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Sample records for clinical group case-mix

  1. Variability in prescription drug expenditures explained by adjusted clinical groups (ACG case-mix: A cross-sectional study of patient electronic records in primary care

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    Serrat Josep

    2008-03-01

    Full Text Available Abstract Background In view of rapidly increasing prescription costs, case-mix adjustment should be considered for effective control of costs. We have estimated the variability in pharmacy costs explained by ACG in centers using patient electronic records, profiled centers and physicians and analyzed the correlation between cost and quality of prescription. Methods We analyzed 65,630 patient records attending five primary care centers in Spain during 2005. Variables explored were age, gender, registered diagnosed episodes of care during 2005, total cost of prescriptions, physician and center. One ACG was assigned to each patient with ACG case-mix software version 7.1. In a two-part model, logistic regression was used to explain the incurrence of drug expenditure at the first stage and a linear mixed model that considered the multilevel structure of data modeled the cost, conditional upon incurring any expense. Risk and efficiency indexes in pharmacy cost adjusted for ACG were obtained for centers and physicians. Spearman rank correlation between physician expenditure, adjusted for ACG, and a prescription quality index was also obtained. Pediatric and adult data were analyzed separately. Results No prescription was recorded for 13% of adults and 39.6% of children. The proportion of variance of the incurrence of expenditure explained by ACGs was 0.29 in adults and 0.21 in children. For adults with prescriptions, the variance of cost explained by ACGs was 35.4%, by physician-center was 1.8% and age 10.5% (residual 52.3%. For children, ACGs explained 22.4% of cost and physician-center 10.9% (residual 66.7%. Center efficiency index for adults ranged 0.58 to 1.22 and for children 0.32 to 2.36. Spearman correlation between expenditure and prescription quality index was -0.36 in family physicians (p = 0.019, N = 41 and -0.52 in pediatricians (p = 0.08, N = 12. Conclusion In our setting, ACG is the variable studied that explains more variability in

  2. The application of the Ten Group classification system (TGCS in caesarean delivery case mix adjustment. A multicenter prospective study.

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    Gianpaolo Maso

    Full Text Available BACKGROUND: Caesarean delivery (CD rates are commonly used as an indicator of quality in obstetric care and risk adjustment evaluation is recommended to assess inter-institutional variations. The aim of this study was to evaluate whether the Ten Group classification system (TGCS can be used in case-mix adjustment. METHODS: Standardized data on 15,255 deliveries from 11 different regional centers were prospectively collected. Crude Risk Ratios of CDs were calculated for each center. Two multiple logistic regression models were herein considered by using: Model 1- maternal (age, Body Mass Index, obstetric variables (gestational age, fetal presentation, single or multiple, previous scar, parity, neonatal birth weight and presence of risk factors; Model 2- TGCS either with or without maternal characteristics and presence of risk factors. Receiver Operating Characteristic (ROC curves of the multivariate logistic regression analyses were used to assess the diagnostic accuracy of each model. The null hypothesis that Areas under ROC Curve (AUC were not different from each other was verified with a Chi Square test and post hoc pairwise comparisons by using a Bonferroni correction. RESULTS: Crude evaluation of CD rates showed all centers had significantly higher Risk Ratios than the referent. Both multiple logistic regression models reduced these variations. However the two methods ranked institutions differently: model 1 and model 2 (adjusted for TGCS identified respectively nine and eight centers with significantly higher CD rates than the referent with slightly different AUCs (0.8758 and 0.8929 respectively. In the adjusted model for TGCS and maternal characteristics/presence of risk factors, three centers had CD rates similar to the referent with the best AUC (0.9024. CONCLUSIONS: The TGCS might be considered as a reliable variable to adjust CD rates. The addition of maternal characteristics and risk factors to TGCS substantially increase the

  3. Nonverbal Interventions in Clinical Groups.

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    Shadish, William R., Jr.

    1980-01-01

    A comparison of nonverbal with verbal clinical group interventions suggested that some traditional self-report devices show less differentiation between these two interventions than do measures of group cohesion. A strong, replicable manipulation tested these findings, which were consistent with previous research. (Author/BEF)

  4. A case-mix in-service education program.

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    Arons, R R

    1985-01-01

    The new case-mix in-service education program at the Presbyterian Hospital in the City of New York is a fine example of physicians and administration working together to achieve success under the new prospective pricing system. The hospital's office of Case-Mix Studies has developed an accurate computer-based information system with historical, clinical, and demographic data for patients discharged from the hospital over the past five years. Reports regarding the cases, diagnoses, finances, and characteristics are shared in meetings with the hospital administration and directors of sixteen clinical departments, their staff, attending physicians, and house officers in training. The informative case-mix reports provide revealing sociodemographic summaries and have proven to be an invaluable tool for planning, marketing, and program evaluation. PMID:10310960

  5. Complexity of case mix in a regional allergy service

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    Kaminski Edward R

    2012-02-01

    Full Text Available Abstract Background Currently in the United Kingdom (UK, there is a mismatch between limited financial resources and the large proportion of patients with suspected allergies actually being referred to specialist allergy clinics. To better understand the case mix of patients being referred, we audited referrals to a regional allergy service over an 8 year period. The main source of data was consultant letters to General Practitioners (GP summarising the diagnosis of patients, archived from January 2002 to September 2009. Letters were reviewed, extracting the clinic date, doctor seen, gender, date of birth, postcode, GP, and diagnoses. Diagnoses were classified into seven groups and illustrative cases for each group noted. Findings Data from 2,028 new referrals with suspected allergy were analysed. The largest group of patients (43% were diagnosed with a type I hypersensitivity. The other diagnostic groups were chronic idiopathic (spontaneous urticaria (35%, suspected type I hypersensitivity but no allergen identified (8%, idiopathic (spontaneous angioedema (8%, physical urticaria (2.5%, non-allergic symptoms (1.6%, type IV hypersensitivity (0.8% and ACE inhibitor sensitivity (0.5%. Two thirds of patients seen were female with a higher percentage of female patients in the non type-I hypersensitivity group (71% than the type 1 hypersensitivity (66% (χ2 = 5.1, 1df, p = 0.024. The type 1 hypersensitivity patients were younger than other patients (38 Vs 46 years, t = -10.8, p Conclusions This study highlights the complexity of specialist allergy practice and the large proportion of patients referred with non-type I hypersensitivities, chronic idiopathic (spontaneous urticaria being by far the largest group. Such information is critical to inform commissioning decisions, define referral pathways and in primary care education.

  6. Use of functioning-disability and dependency for case-mix and subtyping of schizophrenia

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    Susana Ochoa

    2012-03-01

    Full Text Available Background and Objectives: To evaluate the utility of the constructs functioning and disability (F & D and dependency for case-mix and subtyping of patients with schizophrenia by psychosocial, clinical, use of services and attention received from informal carers. Methods: A randomly selected total of 205 people with schizophrenia, and their careers were evaluated through PANSS, DAS-sv, Objective and Subjective Burden Scale (ECFOS-II and use of services. Results: Two groups and Four profiles were identified according to levels of Dependency: The non-dependent group was made of two profiles: independent (I, and persons with disability in the community (DiC. The dependent group included persons with dependency in the community (DeC and persons with dependency in hospital care (DeH. There are clinical and psychosocial differences between these profiles being the dependent the most severe. Regarding use of services, DeC use the most resources, with the exception DeH (more hospitalization resources. The DeC profile generate greater family burden in the following areas; taking medication, being accompanied to appointments, and management than the DiC, despite both groups showing a high need for support. Conclusions: Dependency is a relevant construct for case-mix and subtyping in schizophrenia, and it is related to severity both at the social and clinical level. DeC generate more family burden than the other profiles, followed by DiC (patients with schizophrenia with disability but non-dependent.

  7. Improving and measuring inpatient documentation of medical care within the MS-DRG system: education, monitoring, and normalized case mix index.

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    Rosenbaum, Benjamin P; Lorenz, Robert R; Luther, Ralph B; Knowles-Ward, Lisa; Kelly, Dianne L; Weil, Robert J

    2014-01-01

    Documentation of the care delivered to hospitalized patients is a ubiquitous and important aspect of medical care. The majority of references to documentation and coding are based on the Centers for Medicare and Medicaid Services (CMS) Medicare Severity Diagnosis Related Group (MS-DRG) inpatient prospective payment system (IPPS). We educated the members of a clinical care team in a single department (neurosurgery) at our hospital. We measured subsequent documentation improvements in a simple, meaningful, and reproducible fashion. We created a new metric to measure documentation, termed the "normalized case mix index," that allows comparison of hospitalizations across multiple unrelated MS-DRG groups. Compared to one year earlier, the traditional case mix index, normalized case mix index, severity of illness, and risk of mortality increased one year after the educational intervention. We encourage other organizations to implement and systematically monitor documentation improvement efforts when attempting to determine the accuracy and quality of documentation achieved.

  8. Assessing clinical competency: reports from discussion groups.

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    Turnwald, Grant; Stone, Elizabeth; Bristol, David; Fuentealba, Carmen; Hardie, Lizette; Hellyer, Peter; Jaeger, Laurie; Kerwin, Sharon; Kochevar, Deborah; Lissemore, Kerry; Olsen, Christopher; Rogers, Kenita; Sabin, Beth; Swanson, Cliff; Warner, Angeline

    2008-01-01

    This report describes proposed new models for assessment of eight of the nine clinical competencies the American Veterinary Medical Association Council on Education requires for accreditation. The models were developed by discussion groups at the Association of American Veterinary Medical Colleges' Clinical Competency Symposium. Clinical competencies and proposed models (in parentheses) are described. Competency 1: comprehensive patient diagnosis (neurologic examination on a dog, clinical reasoning skills); Competency 2: comprehensive treatment planning (concept mapping, computerized case studies); Competency 3: anesthesia, pain management (student portfolio); Competency 4: surgery skills (objective structured clinical examination, cased-based examination, "super dog" model); Competency 5: medicine skills (clinical reasoning and case management, skills checklist); Competency 6: emergency and intensive care case management (computerized case study or scenario); Competency 7: health promotion, disease prevention/biosecurity (360 degrees evaluation, case-based computer simulation); Competency 8: client communications and ethical conduct (Web-based evaluation forms, client survey, communicating with stakeholders, telephone conversation, written scenario-based cases). The report also describes faculty recognition for participating in clinical competency assessments.

  9. Development of a Medicaid Behavioral Health Case-Mix Model

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    Robst, John

    2009-01-01

    Many Medicaid programs have either fully or partially carved out mental health services. The evaluation of carve-out plans requires a case-mix model that accounts for differing health status across Medicaid managed care plans. This article develops a diagnosis-based case-mix adjustment system specific to Medicaid behavioral health care. Several…

  10. Nurses' experiences of clinical commissioning group boards.

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    Allan, Helen; O'Driscoll, Mike; Savage, Jan; Lee, Gay; Dixon, Roz

    2016-06-15

    Aim To explore the experience of governing body nurses appointed to clinical commissioning group (CCG) boards; how they perform their responsibilities; and their perceived effectiveness in ensuring safe, patient-centred care and the factors that influence their effectiveness. Method This was a small pilot study using a mixed methods approach. There were four phases of the study: literature review, qualitative data collection (interviews), quantitative data collection (survey), and final data analysis. Findings In the early stages of the formation of CCGs, few governing body nurses had relevant experience to meet the needs of a strategic role, and many of these nurses had no proper job description, too little time to carry out their responsibilities, little management support, and unequal access to training, development, formal support or supervision compared to GP colleagues. Two working patterns or models of work of governing body nurses emerged: the full-time integrated executive statutory role and the part-time non-executive statutory role. Quality and quality assurance were the most frequently cited roles or responsibilities of governing body nurses in CCGs, and their highest priority was to improve the population's health. Conclusion The role of governing body nurse has emerged at a time of organisational change, and following extensive criticism of nursing and nurses in the media. Nurses' roles and experiences are affected by these contextual events and by the emerging structures and diversity of CCGs. Further research is required into the leadership role of governing body nurses, succession planning, and the effectiveness of their relationships with other senior nurses. PMID:27305258

  11. Contributions of case mix and intensity change to hospital cost increases

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    Bradley, TB; Kominski, GF

    1992-01-01

    The 28-percent change in average Medicare inpatient cost per case between 1984 and 1987 is decomposed into three components: input price inflation, changes in average cost within diagnosis-related groups (DRGs) (intensity), and changes in the distribution of cases across DRGs (case mix). We estimate the contributions of technology diffusion and outpatient shifts to within- DRG and across-DRG cost changes. We also use California data to estimate the contribution of changes in the quantity of s...

  12. Attachment disorganization in different clinical groups: What underpins unresolved attachment?

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    Juen Florian; Arnold Lisa; Meissner Dominik; Nolte Tobias; Buchheim Anna

    2013-01-01

    This paper summarizes findings and clinical implications of research on attachment disorganization in diverse clinical groups. Disorganized/unresolved attachment is overrepresented in these groups compared to healthy control participants, but disorder specific characteristics of this attachment pattern are still poorly understood. The focus of this study was to explore defensive processes in participants whose narratives were classified as disorganized/unresolved using the Adult Attach...

  13. A case mix simulation decision support system model for negotiating hospital rates.

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    Hatcher, M E; Connelly, C

    1988-12-01

    The institution of prospective payment systems by many health care insurers has drawn increased attention to case-based financial planning in hospitals. When hospital revenues are directly linked to patient diagnoses rather than to the types and quantities of services supplied to patients, managers must be aware of the financial implications of different case mixes and must be prepared to influence insurers' price structures. A case-based financial planning model is presented here for the purpose of assisting managerial decision making in the strategic areas of case mix planning and pricing. The computerized model characterizes hospitals as product manufacturers, the product being discharged patients. Diagnosis serves to differentiate the "products"; however, diagnoses are grouped by payor and similar treatment cost experiences to create a limited set of managerially meaningful case types. Diagnostic and treatment costs are also aggregated to facilitate the modeling of the hospital production process. The computerized model projects the number of patients of each case-type and total patient volume, based on estimated patient volume growth rates. The model also projects prices and contribution margins for each case-type, as well as total contribution to hospital overhead. Testing the model with a hypothetical example of a hospital strategic planning problem demonstrates the model's potential as a decision-making aid in case mix planning and case-type pricing. It also reveals several model shortcomings that require further developmental effort. PMID:3148679

  14. Attachment disorganization in different clinical groups: What underpins unresolved attachment?

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    Juen Florian

    2013-01-01

    Full Text Available This paper summarizes findings and clinical implications of research on attachment disorganization in diverse clinical groups. Disorganized/unresolved attachment is overrepresented in these groups compared to healthy control participants, but disorder specific characteristics of this attachment pattern are still poorly understood. The focus of this study was to explore defensive processes in participants whose narratives were classified as disorganized/unresolved using the Adult Attachment Projective Picture System (AAP. Besides the predominance of disorganized attachment, clinical participants demonstrated more “segregated system material” especially in stories representing aloneness and more “Personal Experience material” compared to healthy individuals. Within the disorganized/ unresolved clinical individuals, BPD and PTSD patients showed the highest proportion of attachment disorganization and were less able to use other attachment-related defenses to maintain organized. Furthermore, PTSD patients were emotionally overwhelmed by the projective attachment scenes compared to the other clinical groups as indexed by an incapacity to complete sections of the AAP. BPD and addicted patients were characterized by a high degree of self-other boundary confusion. Depressive and schizophrenic patients showed a high overall defensive intensity to remain organized.

  15. Group-sequential clinical trials with multiple co-objectives

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    Hamasaki, Toshimitsu; Evans, Scott R; Ochiai, Toshimitsu

    2016-01-01

    This book focuses on group sequential methods for clinical trials with co-primary endpoints based on the decision-making frameworks for: (1) rejecting the null hypothesis (stopping for efficacy), (2) rejecting the alternative hypothesis (stopping for futility), and (3) rejecting the null or alternative hypothesis (stopping for either futility or efficacy), where the trial is designed to evaluate whether the intervention is superior to the control on all endpoints. For assessing futility, there are two fundamental approaches, i.e., the decision to stop for futility based on the conditional probability of rejecting the null hypothesis, and the other based on stopping boundaries using group sequential methods. In this book, the latter approach is discussed. The book also briefly deals with the group sequential methods for clinical trials designed to evaluate whether the intervention is superior to the control on at least one endpoint. In addition, the book describes sample size recalculation and the resulting ef...

  16. Characteristics of CDC group 1 and group 1-like coryneform bacteria isolated from clinical specimens.

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    Funke, G; Lucchini, G M; Pfyffer, G E; Marchiani, M; von Graevenitz, A

    1993-01-01

    Fifteen strains of CDC group 1 coryneform and biochemically similar bacteria were isolated from clinical specimens. Of the 15 strains isolated, 11 were derived from abscesses and purulent lesions, mostly from the upper part of the body, and 3 were grown from blood cultures. Nine strains were associated with mixed anaerobic but no other aerobic flora. Seven strains exhibited the classical biochemical profile of CDC coryneform group 1; however, eight strains were unable to reduce nitrate and we...

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

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    Drakulić, Aleksandra Mindoljević

    2011-03-01

    Modern history of short-term group psychotherapy dates back to the late 1950-ies. From then to present day, this psychotherapeutic method has been used in various forms, from dynamic-oriented to cognitive behavioural psychotherapies. Although it has always been considered rather controversial, due its cost-effectiveness, it has been capturing more and more popularity. This paper presents the specificities of first session short-term psychotherapy psychodrama group through session work with two examined groups: a group of 20 adult women who suffer from mild or moderate forms of unipolar depression and a group of 20 students of the School of Medicine in Zagreb without any psychiatric symptomatology. The results indicate the high importance of having structure in first psychodrama session, of relating it with the previously thoroughly conducted, initial, clinical, interviews, and of the clarity and focus in terms of determining the goals of therapy, especially in a clinical context. This study also confirmed assumptions regarding the need for different approaches of warming-up in psychodrama, both in the clinical and in non-clinical samples. A psychodrama psychotherapist should have good time managing skills and capability to convert the time available into an opportunity for directly boosting the group energy and work on therapeutic alliance. PMID:21661367

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

    Science.gov (United States)

    Drakulić, Aleksandra Mindoljević

    2011-03-01

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

  19. Views on clinically suspect arthralgia: a focus group study.

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    Newsum, Elize C; van der Helm-van Mil, Annette H M; Kaptein, Adrian A

    2016-05-01

    The rheumatology field is moving towards identifying individuals with an increased risk for rheumatoid arthritis (RA) at a stage when arthritis is still absent but persons having clinically suspect arthralgia (CSA). Incorporating patients' views in rheumatologic care is pivotal; however, the views of persons with CSA on their condition are unknown. We aimed to help fill this gap by exploring illness perceptions of persons with CSA and their views on hypothetical prognoses for developing RA. Persons with CSA were invited to participate in a semi-structured focus group discussion. Illness perceptions according to the Common Sense Model (CSM) and four a priori formulated themes were explored in detail during the group discussion. The discussion was audio-taped and transcribed verbatim. Transcripts were analysed in an interpretative phenomenological approach manner, on the basis of the dimensions of the CSM by three researchers independently. The views of four participants with CSA were explored during one focus group discussion. Four dimensions of the CSM were mainly observed: Identity, Consequences, Personal Control and Concern. None of the patients identified themselves as being a patient. They did experience pain and impairments in daily functioning and were concerned that their symptoms would progress. In the absence of physician-initiated treatment, some patients changed lifestyle in order to reduce pain and to promote health. Patients unanimously said that they could not interpret prognostic information on RA development expressed in hypothetical chances. Persons with CSA do not consider themselves patients. Prognostic information related to the development of RA based on risk percentages was considered as not useful by persons with CSA. Understanding of the illness perceptions of persons with CSA by health care professionals might improve medical management and facilitate shared decision-making.

  20. AN UNUSUAL CLINICAL PRESENTATION OF GROUP A STREPTOCOCCAL INFECTION

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    H.V., Prashanth; R.M, Saldanha Dominic; Shenoy, Shalini; Baliga, Shrikala

    2011-01-01

    After two decades of decline of Group A streptococcal infections, the recent years are witnessing a resurgence in the incidence and severity of infections caused by Group A Streptococcus including necrotizing fasciitis and streptococcal toxic shock syndrome sometimes with fatal outcomes. We present an unusual case of Group A streptococcal infection in a 4-year-old boy who did not have any predisposing factors for Group A streptococcal infection.

  1. [Clinical features and genetics of the ichthyosis vulgaris group].

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    Traupe, H; Happle, R

    1980-12-11

    Combined application of clinical, genetic and histological criteria in general allows a definite diagnosis of autosomal dominant ichthyosis vulgaris and of X-linked recessive ichthyosis. For differential diagnosis, the following rare syndromes should be considered: ichthyosis bullosa: Refsum syndrome; Jung-Vogel syndrome; ichthyosis with corneal opacity, pili torti and alopecia; ichthyosis with deafness, pili torti and dental anomalies; and ichthyosis with hepatosplenomegaly and cerebellar degeneration.

  2. The relationship between effectiveness and costs measured by a risk-adjusted case-mix system: multicentre study of Catalonian population data bases

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    Flor-Serra Ferran

    2009-06-01

    Full Text Available Abstract Background The main objective of this study is to measure the relationship between morbidity, direct health care costs and the degree of clinical effectiveness (resolution of health centres and health professionals by the retrospective application of Adjusted Clinical Groups in a Spanish population setting. The secondary objectives are to determine the factors determining inadequate correlations and the opinion of health professionals on these instruments. Methods/Design We will carry out a multi-centre, retrospective study using patient records from 15 primary health care centres and population data bases. The main measurements will be: general variables (age and sex, centre, service [family medicine, paediatrics], and medical unit, dependent variables (mean number of visits, episodes and direct costs, co-morbidity (Johns Hopkins University Adjusted Clinical Groups Case-Mix System and effectiveness. The totality of centres/patients will be considered as the standard for comparison. The efficiency index for visits, tests (laboratory, radiology, others, referrals, pharmaceutical prescriptions and total will be calculated as the ratio: observed variables/variables expected by indirect standardization. The model of cost/patient/year will differentiate fixed/semi-fixed (visits costs of the variables for each patient attended/year (N = 350,000 inhabitants. The mean relative weights of the cost of care will be obtained. The effectiveness will be measured using a set of 50 indicators of process, efficiency and/or health results, and an adjusted synthetic index will be constructed (method: percentile 50. The correlation between the efficiency (relative-weights and synthetic (by centre and physician indices will be established using the coefficient of determination. The opinion/degree of acceptance of physicians (N = 1,000 will be measured using a structured questionnaire including various dimensions. Statistical analysis: multiple regression

  3. Group sequential and confirmatory adaptive designs in clinical trials

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    Wassmer, Gernot

    2016-01-01

    This book provides an up-to-date review of the general principles of and techniques for confirmatory adaptive designs. Confirmatory adaptive designs are a generalization of group sequential designs. With these designs, interim analyses are performed in order to stop the trial prematurely under control of the Type I error rate. In adaptive designs, it is also permissible to perform a data-driven change of relevant aspects of the study design at interim stages. This includes, for example, a sample-size reassessment, a treatment-arm selection or a selection of a pre-specified sub-population. Essentially, this adaptive methodology was introduced in the 1990s. Since then, it has become popular and the object of intense discussion and still represents a rapidly growing field of statistical research. This book describes adaptive design methodology at an elementary level, while also considering designing and planning issues as well as methods for analyzing an adaptively planned trial. This includes estimation methods...

  4. Scale Development of a Measure to Assess Community-Based and Clinical Intervention Group Environments

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    Wilson, Patrick A.; Hansen, Nathan B.; Tarakeshwar, Nalini; Neufeld, Sharon; Kochman, Arlene; Sikkema, Kathleen J.

    2008-01-01

    Though group interventions are widely used in community-based and clinical settings, there are few brief instruments for assessing the group environment. Two studies on the development of a brief measure to assess intervention group environments are described, and psychometric properties of the new scale are presented. The new measure is based on…

  5. 42 CFR 484.220 - Calculation of the adjusted national prospective 60-day episode payment rate for case-mix and...

    Science.gov (United States)

    2010-10-01

    ...-day episode payment rate for case-mix and area wage levels. 484.220 Section 484.220 Public Health... Calculation of the adjusted national prospective 60-day episode payment rate for case-mix and area wage levels... case-mix using a case-mix index to explain the relative resource utilization of different patients....

  6. Variation in case-mix between hospitals treating colorectal cancer patients in the Netherlands

    NARCIS (Netherlands)

    Kolfschoten, N.E.; Marang van de Mheen, P.J.; Gooiker, G.A.; Eddes, E.H.; Kievit, J.; Tollenaar, R.A.E.M.; Wouters, M.W.; Bemelman, W.A.; Busch, O.R.; Dam, R.M. van; Harst, E. van der; Jansen-Landheer, M.L.E.A; Karsten, T.M.; Krieken, J.H.J.M. van; Kuijpers, W.G.T.; Lemmens, V.E.; Manusama, E.R.; Meijerink, W.J.H.J.; Rutten, H.J.; Wiggers, T.; Velde, C.J. van de

    2011-01-01

    AIMS: The purpose of this study was to determine how expected mortality based on case-mix varies between colorectal cancer patients treated in non-teaching, teaching and university hospitals, or high, intermediate and low-volume hospitals in the Netherlands. MATERIAL AND METHODS: We used the databas

  7. Using case-mix information in strategic hospital marketing. Deriving market research from patient data.

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    Little, A

    1992-01-01

    Hospital survival requires adaptation, adaptation requires understanding, and understanding requires information. These are the basic equations behind hospital strategic marketing, and one of the answers may lie in hospitals' own patient-data systems. Marketers' and administrators' enlightened application of case-mix information could become one more hospital survival tool.

  8. Case-mix adjustment for evaluation of mortality in cystic fibrosis.

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    O'Connor, Gerald T; Quinton, Hebe B; Kahn, Richard; Robichaud, Priscilla; Maddock, Joanne; Lever, Thomas; Detzer, Mark; Brooks, John G

    2002-02-01

    Comparison of patient mortality rates in cystic fibrosis (CF) obtained from different institutions requires the use of case-mix adjustment methods to account for baseline differences in patient and disease characteristics. There is no current professional consensus on the use of case-mix adjustment methods for use in comparing mortality rates in CF. Characteristics used for this case-mix adjustment should include those that are different across institutions and are associated with patient survival. They should not include characteristics of disease severity that may be a consequence of effectiveness of treatment. The goal of these analyses was to identify a set of these characteristics of patients or disease that would be useful for case-mix adjustment of CF mortality rates. Data from the Cystic Fibrosis Foundation Patient Registry and from the United States Census of the Population (1990) were used in these analyses. Kaplan-Meier techniques, the log-rank test, and Cox proportional hazards regression were used to estimate survivorship, calculate hazard ratios (HR), 95% confidence intervals (CI(95%)), and to conduct tests of statistical significance. The data set included all 30,469 CF patients seen at CF Care Centers from 1982-1998. There were 5,906 deaths during 508,721 person-years of follow-up. In multivariate analyses, female gender (HR 1.30, CI(95%) (1.16, 1,47), P $50,000/year (corrected for the 1999 consumer price index) were compared with those living in areas with a median household income uses patient and disease characteristics available at the time of diagnosis of CF, and is not believed to be influenced by subsequent treatment to predict the risk of death. If these case-mix adjustment methods are adopted broadly, they will make it possible to study treatment effects and differences in mortality outcomes, while adjusting for baseline differences in patient and disease characteristics.

  9. The European Register for Clinical Chemists. (European Communities Confederation of Clinical Chemistry, Working Group on Registration).

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    Sanders, G T; Kelly, A M; Breuer, J; Kohse, K P; Mocarelli, P; Sachs, C

    1997-10-01

    To ensure freedom of movement in the European Union, a limited number of professions is regulated by a so-called Sectorial Directive; all other disciplines, including clinical chemistry, fall under a General Directive. However, clinical chemists in the EU wish their specialty to be more specifically regulated; this means that common standards of education, training, experience and compliance with continuing professional developments must be guaranteed. Therefore, the European Communities Confederation of Clinical Chemistry (EC4) is about to implement the European Register for clinical chemists, and has composed a guide to this Register. The document describes the conditions for entry to specialty training, the minimum standards for registration (university education and postgraduate vocational training with a minimum total of eight years), the competencies of those qualifying for registration, and the operation of the register. Registration guarantees professional and managerial competencies; the title conferred is "European Clinical Chemist". EC4 recognises the existing national registers as far as they are based on the minimal requirements as indicated. An EC4 Register Commission (EC4RC) will maintain and control the European Register, supported by National Clinical Chemistry Registration Committees (NCCRC). An NCCRC controls the quality of the education in each country and assesses candidates. An individual (EU citizen or non-EU citizen trained in an EU country) applies privately for the European Register to EC4RC and, where applicable, the application is accompanied by a document from the NCCRC of the country of registration, stating that the applicant has the necessary qualifications. For EU citizens trained outside the EU the final decision is with EC4RC; non-EU citizens not trained in an EU country are not eligible for registration. Registration is renewed once every five years. PMID:9368800

  10. Clinical and No-Clinical Setting Specificities in First Session Short-Term Psychotherapy Psychodrama Group

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    Mindoljević Drakulić, Aleksandra

    2011-01-01

    Modern history of short-term group psychotherapy dates back to the late 1950-ies. From then to present day, this psychotherapeutic method has been used in various forms, from dynamic-oriented to cognitive behavioural psychotherapies. Although it has always been considered rather controversial, due its cost-effectiveness, it has been capturing more and more popularity. This paper presents the specificities of first session short-term psychotherapy psychodrama group through session ...

  11. Clinical presentation of infective endocarditis caused by different groups of non-beta haemolytic streptococci.

    Science.gov (United States)

    Nilson, B; Olaison, L; Rasmussen, M

    2016-02-01

    Streptococci are common causes of infective endocarditis (IE) and matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) has provided a practical tool for their species determination. We aimed to investigate if particular groups of non-beta heamolytic streptococci were associated with IE or to specific presentations thereof. The Swedish Registry of Infective Endocarditis was used to identify cases of IE caused by streptococci and a local database to identify cases of streptococcal bacteremia. The bacteria were grouped using MALDI-TOF MS and the clinical characteristics of IE caused by different groups were compared. We identified a group of 201 streptococcal IE isolates: 18 isolates belonged to the anginosus, 19 to the bovis, 140 to the mitis, 17 to the mutans, and seven to the salivarius groups. The mitis and mutans groups were significantly more common and the anginosus group less common among IE cases as compared to all cause bacteremia. Patients infected with the bovis group isolates were older, had more cardiac devices, and had more commonly prosthetic valve IE compared to IE caused by streptococci of the other groups. Twenty-one percent of patients needed surgery, and in-hospital mortality was 8% with no significant differences between the groups. Grouping of non-beta haemolytic streptococci using MALDI-TOF MS can provide a basis for decision-making in streptococcal bacteremia. IE caused by bovis group isolates have clinical characteristics distinguishing them from IE caused by other groups of Streptococcus. PMID:26610338

  12. An Empirical Investigation of Group Treatment for a Clinical Population of Adult Female Incest Survivors.

    Science.gov (United States)

    Saxe, Brenda J.; Johnson, Susan M.

    1999-01-01

    Empirically assesses the effectiveness of a group treatment program on intrapersonal symptomatology and interpersonal difficulties in a clinical population of women with a history of incest. Results indicate that a time-limited group, which focuses on the original trauma, is effective in reducing intrapersonal symptomatology for women with a…

  13. Factors Influencing Electronic Clinical Information Exchange in Small Medical Group Practices

    Science.gov (United States)

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

    2012-01-01

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

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

    OpenAIRE

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

    2008-01-01

    Recommendations for specimen collection and handling have been developed for adoption across breast cancer clinical trials conducted by the Breast International Group (BIG)-sponsored Groups and the National Cancer Institute (NCI)-sponsored North American Cooperative Groups. These recommendations are meant to promote identifiable standards for specimen collection and handling within and across breast cancer trials, such that the variability in collection/handling practices that currently exist...

  15. Hospital financing reform and case-mix measurement: An international review

    OpenAIRE

    Wiley, Miriam M.

    1992-01-01

    A review of reforms in the financing of hospital services in eight European countries and Australia reveals a commitment to a common objective of relating resource use to hospital workload by means of a standardized case-mix framework in the pursuit of greater efficiency. While this objective is also shared with the U.S. prospective payment system (PPS), it is noteworthy that the majority of countries reviewed favor a global budgeting approach to financing hospital services. Ongoing evaluatio...

  16. Similar barriers and facilitators to physical activity across different clinical groups experiencing lower limb spasticity.

    Science.gov (United States)

    Hundza, Sandra; Quartly, Caroline; Kim, Jasmine M; Dunnett, James; Dobrinsky, Jill; Loots, Iris; Choy, Kim; Chow, Brayley; Hampshire, Alexis; Temple, Viviene A

    2016-07-01

    Purpose Given the importance of physical activity in maintaining health and wellness, an improved understanding of physical activity patterns across different clinical populations is required. This study examines the facilitators for, and barriers to, participation in physical activity across multiple contexts for three clinical groups with chronic lower limb spasticity (individuals with stroke, multiple sclerosis and incomplete spinal cord injury). Method This cross-sectional study employed quantitative measures for spasticity, ankle range of motion, pain, falls, cognition, mobility, and physical activity as well as qualitative semi-structured interviews. Results There were similar impairments in body functions and structures and limitations in activities across the clinical groups. These impairments and limitations negatively impacted participation in physical activity, which was low. Environmental and personal factors exacerbated or mitigated the limiting effects of body functions and structures and activities on physical activity in many areas of life. Conclusions In this population, participation in physical activity includes activities such as housework which are different than what is typically considered as physical activity. Further, the presence of similar barriers and facilitators across the groups suggests that support and services to promote valued forms of physical activity could be organised and delivered based on limitations in mobility and functioning rather than clinical diagnosis. Implications for rehabilitation Physical activity is of utmost importance in maintaining health and wellness in clinical populations. This research highlights the desired and actual physical activity for these populations can look different than what may traditionally be considered as physical activity (e.g. housework is not typically considered participation physical activity). Therefore, rehabilitation interventions need to be directly designed to enhance clients

  17. Ethical Challenges and Lessons Learned During the Clinical Development of a Group A Meningococcal Conjugate Vaccine

    OpenAIRE

    Martellet, Lionel; Sow, Samba O.; Diallo, Aldiouma; Hodgson, Abraham; Kampmann, Beate; Hirve, Siddhivinayak; Tapia, Milagritos; Haidara, Fadima Cheick; Ndiaye, Assane; Diarra, Bou; Ansah, Patrick Odum; Akinsola, Adebayo; Idoko, Olubukola T.; Adegbola, Richard A.; Bavdekar, Ashish

    2015-01-01

    Background.  The group A meningococcal vaccine (PsA-TT) clinical development plan included clinical trials in India and in the West African region between 2005 and 2013. During this period, the Meningitis Vaccine Project (MVP) accumulated substantial experience in the ethical conduct of research to the highest standards. Methods.  Because of the public–private nature of the sponsorship of these trials and the extensive international collaboration with partners from a diverse setting of countr...

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

    Directory of Open Access Journals (Sweden)

    Kritaya Sawangchareon

    2013-11-01

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

  19. The first 10,000 Adult Attachment Interviews: distributions of adult attachment representations in clinical and non-clinical groups.

    Science.gov (United States)

    Bakermans-Kranenburg, Marian J; van IJzendoorn, Marinus H

    2009-05-01

    More than 200 adult attachment representation studies, presenting more than 10,500 Adult Attachment Interview (AAI; George, Kaplan, & Main, 1985) classifications, have been conducted in the past 25 years. In a series of analyses on the distributions of the AAI classifications in various cultural and age groups, fathers, and high-risk and clinical samples, we used the distribution of the combined samples of North American non-clinical mothers (23% dismissing, 58% secure, 19% preoccupied attachment representations, and 18% additionally coded for unresolved loss or other trauma) to examine deviations from this normative pattern, through multinomial tests and analyses of correspondence. The analyses were restricted to AAI classifications coded according to the Main, Goldwyn, and Hesse (2003) system. We did not find gender differences in the use of dismissing versus preoccupied attachment strategies, and the AAI distributions were largely independent of language and country of origin. Clinical subjects showed more insecure and unresolved attachment representations than the norm groups. Disorders with an internalizing dimension (e.g., borderline personality disorders) were associated with more preoccupied and unresolved attachments, whereas disorders with an externalizing dimension (e.g., antisocial personality disorders) displayed more dismissing as well as preoccupied attachments. Depressive symptomatology was associated with insecurity but not with unresolved loss or trauma, whereas adults with abuse experiences or PTSD were mostly unresolved. In order to find more reliable associations with clinical symptoms and disorders, future AAI studies may make more fruitful use of continuous AAI scales in addition to the conventionally used categorical classifications.

  20. Using computer simulations and focus groups for planned change in prenatal clinics.

    Science.gov (United States)

    Lowry, L W; Callahan, A L; Philippe, T

    2001-01-01

    The Colleges of Nursing and Engineering in a southwest Florida university combined efforts to design a project to use time/motion techniques and focus groups to assess patent flow and effective and efficient use of human resources in public health clinics. Data for 877 observations were entered into a computer simulation program that displayed alternative configurations for health resource management. Information from focus groups was used to plan for ways to use clinic wait time more effectively. This article describes data collection and findings. PMID:11898674

  1. Relationship between ABO blood groups and malaria with clinical outcome in rural area of South India

    Directory of Open Access Journals (Sweden)

    Gayathri B.N.

    2013-05-01

    Full Text Available Background A number of studies have shown that susceptibility to several infectious diseases is related to the patient’s blood group. Although the relationship between blood group and susceptibility to malaria has been studied by several researchers, the results have been contradictory. Since malaria has re-emerged as a major problem in India during the past few years, it would be useful to know whether there is any relationship between blood group and infection. Objectives The study will be undertaken to correlate the blood groups and clinical presentations in malaria patients and to understand the differential host susceptibility in malaria. Method Over a period of 4 years malaria positive samples identified by peripheral smear (thin and thick smears will be evaluated in this study. Haemoglobin, total leucocyte count, differential leucocyte count and platelet count of each patient done on an automated cell counter will be retrieved from the data. Blood group was determined by forward and reverse method. The demographic details of the patients and clinical details were obtained from case records of the patients. Malarial species and the severity of clinical course were correlated with blood groups Results A total of 205 patients were included in the study, of which 123 cases were positive for plasmodium falciparum and 78 cases were positive for P. vivax infection and 4 patients had mixed infection. The results of blood groups showed 33 -‘A’ group, 84 -‘B’ group, 70 -‘O’ group and 18 were ‘AB’ group. When the clinical courses between different groups were compared using the following parameters for severe infection- a parasitic load of > 10/1000 RBCs, severe anemia with haemoglobin 101o F and the other organ involvement, it was observed that there was no significant relationship between ABO blood group and malaria in our population, this could be due to various demographic reasons. Conclusions The present study indicate that

  2. Sample size and power for comparing two or more treatment groups in clinical trials.

    OpenAIRE

    Day, S. J.; Graham, D F

    1989-01-01

    Methods for determining sample size and power when comparing two groups in clinical trials are widely available. Studies comparing three or more treatments are not uncommon but are more difficult to analyse. A linear nomogram was devised to help calculate the sample size required when comparing up to five parallel groups. It may also be used retrospectively to determine the power of a study of given sample size. In two worked examples the nomogram was efficient. Although the nomogram offers o...

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

    Science.gov (United States)

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

    2008-01-01

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

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

    NARCIS (Netherlands)

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

    2015-01-01

    OBJECTIVE: To assess the change in level of diabetes quality management in primary care groups and outpatient clinics after feedback and tailored support. RESEARCH DESIGN AND METHODS: This before-and-after study with a 1-year follow-up surveyed qualitymanagers on six domains of quality management. Q

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

    DEFF Research Database (Denmark)

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

    2009-01-01

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

  6. Dreams of Deceased Children and Countertransference in the Group Psychotherapy of Bereaved Mothers: Clinical Illustration

    Science.gov (United States)

    Begovac, Branka; Begovac, Ivan

    2012-01-01

    This article presents, in the form of a clinical illustration, a therapeutic group of bereaved mothers with special reference to their dreams about their deceased children. The article presents descriptions of the emotions of these mothers and countertransference feelings, a topic that, to our knowledge, has not been frequently studied. The group…

  7. Differences in Clinical and Laboratory Findings between Group D and Non-Group D Non-Typhoidal Salmonella Gastroenteritis in Children

    OpenAIRE

    Park, Heung Keun; Rhie, Kyuyol; Yeom, Jung Sook; Park, Ji Sook; Park, Eun Sil; Seo, Ji-Hyun; Lim, Jae Young; Park, Chan-Hoo; Woo, Hyang-Ok; Youn, Hee-Shang; Kang, Ki Ryeon; Park, Jung Je

    2015-01-01

    Purpose To investigate the differences in clinical features and laboratory findings between group D and non-group D non-typhoidal Salmonella (NTS) gastroenteritis in children. Methods A retrospective chart review of children diagnosed with NTS confirmed by culture study was performed. The clinical features and laboratory findings of group D and non-group D NTS were compared. Results From 2003 to 2012, 75 cases were diagnosed as NTS at our center. The number of group D and non-group D patients...

  8. A group-mediated psychotherapy with children: Clinical observation and assessment

    Directory of Open Access Journals (Sweden)

    Sara Cuticchio

    2014-09-01

    Full Text Available The study is based on clinical evaluation of a psychotherapy group for children, employing Sicilian puppets, objects as mediators, to reflect on significant moments and the dynamic processes of change during the therapy. TCM (Therapeutic Cycle Model, 1996, designed by Mergenthaler, is used to identify whether and how the assessment corresponds to the changes detected by observation of each subject and the group. During the 8 sessions of therapy, verbal productions of children and therapists were analyzed and compared. Keywords:Evaluation; Group therapy; Mediating object; Children 

  9. [Group psychotherapy with an analytical orientation at the Tlatelolco clinic of neuropsychiatry].

    Science.gov (United States)

    1977-01-01

    Since most of the patients who attend for psychiatric consultation at a clinic are little motivated for psychotherapy, analytic group therapy was attempted, with basis on studies on psychological genetics, on groups management, and on the theories of Freud, Klein and Bion. Several open groups were handled, with the following achievements: 1. A decrease in anxiety, and increase in the objective vision of reality and in increase in the ability to see past and present conflicts. 2. A greater tolerance to agressive and sexual instincts and to frustration. 3. A greater personal acceptance, ability to sublimate productively and elimination of clinical symptoms. Varying degrees of improvement, and lesser need for psychiatric medication and hospitalization were obtained. Several problems were encountered: a) Desertion of 30% of patients from the sessions, due to the disapearance of symptoms buth with no character changes (resistances). b) Temporary absence or habit of arriving late to the sessions (resistances). c) Overwhelming passivity. The groups were handled in cotherapy and the work was supervised with experienced therapists. To attempt solving the above mentioned problems a better selection of patients was made, complete clinical histories were elaborated, a battery of psychological tests was made, and diagnosis, dynamics and prognosis of each case were outlined; this allowed the evaluation of middle and long term treatment. It was suggested to change the technique to that of operative groups.

  10. Neonatal Nasopharyngeal Colonization with Group B Streptococcus and its Association with Clinical Sepsis.

    Science.gov (United States)

    Malik, Anuj; Kothari, Chetna; Paulose, Ammukutty; Fogel, Joshua; Boxer, Harriet; Doraiswamy, Brinda

    2016-07-01

    Objective This study aims to determine whether nasopharyngeal (NP) colonization with group B streptococcus (GBS) is associated with early-onset clinical sepsis within 72 hours of birth, prolonged antibiotic duration, longer neonatal intensive care unit (NICU) stay, and delay in tolerating full feeds among neonates ≥ 35 weeks gestation. Study Design A retrospective cohort study of 192 NICU neonates admitted for sepsis evaluation. Based on their GBS colonization status, the mother-neonate pairs were divided into four groups of mother-negative neonate (baby)-positive (MNBP), mother-positive neonate-positive (MPBP), mother-positive neonate-negative (MPBN), and a reference group of mother-negative neonate-negative (MNBN). Neonates with GBS-positive blood cultures were excluded. Results The colonized neonate groups of MNBP (odds ratio [OR]: 21.8, 95% confidence interval [CI]: 7.99, 59.44) and MPBP (OR: 35.5, 95% CI: 9.57, 131.70) were each associated with increased odds for clinical sepsis (p NICU stay (adjusted β: 0.1, standard error = 0.05, p < 0.01). None of the GBS groups were associated with increased days to full feeds. Conclusion Neonatal NP GBS colonization was found among a substantial proportion of GBS-negative mothers and was associated with an increased diagnosis of clinical sepsis. PMID:26906181

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

    Science.gov (United States)

    Bhateja, S; Arora, G

    2014-01-01

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

  12. Prescription Writing in Small Groups as a Clinical Pharmacology Educational Intervention: Perceptions of Preclerkship Medical Students.

    Science.gov (United States)

    James, Henry; Tayem, Yasin I Y; Al Khaja, K A J; Veeramuthu, Sindhan; Sequeira, Reginald P

    2016-08-01

    Medical students do not perform well in writing prescriptions, and the 3 variables-learner, teacher, and instructional method-are held responsible to various degrees. The objective of this clinical pharmacology educational intervention was to improve medical students' perceptions, motivation, and participation in prescription-writing sessions. The study participants were second-year medical students of the College of Medicine and Medical Sciences of the Arabian Gulf University, Bahrain. Two prescription-writing sessions were conducted using clinical case scenarios based on problems the students had studied as part of the problem-based learning curriculum. At the end of the respiratory system subunit, the training was conducted in small groups, each facilitated by a tutor. At the end of the cardiovascular system subunit, the training was conducted in a traditional large-group classroom setting. Data were collected with the help of a questionnaire at the end of each session and a focus group discussion. A majority of the students (95.3% ± 2.4%) perceived the small-group method better for teaching and learning of all aspects of prescription writing: analyzing the clinical case scenario, applying clinical pharmacology knowledge for therapeutic reasoning, using a formulary for searching relevant prescribing information, and in writing a complete prescription. Students also endorsed the small-group method for better interaction among themselves and with the tutor and for the ease of asking questions and clarifying doubts. In view of the principles of adult learning, where motivation and interaction are important, teaching and learning prescription writing in small groups deserve a serious consideration in medical curricula. PMID:26677798

  13. Ethical Challenges and Lessons Learned During the Clinical Development of a Group A Meningococcal Conjugate Vaccine

    Science.gov (United States)

    Martellet, Lionel; Sow, Samba O.; Diallo, Aldiouma; Hodgson, Abraham; Kampmann, Beate; Hirve, Siddhivinayak; Tapia, Milagritos; Haidara, Fadima Cheick; Ndiaye, Assane; Diarra, Bou; Ansah, Patrick Odum; Akinsola, Adebayo; Idoko, Olubukola T.; Adegbola, Richard A.; Bavdekar, Ashish; Juvekar, Sanjay; Viviani, Simonetta; Enwere, Godwin C.; Marchetti, Elisa; Chaumont, Julie; Makadi, Marie-Francoise; Pallardy, Flore; Kulkarni, Prasad S.; Preziosi, Marie-Pierre; LaForce, F. Marc

    2015-01-01

    Background. The group A meningococcal vaccine (PsA-TT) clinical development plan included clinical trials in India and in the West African region between 2005 and 2013. During this period, the Meningitis Vaccine Project (MVP) accumulated substantial experience in the ethical conduct of research to the highest standards. Methods. Because of the public–private nature of the sponsorship of these trials and the extensive international collaboration with partners from a diverse setting of countries, the ethical review process was complex and required strategic, timely, and attentive communication to ensure the smooth review and approval for the clinical studies. Investigators and their site teams fostered strong community relationships prior to, during, and after the studies to ensure the involvement and the ownership of the research by the participating populations. As the clinical work proceeded, investigators and sponsors responded to specific questions of informed consent, pregnancy testing, healthcare, disease prevention, and posttrial access. Results. Key factors that led to success included (1) constant dialogue between partners to explore and answer all ethical questions; (2) alertness and preparedness for emerging ethical questions during the research and in the context of evolving international ethics standards; and (3) care to assure that approaches were acceptable in the diverse community contexts. Conclusions. Many of the ethical issues encountered during the PsA-TT clinical development are familiar to groups conducting field trials in different cultural settings. The successful approaches used by the MVP clinical team offer useful examples of how these problems were resolved. Clinical Trials Registration. ISRCTN17662153 (PsA-TT-001); ISRTCN78147026 (PsA-TT-002); ISRCTN87739946 (PsA-TT-003); ISRCTN46335400 (PsA-TT-003a); ISRCTN82484612 (PsA-TT-004); CTRI/2009/091/000368 (PsA-TT-005); PACTR ATMR2010030001913177 (PsA-TT-006); PACTR201110000328305

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

    Directory of Open Access Journals (Sweden)

    Lucia Zannini

    2012-07-01

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

  15. Clinically Significant Minor Blood Group Antigens amongst North Indian Donor Population

    Directory of Open Access Journals (Sweden)

    Divjot Singh Lamba

    2013-01-01

    Full Text Available Background. Racial differences in blood group antigen distribution are common and may result in striking and interesting findings. These differences in blood group antigen distribution are important due to their influence on the clinical practice of transfusion medicine. Study Design and Methods. This is a prospective study, involving 1000 healthy regular repeat voluntary blood donors associated with the department. The clinically significant minor blood group antigens of these donors were studied. Results. Out of 1000 healthy regular repeat voluntary blood donors, 93% were D positive and 2.8% were K positive. Amongst the Rh antigens, e was the most common (99%, followed by D (93%, C (85.1%, c (62.3%, and E (21.5%. Within the MNS blood group system, antigen frequency was M (88%, N (57.5%, S (57.8%, and s (87.5%. Within the Duffy blood group system, antigen frequency was Fya (87.3% and Fyb (58.3%. Conclusions. This data base will help us to prevent alloimmunisation in young females, pregnant women, and patients who are expected to require repeated transfusions in life by providing them with antigen matched blood. Antigen negative blood can also be made available without delay to already alloimmunized multitransfused patients.

  16. Levels of the Staff's Exposure to Violence at Locked Psychiatric Clinics: A Comparison by Occupational Groups.

    Science.gov (United States)

    Bilici, Rabia; Sercan, Mustafa; Izci, Filiz

    2016-07-01

    This study explored the rates of exposure to violence among physicians, nurses, and other health care staff members working at the locked psychiatric clinics, to examine the quantity and types of violence exposed, and to compare occupational groups by the level of exposure to violence. In parallel with the existing literature, the present study supports the proposition that physicians and nurses working at psychiatric units represent a risky group in terms of exposure to violence. The survey found that 87.6% of staff members viewed security measures insufficient. It is considered by the authors that preventive actions should be taken to reduce the risk of exposure to violence against the staff members working at the locked psychiatric clinics. PMID:27104294

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

    Science.gov (United States)

    Ferriere, Michael; Van Ness, Brian

    2012-04-01

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

  18. Biomarkers of sarcopenia in clinical trials—recommendations from the International Working Group on Sarcopenia

    OpenAIRE

    Cesari, Matteo; Pahor, Marco; Goodpaster, Bret; Hellerstein, Marc; Van Kan, Gabor A.; Anker, Stefan D.; Vrijbloed, J. Willem; Isaac, Maria; Rolland, Yves; M’Rini, Christine; Aubertin-Leheudre, Mylène; Cedarbaum, Jesse M.; Zamboni, Mauro; Sieber, Cornell C.; Laurent, Didier

    2012-01-01

    Sarcopenia, the age-related skeletal muscle decline, is associated with relevant clinical and socioeconomic negative outcomes in older persons. The study of this phenomenon and the development of preventive/therapeutic strategies represent public health priorities. The present document reports the results of a recent meeting of the International Working Group on Sarcopenia (a task force consisting of geriatricians and scientists from academia and industry) held on June 7–8, 2011 in Toulouse (...

  19. [Activity and Future Perspective of Local Independent Clinical Trial Group (OGSG)].

    Science.gov (United States)

    Tsujinaka, Toshimasa

    2016-04-01

    Osaka Gastrointestinal Cancer Chemotherapy Study Group (OGSG) was established in 2000 and has been conducting investigator initiated multi-institutional collaboration trials regarding the treatment of gastrointestinal cancer, especially using chemotherapeutic agents. Although organization of OGSG has been renovated to perform post-marketing clinical trials with high quality, OGSG is now facing severe financial crisis because of shortage of donation from pharmaceutical companies. Here, present problems and future perspectives are discussed. PMID:27220796

  20. Developing a clinical research network : the Northern Region Endoscopy Group experience.

    OpenAIRE

    Rajasekhar, P.; Rees, C. van; Rutter, M; Hungin, P

    2014-01-01

    Research is central to the National Health Service. Clinical trial recruitment has been aided by the National Institute for Health Research's Comprehensive Research Network but these networks do not support development of research. The Northern Region Endoscopy Group (NREG) was founded in 2007, encompasses 17 endoscopy units and has become a highly successful collaborative research network. The network is now a major contributor to UK trials, has published over 20 papers (>60 abstracts) and h...

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

    OpenAIRE

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

    2013-01-01

    Objective To explore the relational challenges for general practitioner (GP) leaders setting up new network-centric commissioning organisations in the recent health policy reform in England, we use innovation network theory to identify key network leadership practices that facilitate healthcare innovation. Design Mixed-method, multisite and case study research. Setting Six clinical commissioning groups and local clusters in the East of England area, covering in total 208 GPs and 1 662 000 pop...

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

    Science.gov (United States)

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

    2016-01-01

    The carbapenem breakpoints set by different organizations for Acinetobacter are discordant, but supporting clinical data are lacking. This study aimed to provide the first clinical outcome data to support the carbapenem breakpoints for Acinetobacter baumannii (Ab) group in patients with bacteremia. This study included 117 adults who received carbapenems for treatment of Ab group bacteremia in Taipei Veterans General Hospital over an 8-year period. We analyzed 30-day mortality rates among patient groups acquiring isolates with different carbapenem minimal inhibitory concentrations (MICs). The carbapenem MIC breakpoint derived from classification and regression tree (CART) analysis to delineate the risk of 30-day mortality was between MICs of ≤ 4 mg/L and ≥ 8 mg/L. Mortality rate was higher in patients acquiring isolates with carbapenem MIC ≥ 8 mg/L than ≤ 4 mg/L, by bivariate (54.9% [28/51] vs 25.8% [17/66]; P = 0.003) and survival analysis (P = 0.001 by log-rank test). Multivariate analysis using logistic regression and Cox regression models including severity of illness indices demonstrated that treating patients with Ab group bacteremia caused by isolates with a carbapenem MIC ≥ 8 mg/L with carbapenem was an independent predictor of 30-day mortality (odds ratio, 5.125; 95% confidence interval [CI], 1.946-13.498; P = 0.001, and hazard ratio, 2.630; 95% CI, 1.431-4.834; P = 0.002, respectively). The clinical outcome data confirmed that isolates with MIC ≤ 4 mg/L were susceptible to carbapenem, and those with MIC ≥ 8 mg/L were resistant in patients with Ab group bacteremia. PMID:27644087

  3. Clinical use of electronic portal imaging: Report of AAPM Radiation Therapy Committee Task Group 58

    International Nuclear Information System (INIS)

    AAPM Task Group 58 was created to provide materials to help the medical physicist and colleagues succeed in the clinical implementation of electronic portal imaging devices (EPIDs) in radiation oncology. This complex technology has matured over the past decade and is capable of being integrated into routine practice. However, the difficulties encountered during the specification, installation, and implementation process can be overwhelming. TG58 was charged with providing sufficient information to allow the users to overcome these difficulties and put EPIDs into routine clinical practice. In answering the charge, this report provides; comprehensive information about the physics and technology of currently available EPID systems; a detailed discussion of the steps required for successful clinical implementation, based on accumulated experience; a review of software tools available and clinical use protocols to enhance EPID utilization; and specific quality assurance requirements for initial and continuing clinical use of the systems. Specific recommendations are summarized to assist the reader with successful implementation and continuing use of an EPID

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

    Science.gov (United States)

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

    2010-10-01

    This paper profiles the establishment and evaluation of the Neophyte Writers' Group, run by nurse academics in collaboration with clinical nurses. The growing demand for nurses to write, publish and present their work had inspired the introduction of a series of workshops designed to develop and improve writing and presentation skills, which eventuated in formation of the Neophytes. The group was founded on the basis of Bandura's theory of self-efficacy (1997), a concept which has been discussed extensively in social psychology literature to explain motivation and learning theory. People with high assurance in their capabilities regard difficult tasks as challenges to be mastered rather than as threats to be avoided (Bandura, 1994). The Neophytes' group employs a collaborative approach intended to increase and reinforce members' self-confidence; the underlying philosophy is to promote and enhance writers' motivation, capacity and self-efficacy in order to achieve future publication goals confidently and independently. Support which engenders these strengths through a program relevant to participants' needs is likely, as this group found, to increase publication productivity. Additional unexpected outcomes resulted, such as engagement by clinical nurses' in academic work, and an increase in research higher degree enrolments. PMID:20096487

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

    Science.gov (United States)

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

    2015-06-01

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

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

    Science.gov (United States)

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

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

  7. Hepato-biliary clinical trials and their inclusion in the Cochrane Hepato-Biliary Group register and reviews

    DEFF Research Database (Denmark)

    Klingenberg, Sarah Louise; Nikolova, Dimitrinka; Alexakis, Nicholas;

    2011-01-01

    The Cochrane Hepato-Biliary Group (CHBG) is one of the 52 collaborative review groups within The Cochrane Collaboration. The activities of the CHBG focus on collecting hepato-biliary randomized clinical trials (RCT) and controlled clinical trials (CCT), and including them in systematic reviews...

  8. The involvement of the thalamus in semantic retrieval: a clinical group study.

    Science.gov (United States)

    Pergola, Giulio; Bellebaum, Christian; Gehlhaar, Britta; Koch, Benno; Schwarz, Michael; Daum, Irene; Suchan, Boris

    2013-06-01

    There is increasing attention about the role of the thalamus in high cognitive functions, including memory. Although the bulk of the evidence refers to episodic memory, it was recently proposed that the mediodorsal (MD) and the centromedian-parafascicular (CM-Pf) nuclei of the thalamus may process general operations supporting memory performance, not only episodic memory. This perspective agrees with other recent fMRI findings on semantic retrieval in healthy participants. It can therefore be hypothesized that lesions to the MD and the CM-Pf impair semantic retrieval. In this study, 10 patients with focal ischemic lesions in the medial thalamus and 10 healthy controls matched for age, education, and verbal IQ performed a verbal semantic retrieval task. Patients were assigned to a target clinical group and a control clinical group based on lesion localization. Patients did not suffer from aphasia and performed in the range of controls in a categorization and a semantic association task. However, target patients performed poorer than healthy controls on semantic retrieval. The deficit was not because of higher distractibility but of an increased rate of false recall and, in some patients, of a considerably increased rate of misses. The latter deficit yielded a striking difference between the target and the control clinical groups and is consistent with anomia. Follow-up high-resolution structural scanning session in a subsample of patients revealed that lesions in the CM-Pf and MD were primarily associated with semantic retrieval deficits. We conclude that integrity of the MD and the CM-Pf is required for semantic retrieval, possibly because of their role in the activation of phonological representations.

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

    Directory of Open Access Journals (Sweden)

    Campo Osaba Maria-Antonia

    2012-03-01

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

  10. Case-mix & patients' reports of outcome in Independent Sector Treatment Centres: Comparison with NHS providers

    Directory of Open Access Journals (Sweden)

    van der Meulen Jan

    2008-04-01

    Full Text Available Abstract Background There has been considerable concern expressed about the outcomes achieved in Independent Sector Treatment Centres (ISTCs introduced in England since 2003. Our aim was to compare the case-mix and patients' reported outcomes of surgery in ISTCs and in NHS providers. Methods Prospective cohort study of 769 patients treated in six ISTCs and 1895 treated in 20 NHS providers (acute hospitals and treatment centres in England during 2006–07. Participants underwent one of three day surgery procedures (inguinal hernia repair, varicose vein surgery, cataract extraction or hip or knee replacement. Change in patient-reported health status and health related quality of life (measured using a disease-specific and a generic (EQ-5D instrument was assessed either 3-months (day surgery or 6-months (hip/knee after surgery. In addition patient-reported post-operative complications and an overall assessment of success of surgery were collected. Outcome measures were adjusted (using multivariable regression for patient characteristics (disease severity, duration of symptoms, age, sex, socioeconomic status, general health, previous similar surgery, comorbidity. Results Post-operative response rates varied by procedure (73%–88% and were similar for those treated in ISTCs and NHS facilities. Patients treated in ISTCs were healthier, were less likely to have any comorbidity and, for those undergoing cataract surgery or joint replacement, their primary condition was less severe. Those undergoing hernia repair or joint replacement were less likely to have had similar surgery before. When adjustment was made for pre-operative characteristics, patients undergoing cataract surgery or hip replacement in ISTCs achieved a slightly greater improvement in functional status and quality of life than those treated in NHS facilities, while the opposite was true of patients undergoing hernia repair. No significant differences were found for the two other

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

    Directory of Open Access Journals (Sweden)

    Cordioli Aristides V

    2002-01-01

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

  12. Analysis of a group of clinical and social processing to caregivers of patients with dementia

    Directory of Open Access Journals (Sweden)

    Antonino Giorgi

    2014-09-01

    Full Text Available In Italy, according to recent data, the over 65 are about 20% of the population, while those over 80 are as many as 3 million (Istat, 2011. Over 600 thousand people are affected by Alzheimer's disease, the most common of the dementias. This pandemic is concerned, more or less directly, the majority of Italian families. A territorial service which wants to approach to families in difficulty must be organized on professional performances of experts and operators, whose diversity of competence is warranty for taking charge and for overcoming of the detected uneasiness. In this sense, the elaboration group for family members (caregivers that we present, offers the chance to receive and give sense to the effort due to the emotional implications that the disease of the elderly person involves. The work, presented here, has been designed and built by a perspective groupanalityc subjectual (Lo Verso, Di Blasi, 2011. It has set itself the goal of helping families to cope with the implications emotional / affective related to the topics of death and loss. The group device well it is combined with these clinical needs because it provided support and processing of emotional and cognitive experiences, has put in network information, has enabled the sharing of specific experiences. Through rigorous qualitative methodology, are therefore presented the outcomes of the group experience. Keywords:dementia, caregivers, group

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

    Science.gov (United States)

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

    2015-04-01

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

  14. Developing clinical practice guidelines for epilepsy: A report from the ILAE Epilepsy Guidelines Working Group.

    Science.gov (United States)

    Sauro, Khara M; Wiebe, Samuel; Perucca, Emilio; French, Jacqueline; Dunkley, Colin; de Marinis, Alejandro; Kirkpatrick, Martin; Jetté, Nathalie

    2015-12-01

    Clinical practice guidelines (CPGs) contain evidence-based recommendations to guide clinical care, policy development, and quality of care improvement. A recent systematic review of epilepsy guidelines identified considerable variability in the quality of available guidelines. Although excellent frameworks for CPG development exist, processes are not followed uniformly internationally, and resources to develop CPGs may be limited in certain settings. An International League Against Epilepsy (ILAE) working group was charged with proposing methodology to guide the development of future epilepsy-specific CPGs. A comprehensive literature search (1985-2014) identified articles related to CPG development and handbooks. Guideline handbooks were included if they were publicly available, and if their methodology had been used to develop CPGs. The working group's expertise also informed the creation of methodologies and processes to develop future CPGs for the ILAE. Five handbooks from North America (American Academy of Neurology), Europe (Scottish Intercollegiate Guidelines Network & National Institute for Health and Care Excellence), Australia (National Health and Medical Research Council), World Health Organization (WHO), and additional references were identified to produce evidence-based, consensus-driven methodology for development of epilepsy-specific CPGs. Key components of CPG development include the following: identifying the topic and defining the scope; establishing a working group; identifying and evaluating the evidence; formulating recommendations and determining strength of recommendations; obtaining peer reviews; dissemination, implementation, and auditing; and updating and retiring the CPG. A practical handbook and toolkit was developed. The resulting CPG development toolkit should facilitate the development of high-quality ILAE CPGs to improve the care of persons with epilepsy.

