones in pregnancy management. (United States)

    De Bonis, M; Vellucci, F L; Di Tommaso, M; Voltolini, C; Torricelli, M; Petraglia, F


    Across human pregnancy, placenta represents a transit of oxygen and nutrients from the mother to the fetus and actively produces a large number of hormones that serve to regulate and balance maternal and fetal physiology. An abnormal secretion of placental hormones may be part of the pathogenesis of the main obstetric syndrome, from early to late pregnancy, in particular chromosomopathies, miscarriage, gestational trophoblastic diseases, preeclampsia, gestational diabetes, and pre-term delivery. The possibility to measure placental hormones represents an important tool not only for the diagnosis and management of gestational disorders, but it is also fundamental in the early identification of women at risk for these pregnancy complications. In the last decades, the use of ultrasound examination has provided additional biophysical markers, improving the early diagnosis of gestational diseases. In conclusion, while few placental hormones have sufficient sensitivity for clinical application, there are promising new biochemical and biophysical markers that, if used in combination, may provide a valid screening tool.

  9. Risk management in clinical practice. Part 9. Dental implants. (United States)

    Palmer, R M


    Patients have high expectations of dental implants in terms of appearance, function and longevity. It is essential that these expectations are realistically managed and that treatment of the highest standard is provided. This involves very careful evaluation, including clinical and radiographic, and presentation of the pros and cons of treatment alternatives. Provision of a successful implant restoration requires many skills including a surgical procedure to place the implant in the best possible position and prosthodontic techniques to provide an aesthetic restoration in occlusal harmony with the rest of the dentition. Recognition of risk factors and long-term maintenance requirements are equally important. Clinicians involved in these treatments must obtain adequate training and develop skills through treatment of straightforward cases using well established protocols before embarking on more demanding cases.

  10. Clinical management of supernumerary teeth: A report of two cases

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    Mittal M


    Full Text Available Supernumerary tooth may closely resemble the teeth of the group to which it belongs, i.e. molars, premolars or anterior teeth, or it may bear little resemblancein size or shape to which it is associated. Many complications can be associated with supernumeraries, like impaction, delayed eruption or ectopic eruption of adjacent teeth, crowding, development of median diastema and eruption into floor of the nasal cavity. This may also cause the formation of follicular cysts with significant bone destruction. Early intervention to remove it is usually required to obtain reasonable alignment and occlusal relationship. This article will present the clinical management of an (i impacted supernumerary tooth impeding the eruption of maxillary central incisor and (ii erupted supernumerary tooth with midline diastema.

  11. Recent Advances in the Clinical Management of Lead Poisoning.

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    Sina Kianoush


    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.

  12. Nutritional therapy for the management of diabetic gastroparesis: clinical review

    Directory of Open Access Journals (Sweden)

    Sadiya A


    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


    Directory of Open Access Journals (Sweden)

    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

  14. Key success factors for clinical knowledge management systems: Comparing physician and hospital manager viewpoints. (United States)

    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.

  15. Nutritional therapy for the management of diabetic gastroparesis: clinical review. (United States)

    Sadiya, Amena


    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.

  16. Nutritional therapy for the management of diabetic gastroparesis: clinical review (United States)

    Sadiya, Amena


    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

  17. Assessing hospitals' clinical risk management: Development of a monitoring instrument

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    Pfeiffer Yvonne


    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.

  18. Clinical Features and Patient Management of Lujo Hemorrhagic Fever (United States)

    Sewlall, Nivesh H.; Richards, Guy; Duse, Adriano; Swanepoel, Robert; Paweska, Janusz; Blumberg, Lucille; Dinh, Thu Ha; Bausch, Daniel


    Background 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. Methods and Findings 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. Conclusions 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

  19. Clinical features and patient management of Lujo hemorrhagic fever.

    Directory of Open Access Journals (Sweden)

    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

  20. Subluxed traumatic cataract: optical coherence tomography findings and clinical management

    Directory of Open Access Journals (Sweden)

    Kuriyan AE


    Full Text Available Ajay E Kuriyan, Harry W Flynn Jr, Sonia H YooDepartment of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, FLAbstract: This case report describes the optical coherence tomography (OCT findings and clinical management of a patient with traumatic subluxed cataract. The patient presented with a traumatic subluxed cataract and vitreous prolapse into the anterior chamber. The anterior segment OCT showed vacuoles in the anterior subcapsular regions of the crystalline lens. The patient was treated with pars plana lensectomy, vitrectomy, and placement of an anterior chamber intraocular lens. The patient's best corrected visual acuity improved from hand motion at presentation to 20/25 during 3 years of follow-up. Anterior segment OCT demonstrates that the clinically visible vacuoles in traumatic cataract are located in the anterior subcapsular part of the lens. This is the first report in the literature using anterior segment OCT to visualize the subcapsular vacuolar changes in a traumatic cataract.Keywords: traumatic cataract, subluxed lens, vacuoles, anterior chamber intraocular lens, anterior segment optical coherence tomography

  1. Common recurrent microduplication syndromes: diagnosis and management in clinical practice. (United States)

    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.

  2. Changing Management of Clinical Low-Stage Testicular Cancer

    Directory of Open Access Journals (Sweden)

    Timothy Gilligan


    Full Text Available Stage I and II testicular germ cell tumors (GCTs are almost always cured with appropriate treatment and most ongoing research regarding these tumors focuses on minimizing treatment toxicity. The management of clinical stage I testicular GCTs has grown more complicated due to the emergence of a brief course of chemotherapy as an additional treatment option for stage I seminomas and stage I nonseminomas. In addition, growing concern about radiation-induced cancers and other late toxicity has dulled enthusiasm for radiotherapy as a treatment for stage I seminomas. However, recent randomized trials have shown that radiotherapy doses and field sizes can be lowered without compromising cure rates and it is possible that this reduction in radiation exposure will reduce the rate of secondary cancers. At this point in history, stage I patients have three treatment options following radical orchiectomy: adjuvant (sometimes called “primary” chemotherapy (carboplatin for seminomas and the combined regimen of bleomycin, etoposide, and cisplatin for nonseminomas, surveillance, and either retroperitoneal lymph node dissection (for nonseminomas or radiotherapy (for pure seminomas. Clinical studies have made it possible to identify subgroups of patients at high and low risk for relapse and this has made it possible to tailor treatment decisions to the individual patient's postorchiectomy relapse risk.

  3. Podometrics as a Potential Clinical Tool for Glomerular Disease Management. (United States)

    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.

  4. Sleep disorders and chronic craniofacial pain: Characteristics and management possibilities. (United States)

    Almoznino, Galit; Benoliel, Rafael; Sharav, Yair; Haviv, Yaron


    Chronic craniofacial pain involves the head, face and oral cavity and is associated with significant morbidity and high levels of health care utilization. A bidirectional relationship is suggested in the literature for poor sleep and pain, and craniofacial pain and sleep are reciprocally related. We review this relationship and discuss management options. Part I reviews the relationship between pain and sleep disorders in the context of four diagnostic categories of chronic craniofacial pain: 1) primary headaches: migraines, tension-type headache (TTH), trigeminal autonomic cephalalgias (TACs) and hypnic headache, 2) secondary headaches: sleep apnea headache, 3) temporomandibular joint disorders (TMD) and 4) painful cranial neuropathies: trigeminal neuralgia, post-herpetic trigeminal neuropathy, painful post-traumatic trigeminal neuropathy (PTTN) and burning mouth syndrome (BMS). Part II discusses the management of patients with chronic craniofacial pain and sleep disorders addressing the factors that modulate the pain experience as well as sleep disorders and including both non-pharmacological and pharmacological modalities.

  5. Functional capacity of Brazilian patients with Parkinson's disease (PD): relationship between clinical characteristics and disease severity. (United States)

    Barbieri, Fabio A; Rinaldi, Natalia M; Santos, Paulo Cezar R; Lirani-Silva, Ellen; Vitório, Rodrigo; Teixeira-Arroyo, Cláudia; Stella, Florindo; Gobbi, Lilian Teresa B


    The present study had three objectives: (a) to characterize the functional capacity of patients with PD, (b) to assess the relationship between the physical fitness components of functional capacity with clinical characteristics and disease severity, and (c) to compare the physical fitness components of functional capacity with clinical characteristics according to disease severity. The study included 54 patients with idiopathic PD who were distributed into two groups according to PD severity: unilateral group (n=35); and bilateral group (n=19). All patients underwent psychiatric assessment by means of the Hoehn and Yahr (HY) staging of PD, the Unified Parkinson's Disease Rating Scale (UPDRS), the Hospital Anxiety and Depression Scale (HADS-A and HADS-D, respectively), and The Mini-Mental State Examination (MMSE). The physical fitness components of functional capacity were evaluated over a 2-day period, using recommendations by the American Alliance for Health, Physical Education, Recreation and Dance, and the Berg Balance Scale (BBS). Pearson correlation coefficients and multiple regressions were calculated to test the correlation between functional capacity and clinical characteristics, and to predict clinical scores from physical performance, respectively. Clinical variables and physical component data were compared between groups using analysis of variance to determine the effects of disease severity. Patients with advanced disease showed low levels of functional capacity. Interestingly, patients with good functional capacity in one of the physical fitness components also showed good capacities in the other components. Disease severity is a major factor affecting functional capacity and clinical characteristics. Medical providers should take disease severity into consideration when prescribing physical activity for PD patients, since the relationship between functional capacity and clinical characteristics is dependent on disease severity.