  15. Cohesion and alliance between clinic and research, in a time-limited group for young adults in a mental health center: A study of clinical efficacy

    OpenAIRE

    Maria Teresa Gargano; Vittorio Lenzo; Giuseppa Salanitro; Savio Camizzi; Girolamo Lo Verso

    2014-01-01

    Currently, the clinical efficacy of psychodynamic group psychotherapy, is still poorly studied. Also some process variables, such as cohesion and alliance, are poorly investigated, despite the group-setting is widely used in italian public health system. Hence a progressive separation between the scientific work of empirical research and clinical practice conducted in the italian public health system. Starting from these premises, a single-case research was realized, whose results are describ...

  16. Disability and countertransference in group psychotherapy: connecting social oppression with the clinical frame.

    Science.gov (United States)

    Watermeyer, Brian

    2012-07-01

    Psychoanalysis has paid limited attention to disability, and at times the approach has lacked political awareness. Over recent decades the international disability rights movement has argued that disabled people constitute an oppressed, systemically disadvantaged minority. Lately, a critical psychoanalytic view has connected disablist discrimination to universal unconscious conflicts evoked by impairment. Corresponding evocations emerge in the therapeutic frame, producing countertransference responses to the impaired body. Drawing on psychoanalytically oriented group psychotherapy with severely physically impaired adults, countertransference phenomena were studied in developing discussion on disability-related clinical work. The complex, uncertain role of psychoanalytic practice in combating oppression was also examined. Key issues include challenges to the traditional frame, the crossing of psychic boundaries, anxieties relating to not knowing, and the role of unconscious factors in marginalizing disabled experience. PMID:22676787

  17. Clinical trials update of the European Organization for Research and Treatment of Cancer Breast Cancer Group

    International Nuclear Information System (INIS)

    The present clinical trial update consists of a review of two of eight current studies (the 10981-22023 AMAROS trial and the 10994 p53 trial) of the European Organization for Research and Treatment of Cancer Breast Cancer Group, as well as a preview of the MIND-ACT trial. The AMAROS trial is designed to prove equivalent local/regional control for patients with proven axillary lymph node metastasis by sentinel node biopsy if treated with axillary radiotherapy instead of axillary lymph node dissection, with reduced morbidity. The p53 trial started to assess the potential predictive value of p53 using a functional assay in yeast in patients with locally advanced/inflammatory or large operable breast cancer prospectively randomised to a taxane regimen versus a nontaxane regimen

  18. Clinical characteristics of a group of adults with nodular lymphoid hyperplasia: A single center experience

    Institute of Scientific and Technical Information of China (English)

    Alberto Rubio-Tapia; Jorge Hernéndez-Calleros; Sagrario Trinidad-Hernández; Luis Uscanga

    2006-01-01

    AIM: To describe the clinical and histological characteristics of a group of adults with small-bowel nodular lymphoid hyperplasia (NLH).METHODS: Patients were searched for five years in pathology records of our institution. The biopsy material was reassessed using strict histopathological criteria.Clinical data were obtained from medical records.RESULTS: Small-bowel NLH was diagnosed in 18 cases.The female: male ratio was 2: 1. The most frequent symptoms were diarrhea (72%), involuntary weight loss (72%) and abdominal pain (61%). Nine patients (50%)had immunodeficiency. Small-bowel bacterial overgrowth was found in three (17%) cases. At small-bowel NLH diagnosis, three (17%) had associated lymphoma: two intestinal and one extra-intestinal lymphomas. In two patients with villous atrophy and anti-endomysial antibodies the diagnosis of celiac disease was established.Giardia lamblia infection was found in only one patientwith hypogammaglobulinemia (Herman's syndrome).CONCLUSIONS; NLH is uncommon in adult patients.Associated diseases are immunodeficiency and lymphoid tissue malignancies.

  19. Integration of noninvasive prenatal prediction of fetal blood group into clinical prenatal care.

    Science.gov (United States)

    Clausen, Frederik Banch

    2014-05-01

    Incompatibility of red blood cell blood group antigens between a pregnant woman and her fetus can cause maternal immunization and, consequently, hemolytic disease of the fetus and newborn. Noninvasive prenatal testing of cell-free fetal DNA can be used to assess the risk of hemolytic disease of the fetus and newborn to fetuses of immunized women. Prediction of the fetal RhD type has been very successful and is now integrated into clinical practice to assist in the management of the pregnancies of RhD immunized women. In addition, noninvasive prediction of the fetal RhD type can be applied to guide targeted prenatal prophylaxis, thus avoiding unnecessary exposure to anti-D in pregnant women. The analytical aspect of noninvasive fetal RHD typing is very robust and accurate, and its routine utilization has demonstrated high sensitivities for fetal RHD detection. A high compliance with administering anti-D is essential for obtaining a clinical effect. Noninvasive fetal typing of RHC/c, RHE/e, and KEL may become more widely used in the future. PMID:24431264

  20. Group sequential control of overall toxicity incidents in clinical trials - non-Bayesian and Bayesian approaches.

    Science.gov (United States)

    Yu, Jihnhee; Hutson, Alan D; Siddiqui, Adnan H; Kedron, Mary A

    2016-02-01

    In some small clinical trials, toxicity is not a primary endpoint; however, it often has dire effects on patients' quality of life and is even life-threatening. For such clinical trials, rigorous control of the overall incidence of adverse events is desirable, while simultaneously collecting safety information. In this article, we propose group sequential toxicity monitoring strategies to control overall toxicity incidents below a certain level as opposed to performing hypothesis testing, which can be incorporated into an existing study design based on the primary endpoint. We consider two sequential methods: a non-Bayesian approach in which stopping rules are obtained based on the 'future' probability of an excessive toxicity rate; and a Bayesian adaptation modifying the proposed non-Bayesian approach, which can use the information obtained at interim analyses. Through an extensive Monte Carlo study, we show that the Bayesian approach often provides better control of the overall toxicity rate than the non-Bayesian approach. We also investigate adequate toxicity estimation after the studies. We demonstrate the applicability of our proposed methods in controlling the symptomatic intracranial hemorrhage rate for treating acute ischemic stroke patients.

  1. Sociodemographic analysis of patients in radiation therapy oncology group clinical trials

    International Nuclear Information System (INIS)

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

  2. Hepato-biliary clinical trials and their inclusion in the Cochrane Hepato-Biliary Group register and reviews

    DEFF Research Database (Denmark)

    Klingenberg, Sarah Louise; Nikolova, Dimitrinka; Alexakis, Nicholas;

    2011-01-01

    The Cochrane Hepato-Biliary Group (CHBG) is one of the 52 collaborative review groups within The Cochrane Collaboration. The activities of the CHBG focus on collecting hepato-biliary randomized clinical trials (RCT) and controlled clinical trials (CCT), and including them in systematic reviews with...... meta-analyses of the trials. In this overview, we present the growth of The CHBG Controlled Trials Register, as well as the systematic reviews that have been produced since March 1996....

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

    Science.gov (United States)

    Scott, Dee; Jelsma, Jennifer

    2014-01-01

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

  4. Accountable Care Organizations and Clinical Commissioning Groups face an uncertain challenge for improving public health

    Directory of Open Access Journals (Sweden)

    Douglas J. Noble

    2012-04-01

    Full Text Available Accountable Care Organizations (ACO in the United States of America (USA and Clinical Commissioning Groups (CCG in the United Kingdom (UK are new proposed organizations in health services both tasked with a role which includes improving public health.  Although there are very significant differences between the UK and USA health systems there appears to be a similar confusion as to how ACO and CCG will regard and address public or population health.  The role of ACO in improving population health and evaluating the health needs of their registered and insured patients remains ill-defined and poorly explored.  Likewise, in the current UK National Health Service (NHS reorganisation, control and commissioning of appropriate local health services are passing from Primary Care Trusts (PCT to new cross-organizational structures (CCG.  CCG groups aim to be, like ACO, physician led.  They will also assume a role for public or population health, but this role, like that of the newly-forming ACO, is currently unclear.  Lessons learned from the USA and UK experience of new organizations tasked with a role in improving public health may inform mechanisms for physician led organizations in the UK and the USA to assess health needs, monitor population health information and improve population health outcomes.

  5. Intensive Care in India: The Indian Intensive Care Case Mix and Practice Patterns Study

    Directory of Open Access Journals (Sweden)

    Jigeeshu V Divatia

    2016-01-01

    Full Text Available Aims: To obtain information on organizational aspects, case mix and practices in Indian Intensive Care Units (ICUs. Patients and Methods: An observational, 4-day point prevalence study was performed between 2010 and 2011 in 4209 patients from 124 ICUs. ICU and patient characteristics, and interventions were recorded for 24 h of the study day, and outcomes till 30 days after the study day. Data were analyzed for 4038 adult patients from 120 ICUs. Results: On the study day, mean age, Acute Physiology and Chronic Health Evaluation (APACHE II and sequential organ failure assessment (SOFA scores were 54.1 ± 17.1 years, 17.4 ± 9.2 and 3.8 ± 3.6, respectively. About 46.4% patients had ≥1 organ failure. Nearly, 37% and 22.2% patients received mechanical ventilation (MV and vasopressors or inotropes, respectively. Nearly, 12.2% patients developed an infection in the ICU. About 28.3% patients had severe sepsis or septic shock (SvSpSS during their ICU stay. About 60.7% patients without infection received antibiotics. There were 546 deaths and 183 terminal discharges (TDs from ICU (including left against medical advice or discharged on request, with ICU mortality 729/4038 (18.1%. In 1627 patients admitted within 24 h of the study day, the standardized mortality ratio was 0.67. The APACHE II and SOFA scores, public hospital ICUs, medical ICUs, inadequately equipped ICUs, medical admission, self-paying patient, presence of SvSpSS, acute respiratory failure or cancer, need for a fluid bolus, and MV were independent predictors of mortality. Conclusions: The high proportion of TDs and the association of public hospitals, self-paying patients, and inadequately equipped hospitals with mortality has important implications for critical care in India.

  6. A pilot evaluation of group-based programming offered at a Canadian outpatient adult eating disorders clinic.

    Science.gov (United States)

    Mac Neil, Brad A; Leung, Pauline; Nadkarni, Pallavi; Stubbs, Laura; Singh, Manya

    2016-10-01

    Eating disorder clinics across Canada place heavy reliance on group-based programming. However, little work has examined whether this modality of treatment is well-received by patients and results in clinical improvements. The purpose of this pilot study was to evaluate patient satisfaction and outcomes for group-based programming offered through an adult eating disorders clinic. Participants were 81 adults who met DSM-5 criteria for an eating disorder and participated in the study as part of the clinic's program evaluation. Participants received medical monitoring, psychiatric follow-up, adjunct nutrition and pre-psychological treatment, and participated in the clinic's core cognitive behavioural therapy (CBT) group. Demographic information and weight were collected at intake. Participants also completed pre- and post-group programming measures of life satisfaction, depressive and anxiety symptoms, psychological symptoms of the eating disorder, and satisfaction with the programming. Participants' experienced a significant increase in satisfaction with life, and decreases in depressive symptoms and psychological symptoms of the eating disorder post-group. Adults endorsed feeling fairly satisfied with the group-based services provided. Results draw attention to the importance of program evaluation as an integral component of an adult outpatient eating disorder clinic by providing a voice for patients' views of the services received and program outcomes. PMID:27288960

  7. A pilot evaluation of group-based programming offered at a Canadian outpatient adult eating disorders clinic.

    Science.gov (United States)

    Mac Neil, Brad A; Leung, Pauline; Nadkarni, Pallavi; Stubbs, Laura; Singh, Manya

    2016-10-01

    Eating disorder clinics across Canada place heavy reliance on group-based programming. However, little work has examined whether this modality of treatment is well-received by patients and results in clinical improvements. The purpose of this pilot study was to evaluate patient satisfaction and outcomes for group-based programming offered through an adult eating disorders clinic. Participants were 81 adults who met DSM-5 criteria for an eating disorder and participated in the study as part of the clinic's program evaluation. Participants received medical monitoring, psychiatric follow-up, adjunct nutrition and pre-psychological treatment, and participated in the clinic's core cognitive behavioural therapy (CBT) group. Demographic information and weight were collected at intake. Participants also completed pre- and post-group programming measures of life satisfaction, depressive and anxiety symptoms, psychological symptoms of the eating disorder, and satisfaction with the programming. Participants' experienced a significant increase in satisfaction with life, and decreases in depressive symptoms and psychological symptoms of the eating disorder post-group. Adults endorsed feeling fairly satisfied with the group-based services provided. Results draw attention to the importance of program evaluation as an integral component of an adult outpatient eating disorder clinic by providing a voice for patients' views of the services received and program outcomes.

  8. Effects of Group Training on Depression and Anxiety among Patients with Type I Diabetes: a Randomized Clinical Trial

    Directory of Open Access Journals (Sweden)

    Shanaz Rostami

    2016-05-01

    Full Text Available Background Depression and anxiety can have a significant impact on prognosis in diabetic patients. In this study we evaluate how the effect of group learning on anxiety and depression in adolescents with type 1 diabetes at clinics of Ahvaz Jundishapur University of Medical Science. Materials and Methods  This study was carried out via a pretest- posttest design on the adolescent 11-21 ages with type I diabetes. 74 patients were randomized in education group (n=37 either to the control group (n=37. Data collection tools included demographic and clinical status questionnaires, and the Beck anxiety and depression inventory. Group training intervention was done for intervention group and three months after study two groups filled questionnaires and inventories. Data analyzed using chi-square test and t-test using SPSS- 22 software. Results  Findings showed that there was a significant difference between patients mean of depression in intervention group before and after intervention (P

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

    Directory of Open Access Journals (Sweden)

    Pavlovic Nada J

    2007-07-01

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

  10. Quantifying morbidities by Adjusted Clinical Group system for a Taiwan population: A nationwide analysis

    Directory of Open Access Journals (Sweden)

    Lee Wui-Chiang

    2008-07-01

    Full Text Available Abstract Background The Adjusted Clinical Group (ACG system has been used in measuring an individual's and a population's morbidities. Although all required inputs for running the ACG system are readily available, patients' morbidities and their associations to health care utilizations have been rarely studied in Taiwan. Therefore, the objective of this study was using the ACG system to quantify morbidities for Taiwanese population and to examine their relationship to ambulatory utilizations and costs. Methods This secondary analysis examined claims data for ambulatory services provided to 2.71 million representative Taiwanese in 2002 and 2003. People were grouped by the ACG system according to age, gender, and all ambulatory diagnosis codes in a given year. The software collapses the full set of ACGs into six morbidity categories (Non-users, Healthy, Low-morbidity, Moderate-, High- and Very-high termed Resource Utilization Bands (RUBs. Each ACG was assigned a relative weight (RW, which was calculated as the ratio of mean ambulatory cost for each ACG to that for the overall. The distribution of morbidities was compared between years 2002 and 2003. The consistency of the distributions of visits, costs, and RWs of each ACG were examined for a two-year period. The relationship between people's morbidities and their ambulatory utilizations and costs was assessed. Results Ninety-eight percent of the subjects were correctly assigned to ACGs. Except for non-users (7.9 ~ 8.3%, most subjects were assigned to ACGs of acute and minor diseases and ACGs of moderate-to-high-morbid chronic diseases. The distributions of ACG-based morbidities were highly consistent (r = 0.949, p between 2002 and 2003. The ACG-specific visits (r = 0.955, p , costs (r = 0.966, p and RWs (r = 0.991, p were correlated across two years. People grouped to the high-morbid ACGs had more visits and costs than those grouped to the low-morbid ACGs. Forty-six percent of the total

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

    Energy Technology Data Exchange (ETDEWEB)

    Park, Chan Ho; Han, Jong Kyu; Kim, Young Tong; Shin, Hyeong Cheol; Kim, Hyung Hwan; Jou, Sung Shick [Dept. of Radiology, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan (Korea, Republic of)

    2012-04-15

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

  12. A simplified surveillance case definition of AIDS derived from empirical clinical data. The Clinical AIDS Study Group, and the Working Group on AIDS case definition.

    Science.gov (United States)

    Weniger, B G; Quinhões, E P; Sereno, A B; de Perez, M A; Krebs, J W; Ismael, C; Sion, F S; Ramos-Filho, C F; de Sá, C A; Byers, R H

    1992-12-01

    A clinical AIDS case definition is needed for surveillance in countries where the CDC case definition is not practical. To derive such a definition, we compared 110 HIV-seropositive and 135 randomly selected HIV-seronegative adult medical-ward inpatients in Brazil. Multivariate analysis of clinical signs and symptoms and simple diagnoses resulted in a discriminant function with sensitivity of 89% and specificity of 96% in predicting for AIDS. These data were the empirical basis for a clinical definition of AIDS in adults drafted in a Caracas, Venezuela, workshop sponsored by the Pan American Health Organization. The revised "Caracas" definition presented here requires a positive HIV serology, the absence of cancer or other cause of immunosuppression, plus > or = 10 cumulative points, as follows: Kaposi's sarcoma (10 points); extrapulmonary/noncavitary pulmonary tuberculosis (10); oral candidiasis or hairy leukoplakia (5); cavitary pulmonary/unspecified tuberculosis (5); herpes zoster or = 1 month (2); fever > or = 1 month (2); cachexia or > 10% weight loss (2); asthenia > or = 1 month (2); persistent dermatitis (2); anemia, lymphopenia, or thrombocytopenia (2); persistent cough or any pneumonia except TB (2); and lymphadenopathy > or = 1 cm at > or = 2 noninguinal sites for > or = 1 month (2). This definition has a sensitivity of 95% and a specificity of 100% (91% without HIV serology) when applied to the Brazilian patients in this study. The Caracas definition has been adopted by Brazil, Honduras, and Surinam, and is in validation elsewhere. The use of a reasonably sensitive and specific case definition commensurate with available diagnostic resources should facilitate AIDS surveillance in developing countries. PMID:1453332

  13. Cognitive behavioral therapy for depression among adults in Japanese clinical settings: a single-group study

    Directory of Open Access Journals (Sweden)

    Kikuchi Toshiaki

    2010-06-01

    Full Text Available Abstract Background Empirical support for cognitive behavioral therapy (CBT for treating Japanese patients with major depression is lacking, therefore, a feasibility study of CBT for depression in Japanese clinical settings is urgently required. Findings A culturally adapted, 16-week manualized individual CBT program for Japanese patients with major depressive disorder was developed. A total of 27 patients with major depression were enrolled in a single-group study with the purpose of testing the feasibility of the program. Twenty six patients (96% completed the study. The mean total score on the Beck Depression Inventory-II (BDI-II for all patients (Intention-to-treat sample improved from 32.6 to 11.7, with a mean change of 20.8 (95% confidence interval: 17.0 to 24.8. Within-group effect size at the endpoint assessment was 2.64 (Cohen's d. Twenty-one patients (77.7% showed treatment response and 17 patients (63.0% achieved remission at the end of the program. Significant improvement was observed in measurement of subjective and objective depression severity (assessed by BDI-II, Quick Inventory of Depressive Symptomatology-Self Rated, and Hamilton Depression Rating Scale, dysfunctional attitude (assessed by Dysfunctional Attitude Scale, global functioning (assessed by Global Assessment of Functioning of DSM-IV and subjective well-being (assessed by WHO Subjective Well-being Inventory (all p values Conclusions Our manualized treatment comprised of a 16-week individual CBT program for major depression appears feasible and may achieve favorable treatment outcomes among Japanese patients with major depression. Further research involving a larger sample in a randomized, controlled trial design is warranted. Trial registration UMIN-CTR UMIN000002542.

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

    Directory of Open Access Journals (Sweden)

    Sophia K Smith

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

  15. Veal calves’ clinical/health status in large groups fed with automatic feeding devices

    Directory of Open Access Journals (Sweden)

    Giulio Cozzi

    2010-01-01

    Full Text Available Aim of the current study was to evaluate the clinical/health status of veal calves in 3 farms that adopt large group housing and automatic feeding stations in Italy. Visits were scheduled in three phases of the rearing cycle (early, middle, and end. Results showed a high incidence of coughing, skin infection and bloated rumen particularly in the middle phase while cross-sucking signs were present at the early stage when calves’ nibbling proclivity is still high. Throughout the rearing cycle, the frequency of bursitis increased reaching 53% of calves at the end. The percentage of calves with a poorer body condition than the mid-range of the batch raised gradually as well, likely due to the non-proportioned teat/calves ratio that increases competition for feed and reduces milk intake of the low ranking animals. The remarked growth differences among pen-mates and the mortality rate close to 7% showed by the use of automatic feeding devices for milk delivery seem not compensating the lower labour demand, therefore its sustainability at the present status is doubtful both for the veal calves’ welfare and the farm incomes.

  16. Relationship of femorodistal bypass patency to clinical outcome. Iloprost Bypass International Study Group

    DEFF Research Database (Denmark)

    Watson, H R; Schroeder, T V; Simms, M H;

    1999-01-01

    To investigate the relationship between bypass patency, limb survival and clinical symptoms after femorodistal bypass procedures.......To investigate the relationship between bypass patency, limb survival and clinical symptoms after femorodistal bypass procedures....

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

    DEFF Research Database (Denmark)

    Buus, Niels; Angel, Sanne; Traynor, Michael;

    2011-01-01

    This paper is a report of an interview study exploring psychiatric hospital nursing staff members' reflections on participating in supervision. Clinical supervision is a pedagogical process designed to direct, develop, and support clinical nurses. Participation rates in clinical supervision in ps...

  18. Central review of cytogenetics is necessary for cooperative group correlative and clinical studies of adult acute leukemia: The Cancer and Leukemia Group B experience

    OpenAIRE

    Mrózek, Krzysztof; Carroll, Andrew J.; Maharry, Kati; Rao, Kathleen W.; Patil, Shivanand R.; Pettenati, Mark J.; Watson, Michael S.; Arthur, Diane C.; Tantravahi, Ramana; Heerema, Nyla A.; Koduru, Prasad R. K.; Block, AnneMarie W; Qumsiyeh, Mazin B.; Edwards, Colin G.; Sterling, Lisa J.

    2008-01-01

    The Cancer and Leukemia Group B has performed central review of karyotypes submitted by institutional cytogenetics laboratories from patients with acute myeloid (AML) and acute lymphoblastic (ALL) leukemia since 1986. We assessed the role of central karyotype review in maintaining accurate, high quality cytogenetic data for clinical and translational studies using two criteria: the proportion of karyotypes rejected (i.e. inadequate), and, among accepted (i.e. adequate) cases, the proportion o...

  19. Confronting diversity in the production of clinical evidence goes beyond merely including under-represented groups in clinical trials

    NARCIS (Netherlands)

    Stronks, Karien; Wieringa, Nicolien F.; Hardon, Anita

    2013-01-01

    There is increasing evidence that outcomes of health care differ by patient characteristics, such as gender and ethnicity. If evidence-based medicine is to improve quality of care for all patients, it is essential to take this diversity into account when designing clinical studies. So far, this noti

  20. Gait analysis in clinically healthy sheep from three different age groups using a pressure-sensitive walkway

    OpenAIRE

    Agostinho Felipe S; Rahal Sheila C; Araújo Fábio A P; Conceição Renato T; Hussni Carlos A; El-Warrak Alexander O; Monteiro Frederico O B

    2012-01-01

    Abstract Background Understanding normal gait requires allowing for variations in normal patterns by the sex, age, and species in question. Therefore, the aim of this study was to evaluate kinetic and temporospatial parameters in clinically healthy sheep from three different age groups with a pressure-sensing walkway. The sheep were judged to be healthy based on the results of complete physical and orthopaedic examinations and had no history of lameness. Twenty-one clinically healthy female S...

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

    OpenAIRE

    Kritaya Sawangchareon; Sineenard Pranboon; Somsak Tiamkao; Kittisak Sawanyawisuth

    2013-01-01

    Introduction: People with epilepsy (PWE) face physical and mental illness, and social stigma, which affect their self-esteem and quality of life. The purpose of this study was to examine the effects of a support group on the self-esteem of PWE. Methods: A Quasi-experimental study was performed on 120 PWE in the Epilepsy Clinic at Srinagarind Hospital. The experimental group (N=60) attended the support group before receiving regular health care services. The control group (N=60) received only...

  2. Anti-choice group seeks Supreme Court review of federal clinic access law; Congress holds hearings.

    Science.gov (United States)

    1995-05-19

    The Freedom of Access to Clinic Entrances Act (FACE) is a federal statute which was signed into law May 1994 prohibiting the use of force, threat of force, or physical obstruction to intentionally injure, intimidate, or interfere with anyone providing reproductive health services. Since FACE was enacted, seven federal district courts and one federal appellate court have found the measure constitutional, although one federal district court in Wisconsin did rule against FACE. Anti-choice activists have argued that neither the Commerce Clause nor the Fourteenth Amendment to the US Constitution empower Congress to enact FACE. Congress relied upon both constitutional provisions when it enacted the statute, recognizing that illegal, violent acts against abortion providers and their patients threaten to disrupt medical care nationwide and eliminate the right to choose abortion. The US Court of Appeals for the Fourth Circuit on February 13, 1995, however, unanimously upheld a lower court's dismissal of the case, finding that FACE does not violate the US Constitution. Relying upon an April 26 Supreme Court decision in United States vs. Lopez, which held that Congress did not have the power under the Commerce Clause to enact a federal statute prohibiting the possession of a firearm within 100 feet of a school zone, an anti-choice group and several individuals petitioned the US Supreme Court in a May 12 filing to review the appellate court ruling in American Life League vs. Reno. The petitioners also challenge the broad powers of Congress under the Fourteenth Amendment to remedy infringements upon constitutional rights and assert FACE violates the First Amendment and the Religious Freedom Restoration Act. PMID:12346170

  3. Anti-choice group seeks Supreme Court review of federal clinic access law; Congress holds hearings.

    Science.gov (United States)

    1995-05-19

    The Freedom of Access to Clinic Entrances Act (FACE) is a federal statute which was signed into law May 1994 prohibiting the use of force, threat of force, or physical obstruction to intentionally injure, intimidate, or interfere with anyone providing reproductive health services. Since FACE was enacted, seven federal district courts and one federal appellate court have found the measure constitutional, although one federal district court in Wisconsin did rule against FACE. Anti-choice activists have argued that neither the Commerce Clause nor the Fourteenth Amendment to the US Constitution empower Congress to enact FACE. Congress relied upon both constitutional provisions when it enacted the statute, recognizing that illegal, violent acts against abortion providers and their patients threaten to disrupt medical care nationwide and eliminate the right to choose abortion. The US Court of Appeals for the Fourth Circuit on February 13, 1995, however, unanimously upheld a lower court's dismissal of the case, finding that FACE does not violate the US Constitution. Relying upon an April 26 Supreme Court decision in United States vs. Lopez, which held that Congress did not have the power under the Commerce Clause to enact a federal statute prohibiting the possession of a firearm within 100 feet of a school zone, an anti-choice group and several individuals petitioned the US Supreme Court in a May 12 filing to review the appellate court ruling in American Life League vs. Reno. The petitioners also challenge the broad powers of Congress under the Fourteenth Amendment to remedy infringements upon constitutional rights and assert FACE violates the First Amendment and the Religious Freedom Restoration Act.

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

    DEFF Research Database (Denmark)

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

    2010-01-01

    Sows suffering from clinical signs of disease (e.g. lameness, wounds and shoulder ulcers) are often involuntarily culled, affecting the farmer's economy and the welfare of the animals. In order to investigate the interrelationships between clinical signs of individual pregnant group-housed sows, we...... the explanatory factor analysis, we identified three factors describing the underlying structure of the 16 clinical variables. We interpreted the factors as ‘pressure marks', ‘wounds' and ‘lameness' Logistic analyses were performed to investigate the effect of the three factors and the parity number of each sow...

  5. The articulation of integration of clinical and basic sciences in concept maps: differences between experienced and resident groups.

    Science.gov (United States)

    Vink, Sylvia; van Tartwijk, Jan; Verloop, Nico; Gosselink, Manon; Driessen, Erik; Bolk, Jan

    2016-08-01

    To determine the content of integrated curricula, clinical concepts and the underlying basic science concepts need to be made explicit. Preconstructed concept maps are recommended for this purpose. They are mainly constructed by experts. However, concept maps constructed by residents are hypothesized to be less complex, to reveal more tacit basic science concepts and these basic science concepts are expected to be used for the organization of the maps. These hypotheses are derived from studies about knowledge development of individuals. However, integrated curricula require a high degree of cooperation between clinicians and basic scientists. This study examined whether there are consistent variations regarding the articulation of integration when groups of experienced clinicians and basic scientists and groups of residents and basic scientists-in-training construct concept maps. Seven groups of three clinicians and basic scientists on experienced level and seven such groups on resident level constructed concept maps illuminating clinical problems. They were guided by instructions that focused them on articulation of integration. The concept maps were analysed by features that described integration. Descriptive statistics showed consistent variations between the two expertise levels. The concept maps of the resident groups exceeded those of the experienced groups in articulated integration. First, they used significantly more links between clinical and basic science concepts. Second, these links connected basic science concepts with a greater variety of clinical concepts than the experienced groups. Third, although residents did not use significantly more basic science concepts, they used them significantly more frequent to organize the clinical concepts. The conclusion was drawn that not all hypotheses could be confirmed and that the resident concept maps were more elaborate than expected. This article discusses the implications for the role that residents and

  6. Maternal evaluations of young children’s developmental status: A comparison of clinic- and non-clinic-groups

    Directory of Open Access Journals (Sweden)

    Pia Deimann

    2011-06-01

    Full Text Available The question whether parents’ reports on their children’s development provide reliable information is a subject of controversial debate. While parental rating scales and parental interviews are widely used in clinical practice, empirical findings have shown that parents cannot assess their children well. Previous research has illustrated that most parents tend to overestimate the developmental status and cognitive performance of their children. If the child displays behavior problems, the accuracy of mothers’ appraisals decreases substantially. The aim of this study was (1 to examine whether mothers who are concerned about their children’s development still overestimate the developmental status and (2 whether maternal beliefs about developmental norms influence the accuracy of evaluation. The sample consisted of 14 mother-child-dyads who were clients of two outpatient clinics in Vienna and had concerns about the child’s development, 16 mother-child-dyads without concerns who sought advice because of their children’s potential high abilities, and 30 mother-child-dyads without concerns and no clinic referral. While the children were tested using the Wiener Entwicklungstest (Viennese Developmental Test, WET, Kastner-Koller & Deimann, 2002, a developmental test for children 3 to 6 years old, mothers were asked to estimate which items of the WET (1 their own child and (2 a normal peer would be able to solve. Mothers with concerns had limited knowledge of what a child of a certain age can achieve and they expected too much. Though they realized that their own developmentally delayed child did not fulfill these high expectations, they were not able to appraise his/her performance accurately. Mothers whose children were normally developed or even above average were able to evaluate their own children much more precisely. Moreover, these mothers estimated developmental norms more accurately. Both mothers of gifted children and of

  7. Clinical intuition in mental health care: A discussion and focus groups

    NARCIS (Netherlands)

    Witteman, C.L.M.; Spaanjaars, N.L.; Aarts, A.A.

    2012-01-01

    Clinical intuition in mental health care has been written off as a mysterious kind of ability to ‘see through’ clients, something that clinicians who favour evidence-based practice should have nothing to do with. We propose another understanding of clinical intuition. Similar to other types of profe

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

    Science.gov (United States)

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

    2010-08-01

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

  9. RADIATION THERAPY ONCOLOGY GROUP TRANSLATIONAL RESEARCH PROGRAM STEM CELL SYMPOSIUM : INCORPORATING STEM CELL HYPOTHESES INTO CLINICAL TRIALS

    NARCIS (Netherlands)

    Woodward, Wendy A.; Bristow, Robert G.; Clarke, Michael F.; Coppes, Robert P.; Cristofanilli, Massimo; Duda, Dan G.; Fike, John R.; Hambardzumyan, Dolores; Hill, Richard P.; Jordan, Craig T.; Milas, Luka; Pajonk, Frank; Curran, Walter J.; Dicker, Adam P.; Chen, Yuhchyau

    2009-01-01

    At a meeting of the Translation Research Program of the Radiation Therapy Oncology Group held in early 2008, attendees focused on updating the current state of knowledge in cancer stem cell research and discussing ways in which this knowledge can be translated into clinical use across all disease si

  10. Variable prospective financing in the Danish hospital sector and the development of a Danish case-mix system.

    Science.gov (United States)

    Ankjaer-Jensen, Anni; Rosling, Pernille; Bilde, Lone

    2006-08-01

    This article aims to describe and assess the Danish case-mix system, the cost accounting applied in setting national tariffs and the introduction of variable, prospective payment in the Danish hospital sector. The tariffs are calculated as a national average from hospital data gathered in a national cost database. However, uncertainty, mainly resulting from the definition of cost centres at the individual hospital, implies that the cost weights may not fully reflect the hospital treatment cost. As variable prospective payment of hospitals currently only applies to 20% of a hospital's budget, the incentives and the effects on productivity, quality and equality are still limited. PMID:17016932

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

    OpenAIRE

    Burgess, Annette; Goulston, Kerry; Oates, Kim

    2015-01-01

    Background Role modelling by clinicians assists in development of medical students’ professional competencies, values and attitudes. Three core characteristics of a positive role model include 1) clinical attributes, 2) teaching skills, and 3) personal qualities. This study was designed to explore medical students’ perceptions of their bedside clinical tutors as role models during the first year of a medical program. Methods The study was conducted with one cohort (n = 301) of students who ha...

  12. The Pediatric Home Care/Expenditure Classification Model (P/ECM): A Home Care Case-Mix Model for Children Facing Special Health Care Challenges

    OpenAIRE

    Phillips, Charles D

    2015-01-01

    Case-mix classification and payment systems help assure that persons with similar needs receive similar amounts of care resources, which is a major equity concern for consumers, providers, and programs. Although health service programs for adults regularly use case-mix payment systems, programs providing health services to children and youth rarely use such models. This research utilized Medicaid home care expenditures and assessment data on 2,578 children receiving home care in one large sta...

  13. A Novel Religious/Spiritual Group Psychotherapy Reduces Depressive Symptoms in a Randomized Clinical Trial.

    Science.gov (United States)

    Chida, Yoichi; Schrempft, Stephanie; Steptoe, Andrew

    2016-10-01

    This randomized controlled trial aimed to examine the effect of the Happy Science doctrine-based group psychotherapy on depressive symptoms in 118 Japanese mental disorder outpatients. The treatment group (n = 58) took part in five 90-min sessions at one-week intervals, while the control group (n = 60) received standard care including medication. Depressive symptoms were assessed before the intervention, 5 weeks after the intervention, and at 3-month follow-up. Compared to the control group, the treatment group showed a significant reduction in depressive symptoms both at post-intervention and at 3-month follow-up. In conclusion, this group psychotherapy might be of benefit in treating depressive symptoms. PMID:26320001

  14. An Australasian perspective on sarcoma research, translational biology and clinical trials: the Australasian Sarcoma Study Group (ASSG).

    Science.gov (United States)

    Bae, Susie; Caruso, Denise; Desai, Jayesh

    2014-02-01

    Each year approximately 800 Australians are diagnosed with sarcoma, accounting for less than 1% of cancer diagnoses overall. A significant proportion of these sarcoma cases are in children and adolescents. The rarity and heterogeneity of this group of tumours, coupled with Australasia's relative geographical isolation, pose significant challenges in developing locoregional basic, translational and clinical research. The Australasian Sarcoma Study Group (ASSG) was established in 2008 as a Cooperative Cancer Clinical Research Group and is now the peak body for sarcoma research in Australasia, providing a mechanism to drive and coordinate collaborative research, promote education and assist with advocating for sarcoma within the region. This paper describes the development of ASSG and examines the current state of play with regard to sarcoma research in Australasia. PMID:24378392

  15. Relationship between ABO blood groups and malaria with clinical outcome in rural area of South India

    OpenAIRE

    Gayathri B.N.; Harendra Kumar M.L.; Gomathi. N.; Jeevan Shetty; Reethesh R. P.

    2013-01-01

    Background A number of studies have shown that susceptibility to several infectious diseases is related to the patient’s blood group. Although the relationship between blood group and susceptibility to malaria has been studied by several researchers, the results have been contradictory. Since malaria has re-emerged as a major problem in India during the past few years, it would be useful to know whether there is any relationship between blood group and infection. Objectives The study will be...

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

    DEFF Research Database (Denmark)

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

    Background: The efficacy of a group cognitive behavioural therapy program (Cool Kids) of childhood anxiety has been demonstrated in a university-clinic setting in Australia (Hudson et al., 2009) and findings from a randomized controlled trial (RCT) at a University-clinic supports its efficacy...... in Denmark (Arendt & Thastum, 2013). Objective: To evaluate the outcomes of evidence based, manualized group cognitive-behavioural treatment (CBT) for children and adolescent with anxiety disorders, when delivered in an outpatient Child and Adolescent Psychiatry or in a community based School Counselling...... with the children and their parents at pre- and post-treatment and at 3-month follow-up (ADIS-C/P: Silverman & Nelles, 1988), as well as by self-report child and parent scales pre- and post-treatment, and at 3- and 12 month follow-ups. Parents’ symptoms of anxiety and depression are also measured. Results...

  17. Is RoAsT tougher than StEAk?: The effect of case mixing on perception of multi-letter graphemes

    Directory of Open Access Journals (Sweden)

    Jelena Havelka

    2010-03-01

    Full Text Available Case mixing is a technique that is used to investigate the perceptual processes involved in visual word recognition. Two experiments examined the effect of case mixing on lexical decision latencies. The aim of these experiments was to establish whether different case mixing patterns would interact with the process of appropriate visual segmentation and phonological assembly in word reading. In the first experiment, case mixing had a greater effect on response times to words when it led to visual disruption of the multi-letter graphemes (MLGs as well as the overall word shape (e.g. pLeAd, compared to when it disrupted overall word shape only (e.g. plEAd. A second experiment replicated this finding with words in which MLGs represent either the vowel (e.g. bOaST vs. bOAst or the consonant sound (e.g. sNaCK vs. sNAcK. These results confirm that case mixing can have different effect depending on the type of orthographic unit that is broken up by the manipulation. They demonstrate that graphemes are units that play an important role in visual word recognition, and that manipulation of their presentation by case mixing will have a significant effect on response latencies to words in a lexical decision task. As such these findings need to be taken into account by the models of visual word recognition.

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

    DEFF Research Database (Denmark)

    Christophersen, J; Menné, T; Tanghøj, P;

    1989-01-01

    patch tested with the standard series of the International Contact Dermatitis Research Group (ICDRG) by members of the Danish Contact Dermatitis Group (DCDG) over a period of 6 months. For the 8 test allergens most often found positive (nickel, fragrance-mix, cobalt, chromate, balsam of Peru, carba...

  19. Group Therapy with Patients in the Waiting Room of an Oncology Clinic.

    Science.gov (United States)

    Arnowitz, Edward; And Others

    1983-01-01

    Describes a therapy group for cancer patients, conducted by cotherapists in an oncology waiting room. Group members provided mutual support and shared concerns and coping methods. Medical staff members became more involved and were more able to address the affective needs of the patients and their families. (JAC)

  20. Clinical education and training: Using the nominal group technique in research with radiographers to identify factors affecting quality and capacity

    International Nuclear Information System (INIS)

    There are a number of group-based research techniques available to determine the views or perceptions of individuals in relation to specific topics. This paper reports on one method, the nominal group technique (NGT) which was used to collect the views of important stakeholders on the factors affecting the quality of, and capacity to provide clinical education and training in diagnostic imaging and radiotherapy and oncology departments in the UK. Inclusion criteria were devised to recruit learners, educators, practitioners and service managers to the nominal groups. Eight regional groups comprising a total of 92 individuals were enrolled; the numbers in each group varied between 9 and 13. A total of 131 items (factors) were generated across the groups (mean = 16.4). Each group was then asked to select the top three factors from their original list. Consensus on the important factors amongst groups found that all eight groups agreed on one item: staff attitude, motivation and commitment to learners. The 131 items were organised into themes using content analysis. Five main categories and a number of subcategories emerged. The study concluded that the NGT provided data which were congruent with the issues faced by practitioners and learners in their daily work; this was of vital importance if the findings are to be regarded with credibility. Further advantages and limitations of the method are discussed, however it is argued that the NGT is a useful technique to gather relevant opinion; to select priorities and to reach consensus on a wide range of issues

  1. Incidence and clinical characteristics of group A rotavirus infections among children admitted to hospital in Kilifi, Kenya.

    Directory of Open Access Journals (Sweden)

    D James Nokes

    2008-07-01

    Full Text Available BACKGROUND: Rotavirus, predominantly of group A, is a major cause of severe diarrhoea worldwide, with the greatest burden falling on young children living in less-developed countries. Vaccines directed against this virus have shown promise in recent trials, and are undergoing effectiveness evaluation in sub-Saharan Africa. In this region limited childhood data are available on the incidence and clinical characteristics of severe group A rotavirus disease. Advocacy for vaccine intervention and interpretation of effectiveness following implementation will benefit from accurate base-line estimates of the incidence and severity of rotavirus paediatric admissions in relevant populations. The study objective was to accurately define the incidence and severity of group A rotavirus disease in a resource-poor setting necessary to make informed decisions on the need for vaccine prevention. METHODS AND FINDINGS: Between 2002 and 2004 we conducted prospective surveillance for group A rotavirus infection at Kilifi District Hospital in coastal Kenya. Children 2% of children are admitted to hospital with group A rotavirus diarrhoea in the first 5 y of life. This translates into over 28,000 vaccine-preventable hospitalisations per year across Kenya, and is likely to be a considerable underestimate. Group A rotavirus diarrhoea is associated with acute life-threatening metabolic derangement in otherwise healthy children. Although mortality is low in this clinical research setting this may not be generally true in African hospitals lacking rapid and appropriate management.

  2. The impact of payer-specific hospital case mix on hospital costs and revenues for third-party patients.

    Science.gov (United States)

    Lee, Keon-Hyung; Roh, M P H Chul-Young

    2007-02-01

    Competition among hospitals and managed care have forced hospital industry to be more efficient. With higher degrees of hospital competition and managed care penetration, hospitals have argued that the rate of increase in hospital cost is greater than the rate of increase in hospital revenue. By developing a payer-specific case mix index (CMI) for third-party patients, this paper examined the effect of hospital case mix on hospital cost and revenue for third-party patients in California using the hospital financial and utilization data covering 1986-1998. This study found that the coefficients for CMIs in the third-party hospital revenue model were greater than those in the hospital cost model until 1995. Since 1995, however, the coefficients for CMIs in the third-party hospital revenue model have been less than those in hospital cost models. Over time, the differences in coefficients for CMIs in hospital revenue and cost models for third-party patients have become smaller and smaller although those differences are statistically insignificant.

  3. Radiation Therapy Oncology Group Translational Research Program Stem Cell Symposium: Incorporating Stem Cell Hypotheses into Clinical Trials

    International Nuclear Information System (INIS)

    At a meeting of the Translation Research Program of the Radiation Therapy Oncology Group held in early 2008, attendees focused on updating the current state of knowledge in cancer stem cell research and discussing ways in which this knowledge can be translated into clinical use across all disease sites. This report summarizes the major topics discussed and the future directions that research should take. Major conclusions of the symposium were that the flow cytometry of multiple markers in fresh tissue would remain the standard technique of evaluating cancer-initiating cells and that surrogates need to be developed for both experimental and clinical use.

  4. The use of hirudin as universal anticoagulant in haematology, clinical chemistry and blood grouping.

    Science.gov (United States)

    Menssen, H D; Melber, K; Brandt, N; Thiel, E

    2001-12-01

    Undesirable interactions between anticoagulants and diagnostic test kit procedures so far have prevented the development of a single uniform blood sampling tube. Contrary to K2-EDTA, heparin and other anticoagulants, hirudin only minimally alters blood cells and dissolved blood constituents, thus qualifying as a universal anticoagulant for diagnostic purposes. Automated complete blood counts, automated analyses of clinical chemistry analytes and immunohaematology were performed from hirudinised and routinely processed blood obtained from healthy volunteers (n=35) and hospitalised patients (n=45). Hirudin (400 ATU/ml blood) sufficiently anticoagulated blood for diagnostic purposes. The measurements of automated complete blood counts obtained from K2-EDTA-anticoagulated and hirudinised blood correlated significantly as did the measurements of 24 clinical chemistry analytes from hirudinised plasma and serum. Regression analysis revealed that the results of complete blood counts and clinical chemistry tests were predictable from the respective measurements from hirudinised blood (p=0.001). Immunohaematological tests and cross-matching from hirudinised and native blood of the same donors gave identical results. Single clotting factors, but not global coagulation analytes, could be measured from hirudinised blood. Therefore, a universal hirudin-containing blood sampling tube could be designed for automated analysis of haematological, serological and clinical chemistry analytes. PMID:11798089

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

    DEFF Research Database (Denmark)

    Buus, Niels; Angel, Sanne; Traynor, Michael;

    2010-01-01

    reasons for their ambivalence. Semi-structured interviews were conducted with 22 psychiatric nurses at a Danish university hospital. The results indicated that participation in clinical supervision was difficult for the nurses because of an uncomfortable exposure to the professional community. The sense...

  6. Clinical research on peri-implant diseases: consensus report of Working Group 4.

    LENUS (Irish Health Repository)

    Sanz, Mariano

    2012-02-01

    Two systematic reviews have evaluated the quality of research and reporting of observational studies investigating the prevalence of, the incidence of and the risk factors for peri-implant diseases and of experimental clinical studies evaluating the efficacy of preventive and therapeutic interventions.

  7. Post-Polio Directory 2014: Post-Polio Clinics, Health Professionals, Support Groups

    Science.gov (United States)

    ... Orthopedics & Sports Medicine 12499 University Ave, Ste 210 Clive, IA 50325 515-440-2676 IOWA–Support Group ... Health Professionals TMR Orthotic Prosthetic Service Ethel Mieles Robert Martinez 2418 Ditmars Blvd Astoria, NY 11105 718- ...

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

    International Nuclear Information System (INIS)

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

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

    Science.gov (United States)

    Jensen, T B; Bonde, M K; Kongsted, A G; Toft, N; Sørensen, J T

    2010-11-01

    Sows suffering from clinical signs of disease (e.g. lameness, wounds and shoulder ulcers) are often involuntarily culled, affecting the farmer's economy and the welfare of the animals. In order to investigate the interrelationships between clinical signs of individual pregnant group-housed sows, we performed an explanatory factor analysis to identify factors describing the patterns of variation of clinical signs. Moreover, we investigated how these emerging factors affected the probability of a sow to be either (i) euthanized, (ii) suddenly dead, (iii) sent to slaughter due to clinical signs of disease such as claw lesions or wounds or (iv) involuntarily culled (representing a pool of sows that were either euthanized, dead or sent to slaughter due to disease). Data from 2.989 pregnant sows in group-housing systems from 33 sow herds were included in the study. A thorough clinical examination was performed for each sow by using a protocol including 16 different clinical signs. Farmers recorded all cullings and deaths and the reasons for these actions in a 3-month period after the clinical examination. Among the observed sows, 4.2% were involuntarily culled during the 3-month period. From the explanatory factor analysis, we identified three factors describing the underlying structure of the 16 clinical variables. We interpreted the factors as 'pressure marks', 'wounds' and 'lameness' Logistic analyses were performed to investigate the effect of the three factors and the parity number of each sow on the four outcomes: (i) euthanized, (ii) suddenly dead, (iii) sent to slaughter due to clinical signs of disease and (iv) involuntarily culled. The analyses showed that 'lameness' significantly increased the risk of sows to be involuntarily culled (P = 0.016) or sent to slaughter due to clinical signs of disease (P = 0.026). Lameness is generally considered to be an important welfare problem in sows, which could explain the increased risk seen in this study. By contrast

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

    Science.gov (United States)

    Jensen, T B; Bonde, M K; Kongsted, A G; Toft, N; Sørensen, J T

    2010-11-01

    Sows suffering from clinical signs of disease (e.g. lameness, wounds and shoulder ulcers) are often involuntarily culled, affecting the farmer's economy and the welfare of the animals. In order to investigate the interrelationships between clinical signs of individual pregnant group-housed sows, we performed an explanatory factor analysis to identify factors describing the patterns of variation of clinical signs. Moreover, we investigated how these emerging factors affected the probability of a sow to be either (i) euthanized, (ii) suddenly dead, (iii) sent to slaughter due to clinical signs of disease such as claw lesions or wounds or (iv) involuntarily culled (representing a pool of sows that were either euthanized, dead or sent to slaughter due to disease). Data from 2.989 pregnant sows in group-housing systems from 33 sow herds were included in the study. A thorough clinical examination was performed for each sow by using a protocol including 16 different clinical signs. Farmers recorded all cullings and deaths and the reasons for these actions in a 3-month period after the clinical examination. Among the observed sows, 4.2% were involuntarily culled during the 3-month period. From the explanatory factor analysis, we identified three factors describing the underlying structure of the 16 clinical variables. We interpreted the factors as 'pressure marks', 'wounds' and 'lameness' Logistic analyses were performed to investigate the effect of the three factors and the parity number of each sow on the four outcomes: (i) euthanized, (ii) suddenly dead, (iii) sent to slaughter due to clinical signs of disease and (iv) involuntarily culled. The analyses showed that 'lameness' significantly increased the risk of sows to be involuntarily culled (P = 0.016) or sent to slaughter due to clinical signs of disease (P = 0.026). Lameness is generally considered to be an important welfare problem in sows, which could explain the increased risk seen in this study. By contrast

  11. Benefits of Group Singing for People with Eating Disorders: Preliminary Findings from a Non-Clinical Study

    Directory of Open Access Journals (Sweden)

    Metaxia Pavlakou

    2009-01-01

    Full Text Available The purpose of this study is to examine the possible benefits of participation in group singing for people with eating disorders in a non-clinical context. The creation of a group singing workshop for women that exhibited disordered eating provided the opportunity to explore the participants’ experiences as perceived by them. A qualitative approach utilizing a semi-structured interview was employed to explore in depth the women’s perceptions regarding the group singing workshop. A thematic analysis of the data identified four main categories concerning the benefits of group singing for the population under study. The theoretical model of Sears (1968 of the processes in music therapy and its application on anorexic clients (Parente 1989 informed the discussion of the empirical findings.

  12. Under-representation of women on governing bodies: women general practitioners on Clinical Commissioning Groups in England.

    Science.gov (United States)

    Segar, Julia

    2015-10-01

    Recently formed Clinical Commissioning Groups in the English National Health Service have important responsibility for commissioning local health and care services. Women are under-represented on the governing bodies of these significant primary care based organizations despite the fact that they constitute almost half of the general practitioner workforce in England. This essay examines some of the reasons for this under-representation including the predominance of women in the salaried and part-time sector of general practice and gendered management styles within the National Health Service. It is argued that the under-representation of women on Clinical Commissioning Group governing bodies matters in terms of social justice, representation of the broader community and role models. PMID:25589088

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

    Science.gov (United States)

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

    2012-07-04

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

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

    Directory of Open Access Journals (Sweden)

    Eccles Martin P

    2012-07-01

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

  15. Assessment of the Need to Integrate Academic Electronic Medical Records Into the Undergraduate Clinical Practicum: A Focus Group Interview.

    Science.gov (United States)

    Choi, Mona; Park, Joon Ho; Lee, Hyeong Suk

    2016-06-01

    As healthcare systems demand that nurses be competent in using electronic medical records for patient care, the integration of electronic medical records into nursing curricula has become necessary. The purpose of this study was to explore how students, new nurses, clinical instructors, and faculty perceive the integration of academic electronic medical records into the undergraduate clinical practicum. From January to February 2014, four focus group interviews with 18 participants were conducted based on purposive sampling. Content analysis was used on the unabridged transcripts to extract themes and develop meaningful categories. Three major themes and eight subthemes were revealed from the focus group interviews. The major themes were "electronic medical record as a learning tool for clinical practicum," "essential functions of academic electronic medical records," and "expected outcomes of academic electronic medical record." Participants expected academic electronic medical records to enhance students' nursing informatics competencies. The findings of this study can inform the process of developing academic electronic medical records for clinical practicum, which will then augment students' informatics competencies. PMID:27081757

  16. Social and behavioral research in genomic sequencing: approaches from the Clinical Sequencing Exploratory Research Consortium Outcomes and Measures Working Group.

    Science.gov (United States)

    Gray, Stacy W; Martins, Yolanda; Feuerman, Lindsay Z; Bernhardt, Barbara A; Biesecker, Barbara B; Christensen, Kurt D; Joffe, Steven; Rini, Christine; Veenstra, David; McGuire, Amy L

    2014-10-01

    The routine use of genomic sequencing in clinical medicine has the potential to dramatically alter patient care and medical outcomes. To fully understand the psychosocial and behavioral impact of sequencing integration into clinical practice, it is imperative that we identify the factors that influence sequencing-related decision making and patient outcomes. In an effort to develop a collaborative and conceptually grounded approach to studying sequencing adoption, members of the National Human Genome Research Institute's Clinical Sequencing Exploratory Research Consortium formed the Outcomes and Measures Working Group. Here we highlight the priority areas of investigation and psychosocial and behavioral outcomes identified by the Working Group. We also review some of the anticipated challenges to measurement in social and behavioral research related to genomic sequencing; opportunities for instrument development; and the importance of qualitative, quantitative, and mixed-method approaches. This work represents the early, shared efforts of multiple research teams as we strive to understand individuals' experiences with genomic sequencing. The resulting body of knowledge will guide recommendations for the optimal use of sequencing in clinical practice.

  17. Viridans Group Streptococci clinical isolates: MALDI-TOF mass spectrometry versus gene sequence-based identification.

    Directory of Open Access Journals (Sweden)

    Silvia Angeletti

    Full Text Available Viridans Group Streptococci (VGS species-level identification is fundamental for patients management. Matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS has been used for VGS identification but discrimination within the Mitis group resulted difficult. In this study, VGS identifications with two MALDI-TOF instruments, the Biotyper (Bruker and the VITEK MS (bioMérieux have been compared to those derived from tuf, soda and rpoB genes sequencing. VGS isolates were clustered and a dendrogram constructed using the Biotyper 3.0 software (Bruker. RpoB gene sequencing resulted the most sensitive and specific molecular method for S. pneumonia identification and was used as reference method. The sensitivity and the specificity of the VITEK MS in S. pneumonia identification were 100%, while the Biotyper resulted less specific (92.4%. In non pneumococcal VGS strains, the group-level correlation between rpoB and the Biotyper was 100%, while the species-level correlation was 61% after database upgrading (than 37% before upgrading. The group-level correlation between rpoB and the VITEK MS was 100%, while the species-level correlation was 36% and increases at 69% if isolates identified as S. mitis/S. oralis are included. The less accurate performance of the VITEK MS in VGS identification within the Mitis group was due to the inability to discriminate between S. mitis and S. oralis. Conversely, the Biotyper, after the release of the upgraded database, was able to discriminate between the two species. In the dendrogram, VGS strains from the same group were grouped into the same cluster and had a good correspondence with the gene-based clustering reported by other authors, thus confirming the validity of the upgraded version of the database. Data from this study demonstrated that MALDI-TOF technique can represent a rapid and cost saving method for VGS identification even within the Mitis group but improvements of spectra

  18. Characterization, in vitro susceptibility, and clinical significance of CDC group HB-5 from Rwanda.

    OpenAIRE

    Bogaerts, J.; Verhaegen, J.; Martinez Tello, W.; Allen, S.; Verbist, L; Van Dyck, E; Piot, P.

    1990-01-01

    From June 1984 until July 1988, CDC group HB-5 isolates were recovered from the exudates of genital ulcers in 25 of 675 (3.6%) patients (204 women, 471 men) in Kigali, Rwanda. Among a group of 145 men presenting with urethritis but without genital ulcers, a positive culture for HB-5 of a specimen from the coronal groove of the penis of only 1 man (0.7%) was found. During the same period, the organism was not obtained in cultures of vaginal specimens from 838 women without genital ulcer diseas...

  19. Design and internal validation of an obstetric early warning score: secondary analysis of the Intensive Care National Audit and Research Centre Case Mix Programme database.

    Science.gov (United States)

    Carle, C; Alexander, P; Columb, M; Johal, J

    2013-04-01

    We designed and internally validated an aggregate weighted early warning scoring system specific to the obstetric population that has the potential for use in the ward environment. Direct obstetric admissions from the Intensive Care National Audit and Research Centre's Case Mix Programme Database were randomly allocated to model development (n = 2240) or validation (n = 2200) sets. Physiological variables collected during the first 24 h of critical care admission were analysed. Logistic regression analysis for mortality in the model development set was initially used to create a statistically based early warning score. The statistical score was then modified to create a clinically acceptable early warning score. Important features of this clinical obstetric early warning score are that the variables are weighted according to their statistical importance, a surrogate for the FI O2 /Pa O2 relationship is included, conscious level is assessed using a simplified alert/not alert variable, and the score, trigger thresholds and response are consistent with the new non-obstetric National Early Warning Score system. The statistical and clinical early warning scores were internally validated using the validation set. The area under the receiver operating characteristic curve was 0.995 (95% CI 0.992-0.998) for the statistical score and 0.957 (95% CI 0.923-0.991) for the clinical score. Pre-existing empirically designed early warning scores were also validated in the same way for comparison. The area under the receiver operating characteristic curve was 0.955 (95% CI 0.922-0.988) for Swanton et al.'s Modified Early Obstetric Warning System, 0.937 (95% CI 0.884-0.991) for the obstetric early warning score suggested in the 2003-2005 Report on Confidential Enquiries into Maternal Deaths in the UK, and 0.973 (95% CI 0.957-0.989) for the non-obstetric National Early Warning Score. This highlights that the new clinical obstetric early warning score has an excellent ability to

  20. The Effect of Spiritual and Religious Group Psychotherapy on Suicidal Ideation in Depressed Patients: A Randomized Clinical Trial

    Directory of Open Access Journals (Sweden)

    Hossein Ebrahimi

    2014-06-01

    Full Text Available Introduction: Suicide is a great economical, social and public health problem. It is prevalent worldwide and has a lot of negative effects on individuals, families and society. Depression is often prelude to Suicide. An important part of the treatment of the mentally ill patients is spiritual-religious psychotherapy which should be done after physical treatment. The aim of this study was to determine the effect of spiritual and religious group psychotherapy on suicidal ideation in depressed patients. Methods: 51 depressed patients with suicidal ideation from Razi hospital (Tabriz, Iran participated in this clinical trial. To collect Data questionnaire was used which included demographic and Beck Suicide Scale Ideation. Experimental group participated in 10 sessions of group psychotherapy. Each section lasted 1 hour. Two weeks after the last section post test was done. Statistical software SPSS ver 13 was used for data analysis. Results: Results of independent t-test revealed no difference between two groups in terms of suicidal ideation before intervention but after study there is a statistical difference. Also the results of ANCOVA test showed a significant relationship between spiritual group therapy and decrease in suicidal ideation, so that this intervention can make 57% of variance in suicidal ideation of experimental group.Conclusion: Regarding positive effect of spiritual and religious group psychotherapy on decreasing suicidal ideation of depressed patients, we suggest this intervention to be held in Psychiatric Wards and also more study on depression and other psychiatric patients with greater sample size would be helpful.

  1. Self-Compassion among College Counseling Center Clients: An Examination of Clinical Norms and Group Differences

    Science.gov (United States)

    Lockard, Allison J.; Hayes, Jeffrey A.; Neff, Kristin; Locke, Benjamin D.

    2014-01-01

    There has been growing interest in the mental health benefits of self-compassion. This study was designed to establish norms on the Self-Compassion Scale-Short Form, a popular measure of self-compassion for individuals seeking counseling, and to examine group differences in self-compassion based on gender, race/ethnicity, sexual orientation,…

  2. Integration of noninvasive prenatal prediction of fetal blood group into clinical prenatal care

    DEFF Research Database (Denmark)

    Clausen, Frederik Banch

    2014-01-01

    Incompatibility of red blood cell blood group antigens between a pregnant woman and her fetus can cause maternal immunization and, consequently, hemolytic disease of the fetus and newborn. Noninvasive prenatal testing of cell-free fetal DNA can be used to assess the risk of hemolytic disease...

  3. Can Group Interventions Facilitate Forgiveness of an Ex-Spouse?: A Randomized Clinical Trial

    Science.gov (United States)

    Rye, Mark S.; Pargament, Kenneth I.; Pan, Wei; Yingling, David W.; Shogren, Karrie A.; Ito, Masako

    2005-01-01

    This study evaluated the effectiveness of 2 versions of an 8-session forgiveness group intervention for divorced individuals. Participants (randomized, n = 192; analyzed, n = 149) were randomly assigned to a secular forgiveness condition, a religious forgiveness condition, or a no-intervention comparison condition. Measures of forgiveness and…

  4. Prize Reinforcement Contingency Management for Cocaine Dependence: Integration with Group Therapy in a Methadone Clinic

    Science.gov (United States)

    Petry, Nancy M.; Martin, Bonnie; Simcic, Francis

    2005-01-01

    In this study, the authors evaluated a low-cost contingency management (CM) procedure for reducing cocaine use and enhancing group therapy attendance in 77 cocaine-dependent methadone patients. Patients were randomly assigned to 12 weeks of standard treatment or standard treatment with CM, in which patients earned the opportunity to win prizes…

  5. Aggression in Children with Autism Spectrum Disorders and a Clinic-Referred Comparison Group

    Science.gov (United States)

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

    2015-01-01

    A gap exists in the literature regarding aggression in autism spectrum disorders and how this behavior compares to other groups. In this multisite study, the "Children's Scale for Hostility and Aggression: Reactive/Proactive" and the Aggression subscale of the "Child Behavior Checklist" were rated for 414 children with autism…

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

    Directory of Open Access Journals (Sweden)

    Chin-Chen Wen

    2015-02-01

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

  7. Abandon the coat Experiential group about clinical psychologist’s identity

    Directory of Open Access Journals (Sweden)

    Maria Caterina Branca

    2014-12-01

    Full Text Available This research was driven by the fundamental idea that one of the main methodological competencies of a psychologist is to be able to think one’s emotions (especially those formed within a relationship and to use them to build theories on the relationship itself. In this context, the project aims to explore the role identity of the trainee psychologist, that is to say the mental representations (fantasies, subconscious associations, myths of those who have just finished their university journey and are about to embark upon the world of work in the field of applied clinical psychology.

  8. Teamwork for clinical emergencies: interprofessional focus group analysis and triangulation with simulation.

    Science.gov (United States)

    Bristowe, Katherine; Siassakos, Dimitrios; Hambly, Helen; Angouri, Jo; Yelland, Andrew; Draycott, Timothy J; Fox, Robert

    2012-10-01

    Our purpose was to investigate health care professionals' beliefs about effective teamwork in medical emergencies based on their experiences. We used framework analysis of interprofessional focus groups in four secondary and tertiary maternity units. The participants were randomly selected senior and junior doctors, senior and junior midwives, and health care assistants, in five groups of 5 to 7 participants each. We found that optimal teamwork was perceived to be dependent on good leadership and availability of experienced staff. The participants described a good leader as one who verbally declares being the leader, communicates clear objectives, and allocates critical tasks, including communication with patients or their family, to suitable individual members. We triangulated the results with evidence from simulation to identify convergent findings and issues requiring further research. The findings will inform the development of teaching programs for medical teams who manage emergencies to improve patient safety and experience.

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

    OpenAIRE

    Campo Osaba Maria-Antonia; Del Val José-Luis; Lapena Carolina; Laguna Vicencia; García Araceli; Lozano Olga; Martín Ziortza; Rodriguez Rómulo; Borrás Enriqueta; Orfila Francesc; Tierno María Teresa

    2012-01-01

    Abstract Background The promotion of health and the interventions in community health continue to be one of the pending subjects of our health system. The most prevalent health problems (cardiovascular diseases, cancer, diabetes...) are for the most part related to life habits. We propose a holistic and integral approach as the best option for tackling behavior and its determinants. The research team has elaborated the necessary educational material to realize group teaching, which we call "H...

  10. Surfactant treatment in neonatal group B streptococcal pneumonia : experimental and clinical studies

    OpenAIRE

    Herting, Egbert

    1999-01-01

    Surfactant dysfunction is probably involved in the pathophysiology of neonatal group B streptococcal (GBS) pneumonia. Aim of the present studies was to evaluate efficacy and safety of surfactant replacement therapy for term and preterm neonates with severe respiratory failure due to GBS infection. We investigated the effects of surfactant on growth of GBS and on oxidative metabolism of polymorphonuclear neutrophilic granulocytes (PMN) stimulated with GBS, and developed an an...

  11. Clinical Feature And Pathogeny Analysis Of Brain Hemorrhage In Young Adult Group

    Institute of Scientific and Technical Information of China (English)

    Wang Jianming; Zeng Xiaoyun

    2000-01-01

    Objection: The trend of brain hemorrhage cases of young adults have increased recently. In this article, We studied brain hemorrhage clinical feature and pathogenic causes of 72 young adults, Whose ages are all beneath 45Y. We found That the major pathogen reasons of young adult brain hemorrhage are blood system diseases、 arteriovenous malformation of cerebral blood vessel、 hypertension arteriosclerosis、 arteritis and rheumatic heart disease et. We also found that the trend can be related to hard work、 tense life、 drinking too much alcohol and eating high lipid food, and cercbral vascular disease family history. So in order to reduce the incidence of young adult brain hemorrhage, Young adults should not drink and smoke heavily, should not eat too much high lipid food. Young adults who have hypertension and brain vessel disease family history should be regularly measured blood pressure and blood lipid. If they had hypertension, should be treated regularly.

  12. Demographics features, clinical findings and functional status in a group of subjects with cervical myofascial pain syndrome.

    Science.gov (United States)

    Sahin, Nilay; Karataş, Omer; Ozkaya, Murat; Cakmak, Ayşegül; Berker, Ender

    2008-07-01

    Subjects with myofascial pain of muscles of the neck region may present with various clinical symptoms. The aim of this study was to explore the demographics features, clinical findings and functional status in a group of patients presenting with myofascial pain of the cervical muscles. 94 cervical myofascial pain syndrome patients were recruited from the out-patient clinic. Evaluated of patient short form health survey (SF-36), pain, depression, patient demographics and physical examinations. Outcome measures; SF-36 Health Survey, visual analog scale, Beck Depression Inventory, history, physical examination. A total of 82 patients with a diagnosis of cervical myofascial syndrome were included in the study. All patients were in the young age group 37.4+/-9, and 87.8% were females. 53.1% had trigger points in the trapezius muscle with high percentage of autonomic phenomena like skin reddening, lacrimation, tinnitus and vertigo. 58.5% of the series had suffered from former cervical trauma and 40.2% also had fibromyalgia syndrome and 18.5% had benign Joint hypermobility syndrome. Younger female patients presenting with autonomic phenomena and early onset cervical injury should be examined for cervical myofascial pain syndrome and also for fibromyalgia syndrome since this study demonstrated a high percentage of fibromyalgia syndrome in these patients.

  13. Fostering integrated learning and clinical professionalism using contextualized simulation in a small-group role-play.

    Science.gov (United States)

    Baillie, Sarah; Pierce, Stephanie E; May, Stephen A

    2010-01-01

    Teaching and learning in a clinical setting is important in veterinary and medical training but presents many challenges, including providing enough hands-on experience while not putting patients (animal or human) at risk. Some of the issues have been addressed with the introduction of clinical skills laboratories and communication skills training using role play. However, in both instances skills are learned in isolation, whereas the real task requires the integration of many skills including technical competencies, effective communication, decision making, and professionalism. In our study, we trialed "contextualized simulation" by combining role play with a simulator, the haptic cow, in a small-group tutorial, the Simulated Fertility Visit. Students took turns as the veterinarian; they had to establish the cow's history from the farmer (a role player), palpate the simulation, make a diagnosis, and decide on treatment, if appropriate. We included scenarios varying from common cases to challenging situations. The tutorial was introduced in the farm-animal clinical rotation, and feedback was gathered from students by means of a questionnaire. The tutorial was attended by 178 students (98% of that year's students), and 151 questionnaires were returned (85% response rate). Students reported that the tutorial was a positive learning experience and recognized that it presented an opportunity to integrate the skills needed for clinical work. Student feedback suggests that contextualized simulation provides a valuable complement to clinical cases, and we recommend extending this teaching method to other clinical scenarios and species, particularly because it provides a safe environment in which to experience, and learn from, mistakes.

  14. Clinical study on magnetic resonance imaging of lacunar infarcts and cerebrovascular high-risk group

    Energy Technology Data Exchange (ETDEWEB)

    Hironaka, Masatoshi (Hiroshima Univ. (Japan). School of Medicine)

    1990-04-01

    Magnetic resonance imaging (MRI) study was performed in 32 patients with recent lacunar stroke. T2-weighted images showed ischemic lesions more clearly than T1-weighted images. Sixty-six percent of 32 patients had periventricular lesions. Eighty-four percent had subcortical white matter lesions. Sixty-nine percent had lesions in basal ganglia. Twenty-eight percent had lesions in brainstem. Periventricular lesions were revealed symmetrically. On the other hand, lesions in other areas were not detected symmetrically. Severe periventricular lesions on MRI were similar to those of Binswanger's disease. Patients with severe periventricular lesions had often hypertension. Moreover, two of them had dementia. Twenty-three patients with transient ischemic attack had less remarkable lesions than patients with lacunar stroke. Thirty-seven patients with a history of cerebrovascular risk factors (hypertension, diabetes mellitus) had severer lesions compared with normal controls. Sixty-one percent of controls, who had no cerebrovascular symptoms and signs, had MRI lesions. These results suggest that MRI is useful for detection of cerebral ischemic lesions with no associated clinical symptoms or signs. (author).

  15. Clinical study on magnetic resonance imaging of lacunar infarcts and cerebrovascular high-risk group

    International Nuclear Information System (INIS)

    Magnetic resonance imaging (MRI) study was performed in 32 patients with recent lacunar stroke. T2-weighted images showed ischemic lesions more clearly than T1-weighted images. Sixty-six percent of 32 patients had periventricular lesions. Eighty-four percent had subcortical white matter lesions. Sixty-nine percent had lesions in basal ganglia. Twenty-eight percent had lesions in brainstem. Periventricular lesions were revealed symmetrically. On the other hand, lesions in other areas were not detected symmetrically. Severe periventricular lesions on MRI were similar to those of Binswanger's disease. Patients with severe periventricular lesions had often hypertension. Moreover, two of them had dementia. Twenty-three patients with transient ischemic attack had less remarkable lesions than patients with lacunar stroke. Thirty-seven patients with a history of cerebrovascular risk factors (hypertension, diabetes mellitus) had severer lesions compared with normal controls. Sixty-one percent of controls, who had no cerebrovascular symptoms and signs, had MRI lesions. These results suggest that MRI is useful for detection of cerebral ischemic lesions with no associated clinical symptoms or signs. (author)

  16. Changes in quality of life following group CBT for anxiety and depression in a psychiatric outpatient clinic.

    Science.gov (United States)

    Oei, Tian Po; McAlinden, Niamh May

    2014-12-30

    The present study examined the relationship between quality of life and symptom change following group CBT treatment for anxiety or depression in a psychiatric hospital outpatient setting. One hundred seventy seven outpatients undergoing eight sessions of group CBT for anxiety (n=124) or mood disorders (n=53) participated. The Beck Anxiety Inventory (BAI), Zung Self-Rating Depression Scale (Zung-SRDS), Quality of Life Inventory (QOLI), and Satisfaction with Life Scale (SWLS) were administered at baseline and post-treatment. Additionally, the QOLI and SWLS scores of those who achieved reliable improvement or clinically significant symptom change were compared to those who experienced no reliable symptom improvement. There were significant changes across the QOLI, SWLS, BAI and Zung-SRDS outcome measures between baseline and post-treatment, with moderate to very large effect sizes observed. Patients with reliable or clinically significant change in their symptoms experienced significant increases in QOLI and SWLS scores when compared to those whose symptoms did not change reliably. Overall, in a psychiatric hospital outpatient setting, group CBT appeared to be successful in increasing quality of life and satisfaction with life in addition to reducing anxiety and depression symptoms.

  17. Whole genome sequencing as a tool for phylogenetic analysis of clinical strains of Mitis group streptococci.

    Science.gov (United States)

    Rasmussen, L H; Dargis, R; Højholt, K; Christensen, J J; Skovgaard, O; Justesen, U S; Rosenvinge, F S; Moser, C; Lukjancenko, O; Rasmussen, S; Nielsen, X C

    2016-10-01

    Identification of Mitis group streptococci (MGS) to the species level is challenging for routine microbiology laboratories. Correct identification is crucial for the diagnosis of infective endocarditis, identification of treatment failure, and/or infection relapse. Eighty MGS from Danish patients with infective endocarditis were whole genome sequenced. We compared the phylogenetic analyses based on single genes (recA, sodA, gdh), multigene (MLSA), SNPs, and core-genome sequences. The six phylogenetic analyses generally showed a similar pattern of six monophyletic clusters, though a few differences were observed in single gene analyses. Species identification based on single gene analysis showed their limitations when more strains were included. In contrast, analyses incorporating more sequence data, like MLSA, SNPs and core-genome analyses, provided more distinct clustering. The core-genome tree showed the most distinct clustering.

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

    Science.gov (United States)

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

    2014-10-01

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

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

    Directory of Open Access Journals (Sweden)

    Ching-Hung eLin

    2013-05-01

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

  20. Clinical-anthropometric characteristics of COPD outpatients belonging to the different groups and having different severity of airway obstruction

    Directory of Open Access Journals (Sweden)

    Gashynova K.Y.

    2015-06-01

    Full Text Available The aim of the study was to compare the clinical and anthropometric characteristics of patients with COPD, which differ in the degree of airways obstruction and belong to groups A, B, C, D in accordance with GOLD, 2011 classification. A total of 112 ambulatory COPD patients in remission made the study sample. Anthropometric data, body mass index, medical history, dyspnea by mMRC scale, and spirometry was performed for all patients. There was confirmed that outpatients with COPD is a heterogeneous group, in which the majority are those with moderate (48.22 % and severe (30.36 %, airway obstruction. Despite the vast majority of men among outpatients, the percentage of women among patients with mild to moderate obstruction (22.58±5.31 % was significantly higher (p=0.002 as compared with those with severe or very severe limitation of airflow (6.00±3.36 %. Patients with severe and very severe obstruction were of significantly older age (p = 0.024. At the same time, the distribution of patients according to the GOLD, 2011 classification, demonstrate that all groups did not differ on any of the anthropometric indicators, including gender and age (p > 0.050. Distribution of patients by groups with different risk for future exacerbations is not a mirror image of gradation in accordance with the degree of airway obstruction. Every second (50.00±4.43 % of cases patient is included in group C and every tenth (10.20±4.32 % belongs to the group D not due to degree of bronchial obstruction, but due to the number of exa­cerbations in the past year. Therefore, in future studies it is advisable to use both principles of patients’ classification.

  1. CLINICAL PROFILE OF CHILDREN IN THE AGE GROUP 6 MONTHS TO 60 MONTHS WITH LOWER RESPIRATORY TRACT INFECTION

    Directory of Open Access Journals (Sweden)

    Bharath Kumar

    2015-05-01

    Full Text Available CONTEXT : Infections of the respiratory tract are perhaps the most common human ailments. Acute Respiratory Infections (ARI has quite a high morbidity and mortality in children in developing countries 1 ARI is responsible for about 30 - 50 percent of visits to health facilities and for about 20 - 40 percent of hospital admissions. Pneumonia is a leading cause of mortality in children worldwide. Because mortality due to pneumonia in developing countries is attributable mainly to bacterial etiology , IM NCI strategy recommends the use of antibiotics when a child presented with tachypnea as defined previously . AIMS : To re - define or refine tachypnea as a specific indicator of bacterial pneumonia. To identify other clinical predictors for identifying bacteri al pneumonia. DESIGNS : The study was designed to be done in two phases . In the first phase it is to be carried out as a descriptive study of children presenting with fever and respiratory distress in the OPD to identify the specific markers for bacterial p neumonia. In the second phase presenting clinical features in children with radiological pneumonia will be analysed to validate the findings from Phase I. MATERIALS AND METHODS : This was a hospital based study and was conducted in Sri Manakula V inayagar Me dical College and Hospital , Puducherry . The study included 100 Children in the age group 6 months to 5 years presenting in the out patients department with fever and respiratory distress Children attending the out - patient department on a fixed day of the w eek (Monday and who come under this study population during the study period were admitted and recruited in the study and informed verbal consent for participation was taken from the parents. Their clinical profiles were recorded as in phase I. All childr en coming under this study population were given antibiotics and supportive treatment. The cases were monitored for any worsening or improvement every 6 th hourly on day 1 and

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

    Science.gov (United States)

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

    2015-01-01

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

  3. Serum high mobility group box-1 (HMGB1 is closely associated with the clinical and pathologic features of gastric cancer

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    Chung Jae

    2009-05-01

    Full Text Available Abstract Background High mobility group box-1 (HMGB1 is a newly recognized factor regulating cancer cell tumorigenesis, expansion and invasion. We investigated the correlation between the serum HMGB1 levels and the clinical and pathologic features of gastric cancer and evaluated the validity of HMGB1 as a potential biomarker for the early diagnosis of gastric cancer. Methods A total of 227 subjects were classified into 5 disease groups according to the 'gastritis-dysplasia-carcinoma' sequence of gastric carcinogenesis and their serum levels of HMGB1 were analyzed by an enzyme-linked immunosorbent assay (ELISA method. Clinical parameters, International Union Against Cancer (UICC TNM stage, cancer size, differentiation or lymphatic invasion, vascular or perineural invasion and prognosis were used as analysis variables. Results The serum HMGB1 levels were significantly different among disease groups (ANOVA, p and HMGB1 levels tended to increase according to the progression of gastric carcinogenesis. Serum HMGB1 levels were significantly associated with depth of invasion, lymph node metastasis, tumor size, and poor prognosis (p . However, HMGB1 levels were not associated with patient gender or age, differentiation of tumor cells, or lymphatic, vascular and perineural invasion, or the existence of distant metastasis in advanced cancer (p > 0.05. The sensitivity and specificity of serum HMGB1 was 71% and 67% (cut-off value of 5 ng/ml for the diagnosis of early gastric cancer, and 70% and 64% (cut-off value of 4 ng/ml for the diagnosis of high-risk lesions, respectively. These values were greater than those for carcinoembryonic antigen (CEA (30–40% of sensitivity. Conclusion HMGB1 appears to be a useful serological biomarker for early diagnosis as well as evaluating the tumorigenesis, stage, and prognosis of gastric cancer.

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

    Directory of Open Access Journals (Sweden)

    Shao XH

    2014-08-01

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

  5. The role of ADME pharmacogenomics in early clinical trials: perspective of the Industry Pharmacogenomics Working Group (I-PWG).

    Science.gov (United States)

    Tremaine, Larry; Brian, William; DelMonte, Terrye; Francke, Stephan; Groenen, Peter; Johnson, Keith; Li, Lei; Pearson, Kimberly; Marshall, Jean-Claude

    2015-12-01

    Genetic polymorphisms in metabolizing enzymes and drug transporters have been shown to significantly impact the exposure of drugs having a high dependence on a single mechanism for their absorption, distribution or clearance, such that genotyping can lead to actionable steps in disease treatment. Recently, global regulatory agencies have provided guidance for assessment of pharmacogenomics during early stages of drug development, both in the form of formal guidance and perspectives published in scientific journals. The Industry Pharmacogenomics Working Group (I-PWG), conducted a survey among member companies to assess the practices relating to absorption, distribution, metabolism, excretion pharmacogenomics) during early stages of clinical development, to assess the impact of the recent Regulatory Guidance issued by the US FDA and EMA on Industry practices.

  6. Effects of an adapted physical activity program in a group of elderly subjects with flexed posture: clinical and instrumental assessment

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    Frizziero Antonio

    2008-11-01

    Full Text Available Abstract Background Flexed posture commonly increases with age and is related to musculoskeletal impairment and reduced physical performance. The purpose of this clinical study was to systematically compare the effects of a physical activity program that specifically address the flexed posture that marks a certain percentage of elderly individuals with a non specific exercise program for 3 months. Methods Participants were randomly divided into two groups: one followed an Adapted Physical Activity program for flexed posture and the other one completed a non-specific physical activity protocol for the elderly. A multidimensional clinical assessment was performed at baseline and at 3 months including anthropometric data, clinical profile, measures of musculoskeletal impairment and disability. The instrumental assessment of posture was realized using a stereophotogrammetric system and a specific biomechanical model designed to describe the reciprocal position of the body segments on the sagittal plane in a upright posture. Results The Adapted Physical Activity program determined a significant improvement in several key parameters of the multidimensional assessment in comparison to the non-specific protocol: decreased occiput-to-wall distance, greater lower limb range of motion, better flexibility of pectoralis, hamstrings and hip flexor muscles, increased spine extensor muscles strength. Stereophotogrammetric analysis confirmed a reduced protrusion of the head and revealed a reduction in compensative postural adaptations to flexed posture characterized by knee flexion and ankle dorsiflexion in the participants of the specific program. Conclusion The Adapted Physical Activity program for flexed posture significantly improved postural alignment and musculoskeletal impairment of the elderly. The stereophotogrammetric evaluation of posture was useful to measure the global postural alignment and especially to analyse the possible compensatory strategies

  7. Increasing antimicrobial resistance in clinical isolates of Staphylococcus intermedius group bacteria and emergence of MRSP in the UK.

    Science.gov (United States)

    Beever, L; Bond, R; Graham, P A; Jackson, B; Lloyd, D H; Loeffler, A

    2015-02-14

    Frequencies of antimicrobial resistance were determined amongst 14,555 clinical Staphylococcus intermedius group (SIG) isolates from UK dogs and cats to estimate resistance trends and quantify the occurrence of meticillin-resistant Staphylococcus pseudintermedius (MRSP). Reports from two diagnostic laboratories (13,313 general submissions, 1242 referral centre only submissions) were analysed retrospectively (2003/2006-2012). MRSP were defined by phenotypic resistance to meticillin and concurrent broad β-lactam resistance; a subset was confirmed genetically (SIG-specific nuc and mecA). Trends were analysed by Cochran-Armitage test. Resistance remained below 10 per cent for cefalexin, amoxicillin-clavulanic acid and the fluoroquinolones. Increasing resistance trends were seen in both laboratories for ampicillin/amoxicillin (both P<0.001), cefovecin (both P<0.046) and enrofloxacin (both P<0.02). Resistance to cefalexin increased over time in referral hospital isolates (P<0.001) to clindamycin (P=0.01) and trimethoprim-sulfamethoxazole (P=0.001) amongst general laboratory submissions. Overall, 106 MRSP were isolated (0.7 per cent of submissions) including 32 (2.6 per cent of submissions, all genetically confirmed) from the referral centre population (inter-laboratory difference P<0.001). Against a background of widely susceptible SIG isolates, a new trend of increasing resistance to important antimicrobials was identified overtime and the emergence of MRSP from UK clinical cases was confirmed. Attention to responsible use of antibacterial therapy in small animal practice is urgently needed.

  8. Notes from the Field: Group A Streptococcal Pharyngitis Misdiagnoses at a Rural Urgent-Care Clinic--Wyoming, March 2015.

    Science.gov (United States)

    Harrist, Alexia; Van Houten, Clayton; Shulman, Stanford T; Van Beneden, Chris; Murphy, Tracy

    2016-01-01

    Group A Streptococcus (GAS) is the most common bacterial cause of pharyngitis, implicated in 20%-30% of pediatric and 5%-15% of adult health care visits for sore throat (1). Along with the sudden onset of throat pain, GAS pharyngitis symptoms include fever, headache, and bilateral tender cervical lymphadenopathy (1,2). Accurate diagnosis and management of GAS pharyngitis is critical for limiting antibiotic overuse and preventing rheumatic fever (2), but distinguishing between GAS and viral pharyngitis clinically is challenging (1). Guidelines for diagnosis and management of GAS pharyngitis have been published by the Infectious Diseases Society of America (IDSA)* (1). IDSA recommends that patients with sore throat be tested for GAS to distinguish between GAS and viral pharyngitis; however, IDSA emphasizes the use of selective testing based on clinical symptoms and signs to avoid identifying GAS carriers rather than acute GAS infections (1). Therefore, testing for GAS usually is not recommended for the following: patients with sore throat and accompanying symptoms (e.g., cough, rhinorrhea) that strongly suggest a viral etiology; children aged pharyngitis (1). IDSA recommends penicillin or amoxicillin as the treatment of choice based on effectiveness and narrow spectrum of activity. To date, penicillin-resistant GAS has never been documented (1). PMID:26719990

  9. Perfil de la casuística hospitalaria de la población inmigrante en Barcelona Profile of the hospital case mix of the immigrant population in Barcelona, Spain

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    F. Cots

    2002-10-01

    la envejecida estructura de edad de los pacientes autóctonos y plantea la necesidad de recuperar el mayor peso de los servicios de ginecología-obstetricia y pediatría. El hecho de que exista menor consumo de recursos por alta hospitalaria en la población inmigrante de países de renta baja contradice la relación esperada de inmigrante-peor situación socioeconómica-mayor intensidad de consumo de recursos por alta hospitalaria. Deben proponerse nuevas hipótesis de trabajo y análisis que permitan explicar esta realidad.Objective: Although the immigrant population in cities such as Barcelona has tripled in the last five years, until now the impact of this group on the health system has not been rigorously evaluated. The aim of this study was to compare hospital resource utilization among the immigrant population with that among the native population through case mix, demographic characteristics and hospital day use. Material and methods: We analyzed 15,057 discharges from Hospital del Mar in Barcelona in 2000. This hospital attends 60% of admissions from the Ciutat Vella district. In 2000, 21% of the population of this district were immigrants. Socio-demographic patient characteristics and case mix were compared between the immigrant and the native population. Hospital resource use was compared according to age, case mix (diagnosis related groups and seriousness (severity, complications and comorbidities of the events requiring medical care. Results: The case mix of the immigrant population differed from that of the autochthonous population due to pronounced ge differences and a higher fertility rate. Thirty-three percent of immigrant admissions were for deliveries. The mean cost of discharge of immigrants from low-income countries was 30% lower than that for the remaining discharges. After adjusting for age, case mix and severity, length of stay among the immigrant population was significantly shorter. A 5% reduction was found after adjusting for case mix and a

  10. Looking for the new preparations for antibacterial therapy III. New antimicrobial agents from the quinolones group in clinical trials.

    Science.gov (United States)

    Karpiuk, Izabela; Tyski, Stefan

    2013-01-01

    There is an essential need for searching for the new compounds effective in the treatment of infections caused by multidrug-resistant bacteria. This paper is the third part of a series associated with the exploration of new antibacterial agents and it discusses the compounds belonging to the group of quinolones and substances possessing a hybrid structure composed of the quinolone molecule and other compounds. Eleven new substances at the stage of clinical trials are presented. Three of them belong to the group of non-fluorinated quinolone (nemonoxacin, ozenoxacin and KRP-AM 1977X), while six are the quinolones containing fluorine atom at 6 position of the carbon atom in the quinoline ring (zabofloxacin, finafloxacin, delafloxacin, JNJ-Q2, WCK771 and KPI-10). The remaining two compounds possess a hybrid construction composed of the quinolone structure and other molecules (cadazolid and CBR-2092). There is a chance in the near future, that the presented compounds can extend the range of existing antibacterial drugs and provide an alternative to currently available medicinal products.

  11. Gait analysis in clinically healthy sheep from three different age groups using a pressure-sensitive walkway

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    Agostinho Felipe S

    2012-06-01

    Full Text Available Abstract Background Understanding normal gait requires allowing for variations in normal patterns by the sex, age, and species in question. Therefore, the aim of this study was to evaluate kinetic and temporospatial parameters in clinically healthy sheep from three different age groups with a pressure-sensing walkway. The sheep were judged to be healthy based on the results of complete physical and orthopaedic examinations and had no history of lameness. Twenty-one clinically healthy female Santa Ines sheep were divided into three groups: G1 – seven animals, aged from 8 to 12 months and weighing 19.5-33 kg; G2 - seven individuals, aged from 2 to 4 years and weighing 26.5-42 kg; and G3 - seven sheep, aged more than 5 years and weighing 37.3-45 kg. The animals were examined from two directions: first on the left side and then on the right side of the handler. The data from the first five valid trials in each direction were collected for each sheep and analysed using the designated software. A trial was considered valid if the sheep walked within the correct velocity (1.1-1.3 m/s and acceleration (from −0.15 to 0.15 m/s2 ranges. The peak vertical force (PVF, vertical impulse (VI, gait cycle time, stance time, swing time, stride length, and the percentage body weight distribution among the four limbs were determined. Results No significant differences were observed, in either the forelimbs or the hind limbs, between the left and right sides or between the two directions for any of the variables. No significant temporospatial differences were found among the groups. Significant PVF (%BW differences were observed in the forelimbs (G1 > G3 and hind limbs (G1 > G3, and significant VI differences were observed in the forelimbs (G1 > G3. Conclusions Young healthy sheep differ from older sheep in the vertical forces they create when walking at the same velocity on a pressure-sensing walkway.

  12. Consensus on the detection and management of prediabetes. Consensus and Clinical Guidelines Working Group of the Spanish Diabetes Society.

    Science.gov (United States)

    Mata-Cases, M; Artola, S; Escalada, J; Ezkurra-Loyola, P; Ferrer-García, J C; Fornos, J A; Girbés, J; Rica, I

    2015-03-01

    In Spain, according to the Di@bet.es study, 13.8% of the adult population suffers from diabetes and 14.8% from some form of prediabetes (impaired glucose tolerance, impaired fasting glucose or both). Since early detection of prediabetes can facilitate the implementation of therapeutic measures to prevent its progression to diabetes, we believe that preventive strategies in primary care and specialized clinical settings should be agreed. Screening for diabetes and prediabetes using a specific questionnaire (FINDRISC) and/or the measurement of fasting plasma glucose in high risk patients leads to detecting patients at risk of developing diabetes and it is necessary to consider how they should be managed. The intervention in lifestyle can reduce the progression to diabetes and reverse a prediabetic state to normal and is a cost-effective intervention. Some drugs, such as metformin, have also been shown effective in reducing the progression to diabetes but are not superior to non-pharmacological interventions. Finally, an improvement in some cardiovascular risk factors has been observed although there is no strong evidence supporting the effectiveness of screening in terms of morbility and mortality. The Consensus and Clinical Guidelines Working Group of the Spanish Diabetes Society has issued some recommendations that have been agreed by the Sociedad Española de Endocrinología y Nutrición, Sociedad Española de Endocrinología Pediátrica, Sociedad Española de Farmacia Comunitaria, Sociedad Española de Medicina Familiar y Comunitaria, Sociedad Española de Médicos Generales, Sociedad Española de Médicos de Atención Primaria, Sociedad Española de Medicina Interna, Asociación de Enfermería Comunitaria and Red de Grupos de Estudio de la Diabetes en Atención Primaria.

  13. [Consensus on the detection and management of prediabetes. Consensus and Clinical Guidelines Working Group of the Spanish Diabetes Society].

    Science.gov (United States)

    Mata-Cases, M; Artola, S; Escalada, J; Ezkurra-Loyola, P; Ferrer-García, J C; Fornos, J A; Girbés, J; Rica, I

    2015-01-01

    In Spain, according to the Di@bet.es study, 13.8% of the adult population suffers from diabetes and 14.8% from some form of prediabetes (impaired glucose tolerance, impaired fasting glucose or both). Since early detection of prediabetes can facilitate the implementation of therapeutic measures to prevent its progression to diabetes, we believe that preventive strategies in primary care and specialized clinical settings should be agreed. Screening for diabetes and prediabetes using a specific questionnaire (FINDRISC) and/or the measurement of fasting plasma glucose in high risk patients leads to detecting patients at risk of developing diabetes and it is necessary to consider how they should be managed. The intervention in lifestyle can reduce the progression to diabetes and reverse a prediabetic state to normal and is a cost-effective intervention. Some drugs, such as metformin, have also been shown effective in reducing the progression to diabetes but are not superior to non-pharmacological interventions. Finally, an improvement in some cardiovascular risk factors has been observed although there is no strong evidence supporting the effectiveness of screening in terms of morbility and mortality. The Consensus and Clinical Guidelines Working Group of the Spanish Diabetes Society has issued some recommendations that have been agreed by the Sociedad Española de Endocrinología y Nutrición, Sociedad Española de Endocrinología Pediátrica, Sociedad Española de Farmacia Comunitaria, Sociedad Española de Medicina Familiar y Comunitaria, Sociedad Española de Médicos Generales, Sociedad Española de Médicos de Atención Primaria, Sociedad Española de Medicina Interna, Asociación de Enfermería Comunitaria and Red de Grupos de Estudio de la Diabetes en Atención Primaria.

  14. [Consensus on the detection and management of prediabetes. Consensus and Clinical Guidelines Working Group of the Spanish Diabetes Society].

    Science.gov (United States)

    Mata-Cases, M; Artola, S; Escalada, J; Ezkurra-Loyola, P; Ferrer-García, J C; Fornos, J A; Girbés, J; Rica, I

    2015-03-01

    In Spain, according to the Di@bet.es study, 13.8% of the adult population suffers from diabetes and 14.8% from some form of prediabetes (impaired glucose tolerance, impaired fasting glucose or both). Since early detection of prediabetes can facilitate the implementation of therapeutic measures to prevent its progression to diabetes, we believe that preventive strategies in primary care and specialized clinical settings should be agreed. Screening for diabetes and prediabetes using a specific questionnaire (FINDRISC) and/or the measurement of fasting plasma glucose in high risk patients leads to detecting patients at risk of developing diabetes and it is necessary to consider how they should be managed. The intervention in lifestyle can reduce the progression to diabetes and reverse a prediabetic state to normal and is a cost-effective intervention. Some drugs, such as metformin, have also been shown effective in reducing the progression to diabetes but are not superior to non-pharmacological interventions. Finally, an improvement in some cardiovascular risk factors has been observed although there is no strong evidence supporting the effectiveness of screening in terms of morbility and mortality. The Consensus and Clinical Guidelines Working Group of the Spanish Diabetes Society has issued some recommendations that have been agreed by the Sociedad Española de Endocrinología y Nutrición, Sociedad Española de Endocrinología Pediátrica, Sociedad Española de Farmacia Comunitaria, Sociedad Española de Medicina Familiar y Comunitaria, Sociedad Española de Médicos Generales, Sociedad Española de Médicos de Atención Primaria, Sociedad Española de Medicina Interna, Asociación de Enfermería Comunitaria and Red de Grupos de Estudio de la Diabetes en Atención Primaria.

  15. Implementation of Remote 3-Dimensional Image Guided Radiation Therapy Quality Assurance for Radiation Therapy Oncology Group Clinical Trials

    International Nuclear Information System (INIS)

    Purpose: To report the process and initial experience of remote credentialing of three-dimensional (3D) image guided radiation therapy (IGRT) as part of the quality assurance (QA) of submitted data for Radiation Therapy Oncology Group (RTOG) clinical trials; and to identify major issues resulting from this process and analyze the review results on patient positioning shifts. Methods and Materials: Image guided radiation therapy datasets including in-room positioning CT scans and daily shifts applied were submitted through the Image Guided Therapy QA Center from institutions for the IGRT credentialing process, as required by various RTOG trials. A centralized virtual environment is established at the RTOG Core Laboratory, containing analysis tools and database infrastructure for remote review by the Physics Principal Investigators of each protocol. The appropriateness of IGRT technique and volumetric image registration accuracy were evaluated. Registration accuracy was verified by repeat registration with a third-party registration software system. With the accumulated review results, registration differences between those obtained by the Physics Principal Investigators and from the institutions were analyzed for different imaging sites, shift directions, and imaging modalities. Results: The remote review process was successfully carried out for 87 3D cases (out of 137 total cases, including 2-dimensional and 3D) during 2010. Frequent errors in submitted IGRT data and challenges in the review of image registration for some special cases were identified. Workarounds for these issues were developed. The average differences of registration results between reviewers and institutions ranged between 2 mm and 3 mm. Large discrepancies in the superior-inferior direction were found for megavoltage CT cases, owing to low spatial resolution in this direction for most megavoltage CT cases. Conclusion: This first experience indicated that remote review for 3D IGRT as part of QA

  16. Toward comprehensive management tailored to prognostic factors of patients with clinical stages I and II in Hodgkin's disease. The EORTC Lymphoma Group controlled clinical trials: 1964-1987.

    Science.gov (United States)

    Tubiana, M; Henry-Amar, M; Carde, P; Burgers, J M; Hayat, M; Van der Schueren, E; Noordijk, E M; Tanguy, A; Meerwaldt, J H; Thomas, J

    1989-01-01

    From 1964 to 1987, the EORTC Lymphoma Group conducted four consecutive controlled clinical trials on clinical stages I and II Hodgkin's disease in which 1,579 patients were entered. From the onset the main aim of these trials was to identify the subsets of patients who could be treated safely by regional radiotherapy (RT). Therefore, several prognostic indicators were prospectively registered and progressively used in the trial protocols for the delineation of the favorable and unfavorable subgroups as soon as they were recognized of high predictive value. In the H2 trial (1972 to 1976), the histologic subtype was the only variable taken into account for the therapeutic strategy and the staging laparotomy findings were found to be of prognostic value only in patients with favorable prognostic indicators. In the H5 trial (1977 to 1982), patients were subdivided into two subgroups according to six prognostic indicators. Patients with favorable features were submitted to a staging laparotomy (lap); lap negative patients were randomized between mantle field RT and mantle field plus paraaortic RT. Disease free survival (DFS) and total survival (S) were similar in the two arms. Among patients with unfavorable features, DFS and S were significantly higher in the arm treated by combination of mechlorethamine, vincristine, procarbazine, prednisone (MOPP) chemotherapy (CT) and RT than in the arm treated by total nodal irradiation. Nevertheless, in patients below the age of 40, the overall survival rates were equivalent in the two arms. In the H6 trial, the delineation of the favorable subgroup was based on (a) absence of systemic symptoms and elevated ESR, (b) no more than one or two lymph node areas involved. The aim of the study was to assess the impact on survival of a therapeutic strategy including staging laparotomy. At a 4-year follow-up, no difference in survival was evidenced. In patients with unfavorable prognostic indicators, 3 MOPP-RT-3 MOPP were compared with 3

  17. Clinical Usefulness of Oral Supplementation with Alpha-Lipoic Acid, Curcumin Phytosome, and B-Group Vitamins in Patients with Carpal Tunnel Syndrome Undergoing Surgical Treatment

    OpenAIRE

    Giorgio Pajardi; Paola Bortot; Veronica Ponti; Chiara Novelli

    2014-01-01

    We investigated the clinical usefulness of oral supplementation with a combination product containing alpha-lipoic acid, curcumin phytosome, and B-group vitamins in 180 patients with carpal tunnel syndrome (CTS), scheduled to undergo surgical decompression of the median nerve. Patients in Group A (n = 60) served as controls and did not receive any treatment either before or after surgery. Patients in Group B (n = 60) received oral supplementation twice a day for 3 months both before and after...

  18. Los adjusted clinicals groups: Un sistema de clasificación de pacientes por ajuste de riesgos

    Directory of Open Access Journals (Sweden)

    Antonio Sicras-Mainar

    2013-06-01

    Full Text Available Los Adjusted Clinical Groups (ACG son un sistema de ajuste de riesgos que clasifica a las personas según su edad y sexo y las condiciones médicas que presentan, y estas personas tienen un consumo similar de recursos sanitarios durante un periodo. Fueron desarrollados por Starfield y Weiner (Universidad Johns Hopkins, EE. UU. 1991, y su objetivo es medir el grado de enfermedad en poblaciones de pacientes basándose en sus niveles de comorbilidad. Entre sus principales aplicaciones destacan: a evaluar la eficiencia en la utilización de los servicios sanitarios, b medir la comorbilidad de la población, y c programar la financiación o pago capitativo para grupos de proveedores. Entre las ventajas del sistema ACG destaca la necesidad de un número limitado de variables para cada paciente (edad, sexo y diagnósticos y que la unidad de medida es el paciente. Se comentan algunas características de este sistema de ajuste de riesgos poblacionales.

  19. Establishing clinically significant change : increment of precision and the distinction between individual and group level of analysis

    NARCIS (Netherlands)

    Hageman, WJJM; Arrindell, WA

    1999-01-01

    Some essential adaptations to the method for determining clinically significant change originally introduced by Jacobson, Follette and Revenstorf [Jacobson, N. S., Follette, W. C. & Revenstorf, D. (1984a). Psychotherapy outcome research: methods for reporting variability and evaluating clinical sign

  20. A snapshot of the predominant single nucleotide polymorphism cluster groups of Mycobacterium tuberculosis clinical isolates in Delhi, India.

    Science.gov (United States)

    Varma-Basil, Mandira; Narang, Anshika; Chakravorty, Soumitesh; Garima, Kushal; Gupta, Shraddha; Kumar Sharma, Naresh; Giri, Astha; Zozio, Thierry; Couvin, David; Hanif, Mahmud; Bhatnagar, Anuj; Menon, Balakrishnan; Niemann, Stefan; Rastogi, Nalin; Alland, David; Bose, Mridula

    2016-09-01

    Several attempts have been made to associate phylogenetic differences among Mycobacterium tuberculosis strains to variations in the clinical outcome of the disease and to drug resistance. We genotyped 139 clinical isolates of M. tuberculosis obtained from patients of pulmonary tuberculosis in North Delhi region. The isolates were analyzed using nine Single nucleotide polymorphism (SNP) markers, spoligotyping and MIRU-VNTRs; and the results were correlated with their drug susceptibility profile. Results of SNP cluster group (SCG) analysis (available for 138 isolates) showed that the most predominant cluster was SCG 3a, observed in 58.7% (81/138) of the isolates with 44.4% (36/81) of these being drug susceptible, while 16% (13/81) were multidrug resistant (MDR). Of the ancestral cluster SCG 1 observed in 19.5% (27/138) of the isolates, 14.8% (4/27) were MDR while 44.4% (12/27) were drug susceptible. SCG 2 formed 5.79% (8/138) of the isolates and 50% (4/8) of these were multidrug resistant (MDR). Spoligotyping subdivided the strains into 45 shared types (n = 125) and 14 orphan strains. The orphan strains were mostly associated with SCG 3a or SCG 1, reflecting the principal SCGs found in the Indian population. SCG 1 and SCG 2 genotypes were concordant with the East African Indian (EAI) and Beijing families respectively. Central Asian (CAS) clade and its sublineages were predominantly associated with SCG 3a. No consistent association was seen between the SCGs and Harlem, T or X clades. The 15 loci MIRU-VNTR typing revealed 123/136 isolates to be unclustered, while 13 isolates were present in 6 clusters of 2-3 isolates each. However, correlating the cluster analysis with patient details did not suggest any evidence of recent transmission. In conclusion, though our study revealed the preponderance of SCG 1 and 3a in the M. tuberculosis population circulating in the region, the diversity of strains highlights the changes occurring within lineages and reemphasizes the

  1. Prevention of cisplatin nephrotoxicity: state of the art and recommendations from the European Society of Clinical Pharmacy Special Interest Group on Cancer Care.

    Science.gov (United States)

    Launay-Vacher, Vincent; Rey, Jean-Baptiste; Isnard-Bagnis, Corinne; Deray, Gilbert; Daouphars, Mikael

    2008-05-01

    Antineoplastic drugs used in the treatment of cancers present with variable renal tolerance profiles. Among drugs with a potential for renal toxicity, platinum salts, and especially cisplatin is a well-known agent that may induce acute and chronic renal failure. The mechanisms of its renal toxicity and the means of its prevention are presented in this article which represent the Clinical Recommendation from the Special Interest Group on Cancer Care of the European Society of Clinical Pharmacy (ESCP).

  2. Feedback versus no feedback in improving patient outcome in group psychotherapy for eating disorders (F-EAT): protocol for a randomized clinical trial

    OpenAIRE

    Davidsen, Annika Helgadóttir; Poulsen, Stig; Waaddegaard, Mette; Lindschou, Jane; Lau, Marianne

    2014-01-01

    Background Continuous feedback on patient improvement and the therapeutic alliance may reduce the number of dropouts and increase patient outcome. There are, however, only three published randomized trials on the effect of feedback on the treatment of eating disorders, showing inconclusive results, and there are no randomized trials on the effect of feedback in group therapy. Accordingly the current randomized clinical trial, initiated in September 2012 at the outpatient clinic for eating dis...

  3. Clinical Trial Adaptation by Matching Evidence in Complementary Patient Sub-groups of Auxiliary Blinding Questionnaire Responses.

    Directory of Open Access Journals (Sweden)

    Ognjen Arandjelović

    Full Text Available Clinical trial adaptation refers to any adjustment of the trial protocol after the onset of the trial. Such adjustment may take on various forms, including the change in the dose of administered medicines, the frequency of administering an intervention, the number of trial participants, or the duration of the trial, to name just some possibilities. The main goal is to make the process of introducing new medical interventions to patients more efficient, either by reducing the cost or the time associated with evaluating their safety and efficacy. The principal challenge, which is an outstanding research problem, is to be found in the question of how adaptation should be performed so as to minimize the chance of distorting the outcome of the trial. In this paper we propose a novel method for achieving this. Unlike most of the previously published work, our approach focuses on trial adaptation by sample size adjustment i.e. by reducing the number of trial participants in a statistically informed manner. We adopt a stratification framework recently proposed for the analysis of trial outcomes in the presence of imperfect blinding and based on the administration of a generic auxiliary questionnaire that allows the participants to express their belief concerning the assigned intervention (treatment or control. We show that this data, together with the primary measured variables, can be used to make the probabilistically optimal choice of the particular sub-group a participant should be removed from if trial size reduction is desired. Extensive experiments on a series of simulated trials are used to illustrate the effectiveness of our method.

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

    Directory of Open Access Journals (Sweden)

    Gurung Anup

    2011-12-01

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

  5. Development and Preliminary Validation of a Measure for Assessing Staff Perspectives on the Quality of Clinical Group Supervision

    Science.gov (United States)

    Horton, Simon; de Lourdes Drachler, Maria; Fuller, Alison; de Carvalho Leite, Jose Carlos

    2008-01-01

    Background: In the UK clinical supervision is regarded as an essential process supporting quality improvement within the clinical governance framework, and the Royal College of Speech and Language Therapists regards it as a tool for promoting critical reflective practice. There is limited evidence of the impact on practice or improvements in…

  6. Belonging to a peer support group enhance the quality of life and adherence rate in patients affected by breast cancer: A non-randomized controlled clinical trial*

    OpenAIRE

    Tehrani, Afsaneh Malekpour; Farajzadegan, Ziba; Rajabi, Fariborz Mokarian; Zamani, Ahmad Reza

    2011-01-01

    BACKGROUND: Breast cancer is the most common cancer in women. It seems that breast cancer patients benefit from meeting someone who had a similar experience. This study evaluated the effect of two kinds of interventions (peer support and educational program) on quality of life in breast cancer patients. METHODS: This study was a controlled clinical trial on women with non-metastatic breast cancer. The patients studied in two experimental and control groups. Experimental group took part in pee...

  7. EGFR testing and clinical management of advanced NSCLC: a Galician Lung Cancer Group study (GGCP 048-10

    Directory of Open Access Journals (Sweden)

    Vázquez S

    2016-02-01

    Full Text Available Sergio Vázquez,1 Joaquín Casal,2 Francisco Javier Afonso Afonso,3 José Luis Fírvida,4 Lucía Santomé,5 Francisco Barón,6 Martín Lázaro,7 Carolina Pena,7 Margarita Amenedo,8 Ihab Abdulkader,9 Carmen González-Arenas,10 Laura Fachal,11 Ana Vega11 On behalf of the Galician Lung Cancer Group (GGCP1Medical Oncology Department, Lucus Augusti University Hospital, Lugo, 2Medical Oncology Department, University Hospital Complex of Vigo, Pontevedra, 3Medical Oncology Department, University Hospital Complex of Ferrol, Ferrol, 4Medical Oncology Department, University Hospital Complex of Ourense, Ourense, 5Medical Oncology Department Povisa Hospital, Vigo, 6Medical Oncology Department, University Hospital Complex of Santiago de Compostela, Santiago de Compostela, 7Medical Oncology Department, Hospital Complex of Pontevedra, Pontevedra, 8Medical Oncology Department, Oncology Center of Galicia, A Coruña, 9Anatomical Pathology Department, University Hospital Complex of Santiago de Compostela, Santiago de Compostela, 10AstraZeneca, Madrid, 11Galician Public Foundation of Genomic Medicine-SERGAS, Santiago de Compostela Clinic Hospital, Santiago de Compostela, Spain Purpose: This study aimed to assess the incidence of mutations in the epidermal growth factor receptor (EGFR gene in non-small-cell lung cancer (NSCLC patients in the Galician region of Spain and the clinical management and outcome of patients carrying EGFR mutations. Patients and methods: All newly diagnosed advanced or metastatic NSCLC patients were screened for EGFR mutations in matched tumor samples (tissue or cytology specimens and serum samples. Results: Of 198 patients screened for EGFR mutations in tumor samples, 184 had evaluable data and, of these, 25 (13.6% had EGFR mutations (84% sensitizing mutations. EGFR mutation was found in serum in 14 (8.1% patients (of 174 evaluable. Compared to matched tumor tissue, serum EGFR mutation testing specificity and sensitivity were 99% and 52

  8. Implementing a system of structured clinical supervision with a group of DipHE(nursing) RMN students.

    Science.gov (United States)

    Markham, V; Turner, P

    1998-01-01

    Clinical supervision is to become an integral part of mental health nursing, and the United Kingdom Central Council for Nursing, Midwifery & Health Visiting has recommended that it be incorporated in pre-registration education. This paper describes teachers' experiences of delivering a programme of clinical supervision education within the mental health branch of a diploma in nursing course. It outlines the implementation and evaluation of the programme, including discussion of the process and difficulties encountered. The programme appears to have provided a positive first experience for the students and to have given them the enthusiasm to adopt clinical supervision as part of their future roles as qualified practitioners.

  9. Are senior nurses on Clinical Commissioning Groups in England inadvertently supporting the devaluation of their profession?: A critical integrative review of the literature.

    Science.gov (United States)

    Allan, Helen Therese; Dixon, Roz; Lee, Gay; O'Driscoll, Michael; Savage, Jan; Tapson, Christine

    2016-06-01

    In this study, we discuss the role of senior nurses who sit on clinical commissioning groups that now plan and procure most health services in England. These nurses are expected to bring a nursing view to all aspects of clinical commissioning group business. The role is a senior level appointment and requires experience of strategic commissioning. However, little is known about how nurses function in these roles. Following Barrientos' methodology, published policy and literature were analysed to investigate these roles and National Health Service England's claim that nursing can influence and advance a nursing perspective in clinical commissioning groups. Drawing on work by Berg, Barry and Chandler on 'new public management', we discuss how nurses on clinical commissioning groups work at the alignment of the interests of biomedicine and managerialism. We propose that the way this nursing role is being implemented might paradoxically offer further evidence of the devaluing of nursing rather than the emergence of a strong professional nursing voice at the level of strategic commissioning. PMID:27187276

  10. The clinical database and the treatment guidelines of the Danish Breast Cancer Cooperative Group (DBCG); its 30-years experience and future promise

    DEFF Research Database (Denmark)

    Moller, S.; Jensen, M.B.; Ejlertsen, B.;

    2008-01-01

    Introduction. Since 30 years, DBCG (Danish Breast Cancer Cooperative Group) has maintained a clinical database allowing the conduct of quality control studies, of randomised trials, examination of the epidemiology of breast cancer and of prognostic and predictive factors. Material and methods. The...

  11. Challenges relating to solid tumour brain metastases in clinical trials, part 1: patient population, response, and progression. A report from the RANO group.

    Science.gov (United States)

    Lin, Nancy U; Lee, Eudocia Q; Aoyama, Hidefumi; Barani, Igor J; Baumert, Brigitta G; Brown, Paul D; Camidge, D Ross; Chang, Susan M; Dancey, Janet; Gaspar, Laurie E; Harris, Gordon J; Hodi, F Stephen; Kalkanis, Steven N; Lamborn, Kathleen R; Linskey, Mark E; Macdonald, David R; Margolin, Kim; Mehta, Minesh P; Schiff, David; Soffietti, Riccardo; Suh, John H; van den Bent, Martin J; Vogelbaum, Michael A; Wefel, Jeffrey S; Wen, Patrick Y

    2013-09-01

    Therapeutic outcomes for patients with brain metastases need to improve. A critical review of trials specifically addressing brain metastases shows key issues that could prevent acceptance of results by regulatory agencies, including enrolment of heterogeneous groups of patients and varying definitions of clinical endpoints. Considerations specific to disease, modality, and treatment are not consistently addressed. Additionally, the schedule of CNS imaging and consequences of detection of new or progressive brain metastases in trials mainly exploring the extra-CNS activity of systemic drugs are highly variable. The Response Assessment in Neuro-Oncology (RANO) working group is an independent, international, collaborative effort to improve the design of trials in patients with brain tumours. In this two-part series, we review the state of clinical trials of brain metastases and suggest a consensus recommendation for the development of criteria for future clinical trials.

  12. [Group psychotherapy. Experience with a changing process at a clinic of the Instituto del Servicio de Seguridad Social de los Trabajadores del Estado (ISSSTE)].

    Science.gov (United States)

    Velasco de Ongay, M E

    1977-01-01

    The problems of an ISSSTE clinic were approached within the general systems theory and it was observed that within the group there existed forces to maintain the status-quo and forces towards change; to produce the latter the group was handled during 20 hours with a slightly directive technique. The goals were to improve interpersonal relationships, to increase communication, to make known to individuals their attitudes within a group and make them sensitive to problems they shared with others. The results were good, the status-quo was broken and change started occurring.

  13. Clinical and genetic features of International Collaborative Group-hereditary nonpolyposis colorectal cancer families and suspected hereditary nonpolyposis colorectal cancer families

    Institute of Scientific and Technical Information of China (English)

    袁瑛; 叶俊; 郑树

    2004-01-01

    Background Hereditary nonpolyposis colorectal cancer (HNPPC) is one of the most common genetic syndrome related with mutation of human mismatch repair genes. This study was to evaluate the clinical significance of suspected hereditary nonpolyposis colorectal cancer (sHNPCC) criteria I and the clinical and genetic features of International Collaborative Group-HNPCC (ICG-HNPCC) and sHNPCC families.Methods Twenty-nine ICG-HNPCC families fulfilling the Amsterdam criteria and 34 sHNPCC families fulfilling the sHNPCC criteria I were collected. PCR-SSCP and DNA sequencing analysis were employed to screen the germline mutations of the hMLH1 and hMSH2 genes in these families.Results The ICG group had more colorectal cancer (CRC) patients per family than did the suspected group (P0.05), mutation type, and mutation distribution. Comparison of the families with and without mutation showed no significant difference in CRC patients per family, Lynch classification, and tumor spectrum.Conclusions ICG-HNPCC and sHNPCC families that have similar clinical manifestations and genetic basis indicate a similar nature for cancer development. The application of sHNPCC criteria I will facilitate clinical diagnosis and treatment of small families.

  14. Clinical usefulness of oral supplementation with alpha-lipoic Acid, curcumin phytosome, and B-group vitamins in patients with carpal tunnel syndrome undergoing surgical treatment.

    Science.gov (United States)

    Pajardi, Giorgio; Bortot, Paola; Ponti, Veronica; Novelli, Chiara

    2014-01-01

    We investigated the clinical usefulness of oral supplementation with a combination product containing alpha-lipoic acid, curcumin phytosome, and B-group vitamins in 180 patients with carpal tunnel syndrome (CTS), scheduled to undergo surgical decompression of the median nerve. Patients in Group A (n = 60) served as controls and did not receive any treatment either before or after surgery. Patients in Group B (n = 60) received oral supplementation twice a day for 3 months both before and after surgery (totaling 6 months of supplementation). Patients in Group C (n = 60) received oral supplementation twice a day for 3 months before surgery only. Patients in Group B showed significantly lower nocturnal symptoms scores compared with Group A subjects at both 40 days and 3 months after surgery (both P values <0.05). Moreover, patients in Group B had a significantly lower number of positive Phalen's tests at 3 months compared with the other study groups (P < 0.05). We conclude that oral supplementation with alpha-lipoic acid, curcumin phytosome, and B-group vitamins twice a day both before and after surgery is safe and effective in CTS patients scheduled to undergo surgical decompression of the median nerve. PMID:24563654

  15. Clinical Usefulness of Oral Supplementation with Alpha-Lipoic Acid, Curcumin Phytosome, and B-Group Vitamins in Patients with Carpal Tunnel Syndrome Undergoing Surgical Treatment

    Directory of Open Access Journals (Sweden)

    Giorgio Pajardi

    2014-01-01

    Full Text Available We investigated the clinical usefulness of oral supplementation with a combination product containing alpha-lipoic acid, curcumin phytosome, and B-group vitamins in 180 patients with carpal tunnel syndrome (CTS, scheduled to undergo surgical decompression of the median nerve. Patients in Group A (n=60 served as controls and did not receive any treatment either before or after surgery. Patients in Group B (n=60 received oral supplementation twice a day for 3 months both before and after surgery (totaling 6 months of supplementation. Patients in Group C (n=60 received oral supplementation twice a day for 3 months before surgery only. Patients in Group B showed significantly lower nocturnal symptoms scores compared with Group A subjects at both 40 days and 3 months after surgery (both P values <0.05. Moreover, patients in Group B had a significantly lower number of positive Phalen’s tests at 3 months compared with the other study groups (P<0.05. We conclude that oral supplementation with alpha-lipoic acid, curcumin phytosome, and B-group vitamins twice a day both before and after surgery is safe and effective in CTS patients scheduled to undergo surgical decompression of the median nerve.

  16. Application of Clinical Pathway on Group Health Examination%临床路径在团体人群健康体检中的应用

    Institute of Scientific and Technical Information of China (English)

    管丽红; 谭洁; 黄郁; 王占科

    2012-01-01

    Objective To investigate the application effect of clinical pathway on group health examination, and to standardize nursing behaviors during group health examination. Methods People undergoing group health examination were divided into conventional management group to receive the routine management and method of health examination and clinical pathway management group to receive the management and method of clinical pathway. Comparisons were conducted in the differences of satisfaction, physical examination defect incidence (missing probability, untimely collection of examination results, late reporting, etc. ) and physical examination process indicators. Results The satisfaction rate was significantly higher,the examination defect rate was significantly lower and the examination process was significantly faster in clinical pathway management group than those in the conventional group(P<0. 01). Conclusion Clinical pathway management in group health examination can elevate the medical work efficiency, reduce the incidence of physical examination defects and improve the satisfaction of health examination.%目的 探讨临床路径在团体人群健康体检中的应用效果,规范团体健康体检中的护理行为.方法 依据团体体检者来院体检时间分成常规管理组和临床路径管理组,常规管理组采用传统组织及实施方法,临床路径管理组采用临床路径组织及实施方法,比较两组体检者的满意度、体检缺陷发生率(漏检、体检结果未及时收集、报告延迟发放等)及体检进程速度等指标的差异.结果 临床路径管理组体检者满意度测评结果高于常规管理组、体检缺陷发生率低于常规管理组、体检进程快于常规组,差异均有统计学意义(均P<0.01).结论 在团体人群健康体检中实施临床路径管理,可提高体检工作效率,降低体检缺陷发生率,提高体检者满意度.

  17. Expert Consensus Group report on the use of apomorphine in the treatment of Parkinson's disease - Clinical practice recommendations

    NARCIS (Netherlands)

    Trenkwalder, Claudia; Chaudhuri, K. Ray; Garcia Ruiz, Pedro J.; LeWitt, Peter; Katzenschlager, Regina; Sixel-Doering, Friederike; Henriksen, Tove; Sesar, Angel; Poewe, Werner; Baker, Mary; Ceballos-Baumann, Andres; Deuschl, Guenther; Drapier, Sophie; Ebersbach, Georg; Evans, Andrew; Fernandez, Hubert; Isaacson, Stuart; van Laar, Teus; Lees, Andrew; Lewis, Simon; Martinez Castrillo, Juan Carlos; Martinez-Martin, Pablo; Odin, Per; O'Sullivan, John; Tagaris, Georgios; Wenzel, Karoline

    2015-01-01

    Extensive published evidence supports the use of subcutaneously-administered apomorphine as an effective therapy for Parkinson's disease (PD) but to date no consensus recommendations have been available to guide healthcare professionals in the optimal application of apomorphine therapy in clinical p

  18. The Articulation of Integration of Clinical and Basic Sciences in Concept Maps: Differences between Experienced and Resident Groups

    Science.gov (United States)

    Vink, Sylvia; van Tartwijk, Jan; Verloop, Nico; Gosselink, Manon; Driessen, Erik; Bolk, Jan

    2016-01-01

    To determine the content of integrated curricula, clinical concepts and the underlying basic science concepts need to be made explicit. Preconstructed concept maps are recommended for this purpose. They are mainly constructed by experts. However, concept maps constructed by residents are hypothesized to be less complex, to reveal more tacit basic…

  19. Pregnancy-Related Group A Streptococcal Infections: Temporal Relationships Between Bacterial Acquisition, Infection Onset, Clinical Findings, and Outcome

    OpenAIRE

    Stephanie M Hamilton; Stevens, Dennis L.; Bryant, Amy E.

    2013-01-01

    The development and outcome of pregnancy-related group A streptococcal infections are dependent upon the stage of pregnancy or puerperium, epidemiologic factors of the patient's home and hospital environments, and virulence of the prevalent pathogens.

  20. Clinical Implications for Muscle Strength Differences in Women of Different Age and Racial Groups: The WIN Study

    Science.gov (United States)

    Trudelle-Jackson, Elaine; Ferro, Emerenciana; Morrow, James R.

    2011-01-01

    Background Reduction in muscle strength is strongly associated with functional decline in women, and women with lower quadriceps strength adjusted for body weight are more likely to develop knee osteoarthritis. Objective To compare body weight--adjusted strength among women of different age/racial groups. Study Design Cross-sectional study of muscle strength in 918 women aged 20--83 (M ± SD = 52 ± 13). Methods An orthopedic examination was conducted including measurement of handgrip and lower extremity strength (hip abductors/external rotators, knee flexors/extensors). Data were grouped into young (20--39 years, n = 139), middle (40--54 years, n = 300), and older (55+ years, n = 424) ages for white (n = 699) and African American (AA) (n = 164) women. Means and standard deviations for strength adjusted for body weight were calculated for each age and racial group and compared using 2-way multivariate analysis of variance and post hoc tests. Results No significant age-by-race interaction (P = .092) but significant main effects for age and race (P < .001). Pairwise comparisons revealed significant differences in knee extensor and flexor strength between all age groups. For grip and hip external rotator strength, significant differences were found between the middle and older groups. Differences in hip abductor strength were found between the young and middle-aged groups. AA women had lower strength than white women in all muscle groups (P < .05) except hip external rotators. Conclusions Strength decreased with age in all muscle groups but magnitude of decrease varied by muscle. Strengthening programs should target different muscles, depending on a woman's age and race. PMID:21666779

  1. Consequences of overutilization and underutilization of thrombolytic therapy in clinical practice. TRACE Study Group. TRAndolapril Cardiac Evaluation

    DEFF Research Database (Denmark)

    Ottesen, M M; Køber, L; Jørgensen, S;

    2001-01-01

    OBJECTIVES: The aim of this study was to evaluate the consequences, measured as mortality and in-hospital stroke, of the use of thrombolytic therapy among patients with acute myocardial infarction (AMI), who do not fulfill accepted criteria or who have contraindications to thrombolytic therapy (i.......e., overutilization) and among patients who are withheld thrombolytic treatment despite fulfilling indications and having no contraindications (i.e., underutilization). BACKGROUND: The implementation of treatment with thrombolysis in clinical practice is not in accordance with the accepted criteria from randomized...... studies. The consequence has been over- and underutilization of thrombolytic therapy among patients with AMI in clinical practice. The outcome of overutilization of thrombolytic therapy has not been described previously. METHODS: We examined 6,676 consecutive patients admitted to the hospital with an AMI...

  2. A phase II clinical trial of endoscopic submucosal dissection for early gastric cancer of undifferentiated type: Japan Clinical Oncology Group study JCOG1009/1010.

    Science.gov (United States)

    Takizawa, Kohei; Takashima, Atsuo; Kimura, Aya; Mizusawa, Junki; Hasuike, Noriaki; Ono, Hiroyuki; Terashima, Masanori; Muto, Manabu; Boku, Narikazu; Sasako, Mitsuru; Fukuda, Haruhiko

    2013-01-01

    A Phase II clinical trial has been initiated to evaluate the efficacy and safety of endoscopic submucosal dissection for intramucosal (cT1a) gastric cancer of undifferentiated type. Patients with cT1a gastric cancer with undifferentiated-type adenocarcinoma are eligible for the study. The tumor size should be 2 cm or less without ulceration. The study will enroll a total of 325 patients from 51 institutions over a 4-year period. The primary endpoint is proportion of 5-year overall survival (% 5-year overall survival) in patients with undifferentiated dominant type. The secondary endpoints are overall survival, relapse-free survival, distant metastasis-free survival, % 5-year overall survival without either recurrence or gastrectomy, % en-bloc resection with endoscopic submucosal dissection, % pathological curative resection with endoscopic submucosal dissection, % 5-year overall survival in patients with differentiated dominant type, % 5-year overall survival in patients with pathologically curative resection with endoscopic submucosal dissection and adverse events.

  3. A dance movement therapy group for depressed adult patients in a psychiatric outpatient clinic: effects of the treatment

    OpenAIRE

    Pylvänäinen, Päivi M.; Muotka, Joona S.; Lappalainen, Raimo

    2015-01-01

    We were interested in investigating the effects of dance movement therapy (DMT) in a psychiatric outpatient clinic with patients diagnosed with depression. DMT aims to engage the patients in physical and verbal exploration of their experiences generated in movement based interaction. The assumption was that DMT, which includes both physical engagement as well as emotional and social exploration, would alleviate the mood and psychiatric symptoms. All adult patients (n = 33) incl...