  6. Emerging clinical role of ranolazine in the management of angina

    Directory of Open Access Journals (Sweden)

    David S Vadnais


    Full Text Available David S Vadnais, Nanette K WengerDivision of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USAAbstract: Chronic stable angina is an exceedingly prevalent condition with tremendous clinical, social, and financial implications. Traditional medical therapy for angina consists of beta-blockers, calcium channel blockers, and nitrates. These agents decrease myocardial oxygen demand and ischemia by reducing heart rate, lowering blood pressure, and/or optimizing ventricular loading characteristics. Unique in its mechanism of action, ranolazine is the first new antianginal agent approved for use in the US for chronic angina in over 25 years. By inhibiting the late inward sodium current (INa, ranolazine prevents pathologic intracellular calcium accumulation that leads to ischemia, myocardial dysfunction, and electrical instability. Ranolazine has been proven in multiple clinical trials to reduce the symptoms of angina safely and effectively and to improve exercise tolerance in patients with symptomatic coronary heart disease. These benefits occur without reduction in heart rate and blood pressure or increased mortality. Although ranolazine prolongs the QTc, experimental data indicate that ranolazine may actually be antiarrhythmic. In a large acute coronary syndrome clinical trial, ranolazine reduced the incidence of supraventricular tachycardia, ventricular tachycardia, new-onset atrial fibrillation, and bradycardic events. Additional benefits of ranolazine under investigation include reductions in glycosylated hemoglobin levels and improved left ventricular function. Ranolazine is a proven antianginal medication in patients with symptomatic coronary heart disease, and should be considered as an initial antianginal agent for those with hypotension or bradycardia.Keywords: chronic angina, myocardial ischemia, ranolazine, pharmacotherapy, antianginal, sodium current

  7. Clinical and Pathologic Characteristics of Myocarditis as a Cause of Sudden Death (United States)


    Clinical and Pathologic Characteristics of  Myocarditis  as a Cause of Sudden Death Lena Avedissian, Jennifer A. McNear, David A. Appel, Laudino M...00-00-2008 to 00-00-2008 4. TITLE AND SUBTITLE Clinical and Pathologic Characteristics of Myocarditis as a Cause of Sudden Death 5a. CONTRACT...unclassified b. ABSTRACT unclassified c. THIS PAGE unclassified Standard Form 298 (Rev. 8-98) Prescribed by ANSI Std Z39-18  Myocarditis  as a


    Directory of Open Access Journals (Sweden)



    Full Text Available Retinal vein occlusion is the most common retinal occlusive disorder encountered by Ophthalmologists and is usually associated with a variable amount of visual loss. This is the second most common retinal vascular disease next to diabetic retinopathy. Liebreich initially described dramatic obstruction of veins as retinal apoplexy. Leber ( 1 (1877 reported the first case of BRVO and called it Hem orrhagic retinitis. RVO most commonly affects the venous blood supply of the entire retina (CRVO or a quadrant drained by one of the branches (BRVO or less commonly the superior or inferior half of the retina alone is affected (HCRVO. For discussion and management purpose RVO is broadly classified into six clinical entities includes (1 Non - ischemic CRVO (2 Ischemic CRVO (3 Non ischemic HCRVO (4Ischemic HCRVO (5 Major BRVO (6Macular BRVO. So much of confusion still exists regarding its natural histo ry, degree of severity, management and its progression. The clinical study of RVO is taken up mainly with a view to study the importance of systemic risk factors in etiopathogenisis of RVO, to study the clinical features and effectiveness of treatment in m odification of the natural course and complications of RVO. Depending on type of venous occlusion patient may present with loss of central vision frequently noticed on waking up in the morning, or field contraction, erythropsia, floates, black spots. Episo des of amaurosis fugax lasts for minutes to hours may be present. There may be metamor - phopsia. Signs of decreased visual acuty, RAPD, visual field defects are observed. Fundus picture shows Retinal hemorrhages distributed based on type of venous occlusion . In ischemic CRVO the picture shows “berries on a twig”. Various sequel & complications include macular edema, anterior segment and retinal neovascularisation, vitreous hemorrhage, retinal detachment may be encountered. Various risk factors include Hypert ension, Diabetes, Hyper lipidemia, IHD

  9. Characteristics of the USA dairy herd as related to management and demographic elements (United States)

    The data characteristics of the United States dairy herd related to animals enrolled in milk recording (dairy herd improvement) are the basic foundation and important influencers for the management and genetic progress achieved in a population or animal production unit. The amount, characteristics ...

  10. The influence of perceived characteristics of management development programs on employee outcomes.

    NARCIS (Netherlands)

    Ardts, J.C.A.; van der Velde, M.E.G.; Maurer, T.


    Employees’ perceptions of Management Development (MD) programs is the topic of this study. The purpose is to examine the influence of three important perceived characteristics of MD programs on relevant MD outcomes. The MD characteristics are: availability of role models, perceived control, and unde

  11. Virologic and clinical characteristics of HBV genotypes/subgenotypes in 487 Chinese pediatric patients with CHB


    Gu Mei-Lei; Li Xiao-Dong; Xing Xiao-Yan; Dong Yi; Duan Zhong-Ping; Song Hong-Bin; Li Jin; Zhong Yan-Wei; Han Yu-Kun; Zhu Shi-Shu; Zhang Hong-Fei


    Abstract Background The association of hepatitis B virus (HBV) genotypes/subgenotypes with clinical characteristics is increasingly recognized. However, the virologic and clinical features of HBV genotypes/subgenotypes in pediatric patients remain largely unknown. Methods Four hundred and eighty-seven pediatric inpatients with CHB were investigated, including 217 nucleos(t)ide analog-experienced patients. HBV genotypes/subgenotypes and reverse transcriptase (RT) mutations were determined by d...

  12. Aquifers of Arkansas: protection, management, and hydrologic and geochemical characteristics of groundwater resources in Arkansas (United States)

    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.

  13. Study of Relationships between Apparel Manufacturers' Supply Chain Management, Company Characteristics, and Inventory Performance


    Lee, Yuri


    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 ...

  14. Infrastructure and clinical practice for the detection and management of trauma-associated haemorrhage and coagulopathy

    DEFF Research Database (Denmark)

    Driessen, Annemariek; Schäfer, N; Albrecht, V


    PURPOSE: Early detection and management of post-traumatic haemorrhage and coagulopathy have been associated with improved outcomes, but local infrastructures, logistics and clinical strategies may differ. METHODS: To assess local differences in infrastructure, logistics and clinical management...... intake of anticoagulants including "new oral anticoagulants" and platelet inhibitors as an increasing threat to bleeding trauma patients. CONCLUSIONS: This study confirms differences in infrastructure, logistics and clinical practice for the detection and management of trauma-haemorrhage and trauma...

  15. Clinical application of family management styles to families of children with cancer. (United States)

    Ogle, Susan K


    The potential clinical application of family management styles for working with families who have children with cancer is discussed. Case studies are used to illustrate the usefulness and clinical application of the model.

  16. Mobile applications for obesity and weight management: current market characteristics. (United States)

    Nikolaou, C K; Lean, M E J


    Mobile-Health (mHealth) is the fastest-developing eHealth sector, with over 100 000 health applications (apps) currently available. Overweight/obesity is a problem of wide public concern that is potentially treatable/preventable through mHealth. This study describes the current weight-management app-market. Five app stores (Apple, Google, Amazon, Windows and Blackberry) in UK, US, Russia, Japan and Germany, Italy, France, China, Australia and Canada were searched for keywords: 'weight', 'calorie', 'weight-loss', 'slimming', 'diet', 'dietitian' and 'overweight' in January/February 2016 using App-Annie software. The 10 most downloaded apps in the lifetime of an app were recorded. Developers' lists and the app descriptions were searched to identify any professional input with keywords 'professional', 'dietitian' and 'nutritionist'. A total of 28 905 relevant apps were identified as follows: Apple iTunes=8559 (4634, 54% paid), Google Play=1762 (597, 33.9% paid), Amazon App=13569 (4821, 35.5% paid), Windows=2419 (819, 17% paid) and Blackberry=2596 (940, 36% paid). The 28 905 identified apps focused mainly on physical activity (34%), diet (31%), and recording/monitoring of exercise, calorie intake and body weight (23%). Only 17 apps (0.05%) were developed with identifiable professional input. Apps on weight management are widely available and very popular but currently lack professional content expertise. Encouraging app development based on evidence-based online approaches would assure content quality, allowing healthcare professionals to recommend their use.

  17. Standardized Clinical Assessment And Management Plans (SCAMPs) Provide A Better Alternative To Clinical Practice Guidelines (United States)

    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

  18. [Management of the diabetic foot: which criteria for clinical evaluation and initial management?]. (United States)

    Egli, M


    The diabetic foot remains a diabetes complication with potentially devastating consequences, which is initially silent and too often neglected. Its systematic screening first has to target the estimation of the risk level of foot lesions. This estimation is based on clinical examination regarding the severity of neuropathy, its consequences and of a possibly associated arterial disease. Preventive interventions are determined according to the risk level. They always rely on an important involvement of the patient, which in turn requires the healthcare professionals' engagement in individualized patient education and psychosocial support. Wound management and its diagnostic and therapeutic challenges usually calls for a collaborative approach involving several different specialists.

  19. Determining the agent factors related with time management of responsible doctors and nurses in clinics at Ankara University hospitals. (United States)

    Acuner, Ahmet Munir; Nilgun, Sarp; Cifteli, F Gulay


    This research has been planned and conducted as a descriptive scanning model field study in order to determine the agent factors related with time management of doctors and nurses in positions of responsibility at Ankara University hospitals. As data collection instruments; the "Personal Information Form" which has been developed to determine the socio-demographical characteristics of the research group, the questionnaire of "Determining the Time Management Attitudes and Behaviour of Managers, Time Management Opportunities of the Managers, Prodcutive Working Times of the Managers and the Factors Causing Them to Lose Time", developed by Erdem has been used. It has been determined that the time management attitudes and behaviour of doctors, nurses and nurse assistants responsible for clinics are all different. It was found that nurse assistants graduated from pre-undergraduate or high schools are the least conscious of time management. In particular, nurse assistants of 36 years old and over with 21 years of work experience and 11 years of management experience show little awareness of time management. The time losing factors of the research group were found to be unnecessary visitors, lack of materials and the excessive amount of time spent on obtaining the necessary equipment.


    Directory of Open Access Journals (Sweden)



    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

  1. [The importance of clinical data management in improvement of drug evaluation]. (United States)

    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.

  2. Metadata registry and management system based on ISO 11179 for Cancer Clinical Trials Information System. (United States)

    Park, Yu Rang; Kim, Ju Han


    Standardized management of data elements (DEs) for Case Report Form (CRF) is crucial in Clinical Trials Information System (CTIS). Traditional CTISs utilize organization-specific definitions and storage methods for Des and CRFs. We developed metadata-based DE management system for clinical trials, Clinical and Histopathological Metadata Registry (CHMR), using international standard for metadata registry (ISO 11179) for the management of cancer clinical trials information. CHMR was evaluated in cancer clinical trials with 1625 DEs extracted from the College of American Pathologists Cancer Protocols for 20 major cancers.

  3. Semantic characteristics of NLP-extracted concepts in clinical notes vs. biomedical literature. (United States)

    Wu, Stephen; Liu, Hongfang


    Natural language processing (NLP) has become crucial in unlocking information stored in free text, from both clinical notes and biomedical literature. Clinical notes convey clinical information related to individual patient health care, while biomedical literature communicates scientific findings. This work focuses on semantic characterization of texts at an enterprise scale, comparing and contrasting the two domains and their NLP approaches. We analyzed the empirical distributional characteristics of NLP-discovered named entities in Mayo Clinic clinical notes from 2001-2010, and in the 2011 MetaMapped Medline Baseline. We give qualitative and quantitative measures of domain similarity and point to the feasibility of transferring resources and techniques. An important by-product for this study is the development of a weighted ontology for each domain, which gives distributional semantic information that may be used to improve NLP applications.


    Directory of Open Access Journals (Sweden)

    UROŠEVIĆ Snežana


    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.

  5. The clinical characteristics,treatment and outcome of macrolide-resistant Mycoplasma pneumoniae pneumonia in children

    Institute of Scientific and Technical Information of China (English)



    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

  6. Cerebellar Ataxia with Bilateral Vestibulopathy: Description of a Syndrome and Its Characteristic Clinical Sign (United States)

    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…

  7. Clinical characteristics and heterogeneity in patients with ketosis-prone diabetes

    Institute of Scientific and Technical Information of China (English)



    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

  8. Clinical characteristic of pulse wave velocity and arterial compliance in elderly patients with diabetes mellitus

    Institute of Scientific and Technical Information of China (English)



    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

  9. Clinical patterns and characteristics of uveitis in a tertiary center for uveitis in China

    NARCIS (Netherlands)

    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

  10. The concept and characteristics of clinical practice ability in Master Degree of Nursing (specialty)

    Institute of Scientific and Technical Information of China (English)

    Jing Zeng; Jing-Ci Zhu; Xiao-Yu Zhao


    The concepts of ability, practice ability, and professional practice ability were analyzed using a theoretical research method. Based on the results of the analysis, the concept of clinical practice ability for Master Degree of Nursing (specialty) students was defined, and the characteristics were interpreted to provide references for future in-depth studies.

  11. Enterococcus hirae-associated endocarditis outbreaks in broiler flocks : clinical and pathological characteristics and molecular epidemiology

    NARCIS (Netherlands)

    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

  12. Enterococcus hirae-associated endocarditis outbreaks in broiler flocks: clinical and pathological characteristics and molecular epidemiology.

    NARCIS (Netherlands)

    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

  13. Clinical characteristics of familial and sporadic age-related macular degeneration: differences and similarities

    NARCIS (Netherlands)

    Saksens, N.T.M.; Kersten, E.; Groenewoud, J.M.M.; Grinsven, M.J.J.P. van; Ven, J.P.H. van de; Sanchez, C.I.; Schick, T.; Fauser, S.; Hollander, A.I. den; Hoyng, C.B.; Boon, C.J.F.


    PURPOSE: We describe the differences and similarities in clinical characteristics and phenotype of familial and sporadic patients with age-related macular degeneration (AMD). METHODS: We evaluated data of 1828 AMD patients and 1715 controls enrolled in the European Genetic Database. All subjects und

  14. Clinical utility of pharmacogenomics in the management of hepatitis C

    Directory of Open Access Journals (Sweden)

    Trinks J


    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

  15. Quality management in clinical application of mass spectrometry measurement systems. (United States)

    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.

  16. [International clinical practice guidelines and management of rheumatology in Madagascar]. (United States)

    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.

  17. Clinical features and management of Crohn's disease in Chinese patients

    Institute of Scientific and Technical Information of China (English)

    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.

  18. Bacteremia in previously healthy children in emergency departments: clinical and microbiological characteristics and outcome. (United States)

    Gomez, B; Hernandez-Bou, S; Garcia-Garcia, J J; Mintegi, S


    A blood culture (BC) is frequently requested in both patients with a suspected occult bacteremia/invasive infection as well as those with certain focal infections. Few data are available on the characteristics of patients in whom a bacteremia is identified in the Pediatric Emergency Department (PED). A prospective multicenter registry was established by the Spanish Pediatric Emergency Society. Epidemiological data, complementary test results, clinical management, and final outcome were recorded. Data from the first three years of the registry were analyzed. A true bacterial pathogen grew in 932 of 65,169 BCs collected [1.43 %; 95 % confidence interval (CI) 1.34-1.51 %], with 711 of them collected in patients without previously known bacteremia risk factors. Among them, 335 (47.1 %) were younger than 1 year old and 467 (65.7 %) had a normal Pediatric Assessment Triangle (PAT) on admission. Overall, the most frequently isolated bacterial species was Streptococcus pneumoniae (27.3 %; 47.6 % among patients with an altered PAT). The main pathogens were Escherichia coli (40.3 %) and S. agalactiae (35.7 %) among patients younger than 3 months, S. pneumoniae among patients 3-60 months old (40.0 %), and S. aureus (31.9 %) among patients over 60 months of age. Neisseria meningitidis was the leading cause of sepsis in patients older than 3 months. Eight patients died; none of them had a pneumococcal bacteremia and all had abnormal PAT findings on admission. S. pneumoniae is the main cause of bacteremia in patients without bacteremia risk factors who attended Spanish PEDs. Age and general appearance influence the frequency of each bacterial species. General appearance also influences the associated mortality.

  19. Clinical characteristics and survival of children with hepatoblastoma: Single centre experience

    Directory of Open Access Journals (Sweden)

    Krstovski Nada


    Full Text Available INTRODUCTION Hepatoblastoma is the most frequent malignant liver tumour of childhood and it accounts for 1% of all paediatric cancers. The outcome is significantly improved by introducing intensive chemotherapy regimens followed by complete surgical tumour resection. The long-term survival is 75-95% at present. OBJECTIVE To summarize clinical characteristics and treatment results in children with hepatoblastoma. METHOD The patients diagnosed with hepatoblastoma and treated at the Department of Haematology of the University Children's Hospital in Belgrade, between January 1995 and December 2007 were retrospectively analyzed. We analyzed mode of therapy, surgical management and patients' survival according to Kaplan Mayer statistical test. RESULTS Eleven patients were treated (ten boys and one girl, aged from 6 months to 13 years, mean 32 months, median 12 months. The most frequent presenting sign was abdominal distension. Routine laboratory examination showed elevated alpha-fetoprotein (AFP, range 147 to 44880 ng/ml, mean 8667 ng/ml. Ten patients (91% had elevated platelet count, range 450 to 909x109/l. Initial lung metastasis developed in 3 patients (27%. The diagnosis was established by an open surgical biopsy in 6 patients and after complete tumour resection in 4 patients, namely 2 patients after preoperative chemotherapy and in 2 patients with no previous chemotherapy. Histopathology verified hepatoblastoma in 10 patients: in 7 patients with epithelial type and in 3 patients with mixed epithelial-mesenchyme type. Six patients were in continuous remission with mean follow up of 58 months. One patient was lost to follow up. Four patients died; three patients due to disease progression and one patient due to sepsis after the first cycle of chemotherapy. CONCLUSION Combined preoperative chemotherapy with complete tumour resection followed by postoperative chemotherapy results in a high percentage of definitive cures.