  4. International neurocognitive normative study: neurocognitive comparison data in diverse resource-limited settings: AIDS Clinical Trials Group A5271.

    Science.gov (United States)

    Robertson, K; Jiang, H; Evans, S R; Marra, C M; Berzins, B; Hakim, J; Sacktor, N; Silva, M Tulius; Campbell, T B; Nair, A; Schouten, J; Kumwenda, J; Supparatpinyo, K; Tripathy, S; Kumarasamy, N; la Rosa, A; Montano, S; Mwafongo, A; Firnhaber, C; Sanne, I; Naini, L; Amod, F; Walawander, A

    2016-08-01

    Infrastructure for conducting neurological research in resource-limited settings (RLS) is limited. The lack of neurological and neuropsychological (NP) assessment and normative data needed for clinical interpretation impedes research and clinical care. Here, we report on ACTG 5271, which provided neurological training of clinical site personnel and collected neurocognitive normative comparison data in diverse settings. At ten sites in seven RLS countries, we provided training for NP assessments. We collected normative comparison data on HIV- participants from Brazil (n = 240), India (n = 480), Malawi (n = 481), Peru (n = 239), South Africa (480), Thailand (n = 240), and Zimbabwe (n = 240). Participants had a negative HIV test within 30 days before standardized NP exams were administered at baseline and 770 at 6 months. Participants were enrolled in eight strata, gender (female and male), education (memory and speed of processing tests, while men performed better on motor tests. This study provides the necessary neurocognitive normative data needed to build infrastructure for future neurological and neurocognitive studies in diverse RLS. These normative data are a much-needed resource for both clinicians and researchers. PMID:26733457

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

    Directory of Open Access Journals (Sweden)

    Alexsandra Maria Silva Lima

    2014-04-01

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

  6. Does accountability for reasonableness work? A protocol for a mixed methods study using an audit tool to evaluate the decision-making of clinical commissioning groups in England

    OpenAIRE

    Kieslich, Katharina; Littlejohns, Peter

    2015-01-01

    Introduction Clinical commissioning groups (CCGs) in England are tasked with making difficult decisions on which healthcare services to provide against the background of limited budgets. The question is how to ensure that these decisions are fair and legitimate. Accounts of what constitutes fair and legitimate priority setting in healthcare include Daniels’ and Sabin's accountability for reasonableness (A4R) and Clark's and Weale's framework for the identification of social values. This study...

  7. Comparative analysis of agr groups and virulence genes among subclinical and clinical mastitis Staphylococcus aureus isolates from sheep flocks of the Northeast of Brazil

    OpenAIRE

    de Almeida, Lara M.; de Almeida, Mayra Zilta P.R.B.; Carla L. Mendonça; Mamizuka, Elsa M.

    2013-01-01

    Staphylococcus aureus is one of the most frequent mastitis causative agents in small ruminants. The expression of most virulence genes of S. aureus is controlled by an accessory gene regulator (agr) locus. This study aimed to ascertain the prevalence of the different agr groups and to evaluate the occurrence of encoding genes for cytotoxin, adhesins and toxins with superantigen activity in S. aureus isolates from milk of ewes with clinical and subclinical mastitis in sheep flocks raised for m...

  8. Parsing the recognition memory components of the WMS-III face memory subtest: normative data and clinical findings in dementia groups.

    Science.gov (United States)

    Holdnack, James A; Delis, Dean C

    2004-06-01

    The WMS-III face memory subtest was developed as a quick, reliable, measure of non-verbal recognition memory. While the face memory subtest has demonstrated clinical sensitivity, the test has been criticized for low correlation with other WMS-III visual memory subtests and for failing to differentiate performance between clinical groups. One possible reason for these findings may be due to the impact of response bias associated with recognition memory tests. Four studies were conducted to evaluate the utility of applying signal detection measures to the face memory subtests. The first two studies used the WMS-III standardization data set to determine age and education effects and to present normative and reliability data for hits, false positives, discriminability and response bias. The third study tested the hypothesis that using response components and signal detection measures would enhance the correlation between face memory and the other WMS-III visual memory subtests. The fourth study compared performance of patients with Alzheimer's disease, Huntington's disease, Korsakoff's syndrome and demographically matched controls on the new face memory scores. The new measures did not have higher correlation with other WMS-III visual memory measures than the standard scoring of the test. Analysis of the clinical samples indicated that the discriminability index best differentiated patients from controls. The response components, particularly delayed false positives, differentiated performance among the clinical groups. Normative and reliability data are presented.

  9. Transforming Clinical Documentation in EHRs for 2020: Recommendations from University of Minnesota's Big Data Conference Working Group.

    Science.gov (United States)

    Weaver, Charlotte; O'Brien, Ann

    2016-01-01

    In 2014, a group of diverse informatics leaders from practice, academia, and the software industry formed to address how best to transform electronic documentation to provide knowledge at the point of care and to deliver value to front line nurses and nurse leaders. This presentation reports the recommendations from this Working Group geared towards a 2020 framework. The recommendations propose redesign to optimize nurses' documentation efficiency while contributing to knowledge generation and attaining a balance that ensures the capture of nursing's impact on safety, quality, yet minimizes "death by data entry."

  10. Transforming Clinical Documentation in EHRs for 2020: Recommendations from University of Minnesota's Big Data Conference Working Group.

    Science.gov (United States)

    Weaver, Charlotte; O'Brien, Ann

    2016-01-01

    In 2014, a group of diverse informatics leaders from practice, academia, and the software industry formed to address how best to transform electronic documentation to provide knowledge at the point of care and to deliver value to front line nurses and nurse leaders. This presentation reports the recommendations from this Working Group geared towards a 2020 framework. The recommendations propose redesign to optimize nurses' documentation efficiency while contributing to knowledge generation and attaining a balance that ensures the capture of nursing's impact on safety, quality, yet minimizes "death by data entry." PMID:27332154

  11. Comparative analysis of agr groups and virulence genes among subclinical and clinical mastitis Staphylococcus aureus isolates from sheep flocks of the Northeast of Brazil

    Directory of Open Access Journals (Sweden)

    Lara M. de Almeida

    2013-01-01

    Full Text Available Staphylococcus aureus is one of the most frequent mastitis causative agents in small ruminants. The expression of most virulence genes of S. aureus is controlled by an accessory gene regulator (agrlocus. This study aimed to ascertain the prevalence of the different agr groups and to evaluate the occurrence of encoding genes for cytotoxin, adhesins and toxins with superantigen activity in S. aureus isolates from milk of ewes with clinical and subclinical mastitis in sheep flocks raised for meat production The agr groups I and II were identified in both cases of clinical and subclinical mastitis. Neither the arg groups III and IV nor negative agr were found. The presence of cflA gene was identified in 100% of the isolates. The frequency of hla and lukE-D genes was high -77.3 and 82.8%, respectively and all isolates from clinical mastitis presented these genes. The sec gene, either associated to tst gene or not, was identified only in isolates from subclinical mastitis. None of the following genes were identified: bbp, ebpS, cna, fnbB, icaA, icaD, bap, hlg, lukM-lukF-PV and se-a-b-d-e.

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

    Directory of Open Access Journals (Sweden)

    Nadine Correia Santos

    2014-02-01

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

  13. Comparative analysis of agr groups and virulence genes among subclinical and clinical mastitis Staphylococcus aureus isolates from sheep flocks of the Northeast of Brazil.

    Science.gov (United States)

    de Almeida, Lara M; de Almeida, Mayra Zilta P R B; de Mendonça, Carla L; Mamizuka, Elsa M

    2013-01-01

    Staphylococcus aureus is one of the most frequent mastitis causative agents in small ruminants. The expression of most virulence genes of S. aureus is controlled by an accessory gene regulator (agr) locus. This study aimed to ascertain the prevalence of the different agr groups and to evaluate the occurrence of encoding genes for cytotoxin, adhesins and toxins with superantigen activity in S. aureus isolates from milk of ewes with clinical and subclinical mastitis in sheep flocks raised for meat production The agr groups I and II were identified in both cases of clinical and subclinical mastitis. Neither the arg groups III and IV nor negative agr were found. The presence of cflA gene was identified in 100% of the isolates. The frequency of hla and lukE-D genes was high - 77.3 and 82.8%, respectively and all isolates from clinical mastitis presented these genes. The sec gene, either associated to tst gene or not, was identified only in isolates from subclinical mastitis. None of the following genes were identified: bbp, ebpS, cna, fnbB, icaA, icaD, bap, hlg, lukM-lukF-PV and se-a-b-d-e.

  14. Comparative analysis of agr groups and virulence genes among subclinical and clinical mastitis Staphylococcus aureus isolates from sheep flocks of the Northeast of Brazil.

    Science.gov (United States)

    de Almeida, Lara M; de Almeida, Mayra Zilta P R B; de Mendonça, Carla L; Mamizuka, Elsa M

    2013-01-01

    Staphylococcus aureus is one of the most frequent mastitis causative agents in small ruminants. The expression of most virulence genes of S. aureus is controlled by an accessory gene regulator (agr) locus. This study aimed to ascertain the prevalence of the different agr groups and to evaluate the occurrence of encoding genes for cytotoxin, adhesins and toxins with superantigen activity in S. aureus isolates from milk of ewes with clinical and subclinical mastitis in sheep flocks raised for meat production The agr groups I and II were identified in both cases of clinical and subclinical mastitis. Neither the arg groups III and IV nor negative agr were found. The presence of cflA gene was identified in 100% of the isolates. The frequency of hla and lukE-D genes was high - 77.3 and 82.8%, respectively and all isolates from clinical mastitis presented these genes. The sec gene, either associated to tst gene or not, was identified only in isolates from subclinical mastitis. None of the following genes were identified: bbp, ebpS, cna, fnbB, icaA, icaD, bap, hlg, lukM-lukF-PV and se-a-b-d-e. PMID:24294245

  15. A Model of Small-Group Problem-Based Learning in Pharmacy Education: Teaching in the Clinical Environment

    Science.gov (United States)

    Khumsikiew, Jeerisuda; Donsamak, Sisira; Saeteaw, Manit

    2015-01-01

    Problem-based Learning (PBL) is an alternate method of instruction that incorporates basic elements of cognitive learning theory. Colleges of pharmacy use PBL to aid anticipated learning outcomes and practice competencies for pharmacy student. The purpose of this study were to implement and evaluate a model of small group PBL for 5th year pharmacy…

  16. Clinical use of cancer biomarkers in epithelial ovarian cancer: updated guidelines from the European Group on Tumor Markers

    NARCIS (Netherlands)

    Sölétormos, G.; Duffy, M.J.; Othman Abu Hassan, S.; Verheijen, RHM; Tholander, B.; Bast jr., R.C.; Gaarenstroom, K.N.; Sturgeon, C.M.; Bonfrer, J.M.G.; Petersen, P.H.; Troonen, H.; Carlo Torre, G.; Kanty Kulpa, J.; Tuxen, M.K.; Molina, R.

    2016-01-01

    OBJECTIVE: To present an update of the European Group on Tumor Markers guidelines for serum markers in epithelial ovarian cancer. METHODS: Systematic literature survey from 2008 to 2013. The articles were evaluated by level of evidence and strength of recommendation. RESULTS: Because of its low sens

  17. Case-mix study of single incision laparoscopic surgery (SILS) vs. Conventional laparoscopic surgery in colonic cancer resections

    DEFF Research Database (Denmark)

    Mynster, Tommie; Wille-Jørgensen, Peer

    2013-01-01

    Single incision laparoscopic surgery (SILS) may be even less invasive to a patient than conventional laparoscopic surgery (CLS). Aim of the study of the applicability of the procedure, the first 1½ year of experiences and comparison with CLS for colonic cancer resections Material and methods. Since...... and hospital stay, but length of vascular pedicle was significantly larger in SILS procedures. Although only 50% of SILS patients received opioids postoperatively, this was not significantly different from the 71% receiving opioids in the CLS group, and similarly no significant difference in number...... of administrations or amount of opioids were seen. Conclusion. With reservation of a small study group we find SILS is like worthy to CLS in colorectal cancer surgery and a benefit in postoperative recovery and pain is possible, but has to be investigated in larger randomised studies....

  18. International neurocognitive normative study: neurocognitive comparison data in diverse resource-limited settings: AIDS Clinical Trials Group A5271.

    Science.gov (United States)

    Robertson, K; Jiang, H; Evans, S R; Marra, C M; Berzins, B; Hakim, J; Sacktor, N; Silva, M Tulius; Campbell, T B; Nair, A; Schouten, J; Kumwenda, J; Supparatpinyo, K; Tripathy, S; Kumarasamy, N; la Rosa, A; Montano, S; Mwafongo, A; Firnhaber, C; Sanne, I; Naini, L; Amod, F; Walawander, A

    2016-08-01

    Infrastructure for conducting neurological research in resource-limited settings (RLS) is limited. The lack of neurological and neuropsychological (NP) assessment and normative data needed for clinical interpretation impedes research and clinical care. Here, we report on ACTG 5271, which provided neurological training of clinical site personnel and collected neurocognitive normative comparison data in diverse settings. At ten sites in seven RLS countries, we provided training for NP assessments. We collected normative comparison data on HIV- participants from Brazil (n = 240), India (n = 480), Malawi (n = 481), Peru (n = 239), South Africa (480), Thailand (n = 240), and Zimbabwe (n = 240). Participants had a negative HIV test within 30 days before standardized NP exams were administered at baseline and 770 at 6 months. Participants were enrolled in eight strata, gender (female and male), education (country differences were evident in all the neurocognitive test scores (p < 0.0001). There was variation between the age, gender, and education strata on the neurocognitive tests. Age and education were important variables for all tests; older participants had poorer performance, and those with higher education had better performance. Women had better performance on verbal learning/memory and speed of processing tests, while men performed better on motor tests. This study provides the necessary neurocognitive normative data needed to build infrastructure for future neurological and neurocognitive studies in diverse RLS. These normative data are a much-needed resource for both clinicians and researchers.

  19. Acupuncture treatment for pain: systematic review of randomised clinical trials with acupuncture, placebo acupuncture, and no acupuncture groups

    DEFF Research Database (Denmark)

    Madsen, Matias Vested; Gøtzsche, Peter C; Hróbjartsson, Asbjørn

    2009-01-01

    OBJECTIVES: To study the analgesic effect of acupuncture and placebo acupuncture and to explore whether the type of the placebo acupuncture is associated with the estimated effect of acupuncture. DESIGN: Systematic review and meta-analysis of three armed randomised clinical trials. DATA SOURCES.......26 to -0.08), corresponding to 4 mm (2 mm to 6 mm) on a 100 mm visual analogue scale. No statistically significant heterogeneity was present (P=0.10, I(2)=36%). A moderate difference was found between placebo acupuncture and no acupuncture: standardised mean difference -0.42 (-0.60 to -0.23). However...

  20. Regional differences in clinical care among patients with type 1 diabetes in Brazil: Brazilian Type 1 Diabetes Study Group

    Directory of Open Access Journals (Sweden)

    Gomes Marília B

    2012-10-01

    Full Text Available Abstract Background To determine the characteristics of clinical care offered to type 1 diabetic patients across the four distinct regions of Brazil, with geographic and contrasting socioeconomic differences. Glycemic control, prevalence of cardiovascular risk factors, screening for chronic complications and the frequency that the recommended treatment goals were met using the American Diabetes Association guidelines were evaluated. Methods This was a cross-sectional, multicenter study conducted from December 2008 to December 2010 in 28 secondary and tertiary care public clinics in 20 Brazilian cities in north/northeast, mid-west, southeast and south regions. The data were obtained from 3,591 patients (56.0% females and 57.1% Caucasians aged 21.2 ± 11.7 years with a disease duration of 9.6 ± 8.1 years ( Results Overall, 18.4% patients had HbA1c levels Conclusions A majority of patients, mainly in the north/northeast and mid-west regions, did not meet metabolic control goals and were not screened for diabetes-related chronic complications. These results should guide governmental health policy decisions, specific to each geographic region, to improve diabetes care and decrease the negative impact diabetes has on the public health system.

  1. Clinical information system services and capabilities desired for scalable, standards-based, service-oriented decision support: consensus assessment of the Health Level 7 clinical decision support Work Group.

    Science.gov (United States)

    Kawamoto, Kensaku; Jacobs, Jason; Welch, Brandon M; Huser, Vojtech; Paterno, Marilyn D; Del Fiol, Guilherme; Shields, David; Strasberg, Howard R; Haug, Peter J; Liu, Zhijing; Jenders, Robert A; Rowed, David W; Chertcoff, Daryl; Fehre, Karsten; Adlassnig, Klaus-Peter; Curtis, A Clayton

    2012-01-01

    A standards-based, service-oriented architecture for clinical decision support (CDS) has the potential to significantly enhance CDS scalability and robustness. To enable such a CDS architecture, the Health Level 7 CDS Work Group reviewed the literature, hosted multi-stakeholder discussions, and consulted domain experts to identify and prioritize the services and capabilities required from clinical information systems (CISs) to enable service-oriented CDS. In addition, relevant available standards were identified. Through this process, ten CIS services and eight CIS capabilities were identified as being important for enabling scalable, service-oriented CDS. In particular, through a survey of 46 domain experts, five services and capabilities were identified as being especially critical: 1) the use of standard information models and terminologies; 2) the ability to leverage a Decision Support Service (DSS); 3) support for a clinical data query service; 4) support for an event subscription and notification service; and 5) support for a user communication service. PMID:23304315

  2. Clinical Information System Services and Capabilities Desired for Scalable, Standards-Based, Service-oriented Decision Support: Consensus Assessment of the Health Level 7 Clinical Decision Support Work Group

    Science.gov (United States)

    Kawamoto, Kensaku; Jacobs, Jason; Welch, Brandon M.; Huser, Vojtech; Paterno, Marilyn D.; Del Fiol, Guilherme; Shields, David; Strasberg, Howard R.; Haug, Peter J.; Liu, Zhijing; Jenders, Robert A.; Rowed, David W.; Chertcoff, Daryl; Fehre, Karsten; Adlassnig, Klaus-Peter; Curtis, A. Clayton

    2012-01-01

    A standards-based, service-oriented architecture for clinical decision support (CDS) has the potential to significantly enhance CDS scalability and robustness. To enable such a CDS architecture, the Health Level 7 CDS Work Group reviewed the literature, hosted multi-stakeholder discussions, and consulted domain experts to identify and prioritize the services and capabilities required from clinical information systems (CISs) to enable service-oriented CDS. In addition, relevant available standards were identified. Through this process, ten CIS services and eight CIS capabilities were identified as being important for enabling scalable, service-oriented CDS. In particular, through a survey of 46 domain experts, five services and capabilities were identified as being especially critical: 1) the use of standard information models and terminologies; 2) the ability to leverage a Decision Support Service (DSS); 3) support for a clinical data query service; 4) support for an event subscription and notification service; and 5) support for a user communication service. PMID:23304315

  3. Clinical information system services and capabilities desired for scalable, standards-based, service-oriented decision support: consensus assessment of the Health Level 7 clinical decision support Work Group.

    Science.gov (United States)

    Kawamoto, Kensaku; Jacobs, Jason; Welch, Brandon M; Huser, Vojtech; Paterno, Marilyn D; Del Fiol, Guilherme; Shields, David; Strasberg, Howard R; Haug, Peter J; Liu, Zhijing; Jenders, Robert A; Rowed, David W; Chertcoff, Daryl; Fehre, Karsten; Adlassnig, Klaus-Peter; Curtis, A Clayton

    2012-01-01

    A standards-based, service-oriented architecture for clinical decision support (CDS) has the potential to significantly enhance CDS scalability and robustness. To enable such a CDS architecture, the Health Level 7 CDS Work Group reviewed the literature, hosted multi-stakeholder discussions, and consulted domain experts to identify and prioritize the services and capabilities required from clinical information systems (CISs) to enable service-oriented CDS. In addition, relevant available standards were identified. Through this process, ten CIS services and eight CIS capabilities were identified as being important for enabling scalable, service-oriented CDS. In particular, through a survey of 46 domain experts, five services and capabilities were identified as being especially critical: 1) the use of standard information models and terminologies; 2) the ability to leverage a Decision Support Service (DSS); 3) support for a clinical data query service; 4) support for an event subscription and notification service; and 5) support for a user communication service.

  4. Dengue: clinical forms and risk groups in a high incidence city in the southeastern region of Brazil

    OpenAIRE

    Ivana Macedo Cardoso; Aline de Souza Areias Cabidelle; Patrícia de Castro e Leão Borges; Carolina Ferreira Lang; Fabrício Greco Calenti; Larissa de Oliveira Nogueira; Aloisio Falqueto; Crispim Cerutti Junior

    2011-01-01

    INTRODUCTION: The article describes the epidemiologic profile of dengue cases in Vitória, the capital of Espírito Santo, Brazil, from 2000 to 2009, aimed at identifying risk groups regarding the incidence and severity of the disease. METHODS: Confirmed cases of dengue among city residents during ten years were classified as dengue fever, dengue hemorrhagic fever, dengue shock syndrome and dengue with complications, and analyzed according to sex, age, race-color and education. RESULTS: The pro...

  5. Feedback versus no feedback to improve patient outcome in group psychotherapy for eating disorders (F-EAT): A randomized clinical trial

    DEFF Research Database (Denmark)

    Davidsen, Annika Helgadóttir; Waaddegaard, Mette; Poulsen, Stig Bernt;

    Background: A high rate of dropout in the treatment of eating disorders calls for ways to improve treatment attendance. Research indicates that continuous feedback on patient improvement and the therapeutic alliance reduces the number of dropouts and increases patient outcome. There are, however......, only three published randomized trials on the effect of feedback on the treatment of eating disorders showing inconclusive results, and there are no randomized trials on the effect of feedback in group therapy. Objective: The current randomized clinical trial aims to investigate the impact...... of continuous feedback on adherence and outcome in group psychotherapy. Methods/design: The trial is set up in a randomized design for outpatients diagnosed with bulimia nervosa, binge eating disorder, or eating disorder not otherwise specified (DSM-IV). They are allocated 1:1 to the experimental group...

  6. [Nutritional and Functional assessment of peritoneal dialysis patients in the clinical practice: Report from MITO-DP Group].

    Science.gov (United States)

    Cupisti, Adamasco; D'Alessandro, Claudia; Caselli, Gian Marco

    2016-01-01

    Nutritional abnormalities and physical inactivity are risk factors of increased morbidity and mortality in patients with ESRD. Identify and define malnutrition, in particular protein-energy depletion (PEW), is an important task in the management of renal patients. The aim of this multicenter observational study was to implement the assessment of nutritional status and functional capacity in patients on peritoneal dialysis, including tests and validated methods which are relatively easy to apply in daily clinical practice. The study includes all the 133 prevalent patients (80 m, 53 f, age 65 14 years), in peritoneal dialysis treatment (vintage 26 19 months) in 9 centers in Tuscany. We performed anthropometry, bioimpedance (BIA), clinical biochemistry, evaluation of habitual physical activity (RAPA tests) and performance (Sit-To-Stand test), appetite-evaluation questionnaire, and indices including the Malnutrition Inflammation Score (MIS), Geriatric Nutrition Risk Index (GNRI), Charlson comorbidity index, Barthel and Karnowsky index. The latter showed a condition of dependence in 7.2% and 19.7% of cases, respectively. Poor appetite was recorded in 48.2%. The majority of patients fell within the overweight / obesity range (51%) with waist circumference values associated with increased cardiovascular risk in 51% of males and 60% of females. At the BIA analysis, a BCMI 11, indicative of PEW, took place in 12.7% of cases. The values of the MIS correlated directly with age and the degree of comorbidity and inversely with the sit-to-stand test, RAPA tests and appetite level. The data in this study show that single tests indicative of malnutrition disorders are frequent to be found in our series of peritoneal dialysis patients. However, a diagnosis of PEW is quite infrequent. A large percentage of patients are overweight with increased abdominal adiposity, and reduced cell mass and protein intake below recommended levels; the level of habitual physical activity is low, and

  7. Ensuring Resident Competence: A Narrative Review of the Literature on Group Decision Making to Inform the Work of Clinical Competency Committees.

    Science.gov (United States)

    Hauer, Karen E; Cate, Olle Ten; Boscardin, Christy K; Iobst, William; Holmboe, Eric S; Chesluk, Benjamin; Baron, Robert B; O'Sullivan, Patricia S

    2016-05-01

    Background The expectation for graduate medical education programs to ensure that trainees are progressing toward competence for unsupervised practice prompted requirements for a committee to make decisions regarding residents' progress, termed a clinical competency committee (CCC). The literature on the composition of these committees and how they share information and render decisions can inform the work of CCCs by highlighting vulnerabilities and best practices. Objective We conducted a narrative review of the literature on group decision making that can help characterize the work of CCCs, including how they are populated and how they use information. Methods English language studies of group decision making in medical education, psychology, and organizational behavior were used. Results The results highlighted 2 major themes. Group member composition showcased the value placed on the complementarity of members' experience and lessons they had learned about performance review through their teaching and committee work. Group processes revealed strengths and limitations in groups' understanding of their work, leader role, and information-sharing procedures. Time pressure was a threat to the quality of group work. Conclusions Implications of the findings include the risks for committees that arise with homogeneous membership, limitations to available resident performance information, and processes that arise through experience rather than deriving from a well-articulated purpose of their work. Recommendations are presented to maximize the effectiveness of CCC processes, including their membership and access to, and interpretation of, information to yield evidence-based, well-reasoned judgments.

  8. Expert Consensus Group report on the use of apomorphine in the treatment of Parkinson's disease - Clinical practice recommendations

    DEFF Research Database (Denmark)

    Trenkwalder, Claudia; Chaudhuri, K Ray; García Ruiz, Pedro J;

    2015-01-01

    Extensive published evidence supports the use of subcutaneously-administered apomorphine as an effective therapy for Parkinson's disease (PD) but to date no consensus recommendations have been available to guide healthcare professionals in the optimal application of apomorphine therapy in clinical....... Apomorphine is a suitable therapeutic option for PD patients who experience troublesome 'off' periods despite optimized treatment with oral PD medications. Due to its speed of onset, apomorphine injection is particularly suited to those patients requiring rapid, reliable relief of both unpredictable and...... predictable 'off' periods, those who require reliable and fast relief when anticipating an 'off', those with levodopa absorption or gastric emptying problems resulting in delayed or failed 'on', or for rapid relief of early morning dystonia or akinesia. Apomorphine infusion(1) is suited for patients whose...

  9. [Use of reactions with Limulus amoebocyte lysate (LAL) to determine biological activity of lipopolysaccharides from reference and clinical strains of the Bacteroides fragilis group].

    Science.gov (United States)

    Rokosz, Alicja; Fiejka, Maria; Górska, Paulina; Aleksandrowicz, Janina; Meisel-Mikołajczyk, Felicja; Łuczak, MirosŁaw

    2002-01-01

    The aim of this study was to determine and compare a biological activity of lipopolysaccharides (LPS) from reference and clinical strains of strictly anaerobic bacteria belonging to the Bacteroides fragilis group (BFG) by means of quantitative, photometric BET (LAL) method with Limulus polyphemus amoebocyte lysate and chromogenic substrate S-2423. Lipopolysaccharides of five BFG species were extracted by Westphal and Jann method (1965) from eight reference and two clinical strains of B. fragilis group. Crude LPS preparations were purified according to the procedure described by Gmeiner (1975) with ultracentrifugation and nuclease treatment. Biological activities of bacterial endotoxins were determined by quantitative BET method with chromogenic substrate S-2423 (ENDOCHROME kit, Charles River Endosafe Ltd., USA). Tests were performed according to the producer's recommendations. E. coli O55:B5 LPS was applied to compare its activity in reaction with LAL reagent with activities of LPS preparations from rods of the Bacteroides genus. Among examined bacterial compounds the most active in BET method was E. coli O55:B5 LPS. Activities of lipopolysaccharides from five species of BFG rods in reaction with Limulus amoebocyte lysate were differentiated. Greater ability to activate LAL proenzyme revealed lipopolysaccharides of these species of the Bacteroides genus, which are important from the clinical point of view--B. fragilis and B. thetaiotaomicron.

  10. A Complex Multiherbal Regimen Based on Ayurveda Medicine for the Management of Hepatic Cirrhosis Complicated by Ascites: Nonrandomized, Uncontrolled, Single Group, Open-Label Observational Clinical Study

    Directory of Open Access Journals (Sweden)

    Manish V. Patel

    2015-01-01

    Full Text Available Hepatic cirrhosis is one of the leading causes of death worldwide, especially if complicated by ascites. This chronic condition can be related to the classical disease entity jalodara in Traditional Indian Medicine (Ayurveda. The present paper aims to evaluate the general potential of Ayurvedic therapy for overall clinical outcomes in hepatic cirrhosis complicated by ascites (HCcA. In form of a nonrandomized, uncontrolled, single group, open-label observational clinical study, 56 patients fulfilling standardized diagnostic criteria for HCcA were observed during their treatment at the P. D. Patel Ayurveda Hospital, Nadiad, India. Based on Ayurvedic tradition, a standardized treatment protocol was developed and implemented, consisting of oral administration of single and compound herbal preparations combined with purificatory measures as well as dietary and lifestyle regimens. The outcomes were assessed by measuring liver functions through specific clinical features and laboratory parameters and by evaluating the Child-Pugh prognostic grade score. After 6 weeks of treatment and a follow-up period of 18 weeks, the outcomes showed statistically significant and clinically relevant improvements. Further larger and randomized trials on effectiveness, safety, and quality of the Ayurvedic approach in the treatment of HCcA are warranted to support these preliminary findings.

  11. In vitro antibacterial activity of some antihistaminics belonging to different groups against multi-drug resistant clinical isolates

    Directory of Open Access Journals (Sweden)

    Moustafa A El-Nakeeb

    2011-09-01

    Full Text Available Antihistaminics are widely used for various indications during microbial infection. Hence, this paper investigates the antimicrobial activities of 10 antihistaminics belonging to both old and new generations using multiresistant Gram-positive and Gram-negative clinical isolates. The bacteriostatic activity of antihistaminics was investigated by determining their MIC both by broth and agar dilution techniques against 29 bacterial strains. Azelastine, cyproheptadine, mequitazine and promethazine were the most active among the tested drugs. Diphenhydramine and cetirizine possessed weaker activity whereas doxylamine, fexofenadine and loratadine were inactive even at the highest tested concentration (1 mg/ml. The MIC of meclozine could not be determined as it precipitated with the used culture media. The MBC values of antihistaminics were almost identical to the corresponding MIC values. The bactericidal activity of antihistaminics was also studied by the viable count technique in sterile saline solution. Evident killing effects were exerted by mequitazine, meclozine, azelastine and cyproheptadine. Moreover, the dynamics of bactericidal activity of azelastine were studied by the viable count technique in nutrient broth. This activity was found to be concentration-dependant. This effect was reduced on increasing the inoculum size while it was increased on raising the pH. The post-antimicrobial effect of 100 fg/ml azelastine was also determined and reached up to 3.36 h.

  12. Clinical outcomes after hepatitis C infection from contaminated anti-D immune globulin. Irish Hepatology Research Group.

    LENUS (Irish Health Repository)

    Kenny-Walsh, E

    2012-02-03

    BACKGROUND AND METHODS: In February 1994, batches of anti-D immune globulin used in Ireland during 1977 and 1978 to prevent Rh isoimmunization were found to be contaminated with hepatitis C virus (HCV) from a single infected donor. In March 1994, a national screening program was initiated for all women who had received anti-D immune globulin between 1970 and 1994. Of the 62,667 women who had been screened when this study began, 704 (1.1 percent) had evidence of past or current HCV infection, and 390 of those 704 (55 percent) had positive tests for serum HCV RNA on reverse-transcription-polymerase-chain-reaction analysis. All 390 were offered a referral for clinical assessment and therapy. We evaluated 376 of these 390 women (96 percent); the other 14 were not seen at one of the designated treatment centers. RESULTS: The mean (+\\/-SD) age of the 376 women was 45+\\/-6 years at the time of screening. They had been infected with hepatitis C for about 17 years. A total of 304 women (81 percent) reported symptoms, most commonly fatigue (248 [66 percent]). Serum alanine aminotransferase concentrations were slightly elevated (40 to 99 U per liter) in 176 of 371 women (47 percent), and the concentrations were 100 U per liter or higher in 31 (8 percent). Liver biopsies showed inflammation in 356 of 363 women (98 percent); in most cases the inflammation was slight (41 percent) or moderate (52 percent). Although the biopsy samples from 186 of the 363 women (51 percent) showed evidence of fibrosis, only 7 women (2 percent) had probable or definite cirrhosis. Two of the seven reported excessive alcohol consumption. CONCLUSIONS: Most of the women with HCV infection 17 years after receiving HCV-contaminated anti-D immune globulin had evidence of slight or moderate hepatic inflammation on liver biopsy, about half had fibrosis, and 2 percent had probable or definite cirrhosis.

  13. Novel Three-Day, Community-Based, Nonpharmacological Group Intervention for Chronic Musculoskeletal Pain (COPERS): A Randomised Clinical Trial

    Science.gov (United States)

    Taylor, Stephanie J. C.; Carnes, Dawn; Homer, Kate; Kahan, Brennan C.; Hounsome, Natalia; Eldridge, Sandra; Spencer, Anne; Pincus, Tamar; Underwood, Martin

    2016-01-01

    Background Chronic musculoskeletal pain is the leading cause of disability worldwide. The effectiveness of pharmacological treatments for chronic pain is often limited, and there is growing concern about the adverse effects of these treatments, including opioid dependence. Nonpharmacological approaches to chronic pain may be an attractive alternative or adjunctive treatment. We describe the effectiveness of a novel, theoretically based group pain management support intervention for chronic musculoskeletal pain. Methods and Findings We conducted a multi-centre, pragmatic, randomised, controlled effectiveness and cost-effectiveness (cost–utility) trial across 27 general practices and community musculoskeletal services in the UK. We recruited 703 adults with musculoskeletal pain of at least 3 mo duration between August 1, 2011, and July 31, 2012, and randomised participants 1.33:1 to intervention (403) or control (300). Intervention participants were offered a participative group intervention (COPERS) delivered over three alternate days with a follow-up session at 2 wk. The intervention introduced cognitive behavioural approaches and was designed to promote self-efficacy to manage chronic pain. Controls received usual care and a relaxation CD. The primary outcome was pain-related disability at 12 mo (Chronic Pain Grade [CPG] disability subscale); secondary outcomes included the CPG disability subscale at 6 mo and the following measured at 6 and 12 mo: anxiety and depression (Hospital Anxiety and Depression Scale [HADS]), pain acceptance (Chronic Pain Acceptance Questionnaire), social integration (Health Education Impact Questionnaire social integration and support subscale), pain-related self-efficacy (Pain Self-Efficacy Questionnaire), pain intensity (CPG pain intensity subscale), the census global health question (2011 census for England and Wales), health utility (EQ-5D-3L), and health care resource use. Analyses followed the intention-to-treat principle

  14. Immunocompromentation of persons from groups with high risk of parenteral contamination with hepatitis B and C viruses: mechanisms of development and clinical pathogenetical significance

    Directory of Open Access Journals (Sweden)

    M. K. Mamedov

    2012-01-01

    Full Text Available The paper contains data demonstrated that majority of persons belonged to groups with high risk of parenteral contamination with hepatitis B and C viruses yet before contamination with these viruses have complex of immunological disorders. In the article is presented the data reflecting main causes of these disorders development at different categories of such persons and main aspects of their pathogenetical and clinical significance are discussed.

  15. Analysis of NF-B Pathway Proteins in Pediatric Hodgkin Lymphoma: Correlations with EBV Status and Clinical Outcome—A Children's Oncology Group Study

    OpenAIRE

    Horton, Terzah M.; Sheehan, Andrea M.; Dolores López-Terrada; Hutchison, Robert E.; Sonia Narendra; Meng-Fen Wu; Hao Liu

    2012-01-01

    Constitutively active nuclear factor-κB (NF-κB) is integral to the survival of Hodgkin/Reed-Sternberg cells (H/RS) in Hodgkin lymphoma (HL). To investigate NF-κB pathway proteins in pediatric HL, we utilized a tissue microarray compiled from 102 children enrolled in the Children's Oncology Group intermediate-risk clinical trial AHOD0031 (56 male, 78 Caucasian, median age 15 years (range 1–20 years), 85 nodular sclerosing subtype, 23 Epstein-Barr virus (EBV) positive, and 24 refractory/relapse...

  16. Dengue: clinical forms and risk groups in a high incidence city in the southeastern region of Brazil

    Directory of Open Access Journals (Sweden)

    Ivana Macedo Cardoso

    2011-08-01

    Full Text Available INTRODUCTION: The article describes the epidemiologic profile of dengue cases in Vitória, the capital of Espírito Santo, Brazil, from 2000 to 2009, aimed at identifying risk groups regarding the incidence and severity of the disease. METHODS: Confirmed cases of dengue among city residents during ten years were classified as dengue fever, dengue hemorrhagic fever, dengue shock syndrome and dengue with complications, and analyzed according to sex, age, race-color and education. RESULTS: The proportion of dengue cases was highest among women aged 20 to 29 years-old and similar between whites and blacks. A gradual decrease occurred in the percentage of dengue cases in the population aged 15 years-old or more, in the historical series of 10 years, and a growing increase in individuals less than 15 years-old, showing statistical significance. The fatality rate ranged from zero to 0.3% for all forms of dengue and from 0.2% to 18.2% for severe forms. CONCLUSIONS: The profile of those affected by the disease in the municipality is similar to those affected in Brazil. The increasing number of cases in individuals under 15 years-old corroborates the results of recent studies in other Brazilian municipalities.

  17. Barriers to a Career Focus in Cancer Prevention: A Report and Initial Recommendations From the American Society of Clinical Oncology Cancer Prevention Workforce Pipeline Work Group

    Science.gov (United States)

    Meyskens, Frank L.; Bajorin, Dean F.; George, Thomas J.; Jeter, Joanne M.; Khan, Shakila; Tyne, Courtney A.; William, William N.

    2016-01-01

    Purpose To assist in determining barriers to an oncology career incorporating cancer prevention, the American Society of Clinical Oncology (ASCO) Cancer Prevention Workforce Pipeline Work Group sponsored surveys of training program directors and oncology fellows. Methods Separate surveys with parallel questions were administered to training program directors at their fall 2013 retreat and to oncology fellows as part of their February 2014 in-training examination survey. Forty-seven (67%) of 70 training directors and 1,306 (80%) of 1,634 oncology fellows taking the in-training examination survey answered questions. Results Training directors estimated that ≤ 10% of fellows starting an academic career or entering private practice would have a career focus in cancer prevention. Only 15% of fellows indicated they would likely be interested in cancer prevention as a career focus, although only 12% thought prevention was unimportant relative to treatment. Top fellow-listed barriers to an academic career were difficulty in obtaining funding and lower compensation. Additional barriers to an academic career with a prevention focus included unclear career model, lack of clinical mentors, lack of clinical training opportunities, and concerns about reimbursement. Conclusion Reluctance to incorporate cancer prevention into an oncology career seems to stem from lack of mentors and exposure during training, unclear career path, and uncertainty regarding reimbursement. Suggested approaches to begin to remedy this problem include: 1) more ASCO-led and other prevention educational resources for fellows, training directors, and practicing oncologists; 2) an increase in funded training and clinical research opportunities, including reintroduction of the R25T award; 3) an increase in the prevention content of accrediting examinations for clinical oncologists; and 4) interaction with policymakers to broaden the scope and depth of reimbursement for prevention counseling and

  18. Oral fibrinogen-depleting agent lumbrokinase for secondary ischemic stroke prevention: results from a multicenter, randomized, parallel-group and controlled clinical trial

    Institute of Scientific and Technical Information of China (English)

    CAO Yong-jun; ZHANG Xia; WANG Wan-hua; ZHAI Wan-qing; QIAN Ju-fen; WANG Jian-sheng; CHEN Jun

    2013-01-01

    Background Elevated fibrinogen (Fg) level is a known risk factor for ischemic stroke.There are few clinical trials on oral fibrinogen-depleting therapies for secondary ischemic stroke prevention.We aimed to assess the effects of one-year therapy with oral lumbrokinase enteric-coated capsules on secondary ischemic stroke prevention.Methods This is a multicenter,randomized,parallel group and controlled study that began treatment in hospitalized patients with ischemic stroke and continued for 12 months.Patients were randomized to either the control group that received the standard stroke treatment or the fibrinogen-depleting group that received the standard stroke treatment plus enteric-coated lumbrokinase capsules.The NIH Stroke Scale scores (NIHSSs) and plasma Fg level were recorded.The carotid artery intima-media thickness (IMT) and status of plaques were examined through carotid ultrasound examination.Primary outcomes included all-cause mortality,any event of recurrent ischemic stroke/transient ischemic attack (TIA),hemorrhagic stroke,myocardial infarction and angina,and other noncerebral ischemia or hemorrhage.Kaplan-Meier survival analysis and the Long-rank test were used to compare total vascular end point incidence between the two groups.Comparison of median values between two groups was done by the Student t test,one-way analysis of variance (ANOVA),or non-parametric rank sum test.Results A total of 310 patients were enrolled,192 patients in the treatment group and 118 patients in the control group.Compared to the control group,the treatment group showed favorable outcomes in the Fg level,carotid IMT,the detection rate of vulnerable plaques,the volume of carotid plaques,NIHSS scores,and incidence of total vascular (6.78% and 2.08%,respectively) and cerebral vascular events (5.93% and 1.04%,respectively) (P <0.05).In the treatment group,the volume of carotid plaques was significantly related to the carotid IMT,the plaque diameter,width and number (P

  19. Prognostic significance of clinical grading of patients envenomed by Bothrops lanceolatus in Martinique. Members of the Research Group on Snake Bite in Martinique.

    Science.gov (United States)

    Thomas, L; Tyburn, B; Ketterlé, J; Biao, T; Mehdaoui, H; Moravie, V; Rouvel, C; Plumelle, Y; Bucher, B; Canonge, D; Marie-Nelly, C A; Lang, J

    1998-01-01

    The correlation between clinical grading of patients bitten by Bothrops lanceolatus and the subsequent development of their envenoming was examined. Severity of envenoming was graded using a 1-4 scale (minor to major). Patients were classified into 2 groups according to the time elapsed between bite and treatment with a specific purified equine F(ab')2 antivenom. The late/no treatment group (n = 33) was characterized by a systemic thrombotic complication rate of 14/33 (42.4%) leading to 4 deaths, which increased with the maximum severity assessed on the first day following the bite (P = 0.003). However, infarctions could develop in patients who presented initially with signs of moderate envenoming, normal blood clotting and low serum levels of venom antigens. No such complication of fatality occurred in the early (0.5-6 h) treatment group (n = 70). Multiple regression analysis showed that duration of stay in hospital in this group increased with the length of the snake (P = 0.017), venom antigenaemia (P = 0.016), initial grading (P < 0.001), and with the need for surgical debridement (n = 10/70, P < 0.001). Outcome was correlated with initial severity of envenoming. However, the only factor with a positive prognostic significance for the individual envenomed patient was the early infusion of specific antivenom, which led to 100% recovery in our series. PMID:9861375

  20. Clinical characteristics and public health management of invasive meningococcal group W disease in the East Midlands region of England, United Kingdom, 2011 to 2013.

    Science.gov (United States)

    Bethea, Jane; Makki, Sophia; Gray, Steve; MacGregor, Vanessa; Ladhani, Shamez

    2016-06-16

    In England and Wales, meningococcal disease caused by group W has historically been associated with outbreaks of disease among travellers to high-risk countries. Following a large outbreak associated with travel to the Hajj in 2000, the number of cases declined and, in 2008, only 19 laboratory-confirmed cases were identified nationally. In 2013, in the East Midlands region of England, eight cases of meningococcal disease caused by this serogroup were recorded, compared with six from 2011 to 2012. To explore this further, data for all cases with a date of onset between 1 January 2011 and 31 December 2013 were collected. Data collected included geographical location, clinical presentation and outcome. Fourteen cases were identified; two died as a result of their illness and two developed long-term health problems. No commonality in terms of geographical location, shared space or activities was identified, suggesting that group W is circulating endemically with local transmission. Clinical presentation was variable. Half presented with symptoms not typical of a classical meningococcal disease, including two cases of cellulitis, which may have implications for clinicians, in terms of timely identification and treatment, and public health specialists, for offering timely antibiotic chemoprophylaxis to close contacts. PMID:27336327

  1. National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: III. The 2014 Biomarker Working Group Report.

    Science.gov (United States)

    Paczesny, Sophie; Hakim, Frances T; Pidala, Joseph; Cooke, Kenneth R; Lathrop, Julia; Griffith, Linda M; Hansen, John; Jagasia, Madan; Miklos, David; Pavletic, Steven; Parkman, Robertson; Russek-Cohen, Estelle; Flowers, Mary E D; Lee, Stephanie; Martin, Paul; Vogelsang, Georgia; Walton, Marc; Schultz, Kirk R

    2015-05-01

    Biology-based markers to confirm or aid in the diagnosis or prognosis of chronic graft-versus-host disease (GVHD) after allogeneic hematopoietic cell transplantation or monitor its progression are critically needed to facilitate evaluation of new therapies. Biomarkers have been defined as any characteristic that is objectively measured and evaluated as an indicator of a normal biological or pathogenic process, or of a pharmacologic response to a therapeutic intervention. Applications of biomarkers in chronic GVHD clinical trials or patient management include the following: (1) diagnosis and assessment of chronic GVHD disease activity, including distinguishing irreversible damage from continued disease activity; (2) prognostic risk to develop chronic GVHD; and (3) prediction of response to therapy. Sample collection for chronic GVHD biomarkers studies should be well documented following established quality control guidelines for sample acquisition, processing, preservation, and testing, at intervals that are both calendar and event driven. The consistent therapeutic treatment of subjects and standardized documentation needed to support biomarker studies are most likely to be provided in prospective clinical trials. To date, no chronic GVHD biomarkers have been qualified for use in clinical applications. Since our previous chronic GVHD Biomarkers Working Group report in 2005, an increasing number of chronic GVHD candidate biomarkers are available for further investigation. This paper provides a 4-part framework for biomarker investigations: identification, verification, qualification, and application with terminology based on Food and Drug Administration and European Medicines Agency guidelines. PMID:25644957

  2. 通过临床小讲课培养学生临床思维能力%Development of clinical reasoning by small group session

    Institute of Scientific and Technical Information of China (English)

    朱蓓; 王艳霞

    2008-01-01

    Clinical small group session is one of the essential elements of medical training pro-grams, it is a great opportunity for the medical students to refresh what they learnt from the classroom and to enhance their abilities in analyzing and solving clinical problems, and it is also a valuable approach for the teachers to improve their lecturing skills. As a result, both the teachers and students benefit from this unique format of teaching-learning experience. The paper summarizes the evaluation on the effectiveness of a clinical small group session teaching case, which is a part of the 2007 undergraduate education survey conducted in Beijing University by the Ministry of Education of People's Republic of China.%临床小讲课是传授医学知识的重要方法,是医学生巩固课堂知识,提高分析问题、解决问题能力的重要环节,是带教教师提高授课水平的过程,是教学相长、师生共同受益的有效途径.本文从积累丰富的教学资料,精心选择教学内容,有的放失地设置问题,有效提高学生解决问题能力.适量开展双语教学,制作精致多媒体课件等方面,总结了临床小讲课的讲课技巧,以及教育部本科教学工作水平评估专家组对临床小讲课的评价.

  3. A case-based, small-group cooperative learning course in preclinical veterinary science aimed at bridging basic science and clinical literacy.

    Science.gov (United States)

    Schoeman, J P; van Schoor, M; van der Merwe, L L; Meintjes, R A

    2009-03-01

    In 1999 a dedicated problem-based learning course was introduced into the lecture-based preclinical veterinary curriculum of the University of Pretoria. The Introduction to Clinical Studies Course combines traditional lectures, practical sessions, student self-learning and guided tutorials. The self-directed component of the course utilises case-based, small-group cooperative learning as an educational vehicle to link basic science with clinical medicine. The aim of this article is to describe the objectives and structure of the course and to report the results of the assessment of the students' perceptions on some aspects of the course. Students reacted very positively to the ability of the course to equip them with problem-solving skills. Students indicated positive perceptions about the workload of the course. There were, however, significantly lower scores for the clarity of the course objectives. Although the study guide for the course is very comprehensive, the practice regarding the objectives is still uncertain. It is imperative to set clear objectives in non-traditional, student-centred courses. The objectives have to be explained at the outset and reiterated throughout the course. Tutors should also communicate the rationale behind problem-based learning as a pedagogical method to the students. Further research is needed to verify the effectiveness of this course in bridging the gap between basic science and clinical literacy in veterinary science. Ongoing feedback and assessment of the management and content are important to refine this model for integrating basic science with clinical literacy. PMID:19653516

  4. High Accuracy of Common HIV-Related Oral Disease Diagnoses by Non-Oral Health Specialists in the AIDS Clinical Trial Group.

    Directory of Open Access Journals (Sweden)

    Caroline H Shiboski

    Full Text Available Many studies include oral HIV-related endpoints that may be diagnosed by non-oral-health specialists (non-OHS like nurses or physicians. Our objective was to assess the accuracy of clinical diagnoses of HIV-related oral lesions made by non-OHS compared to diagnoses made by OHS.A5254, a cross-sectional study conducted by the Oral HIV/AIDS Research Alliance within the AIDS Clinical Trial Group, enrolled HIV-1-infected adults participants from six clinical trial units (CTU in the US (San Francisco, New York, Chapel Hill, Cleveland, Atlanta and Haiti. CTU examiners (non-OHS received standardized training on how to perform an oral examination and make clinical diagnoses of specific oral disease endpoints. Diagnoses by calibrated non-OHS were compared to those made by calibrated OHS, and sensitivity and specificity computed.Among 324 participants, the majority were black (73%, men (66%, and the median CD4+ cell count 138 cells/mm(3. The overall frequency of oral mucosal disease diagnosed by OHS was 43% in US sites, and 90% in Haiti. Oral candidiasis (OC was detected in 153 (47% by OHS, with erythematous candidiasis (EC the most common type (39% followed by pseudomembranous candidiasis (PC; 26%. The highest prevalence of OC (79% was among participants in Haiti, and among those with CD4+ cell count ≤ 200 cells/mm(3 and HIV-1 RNA > 1000 copies/mL (71%. The sensitivity and specificity of OC diagnoses by non-OHS were 90% and 92% (for EC: 81% and 94%; PC: 82% and 95%. Sensitivity and specificity were also high for KS (87% and 94%, respectively, but sensitivity was < 60% for HL and oral warts in all sites combined. The Candida culture confirmation of OC clinical diagnoses (as defined by ≥ 1 colony forming unit per mL of oral/throat rinse was ≥ 93% for both PC and EC.Trained non-OHS showed high accuracy of clinical diagnoses of OC in comparison with OHS, suggesting their usefulness in studies in resource-poor settings, but detection of less common

  5. Do randomized clinical trials with inadequate blinding report enhanced placebo effects for intervention groups and nocebo effects for placebo groups? A protocol for a meta-epidemiological study of PDE-5 inhibitors

    Directory of Open Access Journals (Sweden)

    Feys Frederik

    2012-11-01

    Full Text Available Abstract Background Patients’ expectations of treatment effects may contribute to positive (placebo and negative (nocebo outcomes. The effect of patient expectations may be pronounced in subjectively assessed conditions, such as male erectile dysfunction. The aim of this project is to examine the magnitude of expectancy in trials of phosphodiesterase-5 inhibitors. We hypothesize that randomized controlled trials with inadequate blinding will report enhanced placebo effects for intervention groups and nocebo effects for placebo groups, compared with adequately blinded studies. Methods/design We will quantify the magnitude of expectancy by comparing the effect estimates of trials with inadequate and adequate blinding. Blinding will be assessed using four domains from the Cochrane ‘risk-of-bias’ tool: allocation concealment; blinding of patient; caregiver; and outcome assessor. Our secondary aim is to identify factors that can modify expectations, such as prior experience with the intervention and drug side effects. We will perform an electronic search using a combination of controlled vocabulary and free text words in the following databases: MEDLINE, EMBASE, CENTRAL, and a clinical trials register. We will include randomized controlled trials, with either parallel or crossover design, that compare one phosphodiesterase-5 inhibitor with a placebo. The study’s primary aim should be to investigate the efficacy of phosphodiesterase-5 inhibitors for treating male erectile dysfunction. Screening will take place at two levels: abstracts and titles, followed by full text reports. Two reviewers will independently extract data on the primary outcome and assess risk of bias. We will meta-analyze treatment effects, if appropriate, to assess the magnitude of enhanced placebo effects and nocebo effects in intervention and placebo groups, respectively. We will explore possible mediators of placebo and nocebo effects with subgroup and meta

  6. Klebsiella pneumoniae lipopolysaccharide O typing: revision of prototype strains and O-group distribution among clinical isolates from different sources and countries.

    Science.gov (United States)

    Hansen, D S; Mestre, F; Alberti, S; Hernández-Allés, S; Alvarez, D; Doménech-Sánchez, A; Gil, J; Merino, S; Tomás, J M; Benedí, V J

    1999-01-01

    We have previously described an inhibition enzyme-linked immunosorbent assay method for the O typing of O1 lipopolysaccharide from Klebsiella pneumoniae which overcomes the technical problems and limitations of the classical O-typing method. In this study, we have extended the method to all of the currently recognized O types. The method was validated by studying the prototype strains that have defined the O groups by the classical tube agglutinatination O-typing method. Based on these results, we confirmed the O types of 60 of 64 typeable strains, and we propose a revised O-antigenic scheme, with minor but necessary changes, consisting of serogroups or serotypes O1, O2, O2ac, O3, O4, O5, O7, O8, and O12. Application of this typing method to 638 K. pneumoniae clinical isolates from Denmark, Spain, and the United States from different sources (blood, urine, and others) showed that up to 80% of these isolates belong to serotypes or serogroups O1, O2, O3, and O5, independently of the source of isolation, and that a major group of nontypeable isolates, representing about 17% of the total, consists of half O+ and half O- strains. Differences were observed, however, in the prevalence of the lipopolysaccharide O types or groups, depending on the country and isolation source.

  7. AIDS Clinical Trials Group Network

    Science.gov (United States)

    ... Search About Our Mission History of the ACTG Network Leadership Committees Organizational Matrix (PDF - 68 KB) State ... Guidelines Annual Progress Reports Leadership and Operations Center Network Coordinating Center Statistical and Data Management Center Performance ...

  8. Fixed combination of cinnarizine and dimenhydrinate versus betahistine dimesylate in the treatment of Ménière's disease: a randomized, double-blind, parallel group clinical study.

    Science.gov (United States)

    Novotný, Miroslav; Kostrica, Rom

    2002-01-01

    In a randomized, double-blind clinical study, we evaluated the efficacy and tolerability of the fixed combination of cinnarizine, 20 mg, and dimenhydrinate, 40 mg (Arlevert [ARL]) in comparison to betahistine dimesylate (12 mg) in 82 patients suffering from Ménière's disease for at least 3 months and showing the characteristic triad of symptoms (paroxysmal vertigo attacks, cochlear hearing loss, and tinnitus). The treatment (one tablet three times daily) extended to 12 weeks, with control visits at 1, 3, 6, and 12 weeks after drug intake. The study demonstrated for both the fixed-combination ARL and for betahistine a highly efficient reduction of vertigo symptoms in the course of the 12 weeks of treatment; however, no statistically significant difference between the two treatment groups could be established. Similar results were found for tinnitus (approximately 60% reduction) and for the associated vegetative symptoms (almost complete disappearance). Vestibulospinal reactions, recorded by means of craniocorpography, also improved distinctly, with a statistically significant superiority of ARL versus betahistine (p < .042) for the parameter of lateral sway (Unterberger's test). The caloric tests (electronystagmography) showed only minor changes for both treatment groups in the course of the study. A statistically significant improvement of hearing function of the affected ear (p = .042) was found for the combination preparation after 12 weeks of treatment. The tolerability was judged by the vast majority of patients (97.5%) in both groups to be very good. Only one patient (betahistine group) reported a nonserious adverse event, and two betahistine patients did not complete the study. In conclusion, the combination preparation proved to be a highly efficient and safe treatment option for Ménière's disease and may be used both in the management of acute episodes and in long-term treatment. Efficacy and safety were found to be similar to the widely used standard

  9. Changing the Ties That Bind? The Emerging Roles and Identities of General Practitioners and Managers in the New Clinical Commissioning Groups in the English NHS

    Directory of Open Access Journals (Sweden)

    Julia Segar

    2014-10-01

    Full Text Available The English National Health Service (NHS is undergoing significant reorganization following the 2012 Health and Social Care Act. Key to these changes is the shift of responsibility for commissioning services from Primary Care Trusts (PCTs to general practitioners (GPs working together in Clinical Commissioning Groups (CCGs. This article is based on an empirical study that examined the development of emerging CCGs in eight case studies across England between September 2011 and June 2012. The findings are based on interviews with GPs and managers, observations of meetings, and reading of related documents. Scott’s notion that institutions are constituted by three pillars—the regulative, normative, and cognitive–cultural—is explored here. This approach helps to understand the changing roles and identities of doctors and managers implicated by the present reforms. This article notes the far reaching changes in the regulative pillar and questions how these changes will affect the normative and cultural–cognitive pillars.

  10. The role of European Federation of Clinical Chemistry and Laboratory Medicine Working Group for Preanalytical Phase in standardization and harmonization of the preanalytical phase in Europe

    DEFF Research Database (Denmark)

    Cornes, Michael P; Church, Stephen; van Dongen-Lases, Edmée;

    2016-01-01

    and Laboratory Medicine Working Group for Preanalytical Phase (EFLM WG-PRE) was established to lead in standardization and harmonization of preanalytical policies and practices at a European level. One of the key activities of the WG-PRE is the organization of the biennial EFLM-BD conference on the preanalytical......Patient safety is a leading challenge in healthcare and from the laboratory perspective it is now well established that preanalytical errors are the major contributor to the overall rate of diagnostic and therapeutic errors. To address this, the European Federation of Clinical Chemistry...... summarises the work that has and will be done in these areas. The goal of this initiative is to ensure the EFLM WG-PRE produces work that meets the needs of the European laboratory medicine community. Progress made in the identified areas will be updated at the next preanalytical phase conference and show...

  11. Klebsiella pneumoniae lipopolysaccharide O typing: revision of prototype strains and O-group distribution among clinical isolates from different sources and countries

    DEFF Research Database (Denmark)

    Hansen, D S; Mestre, F; Alberti, S;

    1999-01-01

    We have previously described an inhibition enzyme-linked immunosorbent assay method for the O typing of O1 lipopolysaccharide from Klebsiella pneumoniae which overcomes the technical problems and limitations of the classical O-typing method. In this study, we have extended the method to all......, with minor but necessary changes, consisting of serogroups or serotypes O1, O2, O2ac, O3, O4, O5, O7, O8, and O12. Application of this typing method to 638 K. pneumoniae clinical isolates from Denmark, Spain, and the United States from different sources (blood, urine, and others) showed that up to 80......% of these isolates belong to serotypes or serogroups O1, O2, O3, and O5, independently of the source of isolation, and that a major group of nontypeable isolates, representing about 17% of the total, consists of half O+ and half O- strains. Differences were observed, however, in the prevalence...

  12. Introduction of online adaptive radiotherapy for bladder cancer through a multicentre clinical trial (Trans-Tasman Radiation Oncology Group 10.01): lessons learned

    International Nuclear Information System (INIS)

    Online adaptive radiotherapy for bladder cancer is a novel radiotherapy technique that was found feasible in a pilot study at a single academic institution. In September 2010 this technique was opened as a multicenter study through the Trans-Tasman Radiation Oncology Group (TROG 10.01 bladder online adaptive radiotherapy treatment). Twelve centers across Australia and New-Zealand registered interest into the trial. A multidisciplinary team of radiation oncologists, radiation therapists and medical physicists represented the trial credentialing and technical support team. To provide timely activation and proper implementation of the adaptive technique the following key areas were addressed at each site: Staff education/training; Practical image guided radiotherapy assessment; provision of help desk and feedback. The trial credentialing process involved face-to-face training and technical problem solving via full day site visits. A dedicated 'help-desk' team was developed to provide support for the clinical trial. 26% of the workload occurred at the credentialing period while the remaining 74% came post-center activation. The workload was made up of the following key areas; protocol clarification (36%), technical problems (46%) while staff training was less than 10%. Clinical trial credentialing is important to minimizing trial deviations. It should not only focus on site activation quality assurance but also provide ongoing education and technical support. (author)

  13. Introduction of online adaptive radiotherapy for bladder cancer through a multicentre clinical trial (Trans-Tasman Radiation Oncology Group 10.01: Lessons learned

    Directory of Open Access Journals (Sweden)

    Daniel Pham

    2013-01-01

    Full Text Available Online adaptive radiotherapy for bladder cancer is a novel radiotherapy technique that was found feasible in a pilot study at a single academic institution. In September 2010 this technique was opened as a multicenter study through the Trans-Tasman Radiation Oncology Group (TROG 10.01 bladder online adaptive radiotherapy treatment. Twelve centers across Australia and New-Zealand registered interest into the trial. A multidisciplinary team of radiation oncologists, radiation therapists and medical physicists represented the trial credentialing and technical support team. To provide timely activation and proper implementation of the adaptive technique the following key areas were addressed at each site: Staff education/training; Practical image guided radiotherapy assessment; provision of help desk and feedback. The trial credentialing process involved face-to-face training and technical problem solving via full day site visits. A dedicated "help-desk" team was developed to provide support for the clinical trial. 26% of the workload occurred at the credentialing period while the remaining 74% came post-center activation. The workload was made up of the following key areas; protocol clarification (36%, technical problems (46% while staff training was less than 10%. Clinical trial credentialing is important to minimizing trial deviations. It should not only focus on site activation quality assurance but also provide ongoing education and technical support.