  20. Clinical Characteristics and Urodynamic Analysis of Urinary Dysfunction in Multiple Sclerosis

    Institute of Scientific and Technical Information of China (English)

    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.

  1. Clinical characteristics, neurophysiological grade and outcome of patients with carpal tunnel syndrome A retrospective study

    Institute of Scientific and Technical Information of China (English)

    Jingxia Dang


    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

  2. Clinical and Biochemical Characteristics of Growth Hormone-Secreting Pituitary Tumors

    Institute of Scientific and Technical Information of China (English)


    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.

  3. Identifying an appropriate Content Management System to develop Clinical Practice Guidelines: A perspective. (United States)

    Reddy, Sandeep; Herring, Sally; Gray, Allison


    Clinical Practice Guidelines are widely used to inform and improve the quality and consistency of clinical practice. Developing and publishing Clinical Practice Guidelines is a complex task involving multiple components. Electronic Content Management Systems are increasingly employed to make this task more manageable. The Content Management System market offers a variety of options for publishing content on the Internet. However, there are limited products that comprehensively address the requirements of publishing Clinical Practice Guidelines. The authors are involved in publishing guidelines for remote clinical practitioners in Australia and present their perspective about identifying an appropriate Content Management System. Several elements essential to addressing their unique editing needs are defined in this article. Unfortunately, customisation is very expensive and laborious: few Content Management System providers can comprehensively meet the needs of Clinical Practice Guidelines publishing. Being pragmatic about the level of functionality a product can offer to support publication is essential.

  4. Incidence, frequency and clinical characteristics of type 3 myocardial infarction in clinical practice

    DEFF Research Database (Denmark)

    Jangaard, Nikolaj; Sarkisian, Laura; Saaby, Lotte


    the Danish Register of Causes of Death, ambulance and hospital patient files. Adjudication of the diagnosis was done by two local experts and one external senior cardiologist. RESULTS: A total of 2766 of the 246.723 adult residents in the region had died. A type 3 myocardial infarction was diagnosed in 18......OBJECTIVES: Cardiac death in a patient with symptoms and electrocardiographic changes indicative of myocardial ischemia but without available measurements of cardiac biomarkers is designated a type 3 myocardial infarction. We wanted to investigate the incidence, the frequency...... and the characteristics of patients diagnosed as type 3 myocardial infarction. METHODS: The occurrence of deaths in a well-defined geographic region was retrieved from the Danish Civil Registration System during a one-year period from 2010 to 2011. Complementary data concerning causes of deaths were obtained from...

  5. Restless legs syndrome in Parkinson's disease: clinical characteristics and biochemical correlations

    Directory of Open Access Journals (Sweden)

    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.

  6. Clinical features and management of intoxication due to hallucinogenic drugs. (United States)

    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.

  7. Anticoagulation manager: development of a clinical decision support mobile application for management of anticoagulants. (United States)

    Chih-Wen Cheng; Hang Wu; Thompson, Pamela J; Taylor, Julie R; Zehnbauer, Barbara A; Wilson, Karlyn K; Wang, May D


    Patients with certain clotting disorders or conditions have a greater risk of developing arterial or venous clots and downstream embolisms, strokes, and arterial insufficiency. These patients need prescription anticoagulant drugs to reduce the possibility of clot formation. However, historically, the clinical decision making workflow in determining the correct type and dosage of anticoagulant(s) is part science and part art. To address this problem, we developed Anticoagulation Manager, an intelligent clinical decision workflow management system on iOS-based mobile devices to help clinicians effectively choose the most appropriate and helpful follow-up clotting tests for patients with a common clotting profile. The app can provide physicians guidance to prescribe the most appropriate medication for patients in need of anticoagulant drugs. This intelligent app was jointly designed and developed by medical professionals in CDC and engineers at Georgia Tech, and will be evaluated by physicians for ease-of-use, robustness, flexibility, and scalability. Eventually, it will be deployed and shared in both physician community and developer community.

  8. Municipal solid waste management in Beijing: characteristics and challenges. (United States)

    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.

  9. [Multi-national clinical therapy studies. Design, management and costs]. (United States)

    Demol, P; Weihrauch, T R


    The development of new drugs requires increasingly the performance of large multinational clinical trials (MCT) with a common protocol. They must be planned when the demonstration of a hypothesis, which requires specific conditions (for example availability of patients with rare diseases, a particular infrastructure or expert knowledge in trial centers) has to be proven in an acceptable time. Our own experience has shown that such multinational trials are more time-consuming in their preparation and their analysis than multicenter trials which are run in one country. MCTs are associated with complex problems due to many differences in medical culture, treatment strategies, administrative guidelines, etc., between countries. When possible MCTs should be realized in countries and centers with relatively similar medical practices. A global coordination is necessary to control the progress of the trial in the different countries. The major requirements for the successful realisation of an MCT, from the writing of the first draft of the protocol until the publication of the results, are a well-coordinated multidisciplinary team and an effective project management.

  10. Scientific understanding and clinical management of Dupuytren disease. (United States)

    Shih, Barbara; Bayat, Ardeshir


    Dupuytren disease (DD) is a fibroproliferative disorder of unknown etiology that often results in shortening and thickening of the palmar fascia, leading to permanent and irreversible flexion contracture of the digits. This Review provides a detailed update of the scientific understanding of DD and its clinical management, with perspectives on emerging research and therapy. Established risk factors include genetic predisposition and ethnicity, as well as sex and age. Several environmental risk factors (some considered controversial) include smoking, alcohol intake, trauma, diabetes, epilepsy and use of anticonvulsant drugs, and exposure to vibration. DD has been variously attributed to the presence of oxygen free radicals, trauma to the palmar fascia, or aberrant immune responses with altered antigen presentation, or to interactions between these proposed mechanisms. The presence of immune cells and related phenomena in DD-affected tissue suggests that DD is possibly immune-related. Mechanically, digital contracture is caused by myofibroblasts in the DD palmar fascia; however, the exact origin of this cell type remains unknown. The mainstay of treatment is surgical release or excision of the affected palmodigital tissue, but symptoms often recur. Nonsurgical correction of DD contractures can be achieved by Clostridium histolyticum collagenase injection, although the long-term safety and recurrence rate of this procedure requires further assessment.

  11. Adult HIV care resources, management practices and patient characteristics in the Phase 1 IeDEA Central Africa cohort

    Directory of Open Access Journals (Sweden)

    Jules Mushingantahe


    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

  12. Clinical presentation and management of diabetes mellitus in pregnancy

    Directory of Open Access Journals (Sweden)

    Al-Azemi N


    Full Text Available Nasser Al-Azemi,1 Michael F Diejomaoh,1,2 Elisavet Angelaki,1 Asiya T Mohammed2 1Maternity Hospital, Shuwaikh, Kuwait; 2Department of Obstetrics and Gynecology, Faculty of Medicine, Kuwait University, Safat, Kuwait Objective: To evaluate the clinical presentation, management, and the outcome of diabetes mellitus in pregnancy. Methods: One hundred seventy-one patients with diabetes mellitus admitted between September 1, 2006, and June 30, 2008, to the labor room at Maternity Hospital in Kuwait for induction of labor made up the study population; while an equivalent number of patients without medical complications who also were admitted for induction of labor made up the control group. The patients were assessed at admission, and their medical data were extracted. The study and control patients were monitored through labor/puerperium, and the outcome was documented. Results: Gestational diabetes mellitus was diagnosed in 71.9% of the study patients, a past history of diabetes mellitus was recorded in 81.34% of the study patients, and 49.2% of the patients were admitted at 8–12 weeks of gestation for diabetic control. The mean weight gained in pregnancy was significantly higher for control patients (11.52±5.643 versus [vs] 9.90±5.757 kg/m2; P<0.009, and the body mass index of study patients was higher (32.00±6.160 vs 28.20±5.885 kg/m2; P<0.0001. Of the study population, 64.3% of the patients were managed with diet and increased physical activity and 35.7% with insulin, diet, and increased physical activity. The incidences of maternal morbidity in both study and control groups were comparable, and the incidence of preeclampsia was low, at 2.3%. The gestational age at delivery was higher in the control group (39.02±1.834 weeks vs 38.62±1.773 weeks; P<0.0001, and the percentage of cesarean deliveries was higher in the study population (44.4% vs 33.3%; P=0.046. The Apgar scores of the both groups were comparable and in the normal range, and the

  13. Can Psychological, Social and Demographical Factors Predict Clinical Characteristics Symptomatology of Bipolar Affective Disorder and Schizophrenia? (United States)

    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.