  14. Padrões clínicos de acne em mulheres de diferentes faixas etárias Acne in women: clinical patterns in different age-groups

    Directory of Open Access Journals (Sweden)

    Juliano Vilaverde Schmitt

    2009-08-01

    Full Text Available FUNDAMENTOS: Acne é dermatose comum que acomete ambos os gêneros e todas as faixas etárias. Mulheres apresentam diferentes padrões clínicos da doença, além de frequente persistência da acne após a adolescência. OBJETIVO: Analisar características clínicas e epidemiológicas associadas às diferentes faixas etárias acometidas por acne feminina. MÉTODOS: Estudo transversal envolvendo mulheres com diagnóstico de acne, atendidas em ambulatório de dermatologia geral. Variáveis relacionadas à doença e às pacientes foram avaliadas com o emprego de questionário padronizado. RESULTADOS: Avaliaram-se 103 pacientes, cuja idade média na época da consulta foi 21,7 ± 7,3 anos. Definiram-se dois subgrupos com idade de corte de 21 anos e idades médias de 15,8 ± 2,3 e 28,0 ± 5,1 anos. Houve correlação entre a duração do quadro e a idade das pacientes na consulta (R = 0,7. Observaram-se diferenças entre os grupos nas frequências de uso de contraceptivo oral combinado (OR = 48,1, lesões no colo (OR = 11,6, lesões no dorso (OR = 0,2, predominância na topografia superior da face (OR = 0,1 e idade de início das lesões (OR = 1,8. No grupo de mulheres adultas, 80% relataram início do quadro antes dos 20 anos. CONCLUSÕES: Identificaram-se padrões clínicos cronológicos e topográficos que caracterizaram a acne feminina em diferentes faixas etárias, alertando para a importância da abordagem diagnóstica e terapêutica individualizada.BACKGROUND: Acne is a frequent skin disease that occurs in both sexes and all age-groups. Women present several clinical disease patterns; moreover, persistence after adolescence is common. OBJECTIVE: To analyze clinical and epidemiological characteristics associated with different age-groups affected by acne in women. METHODS: Cross-sectional study involving female patients diagnosed with acne, at a general dermatology outpatient clinic. Variables related to disease and patients were assessed

  15. Radiotherapy quality assurance review in a multi-center randomized trial of limited-disease small cell lung cancer: the Japan Clinical Oncology Group (JCOG) trial 0202

    International Nuclear Information System (INIS)

    The purpose of this study was to analyze the radiotherapy (RT) quality assurance (QA) assessment in Japan Clinical Oncology Group (JCOG) 0202, which was the first trial that required on-going RT QA review in the JCOG. JCOG 0202 was a multi-center phase III trial comparing two types of consolidation chemotherapy after concurrent chemoradiotherapy for limited-disease small cell lung cancer. RT requirements included a total dose of 45 Gy/30 fx (bis in die, BID/twice a day) without heterogeneity correction; elective nodal irradiation (ENI) of 30 Gy; at least 1 cm margin around the clinical target volume (CTV); and interfraction interval of 6 hours or longer. Dose constraints were defined in regards to the spinal cord and the lung. The QA assessment was classed as per protocol (PP), deviation acceptable (DA), violation unacceptable (VU), and incomplete/not evaluable (I/NE). A total of 283 cases were accrued, of which 204 were fully evaluable, excluding 79 I/NE cases. There were 18 VU in gross tumor volume (GTV) coverage (8% of 238 evaluated); 4 VU and 23 DA in elective nodal irradiation (ENI) (2% and 9% of 243 evaluated, respectively). Some VU were observed in organs at risk (1 VU in the lung and 5 VU in the spinal cord). Overall RT compliance (PP + DA) was 92% (187 of 204 fully evaluable). Comparison between the former and latter halves of the accrued cases revealed that the number of VU and DA had decreased. The results of the RT QA assessment in JCOG 0202 seemed to be acceptable, providing reliable results

  16. Vesicular monoamine transporter protein expression correlates with clinical features, tumor biology, and MIBG avidity in neuroblastoma: a report from the Children's Oncology Group

    Energy Technology Data Exchange (ETDEWEB)

    Temple, William; Mendelsohn, Lori; Nekritz, Erin; Gustafson, W.C.; Matthay, Katherine K. [UCSF School of Medicine, Department of Pediatrics, San Francisco, CA (United States); UCSF Benioff Children' s Hospital, San Francisco, CA (United States); Kim, Grace E. [UCSF School of Medicine, Department of Pathology, San Francisco, CA (United States); Lin, Lawrence; Giacomini, Kathy [UCSF School of Pharmacy, Department of Bioengineering and Therapeutic Sciences, San Francisco, CA (United States); Naranjo, Arlene; Van Ryn, Collin [University of Florida, Children' s Oncology Group Statistics and Data Center, Gainesville, FL (United States); Yanik, Gregory A. [University of Michigan, CS Mott Children' s Hospital, Ann Arbor, MI (United States); Kreissman, Susan G. [Duke University Medical Center, Durham, NC (United States); Hogarty, Michael [University of Pennsylvania, Children' s Hospital of Philadelphia and Perelman School of Medicine, Philadelphia, PA (United States); DuBois, Steven G. [UCSF School of Medicine, Department of Pediatrics, San Francisco, CA (United States); UCSF Benioff Children' s Hospital, San Francisco, CA (United States); UCSF School of Medicine, San Francisco, CA (United States)

    2016-03-15

    Vesicular monoamine transporters 1 and 2 (VMAT1 and VMAT2) are thought to mediate MIBG uptake in adult neuroendocrine tumors. In neuroblastoma, the norepinephrine transporter (NET) has been investigated as the principal MIBG uptake protein, though some tumors without NET expression concentrate MIBG. We investigated VMAT expression in neuroblastoma and correlated expression with MIBG uptake and clinical features. We evaluated VMAT1 and VMAT2 expression by immunohistochemistry (IHC) in neuroblastoma tumors from 76 patients with high-risk metastatic disease treated in a uniform cooperative group trial (COG A3973). All patients had baseline MIBG diagnostic scans centrally reviewed. IHC results were scored as the product of intensity grading (0 - 3+) and percent of tumor cells expressing the protein of interest. The association between VMAT1 and VMAT2 scores and clinical and biological features was tested using Wilcoxon rank-sum tests. Patient characteristics were typical of high-risk neuroblastoma, though the cohort was intentionally enriched in patients with MIBG-nonavid tumors (n = 20). VMAT1 and VMAT2 were expressed in 62 % and 75 % of neuroblastoma tumors, respectively. VMAT1 and VMAT2 scores were both significantly lower in MYCN amplified tumors and in tumors with high mitotic karyorrhectic index. MIBG-avid tumors had significantly higher VMAT2 scores than MIBG-nonavid tumors (median 216 vs. 45; p = 0.04). VMAT1 expression did not correlate with MIBG avidity. VMAT1 and VMAT2 are expressed in the majority of neuroblastomas. Expression correlates with other biological features. The expression level of VMAT2 but not that of VMAT1 correlates with avidity for MIBG. (orig.)

  17. A Novel Biomarker Panel Examining Response to Gemcitabine with or without Erlotinib for Pancreatic Cancer Therapy in NCIC Clinical Trials Group PA.3.

    Directory of Open Access Journals (Sweden)

    David B Shultz

    Full Text Available NCIC Clinical Trials Group PA.3 was a randomized control trial that demonstrated improved overall survival (OS in patients receiving erlotinib in addition to gemcitabine for locally advanced or metastatic pancreatic cancer. Prior to therapy, patients had plasma samples drawn for future study. We sought to identify biomarkers within these samples.Using the proximity ligation assay (PLA, a probe panel was built from commercially available antibodies for 35 key proteins selected from a global genetic analysis of pancreatic cancers, and used to quantify protein levels in 20 uL of patient plasma. To determine if any of these proteins levels independently associated with OS, univariate and mulitbaraible Cox models were used. In addition, we examined the associations between biomarker expression and disease stage at diagnosis using Fisher's exact test. The correlation between Erlotinib sensitivity and each biomarkers was assessed using a test of interaction between treatment and biomarker.Of the 569 eligible patients, 480 had samples available for study. Samples were randomly allocated into training (251 and validation sets (229. Among all patients, elevated levels of interleukin-8 (IL-8, carcinoembryonic antigen (CEA, hypoxia-inducible factor 1-alpha (HIF-1 alpha, and interleukin-6 were independently associated with lower OS, while IL-8, CEA, platelet-derived growth factor receptor alpha and mucin-1 were associated with metastatic disease. Patients with elevated levels of receptor tyrosine-protein kinase erbB-2 (HER2 expression had improved OS when treated with erlotinib compared to placebo. In conclusion, PLA is a powerful tool for identifying biomarkers from archived, small volume serum samples. These data may be useful to stratify patient outcomes regardless of therapeutic intervention.ClinicalTrials.gov NCT00040183.

  18. Observational study of patients with gastroenteropancreatic and bronchial neuroendocrine tumors in Argentina: Results from the large database of a multidisciplinary group clinical multicenter study

    Science.gov (United States)

    O’CONNOR, JUAN MANUEL; MARMISSOLLE, FABIANA; BESTANI, CLAUDIA; PESCE, VERONICA; BELLI, SUSANA; DOMINICHINI, ENZO; MENDEZ, GUILLERMO; PRICE, PAOLA; GIACOMI, NORA; PAIROLA, ALEJANDRO; LORIA, FERNANDO SÁNCHEZ; HUERTAS, EDUARDO; MARTIN, CLAUDIO; PATANE, KARINA; POLERI, CLAUDIA; ROSENBERG, MOISES; CABANNE, ANA; KUJARUK, MIRTA; CAINO, ANALIA; ZAMORA, VICTOR; MARIANI, JAVIER; DIOCA, MARIANO; PARMA, PATRICIA; PODESTA, GUSTAVO; ANDRIANI, OSCAR; GONDOLESI, GABRIEL; ROCA, ENRIQUE

    2014-01-01

    Neuroendocrine tumors (NET) include a spectrum of malignancies arising from neuroendocrine cells throughout the body. The objective of this clinical investigation of retrospectively and prospectively collected data was to describe the prevalence, demographic data, clinical symptoms and methods of diagnosis of NET and the treatment and long-term follow-up of patients with NET. Data were provided by the participating centers and assessed for consistency by internal reviewers. All the cases were centrally evaluated (when necessary) by the pathologists in our group. The tissue samples were reviewed by hematoxylin and eosin and immunohistochemical staining techniques to confirm the diagnosis of NET. In total, 532 cases were documented: 461 gastroenteropancreatic-NET (GEP-NET) and 71 bronchial NET (BNET). All the tumors were immunohistochemically defined according to the World Health Organization (WHO) and European Neuroendocrine Tumor Society criteria. The most common initial symptoms in GEP-NET were abdominal pain, diarrhea, bowel obstruction, flushing, gastrointestinal bleeding and weight loss. The most common tumor types were carcinoid (58.0%), non-functional pancreatic tumor (23.0%), metastatic NET of unknown primary (16.0%) and functional pancreatic tumor (3.0%). Of the BNET, 89.0% were typical and 11.0% atypical carcinoids. Of the patients with GEP-NET, 59.2% had distant metastasis at diagnosis. The locations of the primary tumors in GEP-NET were the small bowel (26.9%), pancreas (25.2%), colon-rectum (12.4%), appendix (7.6%), stomach (6.9%), esophagus (2.8%), duodenum (2.0%) and unknown primary (16.3%). The histological subtypes based on the WHO classification were well-differentiated NET (20.1%), well-differentiated neuroendocrine carcinomas (66.5%) and poorly differentiated neuroendocrine carcinomas (10.3%). Overall, 67.3% of the patients underwent surgery, 41.2% with curative intent and 26.1% for palliative purposes. The 5-year survival rates were 65.1% (95

  19. The role of European Federation of Clinical Chemistry and Laboratory Medicine Working Group for Preanalytical Phase in standardization and harmonization of the preanalytical phase in Europe.

    Science.gov (United States)

    Cornes, Michael P; Church, Stephen; van Dongen-Lases, Edmée; Grankvist, Kjell; Guimarães, João T; Ibarz, Mercedes; Kovalevskaya, Svetlana; Kristensen, Gunn Bb; Lippi, Giuseppe; Nybo, Mads; Sprongl, Ludek; Sumarac, Zorica; Simundic, Ana-Maria

    2016-09-01

    Patient safety is a leading challenge in healthcare and from the laboratory perspective it is now well established that preanalytical errors are the major contributor to the overall rate of diagnostic and therapeutic errors. To address this, the European Federation of Clinical Chemistry and Laboratory Medicine Working Group for Preanalytical Phase (EFLM WG-PRE) was established to lead in standardization and harmonization of preanalytical policies and practices at a European level. One of the key activities of the WG-PRE is the organization of the biennial EFLM-BD conference on the preanalytical phase to provide a forum for National Societies (NS) to discuss their issues. Since 2012, a year after the first Preanalytical phase conference, there has been a rapid growth in the number of NS with a working group engaged in preanalytical phase activities and there are now at least 19 countries that have one. As a result of discussions with NS at the third conference held in March 2015 five key areas were identified as requiring harmonisation. These were test ordering, sample transport and storage, patient preparation, sampling procedures and management of unsuitable specimens. The article below summarises the work that has and will be done in these areas. The goal of this initiative is to ensure the EFLM WG-PRE produces work that meets the needs of the European laboratory medicine community. Progress made in the identified areas will be updated at the next preanalytical phase conference and show that we have produced guidance that has enhanced standardisation in the preanalytical phase and improved patient safety throughout Europe.

  20. Radiation Therapy Oncology Group Consensus Panel Guidelines for the Delineation of the Clinical Target Volume in the Postoperative Treatment of Pancreatic Head Cancer

    International Nuclear Information System (INIS)

    Purpose: To develop contouring guidelines to be used in the Radiation Therapy Oncology Group protocol 0848, a Phase III randomized trial evaluating the benefit of adjuvant chemoradiation in patients with resected head of pancreas cancer. Methods and Materials: A consensus committee of six radiation oncologists with expertise in gastrointestinal radiotherapy developed stepwise contouring guidelines and an atlas for the delineation of the clinical target volume (CTV) in the postoperative treatment of pancreas cancer, based on identifiable regions of interest and margin expansions. Areas at risk for subclinical disease to be included in the CTV were defined, including nodal regions, anastomoses, and the preoperative primary tumor location. Regions of interest that could be reproducibly contoured on postoperative imaging after a pancreaticoduodenectomy were identified. Standardized expansion margins to encompass areas at risk were developed after multiple iterations to determine the optimal margin expansions. Results: New contouring recommendations based on CT anatomy were established. Written guidelines for the delineation of the postoperative CTV and normal tissues, as well as a Web-based atlas, were developed. Conclusions: The postoperative abdomen has been a difficult area for effective radiotherapy. These new guidelines will help physicians create fields that better encompass areas at risk and minimize dose to normal tissues.

  1. Radiation Therapy Oncology Group Consensus Panel Guidelines for the Delineation of the Clinical Target Volume in the Postoperative Treatment of Pancreatic Head Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Goodman, Karyn A., E-mail: goodmank@mskcc.org [Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Regine, William F. [University of Maryland School of Medicine, Baltimore, Maryland (United States); Dawson, Laura A. [Princess Margaret Hospital, University of Toronto, Toronto, Ontario (Canada); Ben-Josef, Edgar [University of Michigan Medical School, Ann Arbor, Michigan (United States); Haustermans, Karin [University Hospital Leuven, Leuven (Belgium); Bosch, Walter R. [Image-Guided Therapy QA Center, Washington University, St. Louis, Missouri (United States); Turian, Julius; Abrams, Ross A. [Rush University Medical College, Chicago, Illinois (United States)

    2012-07-01

    Purpose: To develop contouring guidelines to be used in the Radiation Therapy Oncology Group protocol 0848, a Phase III randomized trial evaluating the benefit of adjuvant chemoradiation in patients with resected head of pancreas cancer. Methods and Materials: A consensus committee of six radiation oncologists with expertise in gastrointestinal radiotherapy developed stepwise contouring guidelines and an atlas for the delineation of the clinical target volume (CTV) in the postoperative treatment of pancreas cancer, based on identifiable regions of interest and margin expansions. Areas at risk for subclinical disease to be included in the CTV were defined, including nodal regions, anastomoses, and the preoperative primary tumor location. Regions of interest that could be reproducibly contoured on postoperative imaging after a pancreaticoduodenectomy were identified. Standardized expansion margins to encompass areas at risk were developed after multiple iterations to determine the optimal margin expansions. Results: New contouring recommendations based on CT anatomy were established. Written guidelines for the delineation of the postoperative CTV and normal tissues, as well as a Web-based atlas, were developed. Conclusions: The postoperative abdomen has been a difficult area for effective radiotherapy. These new guidelines will help physicians create fields that better encompass areas at risk and minimize dose to normal tissues.

  2. Intravenous Autologous Bone Marrow Mononuclear Cell Transplantation for Stroke: Phase1/2a Clinical Trial in a Homogeneous Group of Stroke Patients.

    Science.gov (United States)

    Taguchi, Akihiko; Sakai, Chiaki; Soma, Toshihiro; Kasahara, Yukiko; Stern, David M; Kajimoto, Katsufumi; Ihara, Masafumi; Daimon, Takashi; Yamahara, Kenichi; Doi, Kaori; Kohara, Nobuo; Nishimura, Hiroyuki; Matsuyama, Tomohiro; Naritomi, Hiroaki; Sakai, Nobuyuki; Nagatsuka, Kazuyuki

    2015-10-01

    The goal of this clinical trial was to assess the feasibility and safety of transplanting autologous bone marrow mononuclear cells into patients suffering severe embolic stroke. Major inclusion criteria included patients with cerebral embolism, age 20-75 years, National Institute of Health Stroke Scale (NIHSS) score displaying improvement of ≤ 5 points during the first 7 days after stroke, and NIHSS score of ≥ 10 on day 7 after stroke. Bone marrow aspiration (25 or 50 mL; N = 6 patients in each case) was performed 7-10 days poststroke, and bone marrow mononuclear cells were administrated intravenously. Mean total transplanted cell numbers were 2.5 × 10(8) and 3.4 × 10(8) cells in the lower and higher dose groups, respectively. No apparent adverse effects of administering bone marrow cells were observed. Compared with the lower dose, patients receiving the higher dose of bone marrow cells displayed a trend toward improved neurologic outcomes. Compared with 1 month after treatment, patients receiving cell therapy displayed a trend toward improved cerebral blood flow and metabolic rate of oxygen consumption 6 months after treatment. In comparison with historical controls, patients receiving cell therapy had significantly better neurologic outcomes. Our results indicated that intravenous transplantation of autologous bone marrow mononuclear cells is safe and feasible. Positive results and trends favoring neurologic recovery and improvement in cerebral blood flow and metabolism by cell therapy underscore the relevance of larger scale randomized controlled trials using this approach.

  3. The Racial, Cultural and Social Makeup of Hispanics as a potential Profile Risk for Intensifying the Need for Including this Ethnic Group in Clinical Trials.

    Science.gov (United States)

    López-Candales, Angel; Aponte Rodríguez, Jaime; Harris, David

    2015-01-01

    Hypertension not only is the most frequently listed cause of death worldwide; but also a well-recognized major risk factor for cardiovascular disease and stroke. Based on the latest published statistics published by the American Heart Association, hypertension is very prevalent and found in one of every 3 US adults. Furthermore, data from NHANES 2007 to 2010 claims that almost 6% of US adults have undiagnosed hypertension. Despite this staggering statistic, previous US guidelines for the prevention, detection, and treatment of hypertension (The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure 7 [JNC 7]), released in 2003, stated that; "unfortunately, sufficient numbers of Mexican Americans and other Hispanic Americans... have not been included in most of the major clinical trials to allow reaching strong conclusions about their responses to individual antihypertensive therapies." However, the recently published JNC 8 offers no comment regarding recommendations or guideline treatment suggestions on Hispanics. The purpose of this article not only is to raise awareness of the lack of epidemiological data and treatment options regarding high blood pressure in the US Hispanic population; but also to make a case of the racial, cultural and social makeup of this ethnic group that places them at risk of cardiovascular complications related to hypertension.

  4. The Social Appearance Anxiety Scale in Italian Adolescent Populations: Construct Validation and Group Discrimination in Community and Clinical Eating Disorders Samples.

    Science.gov (United States)

    Dakanalis, Antonios; Carrà, Giuseppe; Calogero, Rachel; Zanetti, M Assunta; Volpato, Chiara; Riva, Giuseppe; Clerici, Massimo; Cipresso, Pietro

    2016-02-01

    Anxiety in situations where one's overall appearance (including body shape) may be negatively evaluated is hypothesized to play a central role in Eating Disorders (EDs) and in their co-occurrence with Social Anxiety Disorder (SAD). Three studies were conducted among community (N = 1995) and clinical (N = 703) ED samples of 11- to 18-year-old Italian girls and boys to (a) evaluate the psychometric qualities and measurement equivalence/invariance (ME/I) of the Social Appearance Anxiety (SAA) Scale (SAAS) and (b) determine to what extent SAA or other situational domains of social anxiety related to EDs distinguish adolescents with an ED only from those with SAD. Results upheld the one-factor structure and ME/I of the SAAS across samples, gender, age categories, and diagnostic status (i.e., ED participants with and without comorbid SAD). The SAAS demonstrated high internal consistency and 3-week test-retest reliability. The strength of the inter-relationships between SAAS and measures of body image, teasing about appearance, ED symptoms, depression, social anxiety, avoidance, and distress, as well as the ability of SAAS to discriminate community adolescents with high and low levels of ED symptoms and community participants from ED participants provided construct validity evidence. Only SAA strongly differentiated adolescents with any ED from those with comorbid SAD (23.2 %). Latent mean comparisons across all study groups were performed and discussed.

  5. CLINICAL AND LABORATORY PROFILE OF CHILDREN OF AGE GROUP 6 MONTHS TO 5 YEARS WITH IRON DEFICIENCY ANEMIA ADMITTED IN A TERTIARY CARE CENTRE

    Directory of Open Access Journals (Sweden)

    Leela Kumari

    2015-11-01

    Full Text Available : Iron deficiency is the commonest micronutrient deficiency worldwide. It is preventable and treatable. Iron deficiency in a child can affect the physical growth as well as the cognitive functions since Iron is essential for growing brain. So early detection and correction of Iron deficiency is very essential. This descriptive study was conducted in 155 anemic children of age 6months to 5 years admitted in a tertiary care centre. Objective was to study the clinical and laboratory profile. This study showed high prevalence of anemia in male children compared to females. Higher grades of anaemiawas found in those taking diet deficient in Iron rich food and those not having periodic deworming. Mild anemia was noted in 34.2%, Moderate in 52.9% severe in 12.9%.47.5 % were in the age group 3-5 years. Significant association was found between Iron deficiency and Febrile seizures.18.7% of study participants had under nutrition and 11% had first degree stunting.

  6. The Social Appearance Anxiety Scale in Italian Adolescent Populations: Construct Validation and Group Discrimination in Community and Clinical Eating Disorders Samples.

    Science.gov (United States)

    Dakanalis, Antonios; Carrà, Giuseppe; Calogero, Rachel; Zanetti, M Assunta; Volpato, Chiara; Riva, Giuseppe; Clerici, Massimo; Cipresso, Pietro

    2016-02-01

    Anxiety in situations where one's overall appearance (including body shape) may be negatively evaluated is hypothesized to play a central role in Eating Disorders (EDs) and in their co-occurrence with Social Anxiety Disorder (SAD). Three studies were conducted among community (N = 1995) and clinical (N = 703) ED samples of 11- to 18-year-old Italian girls and boys to (a) evaluate the psychometric qualities and measurement equivalence/invariance (ME/I) of the Social Appearance Anxiety (SAA) Scale (SAAS) and (b) determine to what extent SAA or other situational domains of social anxiety related to EDs distinguish adolescents with an ED only from those with SAD. Results upheld the one-factor structure and ME/I of the SAAS across samples, gender, age categories, and diagnostic status (i.e., ED participants with and without comorbid SAD). The SAAS demonstrated high internal consistency and 3-week test-retest reliability. The strength of the inter-relationships between SAAS and measures of body image, teasing about appearance, ED symptoms, depression, social anxiety, avoidance, and distress, as well as the ability of SAAS to discriminate community adolescents with high and low levels of ED symptoms and community participants from ED participants provided construct validity evidence. Only SAA strongly differentiated adolescents with any ED from those with comorbid SAD (23.2 %). Latent mean comparisons across all study groups were performed and discussed. PMID:25976291

  7. Patient-reported outcome measures in arthroplasty registries Report of the Patient-Reported Outcome Measures Working Group of the International Society of Arthroplasty Registries Part II. Recommendations for selection, administration, and analysis.

    Science.gov (United States)

    Rolfson, Ola; Bohm, Eric; Franklin, Patricia; Lyman, Stephen; Denissen, Geke; Dawson, Jill; Dunn, Jennifer; Eresian Chenok, Kate; Dunbar, Michael; Overgaard, Søren; Garellick, Göran; Lübbeke, Anne

    2016-07-01

    - The International Society of Arthroplasty Registries (ISAR) Patient-Reported Outcome Measures (PROMs) Working Group have evaluated and recommended best practices in the selection, administration, and interpretation of PROMs for hip and knee arthroplasty registries. The 2 generic PROMs in common use are the Short Form health surveys (SF-36 or SF-12) and EuroQol 5-dimension (EQ-5D). The Working Group recommends that registries should choose specific PROMs that have been appropriately developed with good measurement properties for arthroplasty patients. The Working Group recommend the use of a 1-item pain question ("During the past 4 weeks, how would you describe the pain you usually have in your [right/left] [hip/knee]?"; response: none, very mild, mild, moderate, or severe) and a single-item satisfaction outcome ("How satisfied are you with your [right/left] [hip/knee] replacement?"; response: very unsatisfied, dissatisfied, neutral, satisfied, or very satisfied). Survey logistics include patient instructions, paper- and electronic-based data collection, reminders for follow-up, centralized as opposed to hospital-based follow-up, sample size, patient- or joint-specific evaluation, collection intervals, frequency of response, missing values, and factors in establishing a PROMs registry program. The Working Group recommends including age, sex, diagnosis at joint, general health status preoperatively, and joint pain and function score in case-mix adjustment models. Interpretation and statistical analysis should consider the absolute level of pain, function, and general health status as well as improvement, missing data, approaches to analysis and case-mix adjustment, minimal clinically important difference, and minimal detectable change. The Working Group recommends data collection immediately before and 1 year after surgery, a threshold of 60% for acceptable frequency of response, documentation of non-responders, and documentation of incomplete or missing data. PMID

  8. Identification and Clinical Infusion of B (A) Blood Group%B(A)血型的鉴定及临床输注探讨

    Institute of Scientific and Technical Information of China (English)

    郑望春; 骆宏; 叶有玩; 沈磁石; 黄华霖

    2013-01-01

    目的 对1例常规血清学为B(A)表现型的献血者进行血型鉴定,探讨B(A)血型在临床输注中的安全性和有效性.方法 采用血型血清学、ABO基因第6及第7外显子直接测序和克隆测序的方法,对该例标本的血清学表型和其ABO等位基因进行检测;同时回顾性调查该献血者前次已献血液输注给B型受血者的相关实验记录和病历.结果 被检血样的血型血清学结果初步定型为B(A);直接测序和克隆测序发现:被检者含有O01等位基因,B等位基因在第7外显子存在640A/G突变,证实其为B(A)04等位基因,其基因型为B(A)04/O01;该献血者血液输给B型受血者,Hb升高符合预期值,无输血不良反应发生.结论 发现该例B(A)表现型,其基因型为B(A)04/O01型;在配血相合的情况下,B(A)供血者血液输注给B型受血者是安全有效的.%Objective To explore the identification and clinical infusion of B(A) blood group. Methods B(A) blood groups and B(A) alleles of the samples were checked out by serology and direct sequencing and cloning sequencing of ABO gene exon 6 and 7. Retrospective experiment records were collected to analyze the clinical infusion. Results The serological results of the blood sample was shown as B(A). Result of the sequencing analysis showed the sample harbored an O01 allele.and had the nt640 A/G mutation in B gene,which was previously defined as B(A) 04. B(A) blood of donor was infused to type B receptor,whose Hb rising conformed to the expected value, no adverse reaction of blood transfusion occurred. Conclusion The sample is identified as B(A) phenotype in serological tests, whose genotype is rare B(A)04 / O01. Under the consistency of cross matching.it is safe and effective for the blood of B (A) blood donor infused to type B receptor.

  9. Proposal for a revised definition of dilated cardiomyopathy, hypokinetic non-dilated cardiomyopathy, and its implications for clinical practice: a position statement of the ESC working group on myocardial and pericardial diseases.

    Science.gov (United States)

    Pinto, Yigal M; Elliott, Perry M; Arbustini, Eloisa; Adler, Yehuda; Anastasakis, Aris; Böhm, Michael; Duboc, Denis; Gimeno, Juan; de Groote, Pascal; Imazio, Massimo; Heymans, Stephane; Klingel, Karin; Komajda, Michel; Limongelli, Giuseppe; Linhart, Ales; Mogensen, Jens; Moon, James; Pieper, Petronella G; Seferovic, Petar M; Schueler, Stephan; Zamorano, Jose L; Caforio, Alida L P; Charron, Philippe

    2016-06-14

    In this paper the Working Group on Myocardial and Pericardial Disease proposes a revised definition of dilated cardiomyopathy (DCM) in an attempt to bridge the gap between our recent understanding of the disease spectrum and its clinical presentation in relatives, which is key for early diagnosis and the institution of potential preventative measures. We also provide practical hints to identify subsets of the DCM syndrome where aetiology directed management has great clinical relevance. PMID:26792875

  10. The new final Clinical Skills examination in human medicine in Switzerland: Essential steps of exam development, implementation and evaluation, and central insights from the perspective of the national Working Group

    OpenAIRE

    Berendonk, Christoph; Schirlo, Christian; Balestra, Gianmarco; Bonvin, Raphael; Feller, Sabine; Huber, Philippe; Jünger, Ernst; Monti, Matteo; Schnabel, Kai; Beyeler, Christine; Guttormsen, Sissel; Huwendiek, Sören

    2015-01-01

    Objective: Since 2011, the new national final examination in human medicine has been implemented in Switzerland, with a structured clinical-practical part in the OSCE format. From the perspective of the national Working Group, the current article describes the essential steps in the development, implementation and evaluation of the Federal Licensing Examination Clinical Skills (FLE CS) as well as the applied quality assurance measures. Finally, central insights gained from the last years are ...

  11. 病案分组讨论教学法在临床心电图带教中的应用%Application of Medical Record Group Discussion Teaching Method in the Clinical Electrocardiogram Teaching

    Institute of Scientific and Technical Information of China (English)

    杨桂花

    2016-01-01

    Objective To study the application of medical record group discussion teaching method in the clinical electro-cardiogram teaching. Methods 200 cases of school students majoring in clinic in 2014 were selected as the research ob-jects, and divided into two groups with 100 cases in each according to the admission number, the traditional group adopted the teaching model mainly in analysis and explanation of class medical record, the discussion group adopted medical record group discussion teaching model, and the final grades and students' evaluation of teaching model of the two groups were observed. Results The operation ability and medical record analysis ability in the traditional group were lower than those in the discussion group and the comparison between groups had statistical significance, P0.05);100名学生对该病案讨论模式的平均肯定率为92.3%。结论在临床心电图教学中应用病案分组讨论方式可增加学生对该学科自主学习意识,提升对心电图的了解与掌握,减少该学科学生期末的挂科率,有效增加临床学生对心电图的全面掌握和对疾病判断思维的培养。

  12. Antibiotic use and clinical outcomes in the acute setting under management by an infectious diseases acute physician versus other clinical teams: a cohort study

    Science.gov (United States)

    Jones, Nicola; Mistry, Vikash; Crook, Derrick; Peto, Tim; Walker, A Sarah

    2016-01-01

    Objectives To assess the magnitude of difference in antibiotic use between clinical teams in the acute setting and assess evidence for any adverse consequences to patient safety or healthcare delivery. Design Prospective cohort study (1 week) and analysis of linked electronic health records (3 years). Setting UK tertiary care centre. Participants All patients admitted sequentially to the acute medical service under an infectious diseases acute physician (IDP) and other medical teams during 1 week in 2013 (n=297), and 3 years 2012–2014 (n=47 585). Primary outcome measure Antibiotic use in days of therapy (DOT): raw group metrics and regression analysis adjusted for case mix. Secondary outcome measures 30-day all-cause mortality, treatment failure and length of stay. Results Antibiotic use was 173 vs 282 DOT/100 admissions in the IDP versus non-IDP group. Using case mix-adjusted zero-inflated Poisson regression, IDP patients were significantly less likely to receive an antibiotic (adjusted OR=0.25 (95% CI 0.07 to 0.84), p=0.03) and received shorter courses (adjusted rate ratio (RR)=0.71 (95% CI 0.54 to 0.93), p=0.01). Clinically stable IDP patients of uncertain diagnosis were more likely to have antibiotics held (87% vs 55%; p=0.02). There was no significant difference in treatment failure or mortality (adjusted p>0.5; also in the 3-year data set), but IDP patients were more likely to be admitted overnight (adjusted OR=3.53 (95% CI 1.24 to 10.03), p=0.03) and have longer length of stay (adjusted RR=1.19 (95% CI 1.05 to 1.36), p=0.007). Conclusions The IDP-led group used 30% less antibiotic therapy with no adverse clinical outcome, suggesting antibiotic use can be reduced safely in the acute setting. This may be achieved in part by holding antibiotics and admitting the patient for observation rather than prescribing, which has implications for costs and hospital occupancy. More information is needed to indicate whether any such longer admission will

  13. Functional recovery measures for spinal cord injury : An evidence-based review for clinical practice and research - Functional recovery outcome measures work group

    NARCIS (Netherlands)

    Anderson, Kim; Aito, Sergio; Atkins, Michal; Biering-Sorensen, Fin; Charlifue, Susan; Curt, Armin; Ditunno, John; Glass, Clive; Marino, Ralph; Marshall, Ruth; Mulcahey, Mary Jane; Post, Marcel; Savic, Gordana; Scivoletto, Giorgio; Catz, Amiram

    2008-01-01

    Background/Objective: The end goal of clinical care and clinical research involving spinal cord injury (SCI) is to improve the overall ability of persons living with SCI to function on a daily basis. Neurologic recovery does not always translate into functional recovery. Thus, sensitive outcome meas

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

    DEFF Research Database (Denmark)

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

    2000-01-01

    To improve the patient education process in clinical research, three information materials describing general aspects of design and conduct of randomized clinical trials were developed. The materials varied in length, reading ability level, and reader appeal. Their influence on knowledge about an...

  15. Belonging to a peer support group enhance the quality of life and adherence rate in patients affected by breast cancer: A non-randomized controlled clinical trialFNx01

    OpenAIRE

    Afsaneh Malekpour Tehrani; Ziba Farajzadegan; Fariborz Mokarian Rajabi; Ahmad Reza Zamani

    2011-01-01

    Background: Breast cancer is the most common cancer in women. It seems that breast cancer patients benefit from meeting someone who had a similar experience. This study evaluated the effect of two kinds of interventions (peer support and educational program) on quality of life in breast cancer patients. Methods: This study was a controlled clinical trial on women with non-metastatic breast cancer. The patients studied in two experimental and control groups. Experimental group took part i...

  16. The evaluation of the feasibility and clinical utility of liquid based cytology, human papillomavirus testing and high-resolution anoscopy to screen for anal intraepithelial neoplasia in high-risk groups

    OpenAIRE

    Schofield, Alice

    2016-01-01

    The evaluation of the feasibility and clinical utility of liquid based cytology, human papillomavirus testing and high-resolution anoscopy to screen for anal intraepithelial neoplasia in high-risk groups. Dr Alice Martha Schofield: The University of Manchester for the degree of Doctor of Medicine, January 2016. Background: The increased incidence and natural history of anal cancer in high-risk groups, provides a screening opportunity to detect precancerous lesions, anal intraepithelial neopla...

  17. American Society of Blood and Marrow Transplantation, European Society of Blood and Marrow Transplantation, Blood and Marrow Transplant Clinical Trials Network, and International Myeloma Working Group Consensus Conference on Salvage Hematopoietic Cell Transplantation in Patients with Relapsed

    DEFF Research Database (Denmark)

    Giralt, Sergio; Garderet, Laurent; Durie, Brian;

    2015-01-01

    not been extensively studied in MM patients relapsing after primary therapy. The International Myeloma Working Group together with the Blood and Marrow Transplant Clinical Trials Network, the American Society of Blood and Marrow Transplantation, and the European Society of Blood and Marrow Transplantation...

  18. [Evidence-based medicine. 1. The transfer of research results to clinical practice. The Italian Group for Evidence-Based Medicine-GIMBE].

    Science.gov (United States)

    Cartabellotta, A

    1998-03-01

    Evidence-based Medicine, born officially in November 1992, during last five years is grown everywhere, showing its power to influence virtually all aspects of health care: clinical practice, medical education, patient information and health policy. Because of the raising interest also in Italy for the new paradigm of clinical practice, "Recently Progress in Medicina" launches a series of articles with the aim of giving to physicians tools and skills for searching, critically appraising and implementing in their own decisions the best results of clinical research. For a better explanation of practical aspects of Evidence-based Medicine, the first article discusses about several obstacles existing in transferring correctly and timely the results of research into clinical practice, and about the potential role of Evidence-based Medicine in the evolution of the medical art and the health systems of the third millennium.

  19. Comparing the case mix and survival of women receiving breast cancer care from one London provider with other London women with breast cancer:pilot data exchange and analyses

    OpenAIRE

    Davies, Elizabeth Anne; Coupland, Victoria; Dixon, Steve; Mokbel, Kefah; Jack, Ruth

    2016-01-01

    BackgroundData from providers of private cancer care are not yet formally included in English cancer registration data. This study aimed to test the exchange of breast cancer data from one Hospital Corporation of America International (HCAI) hospital in London with the cancer registration system and assess the suitability of these data for comparative analyses of case mix and adjusted survival.MethodsData on 199 London women receiving ‘only HCAI care’, 278 women receiving ‘some HCAI care’ (HC...

  20. Creative arts therapies in psychiatry : A clinical application of the Bonny method of guided imagery and music and creative arts groups

    OpenAIRE

    Körlin, Dag

    2005-01-01

    The Creative Arts Therapies (CATs) are characterized by imagery in altered states of consciousness, artistic expression (art, music, dance, drama) and metaphoric expression (as in poetry). The CATs implemented in this thesis consist of The Bonny Method of Guided Imagery and Music (BMGIM), and the Spektrum Creative arts group program. Spektrum is a four-week treatment program, where group applications of BMGIM and Art therapy are combined with psychodynamic verbal group and o...

  1. Group Psychotherapy in Italy.

    Science.gov (United States)

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

    2015-10-01

    This article describes the history and the prevailing orientations of group psychotherapy in Italy (psychoanalytically oriented, psychodrama, CBT groups) and particularly group analysis. Provided free of charge by the Italian health system, group psychotherapy is growing, but its expansion is patchy. The main pathways of Italian training in the different group psychotherapy orientations are also presented. Clinical-theoretical elaboration on self development, psychopathology related to group experiences, and the methodological attention paid to objectives and methods in different clinical groups are issues related to group therapy in Italy. Difficulties in the relationship between research and clinical practice are discussed, as well as the empirical research network that tries to bridge the gap between research and clinical work in group psychotherapy. The economic crisis in Italy has led to massive cuts in health care and to an increasing demand for some forms of psychological treatment. For these reasons, and because of its positive cost-benefit ratio, group psychotherapy is now considered an important tool in the national health care system to expand the clinical response to different forms of psychological distress. PMID:26401793

  2. Response Assessment in Neuro-Oncology working group and European Association for Neuro-Oncology recommendations for the clinical use of PET imaging in gliomas.

    Science.gov (United States)

    Albert, Nathalie L; Weller, Michael; Suchorska, Bogdana; Galldiks, Norbert; Soffietti, Riccardo; Kim, Michelle M; la Fougère, Christian; Pope, Whitney; Law, Ian; Arbizu, Javier; Chamberlain, Marc C; Vogelbaum, Michael; Ellingson, Ben M; Tonn, Joerg C

    2016-09-01

    This guideline provides recommendations for the use of PET imaging in gliomas. The review examines established clinical benefit in glioma patients of PET using glucose ((18)F-FDG) and amino acid tracers ((11)C-MET, (18)F-FET, and (18)F-FDOPA). An increasing number of studies have been published on PET imaging in the setting of diagnosis, biopsy, and resection as well radiotherapy planning, treatment monitoring, and response assessment. Recommendations are based on evidence generated from studies which validated PET findings by histology or clinical course. This guideline emphasizes the clinical value of PET imaging with superiority of amino acid PET over glucose PET and provides a framework for the use of PET to assist in the management of patients with gliomas.

  3. The DEMO trial: a randomized, parallel-group, observer-blinded clinical trial of strength versus aerobic versus relaxation training for patients with mild to moderate depression

    DEFF Research Database (Denmark)

    2009-01-01

    OBJECTIVE: To assess the benefit and harm of exercise training in adults with clinical depression. METHOD: The DEMO trial is a randomized pragmatic trial for patients with unipolar depression conducted from January 2005 through July 2007. Patients were referred from general practitioners or psych......OBJECTIVE: To assess the benefit and harm of exercise training in adults with clinical depression. METHOD: The DEMO trial is a randomized pragmatic trial for patients with unipolar depression conducted from January 2005 through July 2007. Patients were referred from general practitioners......: Our findings do not support a biologically mediated effect of exercise on symptom severity in depressed patients, but they do support a beneficial effect of strength training on work capacity. TRIAL REGISTRATION: (ClinicalTrials.gov) Identifier: NCT00103415....

  4. Clinical experience and institutional in a Department of Mental Health: The multifamily groups for parents and children with psychiatric illness in the time of post-modernity

    Directory of Open Access Journals (Sweden)

    Luisella Ferraris

    2014-09-01

    Full Text Available The following work shows the beginning and development of a multifamily group, involving mental health professionals, parents and psychiatric patients, in a mental health center. The group goals and the main functions of this setting, will be described, observing also the social and community changes, occurring in recent years. Finally, starting from the analysis of the major psychoanalysis research findings, the concepts of inter-subjectivity, therapeutic alliance and institution's role regarding the psychiatric patients’ treatment, will be deepened. Keywords: Department of Mental Health; Multifamily group; Community changes; Therapeutic alliance; Psychiatric patients

  5. Genome-wide association study of virologic response with efavirenz-containing or abacavir-containing regimens in AIDS clinical trials group protocols

    NARCIS (Netherlands)

    Lehmann, David S; Ribaudo, Heather J; Daar, Eric S; Gulick, Roy M; Haubrich, Richard H; Robbins, Gregory K; de Bakker, Paul I W; Haas, David W; McLaren, Paul J

    2015-01-01

    BACKGROUND: Efavirenz and abacavir are components of recommended first-line regimens for HIV-1 infection. We used genome-wide genotyping and clinical data to explore genetic associations with virologic failure among patients randomized to efavirenz-containing or abacavir-containing regimens in AIDS

  6. Effects of video-feedback on the communication, clinical competence and motivational interviewing skills of practice nurses: a pre-test posttest control group study

    NARCIS (Netherlands)

    Noordman, J.; Weijden, T.T. van der; Dulmen, S. van

    2014-01-01

    AIMS: To examine the effects of individual video-feedback on the generic communication skills, clinical competence (i.e. adherence to practice guidelines) and motivational interviewing skills of experienced practice nurses working in primary care. BACKGROUND: Continuing professional education may be

  7. Effects of video-feedback on the communication, clinical competence and motivational interviewing skills of practice nurses: a pre-test posttest control group study.

    NARCIS (Netherlands)

    Noordman, J.; Weijden, T. van der; Dulmen, S. van

    2014-01-01

    Aims: To examine the effects of individual video-feedback on the generic communication skills, clinical competence (i.e. adherence to practice guidelines) and motivational interviewing skills of experienced practice nurses working in primary care. Background: Continuing professional education may be

  8. Clinical characteristics of very old patients hospitalized in internal medicine wards for heart failure: a sub-analysis of the FADOI-CONFINE Study Group

    Directory of Open Access Journals (Sweden)

    Paolo Biagi

    2014-03-01

    Full Text Available The incidence and prevalence of chronic heart failure are increasing worldwide, as is the number of very old patients (>85 years affected by this disease. The aim of this sub-analysis of the multicenter, observational CONFINE study was to detect clinical and therapeutic peculiarities in patients with chronic heart failure aged >85 years. We recruited patients admitted with a diagnosis of chronic heart failure and present in the hospital in five index days, in 91 Units of Internal Medicine. The patients’ clinical characteristics, functional and cognitive status, and the management of the heart failure were analyzed. A total of 1444 subjects were evaluated, of whom 329 (23.1% were over 85 years old. Signs and symptoms of chronic heart failure were more common in very old patients, as were severe renal insufficiency, anemia, disability and cognitive impairment. The present survey found important age-related differences (concomitant diseases, cognitive status among patients with chronic heart failure, as well as different therapeutic strategies and clinical outcome for patients over 85 years old. Since these patients are usually excluded from clinical trials and their management remains empirical, specific studies focused on the treatment of very old patients with chronic heart failure are needed.

  9. Clinical analysis of 670 cases in two trials of the European Organization for the Research and Treatment of Cancer Lymphoma Cooperative Group subtyped according to the Revised European-American Classification of Lymphoid Neoplasms: a comparison with the Working Formulation.

    Science.gov (United States)

    Pittaluga, S; Bijnens, L; Teodorovic, I; Hagenbeek, A; Meerwaldt, J H; Somers, R; Thomas, J; Noordijk, E M; De Wolf-Peeters, C

    1996-05-15

    In the Working Formulation (WF), non-Hodgkin's lymphomas (NHL) are grouped according to their clinical behavior. These disorders are listed as entities defined by morphology, phenotype, and cytogenetics in the proposed Revised European-American Classification of Lymphoid Neoplasms (REAL), the clinical relevance of which is still debated. We analyzed 670 NHL cases included in two randomized clinical trials (EORTC 20855 WF-intermediate/high-grade and 20856 WF-low-grade malignancy) with histologic material available for review. Based on hematoxylin-eosin-stained sections, 77% of cases could be subtyped. Immunophenotyping was considered to be mandatory only in diagnosing T-cell lymphoma and anaplastic large-cell lymphoma. Of 522 cases subtyped, 11% were mantle cell lymphoma (MCL), 5% were marginal zone B-cell lymphoma (MZBCL), 46% were follicle center lymphoma, and 32% were diffuse large B-cell lymphoma. Statistical analysis and comparisons between classifications were made only within each trial and treatment group. MCL and MZBCL were characterized by a shorter median survival (3.4 and 4.1 years, respectively) in comparison with low- and intermediate-grade WF groups (> 9.3 and 5.8 years, respectively). In terms of progression-free survival, MCL showed a behavior similar to the low-grade group, with frequent relapses. Follicle center cell lymphomas behaved as low-grade lymphomas as defined by the WF and diffuse large B-cell lymphomas as the WF-intermediate grade group. Because several NHL entities have a clinical behavior of their own, their recognition by the REAL classification offers clinicians additional information that is not obtained when the WF is used.

  10. Comparing telehealth-based and clinic-based group cognitive behavioral therapy for adults with depression and anxiety: a pilot study

    Directory of Open Access Journals (Sweden)

    Khatri N

    2014-05-01

    Full Text Available Nasreen Khatri, Elsa Marziali, Illia Tchernikov, Nancy ShepherdRotman Research Institute, Toronto, ON, CanadaBackground: The primary objective of this pilot study was to demonstrate reliable adherence to a group cognitive behavioral (CBT therapy protocol when delivered using on-line video conferencing as compared with face-to-face delivery of group CBT. A secondary aim was to show comparability of changes in subject depression inventory scores between on-line and face-to-face delivery of group CBT.Methods: We screened 31 individuals, 18 of whom met the criteria for a DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th Edition diagnosis of mood and/or anxiety disorder. All qualifying participants had the necessary equipment (computer, webcam, Internet for participation in the study, but could exercise their preference for either the on-line or face-to-face format. Eighteen completed the 13 weekly session intervention program (ten face-to-face; eight video conferencing. We coded adherence to protocol in both intervention formats and generated pre–post changes in scores on the Beck Depression Inventory Second Edition (BDI-II for each participant.Results: Application of the CBT protocol coding system showed reliable adherence to the group CBT intervention protocol in both delivery formats. Similarly, qualitative analysis of the themes in group discussion indicated that both groups addressed similar issues. Pre–post intervention scores for the BDI-II were comparable across the two delivery formats, with 60% of participants in each group showing a positive change in BDI-II severity classification (eg, from moderate to low symptoms.Conclusion: This pilot study demonstrates that group CBT could be delivered in a technology-supported environment (on-line video conferencing and can meet the same professional practice standards and outcomes as face-to-face delivery of the intervention program.Keywords: psychotherapy, gerontology, mood

  11. Medida de los pesos relativos del coste de la asistencia como efecto de la aplicación retrospectiva de los adjusted clinical groups en atención primaria Measurement of relative cost weights as an effect of the retrospective application of adjusted clinical groups in primary care

    Directory of Open Access Journals (Sweden)

    Antoni Sicras-Mainar

    2006-03-01

    Full Text Available Objetivo: El objeto del estudio es obtener los pesos relativos medios de los costes de la asistencia con la aplicación retrospectiva de los adjusted clinical groups (ACG en población atendida por equipos de atención primaria en situación de práctica clínica habitual. Métodos: Estudio descriptivo de carácter retrospectivo. Fueron incluidos en el estudio todos los pacientes atendidos por 4 equipos de atención primaria durante el año 2003. Las principales mediciones fueron: variables universales (edad y sexo, dependientes (visitas y costes y de casuística o comorbilidad. El modelo de costes para cada paciente se estableció diferenciando los costes fijos y los variables. Se efectuó un análisis de regresión lineal múltiple para la predicción de los modelos. El coste relativo de cada ACG se obtuvo dividiendo el coste medio de cada categoría entre el coste medio de toda la población de referencia. Resultados: El número total de pacientes estudiados fue de 62.311 (intensidad de uso del 76,7%, con una media de 4,8 ± 3,2 episodios y 7,8 ± 7,5 visitas/paciente/año. La distribución de los costes fue de 24.135.236,41 €, el 28,9% fijos. El coste unitario total por visita/año fue de 49,62 ± 24,71 € y el promedio paciente/año de 387,34 ± 145,87 € (pesos relativos de referencia. El poder explicativo de la clasificación ACG fue del 50,1% en las visitas y del 54,9% para los costes totales. Conclusiones: Los ACG se muestran como un aceptable sistema de clasificación de pacientes en situación de práctica clínica habitual. De confirmarse los resultados posibilitarían una mejora en la aplicación práctica de los ACG como una posible herramienta para la gestión clínica en los centros de atención primaria.Objective: The objective of the study is to obtain the cost's relative average weights of the assistance with the retrospective application of the Adjusted Clinical Groups (ACG's in four teams of Primary Care with an attended

  12. Effects of video-feedback on the communication, clinical competence and motivational interviewing skills of practice nurses: a pre-test posttest control group study.

    OpenAIRE

    Noordman, J.; van der Weijden, T; Van Dulmen, S.

    2014-01-01

    Aims: To examine the effects of individual video-feedback on the generic communication skills, clinical competence (i.e. adherence to practice guidelines) and motivational interviewing skills of experienced practice nurses working in primary care. Background: Continuing professional education may be necessary to refresh and reflect on the communication and motivational interviewing skills of experienced primary care practice nurses. A video-feedback method was designed to improve these skills...

  13. Rasburicase in the prevention of laboratory/clinical tumour lysis syndrome in children with advanced mature B-NHL: A Children’s Oncology Group Report

    OpenAIRE

    Galardy, Paul; Hochberg, Jessica; Perkins, Sherrie L.; Harrison, Lauren; Goldman, Stanton; Cairo, Mitchell S

    2013-01-01

    Laboratory (LTLS) and clinical (CTLS) tumour lysis syndrome (TLS) are frequent complications in newly diagnosed children with advanced mature B cell non-Hodgkin lymphoma (B-NHL). Rasburicase, compared to allopurinol, results in more rapid reduction of uric acid in paediatric patients at risk for TLS. However, the safety and efficacy of rasburicase for the treatment or or prevention of TLS has not been prospectively evaluated. Children with newly diagnosed stage III–IV, bone marrow+ and/or cen...

  14. A comparative study of the clinical efficacy and safety of agomelatine with escitalopram in major depressive disorder patients: A randomized, parallel-group, phase IV study

    Directory of Open Access Journals (Sweden)

    Chetan S Urade

    2015-01-01

    Full Text Available Objective: To compare the efficacy of agomelatine with escitalopram in the treatment of major depressive disorder (MDD, improve sleep in MDD patients and study the adverse effects of agomelatine. Materials and Methods: Randomized, parallel-group, open-label study. The primary efficacy outcome was change from baseline to last post-baseline value in Hamilton depression rating scale and Leeds sleep evaluation questionnaire scale. Both parametric and nonparametric tests were applied for analysis. Results: Within-group and between-groups comparison of the mean HAMD17 scores showed statistically significant changes (P < 0.0001. Escitalopram showed early onset of response and remission compared to agomelatine at 10th week (P < 0.0001 and 14th week (P < 0.0001, respectively. In agomelatine, within-group and between-groups change of the mean LSEQ score was statistically significant at subsequent follow-up visits (P < 0.0001. Conclusion: Escitalopram is superior to agomelatine in efficacy, considering the early response, early remission, and better relief from symptoms of MDD in adults. Agomelatine may be preferred in MDD patients having insomnia as a predominant symptom. Liver function monitoring should be done in patients on long-term agomelatine therapy.

  15. Effects of Group-Based Exercise on Range of Motion, Muscle Strength, Functional Ability, and Pain During the Acute Phase After Total Knee Arthroplasty: A Controlled Clinical Trial.

    Science.gov (United States)

    Hiyama, Yoshinori; Kamitani, Tsukasa; Wada, Osamu; Mizuno, Kiyonori; Yamada, Minoru

    2016-09-01

    Study Design Prospective observational study including a historical control group. Background The extent to which group-based exercise (G-EXE) improves knee range of motion (ROM), quadriceps strength, and gait ability is similar to that of individualized exercise (I-EXE) at 6 weeks and 8 months after total knee arthroplasty (TKA). However, the benefits of G-EXE for patients during the acute recovery phase after TKA remain unclear. Objective To determine the effects of G-EXE during the acute recovery phase after TKA on knee ROM, quadriceps strength, functional ability, and knee pain. Methods Two hundred thirty-one patients participated in G-EXE in addition to regular ambulation and activities-of-daily-living exercises twice daily during the hospital stay. Outcomes were compared to those of a retrospectively identified, historical control group (I-EXE group [n = 206]) that included patients who performed exercises identical to those performed by the G-EXE group. The outcomes included knee ROM, quadriceps strength, pain intensity, and timed up-and-go test score at 1 month before surgery and at discharge. Analyses were adjusted for age, body mass index, sex, length of hospital stay, and preoperative values. Results Changes in ROM of knee flexion and extension (PSports Phys Ther 2016;46(9):742-748. Epub 5 Aug 2016. doi:10.2519/jospt.2016.6409. PMID:27494052

  16. Anxiety Disorders: Support Groups

    Science.gov (United States)

    ... Guidelines Scientific Council Special Interest Groups Child & Adolescent Anxiety SIG Peer Consultation OCD & Related Disorders SIG Peer ... Jobs and Fellowships Journal & Multimedia Announcements Depression and Anxiety Podcasts & Videos Resources Clinical Practice Reviews & Teaching Tools ...

  17. Design paper: The CapOpus trial: a randomized, parallel-group, observer-blinded clinical trial of specialized addiction treatment versus treatment as usual for young patients with cannabis abuse and psychosis

    DEFF Research Database (Denmark)

    Hjorthøj, Carsten; Fohlmann, Allan; Larsen, Anne-Mette;

    2008-01-01

    ) treatment as usual. The specialized addiction treatment is manualized and consists of both individual and group-based motivational interviewing and cognitive behavioral therapy, and incorporates both the family and the case manager of the patient.The primary outcome measure will be changes in amount...... of cannabis consumption over time. Other outcome measures will be psychosis symptoms, cognitive functioning, quality of life, social functioning, and cost-benefit analyses. TRIAL REGISTRATION: ClinicalTrials.gov NCT00484302....

  18. Evaluation of an Immunochromatographic Assay for Rapid Detection of Penicillin-Binding Protein 2a in Human and Animal Staphylococcus intermedius Group, Staphylococcus lugdunensis, and Staphylococcus schleiferi Clinical Isolates.

    Science.gov (United States)

    Arnold, A R; Burnham, C-A D; Ford, B A; Lawhon, S D; McAllister, S K; Lonsway, D; Albrecht, V; Jerris, R C; Rasheed, J K; Limbago, B; Burd, E M; Westblade, L F

    2016-03-01

    The performance of a rapid penicillin-binding protein 2a (PBP2a) detection assay, the Alere PBP2a culture colony test, was evaluated for identification of PBP2a-mediated beta-lactam resistance in human and animal clinical isolates of Staphylococcus intermedius group, Staphylococcus lugdunensis, and Staphylococcus schleiferi. The assay was sensitive and specific, with all PBP2a-negative and PBP2a-positive strains testing negative and positive, respectively.

  19. Evaluation of an Immunochromatographic Assay for Rapid Detection of Penicillin-Binding Protein 2a in Human and Animal Staphylococcus intermedius Group, Staphylococcus lugdunensis, and Staphylococcus schleiferi Clinical Isolates.

    Science.gov (United States)

    Arnold, A R; Burnham, C-A D; Ford, B A; Lawhon, S D; McAllister, S K; Lonsway, D; Albrecht, V; Jerris, R C; Rasheed, J K; Limbago, B; Burd, E M; Westblade, L F

    2016-03-01

    The performance of a rapid penicillin-binding protein 2a (PBP2a) detection assay, the Alere PBP2a culture colony test, was evaluated for identification of PBP2a-mediated beta-lactam resistance in human and animal clinical isolates of Staphylococcus intermedius group, Staphylococcus lugdunensis, and Staphylococcus schleiferi. The assay was sensitive and specific, with all PBP2a-negative and PBP2a-positive strains testing negative and positive, respectively. PMID:26677248

  20. Pathogen group specific risk factors for clinical mastitis, intramammary infection and blind quarters at the herd, cow and quarter level in smallholder dairy farms in Jimma, Ethiopia.

    Science.gov (United States)

    Tolosa, T; Verbeke, J; Ayana, Z; Piepers, S; Supré, K; De Vliegher, S

    2015-07-01

    A cross-sectional study on clinical mastitis, intramammary infection (IMI) and blind quarters was conducted on 50 smallholder dairy farms in Jimma, Ethiopia. A questionnaire was performed, and quarters of 211 cows were sampled and bacteriologically cultured. Risk factors at the herd, cow, and quarter level for clinical mastitis and (pathogen-specific) intramammary infection were studied using multilevel modeling. As well, factors associated with quarters being blind were studied. Eleven percent of the cows and 4% of the quarters had clinical mastitis whereas 85% of the cows and 51% of the quarters were infected. Eighteen percent of the cows had one or more blind quarter(s), whereas 6% of the quarters was blind. Non-aureus staphylococci were the most frequently isolated pathogens in both clinical mastitis cases and IMI. The odds of clinical mastitis was lower in herds where heifers were purchased in the last year [odds ratio (OR) with 95% confidence interval: 0.11 (0.01-0.90)], old cows (>4 years) [OR: 0.45 (0.18-1.14)], and quarters not showing teat injury [OR: 0.23 (0.07-0.77)]. The odds of IMI caused by any pathogen was higher in herds not practicing teat drying before milking (opposed to drying teats with 1 towel per cow) [OR: 1.68 (1.05-2.69)], cows in later lactation (>180 DIM opposed to ≤90 DIM) [OR: 1.81 (1.14-2.88)], cows with a high (>3) body condition score (BCS) [OR: 1.57 (1.06-2.31)], right quarters (opposed to a left quarter position) [OR: 1.47 (1.10-1.98)], and quarters showing teat injury [OR: 2.30 (0.97-5.43)]. Quarters of cows in herds practicing bucket-fed calf feeding (opposed to suckling) had higher odds of IMI caused by Staphylococcus aureus [OR: 6.05 (1.31-27.90)]. Except for BCS, IMI caused by non-aureus staphylococci was associated with the same risk factors as IMI caused by any pathogen. No access to feed and water immediately after milking [OR: 2.41 (1.26-4.60)], higher parity [OR: 3.60 (1.20-10.82)] and tick infestation [OR: 2.42 (1

  1. Pathogen group specific risk factors for clinical mastitis, intramammary infection and blind quarters at the herd, cow and quarter level in smallholder dairy farms in Jimma, Ethiopia.

    Science.gov (United States)

    Tolosa, T; Verbeke, J; Ayana, Z; Piepers, S; Supré, K; De Vliegher, S

    2015-07-01

    A cross-sectional study on clinical mastitis, intramammary infection (IMI) and blind quarters was conducted on 50 smallholder dairy farms in Jimma, Ethiopia. A questionnaire was performed, and quarters of 211 cows were sampled and bacteriologically cultured. Risk factors at the herd, cow, and quarter level for clinical mastitis and (pathogen-specific) intramammary infection were studied using multilevel modeling. As well, factors associated with quarters being blind were studied. Eleven percent of the cows and 4% of the quarters had clinical mastitis whereas 85% of the cows and 51% of the quarters were infected. Eighteen percent of the cows had one or more blind quarter(s), whereas 6% of the quarters was blind. Non-aureus staphylococci were the most frequently isolated pathogens in both clinical mastitis cases and IMI. The odds of clinical mastitis was lower in herds where heifers were purchased in the last year [odds ratio (OR) with 95% confidence interval: 0.11 (0.01-0.90)], old cows (>4 years) [OR: 0.45 (0.18-1.14)], and quarters not showing teat injury [OR: 0.23 (0.07-0.77)]. The odds of IMI caused by any pathogen was higher in herds not practicing teat drying before milking (opposed to drying teats with 1 towel per cow) [OR: 1.68 (1.05-2.69)], cows in later lactation (>180 DIM opposed to ≤90 DIM) [OR: 1.81 (1.14-2.88)], cows with a high (>3) body condition score (BCS) [OR: 1.57 (1.06-2.31)], right quarters (opposed to a left quarter position) [OR: 1.47 (1.10-1.98)], and quarters showing teat injury [OR: 2.30 (0.97-5.43)]. Quarters of cows in herds practicing bucket-fed calf feeding (opposed to suckling) had higher odds of IMI caused by Staphylococcus aureus [OR: 6.05 (1.31-27.90)]. Except for BCS, IMI caused by non-aureus staphylococci was associated with the same risk factors as IMI caused by any pathogen. No access to feed and water immediately after milking [OR: 2.41 (1.26-4.60)], higher parity [OR: 3.60 (1.20-10.82)] and tick infestation [OR: 2.42 (1

  2. Teaching clinical interviewing skills using role-playing: conveying empathy to performing a suicide assessment: a primer for individual role-playing and scripted group role-playing.

    Science.gov (United States)

    Shea, Shawn Christopher; Barney, Christine

    2015-03-01

    This article provides a useful introduction to the art of role-playing in both the individual format and the group format using scripted group role-playing (SGRP). Role-playing can provide powerful learning opportunities, but to do so it must be done well. This article imparts guidance toward this goal. SGRP may greatly enhance the acquisition of critical complex interviewing skills, such as suicide assessment and uncovering domestic violence, in health care providers across all disciplines, an educational goal that has not been achievable to date. Although research is at an early stage of development, the hope represented by SGRP is tangible.

  3. Cohesion to the Group and Its Association with Attendance and Early Treatment Response in an Adult Day-Hospital Program for Eating Disorders: A Preliminary Clinical Investigation

    Science.gov (United States)

    Crino, Natalie; Djokvucic, Ivana

    2010-01-01

    Treatment outcome studies demonstrate that day-hospital programs are effective in the treatment of eating disorders. Few descriptions are available on the specifics of treatment, particularly the process of therapy. The group therapy modality is thought to provide important therapeutic benefits. The present study aimed to examine the association…

  4. Comparison of the administration of progesterone versus progesterone and vitamin D in improvement of outcomes in patients with traumatic brain injury: A randomized clinical trial with placebo group

    Directory of Open Access Journals (Sweden)

    Bahram Aminmansour

    2012-01-01

    Full Text Available Background: Due to the heterogeneity of traumatic brain injury (TBI, many of single treatments have not been successful in prevention and cure of these kinds of injuries. The neuroprotective effect of progesterone drug on severe brain injuries has been identified, and recently, the neuroprotective effect of vitamin D has also been studied as the combination of these two drugs has shown better effects on animal samples in some studies. This study was conducted to examine the effect of vitamin D and progesterone on brain injury treatment after brain trauma. Materials and Methods: This study was performed on patients with severe brain trauma (Glasgow Coma Scale (GCS ≤ 8 from April to September, 2011. The patients were divided to 3 groups (placebo, progesterone, progesterone-vitamin D, each with 20 people. Upon the patients′ admission, their GCS and demographic information were recorded. After 3 months, they were reassessed, and their GCS and GOS (Glasgow outcome scale were recorded. The collected data were analyzed using SPSS 18 software (SPSS Inc., Chicago IL, USA. Results: Before intervention, GCS mean of the placebo, progesterone, and progesterone-vitamin D groups were 6.3 ± 0.88, 6.31 ± 0.87, and 6 ± 0.88, respectively. They increased to 9.16 ± 1.11, 10.25 ± 1.34, and 11.27 ± 2.27, respectively 3 months after intervention. There was a significant difference among GCS means of the 3 groups (P-value = 0.001. GOS was classified to 2 main categories of favorable and unfavorable recovery, of which, favorable recovery in placebo, progesterone, and progesterone-vitamin D was 25%, 45%, and 60%, respectively which showed a statistical significant difference among the groups (P-value = 0.03. Conclusion: The results showed that recovery rate in patients with severe brain trauma in the group receiving progesterone and vitamin D together was significantly higher than that of progesterone group, which was in turn higher than that of placebo group.

  5. Belonging to a peer support group enhance the quality of life and adherence rate in patients affected by breast cancer: A non-randomized controlled clinical trialFNx01

    Directory of Open Access Journals (Sweden)

    Afsaneh Malekpour Tehrani

    2011-01-01

    Full Text Available Background: Breast cancer is the most common cancer in women. It seems that breast cancer patients benefit from meeting someone who had a similar experience. This study evaluated the effect of two kinds of interventions (peer support and educational program on quality of life in breast cancer patients. Methods: This study was a controlled clinical trial on women with non-metastatic breast cancer. The patients studied in two experimental and control groups. Experimental group took part in peer support program and control group passed a routine educational program during 3 months. The authors administered SF-36 for evaluating the quality of life pre-and post intervention. Also, patient′s adherence was assessed by means of a simple checklist. Results: Two groups were similar with respect of age, age of onset of the disease, duration of having breast cancer, marital status, type of the treatment receiving now, and type of the received surgery. In the control group, there were statistically significant improvements in body pain, role-physical, role-emotional and social functioning. In experimental group, role-physical, vitality, social functioning, role-emotional and mental health showed significant improvement. Vitality score and mental health score in experimental group was significantly higher than that of the control group, both with p < 0.001. Also, it was shown that adherence was in high levels in both groups and no significant difference was seen after the study was done. Conclusions: According to the results of this study, supporting the patients with breast cancer by forming peer groups or by means of educational sessions could improve their life qualities.

  6. The Social Appearance Anxiety Scale in Italian adolescent populations: Construct validation and group discrimination in community and clinical eating disorders samples

    OpenAIRE

    Dakanalis, Antonios; Carrà, Giuseppe; Calogero, Rachel M.; Zanetti, M. Assunta; Volpato, Chiara; Riva, Giuseppe; Clerici, Massimo; Cipresso, Pietro

    2015-01-01

    Anxiety in situations where one’s overall appearance (including body shape) may be negatively evaluated is hypothesized to play a central role in Eating Disorders (EDs) and in their co-occurrence with Social Anxiety Disorder (SAD). Three studies were conducted among community (N = 1995) and clinical (N = 703) ED samples of 11- to 18-year-old Italian girls and boys to (a) evaluate the psychometric qualities and measurement equivalence/invariance (ME/I) of the Social Appearance Anxiety (SAA) Sc...

  7. Report of the AAPM Task Group No. 105: Issues associated with clinical implementation of Monte Carlo-based photon and electron external beam treatment planning

    International Nuclear Information System (INIS)

    The Monte Carlo (MC) method has been shown through many research studies to calculate accurate dose distributions for clinical radiotherapy, particularly in heterogeneous patient tissues where the effects of electron transport cannot be accurately handled with conventional, deterministic dose algorithms. Despite its proven accuracy and the potential for improved dose distributions to influence treatment outcomes, the long calculation times previously associated with MC simulation rendered this method impractical for routine clinical treatment planning. However, the development of faster codes optimized for radiotherapy calculations and improvements in computer processor technology have substantially reduced calculation times to, in some instances, within minutes on a single processor. These advances have motivated several major treatment planning system vendors to embark upon the path of MC techniques. Several commercial vendors have already released or are currently in the process of releasing MC algorithms for photon and/or electron beam treatment planning. Consequently, the accessibility and use of MC treatment planning algorithms may well become widespread in the radiotherapy community. With MC simulation, dose is computed stochastically using first principles; this method is therefore quite different from conventional dose algorithms. Issues such as statistical uncertainties, the use of variance reduction techniques, the ability to account for geometric details in the accelerator treatment head simulation, and other features, are all unique components of a MC treatment planning algorithm. Successful implementation by the clinical physicist of such a system will require an understanding of the basic principles of MC techniques. The purpose of this report, while providing education and review on the use of MC simulation in radiotherapy planning, is to set out, for both users and developers, the salient issues associated with clinical implementation and

  8. The role of stereotactic ablative radiotherapy in oncological and non-oncological clinical settings: highlights from the 7th Meeting of AIRO--Young Members Working Group (AIRO Giovani).

    Science.gov (United States)

    Franco, Pierfrancesco; De Bari, Berardino; Ciammella, Patrizia; Fiorentino, Alba; Chiesa, Silvia; Amelio, Dante; Pinzi, Valentina; Bonomo, Pierluigi; Vagge, Stefano; Fiore, Michele; Comito, Tiziana; Cecconi, Agnese; Mortellaro, Gianluca; Bruni, Alessio; Trovò, Marco; Filippi, Andrea Riccardo; Greto, Daniela; Alongi, Filippo

    2014-01-01

    Stereotactic ablative radiotherapy is a modern cancer treatment strategy able to deliver highly focused radiation in one or a few fractions with a radical intent in several clinical settings. Young radiation oncologists need a constant and tailored update in this context to improve patient care in daily clinical practice. A recent meeting of AIRO Giovani (AIRO--Young Members Working Group) was specifically addressed to this topic, presenting state-of-the-art knowledge, based on the latest evidence in this field. Highlights of the congress are summarized and presented in this report, including thorough contributions of the speakers dealing with the role of stereotactic ablative radiotherapy in both oncological and non-oncological diseases, divided according to anatomical and clinical scenarios: intra-cranial settings (brain malignant primary tumors, metastases, benign tumors and functional disorders) and extra-cranial indications (lung primary tumors and metastases, thoracic re-irradiation, liver, lymph node and bone metastases, prostate cancer). With literature data discussed during the congress as a background, stereotactic ablative radiotherapy has proved to be a consolidated treatment approach in specific oncological and non-oncological scenarios, as well as a promising option in other clinical settings, requiring a further prospective validation in the near future. We herein present an updated overview of stereotactic ablative radiotherapy use in the clinic. PMID:25688503

  9. Chinese SLE Treatment and Research Group Registry: III. Association of Autoantibodies with Clinical Manifestations in Chinese Patients with Systemic Lupus Erythematosus

    Directory of Open Access Journals (Sweden)

    Jing Li

    2014-01-01

    Full Text Available We investigated the characteristics of Chinese SLE patients by analyzing the association between specific autoantibodies and clinical manifestations of 2104 SLE patients from registry data of CSTAR cohort. Significant (P<0.05 associations were found between anti-Sm antibody, anti-rRNP antibody, and malar rash; between anti-RNP antibody, anti-SSA antibody, and pulmonary arterial hypertension (PAH; between anti-SSB antibody and hematologic involvement; and between anti-dsDNA antibody and nephropathy. APL antibody was associated with hematologic involvement, interstitial lung disease, and a lower prevalence of oral ulcerations (P<0.05. Associations were also found between anti-dsDNA antibody and a lower prevalence of photosensitivity, and between anti-SSA antibody and a lower prevalence of nephropathy (P<0.05. Most of these findings were consistent with other studies in the literature but this study is the first report on the association between anti-SSA and a lower prevalence of nephropathy. The correlations of specific autoantibodies and clinical manifestations could provide clues for physicians to predict organ damages in SLE patients. We suggest that a thorough screening of autoantibodies should be carried out when the diagnosis of SLE is established, and repeated echocardiography annually in SLE patients with anti-RNP or anti-SSA antibody should be performed.

  10. APPROACH AND TREATMENT OF SUICIDAL BEHAVIOR IN THE CLINICAL PRACTICE OF DIFFERENT GROUPS OF HEALTH PROFESSIONALS IN SPAIN: RESULTS OF THE PROJECT EUREGENA.

    Directory of Open Access Journals (Sweden)

    Juan Luis Muñoz

    2014-12-01

    Full Text Available According to the WHO (World Health Organization and the European Union, suicide is considered to be a health problem of prime importance and to be one of the principal causes of unnatural death. In Spain, the number of suicides has increased 12% since 2005 . The Research Project “European Regions Enforcing Actions against Suicide (EUREGENAS, funded by the Health Program 2008-2013, has as main objective the description of an integrated model of Mental Health orientated to the prevention of suicide. The differences that allow distinguishing the meaning of prevention in suicide behavior are described and explained through a qualitative methodological strategy and through the creation of discussion groups formed by different groups of health professionals. The results highlight the existing differences between the diverse health professionals who come more in contact with this problem and it shows as well the coincidence of meaning that suicide has to be considered as a priority in the field of health.

  11. Clinical practice guidelines for the diagnosis and treatment of patients with soft tissue sarcoma by the Spanish group for research in sarcomas (GEIS)

    OpenAIRE

    García del Muro, Xavier; Alava, Enrique de; Artigas, Vicenç; Bague, Silvia; Braña Vigil, Alejandro Francisco; ,

    2015-01-01

    Soft tissue sarcomas (STS) constitute an uncommon and heterogeneous group of tumours, which require a complex and specialized multidisciplinary management. The diagnostic approach should include imaging studies and core needle biopsy performed prior to undertaking surgery. Wide excision is the mainstay of treatment for localized sarcoma, and associated preoperative or postoperative radiotherapy should be administered in high-risk patients. Adjuvant chemotherapy was associated with a modest im...

  12. Distribution of ABO blood group and the clinical characteristics in gastric cancer%胃癌患者的ABO血型分布及临床特点分析

    Institute of Scientific and Technical Information of China (English)

    徐灵均; 张吉翔

    2012-01-01

    目的 探讨胃癌患者的ABO血型分布及临床特点.方法 选择400例胃癌患者的住院病历资料,分析其ABO血型;比较前后5年患者的ABO血型分布,分析后5年患者的一般情况、首发症状、病理特点.结果 与前5年比较,后5年A型血检出率明显减少(41.5% vs 23.5%,P<0.01),O型血检出率明显增多(27.5% vs 42.5%,P<0.01),B型、AB型血无统计学差异.后5年中,各血型患者的首发症状均以上腹痛、腹胀、纳差、体质量下降为主;B型血低分化腺癌患者明显高于A型血患者(68.1% vs 36.1%,P<0.05),70.7%浸润深度达全层,且66.4%有淋巴结转移;累及周围组织的AB型血患者明显高于B型血患者(61.5%vs 25.5%,P<0.05).结论 前后5年胃癌患者的ABO血型分布发生了变化;提示非遗传因素对胃癌发病的影响逐渐增强,血型可能与肿瘤的生物学行为有关.%Objective To explore the distribution of ABO blood group and the clinical features of the patients with gastric cancer (GC). Methods Inpatient medical records of four hundred cases of the patients with CC were choosed and put into statistical analysis of ABO blood group; To compare the distribution of ABO blood group of the patients before and after five years, at the same time analyzing the clinical data of the patients included the generalconditions, clinical manifestation, pathological features, auxiliary examination, staging, treat ment and so on. Results Compared with the prior five years, the detectable rate of A blood group was greatly decreased in the recent five years (41.5% vs 23.5% , P <0.01) , the detectable rate of 0 blood group was obviously increased in the recent five years (27.5% vs 42.5% , P <0.01), the discrepancy of B blood group and AB blood group were not statistically significant. In the recent five years, initial symptoms in each blood type group were mainly upper abdominal pain or distention, anorexia, marasmus; The rates of poorly

  13. The use of cytosolic enzyme increase in cerebrospinal fluid of patients resuscitated after cardiac arrest. Brain Resuscitation Clinical Trial I Study Group.

    Science.gov (United States)

    Vaagenes, P; Mullie, A; Fodstad, D T; Abramson, N; Safar, P

    1994-11-01

    Levels of brain creatine phosphokinase (CPK), glutamic oxalic transaminase, lactate dehydrogenase, and lactate in lumbar cerebrospinal fluid (CSF) were analyzed as an adjunctive study in a randomized clinical trial evaluating the effects of thiopental loading intravenously in comatose survivors of cardiac arrest. Three hospitals participated and a total of 62 cases of enzyme changes were studied. Enzyme levels but not lactate were higher at 48 hours than at 24 hours after restoration of spontaneous circulation. All enzymes were highly correlated with one another at 24 and 48 hours (P < .001). There was a significant negative correlation between cerebral recovery and increased CPK levels at 24 hours (P < .05), and a highly significant correlation with all three enzyme levels at 48 hours (P < .0001). The increase of cytosolic enzyme activity in lumbar CSF reflects permanent brain damage, and there is a relationship between activity levels and cerebral outcome. PMID:7945601

  14. Clinical indicators of envenoming and serum levels of venom antigens in patients bitten by Bothrops lanceolatus in Martinique. Research Group on Snake Bites in Martinique.

    Science.gov (United States)

    Bucher, B; Canonge, D; Thomas, L; Tyburn, B; Robbe-Vincent, A; Choumet, V; Bon, C; Ketterlé, J; Lang, J

    1997-01-01

    An enzyme-linked immunosorbent assay was developed to measure venom antigen levels in the serum of 40 patients bitten by Bothrops lanceolatus. The grading system used for the severity of envenomation (grades 1 to 4, minor to major) was predominantly based on the presence of local signs. Serum venom levels increased with the grade of severity (P or = 15 ng/mL were observed in all patients with progressive aggravation of swelling despite the use of early antivenom therapy. No venom was detectable in blood samples taken after completion of serotherapy. All patients recovered. These results confirm the efficacy of both the clinical severity scoring system used and the therapeutic regimen. PMID:9196765

  15. Preanalytical quality improvement. In pursuit of harmony, on behalf of European Federation for Clinical Chemistry and Laboratory Medicine (EFLM) Working group for Preanalytical Phase (WG-PRE).

    Science.gov (United States)

    Lippi, Giuseppe; Banfi, Giuseppe; Church, Stephen; Cornes, Michael; De Carli, Gabriella; Grankvist, Kjell; Kristensen, Gunn B; Ibarz, Mercedes; Panteghini, Mauro; Plebani, Mario; Nybo, Mads; Smellie, Stuart; Zaninotto, Martina; Simundic, Ana-Maria

    2015-02-01

    Laboratory diagnostics develop through different phases that span from test ordering (pre-preanalytical phase), collection of diagnostic specimens (preanalytical phase), sample analysis (analytical phase), results reporting (postanalytical phase) and interpretation (post-postanalytical phase). Although laboratory medicine seems less vulnerable than other clinical and diagnostic areas, the chance of errors is not negligible and may adversely impact on quality of testing and patient safety. This article, which continues a biennial tradition of collective papers on preanalytical quality improvement, is aimed to provide further contributions for pursuing quality and harmony in the preanalytical phase, and is a synopsis of lectures of the third European Federation of Clinical Chemistry and Laboratory Medicine (EFLM)-Becton Dickinson (BD) European Conference on Preanalytical Phase meeting entitled 'Preanalytical quality improvement. In pursuit of harmony' (Porto, 20-21 March 2015). The leading topics that will be discussed include unnecessary laboratory testing, management of test request, implementation of the European Union (EU) Directive on needlestick injury prevention, harmonization of fasting requirements for blood sampling, influence of physical activity and medical contrast media on in vitro diagnostic testing, recent evidence about the possible lack of necessity of the order of draw, the best practice for monitoring conditions of time and temperature during sample transportation, along with description of problems emerging from inappropriate sample centrifugation. In the final part, the article includes recent updates about preanalytical quality indicators, the feasibility of an External Quality Assessment Scheme (EQAS) for the preanalytical phase, the results of the 2nd EFLM WG-PRE survey, as well as specific notions about the evidence-based quality management of the preanalytical phase.

  16. A randomised phase II trial of preoperative chemotherapy of cisplatin–docetaxel or docetaxel alone for clinical stage IB/II non-small-cell lung cancer: results of a Japan Clinical Oncology Group trial (JCOG 0204)

    OpenAIRE

    Kunitoh, H; Kato, H.; Tsuboi, M; Asamura, H.; Tada, H.; Nagai, K; Mitsudomi, T.; Koike, T.; Nakagawa, K.; Ichinose, Y; Okada, M.; Shibata, T.; Saijo, N.

    2008-01-01

    Preoperative chemotherapy is a promising strategy in patients with early-stage resectable non-small-cell lung cancer (NSCLC); optimal chemotherapy remains unclear. Clinical (c-) stage IB/II NSCLC patients were randomised to receive either two cycles of docetaxel (D)–cisplatin (P) combination chemotherapy (D 60 mg m−2 and P 80 mg m−2 on day 1) every 3–4 weeks or three cycles of D monotherapy (70 mg m−2) every 3weeks. Thoracotomy was performed 4–5 weeks (DP) or 3–4 weeks (D) after chemotherapy....

  17. The EWMA Patient Outcome Group

    DEFF Research Database (Denmark)

    Gottrup, F

    2009-01-01

    Across Europe, clinical experts in wound care and industry representatives have joined forces to propose recommendations for clinical data collection on chronic wound management. Here, the chair of the group, Finn Gottrup, outlines its main objectives.......Across Europe, clinical experts in wound care and industry representatives have joined forces to propose recommendations for clinical data collection on chronic wound management. Here, the chair of the group, Finn Gottrup, outlines its main objectives....

  18. The Effects on Interactive Teaching of Group Discussion in the Clinical The-ory Teaching%分组讨论互动教学法在临床理论教学中的应用

    Institute of Scientific and Technical Information of China (English)

    刘桂清; 王秀清; 沈杨; 裴丽丽; 孙茂林; 董洪宇; 孙忠平

    2015-01-01

    Purpose To discuss the effects on interactive teaching of group discussion in the clinical theory teaching.Methods Choose 206 students in our hospital clinical medical profession as the research object from september 201 1 to december 2013.The interactive teaching in the group discussion was adopted in the observation group,the class was divid-ed into several groups to assign tasks,then discussed and summarized after discussion.The traditional teaching method was adopted in the control group.Results Both test score and the excellence rate of the observation group were significantly better than the control group,the questionnaire of two groups showed obvious difference in the satisfaction of teaching meth-od,the equality of teacher-students relationship and the improvment of teaching ability.Conclusion Group discussion teaching method achieved the overall and comprehensive of interactive teaching,reflects the dominant position of the students,and was worthy of promotion.%目的:探讨小组讨论互动教学在临床理论教学中的应用效果。方法以2011年9月至2013年12月我院临床医疗专业206人作为研究对象,观察组110人采用小组讨论互动教学,把班级分成若干小组,分配好任务,组织讨论并讨论后总结;对照组96人采取传统教学法。结果观察组之间无论理论考试成绩,还是优秀率均明显高于对照组,两组的调查问卷在教学方法满意度、体现师生平等关系及思维能力提高方面均有明显统计学差异。结论小组讨论教学法做到了互动教学的全员性、广泛性,体现了学生的主体地位,值得推广。

  19. Low clinical relevance of risky alcohol consumption in a selected group of high adherent HIV-infected patients attended in the United Kingdom

    Directory of Open Access Journals (Sweden)

    Alicia Gonzalez Baeza

    2014-11-01

    Full Text Available Introduction: The prevalence of risky alcohol consumption, associated factors and its impact on the brain is not well established in clinically stable HIV patients. Materials and Methods: Within the PIVOT neurocognitive sub-study, effectively suppressed HIV-infected adults on either standard cART or ritonavir-boosted PI monotherapy completed the Alcohol Use Disorders Identification Test (AUDIT designed to detect risky alcohol consumption. They also completed a brief neuropsychological assessment (NPZ 5 composed by five measures. For this cross-sectional analysis, we calculated rates of hazardous (AUDIT=8–15 or harmful (AUDIT=16–19 consumption and likely dependence (AUDIT>20. We explored the association between risky alcohol intakes (AUDIT>8 and clinical/demographical variables, conducting logistic regressions when significant association was found (p<.05. Also, the association between cognitive performance and alcohol consumption was calculated and adjusted by potential confounders. Results: Of the 146 included participants, the majority were male (86.3%, white (81.5% and educated (mean years on formal education=15, SD=3.9. Average age was 47.6 years (SD=8.7, and 36.3% had risky consumption (29.5% hazardous, 6.2% harmful, 0.7% likely dependence. White ethnicity and male sex were positively associated with risky consumption (Table 1. After adjustments, white ethnicity remained significantly associated with risky consumption (1.64 [95% CI 0.34–2.95]; p=0.013. Better cognitive performance was associated with risky alcohol consumption in the univariate analysis (p<.001. After adjustment by ethnicity, sex and years of education, cognitive performance and risky alcohol consumption maintained significant association (0.45 [95% CI 0.19–0.70] p=0.001. Conclusions: Despite the substantially high prevalence of risky alcohol consumption, it was not associated with worse adherence, immunological or quality of life measures in this cohort of

  20. Homogeneous group, research, institution

    Directory of Open Access Journals (Sweden)

    Francesca Natascia Vasta

    2014-09-01

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

  1. Blood groups systems

    OpenAIRE

    Ranadhir Mitra; Nitasha Mishra; Girija Prasad Rath

    2014-01-01

    International Society of Blood Transfusion has recently recognized 33 blood group systems. Apart from ABO and Rhesus system, many other types of antigens have been noticed on the red cell membranes. Blood grouping and cross-matching is one of the few important tests that the anaesthesiologist orders during perioperative period. Hence, a proper understanding of the blood group system, their clinical significance, typing and cross-matching tests, and current perspective are of paramount importa...

  2. Clinical predictors of reinfarction among men and women after a first myocardial infarction. SPRINT Study Group. Secondary Prevention Reinfarction Israeli Nifedipine Trial.

    Science.gov (United States)

    Kornowski, R; Goldbourt, U; Boyko, V; Behar, S

    1995-01-01

    Independent clinical factors predicting reinfarction in the 1st year following an initial myocardial infarction were identified among 900 women and 2,795 men. Women were older (65.8 vs. 59.3 years; p men (6.9 vs. 5.6%, p = 0.17). Cumulative 1-month, 1- and 5.5-year all-cause mortality following the first infarction was higher among women who sustained reinfarction (43, 52 and 74%, respectively) than among men (29, 30 and 51%, respectively, p women were (adjusted relative odds): peripheral vascular disease (3.2), postinfarction angina (2.3), diabetes mellitus (2.2), radiographic evidence of cardiomegaly (1.9), anterior location of the first infarction (2.0), congestive heart failure (1.8), prior angina (1.6) and age (10 years) increment (1.2). Predictive variables for men were: anterior infarct location (1.7), peripheral vascular disease (1.6, prior stroke (1.5), prior angina (1.4), systemic hypertension (1.3) and age (10 years) increment (1.1). Our data indicate (a) different cardiac risk factors for reinfarction among men and women after a first myocardial infarction, and (b) a prognostic advantage for men over women following reinfarction.

  3. Krypton laser photocoagulation for neovascular lesions of age-related macular degeneration. Results of a randomized clinical trial. Macular Photocoagulation Study Group.

    Science.gov (United States)

    1990-06-01

    The Age-Related Macular Degeneration Study-Krypton Laser (AMDS-K) is a multicenter controlled clinical trial designed to determine whether krypton red laser photocoagulation is of value in preventing visual acuity loss in eyes with macular degeneration that have either choroidal neovascularization 1 to 199 microns from the center of the foveal avascular zone or choroidal neovascularization 200 microns or farther from the foveal avascular zone center with blood and/or blocked fluorescence extending within 200 microns of the foveal avascular zone center. Recruitment ended in December 1987 after 247 patients had been assigned to photocoagulation and 249 patients had been assigned to no treatment. At 3 years after randomization, 49% (86/174) of treated eyes, in contrast to 58% (98/169) of untreated eyes, had lost six or more lines of visual acuity. The average visual acuity of treated and untreated eyes at that time was 20/200 and 20/250, respectively. The benefit of laser treatment was largest among patients without evidence of hypertension and diminished to no apparent benefit among patients who had highly elevated blood pressure and/or used antihypertensive medication. Treatment of lesions meeting the AMDS-K eligibility criteria in eyes of patients with no hypertension is recommended. However, treatment cannot be recommended uniformly for patients with definite hypertension having lesions similar to those of patients enrolled in the AMDS-K. PMID:1693496

  4. Design paper: The CapOpus trial: A randomized, parallel-group, observer-blinded clinical trial of specialized addiction treatment versus treatment as usual for young patients with cannabis abuse and psychosis

    Directory of Open Access Journals (Sweden)

    Gluud Christian

    2008-07-01

    Full Text Available Abstract Background A number of studies indicate a link between cannabis-use and psychosis as well as more severe psychosis in those with existing psychotic disorders. There is currently insufficient evidence to decide the optimal way to treat cannabis abuse among patients with psychosis. Objectives The major objective for the CapOpus trial is to evaluate the additional effect on cannabis abuse of a specialized addiction treatment program adding group treatment and motivational interviewing to treatment as usual. Design The trial is designed as a randomized, parallel-group, observer-blinded clinical trial. Patients are primarily recruited through early-psychosis detection teams, community mental health centers, and assertive community treatment teams. Patients are randomized to one of two treatment arms, both lasting six months: 1 specialized addiction treatment plus treatment as usual or 2 treatment as usual. The specialized addiction treatment is manualized and consists of both individual and group-based motivational interviewing and cognitive behavioral therapy, and incorporates both the family and the case manager of the patient. The primary outcome measure will be changes in amount of cannabis consumption over time. Other outcome measures will be psychosis symptoms, cognitive functioning, quality of life, social functioning, and cost-benefit analyses. Trial registration ClinicalTrials.gov NCT00484302.

  5. Efficacy and Safety of Crocus sativus L. in Patients with Mild Cognitive Impairment: One Year Single-Blind Randomized, with Parallel Groups, Clinical Trial.

    Science.gov (United States)

    Tsolaki, Magda; Karathanasi, Elina; Lazarou, Ioulietta; Dovas, Kostas; Verykouki, Eleni; Karacostas, Anastasios; Georgiadis, Kostas; Tsolaki, Anthoula; Adam, Katerina; Kompatsiaris, Ioannis; Sinakos, Zacharias

    2016-07-27

    There is evidence to suggest the efficacy of Crocus (saffron) in the management of cognitive decline. This study examined the efficacy of Crocus in patients with amnesic and multi domain MCI (aMCImd). The participants included 17 patients on Crocus and 18 on a waiting list, who were examined with a short neuropsychological battery, MRI 3T, while some patients were examined via 256-channel electroencephalogram (HD-EEG) at baseline and after 12 months. The results showed that patients on Crocus had improved Mini-Mental State Examination scores (p = 0.015), while the control group deteriorated. Also, MRI, EEG, and ERP showed improvement in specific domains. This led us to conclude that Crocus is a good choice for management of aMCImd.

  6. 椎间融合器临床试验分组及评价指标注册要求的变化%Change of Regulatory Requirement on Cohort Grouping and Endpoint Seting for Intervertebral Fusion Device Clinical Trail

    Institute of Scientific and Technical Information of China (English)

    郭晓磊

    2015-01-01

    结合国际主流监管机构技术要求与我国监管现状,目前常规的椎间融合器临床试验注册要求发生了简化,颈胸腰椎病患同组试验,并以影像学评价为主,较为合理地向减轻企业负担做出了尝试。%Combining technical requirement from main international administration and status quo of China administration, current regulatory requirement on clinical trail of conventional intervertebral fusion devices has been simplified. Cervical, thoracic and lumbar cases can be grouped into the same cohort, and primary endpoints are mainly based on imageology rather than clinical score. This is an attempt to rational y lessen industrial burdensome.

  7. Early management of type 2 diabetes based on a SMBG strategy: the way to diabetes regression--the St Carlos study : a 3-year, prospective, randomized, clinic-based, interventional study with parallel groups.

    Science.gov (United States)

    García de la Torre, Nuria; Durán, Alejandra; Del Valle, Laura; Fuentes, Manuel; Barca, Idoya; Martín, Patricia; Montañez, Carmen; Perez-Ferre, Natalia; Abad, Rosario; Sanz, Fuencisla; Galindo, Mercedes; Rubio, Miguel A; Calle-Pascual, Alfonso L

    2013-08-01

    The aims are to define the regression rate in newly diagnosed type 2 diabetes after lifestyle intervention and pharmacological therapy based on a SMBG (self-monitoring of blood glucose) strategy in routine practice as compared to standard HbA1c-based treatment and to assess whether a supervised exercise program has additional effects. St Carlos study is a 3-year, prospective, randomized, clinic-based, interventional study with three parallel groups. Hundred and ninety-five patients were randomized to the SMBG intervention group [I group; n = 130; Ia: SMBG (n = 65) and Ib: SMBG + supervised exercise (n = 65)] and to the HbA1c control group (C group) (n = 65). The primary outcome was to estimate the regression rate of type 2 diabetes (HbA1c 4 kg was 3.6 (1.8-7); p < 0.001. This study shows that the use of SMBG in an educational program effectively increases the regression rate in newly diagnosed type 2 diabetic patients after 3 years of follow-up. These data suggest that SMBG-based programs should be extended to primary care settings where diabetic patients are usually attended.

  8. Epidemiology and clinical relevance of mutations in postpolycythemia vera and postessential thrombocythemia myelofibrosis: A study on 359 patients of the AGIMM group.

    Science.gov (United States)

    Rotunno, Giada; Pacilli, Annalisa; Artusi, Valentina; Rumi, Elisa; Maffioli, Margherita; Delaini, Federica; Brogi, Giada; Fanelli, Tiziana; Pancrazzi, Alessandro; Pietra, Daniela; Bernardis, Isabella; Belotti, Clara; Pieri, Lisa; Sant'Antonio, Emanuela; Salmoiraghi, Silvia; Cilloni, Daniela; Rambaldi, Alessandro; Passamonti, Francesco; Barbui, Tiziano; Manfredini, Rossella; Cazzola, Mario; Tagliafico, Enrico; Vannucchi, Alessandro M; Guglielmelli, Paola

    2016-07-01

    Transformation to secondary myelofibrosis (MF) occurs as part of the natural history of polycythemia vera (PPV-MF) and essential thrombocythemia (PET-MF). Although primary (PMF) and secondary MF are considered similar diseases and managed similarly, there are few studies specifically focused on the latter. The aim of this study was to characterize the mutation landscape, and describe the main clinical correlates and prognostic implications of mutations, in a series of 359 patients with PPV-MF and PET-MF. Compared with PV and ET, the JAK2V617F and CALR mutated allele burden was significantly higher in PPV-MF and/or PET-MF, indicating a role for accumulation of mutated alleles in the process of transformation to MF. However, neither the allele burden nor the type of driver mutation influenced overall survival (OS), while absence of any driver mutation (triple negativity) was associated with significant reduction of OS in PET-MF, similar to PMF. Of the five interrogated subclonal mutations (ASXL1, EZH2, SRSF2, IDH1, and IDH2), that comprise a prognostically detrimental high molecular risk (HMR) category in PMF, only SRSF2 mutations were associated with reduced survival in PET-MF, and no additional mutation profile with prognostic relevance was highlighted. Overall, these data indicate that the molecular landscape of secondary forms of MF is different from PMF, suggesting that unknown mutational events might contribute to the progression from chronic phase disease to myelofibrosis. These findings also support more extended genotyping approaches aimed at identifying novel molecular abnormalities with prognostic relevance for patients with PPV-MF and PET-MF. Am. J. Hematol. 91:681-686, 2016. © 2016 Wiley Periodicals, Inc. PMID:27037840

  9. Clinical and pathological characteristics of breast cancer in different age groups%不同年龄段之间乳腺癌患者的临床病理生物学特点

    Institute of Scientific and Technical Information of China (English)

    徐谦; 艾美凤

    2015-01-01

    目的:深入探讨不同年龄段乳腺癌患者的临床病理生物学特点。方法选取我院2012年11月—2014年10月期间收治的60例乳腺癌患者为研究对象,对不同年龄段患者的临床病理生物学特点进行比较和分析。结果青年患者在激素受体阳性率、病理分期为iii期的发生率及淋巴结转移率都要高于其他年龄阶段的患者。结论相比于中老年乳腺癌患者,青年患者普遍具有转移率高、恶性程度高、肿瘤生长快及病期晚的特点,临床上需要给予更高的重视。%Objective:to investigate the clinical and pathological characteristics of breast cancer in different age groups. Methods:60 patients with breast cancer treated in our hospital from november 2012 to october were selected as the research object, and the clinical and pathological characteristics of different age groups were compared and analyzed. Results:in young patients, the incidence of iii and the rate of lymph node metastasis were higher than those in other age groups. Conclusion:compared to the elderly patients with breast cancer, young patients generally have high transfer rate, high degree of malignancy, tumor growth and the characteristics of the late stage of disease, the clinical need to give more attention.

  10. Designing exercise clinical trials for older adults with cancer: Recommendations from 2015 Cancer and Aging Research Group NCI U13 Meeting

    Science.gov (United States)

    Kilari, Deepak; Soto-Perez-de-Celis, Enrique; Mohile, Supriya Gupta; Alibhai, Shabbir M.H.; Presley, Carolyn J.; Wildes, Tanya M.; Klepin, Heidi D.; Demark-Wahnefried, Wendy; Jatoi, Amina; Harrison, Robert; Won, Elizabeth; Mustian, Karen M.

    2016-01-01

    Cancer and its treatment can lead to a myriad of adverse events and negatively impact quality of life of older cancer patients and survivors. Unmet physical activity needs vary across the cancer continuum and remain an important yet understudied area of research in this population. Exercise interventions have been shown to be effective in treating both the physical and psychological declines associated with cancer and its treatment, with a potential to improve cancer-related outcomes. Despite the current evidence, exercise is clearly underutilized due to several barriers and knowledge gaps in existing trials that include appropriate population identification, design, and outcome measures selection. The benefits of regular exercise in both the primary and secondary prevention of chronic conditions are well established in the non-cancer population. In older cancer patients and survivors, further research is needed before exercise gains widespread acceptance. The Cancer and Aging Research Group convened experts in exercise, aging and cancer to evaluate current scientific evidence and knowledge gaps in geriatric exercise oncology. This report summarizes these findings and provides future research directions. PMID:27197916

  11. Clinical practice guidelines for the prevention and treatment of acute and late radiation reactions from the MASCC Skin Toxicity Study Group.

    Science.gov (United States)

    Wong, Rebecca K S; Bensadoun, René-Jean; Boers-Doets, Christine B; Bryce, Jane; Chan, Alexandre; Epstein, Joel B; Eaby-Sandy, Beth; Lacouture, Mario E

    2013-10-01

    Radiation dermatitis (RD) results from radiotherapy and often occurs within the first 4 weeks of treatment, although late effects also occur. While RD may resolve over time, it can have a profound effect on patients' quality of life and lead to dose modifications. A study group of international, interdisciplinary experts convened to develop RD prevention and treatment guidelines based on evidence from randomized, controlled trials. Evidence-based recommendations were developed after an extensive literature review. Randomized, controlled trials with standardized measurement of outcomes were considered the best evidence, and a majority of the recommendations were formulated from this literature. The adoption of washing with water, with or without a mild soap, and allowing the use of antiperspirants is supported by randomized trials. Use of topical prophylactic corticosteroids (mometasone) is recommended to reduce discomfort and itching. There is some evidence that silver sulfadiazine cream can reduce dermatitis score. There is insufficient evidence to support, and therefore the panel recommends against the use of trolamine, topical sulcrate, hyaluronic acid, ascorbic acid, silver leaf dressing, light-emitting diode lasers, Theta cream, dexpanthenol, calendula, proteolytic enzymes, sulcralfate, oral zinc, and pentoxifylline. Moreover, there is no evidence to support the superiority for any specific intervention in a reactive fashion. For patients with established radiation-induced telangiectasia and fibrosis, the panel suggests the use of pulse dye laser for visual appearance, and the use of pentoxifylline and vitamin E for the reduction of fibrosis.

  12. Group X

    Energy Technology Data Exchange (ETDEWEB)

    Fields, Susannah

    2007-08-16

    This project is currently under contract for research through the Department of Homeland Security until 2011. The group I was responsible for studying has to remain confidential so as not to affect the current project. All dates, reference links and authors, and other distinguishing characteristics of the original group have been removed from this report. All references to the name of this group or the individual splinter groups has been changed to 'Group X'. I have been collecting texts from a variety of sources intended for the use of recruiting and radicalizing members for Group X splinter groups for the purpose of researching the motivation and intent of leaders of those groups and their influence over the likelihood of group radicalization. This work included visiting many Group X websites to find information on splinter group leaders and finding their statements to new and old members. This proved difficult because the splinter groups of Group X are united in beliefs, but differ in public opinion. They are eager to tear each other down, prove their superiority, and yet remain anonymous. After a few weeks of intense searching, a list of eight recruiting texts and eight radicalizing texts from a variety of Group X leaders were compiled.

  13. Leaving out control groups: an internal contrast analysis of gene expression profiles in atrial fibrillation patients--a systems biology approach to clinical categorization.

    Science.gov (United States)

    Vanhoutte, Kurt; de Asmundis, Carlo; Francesconi, Anna; Figysl, Jurgen; Steurs, Griet; Boussy, Tim; Roos, Markus; Mueller, Andreas; Massimo, Lucio; Paparella, Gaetano; Van Caelenberg, Kristien; Chierchia, Gian Battista; Sarkozy, Andrea; Terradellas, Pedro Brugada Y; Zizi, Martin

    2009-01-01

    Atrial fibrillation (AF) is a frequent chronic dysrythmia with an incidence that increases with age (>40). Because of its medical and socio-economic impacts it is expected to become an increasing burden on most health care systems. AF is a multi-factorial disease for which the identification of subtypes is warranted. Novel approaches based on the broad concepts of systems biology may overcome the blurred notion of normal and pathological phenotype, which is inherent to high throughput molecular arrays analysis. Here we apply an internal contrast algorithm on AF patient data with an analytical focus on potential entry pathways into the disease. We used a RMA (Robust Multichip Average) normalized Affymetrix micro-array data set from 10 AF patients (geo_accession #GSE2240). Four series of probes were selected based on physiopathogenic links with AF entryways: apoptosis (remodeling), MAP kinase (cell remodeling), OXPHOS (ability to sustain hemodynamic workload) and glycolysis (ischemia). Annotated probe lists were polled with Bioconductor packages in R (version 2.7.1). Genetic profile contrasts were analysed with hierarchical clustering and principal component analysis. The analysis revealed distinct patient groups for all probe sets. A substantial part (54% till 67%) of the variance is explained in the first 2 principal components. Genes in PC1/2 with high discriminatory value were selected and analyzed in detail. We aim for reliable molecular stratification of AF. We show that stratification is possible based on physiologically relevant gene sets. Genes with high contrast value are likely to give pathophysiological insight into permanent AF subtypes.

  14. Antimicrobial activity of essential oils and carvacrol, and synergy of carvacrol and erythromycin, against clinical, erythromycin-resistant Group A Streptococci.

    Directory of Open Access Journals (Sweden)

    Gloria eMagi

    2015-03-01

    Full Text Available In the present study, we have evaluated the in vitro antibacterial activity of essential oils from Origanum vulgare, Thymus vulgaris, Lavandula angustifolia, Mentha piperita, and Melaleuca alternifolia against 32 erythromycin-resistant [MIC ≥1 µg/mL; inducible, constitutive, and efflux-mediated resistance phenotype; erm(TR, erm(B, and mef(A genes] and cell-invasive Group A streptococci (GAS isolated from children with pharyngotonsillitis in Italy. Over the past decades erythromycin resistance in GAS has emerged in several countries; strains combining erythromycin resistance and cell invasiveness may escape β-lactams because of intracellular location and macrolides because of resistance, resulting in difficulty of eradication and recurrent pharyngitis. Thyme and origanum essential oils demonstrated the highest antimicrobial activity with MICs ranging from 256 to 512 µg/mL. The phenolic monoterpene carvacrol [2-Methyl-5-(1-methylethyl phenol] is a major component of the essential oils of Origanum and Thymus plants. MICs of carvacrol ranged from 64 to 256 µg/mL. In the live/dead assay several dead cells were detected as early as 1 h after incubation with carvacrol at the MIC. In single-step resistance selection studies no resistant mutants were obtained. A synergistic action of carvacrol and erythromycin was detected by the checkerboard assay and calculation of the FIC Index. A 2- to 2048-fold reduction of the erythromycin MIC was documented in checkerboard assays. Synergy (FIC Index ≤0.5 was found in 21/32 strains and was highly significant (p <0.01 in strains where resistance is expressed only in presence of erythromycin. Synergy was confirmed in 17/23 strains using 24-h time-kill curves in presence of carvacrol and erythromycin. Our findings demonstrated that carvacrol acts either alone or in combination with erythromycin against erythromycin-resistant GAS and could potentially serve as a novel therapeutic tool.

  15. Randomized, controlled, parallel-group prospective study to investigate the clinical effectiveness of early insulin treatment in patients with latent autoimmune diabetes in adults

    Directory of Open Access Journals (Sweden)

    Lloyd Janet

    2008-07-01

    Full Text Available Abstract Background Latent autoimmune diabetes in adults [LADA] is a type 1 diabetes that is slowly developing. This means many people are treated as having type 2 diabetes at diagnosis as they are adults who are not immediately insulin dependent. LADA can be distinguished from type 2 diabetes by antibody tests. Patients who are antibody positive have an autoimmune reaction which is similar to that of type 1 diabetes and is not found in type 2 diabetes. We would like to examine the best way of treating LADA in the early phase of the conditions, with tablets (similar to type 2 diabetes or with insulin (similar to type 1 diabetes. Methods/design This is an open parallel group prospective randomised trial. Participants need to have a GAD antibody test results of 101 WHO units or more and a diagnosis of diabetes not requiring insulin at diagnosis. Participants will need to have been diagnosed within 12 months and not treated with insulin at study entry. They will be randomised to receive either insulin (NovoMix 30 or tablets (diet treated followed by metformin followed by glitazone (with or without metformin followed by insulin. Primary outcome assessment will be for change in HbA1c and change in fasting C-peptide over 24 months. Secondary outcome measures will include Quality of life, GAD antibody levels, adverse events, inflammatory markers, insulin resistance, and markers of the metabolic syndrome. Discussion This study seeks the best treatment for early LADA in terms of maintaining glycaemic control and maintaining natural insulin production. Trial registration ISRCTN63815121

  16. Clinical manifestations of patients with chikungunya fever at different age groups%不同年龄组基孔肯雅热患者的临床表现比较

    Institute of Scientific and Technical Information of China (English)

    翟洁卿; 吴福全; 黄育波; 李鸿超; 陈桂轩; 林炳亮

    2011-01-01

    目的 分析不同年龄组基孔肯雅热患者的临床表现.方法 130例基孔肯雅热患者,按年龄分为三组:<30岁、30~岁、≥60岁组,分析其临床症状的差异.结果 三组患者均出现发热,皮疹的发生率分别为86.8%、91.4%、90.9%,关节痛的比例分别为86.8%、91.4%、95.5%,关节痛持续时间超过14d的比例分别为2.6%、30.0%、36.4%;与<30岁组比较,30~岁和≥60岁组患者出现关节痛持续时间超过14 d以及累及3个或以上关节的比例高,差异均有统计学意义(x2= 13.026,P=0.001;x2=6.792,P=0.034).结论 基孔肯雅热主要表现为发热、皮疹、关节痛,中、老年组患者出现关节疼痛持续时间较长,累及的关节多.%Objective To analyze clinical manifestations of different age group patients with chikungunya fever. Methods According to the age, 130 patients with chikungunya fever were divided into 3 groups (Group 1: less than thirty years; Group 2: from thirty to fifty-nine years; Group 3; over sixty years). Results All the patients in three groups had fever, and 86.8% of patients in group 1, 91.4% in group 2 and 95.5% in group 3 had rash. The arthralgia rates of group 1, 2 and 3 were 86.8%, 91.4% and 95.5% respectively. And 2.6% of group 1 patients, 30.0% of group 2, and 36.4% of group 3 were persistently with arthralgia more than 14 days. The rates of having arthraglia more than 14 days and not less than 3 joints of patients in group 2 and group 3 were higher than that in group 1 (x2= 13.026, P=0.001; x2=6.792, P=0.034). Conclusion The main symptoms of chikungunya fever were fever, rash and arthralgia. Older patients had a longer time of rathralgia and more joints injured.

  17. Hot Groups.

    Science.gov (United States)

    Vail, Kathleen

    1996-01-01

    Collaborators sparked by creative ideas and obsessed by a common task may not realize they're part of a "hot group"--a term coined by business professors Harold J. Leavitt and Jean Lipman-Blumen. Spawned by group decision making and employee empowerment, hot groups can flourish in education settings. They're typically small, short lived, and goal…

  18. Abelian Groups

    Energy Technology Data Exchange (ETDEWEB)

    Mishina, A.P.

    1995-10-15

    This fifth survey of reviews on abelian groups comprises papers reviewed in 1985-1992. Just as in the preceding surveys, the issues concerning finite abelian groups, topological groups, ordered groups, group algebras, modules (with rare exceptions), and topics on logic are not considered. The issues on the lattice of subgroups of an abelian group are included in Section 11. In contrast to the fourth survey, this one does not contain Sections 6 (N-high subgroups), 9 (rings with a given additive group), and 10 (valuated groups); since only a few papers treated these topics, the material discussed earlier in Sections 9, and 10 is now included in Section 11 and the material of the former Section 6 will be found in Sections 1, 7, 8, and 11 of this survey. On the other hand, the fifth survey has three new sections devoted to separable groups (a new Sect. 5), Butler groups (a new Sect. 6), and the endormorphism rings and automorphism groups of abelian groups (a new Sect. 9).

  19. Group morphology

    NARCIS (Netherlands)

    Roerdink, Jos B.T.M.

    2000-01-01

    In its original form, mathematical morphology is a theory of binary image transformations which are invariant under the group of Euclidean translations. This paper surveys and extends constructions of morphological operators which are invariant under a more general group TT, such as the motion group

  20. Permutation groups

    CERN Document Server

    Passman, Donald S

    2012-01-01

    This volume by a prominent authority on permutation groups consists of lecture notes that provide a self-contained account of distinct classification theorems. A ready source of frequently quoted but usually inaccessible theorems, it is ideally suited for professional group theorists as well as students with a solid background in modern algebra.The three-part treatment begins with an introductory chapter and advances to an economical development of the tools of basic group theory, including group extensions, transfer theorems, and group representations and characters. The final chapter feature

  1. Galaxy Groups

    Science.gov (United States)

    Tully, R. Brent

    2015-02-01

    Galaxy groups can be characterized by the radius of decoupling from cosmic expansion, the radius of the caustic of second turnaround, and the velocity dispersion of galaxies within this latter radius. These parameters can be a challenge to measure, especially for small groups with few members. In this study, results are gathered pertaining to particularly well-studied groups over four decades in group mass. Scaling relations anticipated from theory are demonstrated and coefficients of the relationships are specified. There is an update of the relationship between light and mass for groups, confirming that groups with mass of a few times {{10}12}{{M}⊙ } are the most lit up while groups with more and less mass are darker. It is demonstrated that there is an interesting one-to-one correlation between the number of dwarf satellites in a group and the group mass. There is the suggestion that small variations in the slope of the luminosity function in groups are caused by the degree of depletion of intermediate luminosity systems rather than variations in the number per unit mass of dwarfs. Finally, returning to the characteristic radii of groups, the ratio of first to second turnaround depends on the dark matter and dark energy content of the universe and a crude estimate can be made from the current observations of {{Ω}matter}˜ 0.15 in a flat topology, with a 68% probability of being less than 0.44.

  2. Galaxy groups

    Energy Technology Data Exchange (ETDEWEB)

    Brent Tully, R. [Institute for Astronomy, University of Hawaii, 2680 Woodlawn Drive, Honolulu, HI 96822 (United States)

    2015-02-01

    Galaxy groups can be characterized by the radius of decoupling from cosmic expansion, the radius of the caustic of second turnaround, and the velocity dispersion of galaxies within this latter radius. These parameters can be a challenge to measure, especially for small groups with few members. In this study, results are gathered pertaining to particularly well-studied groups over four decades in group mass. Scaling relations anticipated from theory are demonstrated and coefficients of the relationships are specified. There is an update of the relationship between light and mass for groups, confirming that groups with mass of a few times 10{sup 12}M{sub ⊙} are the most lit up while groups with more and less mass are darker. It is demonstrated that there is an interesting one-to-one correlation between the number of dwarf satellites in a group and the group mass. There is the suggestion that small variations in the slope of the luminosity function in groups are caused by the degree of depletion of intermediate luminosity systems rather than variations in the number per unit mass of dwarfs. Finally, returning to the characteristic radii of groups, the ratio of first to second turnaround depends on the dark matter and dark energy content of the universe and a crude estimate can be made from the current observations of Ω{sub matter}∼0.15 in a flat topology, with a 68% probability of being less than 0.44.

  3. Galaxy Groups

    CERN Document Server

    Tully, R Brent

    2014-01-01

    Galaxy groups can be characterized by the radius of decoupling from cosmic expansion, the radius of the caustic of second turnaround, and the velocity dispersion of galaxies within this latter radius. These parameters can be a challenge to measure, especially for small groups with few members. In this study, results are gathered pertaining to particularly well studied groups over four decades in group mass. Scaling relations anticipated from theory are demonstrated and coefficients of the relationships are specified. There is an update of the relationship between light and mass for groups, confirming that groups with mass of a few times 10^12 Msun are the most lit up while groups with more and less mass are darker. It is demonstrated that there is an interesting one-to-one correlation between the number of dwarf satellites in a group and the group mass. There is the suggestion that small variations in the slope of the luminosity function in groups are caused by the degree of depletion of intermediate luminosi...

  4. Achieving lipid goals with rosuvastatin compared with simvastatin in high risk patients in real clinical practice: a randomized, open-label, parallel-group, multi-center study: the DISCOVERY-Beta study

    Directory of Open Access Journals (Sweden)

    Toivo Laks

    2008-09-01

    Full Text Available Toivo Laks1, Ester Keba2, Mariann Leiner3, Eero Merilind4, Mall Petersen5, Sirje Reinmets6, Sille Väli7, Terje Sööt8, Karin Otter81Clinic of Internal Medicine, North-Estonia Regional Hospital, Tallinn, Estonia; 2Clinic of Internal Medicine, Viljandi County Hospital, Viljandi, Estonia; 3Mustamäe Family Doctors Centre, Tallinn, Estonia; 4Nõmme Family Doctors Centre, Tallinn, Estonia; 5Saku Health Centre, Saku, Estonia; 6Kristiine Family Doctors, Tallinn, Estonia; 7Family Doctor Sille Väli, Kuressaare, Estonia; 8AstraZeneca, Tallinn, EstoniaAbstract: The aim of this multi-center, open-label, randomized, parallel-group trial was to compare the efficacy of rosuvastatin with that of simvastatin in achieving the 1998 European Atherosclerosis Society (EAS lipid treatment goals. 504 patients (≥18 years with primary hypercholesterolemia and a 10-year cardiovascular (CV risk >20% or history of coronary heart disease (CHD or other established atherosclerotic disease were randomized in a 2:1 ratio to receive rosuvastatin 10 mg or simvastatin 20 mg once daily for 12 weeks. A significantly higher proportion of patients achieved 1998 EAS low-density lipoprotein cholesterol (LDL-C goal after 12 weeks of treatment with rosuvastatin 10 mg compared to simvastatin 20 mg (64 vs 51.5%, p < 0.01. Similarly, significantly more patients achieved the 1998 EAS total cholesterol (TC goal and the 2003 EAS LDL-C and TC goals (p < 0.001 with rosuvastatin 10 mg compared with simvastatin 20 mg. The incidence of adverse events and the proportion of patients who discontinued study treatment were similar between treatment groups. In conclusion, in the DISCOVERY-Beta Study in patients with primary hypercholesterolemia greater proportion of patients in the rosuvastatin 10 mg group achieved the EAS LDL-C treatment goal compared with the simvastatin 20 mg group. Drug tolerability was similar across both treatment groups.Keywords: hypercholesterolemia, low-density lipoprotein

  5. Using Matrix-Assisted Laser Desorption Ionization-Time of Flight (MALDI-TOF) Complemented with Selected 16S rRNA and gyrB Genes Sequencing to Practically Identify Clinical Important Viridans Group Streptococci (VGS).

    Science.gov (United States)

    Zhou, Menglan; Yang, Qiwen; Kudinha, Timothy; Zhang, Li; Xiao, Meng; Kong, Fanrong; Zhao, Yupei; Xu, Ying-Chun

    2016-01-01

    There are challenges in viridans group streptococci (VGS) identification especially for the mitis group. Few studies have investigated the performance of MALDI-TOF MS system in VGS identification. Using 16S rRNA gene and gyrB gene sequencing as a gold standard, the performance of two MALDI-TOF MS instruments in the identification of 181 VGS clinical isolates was studied. The Bruker Biotyper and Vitek MS IVD systems correctly identified 88.4% and 98.9% of the 181 isolates, respectively. The Vitek MS RUO system was the least reliable, only correctly identifying 38.7% of the isolates to species level with several misidentifications and invalid results. The Bruker Biotyper system was very unreliable in the identification of species within the mitis group. Among 22 non-pneumococci isolates (S. mitis/S. oralis/S. pseudopneumoniae), Biotyper misidentified 21 of them as S. pneumoniae leading to a low sensitivity and low positive predictive value in these species. In contrast, the Vitek MS IVD demonstrated a better resolution for pneumococci and non-pneumococci despite the inability to distinguish between S. mitis/S. oralis. For more accurate species-level identification, further improvements in the VGS spectra databases are needed. Based on MALDI-TOF analysis and selected 16S rRNA gene plus gyrB genes sequencing, we designed a practical VGS identification algorithm.

  6. Using Matrix-Assisted Laser Desorption Ionization-Time of Flight (MALDI-TOF) Complemented with Selected 16S rRNA and gyrB Genes Sequencing to Practically Identify Clinical Important Viridans Group Streptococci (VGS).

    Science.gov (United States)

    Zhou, Menglan; Yang, Qiwen; Kudinha, Timothy; Zhang, Li; Xiao, Meng; Kong, Fanrong; Zhao, Yupei; Xu, Ying-Chun

    2016-01-01

    There are challenges in viridans group streptococci (VGS) identification especially for the mitis group. Few studies have investigated the performance of MALDI-TOF MS system in VGS identification. Using 16S rRNA gene and gyrB gene sequencing as a gold standard, the performance of two MALDI-TOF MS instruments in the identification of 181 VGS clinical isolates was studied. The Bruker Biotyper and Vitek MS IVD systems correctly identified 88.4% and 98.9% of the 181 isolates, respectively. The Vitek MS RUO system was the least reliable, only correctly identifying 38.7% of the isolates to species level with several misidentifications and invalid results. The Bruker Biotyper system was very unreliable in the identification of species within the mitis group. Among 22 non-pneumococci isolates (S. mitis/S. oralis/S. pseudopneumoniae), Biotyper misidentified 21 of them as S. pneumoniae leading to a low sensitivity and low positive predictive value in these species. In contrast, the Vitek MS IVD demonstrated a better resolution for pneumococci and non-pneumococci despite the inability to distinguish between S. mitis/S. oralis. For more accurate species-level identification, further improvements in the VGS spectra databases are needed. Based on MALDI-TOF analysis and selected 16S rRNA gene plus gyrB genes sequencing, we designed a practical VGS identification algorithm. PMID:27617008

  7. Different patient case mix by applying the 2003 SCCM/ESICM/ACCP/ATS/SIS sepsis definitions instead of the 1992 ACCP/SCCM sepsis definitions in surgical patients: a retrospective observational study

    Directory of Open Access Journals (Sweden)

    Kron Martina

    2009-05-01

    Full Text Available Abstract Background Revised consensus sepsis definitions have been published in 2003. The present study was performed to compare the prevalence of different stages of sepsis and ICU mortality rates and find out the case mix within the same collective of postoperative/posttraumatic patients applying either the original 1992 ACCP/SCCM or the revised 2003 SCCM/ESICM/ACCP/ATS/SIS sepsis definitions. Methods Retrospective observational single-centre study in surgical critically ill patients admitted to an University adult ICU. From 01/2007 to 12/2007, 742 patients were surveyed daily computer-assisted with respect to different stages of sepsis. Results Within the same patient collective, applying the 2003 definitions instead of the 1992 definitions, prevalence of severe sepsis (61 vs. 56 and septic shock (205 vs. 162 was higher (p Conclusion The prevalence and mortality rates of various sepsis severity stages differ if defined by the 1992 or the 2003 definitions. Thus, transferring conclusions drawn from data sets regarding severity of sepsis generated with the 1992 definitions to the same population applying the 2003 definitions may be misleading. The 1992 definitions may under-classify patients with severe sepsis.

  8. Blood groups systems

    Directory of Open Access Journals (Sweden)

    Ranadhir Mitra

    2014-01-01

    Full Text Available International Society of Blood Transfusion has recently recognized 33 blood group systems. Apart from ABO and Rhesus system, many other types of antigens have been noticed on the red cell membranes. Blood grouping and cross-matching is one of the few important tests that the anaesthesiologist orders during perioperative period. Hence, a proper understanding of the blood group system, their clinical significance, typing and cross-matching tests, and current perspective are of paramount importance to prevent transfusion-related complications. Nonetheless, the knowledge on blood group system is necessary to approach blood group-linked diseases which are still at the stage of research. This review addresses all these aspects of the blood groups system.

  9. Blood groups systems.

    Science.gov (United States)

    Mitra, Ranadhir; Mishra, Nitasha; Rath, Girija Prasad

    2014-09-01

    International Society of Blood Transfusion has recently recognized 33 blood group systems. Apart from ABO and Rhesus system, many other types of antigens have been noticed on the red cell membranes. Blood grouping and cross-matching is one of the few important tests that the anaesthesiologist orders during perioperative period. Hence, a proper understanding of the blood group system, their clinical significance, typing and cross-matching tests, and current perspective are of paramount importance to prevent transfusion-related complications. Nonetheless, the knowledge on blood group system is necessary to approach blood group-linked diseases which are still at the stage of research. This review addresses all these aspects of the blood groups system. PMID:25535412

  10. Hydra groups

    CERN Document Server

    Dison, Will

    2010-01-01

    We give examples of CAT(0), biautomatic, free-by-cyclic, one-relator groups which have finite-rank free subgroups of huge (Ackermannian) distortion. This leads to elementary examples of groups whose Dehn functions are similarly extravagant. This behaviour originates in manifestations of Hercules-versus-the-hydra battles in string-rewriting.

  11. Paying physician group practices for quality: A statewide quasi-experiment.

    Science.gov (United States)

    Conrad, Douglas A; Grembowski, David; Perry, Lisa; Maynard, Charles; Rodriguez, Hector; Martin, Diane

    2013-12-01

    This article presents the results of a unique quasi-experiment of the effects of a large-scale pay-for-performance (P4P) program implemented by a leading health insurer in Washington state during 2001-2007. The authors received external funding to provide an objective impact evaluation of the program. The program was unique in several respects: (1) It was designed dynamically, with two discrete intervention periods-one in which payment incentives were based on relative performance (the "contest" period) and a second in which payment incentives were based on absolute performance compared to achievable benchmarks. (2) The program was designed in collaboration with large multispecialty group practices, with an explicit run-in period to test the quality metrics. Public reporting of the quality scorecard for all participating medical groups was introduced 1 year before the quality incentive payment program's inception, and continued throughout 2002-2007. (3) The program was implemented in stages with distinct medical groups. A control group of comparable group practices also was assembled, and difference-in-differences methodology was applied to estimate program effects. Case mix measures were included in all multivariate analyses. The regression design permitted a contrast of intervention effects between the "contest" approach in the sub-period of 2003-2004 and the absolute standard, "achievable benchmarks of care" approach in sub-period 2005-2007. Most of the statistically significant quality incentive program coefficients were small and negative (opposite to program intent). A consistent pattern of differential intervention impact in the sub-periods did not emerge. Cumulatively, the probit regression estimates indicate that neither the quality scorecard nor the quality incentive payment program had a significant positive effect on general clinical quality. Based on key informant interviews with medical leaders, practicing physicians, and administrators of the

  12. The new final Clinical Skills examination in human medicine in Switzerland: Essential steps of exam development, implementation and evaluation, and central insights from the perspective of the national Working Group

    Directory of Open Access Journals (Sweden)

    Berendonk, Christoph

    2015-10-01

    Full Text Available Objective: Since 2011, the new national final examination in human medicine has been implemented in Switzerland, with a structured clinical-practical part in the OSCE format. From the perspective of the national Working Group, the current article describes the essential steps in the development, implementation and evaluation of the Federal Licensing Examination Clinical Skills (FLE CS as well as the applied quality assurance measures. Finally, central insights gained from the last years are presented. Methods: Based on the principles of action research, the FLE CS is in a constant state of further development. On the foundation of systematically documented experiences from previous years, in the Working Group, unresolved questions are discussed and resulting solution approaches are substantiated (planning, implemented in the examination (implementation and subsequently evaluated (reflection. The presented results are the product of this iterative procedure.Results: The FLE CS is created by experts from all faculties and subject areas in a multistage process. The examination is administered in German and French on a decentralised basis and consists of twelve interdisciplinary stations per candidate. As important quality assurance measures, the national Review Board (content validation and the meetings of the standardised patient trainers (standardisation have proven worthwhile. The statistical analyses show good measurement reliability and support the construct validity of the examination. Among the central insights of the past years, it has been established that the consistent implementation of the principles of action research contributes to the successful further development of the examination.Conclusion: The centrally coordinated, collaborative-iterative process, incorporating experts from all faculties, makes a fundamental contribution to the quality of the FLE CS. The processes and insights presented here can be useful for others planning a

  13. Group Grammar

    Science.gov (United States)

    Adams, Karen

    2015-01-01

    In this article Karen Adams demonstrates how to incorporate group grammar techniques into a classroom activity. In the activity, students practice using the target grammar to do something they naturally enjoy: learning about each other.

  14. MUYANG GROUP

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    @@ With its headquarters in the historic city of Yangzhou,Jiangsu Muyang Group Co.,Ltd has since its founding in 1967 grown into a well-known group corporation whose activities cover research&development.project design,manufacturing,installation and services in a multitude of industries including feed machinery and engineering,storage engineering,grain machinery and engineering,environmental protection,conveying equipment and automatic control systems.