  14. Melancholic features in inpatients with major depressive disorder associate with differential clinical characteristics and treatment outcomes. (United States)

    Lin, Ching-Hua; Huang, Chun-Jen; Liu, Shi-Kai


    To determine whether the presence of melancholic features in hospitalized patients with major depressive disorder (MDD) was associated with specific clinical characteristics and treatment outcomes, supporting melancholic depression as a distinct subtype within MDD. 126 acutely ill inpatients with MDD were enrolled in an open, 6-week trial with fixed-dose fluoxetine 20mg daily. Symptom severity was assessed regularly, using the 17-item Hamilton Depression Rating Scale (HAMD-17) and Clinical Global Impression of Severity (CGI-S). Melancholic features were defined according to the DSM-IV criteria. Clinical variables were compared between patients with and without melancholic features. Generalized estimating equations method was used to explore the differences in HAMD-17 and CGI-S scores between the 2 groups over time. Clinical response was defined as having a 50% or greater reduction in HAMD-17 scores. 96 (76.2%) of the 126 patients with at least one post-baseline assessment met the criteria for melancholic depression. Melancholic depression differed from non-melancholic depression in clinical characteristics and predicted a better response to fluoxetine treatment. The differentiation between melancholic and non-melancholic depression within MDD hence is clinically significant and valid.

  15. ClinData Express – A Metadata Driven Clinical Research Data Management System for Secondary Use of Clinical Data


    Li, Zuofeng; Wen, Jingran; Zhang, Xiaoyan; Wu, Chunxiao; Li, Zuogao; Liu, Lei


    Aim to ease the secondary use of clinical data in clinical research, we introduce a metadata driven web-based clinical data management system named ClinData Express. ClinData Express is made up of two parts: 1) m-designer, a standalone software for metadata definition; 2) a web based data warehouse system for data management. With ClinData Express, what the researchers need to do is to define the metadata and data model in the m-designer. The web interface for data collection and specific dat...

  16. Impact of clinical pathway on clinical outcomes in the management of COPD exacerbation

    Directory of Open Access Journals (Sweden)

    Ban Andrea


    Full Text Available Abstract Background Exacerbations, a leading cause of hospitalization in patients with chronic obstructive pulmonary disease (COPD, affect the quality of life and prognosis. Treatment recommendations as provided in the evidence-based guidelines are not consistently followed, partly due to absence of simplified task-oriented approach to care. In this study, we describe the development and implementation of a clinical pathway (CP and evaluate its effectiveness in the management of COPD exacerbation. Methods We developed a CP and evaluated its effectiveness in a non-randomized prospective study with historical controls on patients admitted for exacerbation of COPD to Universiti Kebangsaan Malaysia Medical Centre (UKMMC. Consecutive patients who were admitted between June 2009 and December 2010 were prospectively recruited into the CP group. Non-CP historical controls were obtained from case records of patients admitted between January 2008 and January 2009. Clinical outcomes were evaluated by comparing the length of stay (LOS, complication rates, readmissions, and mortality rates. Results Ninety-five patients were recruited in the CP group and 98 patients were included in the non-CP historical group. Both groups were comparable with no significant differences in age, sex and severity of COPD (p = 0.641. For clinical outcome measures, patients in the CP group had shorter length of stay than the non-CP group (median (IQR: 5 (4–7 days versus 7 (7–9 days, p p  Conclusion The implementation of CP –reduced the length of stay and complication rates of patients hospitalized for acute exacerbation of COPD.

  17. The need for hospital care of patients with clinically localized prostate cancer managed by noncurative intent

    DEFF Research Database (Denmark)

    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....

  18. Stimulating Healthy Aging with a Model Nurse-Managed Free Clinic in a Senior Center. (United States)

    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…

  19. Clinical characteristics of early- and late-onset gout: A cross-sectional observational study from a Chinese gout clinic. (United States)

    Zhang, Bingqing; Fang, Weigang; Zeng, Xuejun; Zhang, Yun; Ma, Ya; Sheng, Feng; Zhang, Xinlei


    A retrospective cross-sectional study using data from an outpatient clinic in China was conducted to investigate the clinical features of early-onset gout patients.All patients diagnosed with gout were asked about clinical characteristics of their gout and comorbid diseases. Patients presenting with acute flares were asked about common triggers before the flare. "Early-onset" gout was defined as onset of gout before 40 years and "late-onset" as onset ≥40 years. Major joint involvement, flare frequency before presentation, the cumulative number of involved joints, proportions of tophi complications at presentation, flare triggers, as well as any metabolic, cardiovascular, cerebrovascular, and renal comorbidities, were compared between the 2 groups.A total of 778 gout patients were enrolled in this study, including 449 (57.7%) in the early-onset group and 329 (42.3%) in the late-onset group. Compared with the late-onset gout patients, the early-onset gout patients had a higher proportion of ankle/mid-foot involvement (62.8% vs 48.2%, P gout patients had fewer metabolic, cardiovascular, cerebrovascular, or renal complications.Early- and late-onset gout patients had different clinical features. Early-onset seems to be influenced more by lifestyle, while late-onset patients have more complications because of comorbidities.

  20. Classic Kaposi’s sarcoma: The clinical, demographic and teratment characteristics of seventy-four patients

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    Beril Gülüş Demirel


    Full Text Available Background and Design: Classic Kaposi's sarkoma (CKS is a rare disease, generally seen across Mediterranean and the Middle East region. It's an angioproliferative disorder associated with human herpes virus-8 infection. There is a few data on epidemiology and clinical characteristics among Turkish patients with CKS. This study aims to evaluate epidemiologic, clinical characteristics and treatment results in patients with the diagnosis of CKS in Zonguldak. Materials and Methods: We retrospectively evaluated the hospital records of patients with CKS who attended the dermatological and venereal diseases department between 2003 and 2014. Seventy-four patients were included in this study. Demographic and clinical characteristics, applied treatments and responses to treatments were evaluated. Results: During the eleven year examination period, 74 CKS patients have been diagnosed in the dermatology clinic. The prevalence of CKS among dermatologic patients was found to be 0.02%. Patient age at diagnosis ranged from 33 to 90 years (mean: 70.2±11.7. Fifty-two patients were male (70.3% and 22 patients were female (29.7%. Multiple nodules were the most frequently seen clinical forms and the distal lower extremity was the most common site of involvement (80.6%. According to the CKS staging system, it was observed that 47 patients (62.7% were at stage 1, 11 patients (15.49% at stage 2, eight patients (10.7% at stage 3, and six patients (8% were at stage 4. Treatment options were excision for 35.1% of patients (n=26, radiotherapy for 25.7% of patients (n=19, cryosurgery for 14.9% of patients (n=11, and chemotherapy for 10.8% of patients (n=8. Relapse was found to occur most commonly after excision (58.3%. Conclusion: Larger, multicenter studies are needed in order to determine the prevalence of CKS and characteristics of patients with CKS in our country.

  1. CT of jejunal diverticulitis: imaging findings, differential diagnosis, and clinical management

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    Macari, M.; Faust, M.; Liang, H.; Pachter, H.L


    Aim: To describe the imaging findings of jejunal diverticulitis as depicted at contrast-enhanced computed tomography (CT) and review the differential diagnosis and clinical management. Materials and Methods: CT and pathology databases were searched for the diagnosis of jejunal diverticulitis. Three cases were identified and the imaging and clinical findings correlated. Results: Jejunal diverticulitis presents as a focal inflammatory mass involving the proximal small bowel. A trial of medical management with antibiotics may be attempted. Surgical resection may be required if medical management is unsuccessful. Conclusion: The imaging findings at MDCT may allow a specific diagnosis of jejunal diverticulitis to be considered and may affect the clinical management of the patient.

  2. Clinical engineering and risk management in healthcare technological process using architecture framework. (United States)

    Signori, Marcos R; Garcia, Renato


    This paper presents a model that aids the Clinical Engineering to deal with Risk Management in the Healthcare Technological Process. The healthcare technological setting is complex and supported by three basics entities: infrastructure (IS), healthcare technology (HT), and human resource (HR). Was used an Enterprise Architecture - MODAF (Ministry of Defence Architecture Framework) - to model this process for risk management. Thus, was created a new model to contribute to the risk management in the HT process, through the Clinical Engineering viewpoint. This architecture model can support and improve the decision making process of the Clinical Engineering to the Risk Management in the Healthcare Technological process.

  3. An update of clinical management of acute intermittent porphyria

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    Pischik E


    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

  4. The Impact of Demographic, Clinical, Symptom and Psychological Characteristics on the Trajectories of Acute Postoperative Pain After Total Knee Arthroplasty (United States)

    Miaskowski, Christine; Rustøen, Tone; Rosseland, Leiv Arne; Paul, Steven M.; Cooper, Bruce A.; Lerdal, Anners


    Objective. Total knee arthroplasty is a painful procedure. No studies have evaluated modifiable predictors of acute postoperative pain trajectories during hospitalization. Methods. Consecutive patients (N = 188) were enrolled in a longitudinal cohort study and completed a demographic questionnaire, as well as the Brief Pain Inventory, Hospital Depression and Anxiety Scale, Lee Fatigue Scale, Fatigue Severity Scale, and Brief Illness Perception Questionnaire on the day before surgery. Clinical data were extracted from medical records. Setting and Patients. Each patient completed a pain diary that assessed pain at rest and with activity, and hours per day in pain every evening from day of surgery until postoperative day 3. Using hierarchical linear modeling, we investigated which demographic, clinical, symptom, and psychological characteristics predicted initial levels as well as the trajectories of acute pain at rest and with activity, and hours per day in pain. Results. Higher levels of all three acute pain characteristics on the day of surgery resulted in worse trajectories. Higher pain scores with rest and with activity on the day of surgery were associated with more days with femoral block, higher average dose of opioids, and higher emotional response to osteoarthritis. Higher number of comorbidities, higher average dose of opioids, and lower perceived control predicted more hours per day in pain on the day of surgery. Conclusions. This study identified several potentially modifiable predictors of worsening pain trajectories following total knee arthroplasty. Optimal pain management warrants identification of these high-risk patients and treatment of modifiable risk factors. PMID:27165969

  5. Towards knowledge-based systems in clinical practice: development of an integrated clinical information and knowledge management support system. (United States)

    Kalogeropoulos, Dimitris A; Carson, Ewart R; Collinson, Paul O


    Given that clinicians presented with identical clinical information will act in different ways, there is a need to introduce into routine clinical practice methods and tools to support the scientific homogeneity and accountability of healthcare decisions and actions. The benefits expected from such action include an overall reduction in cost, improved quality of care, patient and public opinion satisfaction. Computer-based medical data processing has yielded methods and tools for managing the task away from the hospital management level and closer to the desired disease and patient management level. To this end, advanced applications of information and disease process modelling technologies have already demonstrated an ability to significantly augment clinical decision making as a by-product. The wide-spread acceptance of evidence-based medicine as the basis of cost-conscious and concurrently quality-wise accountable clinical practice suffices as evidence supporting this claim. Electronic libraries are one-step towards an online status of this key health-care delivery quality control environment. Nonetheless, to date, the underlying information and knowledge management technologies have failed to be integrated into any form of pragmatic or marketable online and real-time clinical decision making tool. One of the main obstacles that needs to be overcome is the development of systems that treat both information and knowledge as clinical objects with same modelling requirements. This paper describes the development of such a system in the form of an intelligent clinical information management system: a system which at the most fundamental level of clinical decision support facilitates both the organised acquisition of clinical information and knowledge and provides a test-bed for the development and evaluation of knowledge-based decision support functions.

  6. Management of posttraumatic brain swelling based on clinical typing

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    刘伟国; 裘五四; 沈宏; 王卫民


    Objective: To investigate the clinical typing and prophylactico-therapeutic measures for acute posttraumatic brain swelling (BS).Methods: A retrospective study was performed in 66 cases of acute posttraumatic BS. There were 3 groups based on computered tomography (CT) scanning: 23 cases of hemisphere brain swelling (HBS) with middle line shift for less than 5 mm within 24 hours ( Group A), 20 with middle line shift for more than 5 mm (Group B ), and 23 with bilateral diffuse brain swelling (Group C).Results : (1) The mortality rates of the operative and nonoperative management in Group A, Group B, and Group C were 20.0%, 31.6%, and 75.0% versus 44.4%,0, and 85.7 %, respectively ( P > 0.05 ); while the rates in subgroups with different middle line shift ( more than 5 mm and less or equal 5 mm) were 29.2% and 75.0% versus 75.0% and 44.4%, respectively (0.05 >P >0.01). (2) The good recovery rate and mortality in Group A were 47.8 % and 39.1%, respectively and in Group C, 8.7 % and 78.3%, respectively. There was a very significant difference between Group A and Group C (P <0.01). (3) The total survival rate of the selective comprehensive therapy was 53.1%.Conclusions : ( 1 ) Acute posttraumatic BS needs to be diagnosed correctly and promptly with CT scanning within 4 hours. (2) For patients with midline shift for more than 5 mm, especially with thin-layered subdural hematoma,surgical intervention is essential to reduce the fatality of acute posttraumatic BS.


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    Full Text Available BACKGROUND AND OBJECTIVES ALA has gained importance during recent years as a result of increasing world travel, economic globalization and the growing number of chronically immunosuppressed people. AIDS and the increasing use of organ transplants have led to a new population at risk. In our study we aimed to analyse the clinical presentation and management of Amoebic liver abscess at Sree Rajarajeshwari Medical College and Hospital, Bangalore. METHODS A hospital based prospective observational study was conducted between Dec. 2013 to June 2015 in Sree Rajarajeshwari Medical College and Hospital, Bangalore. All patients admitted with suspicion of liver abscess were confirmed with ultrasonography. After establishing sonological diagnosis according to criteria, the treatment was started from the day of admission which consisted of Antibiotics, USG guided Aspiration, Pigtail catheterization and Open surgical Drainage. RESULTS Forty five cases of Amoebic liver abscess were studied; 28 patients (62% were between 21 and 40 years of age. Male-to-Female ratio was 14:1. All the patients were from rural background. History of alcoholism was present in 10 patients (22.2%. Plain X-ray abdomen showed signs of peritonitis in 2 patients. Right lobe of liver was involved in 40 cases and left lobe in 3 cases. Both lobes were involved in 2 cases. Twenty six cases were treated conservatively, 11 cases by aspiration, 6 patients by pigtail catheterization. Two patients underwent open surgical drainage for perforated liver abscess. Complications noted in our series were rupture into peritoneal cavity in 2 cases; mortality was seen in 1 case. CONCLUSION Amoebic liver abscess is still one of the commonest parasitic infections of the liver in developing countries. Prompt diagnosis, aggressive medical treatment along with minimal intervention can keep the morbidity and mortality associated with this condition to a bare minimum. The scope of surgery in this condition is

  8. Guillain-Barré syndrome: clinical profile and management

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    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.


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    Thais das Neves Fraga MOREIRA

    Full Text Available SUMMARY BCG adverse events (BCG-AE are rare conditions with no well-established treatment. This study aims to describe clinical characteristics and outcome of localized BCG-AE. Children with BCG-AEs who were treated at the Reference Center for Special Immunobiologicals of the Federal University of São Paulo from 2009 to 2011 were included. Patients were followed monthly until 3 months after healing. One hundred and twenty-seven patients with localized BCG-AE were followed: 67 (52.7% had suppurative lymphadenitis; 30 (23.6% injection-site abscess; five (3.9% had enlarged lymph node > 3 cm; four (3.1% had ulcer > 1 cm; and one (0.8% had a local bacterial infection. Five patients (3.9% had more than one BCG-AE simultaneously. Fifteen patients (11.8% had atypical manifestations: seven wart-like lesions; five BCG reactivations; two other dermatologic lesions and one with vasomotor phenomenon. Isoniazid was used in 96 patients with typical BCG-AE (85.7% until lesion resolution which took place 3.1 months later (in median; the healing rate was 90.6%. Patients with atypical manifestations had an individual approach. Regarding the outcome, 105/112 patients with typical AE and 13/15 patients with atypical AE had resolution of BCG-AE. Localized BCG-AE caused by BCG Moreau RJ had positive outcome when treated with a short course of isoniazid. Atypical BCG-AE are not infrequent.

  10. Sociodemographic and Clinical Predictors of Self-Management among People with Poorly Controlled Type 1 and Type 2 Diabetes: The Role of Illness Perceptions and Self-Efficacy

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    Abdul-Razak Abubakari


    Full Text Available 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.

  11. Sociodemographic and Clinical Predictors of Self-Management among People with Poorly Controlled Type 1 and Type 2 Diabetes: The Role of Illness Perceptions and Self-Efficacy. (United States)

    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.

  12. Measuring clinical management by physicians and nurses in European hospitals: development and validation of two scales



    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 Testing of validity and reliability of scales derived from a questionnaire of 21 items was developed on the basis of a previous study and expert opinion and administered in a cross-sectional seven-cou...

  13. Characteristics of operations at fish-landing sites managed by private owners in Thailand


    Yoshimura, Mika; Okamoto, Junichiro; Yasuma, Hiroki; Kimura, Nobuo


    This study presents the results of a survey on the operation characteristics of landing sites managed by private owners in Thailand. The survey was conducted by interviewing private landing site owners, managers of fishery cooperatives, middlemen, and fishers. The results of interviews were summarized with respect to scale of business, fisheries, transaction, types of people associated with landing sites, location, and daily schedule. Landing sites were located along canals in coastal provinc...