  15. Abelian groups

    CERN Document Server

    Fuchs, László

    2015-01-01

    Written by one of the subject’s foremost experts, this book focuses on the central developments and modern methods of the advanced theory of abelian groups, while remaining accessible, as an introduction and reference, to the non-specialist. It provides a coherent source for results scattered throughout the research literature with lots of new proofs. The presentation highlights major trends that have radically changed the modern character of the subject, in particular, the use of homological methods in the structure theory of various classes of abelian groups, and the use of advanced set-theoretical methods in the study of undecidability problems. The treatment of the latter trend includes Shelah’s seminal work on the undecidability in ZFC of Whitehead’s Problem; while the treatment of the former trend includes an extensive (but non-exhaustive) study of p-groups, torsion-free groups, mixed groups, and important classes of groups arising from ring theory. To prepare the reader to tackle these topics, th...

  16. Clinical Significance of Screening of Rh-negative Blood Group and Detection of Irregular Antibody%Rh阴性血型筛查及不规则抗体检测的临床意义

    Institute of Scientific and Technical Information of China (English)

    李岚; 伍昌林; 党鑫堂; 董洪强; 朱奕

    2011-01-01

    目的 通过Rh阴性血型筛查及不规则抗体的检测,对抗体阳性的Rh阴性患者选择相合的血液输注,并分析其临床意义.方法 采用微柱凝集法对363例RhD阴性输血患者进行抗体筛查及Rh血型鉴定,选择Rh因子相合的血液输注,对有抗-c和抗-e抗体Rh阴性患者在血源紧缺的情况下,选择O型ccdEE和CCdee表型红细胞输注,观察临床输血效果.结果 在363例RhD阴性患者中,不规则抗体阳性21例,其中抗-D抗体5例,抗-E抗体8例,抗-c抗体3例,抗-c、E抗体2例,抗-C抗体2例,抗-e抗体1例,对存在不规则抗体的患者选择Rh因子相合的血液输注,临床效果良好.结论 根据抗体筛查及Rh血型鉴定结果,选择Ph因子相合的血液输注,可避免不规则抗体的产生,提高临床输血的有效性,减少输血不良反应的发生.%Objective To choose the matching blood to Rh-negative patients who were positive for irregular antibody by the screening of Rh-negative blood group and the detection of irregular antibody, and analyze its clinical significance.Methods A total of 363 RhD-negative patients were subjected to antibody screening and Rh blood grouping by micro-column agglutination method,based on which the Rh factor-matched blood was selected for transfusion.For lack of matched blood source, the RhD-negative patients with anti-c and anti-e antibodies were transfused with erythrocytes group O of ccdEE and CCdee phenotypes.Results Of the 363 RhD-negative patients, 21 were positive for irregular antibody, including 5 for anti-D, 8 for anti-E, 3 for anti-c, 2 for anti-c and E,2 for anti-C and 1 for anti-e.The patients with irregular antibodies were transfused with selected Rh factor-matched blood, and sarisfactory clinical efficacy was observed.Conclusion By transfusion with Rh factor-matched blood selected based on antibody screening and Rh blood grouping, the production of irregular antibodies was avoided, the efficacy of clinical blood transfusion was

  17. Group dynamics.

    Science.gov (United States)

    Scandiffio, A L

    1990-12-01

    Group dynamics play a significant role within any organization, culture, or unit. The important thing to remember with any of these structures is that they are made up of people--people with different ideas, motivations, background, and sometimes different agendas. Most groups, formal or informal, look for a leader in an effort to maintain cohesiveness of the unit. At times, that cultural bond must be developed; once developed, it must be nurtured. There are also times that one of the group no longer finds the culture comfortable and begins to act out behaviorally. It is these times that become trying for the leader as she or he attempts to remain objective when that which was once in the building phase of group cohesiveness starts to fall apart. At all times, the manager must continue to view the employee creating the disturbance as an integral part of the group. It is at this time that it is beneficial to perceive the employee exhibiting problem behaviors as a special employee, as one who needs the benefit of your experience and skills, as one who is still part of the group. It is also during this time that the manager should focus upon her or his own views in the area of power, communication, and the corporate culture of the unit that one has established before attempting to understand another's point of view. Once we understand our own motivation and accept ourselves, it is then that we may move on to offer assistance to another. Once we understand our insecurities recognizing staff dysfunction as a symptom of system dysfunction will not be so threatening to the concept of the manager that we perceive ourselves to be. It takes a secure person to admit that she or he favors staff before deciding to do something to change things. The important thing to know is that it can be done. The favored staff can find a new way of relating to others, the special employee can find new modes of behavior (and even find self-esteem in the process), the group can find new ways

  18. Group dynamics.

    Science.gov (United States)

    Scandiffio, A L

    1990-12-01

    Group dynamics play a significant role within any organization, culture, or unit. The important thing to remember with any of these structures is that they are made up of people--people with different ideas, motivations, background, and sometimes different agendas. Most groups, formal or informal, look for a leader in an effort to maintain cohesiveness of the unit. At times, that cultural bond must be developed; once developed, it must be nurtured. There are also times that one of the group no longer finds the culture comfortable and begins to act out behaviorally. It is these times that become trying for the leader as she or he attempts to remain objective when that which was once in the building phase of group cohesiveness starts to fall apart. At all times, the manager must continue to view the employee creating the disturbance as an integral part of the group. It is at this time that it is beneficial to perceive the employee exhibiting problem behaviors as a special employee, as one who needs the benefit of your experience and skills, as one who is still part of the group. It is also during this time that the manager should focus upon her or his own views in the area of power, communication, and the corporate culture of the unit that one has established before attempting to understand another's point of view. Once we understand our own motivation and accept ourselves, it is then that we may move on to offer assistance to another. Once we understand our insecurities recognizing staff dysfunction as a symptom of system dysfunction will not be so threatening to the concept of the manager that we perceive ourselves to be. It takes a secure person to admit that she or he favors staff before deciding to do something to change things. The important thing to know is that it can be done. The favored staff can find a new way of relating to others, the special employee can find new modes of behavior (and even find self-esteem in the process), the group can find new ways

  19. Dr. Irvin Yalom Discusses Group Psychotherapy.

    Science.gov (United States)

    Forester-Miller, Holly

    1989-01-01

    In this interview, Dr. Irvin Yalom, director of the Adult Psychiatry Clinic at Stanford University School of Medicine, discusses his beginnings as a group psychotherapist, current issues in group work, and the future of group work. (Author/TE)

  20. Effectiveness of a clinical pathway for acute stroke care in a district general hospital: an audit

    Directory of Open Access Journals (Sweden)

    Siegert Richard J

    2006-02-01

    Full Text Available Abstract Background Organised stroke care saves lives and reduces disability. A clinical pathway might be a form of organised stroke care, but the evidence for the effectiveness of this model of care is limited. Methods This study was a retrospective audit study of consecutive stroke admissions in the setting of an acute general medical unit in a district general hospital. The case-notes of patients admitted with stroke for a 6-month period before and after introduction of the pathway, were reviewed to determine data on length of stay, outcome, functional status, (Barthel Index, BI and Modified Rankin Scale, MRS, Oxfordshire Community Stroke Project (OCSP sub-type, use of investigations, specific management issues and secondary prevention strategies. Logistic regression was used to adjust for differences in case-mix. Results N = 77 (prior to the pathway and 76 (following the pathway. The median (interquartile range, IQR age was 78 years (67.75–84.25, 88% were European NZ and 37% were male. The median (IQR BI at admission for the pre-pathway group was less than the post-pathway group: 6 (0–13.5 vs. 10 (4–15.5, p = 0.018 but other baseline variables were statistically similar. There were no significant differences between any of the outcome or process of care variables, except that echocardiograms were done less frequently after the pathway was introduced. A good outcome (MRS Conclusion A clinical pathway for acute stroke management appeared to have no benefit for the outcome or processes of care and may even have been associated with worse outcomes. These data support the conclusions of a recent Cochrane review.

  1. Group Anonymity

    CERN Document Server

    Chertov, Oleg; 10.1007/978-3-642-14058-7_61

    2010-01-01

    In recent years the amount of digital data in the world has risen immensely. But, the more information exists, the greater is the possibility of its unwanted disclosure. Thus, the data privacy protection has become a pressing problem of the present time. The task of individual privacy-preserving is being thoroughly studied nowadays. At the same time, the problem of statistical disclosure control for collective (or group) data is still open. In this paper we propose an effective and relatively simple (wavelet-based) way to provide group anonymity in collective data. We also provide a real-life example to illustrate the method.

  2. Lego Group

    DEFF Research Database (Denmark)

    Møller Larsen, Marcus; Pedersen, Torben; Slepniov, Dmitrij

    2010-01-01

    The last years’ rather adventurous journey from 2004 to 2009 had taught the fifth-largest toy-maker in the world - the LEGO Group - the importance of managing the global supply chain effectively. In order to survive the largest internal financial crisis in its roughly 70 years of existence......, the management had, among many initiatives, decided to offshore and outsource a major chunk of its production to Flextronics. In this pursuit of rapid cost-cutting sourcing advantages, the LEGO Group planned to license out as much as 80 per cent of its production besides closing down major parts...

  3. Group Learning.

    Science.gov (United States)

    Black, Susan

    1992-01-01

    Research suggests that cooperative learning works best when students are first taught group-processing skills, such as leadership, decision making, communication, trust building, and conflict management. Inadequate teacher training and boring assignments can torpedo cooperative learning efforts. Administrators should reassure teachers with…

  4. Tectaria group

    NARCIS (Netherlands)

    Holttum, R.E.

    1991-01-01

    Polypodiaceae subfam. Dryopteridoideae section A, auct.: C. Chr. in Verdoorn, Man. Pteridol. (1938) 543, p.p. Aspidiaceae tribe Aspidieae auct.: Ching, Sunyatsenia 5 (1940) 250, excl. Lomariopsis and related genera. — Aspidiaceae, group of Ctenitis Copel., Gen. Fil. (1947) 153. Aspidiaceae auct.: Pi

  5. Prevention of cardiovascular disease guided by total risk estimations - challenges and opportunities for practical implementation: highlights of a CardioVascular Clinical Trialists (CVCT) Workshop of the ESC Working Group on CardioVascular Pharmacology and Drug Therapy.

    LENUS (Irish Health Repository)

    Zannad, Faiez

    2011-11-03

    This paper presents a summary of the potential practical and economic barriers to implementation of primary prevention of cardiovascular disease guided by total cardiovascular risk estimations in the general population. It also reviews various possible solutions to overcome these barriers. The report is based on discussion among experts in the area at a special CardioVascular Clinical Trialists workshop organized by the European Society of Cardiology Working Group on Cardiovascular Pharmacology and Drug Therapy that took place in September 2009. It includes a review of the evidence in favour of the \\'treat-to-target\\' paradigm, as well as potential difficulties with this approach, including the multiple pathological processes present in high-risk patients that may not be adequately addressed by this strategy. The risk-guided therapy approach requires careful definitions of cardiovascular risk and consideration of clinical endpoints as well as the differences between trial and \\'real-world\\' populations. Cost-effectiveness presents another issue in scenarios of finite healthcare resources, as does the difficulty of documenting guideline uptake and effectiveness in the primary care setting, where early modification of risk factors may be more beneficial than later attempts to manage established disease. The key to guideline implementation is to improve the quality of risk assessment and demonstrate the association between risk factors, intervention, and reduced event rates. In the future, this may be made possible by means of automated data entry and various other measures. In conclusion, opportunities exist to increase guideline implementation in the primary care setting, with potential benefits for both the general population and healthcare resources.

  6. Is there a potential application of a fermented nutraceutical in acute respiratory illnesses? An in-vivo placebo-controlled, cross-over clinical study in different age groups of healthy subjects.

    Science.gov (United States)

    Marotta, F; Naito, Y; Jain, S; Lorenzetti, A; Soresi, V; Kumari, A; Carrera Bastos, P; Tomella, C; Yadav, H

    2012-01-01

    The role of oxidants in viral diseases is fairly complex because it includes metabolic regulation both of host metabolism and viral replication. However, a role for reactive oxygen species (ROS) and reactive nitrogen species (RNS) as mediators of virus-induced lung damage is supported by studies and antioxidants can thus be expected to act at many different levels. The aim of the present pilot study was to test an antioxidant nutraceutical approach on some relevant immunological parameters known to be affected in common seasonal respiratory tract infection. The study population consisted of 90 sedentary healthy patients, previously selected as being GSTM1-positive, divided into three groups: A) 20-40 years; B) 41-65 years; B) over 65 years. Each patients was administered a life style and dietary questionnaire. Subjects were supplemented for 6 weeks with either 9g/day (4.5g twice a day sublingually) of a fermented papaya preparation (Osato Research Institute, Gifu, Japan) or placebo. After a further month period of wash out, subjects were treated again in a crossover manner. Parameters checked were as follows: routine blood tests with WBC formula, saliva flow rate and secretary IgA and lysozyme production and redox gene expression of Phase II enzyme and SOD from upper airways cells (from nasal lavage). Salivary secretion rate showed an age-related decline and was significantly increased by FPP supplementation only in the youngest age-group (p less than 0.05). Subjects treated with FPP showed a significantly higher lever of IgA and lisozyme production., irrespective of age group while their baseline production was significantly lower in the oldest age-group as compared to the youngest one (C vs A, p less than 0.05). FPP treatment brought about a significant upregulation of all phase II enzyme and SOD gene expression tested in nasal lavage cells. In conclusion, FPP supplementation during 1 month resulted in higher salivary IgA and increase in phase II and SOD enzyme

  7. What differences are detected by superiority trials or ruled out by noninferiority trials? A cross-sectional study on a random sample of two-hundred two-arms parallel group randomized clinical trials

    Directory of Open Access Journals (Sweden)

    Courvoisier Delphine S

    2010-10-01

    Full Text Available Abstract Background The smallest difference to be detected in superiority trials or the largest difference to be ruled out in noninferiority trials is a key determinant of sample size, but little guidance exists to help researchers in their choice. The objectives were to examine the distribution of differences that researchers aim to detect in clinical trials and to verify that those differences are smaller in noninferiority compared to superiority trials. Methods Cross-sectional study based on a random sample of two hundred two-arm, parallel group superiority (100 and noninferiority (100 randomized clinical trials published between 2004 and 2009 in 27 leading medical journals. The main outcome measure was the smallest difference in favor of the new treatment to be detected (superiority trials or largest unfavorable difference to be ruled out (noninferiority trials used for sample size computation, expressed as standardized difference in proportions, or standardized difference in means. Student t test and analysis of variance were used. Results The differences to be detected or ruled out varied considerably from one study to the next; e.g., for superiority trials, the standardized difference in means ranged from 0.007 to 0.87, and the standardized difference in proportions from 0.04 to 1.56. On average, superiority trials were designed to detect larger differences than noninferiority trials (standardized difference in proportions: mean 0.37 versus 0.27, P = 0.001; standardized difference in means: 0.56 versus 0.40, P = 0.006. Standardized differences were lower for mortality than for other outcomes, and lower in cardiovascular trials than in other research areas. Conclusions Superiority trials are designed to detect larger differences than noninferiority trials are designed to rule out. The variability between studies is considerable and is partly explained by the type of outcome and the medical context. A more explicit and rational approach to

  8. COMMUNICATIONS GROUP

    CERN Multimedia

    L. Taylor

    2011-01-01

    The CMS Communications Group, established at the start of 2010, has been busy in all three areas of its responsibility: (1) Communications Infrastructure, (2) Information Systems, and (3) Outreach and Education. Communications Infrastructure There are now 55 CMS Centres worldwide that are well used by physicists working on remote CMS shifts, Computing operations, data quality monitoring, data analysis and outreach. The CMS Centre@CERN in Meyrin, is the centre of the CMS offline and computing operations, hosting dedicated analysis efforts such as during the CMS Heavy Ion lead-lead running. With a majority of CMS sub-detectors now operating in a “shifterless” mode, many monitoring operations are now routinely performed from there, rather than in the main Control Room at P5. The CMS Communications Group, CERN IT and the EVO team are providing excellent videoconferencing support for the rapidly-increasing number of CMS meetings. In parallel, CERN IT and ...

  9. Group therapy

    International Nuclear Information System (INIS)

    Full text: In his review 'Genesis of Unified Gauge Theories' at the symposium in Honour of Abdus Salam (June, page 23), Tom Kibble of Imperial College, London, looked back to the physics events around Salam from 1959-67. He described how, in the early 1960s, people were pushing to enlarge the symmetry of strong interactions beyond the SU(2) of isospin and incorporate the additional strangeness quantum number. Kibble wrote - 'Salam had students working on every conceivable symmetry group. One of these was Yuval Ne'eman, who had the good fortune and/or prescience to work on SU(3). From that work, and of course from the independent work of Murray Gell- Mann, stemmed the Eightfold Way, with its triumphant vindication in the discovery of the omega-minus in 1964.' Yuval Ne'eman writes - 'I was the Defence Attaché at the Israeli Embassy in London and was admitted by Salam as a part-time graduate student when I arrived in 1958. I started research after resigning from the Embassy in May 1960. Salam suggested a problem: provide vector mesons with mass - the problem which was eventually solved by Higgs, Guralnik, Kibble,.... (as described by Kibble in his article). I explained to Salam that I had become interested in symmetry. Nobody at Imperial College at the time, other than Salam himself, was doing anything in groups, and attention further afield was focused on the rotation - SO(N) - groups. Reacting to my own half-baked schemes, Salam told me to forget about the rotation groups he taught us, and study group theory in depth, directing me to Eugene Dynkin's classification of Lie subalgebras, about which he had heard from Morton Hamermesh. I found Dynkin incomprehensible without first learning about Lie algebras from Henri Cartan's thesis, which luckily had been reproduced by Dynkin in his 1946 thesis, using his diagram method. From a copy of a translation of Dynkin's thesis which I found in the British Museum Library, I

  10. Local Group

    Science.gov (United States)

    Mateo, M.; Murdin, P.

    2000-11-01

    Not long after EDWIN HUBBLE established that galaxies are `island universes' similar to our home galaxy, the MILKY WAY, he realized that a few of these external galaxies are considerably closer to us than any others. In 1936 he first coined the term `Local Group' in his famous book The Realm of the Nebulae to identify our nearest galactic neighbors. More than 60 yr later, the galaxies of the Loca...

  11. Anthropometric differences between HIV-infected individuals prior to antiretroviral treatment and the general population from 1998-2007: the AIDS Clinical Trials Group Longitudinal Linked Randomized Trials (ALLRT cohort and NHANES.

    Directory of Open Access Journals (Sweden)

    Benjamin E Atkinson

    Full Text Available OBJECTIVE: To assess differences in body circumferences and body mass index (BMI, kg/m(2 between antiretroviral treatment (ART naïve HIV-infected and HIV-uninfected persons. METHODS: Waist, arm, and thigh circumferences and BMI were measured within the ALLRT and NHANES cohorts between 1998 and 2007. ALLRT is a prospective, longitudinal study of U.S. participants enrolled in randomized HIV treatment studies conducted by the AIDS Clinical Trials Group (ACTG. NHANES is a representative group of the US population. The cohorts were analyzed in two time periods, to account for trends towards increased adiposity. Anthropometrics were displayed in percentiles by age and sex. Multiple linear regression models examined differences between cohorts. RESULTS: ALLRT had more males (82% versus 48%, p<0.0001, more black participants (32% versus 23%, p<0.0001, and less Hispanics (21% versus 30%, p<0.0001 than NHANES. Mean BMI was smaller in ALLRT males and females compared to NHANES by 1.6-2.4 kg/m(2 (p<0.0001. Mean waist and arm circumferences in both sexes and time periods were significantly smaller in ALLRT than in NHANES (p<0.0001. Mean thigh circumference in ALLRT was also smaller than NHANES among males (p<0.0001 in both time periods and females (p = 0.01 in the early time period. CONCLUSIONS: Differences in anthropometrics existed prior to ART initiation, in this large national cohort of HIV-infected individuals, compared to a representative HIV-uninfected cohort, indicating that HIV and its complications have important effects on body shape. Further longitudinal examination of anthropometrics in this HIV-infected cohort may provide additional insight into disease risk. TRIAL REGISTRATION: NCT00001137 at www.clinicaltrials.gov.

  12. Molecular and cellular analysis of the DNA repair defect in a patient in Xeroderma pigmentosum complementation group D who has the clinical features of Xeroderma pigmentosum and Cockayne syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Broughton, B.C.; Thompson, A.F.; Harcourt, S.A.; Cole, J.; Arlett, C.F.; Lehmann, A.R. [Univ. of Sussex, Brighton (United Kingdom); Vermeulen, W.; Hoeijmakers, J.H.J. [Erasmus Univ., Rotterdam (United Kingdom); Botta, E.; Stefanini, M. [Istituto di Genetica, Pavia (Italy)] [and others

    1995-01-01

    Xeroderma pigmentosum (XP) and Cockayne syndrome (CS) are quite distinct genetic disorders that are associated with defects in excision repair of UV-induced DNA damage. A few patients have been described previously with the clinical features of both disorders. In this paper we describe an individual in this category who has unusual cellular responses to UV light. We show that his cultured fibroblasts and lymphocytes are extremely sensitive to irradiation with UV-C, despite a level of nucleotide excision repair that is 30%-40% that of normal cells. The deficiency is assigned to the XP-D complementation group, and we have identified two causative mutations in the XPD gene: a gly{yields}arg change at amino acid 675 in the allele inherited from the patient`s mother and a -1 frameshift at amino acid 669 in the allele inherited from his father. These mutations are in the C-terminal 20% of the 760-amino-acid XPD protein, in a region where we have recently identified several mutations in patients with trichothiodystrophy. 44 refs., 5 figs., 2 tabs.

  13. Primary central nervous system lymphomas in 72 immunocompetent patients: pathologic findings and clinical correlations. Groupe Ouest Est d'étude des Leucénies et Autres Maladies du Sang (GOELAMS)

    Science.gov (United States)

    Camilleri-Broët, S; Martin, A; Moreau, A; Angonin, R; Hénin, D; Gontier, M F; Rousselet, M C; Caulet-Maugendre, S; Cuillière, P; Lefrancq, T; Mokhtari, K; Morcos, M; Broët, P; Kujas, M; Hauw, J J; Desablens, B; Raphaël, M

    1998-11-01

    We reviewed 72 primary central nervous system lymphomas occurring in immunocompetent patients. The cases were reviewed for clinical data, histology, immunophenotype, bcl-2 and p53 expression, and Epstein-Barr virus association. Follow-up was available for 40 patients included in the Groupe Ouest Est d'étude des Leucénies et Autres Maladies du Sang (GOELAMS) lymphomes cérébraux primitifs (LCP 88) trial. Each diagnosis, requiring a consensus among at least 3 pathologists, was performed according to the recent Revised European-American Lymphoma classification and equivalents in the updated Kiel classification. Tumors were predominantly classified as diffuse large B-cell lymphomas. There were 3 T-cell lymphomas and 1 Hodgkin lymphoma. The proteins bcl-2 and p53 were expressed in 35% and 16% of the tested cases, respectively. Epstein-Barr virus was not found by in situ hybridization except in the case classfied as a cerebral localization of Hodgkin disease. No significant association was found between subtypes, bcl-2 or p53 expression, and patient survival. From the standpoint of their biologic characteristics, primary central nervous system lymphomas are very similar to systemic diffuse large B-cell lymphomas. In contrast to AIDS-related primary central nervous system lymphomas, primary central nervous system lymphomas are rarely associated with Epstein-Barr virus and in immunocompetent patients they express bcl-2 at a relatively low rate.

  14. Recommended immunization schedules for adults: Clinical practice guidelines by the Escmid Vaccine Study Group (EVASG), European Geriatric Medicine Society (EUGMS) and the World Association for Infectious Diseases and Immunological Disorders (WAidid).

    Science.gov (United States)

    Esposito, Susanna; Bonanni, Paolo; Maggi, Stefania; Tan, Litjan; Ansaldi, Filippo; Lopalco, Pier Luigi; Dagan, Ron; Michel, Jean-Pierre; van Damme, Pierre; Gaillat, Jacques; Prymula, Roman; Vesikari, Timo; Mussini, Cristina; Frank, Uwe; Osterhaus, Albert; Celentano, Lucia Pastore; Rossi, Marta; Guercio, Valentina; Gavazzi, Gaetan

    2016-07-01

    Rapid population aging has become a major challenge in the industrialized world and progressive aging is a key reason for making improvement in vaccination a cornerstone of public health strategy. An increase in age-related disorders and conditions is likely to be seen in the near future, and these are risk factors for the occurrence of a number of vaccine-preventable diseases. An improvement in infectious diseases prevention specifically aimed at adults and the elderly can therefore also decrease the burden of these chronic conditions by reducing morbidity, disability, hospital admissions, health costs, mortality rates and, perhaps most importantly, by improving the quality of life. Among adults, it is necessary to identify groups at increased risk of vaccine-preventable diseases and highlight the epidemiological impact and benefits of vaccinations using an evidence-based approach. This document provides clinical practice guidance on immunization for adults in order to provide recommendations for decision makers and healthcare workers in Europe. Although immunization is considered one of the most impactful and cost-effective public health measures that can be undertaken, vaccination coverage rates among adults are largely lower than the stated goal of ≥ 95% among adults, and stronger efforts are needed to increase coverage in this population. Active surveillance of adult vaccine-preventable diseases, determining the effectiveness of the vaccines approved for marketing in the last 5 y, the efficacy and safety of vaccines in immunocompromised patients, as well as in pregnant women, represent the priorities for future research. PMID:27135390

  15. First-Stage Development and Validation of a Web-Based Automated Dietary Modeling Tool: Using Constraint Optimization Techniques to Streamline Food Group and Macronutrient Focused Dietary Prescriptions for Clinical Trials

    Science.gov (United States)

    Morrison, Evan; Sullivan, Emma; Dam, Hoa Khanh

    2016-01-01

    Background Standardizing the background diet of participants during a dietary randomized controlled trial is vital to trial outcomes. For this process, dietary modeling based on food groups and their target servings is employed via a dietary prescription before an intervention, often using a manual process. Partial automation has employed the use of linear programming. Validity of the modeling approach is critical to allow trial outcomes to be translated to practice. Objective This paper describes the first-stage development of a tool to automatically perform dietary modeling using food group and macronutrient requirements as a test case. The Dietary Modeling Tool (DMT) was then compared with existing approaches to dietary modeling (manual and partially automated), which were previously available to dietitians working within a dietary intervention trial. Methods Constraint optimization techniques were implemented to determine whether nonlinear constraints are best suited to the development of the automated dietary modeling tool using food composition and food consumption data. Dietary models were produced and compared with a manual Microsoft Excel calculator, a partially automated Excel Solver approach, and the automated DMT that was developed. Results The web-based DMT was produced using nonlinear constraint optimization, incorporating estimated energy requirement calculations, nutrition guidance systems, and the flexibility to amend food group targets for individuals. Percentage differences between modeling tools revealed similar results for the macronutrients. Polyunsaturated fatty acids and monounsaturated fatty acids showed greater variation between tools (practically equating to a 2-teaspoon difference), although it was not considered clinically significant when the whole diet, as opposed to targeted nutrients or energy requirements, were being addressed. Conclusions Automated modeling tools can streamline the modeling process for dietary intervention trials

  16. COMMUNICATIONS GROUP

    CERN Multimedia

    L. Taylor

    2010-01-01

    The CMS Communications Group, established at the start of 2010, has been strengthening the activities in all three areas of its responsibility: (1) Communications Infrastructure, (2) Information Systems, and (3) Outreach and Education. Communications Infrastructure The Communications Group has invested a lot of effort to support the operations needs of CMS. Hence, the CMS Centres where physicists work on remote CMS shifts, Data Quality Monitoring, and Data Analysis are running very smoothly. There are now 55 CMS Centres worldwide, up from just 16 at the start of CMS data-taking. The latest to join are Imperial College London, the University of Iowa, and the Università di Napoli. The CMS Centre@CERN in Meyrin, which is now full repaired after the major flooding at the beginning of the year, has been at the centre of CMS offline and computing operations, most recently hosting a large fraction of the CMS Heavy Ion community during the lead-lead run. A number of sub-detector shifts can now take pla...

  17. COMMUNICATIONS GROUP

    CERN Multimedia

    L. Taylor

    2011-01-01

    The CMS Communications Group has been busy in all three areas of its responsibility: (1) Communications Infrastructure, (2) Information Systems, and (3) Outreach and Education. Communications Infrastructure The 55 CMS Centres worldwide are well used by physicists working on remote CMS shifts, Computing operations, data quality monitoring, data analysis and outreach. The CMS Centre@CERN in Meyrin, is the centre of the CMS Offline and Computing operations, and a number of subdetector shifts can now take place there, rather than in the main Control Room at P5. A new CMS meeting room has been equipped for videoconferencing in building 42, next to building 40. Our building 28 meeting room and the facilities at P5 will be refurbished soon and plans are underway to steadily upgrade the ageing equipment in all 15 CMS meeting rooms at CERN. The CMS evaluation of the Vidyo tool indicates that it is not yet ready to be considered as a potential replacement for EVO. The Communications Group provides the CMS-TV (web) cha...

  18. The inter-examiner reliability of standardized manual palpation for the identification of clinically relevant myofascial triggerpoints

    DEFF Research Database (Denmark)

    Myburgh, Corrie; Lauridsen, Henrik Hein; Larsen, Anders Holsgaard;

    A clinical diagnosis of Myofascial Pain Syndrome (MPS) requires manual palpation for the identification of at least one clinically relevant trigger point (TP). However, few comparable, high quality studies exist regarding the robustness of TP examination. Our aim was to determine the inter....../absence of clinically relevant TP(s) using clinician global assessment (GA). A random case mix of 81 female participants was examined, 14 being asymptomatic and the remainder suffering from neck/shoulder pain. Examiners received psychomotor training and video analysis feedback provided prior to and during the study...

  19. Clinical analysis of neonatal purulent meningitis caused by group B streptococcus%无乳链球菌致新生儿脑膜炎的临床特点分析

    Institute of Scientific and Technical Information of China (English)

    赵宁; 王萍; 魏谋; 卢伟能; 贺娟; 古锐; 江翠婵

    2015-01-01

    目的 分析新生儿无乳链球菌(Group B Streptococcus,GBS)脑膜炎的临床特点及治疗转归情况,为其早期诊断和科学治疗提供理论依据.方法 对2011年11月至2014年4月广州市妇女儿童医疗中心收治的19例新生儿GBS脑膜炎和22例大肠埃希菌脑膜炎患儿的临床资料、实验室检测结果和治疗转归情况进行回顾性分析.结果 GBS脑膜炎患儿占细菌培养阳性新生儿化脓性脑膜炎病例的24.7% (19/77),早发型6例,平均发病时间(11.80±11.34)h,主要表现为气促呻吟;晚发型13例,平均发病时间(17.85±7.77)d,多以发热为初发临床症状.GBS脑膜炎患儿外周血C反应蛋白浓度显著高于大肠埃希菌脑膜炎患儿[(154.43±88.64) mg/L vs.(67.52±64.23) mg/L,P=0.001].GBS脑膜炎患儿平均住院时间和脑脊液异常恢复时间分别为(44.53±20.48)d和(41.50±17.85)d,均较大肠埃希菌脑膜炎患儿延长了10d,差异均有统计学意义(P均<0.05).结论 GBS脑膜炎临床表现非特异,住院时间和脑脊液恢复耗时长,预后欠佳.产前预防、早期发现、及时足量足疗程的青霉素治疗对新生儿GBS脑膜炎患儿非常重要.%Objective To explore the clinical characteristics and outcome of group B streptococcus (GBS) induced neonatal meningitis and to provide the guide for early diagnosis and appropriate treatment.Methods A retrospective chart review was performed.A total of 19 cases of neonatal purulent meningitis caused by GBS and 22 cases of neonatal purulent meningitis caused by Escherichia coli were identified in the NICU of Guangzhou Women and Children's Medical Center from Nov 1,2011 to Apr 31,2014.The clinical features,treatments and clinical turnover were analysed.Results GBS meningitis accounted for 24.7% (19/77) of total bacterial positive cultures of blood or cerebral spinal fluid.The average time of progression to early-onset GBS meningitis of 6 early-onset cases mainly complaining of anhelation and groan

  20. Cardiovascular group

    Science.gov (United States)

    Blomqvist, Gunnar

    1989-01-01

    As a starting point, the group defined a primary goal of maintaining in flight a level of systemic oxygen transport capacity comparable to each individual's preflight upright baseline. The goal of maintaining capacity at preflight levels would seem to be a reasonable objective for several different reasons, including the maintenance of good health in general and the preservation of sufficient cardiovascular reserve capacity to meet operational demands. It is also important not to introduce confounding variables in whatever other physiological studies are being performed. A change in the level of fitness is likely to be a significant confounding variable in the study of many organ systems. The principal component of the in-flight cardiovascular exercise program should be large-muscle activity such as treadmill exercise. It is desirable that at least one session per week be monitored to assure maintenance of proper functional levels and to provide guidance for any adjustments of the exercise prescription. Appropriate measurements include evaluation of the heart-rate/workload or the heart-rate/oxygen-uptake relationship. Respiratory gas analysis is helpful by providing better opportunities to document relative workload levels from analysis of the interrelationships among VO2, VCO2, and ventilation. The committee felt that there is no clear evidence that any particular in-flight exercise regimen is protective against orthostatic hypotension during the early readaptation phase. Some group members suggested that maintenance of the lower body muscle mass and muscle tone may be helpful. There is also evidence that late in-flight interventions to reexpand blood volume to preflight levels are helpful in preventing or minimizing postflight orthostatic hypotension.

  1. Group Work with Transgender Clients

    Science.gov (United States)

    Dickey, Lore M.; Loewy, Michael I.

    2010-01-01

    Drawing on the existing literature, the authors' research and clinical experiences, and the first author's personal journey as a member and leader of the transgender community, this article offers a brief history of group work with transgender clients followed by suggestions for group work with transgender clients from a social justice…

  2. COMMUNICATIONS GROUP

    CERN Multimedia

    L. Taylor

    2010-01-01

    The recently established CMS Communications Group, led by Lucas Taylor, has been busy in all three of its main are areas of responsibility: Communications Infrastructure, Information Systems, and Outreach and Education Communications Infrastructure The damage caused by the flooding of the CMS Centre@CERN on 21st December has been completely repaired and all systems are back in operation. Major repairs were made to the roofs, ceilings and one third of the floor had to be completely replaced. Throughout these works, the CMS Centre was kept operating and even hosted a major press event for first 7 TeV collisions, as described below. Incremental work behind the scenes is steadily improving the quality of the CMS communications infrastructure, particularly Webcasting, video conferencing, and meeting rooms at CERN. CERN/IT is also deploying a pilot service of a new videoconference tool called Vidyo, to assess whether it might provide an enhanced service at a lower cost, compared to the EVO tool currently in w...

  3. COMMUNICATIONS GROUP

    CERN Multimedia

    L. Taylor

    2011-01-01

    Communications Infrastructure The 55 CMS Centres worldwide are well used by physicists working on remote CMS shifts, Computing operations, data quality monitoring, data analysis and outreach. The CMS Centre@CERN in Meyrin is particularly busy at the moment, hosting about 50 physicists taking part in the heavy-ion data-taking and analysis. Three new CMS meeting room will be equipped for videoconferencing in early 2012: 40/5B-08, 42/R-031, and 28/S-029. The CMS-TV service showing LHC Page 1, CMS Page 1, etc. (http://cmsdoc.cern.ch/cmscc/projector/index.jsp) is now also available for mobile devices: http://cern.ch/mcmstv. Figure 12: Screenshots of CMS-TV for mobile devices Information Systems CMS has a new web site: (http://cern.ch/cms) using a modern web Content Management System to ensure content and links are managed and updated easily and coherently. It covers all CMS sub-projects and groups, replacing the iCMS internal pages. It also incorporates the existing CMS public web site (http:/...

  4. COMMUNICATIONS GROUP

    CERN Multimedia

    L. Taylor

    2012-01-01

      Outreach and Education We are fortunate that our research has captured the public imagination, even though this inevitably puts us under the global media spotlight, as we saw with the Higgs seminar at CERN in December, which had 110,000 distinct webcast viewers. The media interest was huge with 71 media organisations registering to come to CERN to cover the Higgs seminar, which was followed by a press briefing with the DG and Spokespersons. This event resulted in about 2,000 generally positive stories in the global media. For this seminar, the CMS Communications Group prepared up-to-date news and public material, including links to the CMS results, animations and event displays [http://cern.ch/go/Ch8thttp://cern.ch/go/Ch8t]. There were 44,000 page-views on the CMS public website, with the Higgs news article being by far the most popular item. CMS event displays from iSpy are fast becoming the iconic media images, featuring on numerous major news outlets (BBC, CNN, MSN...) as well as in the sci...

  5. RTOG Sarcoma Radiation Oncologists Reach Consensus on Gross Tumor Volume and Clinical Target Volume on Computed Tomographic Images for Preoperative Radiotherapy of Primary Soft Tissue Sarcoma of Extremity in Radiation Therapy Oncology Group Studies

    Energy Technology Data Exchange (ETDEWEB)

    Wang Dian, E-mail: dwang@mcw.edu [Medical College of Wisconsin, Milwaukee, WI (United States); Bosch, Walter [Washington University, St. Louis, MO (United States); Roberge, David [McGill University, Montreal, Quebec (Canada); Finkelstein, Steven E. [Moffitt Cancer Center, Tampa, FL (United States); Petersen, Ivy; Haddock, Michael [Mayo Clinic, Rochester, MN (United States); Chen, Yen-Lin E.; Saito, Naoyuki G. [Roswell Park Cancer Institute, Buffalo, NY (United States); Kirsch, David G. [Duke University, Durham, NC (United States); Hitchcock, Ying J. [University of Utah, Salt Lake City, UT (United States); Wolfson, Aaron H. [University of Miami Miller School of Medicine, Miami, FL (United States); DeLaney, Thomas F. [Massachusetts General Hospital, Boston, MA (United States)

    2011-11-15

    Objective: To develop a Radiation Therapy Oncology Group (RTOG) atlas delineating gross tumor volume (GTV) and clinical target volume (CTV) to be used for preoperative radiotherapy of primary extremity soft tissue sarcoma (STS). Methods and Materials: A consensus meeting was held during the RTOG meeting in January 2010 to reach agreement about GTV and CTV delineation on computed tomography (CT) images for preoperative radiotherapy of high-grade large extremity STS. Data were presented to address the local extension of STS. Extensive discussion ensued to develop optimal criteria for GTV and CTV delineation on CT images. Results: A consensus was reached on appropriate CT-based GTV and CTV. The GTV is gross tumor defined by T1 contrast-enhanced magnetic resonance images. Fusion of magnetic resonance and images is recommended to delineate the GTV. The CTV for high-grade large STS typically includes the GTV plus 3-cm margins in the longitudinal directions. If this causes the field to extend beyond the compartment, the field can be shortened to include the end of a compartment. The radial margin from the lesion should be 1.5 cm, including any portion of the tumor not confined by an intact fascial barrier, bone, or skin surface. Conclusion: The consensus on GTV and CTV for preoperative radiotherapy of high-grade large extremity STS is available as web-based images and in a descriptive format through the RTOG. This is expected to improve target volume consistency and allow for rigorous evaluation of the benefits and risks of such treatment.

  6. Design and validation of a qPCR assay for accurate detection and initial serogrouping of Legionella pneumophila in clinical specimens by the ESCMID Study Group for Legionella Infections (ESGLI).

    Science.gov (United States)

    Mentasti, M; Kese, D; Echahidi, F; Uldum, S A; Afshar, B; David, S; Mrazek, J; De Mendonça, R; Harrison, T G; Chalker, V J

    2015-07-01

    Prompt detection of Legionella pneumophila is essential for rapid investigation of legionellosis. Furthermore, as the majority of L. pneumophila infections are caused by serogroup 1 (sg1) strains, rapid identification of such strains can be critical in both routine and outbreak scenarios. The ESCMID Study Group for Legionella Infections (ESGLI) was established in 2012 and immediately identified as a priority the validation of a reliable, easy to perform and interpret, cost-effective qPCR assay to standardise the detection of L. pneumophila DNA amongst members. A novel L. pneumophila assay targeting the mip gene was designed and combined with previously published methodologies amplifying the sg1 marker (wzm) and the green fluorescent protein gene (gfp) internal process control. The resulting triplex assay was validated internationally on the three qPCR platforms used by the majority of European Legionella reference laboratories: ABI 7500 (Life Technologies), LightCycler 480 Instrument II (Roche) and Rotor-Gene Q (Qiagen). Clinical and EQA specimens were tested together with a large panel of strains (251 in total) to validate the assay. The assay proved to be 100% specific for L. pneumophila and sg1 DNA both in silico and in vitro. Efficiency values for mip and wzm assays ranged between 91.97 and 97.69%. Limit of detection values estimated with 95% confidence were adopted for mip and wzm assays on all three qPCR platforms. Inhibition was not observed. This study describes a robust assay that could be widely implemented to standardise the molecular detection of L. pneumophila among ESGLI laboratories and beyond. PMID:25851812

  7. HIV感染高危人群暴露前预防用药临床试验依从性分析%Pre-exposure prophylaxis for HIV high-risk groups: an analysis of clinical compliance

    Institute of Scientific and Technical Information of China (English)

    高菲菲; 黄文祥; 黄爱龙; 钟晓妮; 彭斌; 张燕; 梁浩; 邹云峰; 戴江红; 刘倩萍; 宋本莉

    2012-01-01

    To investigate the factors influencing the compliance of pre-exposure prophylaxis (PrEP) amonghigh-risk groups of human immunodeficiency virus (HIV). Methods A total of 352 subjects were selected into the cohort by non-probability sampling, including 153 men who have sex with men (MSM) , 36 female sex workers (FSMs) , and 163 fixed sex partners(PARs) of HIV carriers. Each subject was randomly given a medication regimen of either once daily or twice a week. The pre-exposure prophylaxis compliance was evaluated by observing the maintenance of the cohort and medication omission every 4 weeks from week 0 to week 28. Cochran-Mantel-Haenszel (CMH) test was employed to conduct univariate analysis and logistic regression was adopted for multiple variable analysis. Results It was found that 76. 70% (270/352) of the subjects finished the 28-week-observation in this PrEP clinical trial among high-risk groups of HIV. The medication omission rate fluctuated around 35% during the follow-up, with the total compliance score being 82. 12 + 27. 48 and the median score being 95. 24. Logistic regression suggested that the monthly income, presence of worries or difficulties during the trials, need for medical service, and the way of follow-up were the factors influencing the maintenance of cohort. The marital status, medication method, presence of worries or difficulties during the trial, and presence of adverse effect were the influencing factors of medication omission. The population type, number of sex partners, taking of other drugs at the same time, need of medical service during the trial, and way of follow-up were the factors impacting the overall compliance score. Conclusion The compliance of the present PrEP clinical trials among high-risk groups of HIV is high, and it has multiple influencing factors. Compliance management should be reinforced among MSM and FSW populations with greater motility. The cohort management model of follow-up by fixed specialists should be continued

  8. Redesigning Radiotherapy Quality Assurance: Opportunities to Develop an Efficient, Evidence-Based System to Support Clinical Trials-Report of the National Cancer Institute Work Group on Radiotherapy Quality Assurance

    Energy Technology Data Exchange (ETDEWEB)

    Bekelman, Justin E., E-mail: bekelman@uphs.upenn.edu [University of Pennsylvania, Philadelphia, Pennsylvania (United States); Deye, James A.; Vikram, Bhadrasain [National Cancer Institute, Bethesda, Maryland (United States); Bentzen, Soren M. [University of Wisconsin, Madison, Wisconsin (United States); Bruner, Deborah [University of Pennsylvania, Philadelphia, Pennsylvania (United States); Curran, Walter J. [Emory University, Atlanta, Georgia (United States); Dignam, James [University of Chicago, Chicago, Illinois (United States); Efstathiou, Jason A. [Massachusetts General Hospital, Boston, Massachusetts (United States); FitzGerald, T.J. [University of Massachusetts, Boston, Massachusetts (United States); Hurkmans, Coen [European Organization for Research and Treatment of Cancer, Brussels (Belgium); Ibbott, Geoffrey S.; Lee, J. Jack [University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Merchant, Thomas E. [St. Jude Children' s Research Hospital, Memphis, Tennessee (United States); Michalski, Jeff [University of Washington, St. Louis, Missouri (United States); Palta, Jatinder R. [University of Florida, Miami, Florida (United States); Simon, Richard [National Institutes of Health, Bethesda, Maryland (United States); Ten Haken, Randal K. [University of Michigan, Ann Arbor, Michigan (United States); Timmerman, Robert [University of Texas Southwestern Medical Center, Dallas, Texas (United States); Tunis, Sean [Center for Medical Technology Policy, Baltimore, Maryland (United States); Coleman, C. Norman [National Cancer Institute, Bethesda, Maryland (United States); and others

    2012-07-01

    Purpose: In the context of national calls for reorganizing cancer clinical trials, the National Cancer Institute sponsored a 2-day workshop to examine challenges and opportunities for optimizing radiotherapy quality assurance (QA) in clinical trial design. Methods and Materials: Participants reviewed the current processes of clinical trial QA and noted the QA challenges presented by advanced technologies. The lessons learned from the radiotherapy QA programs of recent trials were discussed in detail. Four potential opportunities for optimizing radiotherapy QA were explored, including the use of normal tissue toxicity and tumor control metrics, biomarkers of radiation toxicity, new radiotherapy modalities such as proton beam therapy, and the international harmonization of clinical trial QA. Results: Four recommendations were made: (1) to develop a tiered (and more efficient) system for radiotherapy QA and tailor the intensity of QA to the clinical trial objectives (tiers include general credentialing, trial-specific credentialing, and individual case review); (2) to establish a case QA repository; (3) to develop an evidence base for clinical trial QA and introduce innovative prospective trial designs to evaluate radiotherapy QA in clinical trials; and (4) to explore the feasibility of consolidating clinical trial QA in the United States. Conclusion: Radiotherapy QA can affect clinical trial accrual, cost, outcomes, and generalizability. To achieve maximum benefit, QA programs must become more efficient and evidence-based.

  9. Redesigning Radiotherapy Quality Assurance: Opportunities to Develop an Efficient, Evidence-Based System to Support Clinical Trials—Report of the National Cancer Institute Work Group on Radiotherapy Quality Assurance

    International Nuclear Information System (INIS)

    Purpose: In the context of national calls for reorganizing cancer clinical trials, the National Cancer Institute sponsored a 2-day workshop to examine challenges and opportunities for optimizing radiotherapy quality assurance (QA) in clinical trial design. Methods and Materials: Participants reviewed the current processes of clinical trial QA and noted the QA challenges presented by advanced technologies. The lessons learned from the radiotherapy QA programs of recent trials were discussed in detail. Four potential opportunities for optimizing radiotherapy QA were explored, including the use of normal tissue toxicity and tumor control metrics, biomarkers of radiation toxicity, new radiotherapy modalities such as proton beam therapy, and the international harmonization of clinical trial QA. Results: Four recommendations were made: (1) to develop a tiered (and more efficient) system for radiotherapy QA and tailor the intensity of QA to the clinical trial objectives (tiers include general credentialing, trial-specific credentialing, and individual case review); (2) to establish a case QA repository; (3) to develop an evidence base for clinical trial QA and introduce innovative prospective trial designs to evaluate radiotherapy QA in clinical trials; and (4) to explore the feasibility of consolidating clinical trial QA in the United States. Conclusion: Radiotherapy QA can affect clinical trial accrual, cost, outcomes, and generalizability. To achieve maximum benefit, QA programs must become more efficient and evidence-based.

  10. 新生儿B族链球菌脑膜炎13例临床分析和随访%Clinical analysis and follow-up of neonatal purulent meningitis caused by group B streptococcus

    Institute of Scientific and Technical Information of China (English)

    朱敏丽; 朱将虎; 李海静; 留佩宁; 林振浪

    2014-01-01

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

  11. Development of cancer cooperative groups in Japan.

    Science.gov (United States)

    Fukuda, Haruhiko

    2010-09-01

    Investigator-initiated clinical trials are essential for improving the standard of care for cancer patients, because pharmaceutical companies do not conduct trials that evaluate combination chemotherapy using drugs from different companies, surgery, radiotherapy or multimodal treatments. Government-sponsored cooperative groups have played a vital role in developing cancer therapeutics since the 1950s in the USA; however, the establishment of these groups in Japan did not take place until 30 years later. Methodological standards for multicenter cancer clinical trials were established in the 1980s by the National Cancer Institute and cooperative groups. The Japan Clinical Oncology Group, one of the largest cooperative groups in the country, was instituted in 1990. Its data center and operations office, formed during the 1990s, applied the standard methods of US cooperative groups. At present, the Japan Clinical Oncology Group consists of 14 subgroups, a Data Center, an Operations Office, nine standing committees and an Executive Committee represented by the Japan Clinical Oncology Group Chair. Quality control and quality assurance at the Japan Clinical Oncology Group, including regular central monitoring, statistical methods, interim analyses, adverse event reporting and site visit audit, have complied with international standards. Other cooperative groups have also been established in Japan since the 1980s; however, nobody figures out all of them. A project involving the restructuring of US cooperative groups has been ongoing since 2005. Learning from the success of this project will permit further progress of the cancer clinical trials enterprise in Japan. PMID:20670961

  12. The Globalization of Cooperative Groups.

    Science.gov (United States)

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

    2015-10-01

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

  13. Achieving lipid goals with rosuvastatin compared with simvastatin in high risk patients in real clinical practice: a randomized, open-label, parallel-group, multi-center study: the DISCOVERY-Beta study

    OpenAIRE

    Laks, Toivo

    2008-01-01

    Toivo Laks1, Ester Keba2, Mariann Leiner3, Eero Merilind4, Mall Petersen5, Sirje Reinmets6, Sille Väli7, Terje Sööt8, Karin Otter81Clinic of Internal Medicine, North-Estonia Regional Hospital, Tallinn, Estonia; 2Clinic of Internal Medicine, Viljandi County Hospital, Viljandi, Estonia; 3Mustamäe Family Doctors Centre, Tallinn, Estonia; 4Nõmme Family Doctors Centre, Tallinn, Estonia; 5Saku Health Centre, Saku, Estonia; 6Kristiine Family Doctors, Ta...

  14. Incidence and clinical relevance of TEL/AML1 fusion genes in children with acute lymphoblastic leukemia enrolled in the German and Italian multicenter therapy trials. Associazione Italiana Ematologia Oncologia Pediatrica and the Berlin-Frankfurt-Münster Study Group.

    Science.gov (United States)

    Borkhardt, A; Cazzaniga, G; Viehmann, S; Valsecchi, M G; Ludwig, W D; Burci, L; Mangioni, S; Schrappe, M; Riehm, H; Lampert, F; Basso, G; Masera, G; Harbott, J; Biondi, A

    1997-07-15

    The molecular approach for the analysis of leukemia associated chromosomal translocations has led to the identification of prognostic relevant subgroups. In pediatric acute lymphoblastic leukemia (ALL), the most common translocations, t(9;22) and t(4;11), have been associated with a poorer clinical outcome. Recently the TEL gene at chromosome 12p13 and the AML1 gene at chromosome 21q22 were found to be involved in the translocation t(12;21)(p13;q22). By conventional cytogenetics, however, this chromosomal abnormality is barely detectable and occurs in less than 0.05% of childhood ALL. To investigate the frequency of the molecular equivalent of the t(12;21), the TEL/AML1 gene fusion, we have undertaken a prospective screening in the running German Berlin-Frankfurt-Münster (BFM) and Italian Associazione Italiana Ematologia Oncologia Pediatrica (AIEOP) multicenter ALL therapy trials. We have analyzed 334 unselected cases of pediatric ALL patients consecutively referred over a period of 5 and 9 months, respectively. The overall incidence of the t(12;21) in pediatric ALL is 18.9%. The 63 cases positive for the TEL/AML1 chimeric products ranged in age between 1 and 12 years, and all but one showed CD10 and pre-B immunophenotype. Interestingly, one case displayed a pre-pre-B immunophenotype. Among the B-lineage subgroup, the t(12;21) occurs in 22.0% of the cases. Fifteen of 61 (24.6%) cases coexpressed at least two myeloid antigens (CD13, CD33, or CDw65) in more than 20% of the gated blast cells. DNA index was available for 59 of the 63 TEL/AML1 positive cases; a hyperdiploid DNA content (> or = 1.16) was detected in only four patients, being nonhyperdiploid in the remaining 55. Based on this prospective analysis, we retrospectively evaluated the impact of TEL/AML1 in prognosis by identifying the subset of B-lineage ALL children enrolled in the closed German ALL-BFM-90 and Italian ALL-AIEOP-91 protocols who had sufficient material for analysis. A total of 342 children

  15. CLINICAL BIOCHEMISTRY

    Science.gov (United States)

    Assessment of the health status of animals through measurement of cellular, biochemical, and macromolecular constituents in blood, secretions, and excretions has been variously referred to as clinical chemistry, clinical biochemistry, or clinical pathology. he genesis of this dis...

  16. Integrated Groups and Smooth Distribution Groups

    Institute of Scientific and Technical Information of China (English)

    Pedro J. MIANA

    2007-01-01

    In this paper, we prove directly that α-times integrated groups define algebra homo-morphisms. We also give a theorem of equivalence between smooth distribution groups and α-times integrated groups.

  17. Which finite simple groups are unit groups?

    DEFF Research Database (Denmark)

    Davis, Christopher James; Occhipinti, Tommy

    2014-01-01

    We prove that if G is a finite simple group which is the unit group of a ring, then G is isomorphic to either (a) a cyclic group of order 2; (b) a cyclic group of prime order 2^k −1 for some k; or (c) a projective special linear group PSLn(F2) for some n ≥ 3. Moreover, these groups do all occur as...... unit groups. We deduce this classification from a more general result, which holds for groups G with no non-trivial normal 2-subgroup....

  18. Molecular and cellular analysis of the DNA repair defect in a patient in xeroderma pigmentosum complementation group D who has the clinical features of xeroderma pigmentosum and Cockayne syndrome.

    OpenAIRE

    Broughton, B.C.; Thompson, A F; Harcourt, S A; Vermeulen, Wim; Hoeijmakers, Jan; Botta, Elena; Stefanini, Miria; King, M.D.; Weber, Christine; Cole, J.; Arlett, C F; Lehmann, Alan

    1995-01-01

    textabstractXeroderma pigmentosum (XP) and Cockayne syndrome (CS) are quite distinct genetic disorders that are associated with defects in excision repair of UV-induced DNA damage. A few patients have been described previously with the clinical features of both disorders. In this paper we describe an individual in this category who has unusual cellular responses to UV light. We show that his cultured fibroblasts and lymphocytes are extremely sensitive to irradiation with UV-C, despite a level...

  19. Clobazam is equally safe and efficacious for seizures associated with Lennox-Gastaut syndrome across different age groups: Post hoc analyses of short- and long-term clinical trial results.

    Science.gov (United States)

    Ng, Yu-Tze; Conry, Joan; Mitchell, Wendy G; Buchhalter, Jeffrey; Isojarvi, Jouko; Lee, Deborah; Drummond, Rebecca; Chung, Steve

    2015-05-01

    The peak age at onset of Lennox-Gastaut syndrome (LGS) is between 3 and 5years. Patients with LGS frequently experience multiple types of treatment-refractory seizures and require lifelong therapy with several antiepileptic drugs. Here, post hoc analyses of clinical trials (phase III trial OV-1012 and open-label extension trial OV-1004) provide short- and long-term efficacy and safety data of adjunctive clobazam in patients with LGS stratified by age at baseline (≥2 to LGS.

  20. Group dynamics basics and pragmatics for practitioners

    CERN Document Server

    Haynes, Norris M

    2012-01-01

    This book provides a clear and engaging description of group dynamic processes. Group Dynamics will serve as an important text for students and professors and as a valuable guide for those who facilitate groups in a variety of clinical, counseling, educational, research, and organizational settings.

  1. Group Composition, Group Interaction and Achievement in Cooperative Small Groups.

    Science.gov (United States)

    Webb, Noreen M.

    This study investigated interaction and achievement in cooperative small groups in four junior high school mathematics classrooms. Ninety-six students learned a one-week unit on consumer mathematics in mixed-ability or uniform-ability groups. Students in mixed-ability groups scored higher on a problem-solving test than students in uniform-ability…

  2. Group Work Publication-1991.

    Science.gov (United States)

    Zimpfer, David G.

    1992-01-01

    Lists 21 new publications in group work, of which 9 are reviewed. Those discussed include publications on group counseling and psychotherapy, structured groups, support groups, psychodrama, and social group work. (Author/NB)

  3. Clinical biophysics

    Energy Technology Data Exchange (ETDEWEB)

    Anbar, M.; Spangler, R.A.; Scott, P.

    1985-01-01

    Chapters are included on clinical decision making, principles of biomedical engineering, computers and their medical uses, clinical radiobiology, diagnostic x-ray radiology, clinical applications of ultrasonics, nuclear medicine, NMR imaging, diagnostic imaging, bioelectric techniques in diagnosis and therapy, biophysical aspects of the clinical laboratory, and biophysical aspects of modern surgery.

  4. Group dynamic processes in email groups

    OpenAIRE

    Alpay, Esat

    2005-01-01

    Abstract Discussion is given on the relevance of group dynamic processes in promoting decision-making in email discussion groups. General theories on social facilitation and social loafing are considered in the context of email groups, as well as the applicability of psychodynamic and interaction-based models. It is argued that such theories may indeed provide insight into email group interactions, but that...

  5. Group Cohesion in Experiential Growth Groups

    Science.gov (United States)

    Steen, Sam; Vasserman-Stokes, Elaina; Vannatta, Rachel

    2014-01-01

    This article explores the effect of web-based journaling on changes in group cohesion within experiential growth groups. Master's students were divided into 2 groups. Both used a web-based platform to journal after each session; however, only 1 of the groups was able to read each other's journals. Quantitative data collected before and…

  6. Data: ‘Initial Clinical Referral Standards after Newborn Screening for Congenital Hypothyroidism: Final Report of the UK Newborn Screening Programme Centre Expert Working Group and Systematic Evidence Review 2010-2011’.

    Directory of Open Access Journals (Sweden)

    Rachel L. Knowles

    2013-07-01

    Full Text Available The multidisciplinary Expert Working Group was tasked with revising the existing standards of the UK NHS National Screening Programme for diagnosis and management of babies in whom congenital hypothyroidism (CHT is suspected after newborn bloodspot screening. This report includes a systematic evidence review and account of the proceedings of the working group in key areas: screening test performance, referral pathways, diagnostic investigations, treatment and communication with parents. After public consultation, the recommendations were adopted as policy. This final report provides an evidence base for reviewing newborn screening for CHT in other populations and outlines a transparent consensus-based process for agreeing changes to screening standards and policy.

  7. Phase III randomised controlled trial of neoadjuvant chemotherapy plus radical surgery vs radical surgery alone for stages IB2, IIA2, and IIB cervical cancer: a Japan Clinical Oncology Group trial (JCOG 0102)

    OpenAIRE

    Katsumata, N; Yoshikawa, H; Kobayashi, H.; Saito, T.; Kuzuya, K; Nakanishi, T; Yasugi, T; Yaegashi, N; Yokota, H; Kodama, S.; Mizunoe, T; Hiura, M; Kasamatsu, T; Shibata, T.; Kamura, T

    2013-01-01

    Background: A phase III trial was conducted to determine whether neoadjuvant chemotherapy (NACT) before radical surgery (RS) improves overall survival. Methods: Patients with stage IB2, IIA2, or IIB squamous cell carcinoma of the uterine cervix were randomly assigned to receive either BOMP (bleomycin 7 mg days 1–5, vincristine 0.7 mg m−2 day 5, mitomycin 7 mg m−2 day 5, cisplatin 14 mg m−2 days 1–5, every 3 weeks for 2 to 4 cycles) plus RS (NACT group) or RS alone (RS group). Patients with pa...

  8. Probability groups as orbits of groups

    International Nuclear Information System (INIS)

    The set of double cosets of a group with respect to a subgroup and the set of orbits of a group with respect to a group of automorphisms have structures which can be studied as multigroups, hypergroups or Pasch geometries. When the subgroup or the group of automorphisms are finite, the multivalued products can be provided with some weightages forming so-called Probability Groups. It is shown in this paper that some abstract probability groups can be realized as orbit spaces of groups. (author)

  9. Development of a multiplex PCR system and its application in detection of blaSHV, blaTEM, blaCTX-M-1, blaCTX-M-9 and blaOXA-1 group genes in clinical Klebsiella pneumoniae and Escherichia coli strains.

    Science.gov (United States)

    Ogutu, James O; Zhang, Qingmeng; Huang, Ying; Yan, Huo; Su, Lijie; Gao, Bo; Zhang, Wenli; Zhao, Jizi; Cai, Wenhui; Li, Wenjing; Zhao, Hong; Chen, Yang; Song, Wuqi; Chen, Xiaobei; Fu, Yingmei; Zhang, Fengmin

    2015-12-01

    Resistance to β-lactam antibiotics through β-lactamase production by Enterobacteriaceae continues to burden the health-care sector worldwide. Traditional methods for detection of β-lactamases are time-consuming and labor-intensive and newer methods with varying capabilities continue to be developed. The objective of this study was to develop a multiplex PCR (M-PCR) system for the detection of blaSHV, blaTEM, blaCTX-M-1, blaCTX-M-9 and blaOXA-1 group genes and to apply it in clinical Klebsiella pneumoniae and Escherichia coli strains. To do this, we used group-specific PCR primers in singleplex reactions followed by optimization into multiplex reactions. Specificity and sensitivity of the M-PCR were then evaluated using 58 reference strains before its application to detect bla group genes in 203 clinical Enterobacteriaceae strains. PCR amplicons were sequenced to determine the β-lactamase subtypes. The M-PCR system exhibited 100% specificity and sensitivity. In all, 83.7% of K. pneumoniae and 89.8% of E. coli clinical strains harbored bla group genes with 46.9%, 40.1%, 15.0%, 21.1% and 6.1% of K. pneumoniae having blaSHV, blaTEM, blaCTX-M-1, blaCTX-M-9 and blaOXA-1 group genes, respectively, whereas 12.2%, 77.6%, 22.4%, 36.7% and 8.2% of E. coli had blaSHV, blaTEM, blaCTX-M-1, blaCTX-M-9 and blaOXA-1 group genes, respectively. BlaSHV-1, blaSHV-11, blaSHV-27, blaSHV-33, blaSHV-144, blaTEM-1, blaTEM-135, blaOXA-1, blaCTX-M-3, blaCTX-M-9, blaCTX-M-14, blaCTX-M-15, blaCTX-M-27, blaCTX-M-55, blaCTX-M-65 and blaCTX-M-104 were detected. In conclusion, the M-PCR system was efficient and versatile with an advantage of simultaneously detecting all the targeted bla group genes. Hence, it is a potential candidate for developing M-PCR kits for the screening of these genes for clinical or epidemiological purposes. PMID:26104141

  10. Evidence-Based Recommendations for Short- and Long-Term Management of Uninvestigated Dyspepsia in Primary Care: An Update of the Canadian Dyspepsia Working Group (CanDys Clinical Management Tool

    Directory of Open Access Journals (Sweden)

    Sander JO Veldhuyzen van Zanten

    2005-01-01

    Full Text Available The present paper is an update to and extension of the previous systematic review on the primary care management of patients with uninvestigated dyspepsia (UD. The original publication of the clinical management tool focused on the initial four- to eight-week assessment of UD. This update is based on new data from systematic reviews and clinical trials relevant to UD. There is now direct clinical evidence supporting a test-and-treat approach in patients with nondominant heartburn dyspepsia symptoms, and head-to-head comparisons show that use of a proton pump inhibitor is superior to the use of H2-receptor antagonists (H2RAs in the initial treatment of Helicobacter pylori-negative dyspepsia patients. Cisapride is no longer available as a treatment option and evidence for other prokinetic agents is lacking. In patients with long-standing heartburn-dominant (ie, gastroesophageal reflux disease and nonheartburn-dominant dyspepsia, a once-in-a-lifetime endoscopy is recommended. Endoscopy should also be considered in patients with new-onset dyspepsia that develops after the age of 50 years. Conventional nonsteroidal anti-inflammatory drugs, acetylsalicylic acid and cyclooxygenase-2-selective inhibitors can all cause dyspepsia. If their use cannot be discontinued, cotherapy with either a proton pump inhibitor, misoprostol or high-dose H2RAs is recommended, although the evidence is based on ulcer data and not dyspepsia data. In patients with nonheartburn-dominant dyspepsia, noninvasive testing for H pylori should be performed and treatment given if positive. When starting nonsteroidal anti-inflammatory drugs for a prolonged course, testing and treatment with H2RAs are advised if patients have a history of previous ulcers or ulcer bleeding.