  14. Diet Activity Characteristic of Large-scale Sports Events Based on HACCP Management Model

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    Xiao-Feng Su


    Full Text Available The study proposed major sports events dietary management based on "HACCP" management model. According to the characteristic of major sports events catering activities. Major sports events are not just showcase level of competitive sports activities which have become comprehensive special events including social, political, economic, cultural and other factors, complex. Sporting events conferred reach more diverse goals and objectives of economic, political, cultural, technological and other influence and impact.

  15. Metaanalysis vs large clinical trials: which should guide our management? (United States)

    Scifres, Christina M; Iams, Jay D; Klebanoff, Mark; Macones, George A


    Large, randomized clinical trials have long been considered the gold standard to guide clinical care. Metaanalysis is a type of analysis in which results of a number of randomized clinical trials are combined and a summary measure of effect for a given treatment is ascertained. The clinician in practice often is faced with a dilemma regarding the type of evidence that should be used to guide clinical practice; for many clinical problems, there are both randomized controlled trials and metaanalyses available. The cases of calcium and aspirin therapy for the prevention of preeclampsia afford an opportunity to explore the benefits and limitations of each type of study to guide clinical practice. We conclude that, when available, large randomized clinical trials should be used to guide clinical practice.

  16. Clinical teaching of student nurses by unit managers of selected hospitals in Limpopo Province

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    LA Murathi


    Full Text Available The comprehensive nature of nurse training needs the involvement of almost all health team personnel, including unit managers to gain practical experience and learn to correlate theory and practice. The overall aim of the study was to explore and describe the experiences of unit managers regarding teaching of student nurses in the clinical area and to develop recommendations that will enhance clinical teaching, for the production of competent future nurse practitioners who will render quality care to patients. A qualitative design, which is explorative, descriptive and contextual in nature, was employed, utilizing a phenomenological approach to capture the experiences of unit managers regarding teaching of student nurses at selected hospitals, where students are allocated for their clinical exposure. Ethical measures as well as measures to ensure trustworthiness were adhered to. In-depth phenomenological interviews were conducted with unit managers who shared their experiences regarding clinical teaching of student nurses. Data analysis was done according to Tesch’s (1990 open coding method. One major theme emerged, namely that unit managers experienced problems when doing clinical teaching of student nurses. Based on the findings the following recommendations were made: Colleges should open a two-way communication with unit managers, involvement of unit managers in the activities that take place at the college like courses, seminars and workshops on clinical teaching, learning contracts should be developed for the students and issues of clinical learning should be addressed and unit managers should be included in both summative and formative evaluations.

  17. Self-perceived health and clinical characteristics in young adult students from the brazilian northeast

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    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.

  18. Etiology of aseptic meningitis and clinical characteristics in immune-competent adults. (United States)

    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.

  19. [Clinical characteristics of splenic marginal zone lymphoma with abnormal complete blood count]. (United States)

    Yang, Shen-Miao; Jiang, Qian; Jiang, Bin; Chen, Ding-Bao; Wang, Jing; Jiang, Hao; Lu, Jin; Lu, Xi-Jing; Bao, Li; Shi, Hong-Xia; Liu, Yan-Rong; Huang, Xiao-Jun


    The aim of this study was to investigate the clinical and laboratorial characteristics of splenic marginal zone lymphoma (SMZL) with an abnormal complete blood count (CBC). Data of 19 newly diagnosed SMZL patients with abnormal CBC were analyzed retrospectively. Seven patients were diagnosed by using splenic histology, 12 patients who did not undergo splenectomy were diagnosed on the basis of typical clinical presentation and cytologic, immunophenotypic and histologic characteristics of peripheral blood and bone marrow, according to SBLG guidelines. The results showed that leukocytosis (≥ 10.0×10(9)/L) was seen in 5 cases (26.3%); leukocytopenia (complete response was achieved in 9 out of 11 (81.8%) patients. It is concluded that SMZL with abnormal CBC has a higher incidence of cytopenia, bone marrow involvement and autoimmune phenomena. Therapeutic strategies consisting of Rituximab show a better efficacy.

  20. Clinical characteristics of healthcare-associated pneumonia in a public hospital in a metropolitan area of Japan. (United States)

    Sugisaki, Midori; Enomoto, Tatsuji; Shibuya, Yasuhiro; Matsumoto, Aki; Saitoh, Hitoshi; Shingu, Akiko; Narato, Ritsuko; Nomura, Koichiro


    Healthcare-associated pneumonia (HCAP) is a new category that is essential in the present aging society. Knowing the different characteristics and outcomes between patients with HCAP and community-acquired pneumonia (CAP) would help physicians manage and treat HCAP patients. Although HCAP is thought to be heterogeneous in regions, there are no reports from a metropolitan area in Japan. We retrospectively reviewed the clinical findings of all consecutive pneumonia patients who required hospitalized care in our hospital between April 2006 and March 2010. There were 184 (35.0%) patients with HCAP and 342 (65.0%) patients with CAP. Previous hospitalization within 90 days of the infection was the most common criterion for HCAP (63.0%). HCAP patients were significantly older than CAP patients (82.5 vs. 70.0 years, P nutritional status and high severity scores on the pneumonia severity scoring system.

  1. The Structure of Pathological Gambling among Korean Gamblers: A Cluster and Factor Analysis of Clinical and Demographic Characteristics (United States)

    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…

  2. The clinical characteristics and prognostic analysis of gastric mucosa-associated lymphoid tissue lymphoma of 103 cases

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    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

  3. Demographic, clinical and antibody characteristics of patients with digital ulcers in systemic sclerosis

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    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...

  4. Clinical characteristics and epidermal barrier function of papulopustular rosacea: A comparison study with acne vulgaris


    Zhou, Maosong; Xie, Hongfu; Cheng, Lin; Li, Ji


    Objective: To evaluate the clinical characteristics and epidermal barrier function of papulopustular rosacea by comparing with acne vulgaris. Methods: Four hundred and sixty-three papulopustular rosacea patients and four hundred and twelve acne vulgaris patients were selected for the study in Xiangya Hospital of Central South University from March 2015 to May 2016. They were analyzed for major facial lesions, self-conscious symptoms and epidermal barrier function. Results: Erythema, burning, ...

  5. The counseling african americans to control hypertension (caatch) trial: baseline demographic, clinical, psychosocial, and behavioral characteristics


    Diaz-Gloster Marleny; Cassells Andrea; Tobin Jonathan N; Fernandez Senaida; Kalida Chamanara; Ogedegbe Gbenga


    Abstract Background Effectiveness of combined physician and patient-level interventions for blood pressure (BP) control in low-income, hypertensive African Americans with multiple co-morbid conditions remains largely untested in community-based primary care practices. Demographic, clinical, psychosocial, and behavioral characteristics of participants in the Counseling African American to Control Hypertension (CAATCH) Trial are described. CAATCH evaluates the effectiveness of a multi-level, mu...

  6. Assessment of the Influence of Demographic and Professional Characteristics on Health Care Providers' Pain Management Decisions Using Virtual Humans. (United States)

    Boissoneault, Jeff; Mundt, Jennifer M; Bartley, Emily J; Wandner, Laura D; Hirsh, Adam T; Robinson, Michael E


    Disparities in health care associated with patients' gender, race, and age are well documented. Previous studies using virtual human (VH) technology have demonstrated that provider characteristics may play an important role in pain management decisions. However, these studies have largely emphasized group differences. The aims of this study were to examine dentists' and physicians' use of VH characteristics when making clinical judgments (i.e., cue use) and to identify provider characteristics associated with the magnitude of the impact of these cues (β-weights). Providers (N=152; 76 physicians, 76 dentists) viewed video vignettes of VH patients varying in gender (male/female), race (white/black), and age (younger/older). Participants rated VH patients' pain intensity and unpleasantness and then rated their own likelihood of administering non-opioid and opioid analgesics. Compared to physicians, dentists had significantly lower β-weights associated with VH age cues for all ratings (p0.69). These effects varied by provider race and gender. For pain intensity, professional differences were present only among non-white providers. White providers had greater β-weights than non-white providers for pain unpleasantness but only among men. Provider differences regarding the use of VH age cues in non-opioid analgesic administration were present among all providers except non-white males. These findings highlight the interaction of patient and provider factors in driving clinical decision making. Although profession was related to use of VH age cues in pain-related clinical judgments, this relationship was modified by providers' personal characteristics. Additional research is needed to understand what aspects of professional training or practice may account for differences between physicians and dentists and what forms of continuing education may help to mitigate the disparities.

  7. Intraductal Oncocytic Papillary Neoplasm Having Clinical Characteristics of Mucinous Cystic Neoplasm and a Benign Histology

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    Takatomi Oku


    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.

  8. Gender difference of clinical characteristics in Chinese patients with spontaneous variant angina

    Institute of Scientific and Technical Information of China (English)

    ZHU Cheng-gang; GUO Yuan-lin; GAO Zhan; ZHENG Xin; LI Jian-jun; XU Yan-lu; YUAN Jin-qing; QIN Xue-wen; YANG Yue-jin; QIAO Shu-bin; CHEN Ji-lin; CHEN Zai-jia


    Background Spontaneous attack of variant angina (VA) is a unique component of coronary artery disease (CAD), and associated with severe cardiac events. However, no data are available regarding sex differences in Chinese patients with spontaneous attacks of VA. Accordingly, the present retrospective study was initiated to evaluate the Clinical characteristics of Chinese female patients with spontaneous attacks of VA.Methods From January 2003 to January 2008, a total of 209 patients were diagnosed to have had a spontaneous attack of VA at Fu Wai Hospital. Of them, 27 were female, and their clinical findings were collected and compared with male patients for aspects of risk factors, clinical features and angiographical findings.Results Spontaneous attacks of VA was relatively uncommon in female (12.9%) compared with male patients. The female patients were less likely to have a history of smoking (14.8% vs. 79.7%, P <0.001), more likely to have a family history of CAD (33.3% vs. 11.0%, P<0.01), and to have had a greater incidence of ventricular fibrillation during attack (11.1% vs. 2.2%, P<0.05). There were no significant differences in other characteristics between the two groups.Conclusion Chinese female patients who experienced a spontaneous attack of VA had the characteristics of less smoking history, more family history of CAD and higher occurrence of ventricular fibrillation than male patients.

  9. Reporting of research quality characteristics of studies published in 6 major clinical dental specialty journals. (United States)

    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.

  10. Biological characteristics and clinical outcome of triple negative primary breast cancer in older women - comparison with their younger counterparts.

    Directory of Open Access Journals (Sweden)

    Binafsha M Syed

    Full Text Available Triple negative (ER, PgR and HER2 negative breast cancers (TNBCs are often considered as a poor prognostic phenotype. There is dearth of evidence showing the prevalence and biological behaviour of TNBCs in older women. This study aimed to analyse their biological characteristics in comparison with a well characterised younger series from a single centre with long term clinical follow-up. Over 37 years (1973-2010, 1,758 older (≥70 years women with early operable (<5 cm primary breast cancer were managed in a dedicated clinic and have complete clinical information available. Of these 813 patients underwent primary surgery and 575 had good quality tumour samples available for tissue microarray analysis using indirect immunohistochemistry. A total of 127 patients (22.1% had TNBCs and full biological analysis of 15 biomarkers was performed. The results were compared with those of their younger (<70 years counterparts 342 (18.9% from a previously characterised, consecutive series of primary breast cancer treated in the same unit (1986-1998. The 127 older patients with TNBCs showed lower rates of Ki67 and CK 7/8 positivity and high rates of bcl2 and CK18 positivity when compared with their younger counterparts (p<0.05. There was no significant difference in the long term clinical outcome between the two age groups, despite the fact that 47% of the younger patients had adjuvant chemotherapy, while none in the older cohort received such treatment. EGFR, axillary stage and pathological size showed prognostic significance in older women with TNBCs on univariate analysis. Despite not having received adjuvant chemotherapy, the older series had clinical outcome similar to the younger patients almost half of whom had chemotherapy. This appears to be related to other biomarkers (in addition to ER/PgR/HER2 eg Ki67, bcl2 and cytokeratins which have different expression patterns influencing prognosis.

  11. PSA testing without clinical indication for prostate cancer in relation to socio-demographic and clinical characteristics in the Danish Diet, Cancer and Health Study

    DEFF Research Database (Denmark)

    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...

  12. Idiopathic Inflammatory Myopathies; Association with Overlap Myositis and Syndromes: Classification, Clinical Characteristics, and Associated Autoantibodies

    Directory of Open Access Journals (Sweden)

    Pari Basharat


    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.

  13. Incidence and clinical characteristics of fungal keratitis in a Danish population from 2000 to 2013

    DEFF Research Database (Denmark)

    Nielsen, Stine E; Nielsen, Esben; Julian, Hanne Olsen;


    PURPOSE: Fungal keratitis is a severe sight-threatening condition. The aim of this study was to investigate the incidence and clinical characteristics of fungal keratitis patients living in a temperate climate. METHODS: By reviewing medical records from 2000 to July 2013, patients with fungal...... keratitis were identified. Risk factors, clinical signs and outcome were registered. RESULTS: Twenty-five patients were identified: 52% with Candida, 20% with Fusarium, 16% with Aspergillus and 12% with mixed filamentous fungi. A minimum incidence of fungal keratitis of 0.6 cases per million per year...... with corneal transplantation. Patients with Candida infections had a significantly worse visual outcome. CONCLUSION: We found that patients with fungal keratitis had a poor visual outcome. However, knowledge of risk factors and clinical signs leading to early treatment can improve the prognosis....

  14. Open-label randomized trial of titrated disease management for patients with hypertension: Study design and baseline sample characteristics. (United States)

    Jackson, George L; Weinberger, Morris; Kirshner, Miriam A; Stechuchak, Karen M; Melnyk, Stephanie D; Bosworth, Hayden B; Coffman, Cynthia J; Neelon, Brian; Van Houtven, Courtney; Gentry, Pamela W; Morris, Isis J; Rose, Cynthia M; Taylor, Jennifer P; May, Carrie L; Han, Byungjoo; Wainwright, Christi; Alkon, Aviel; Powell, Lesa; Edelman, David


    Despite the availability of efficacious treatments, only half of patients with hypertension achieve adequate blood pressure (BP) control. This paper describes the protocol and baseline subject characteristics of a 2-arm, 18-month randomized clinical trial of titrated disease management (TDM) for patients with pharmaceutically-treated hypertension for whom systolic blood pressure (SBP) is not controlled (≥140mmHg for non-diabetic or ≥130mmHg for diabetic patients). The trial is being conducted among patients of four clinic locations associated with a Veterans Affairs Medical Center. An intervention arm has a TDM strategy in which patients' hypertension control at baseline, 6, and 12months determines the resource intensity of disease management. Intensity levels include: a low-intensity strategy utilizing a licensed practical nurse to provide bi-monthly, non-tailored behavioral support calls to patients whose SBP comes under control; medium-intensity strategy utilizing a registered nurse to provide monthly tailored behavioral support telephone calls plus home BP monitoring; and high-intensity strategy utilizing a pharmacist to provide monthly tailored behavioral support telephone calls, home BP monitoring, and pharmacist-directed medication management. Control arm patients receive the low-intensity strategy regardless of BP control. The primary outcome is SBP. There are 385 randomized (192 intervention; 193 control) veterans that are predominately older (mean age 63.5years) men (92.5%). 61.8% are African American, and the mean baseline SBP for all subjects is 143.6mmHg. This trial will determine if a disease management program that is titrated by matching the intensity of resources to patients' BP control leads to superior outcomes compared to a low-intensity management strategy.

  15. Pathogenesis, clinical features and management of recurrent corneal erosions. (United States)

    Ramamurthi, S; Rahman, M Q; Dutton, G N; Ramaesh, K


    now a well-established treatment modality for RCE and is being used both safely and effectively. Partial ablation of Bowman's layer with PTK gives a smooth surface for the newly generating epithelium to migrate and form adhesion complexes. The pathogenesis, clinical features, and management options of this common disorder are discussed in this review article.

  16. Moyamoya disease and syndromes: from genetics to clinical management

    Directory of Open Access Journals (Sweden)

    Guey S


    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

  17. Diabetes at work. Fatigue in relation to job characteristics, diabetes symptoms and self-management

    NARCIS (Netherlands)

    Weijman, Iris


    The focus of this thesis is on employees with diabetes. Fatigue, work characteristics and diabetes self-management are core aspects. Diabetes may have many consequences in the working situation and is expected to become an even bigger health problem, because the number of people with diabetes is gro

  18. Prevalence, characteristics, and management of childhood functional abdominal pain in general practice

    NARCIS (Netherlands)

    L.A.A. Spee (Leo); Y. Lisman-van Leeuwen (Yvonne); M.A. Benninga (Marc); S.M. Bierma-Zeinstra (Sita); M.Y. Berger (Marjolein)


    textabstractObjective. To (i) describe the proportion of children presenting with abdominal pain diagnosed by the GP as functional abdominal pain (GPFAP); (ii) evaluate the association between patient and disease characteristics and GPFAP; (iii) describe diagnostic management by the GP in children p

  19. Characteristics of Interactional Management Functions in Group Oral by Japanese Learners of English (United States)

    Negishi, Junko


    This study attempted to investigate the characteristics of interaction dynamics in a group oral interaction carried out by Japanese learners of English. The relationship between the participants' language development and interactional management functions (IMFs) was also explored. Oral performance tests in a paired or a small group have recently…

  20. Soil organic matter distribution and microaggregate characteristics as affected by agricultural management and earthworm activity

    NARCIS (Netherlands)

    Pulleman, M.M.; Six, J.; Breemen, van N.; Jongmans, A.G.


    Stable microaggregates can physically protect occluded soil organic matter (SOM) against decomposition. We studied the effects of agricultural management on the amount and characteristics of microaggregates and on SOM distribution in a marine loam soil in the Netherlands. Three long-term farming sys