  11. Vestibular Evoked Myogenic Potential Produced by Bone-Conducted Stimuli: A Study on its Basics and Clinical Applications in Patients With Conductive and Sensorineural Hearing Loss and a Group With Vestibular Schawannoma

    Directory of Open Access Journals (Sweden)

    Parvane Mahdi

    2013-06-01

    Full Text Available Introduction: Vestibular evoked myogenic potential (VEMP has recently been broadly studied in vestibular disorders. As it is evoked by loud sound stimulation, even mild conductive hearing loss may affect VEMP results. Bone-conducted (BC stimulus is an alternative stimulation for evoking this response. This study aims to assess the characteristics of BC-VEMP in different groups of patients.   Materials and Methods: We performed a cross sectional analysis on 20 healthy volunteers with normal pure-tone audiometry as a control group; and on a group of patients consisted of 20 participants with conductive hearing loss, five with bilateral sensorineural hearing loss and four with vestibular schawannoma. AC and BC-VEMP were performed in all participants.   Results: In control group the VEMP responses to both kinds of stimuli had an acceptable morphology and consisted of p13 and n23 waves. Latency value of these main components in each type of stimulus was not significantly different (P>0.05. However, the mean amplitude was larger in BC modality than AC stimulation (P=0.025. In the group with conductive hearing loss, the VEMP response was absent in fifteen (46.87% of the 32 ears using the AC method, whereas all (100% displayed positive elicitability of VEMP by BC method. Normal VEMP responses in both stimuli were evoked in all patients with sensorineural hearing loss. In patients with unilateral vestibular schwannomas (VS, 2 (50.00% had neither AC-VEMP nor BC-VEMP. Conclusion:  Auditory stimuli delivered by bone conduction can evoke VEMP response. These responses are of vestibular origin and can be used in vestibular evaluation of patients with conductive hearing loss.

  12. Phase II trial of concurrent chemoradiotherapy with S-1 plus cisplatin in patients with unresectable locally advanced squamous cell carcinoma of the head and neck. Japan Clinical Oncology Group Study (JCOG0706)

    International Nuclear Information System (INIS)

    A Phase II study was started in Japan to evaluate the efficacy and safety of concurrent chemoradiotherapy with S-1 plus cisplatin in patients with unresectable locally advanced squamous cell carcinoma of the head and neck. This study began in July 2008, and a total of 45 patients will be accrued from 13 institutions within 2 years. The primary endpoint is the clinical complete remission rate. The secondary endpoints are local progression-free survival, overall survival, progression-free survival, time to treatment failure, proportion of patients who achieve nutritional support-free survival and adverse events. (author)

  13. Insulin pump risks and benefits: a clinical appraisal of pump safety standards, adverse event reporting, and research needs: a joint statement of the European Association for the Study of Diabetes and the American Diabetes Association Diabetes Technology Working Group.

    Science.gov (United States)

    Heinemann, Lutz; Fleming, G Alexander; Petrie, John R; Holl, Reinhard W; Bergenstal, Richard M; Peters, Anne L

    2015-04-01

    Insulin pump therapy, also known as continuous subcutaneous insulin infusion (CSII), is an important and evolving form of insulin delivery, which is mainly used for people with type 1 diabetes. However, even with modern insulin pumps, errors of insulin infusion can occur due to pump failure, insulin infusion set (IIS) blockage, infusion site problems, insulin stability issues, user error, or a combination of these. Users are therefore exposed to significant and potentially fatal hazards: interruption of insulin infusion can result in hyperglycemia and ketoacidosis; conversely, delivery of excessive insulin can cause severe hypoglycemia. Nevertheless, the available evidence on the safety and efficacy of CSII remains limited. The European Association for the Study of Diabetes (EASD) and the American Diabetes Association (ADA) have therefore joined forces to review the systems in place for evaluating the safety of pumps from a clinical perspective. We found that useful information held by the manufacturing companies is not currently shared in a sufficiently transparent manner. Public availability of adverse event (AE) reports on the US Food and Drug Administration's Manufacturer and User Facility Device Experience (MAUDE) database is potentially a rich source of safety information but is insufficiently utilized due to the current configuration of the system; the comparable database in Europe (European Databank on Medical Devices [EUDAMED]) is not publicly accessible. Many AEs appear to be attributable to human factors and/or user error, but the extent to which manufacturing companies are required by regulators to consider the interactions of users with the technical features of their products is limited. The clinical studies required by regulators prior to marketing are small and over-reliant on bench testing in relation to "predicate" products. Once a pump is available on the market, insufficient data are made publicly available on its long-term use in a real

  14. Insulin pump risks and benefits: a clinical appraisal of pump safety standards, adverse event reporting and research needs. A joint statement of the European Association for the Study of Diabetes and the American Diabetes Association Diabetes Technology Working Group.

    Science.gov (United States)

    Heinemann, Lutz; Fleming, G Alexander; Petrie, John R; Holl, Reinhard W; Bergenstal, Richard M; Peters, Anne L

    2015-05-01

    Insulin pump therapy, also known as continuous subcutaneous insulin infusion (CSII), is an important and evolving form of insulin delivery, which is mainly used for people with type 1 diabetes. However, even with modern insulin pumps, errors of insulin infusion can occur due to pump failure, insulin infusion set (IIS) blockage, infusion site problems, insulin stability issues, user error or a combination of these. Users are therefore exposed to significant and potentially fatal hazards: interruption of insulin infusion can result in hyperglycaemia and ketoacidosis; conversely, delivery of excessive insulin can cause severe hypoglycaemia. Nevertheless, the available evidence on the safety and efficacy of CSII remains limited. The European Association for the Study of Diabetes (EASD) and American Diabetes Association (ADA) have therefore joined forces to review the systems in place for evaluating the safety of pumps from a clinical perspective. We found that useful information held by the manufacturing companies is not currently shared in a sufficiently transparent manner. Public availability of adverse event (AE) reports on the US Food and Drug Administration's Manufacturer and User Facility Device Experience (MAUDE) database is potentially a rich source of safety information but is insufficiently utilised due to the current configuration of the system; the comparable database in Europe (European Databank on Medical Devices, EUDAMED) is not publicly accessible. Many AEs appear to be attributable to human factors and/or user error, but the extent to which manufacturing companies are required by regulators to consider the interactions of users with the technical features of their products is limited. The clinical studies required by regulators prior to marketing are small and over-reliant on bench testing in relation to 'predicate' products. Once a pump is available on the market, insufficient data are made publicly available on its long-term use in a real

  15. Group theories: relevance to group safety studies.

    Science.gov (United States)

    Benevento, A L

    1998-01-01

    Promoting safety in the workplace has been attempted in a variety of ways. Increasingly, industries are using groups such as safety teams and quality circles to promote worker safety. Group influences on individual behavior and attitudes have long been studied in the social psychology literature, but the theories have not been commonly found outside the psychology arena. This paper describes the group theories of group polarization, risky shift, social loafing, groupthink and team think and attempts to apply these theories to existing studies that examine work group influences on safety. Interesting parallels were found but only one study examined group influences as their primary focus of research. Since groups are increasingly used for safety promotion, future research on safety that studies group influences with respect to current group theories is recommended. PMID:24441299

  16. A DOUBLE BLIND, RANDOMIZED, PARALLEL GROUP, PROSPECTIVE, CLINICAL STUDY FOR EVALUATION OF EFFICACY AND SAFETY OF LOW DOSE DOXEPIN IN COMPARISION WITH ZOPICLONE IN ADULT AND ELDERLY PATIENTS WITH PRIMARY INSOMNIA

    OpenAIRE

    Pali; Deepti

    2015-01-01

    BACKGROUND: Insomnia is underappreciated public health issue. In recent years, insomnia treatment has advanced beyond the routine use of benzodiazepines. AIMS: To compare the efficacy and safety of low dose Doxepin with Zopiclone in patients with primary insomnia. SETTINGS AND DESIGN: A double blind, randomized parallel group, prospective study of low dose Doxepin (n=20) and Zopiclone (n=15) in patients with primary insomnia. METHODS & MATERIAL: Patients fulfilling the sel...

  17. A DOUBLE BLIND, RANDOMIZED, PARALLEL GROUP, PROSPECTIVE, CLINICAL STUDY FOR EVALUATION OF EFFICACY AND SAFETY OF LOW DOSE DOXEPIN IN COMPARISION WITH ZOPICLONE IN ADULT AND ELDERLY PATIENTS WITH PRIMARY INSOMNIA

    Directory of Open Access Journals (Sweden)

    Pali

    2015-11-01

    Full Text Available BACKGROUND: Insomnia is underappreciated public health issue. In recent years, insomnia treatment has advanced beyond the routine use of benzodiazepines. AIMS: To compare the efficacy and safety of low dose Doxepin with Zopiclone in patients with primary insomnia. SETTINGS AND DESIGN: A double blind, randomized parallel group, prospective study of low dose Doxepin (n=20 and Zopiclone (n=15 in patients with primary insomnia. METHODS & MATERIAL: Patients fulfilling the selection criteria were enrolled. Enrolled patients were randomized to 2 groups- of low dose Doxepin(3mg and Zopiclone (3.75mg. Patients were provided with sleep diaries to record sleep parameters, change in alertness and mood, sleepiness scale score and other adverse events were recorded. STATISTICAL ANALYSIS: Student ‘t’ test. RESULTS: Both the groups show significant reduction the time of wakening after sleep onset, with improvement in both total sleep time & sleep efficiency. Both the drugs were well tolerated and percentage change in mood and alertness was comparable. CONCLUSION: Low dose Doxepin was found to be as effective and safe as Zopiclone in patients of primary insomnia

  18. OARSI Clinical Trials Recommendations

    DEFF Research Database (Denmark)

    McAlindon, T. E.; Driban, J. B.; Henrotin, Y.;

    2015-01-01

    The goal of this document is to update the original OARSI recommendations specifically for the design, conduct, and reporting of clinical trials that target symptom or structure modification among individuals with knee osteoarthritis (OA). To develop recommendations for the design, conduct......, and reporting of clinical trials for knee OA we initially drafted recommendations through an iterative process. Members of the working group included representatives from industry and academia. After the working group members reviewed a final draft, they scored the appropriateness for recommendations. After...... and index knee, describing interventions, patient-reported and physical performance measures, structural outcome measures, biochemical biomarkers, and reporting recommendations. In summary, the working group identified 25 recommendations that represent the current best practices regarding clinical trials...

  19. Proteomic-Coupled-Network Analysis of T877A-Androgen Receptor Interactomes Can Predict Clinical Prostate Cancer Outcomes between White (Non-Hispanic) and African-American Groups

    Science.gov (United States)

    Zaman, Naif; Giannopoulos, Paresa N.; Chowdhury, Shafinaz; Bonneil, Eric; Thibault, Pierre; Wang, Edwin; Trifiro, Mark; Paliouras, Miltiadis

    2014-01-01

    The androgen receptor (AR) remains an important contributor to the neoplastic evolution of prostate cancer (CaP). CaP progression is linked to several somatic AR mutational changes that endow upon the AR dramatic gain-of-function properties. One of the most common somatic mutations identified is Thr877-to-Ala (T877A), located in the ligand-binding domain, that results in a receptor capable of promiscuous binding and activation by a variety of steroid hormones and ligands including estrogens, progestins, glucocorticoids, and several anti-androgens. In an attempt to further define somatic mutated AR gain-of-function properties, as a consequence of its promiscuous ligand binding, we undertook a proteomic/network analysis approach to characterize the protein interactome of the mutant T877A-AR in LNCaP cells under eight different ligand-specific treatments (dihydrotestosterone, mibolerone, R1881, testosterone, estradiol, progesterone, dexamethasone, and cyproterone acetate). In extending the analysis of our multi-ligand complexes of the mutant T877A-AR we observed significant enrichment of specific complexes between normal and primary prostatic tumors, which were furthermore correlated with known clinical outcomes. Further analysis of certain mutant T877A-AR complexes showed specific population preferences distinguishing primary prostatic disease between white (non-Hispanic) vs. African-American males. Moreover, these cancer-related AR-protein complexes demonstrated predictive survival outcomes specific to CaP, and not for breast, lung, lymphoma or medulloblastoma cancers. Our study, by coupling data generated by our proteomics to network analysis of clinical samples, has helped to define real and novel biological pathways in complicated gain-of-function AR complex systems. PMID:25409505

  20. Proteomic-coupled-network analysis of T877A-androgen receptor interactomes can predict clinical prostate cancer outcomes between White (non-Hispanic) and African-American groups.

    Science.gov (United States)

    Zaman, Naif; Giannopoulos, Paresa N; Chowdhury, Shafinaz; Bonneil, Eric; Thibault, Pierre; Wang, Edwin; Trifiro, Mark; Paliouras, Miltiadis

    2014-01-01

    The androgen receptor (AR) remains an important contributor to the neoplastic evolution of prostate cancer (CaP). CaP progression is linked to several somatic AR mutational changes that endow upon the AR dramatic gain-of-function properties. One of the most common somatic mutations identified is Thr877-to-Ala (T877A), located in the ligand-binding domain, that results in a receptor capable of promiscuous binding and activation by a variety of steroid hormones and ligands including estrogens, progestins, glucocorticoids, and several anti-androgens. In an attempt to further define somatic mutated AR gain-of-function properties, as a consequence of its promiscuous ligand binding, we undertook a proteomic/network analysis approach to characterize the protein interactome of the mutant T877A-AR in LNCaP cells under eight different ligand-specific treatments (dihydrotestosterone, mibolerone, R1881, testosterone, estradiol, progesterone, dexamethasone, and cyproterone acetate). In extending the analysis of our multi-ligand complexes of the mutant T877A-AR we observed significant enrichment of specific complexes between normal and primary prostatic tumors, which were furthermore correlated with known clinical outcomes. Further analysis of certain mutant T877A-AR complexes showed specific population preferences distinguishing primary prostatic disease between white (non-Hispanic) vs. African-American males. Moreover, these cancer-related AR-protein complexes demonstrated predictive survival outcomes specific to CaP, and not for breast, lung, lymphoma or medulloblastoma cancers. Our study, by coupling data generated by our proteomics to network analysis of clinical samples, has helped to define real and novel biological pathways in complicated gain-of-function AR complex systems.

  1. Proteomic-coupled-network analysis of T877A-androgen receptor interactomes can predict clinical prostate cancer outcomes between White (non-Hispanic and African-American groups.

    Directory of Open Access Journals (Sweden)

    Naif Zaman

    Full Text Available The androgen receptor (AR remains an important contributor to the neoplastic evolution of prostate cancer (CaP. CaP progression is linked to several somatic AR mutational changes that endow upon the AR dramatic gain-of-function properties. One of the most common somatic mutations identified is Thr877-to-Ala (T877A, located in the ligand-binding domain, that results in a receptor capable of promiscuous binding and activation by a variety of steroid hormones and ligands including estrogens, progestins, glucocorticoids, and several anti-androgens. In an attempt to further define somatic mutated AR gain-of-function properties, as a consequence of its promiscuous ligand binding, we undertook a proteomic/network analysis approach to characterize the protein interactome of the mutant T877A-AR in LNCaP cells under eight different ligand-specific treatments (dihydrotestosterone, mibolerone, R1881, testosterone, estradiol, progesterone, dexamethasone, and cyproterone acetate. In extending the analysis of our multi-ligand complexes of the mutant T877A-AR we observed significant enrichment of specific complexes between normal and primary prostatic tumors, which were furthermore correlated with known clinical outcomes. Further analysis of certain mutant T877A-AR complexes showed specific population preferences distinguishing primary prostatic disease between white (non-Hispanic vs. African-American males. Moreover, these cancer-related AR-protein complexes demonstrated predictive survival outcomes specific to CaP, and not for breast, lung, lymphoma or medulloblastoma cancers. Our study, by coupling data generated by our proteomics to network analysis of clinical samples, has helped to define real and novel biological pathways in complicated gain-of-function AR complex systems.

  2. Interagency mechanical operations group numerical systems group

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1997-09-01

    This report consists of the minutes of the May 20-21, 1971 meeting of the Interagency Mechanical Operations Group (IMOG) Numerical Systems Group. This group looks at issues related to numerical control in the machining industry. Items discussed related to the use of CAD and CAM, EIA standards, data links, and numerical control.

  3. Group Dynamic Processes in Email Groups

    Science.gov (United States)

    Alpay, Esat

    2005-01-01

    Discussion is given on the relevance of group dynamic processes in promoting decision-making in email discussion groups. General theories on social facilitation and social loafing are considered in the context of email groups, as well as the applicability of psychodynamic and interaction-based models. It is argued that such theories may indeed…

  4. AREVA group overview; Presentation du groupe AREVA

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2002-02-08

    This document presents the Group Areva, a world nuclear industry leader, from a financial holding company to an industrial group, operating in two businesses: the nuclear energy and the components. The structure and the market of the group are discussed, as the financial assets. (A.L.B.)

  5. Cost-variance analysis by DRGs; a technique for clinical budget analysis.

    Science.gov (United States)

    Voss, G B; Limpens, P G; Brans-Brabant, L J; van Ooij, A

    1997-02-01

    In this article it is shown how a cost accounting system based on DRGs can be valuable in determining changes in clinical practice and explaining alterations in expenditure patterns from one period to another. A cost-variance analysis is performed using data from the orthopedic department from the fiscal years 1993 and 1994. Differences between predicted and observed cost for medical care, such as diagnostic procedures, therapeutic procedures and nursing care are analyzed into different components: changes in patient volume, case-mix differences, changes in resource use and variations in cost per procedure. Using a DRG cost accounting system proved to be a useful technique for clinical budget analysis. Results may stimulate discussions between hospital managers and medical professionals to explain cost variations integrating medical and economic aspects of clinical health care. PMID:10165044

  6. Surgical Precision in Clinical Documentation Connects Patient Safety, Quality of Care, and Reimbursement.

    Science.gov (United States)

    Kittinger, Benjamin J; Matejicka, Anthony; Mahabir, Raman C

    2016-01-01

    Emphasis on quality of care has become a major focus for healthcare providers and institutions. The Centers for Medicare and Medicaid Services has multiple quality-of-care performance programs and initiatives aimed at providing transparency to the public, which provide the ability to directly compare services provided by hospitals and individual physicians. These quality-of-care programs highlight the transition to pay for performance, rewarding physicians and hospitals for high quality of care. To improve the use of pay for performance and analyze quality-of-care outcome measures, the Division of Plastic Surgery at Scott & White Memorial Hospital participated in an inpatient clinical documentation accuracy project (CDAP). Performance and improvement on metrics such as case mix index, severity of illness, risk of mortality, and geometric mean length of stay were assessed after implementation. After implementation of the CDAP, the division of plastic surgery showed increases in case mix index, calculated severity of illness, and calculated risk of mortality and a decrease in length of stay. For academic plastic surgeons, quality of care demands precise documentation of each patient. The CDAP provides one avenue to hone clinical documentation and performance on quality measures. PMID:26903784

  7. Clinical Trials

    Science.gov (United States)

    Clinical trials are research studies that test how well new medical approaches work in people. Each study answers ... prevent, screen for, diagnose, or treat a disease. Clinical trials may also compare a new treatment to a ...

  8. Clinical Analysis of Neonatal Respiratory Distress Syndrome in Different Gestation Age Groups%不同胎龄新生儿呼吸窘迫综合征临床分析

    Institute of Scientific and Technical Information of China (English)

    郑慧芬; 吴本清; 涂惠英; 燕旭东; 张蔚

    2014-01-01

    Objective To explore the correlation factor of neonatal respiratory distress syndrome (NRDS) in dif erent gestation age groups and share the experience of therapy of NRDS. Methods Spontaneous delivery , uterine-incision delivery, gender and therapy were analyzed of NRDS in dif erent gestation age groups by the retrospective analysis. Results It had no dif erence of spontaneous delivery, uterine-incision delivery and gender in dif erent gestation age groups. Pulmonary surfactant (PS) and nasal continuous positive airway pressure (CPAP) can reduce the use of mechanical ventilation of NRDS. Conclusion It is ef ective in patients with NRDS to use earlier PS and reasonably CPAP.%目的:探讨不同胎龄新生儿呼吸窘迫综合征(NRDS)发生的相关因素,分享NRDS的治疗经验。方法回顾性分析NRDS不同胎龄新生儿的分娩方式、性别构成及治疗情况并进行比较。结果不同胎龄新生儿在分娩方式、性别构成方面比较无差异,肺表面活性物质(PS)及经鼻持续气道正压通气(CPAP)可减少NRDS患儿机械通气的使用。结论早期使用PS并适当联用CPAP是NRDS患儿的有效治疗方法。

  9. Introduction to Sporadic Groups

    Directory of Open Access Journals (Sweden)

    Luis J. Boya

    2011-01-01

    Full Text Available This is an introduction to finite simple groups, in particular sporadic groups, intended for physicists. After a short review of group theory, we enumerate the 1+1+16=18 families of finite simple groups, as an introduction to the sporadic groups. These are described next, in three levels of increasing complexity, plus the six isolated ''pariah'' groups. The (old five Mathieu groups make up the first, smallest order level. The seven groups related to the Leech lattice, including the three Conway groups, constitute the second level. The third and highest level contains the Monster group M, plus seven other related groups. Next a brief mention is made of the remaining six pariah groups, thus completing the 5+7+8+6=26 sporadic groups. The review ends up with a brief discussion of a few of physical applications of finite groups in physics, including a couple of recent examples which use sporadic groups.

  10. Introduction to Sporadic Groups

    CERN Document Server

    Boya, Luis J

    2011-01-01

    This is an introduction to finite simple groups, in particular sporadic groups, intended for physicists. After a short review of group theory, we enumerate the $1+1+16=18$ families of finite simple groups, as an introduction to the sporadic groups. These are described next, in three levels of increasing complexity, plus the six isolated "pariah" groups. The (old) five Mathieu groups make up the first, smallest order level. The seven groups related to the Leech lattice, including the three Conway groups, constitute the second level. The third and highest level contains the Monster group $\\mathbb M$, plus seven other related groups. Next a brief mention is made of the remaining six pariah groups, thus completing the $5+7+8+6=26$ sporadic groups. The review ends up with a brief discussion of a few of physical applications of finite groups in physics, including a couple of recent examples which use sporadic groups.

  11. Idiopathic chronic eosinophilic pneumonia. A clinical and follow-up study of 62 cases. The Groupe d'Etudes et de Recherche sur les Maladies "Orphelines" Pulmonaires (GERM"O"P).

    Science.gov (United States)

    Marchand, E; Reynaud-Gaubert, M; Lauque, D; Durieu, J; Tonnel, A B; Cordier, J F

    1998-09-01

    Idiopathic chronic eosinophilic pneumonia (CEP) is a rare disorder of unknown cause with nonspecific respiratory and systemic symptoms but rather characteristic peripheral alveolar infiltrates on imaging, developing mainly in women and in atopic subjects. The disorder is highly responsive to oral corticosteroid therapy, but relapses are frequent on reducing or stopping treatment. The long-term course of the disease and data regarding outcome, particularly the need for prolonged oral corticosteroid therapy and the development of severe asthma, are somewhat contradictory. A multicentric retrospective study was conducted in an attempt to describe better the initial features and, above all, the later course of CEP in a large homogeneous series of 62 stringently selected patients of whom 46 were followed for more than 1 year. The prevalence of smokers was low (6.5%) and about half of our patients (51.6%) had a previous, and often prolonged, history of asthma. The clinical and roentgenographic features were in keeping with previous studies, but we found that computed tomography could disclose ground glass opacities not detected by X-ray, and that migratory infiltrates before treatment were more frequent (25.5%) than reported previously. The bronchoalveolar lavage cellular count always showed a striking eosinophilic pattern, thus allowing distinction between CEP and cryptogenic organizing pneumonia, both syndromes sharing many common clinical and imaging features. About two-thirds of the patients (68%) showed a ventilatory defect in pulmonary function tests, with about one-half of these presenting with an obstructive pattern, sometimes without previous asthma. Along with the submucosal eosinophilic infiltration noted in 2 patients without ventilatory defect, this is strong evidence to confirm that CEP is not only an alveolointerstitial but also an airway disease. The dramatic response to oral corticosteroid therapy was observed in all treated patients. Although only 1

  12. Results of a phase II trial with second-line cystemustine at 60 mg/m2 in advanced soft tissue sarcoma: A trial of the EORTC early clinical studies group

    International Nuclear Information System (INIS)

    The aim of this phase II trial was to examine the efficacy of a new nitrosourea, cystemustine, in soft tissue sarcoma. Between January 1990 and March 1991, 32 pretreated patients with advanced soft tissue sarcoma were enrolled. Cystemustine was given every 2 weeks at 60 mg/m2 via a 15-min i.v. infusion. All eligible patients were considered evaluable for response and toxicity (WHO criteria). Of the 32 enrolled patients, 4 were ineligible, leaving 28 evaluable patients. All but 1 had been pretreated: 6 with adjuvant chemotherapy, 18 patients with first-line palliative chemotherapy without nitrosourea, 3 with both treatments, and 18 had received radiotherapy. Median age was 54 years (range 20-73) and median performance status was 1 (0-2). One partial response (PR, duration 12 weeks), 2 stable disease and 25 progressions were observed, giving an overall response rate of 3.57% (confidence interval: 0.1-18.4%). Toxicity was mild, and was mainly neutropenia (no grade 3 or 4), thrombocytopenia (3.57% grade 3 and grade 4) and nausea-vomiting (no grade 3 or 4). It should be noted that the treatment for the patient who obtained a PR was third line with no previous response. Cystemustine with this schedule appears to have a low clinical activity and toxicity in advanced soft tissue sarcoma. (Copyright (c) 1998 Elsevier Science B.V., Amsterdam. All rights reserved.)

  13. Palbociclib as a first-line treatment in oestrogen receptor-positive, HER2-negative, advanced breast cancer not cost-effective with current pricing: a health economic analysis of the Swiss Group for Clinical Cancer Research (SAKK).

    Science.gov (United States)

    Matter-Walstra, K; Ruhstaller, T; Klingbiel, D; Schwenkglenks, M; Dedes, K J

    2016-07-01

    Endocrine therapy continues to be the optimal systemic treatment for metastatic ER(+)HER2(-) breast cancer. The CDK4/6 inhibitor palbociclib combined with letrozole has recently been shown to significantly improve progression-free survival. Here we examined the cost-effectiveness of this regimen for the Swiss healthcare system. A Markov cohort simulation based on the PALOMA-1 trial (Finn et al. in Lancet Oncol 16:25-35, 2015) was used as the clinical course. Input parameters were based on summary trial data. Costs were assessed from the Swiss healthcare system perspective. Adding palbociclib to letrozole (PALLET) compared to letrozole monotherapy was estimated to cost an additional CHF342,440 and gain 1.14 quality-adjusted life years, resulting in an incremental cost-effectiveness ratio (ICER) of CHF301,227/QALY gained. In univariate sensitivity analyses, no tested variation in key parameters resulted in an ICER below a willingness-to-pay threshold of CHF100,000/QALY. PALLET had a 0 % probability of being cost-effective in probabilistic sensitivity analyses. Lowering PALLET's price by 75 % resulted in an ICER of CHF73,995/QALY and a 73 % probability of being cost-effective. At current prices, PALLET would cost the Swiss healthcare system an additional CHF155 million/year. Palbociclib plus letrozole cannot be considered cost-effective for the first-line treatment of patients with metastatic breast cancer in the Swiss healthcare system. PMID:27277747

  14. Palbociclib as a first-line treatment in oestrogen receptor-positive, HER2-negative, advanced breast cancer not cost-effective with current pricing: a health economic analysis of the Swiss Group for Clinical Cancer Research (SAKK).

    Science.gov (United States)

    Matter-Walstra, K; Ruhstaller, T; Klingbiel, D; Schwenkglenks, M; Dedes, K J

    2016-07-01

    Endocrine therapy continues to be the optimal systemic treatment for metastatic ER(+)HER2(-) breast cancer. The CDK4/6 inhibitor palbociclib combined with letrozole has recently been shown to significantly improve progression-free survival. Here we examined the cost-effectiveness of this regimen for the Swiss healthcare system. A Markov cohort simulation based on the PALOMA-1 trial (Finn et al. in Lancet Oncol 16:25-35, 2015) was used as the clinical course. Input parameters were based on summary trial data. Costs were assessed from the Swiss healthcare system perspective. Adding palbociclib to letrozole (PALLET) compared to letrozole monotherapy was estimated to cost an additional CHF342,440 and gain 1.14 quality-adjusted life years, resulting in an incremental cost-effectiveness ratio (ICER) of CHF301,227/QALY gained. In univariate sensitivity analyses, no tested variation in key parameters resulted in an ICER below a willingness-to-pay threshold of CHF100,000/QALY. PALLET had a 0 % probability of being cost-effective in probabilistic sensitivity analyses. Lowering PALLET's price by 75 % resulted in an ICER of CHF73,995/QALY and a 73 % probability of being cost-effective. At current prices, PALLET would cost the Swiss healthcare system an additional CHF155 million/year. Palbociclib plus letrozole cannot be considered cost-effective for the first-line treatment of patients with metastatic breast cancer in the Swiss healthcare system.

  15. Clinical Research and Clinical Trials

    Science.gov (United States)

    ... Meetings, Conferences & Events Partnering & Donating to the NICHD Staff Directory ... Clinical Research Skip sharing on social media links Share this: Page Content Clinical research is research that directly involves a ...

  16. Clinical features and treatment outcome of very elderly patients over 80 years old with multiple myeloma: comparison with patients in different age groups in the era of novel agents.

    Science.gov (United States)

    Matsue, Kosei; Matsue, Yuya; Fujisawa, Manabu; Fukumoto, Kota; Suehara, Yasuhito; Sugihara, Hiroki; Takeuchi, Masami

    2016-01-01

    We retrospectively analyzed the outcomes of 175 consecutive patients admitted to our hospital between April 2004 and June 2014, and identified 42 (24%), 80 (46%), and 53 (30%) patients ≥ 80, 66-79, and ≤ 65 years old, respectively. The median progression-free survival (PFS) and overall survival (OS) of the ≥ 80, 66-79, and ≤ 65 years old groups were 19.1, 26.3, and 54.3 months, and 31.9, 54.8, and 83.8 months, respectively. Patients ≥ 80 but not ≤ 79 years old with ECOG performance score (PS) ≥ 3 and/or Charlson comorbidity index (CCI) ≥ 5 showed significantly shorter survival. ECOG PS and CCI predicted the treatment outcome of patients ≥ 80 but did not predict ≤ 79 years old.

  17. [Clinical, microbiological and immunological findings in peri-implantitis patients with bar-retained lower removable partial dentures, compared to a healthy control group (12-month-follow-up)].

    Science.gov (United States)

    Mesmer, Christian; Forster, András; Antal, Márk; Nagy, Katalin

    2012-06-01

    Cause, treatment strategies and prognosis of peri-implantitis is not well understood. The aim of this study was to followup clinical, microbiological and immunological findings in individuals wearing bar-retained lower partial dentures with and without peri-implantitis, pre and post treatment. From the Tuebingen Implant Registry recall program 16 peri-implantitis patients were compared to 16 healthy individuals in a prospective, unblinded study. Peri-implantitis was treated with a single anti-inflammatory therapy according to the CIST protocol while the controls received professional implant cleaning. The following findings were recorded at four time points before treatment (T1) and 30, 90, 360 days post treatment (T2-T4): sulcular fluid flow rate, probing depth, plaque and bleeding index, implant stability (Periotest); sulcular concentrations of interleukin-1 beta, plasminogen activator inhibitor 2, prostaglandin E2, and the sum score of five periodonto-pathogenic bacteria species by PCR (Hain Microldent test). Statistically significant differences between healthy and diseased implants were found for probing depth, bleeding on probing, bacterial load, and implant stability. For the first three, a significant decrease in severity was observed after treatment, but reached initial pre-treatment values within one year. No changes could be observed in the individuals without peri-implantitis. The results of the present study confirm marked differences in peri-implant findings between healthy and diseased sites. They demonstrate that a single anti-inflammatory intervention can initially--but not sustained--reduce probing depth, bleeding on probing, and the total bacterial load as evident from PCR diagnostics. Further immunological diagnostic measures do not seem to provide more information in the patients investigated.

  18. Evaluation of combined, conservative treatment impact on the clinical course, blood flow parameters and muscle perfusion in the group of patients with newly diagnosed, untreated peripheral arterial disease (PAD)

    International Nuclear Information System (INIS)

    Background: Epidemiological studies determined incidence of obliterative atherosclerosis as ranging between 2.45 -10 %. The course of disease is often asymptomatic and demonstration of symptoms occurs when vascular lesions are significantly advanced. This article discusses conservative treatment of patients with PAD whose key complaint was intermittent claudication. The Authors proposed multi-stage treatment regimen of this disease including lifestyle modification, treatment of comorbid disorders, and pharmacotherapy (aspirin, pentoxifylline, buflomedil, L-arginine). The study evaluated influence of 6-month treatment on clinical course, blood flow parameters as well as muscle perfusion. Material/Methods: The participants included 35 patients (14 women - 40.0 %, and 21 men - 60.0 %) aged from 49 to 80 (mean age 68.37 ± 10.25 years) first time in life diagnosed with PAD. Physical examination, standard vascular tests (ankle-brachial, thigh-ankle and thigh-shin indices, maximum flow velocity, PI and RI in selected arteries), perfusion scintigraphy of lower limbs muscles at rest and on exertion were carried out before and after 6 months of treatment. Results: Statistically significant increase of total walking distance (198.0 meters vs. 330.0 meters, p< 0.01) and improvement in average values of perfusion indices of all studied areas were detected at rest and after exercise. For shin perfusion index at rest (right and left) and for thigh perfusion index after exercise (right) the difference was statistically significant at p< 0.05. Conclusions: Combined medical treatment brought on positive effect on patients suffering from recently diagnosed, thus not yet treated atherosclerotic lower limb ischaemia of IIA and IIB stages according to Fontaines scale. (authors)

  19. Structural Group Psychotherapy in the Treatment of Schizophrenia During Rehabilitation Period:Clinical Observation of 82 Cases%82例结构式团体心理治疗在精神分裂症康复期的效果观察

    Institute of Scientific and Technical Information of China (English)

    陈波; 张集慧; 鲁建瑞

    2015-01-01

    目的:进一步对结构式团体心理治疗在精神分裂症康复期的效果进行观察。方法:选取我院于2012年至2014年期间收治的164例精神分裂症,分成对照组和观察组,每组各82例,对照组患者采用药物治疗,同时进行适当的康复训练,观察组患者在对照组的基础上联合结构式团体心理治疗,采用住院慢性精神病患者社会功能评定量表、自尊量表、自我和谐量表对两组患者的治疗效果进行检验。结果:经过治疗后,观察组社会功能评定量表得分以及自我和谐量表得分均低于对照组,自尊量表得分明显高于对照组,两组差异明显(P<0.05),具有统计学意义。结论:在精神分裂症康复期患者的治疗过程中,结构式团体心理治疗法能够有效改善患者的社会功能,有利于患者的康复,具有极为重要的意义,今后值得推广和应用。%Objective: To further explore the clinical effects of structural group psychotherapy in patients with schizophrenia during rehabilitation period. Methods: 164 cases that were diagnosed with schizophrenia from 2012 to 2014 were randomly di-vided into a control group and an observation group, with 82 in each group each. Besides the drug therapy and appropriate reha-bilitation training which were implemented with the control group, structural group psychotherapy was also carried out on the ob-servation group. Social function assessment table, self-esteem volume table and self-harmony volume table were used for the testing of the clinical effects of hospitalized chronic psychiatric patients in the two groups. Results:After treatment, the scores of social function assessment table and self-harmony volume table in the observation group were lower than those of the control group. However, the self-esteem scale score of the observation group is significantly higher than that of the control group. Sig-nificant difference was observed in both

  20. 腹针“引气归元”穴组治疗脾虚证的临床研究%Clinical Research on Treatment of Spleen Deficiency Syndrone with Abdominal Acupuncture “Return-qi-to-source” Acupuncture-point-group

    Institute of Scientific and Technical Information of China (English)

    陈红; 陈小刚; 朱志强; 吕春燕; 赖克道

    2011-01-01

    目的:探讨腹针“引气归元”穴组治疗脾虚证的临床疗效.方法:将60例脾虚证患者随机分为腹针治疗组20例、体针对照组20例和中药四君子汤对照组20例,进行治疗观察.结果:腹针治疗组对脾虚证主症食欲减退、神疲懒言、肢体倦怠、食后腹胀、大便溏泻等有明显疗效,腹针治疗组总有效率为95.8%,优于体针对照组(P<0.05),与中药四君子汤对照组相近(P>0.05).该法对脾虚证舌象、脉象、红细胞及血色素、唾液负荷分泌水平亦有改善作用.结论:腹针“引气归元”穴组治疗脾虚证有较好疗效.%Objective: To approach the efficiency of Abdominal Acupuncture " Retum-qi-to-source" Acupuncture-point-group in treating spleen deficiency syndrome. Methods: sixty patients were divided into three groups randomly and evenly, of which Group I was treat with abdominal acupuncture , Group II with body acupuncture , Group M with Sijunzi Decoction. Results; Abdominal Acu puncture " Return-qi-to-source" Acupuncture-point-group improved the main clinical manifestation of the syndrome markedly. The total response rates of three groups were 95% , 82% , and 90% respectively, of which the patients of Group I responded better than Group II (P 0. 05) . Abdominal Acupuncture "Return-qi-to-source" Acupuncture-point-group also improved the picture of the tongue, pulse condition, and the average ratio of salivary secretion of the patients of the syndrome. Conclusjon; Abdominal Acupuncture " Return-qi-to-source" Acupuncture-point-group have good therapeutic effects on spleen deficiency syndrome.

  1. Free Boolean Topological Groups

    Directory of Open Access Journals (Sweden)

    Ol’ga Sipacheva

    2015-11-01

    Full Text Available Known and new results on free Boolean topological groups are collected. An account of the properties that these groups share with free or free Abelian topological groups and properties specific to free Boolean groups is given. Special emphasis is placed on the application of set-theoretic methods to the study of Boolean topological groups.

  2. Flexible scope for ISO 15189 accreditation: a guidance prepared by the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) Working Group Accreditation and ISO/CEN standards (WG-A/ISO).

    Science.gov (United States)

    Thelen, Marc H M; Vanstapel, Florent J L A; Kroupis, Christos; Vukasovic, Ines; Boursier, Guilaime; Barrett, Edward; Bernabeu Andreu, Francisco; Brguljan, Pika Meško; Brugnoni, Duilio; Lohmander, Maria; Sprongl, Ludek; Vodnik, Tatjana; Ghita, Irina; Vaubourdolle, Michel; Huisman, Willem

    2015-07-01

    The recent revision of ISO15189 has further strengthened its position as the standard for accreditation for medical laboratories. Both for laboratories and their customers it is important that the scope of such accreditation is clear. Therefore the European co-operation for accreditation (EA) demands that the national bodies responsible for accreditation describe the scope of every laboratory accreditation in a way that leaves no room for doubt about the range of competence of the particular laboratories. According to EA recommendations scopes may be fixed, mentioning every single test that is part of the accreditation, or flexible, mentioning all combinations of medical field, examination type and materials for which the laboratory is competent. Up to now national accreditation bodies perpetuate use of fixed scopes, partly by inertia, partly out of fear that a too flexible scope may lead to over-valuation of the competence of laboratories, most countries only use fixed scopes. The EA however promotes use of flexible scopes, since this allows for more readily innovation, which contributes to quality in laboratory medicine. In this position paper, the Working Group Accreditation and ISO/CEN Standards belonging to the Quality and Regulation Committee of the EFLM recommends using an approach that has led to successful introduction of the flexible scope for ISO15189 accreditation as intended in EA-4/17 in The Netherlands. The approach is risk-based, discipline and competence-based, and focuses on defining a uniform terminology transferable across the borders of scientific disciplines, laboratories and countries.

  3. Group Work: How to Use Groups Effectively

    Science.gov (United States)

    Burke, Alison

    2011-01-01

    Many students cringe and groan when told that they will need to work in a group. However, group work has been found to be good for students and good for teachers. Employers want college graduates to have developed teamwork skills. Additionally, students who participate in collaborative learning get better grades, are more satisfied with their…

  4. Group Therapy Training in a Doctoral Program.

    Science.gov (United States)

    Caffaro, John

    This document describes a program at the California School of Professional Psychology-Los Angeles that provides a three-semester sequence of group therapy courses to counseling students. In the students' final year, they are required to take an advanced clinical course titled Advanced Group Process. The course synthesizes didactic methods for…

  5. The effect of short term neo-adjuvant androgen deprivation on erectile function in patients treated with external beam radiotherapy for localised prostate cancer: an analysis of the 4- versus 8-month randomised trial (Irish Clinical Oncology Research Group 97-01).

    LENUS (Irish Health Repository)

    Daly, Patricia E

    2012-07-01

    Erectile dysfunction is a common consequence of external beam radiotherapy (EBRT) for prostate cancer. The addition of neo-adjuvant androgen deprivation (NAD) has an indeterminate additive effect. We examined the long-term effect on erectile function (EF) of two durations (4 months: arm 1 and 8 months: arm 2) of NAD prior to radiation (RT) for patients with localised prostate cancer from the Irish Clinical Oncology Research Group (ICORG 97-01) 4- versus 8-month trial. In this study we aimed to (1) analyse the overall effect on EF of NAD in an EBRT population, (2) compare the probability of retained EF over time in an EBRT population treated with either 4 or 8 months of NAD and (3) identify any variables such as risk group and age which may have an additive detrimental effect. This analysis provides unique long term follow up data.

  6. MSUD Family Support Group

    Science.gov (United States)

    ... Group The MSUD Family Support Group is a non-profit 501 (c)(3) organization for those with MSUD ... Family Support Group is a 501(c)(3) non-profit organization with no paid staff. Funds are needed ...

  7. Homomorphisms of quantum groups

    CERN Document Server

    Meyer, Ralf; Woronowicz, Stanisław Lech

    2010-01-01

    We introduce some equivalent notions of homomorphisms between quantum groups that behave well with respect to duality of quantum groups. Our equivalent definitions are based on bicharacters, coactions, and universal quantum groups, respectively.

  8. Redefining Cohesiveness in Groups.

    Science.gov (United States)

    Keyton, Joann; Springston, Jeff

    1990-01-01

    Attempted to replicate and extend research on work of Kelly and Duran in assessing relationship of group member perceptions of group interaction to group effectiveness. Concludes perceived similarity may not always align with perceptions of cohesiveness. (Author/ABL)

  9. Flexible scope for ISO 15189 accreditation: a guidance prepared by the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) Working Group Accreditation and ISO/CEN standards (WG-A/ISO).

    Science.gov (United States)

    Thelen, Marc H M; Vanstapel, Florent J L A; Kroupis, Christos; Vukasovic, Ines; Boursier, Guilaime; Barrett, Edward; Bernabeu Andreu, Francisco; Brguljan, Pika Meško; Brugnoni, Duilio; Lohmander, Maria; Sprongl, Ludek; Vodnik, Tatjana; Ghita, Irina; Vaubourdolle, Michel; Huisman, Willem

    2015-07-01

    The recent revision of ISO15189 has further strengthened its position as the standard for accreditation for medical laboratories. Both for laboratories and their customers it is important that the scope of such accreditation is clear. Therefore the European co-operation for accreditation (EA) demands that the national bodies responsible for accreditation describe the scope of every laboratory accreditation in a way that leaves no room for doubt about the range of competence of the particular laboratories. According to EA recommendations scopes may be fixed, mentioning every single test that is part of the accreditation, or flexible, mentioning all combinations of medical field, examination type and materials for which the laboratory is competent. Up to now national accreditation bodies perpetuate use of fixed scopes, partly by inertia, partly out of fear that a too flexible scope may lead to over-valuation of the competence of laboratories, most countries only use fixed scopes. The EA however promotes use of flexible scopes, since this allows for more readily innovation, which contributes to quality in laboratory medicine. In this position paper, the Working Group Accreditation and ISO/CEN Standards belonging to the Quality and Regulation Committee of the EFLM recommends using an approach that has led to successful introduction of the flexible scope for ISO15189 accreditation as intended in EA-4/17 in The Netherlands. The approach is risk-based, discipline and competence-based, and focuses on defining a uniform terminology transferable across the borders of scientific disciplines, laboratories and countries. PMID:26055950

  10. Economic analysis of a phase III clinical trial evaluating the addition of total androgen suppression to radiation versus radiation alone for locally advanced prostate cancer (Radiation Therapy Oncology Group protocol 86-10)

    International Nuclear Information System (INIS)

    Purpose: To evaluate the cost-effectiveness of adding hormone therapy to radiation for patients with locally advanced prostate cancer, using a Monte Carlo simulation of a Markov Model. Methods and Materials: Radiation Therapy Oncology Group (RTOG) protocol 86-10 randomized patients to receive radiation therapy (RT) alone or RT plus total androgen suppression (RTHormones) 2 months before and during RT for the treatment of locally advanced prostate cancer. A Markov model was designed with Data Pro (TreeAge Software, Williamstown, MA). The analysis took a payer's perspective. Transition probabilities from one state of health (i.e., with no disease progression or with hormone-responsive metastatic disease) to another were calculated from published rates pertaining to RTOG 86-10. Patients remained in one state of health for 1 year. Utility values for each health state and treatment were obtained from the literature. Distributions were sampled at random from the treatment utilities according to a second-order Monte Carlo simulation technique. Results: The mean expected cost for the RT-only treatments was $29,240 (range, $29,138-$29,403). The mean effectiveness for the RT-only treatment was 5.48 quality-adjusted life years (QALYs) (range, 5.47-5.50). The mean expected cost for RTHormones was $31,286 (range, $31,058-$31,555). The mean effectiveness was 6.43 QALYs (range, 6.42-6.44). Incremental cost-effectiveness analysis showed RTHormones to be within the range of cost-effectiveness at $2,153/QALY. Cost-effectiveness acceptability curve analysis resulted in a >80% probability that RTHormones is cost-effective. Conclusions: Our analysis shows that adding hormonal treatment to RT improves health outcomes at a cost that is within the acceptable cost-effectiveness range

  11. The long-term treatment of restless legs syndrome/Willis-Ekbom disease: evidence-based guidelines and clinical consensus best practice guidance: a report from the International Restless Legs Syndrome Study Group.

    Science.gov (United States)

    Garcia-Borreguero, Diego; Kohnen, Ralf; Silber, Michael H; Winkelman, John W; Earley, Christopher J; Högl, Birgit; Manconi, Mauro; Montplaisir, Jacques; Inoue, Yuichi; Allen, Richard P

    2013-07-01

    A Task Force was established by the International Restless Legs Syndrome Study Group (IRLSSG) to develop evidence-based and consensus-based recommendations for the long-term pharmacologic treatment of restless legs syndrome/Willis-Ekbom disease (RLS/WED). The Task Force reviewed the results of all studies of RLS/WED treatments with durations of 6 months or longer presented at meetings over the past 2 years, posted on Web sites of pharmaceutical companies, or published in peer-reviewed journals, asking the questions, "What is the efficacy of this treatment in patients with RLS/WED?" and "What is the safety of this treatment in patients with RLS/WED?" The Task Force developed guidelines based on their review of 61 papers meeting inclusion criteria, and using a modified evidence-grading scheme. Pregabalin has been established as effective for up to 1 year in treating RLS/WED (Level A evidence). Pramipexole, ropinirole, and rotigotine have been established as effective for up to 6 months in treating RLS/WED (Level A). The following drugs have been established as probably effective (Level B) in treating RLS/WED for durations ranging from 1 to 5 years: gabapentin enacarbil, pramipexole, and ropinirole (1 year); levodopa (2 years); and rotigotine (5 years). Because of associated safety concerns, pergolide and cabergoline should not be used in the treatment of RLS/WED unless the benefits clearly outweigh the risks. Other pharmacologic therapies have insufficient evidence to support their long-term use in treating RLS/WED. The IRLSSG Task Force also developed consensus-based strategies for the prevention and treatment of complications (such as augmentation, loss of efficacy, excessive daytime sleepiness, and impulse control disorders) that may develop with the long-term pharmacologic treatment of RLS/WED. The use of either a dopamine-receptor agonist or α2δ calcium-channel ligand is recommended as the first-line treatment of RLS/WED for most patients, with the choice of

  12. Características clinicoepidemiológicas de um grupo de mulheres com HIV/AIDS em Salvador-Bahia Clinical-epidemiological characteristics of a group of HIV/AIDS infected women in Salvador-Bahia

    Directory of Open Access Journals (Sweden)

    Ceuci de Lima Xavier Nunes

    2004-12-01

    Full Text Available A expansão da infecção pelo HIV/AIDS entre as mulheres e os mais pobres, são importantes características da epidemia no Brasil e no mundo. Estudo descritivo delineou-se com objetivo de descrever um grupo de 82 mulheres com HIV/AIDS de Salvador - Bahia. A idade média é 32 ± 7,2 anos; 75% têm filhos, 82,5% estão desempregadas e o grau de instrução situa-se entre analfabeto e primeiro grau em 77,8%. O número de parceiros sexuais foi igual ou inferior a cinco na vida em 71% dos casos e 25% relatavam um único parceiro. Quarenta e seis (55,4% mulheres apresentaram 77 episódios de infecções oportunistas. A maioria das pacientes tem baixo grau de instrução, baixa renda e poucos parceiros sexuais. A forma de transmissão foi predominantemente sexual, muitas mulheres adquiriram o vírus com o próprio companheiro/ marido.The increasing number of HIV/AIDS infected women is one of the main characteristics of the AIDS epidemic, besides the wide expansion of the disease among the poor. This study focused on a group of 82 women with AIDS from Salvador - Bahia. The mean age was 32 ± 7.2 years, 75% had children, 82.5% were jobless, and 77.8% were illiterate or only had basic education. The number of sexual partners was five or fewer in 71% of cases and 25% had only one sexual partner. Forty-six (55.4% women reported up to 77 episodes of opportunist infections. The majority of the patients were from the lower classes, with no good education, a low income and few sexual partners. The main via of transmission was heterosexual, and many of the women were infected by their steady partner/husband.

  13. OARSI Clinical Trials Recommendations

    DEFF Research Database (Denmark)

    Kraus, V B; Blanco, F J; Englund, M;

    2015-01-01

    The objective of this work was to describe requirements for inclusion of soluble biomarkers in osteoarthritis (OA) clinical trials and progress toward OA-related biomarker qualification. The Guidelines for Biomarkers Working Group, representing experts in the field of OA biomarker research from...... both academia and industry, convened to discuss issues related to soluble biomarkers and to make recommendations for their use in OA clinical trials based on current knowledge and anticipated benefits. This document summarizes current guidance on use of biomarkers in OA clinical trials...... and their utility at five stages, including preclinical development and phase I to phase IV trials. As demonstrated by this summary, biomarkers can provide value at all stages of therapeutics development. When resources permit, we recommend collection of biospecimens in all OA clinical trials for a wide variety...

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

    Science.gov (United States)

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

    2001-01-01

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

  15. 蔗糖凝胶治疗细菌性阴道病的多中心、随机、双盲、平行对照Ⅲ期临床试验%Sucrose gel for treatment of bacterial vaginosis:a randomized, double-blind, multi-center, parallel-group, phase Ⅲ clinical trial

    Institute of Scientific and Technical Information of China (English)

    肖冰冰; 张岱; 陈锐; 史惠蓉; 辛晓燕; 王惠兰; 庞义存; 朱赛楠; 姚晨

    2015-01-01

    目的:通过多中心、随机、双盲、平行对照的临床研究,进一步评价蔗糖凝胶治疗细菌性阴道病的有效性及安全性. 方法:选择5个研究中心的533例细菌性阴道病患者作为研究对象,依据随机表按对照组与试验组为2:3比例随机入组,甲硝唑凝胶5. 0 g组(对照组)214例,蔗糖凝胶5. 0 g组(实验组)319例,两组均采取每日早晚各一次阴道上药,连用5 d的疗程进行治疗. 分别于治疗第7~10天、第21~30天进行疗效观察及安全性评价.结果:治疗第7~10天,甲硝唑凝胶组和蔗糖凝胶组的临床综合疗效治愈率分别为70. 53%和80. 83%,阴道分泌物涂片Nugent积分痊愈率分别为71. 50%和81. 15%,差异均有统计学意义(P0. 05). 结论:蔗糖凝胶治疗细菌性阴道病的临床综合疗效近期(治疗第7~10天)及恢复阴道菌群方面明显优于甲硝唑凝胶,远期治愈率(治疗第21~30天)与甲硝唑凝胶相当,可成为治疗细菌性阴道病的新策略.%Objective:To evaluate the cure effectiveness and safety of sucrose gel in the treatment of bacterial vaginosis through a multi-center, randomized, double-blind, parallel controlled clinical study. Methods:A clinical research method of multi-center, randomly double-blind, and dose group parallel comparison was adopted. In the study, 533 patients with bacterial vaginosis were randomly divided into two groups, which included 214 cases in the control group (5. 0 g metronidazole gel) and 319 cases in the trial group (5. 0 g sucrose gel ). The patients were treated with different medication according to the group where they were. All the cases in these two groups were treated with drugs vaginally twice in a day, morning and evening separately, for 5 days. The curative effect and safety evaluation were assessed from 7 to 10 days and 21 to 30 days after treatment respectively. Results: The efficacy of the comprehensive clinical treatment showed that the cure rate of metronidazole gel group

  16. Estado periodontal y de la mucosa oral en un grupo de embarazadas: Estudio clínico Periodontal and mucosal status in a group of pregnant women: Clinical study

    Directory of Open Access Journals (Sweden)

    M. Lacalzada-Pastor

    2011-08-01

    public health centre. An oral exploration was performed. Periodontal status was evaluated by means of the Community Periodontal Index of Treatment Needs (CPITN. Teeth 16, 11, 26, 36, 31 and 46 from each patient were proben and the chosen value was the highest one of all sextants. 56 patients came back for reevaluation. The status of the oral mucosa was also inspected. Results: Among the 165 patients, the 5% were considered non-valuable (9, the 35% scored value 0 (57, the 46% scored value 1 (76, the 12% value 2 (20 and the 2% value 3 (1. Among the 56 who came back for reevaluation 13 of them did improve (23%, 6 got worse (10% and 37 (66% maintained. Only one person had an oral lesion: a ranula. Conclusions: Despite there was a group free of periodontal pathology, 35%, the majority of the patients (46% had gingivitis and some of them periodontitis (14%. It is important for us to recommend the pregnant patients to come for a buccal exploration as well as carrying out a preventive labour in all patients in fertile age.

  17. Ordered groups and infinite permutation groups

    CERN Document Server

    1996-01-01

    The subjects of ordered groups and of infinite permutation groups have long en­ joyed a symbiotic relationship. Although the two subjects come from very different sources, they have in certain ways come together, and each has derived considerable benefit from the other. My own personal contact with this interaction began in 1961. I had done Ph. D. work on sequence convergence in totally ordered groups under the direction of Paul Conrad. In the process, I had encountered "pseudo-convergent" sequences in an ordered group G, which are like Cauchy sequences, except that the differences be­ tween terms of large index approach not 0 but a convex subgroup G of G. If G is normal, then such sequences are conveniently described as Cauchy sequences in the quotient ordered group GIG. If G is not normal, of course GIG has no group structure, though it is still a totally ordered set. The best that can be said is that the elements of G permute GIG in an order-preserving fashion. In independent investigations around that t...

  18. Assertive Training in Groups

    Science.gov (United States)

    Sansbury, David L.

    1974-01-01

    This article describes a group approach to helping the nonassertive client. After describing the group composition and goals, he presents a session by session description for conducting the assertive training group. In addition, he presents suggestions based on experiences in leading the group. (Author)

  19. 非小细胞肺癌N1组淋巴结系统性清扫的临床意义%Clinical significance of systematical resection of N1 group lymph nodes in patients with non-small cell lung cancer

    Institute of Scientific and Technical Information of China (English)

    曹磊; 任华

    2011-01-01

    目的:探讨系统清扫N1组淋巴结对非小细胞肺癌临床分期的影响.方法:对行手术治疗的52例非小细胞肺癌分别进行N1组淋巴结系统性清扫,并结合其临床病理资料进行统计学分析.结果:全组淋巴结清扫平均34(15~62)个,其中纵隔淋巴结清扫平均16(8~32)个,N1组淋巴结清扫平均12(6~23)个,13~14组淋巴结清扫平均3(1~6)个.全组中无淋巴结转移(NO)14例,N1组淋巴结转移21例,其中仅第13~14组淋巴结转移者7例.结论:作为肺癌分期的重要指标,对N1组淋巴结术中系统清扫尤其是对第13~14组的清扫并进行病理分析,对于提高肺癌诊断分期的准确性和指导临床治疗具有重要的意义.%Objective To study the clinical significance of systematical resection of N1 group lymph nodes in NSCLC patients. Methods Filty -two cases of pulmonary resection performed at Thoracic Surgery Department of PUMC Hospital were recruited. The N1 group lymph nodes were systematically resected and their clinical and pathological data were analyzed. Results The average number resected was 34 ( 15 - 62) for total lymph nodes, 16 ( 8 - 32 ) for mediastinal nodes, 12 (6 - 23 ) for N1 group nodes, and 3 ( 1 -6)for group No. 13 - 14 lymph nodes, respectively. Fourteen cases of N0 and 21 cases of N1 were diagnosed in this group. More important, 7 cases had No. 13 - 14 metastasis only. Conclusions Systematical resection and pathological examination of N1 group lymph nodes, especially, the NO. 13 -14 lymph nodes can improve the accuracy of lung cancer staging and guide further treatment.

  20. 髓外固定与髓内固定系统应用于临床分组治疗股骨粗隆间骨折对比分析与评价%Comparative Analysis and Evaluation on Medullary External Fixation and Intramedullary Fixation System Applied in Treating Intertrochanteric Fracture by Clinical Grouping

    Institute of Scientific and Technical Information of China (English)

    蒙向铖; 覃小武; 韦东; 李林峰

    2015-01-01

    Objective To compare and analyze and evaluate the clinical efficacy of external fixation and intramedullary fixation in the treatment of patients with femoral intertrochanteric fracture. Methods Seventy two patients with femoral intertrochanteric fracture were divided into two groups with 36 cases in each group according to different methods of operation. Patients in Group A underwent external system internal fixation of open reduction locking plate medullary (proximal femoral locking plate) treatment, while those in Group B underwent closed reduction or intramedullary system internal fixation treatment of open reduction proximal femoral nail anti-rotation (PFNA).Clinical efficacies on patients in two groups were compared, and the analysis and evaluation were made. Results The comparisons in the operation duration, bleeding amount and hip joint function before and after treatment were not significantly different (P > 0.05).But the complication rate of patients in Group B (8.33%) was lower than that of patients in Group A (19.44%), and the inter-group via statistical analysis satisfied P < 0.05, and the differences were significant. Conclusion External medullary fixation and intramedullary fixation system on patients with femoral intertrochanteric fracture deliver better efficacies, but the incidence of postoperative complications of intramedullary fixation system was significantly lower, suitable operation method should be chosen in clinical treatment according to conditions of patient to get best efficacies.%目的:研究股骨粗隆间骨折患者行髓外固定与髓内固定的临床疗效并进行对比分析与评价。方法将72例股骨粗隆间骨折患者按手术方式的不同分为两组,各36例,A组患者行切开复位锁定钢板髓外系统内固定(股骨近端锁定板)治疗, B组患者行闭合复位或切开复位股骨近端防旋髓内钉(PFNA)髓内系统内固定治疗,对比两组患者临床疗效并进行分析与

  1. Robust Group Linkage

    OpenAIRE

    Li, Pei; Dong, Xin Luna; Guo, Songtao; Maurino, Andrea; Srivastava, Divesh

    2015-01-01

    We study the problem of group linkage: linking records that refer to entities in the same group. Applications for group linkage include finding businesses in the same chain, finding conference attendees from the same affiliation, finding players from the same team, etc. Group linkage faces challenges not present for traditional record linkage. First, although different members in the same group can share some similar global values of an attribute, they represent different entities so can also...

  2. Turnaround for the Denver Clinic.

    Science.gov (United States)

    Norris, M J

    1981-01-01

    By renovating its facility, the Denver Clinic was able to meet the needs of its present patient population and attract new patients. Marketing techniques were employed to redesign the facility and to capitalize on the clinic's competitive edge in the Denver market. Useful information is offered to other clinics who are considering facility renovation and on the advantages group practices have in the medical market plan. PMID:10252836

  3. Clinical Research

    DEFF Research Database (Denmark)

    Christensen, Irene

    2016-01-01

    for years to come. This paper seeks to provide insights into ramp-up management studies through providing an agenda for conducting collaborative clinical research and extend this area by proposing how clinical research could be designed and executed in the Ramp- up management setting.......This paper is about the logic of problem solving and the production of scientific knowledge through the utilisation of clinical research perspective. Ramp-up effectiveness, productivity, efficiency and organizational excellence are topics that continue to engage research and will continue doing so...

  4. Groups as Graphs

    CERN Document Server

    Kandasamy, W B Vasantha

    2009-01-01

    For the first time we represent every finite group in the form of a graph in this book. The authors choose to call these graphs as identity graph, since the main role in obtaining the graph is played by the identity element of the group. This study is innovative because through this description one can immediately look at the graph and say the number of elements in the group G which are self-inversed. Also study of different properties, like the subgroups of a group, normal subgroups of a group, p-sylow subgroups of a group and conjugate elements of a group are carried out using the identity graph of the group in this book. This book has four chapters. The first chapter is introductory. The second chapter represents groups as graphs. In the third chapter, we have defined similar types of graphs for algebraic structures like commutative semigroups, loops, commutative groupoids and commutative rings. The final chapter poses 52 problems.

  5. Higher arithmetic Chow groups

    CERN Document Server

    Gil, J I Burgos

    2009-01-01

    We give a new construction of higher arithmetic Chow groups for quasi-projective arithmetic varieties over a field. Our definition agrees with the higher arithmetic Chow groups defined by Goncharov for projective arithmetic varieties over a field. These groups are the analogue, in the Arakelov context, of the higher algebraic Chow groups defined by Bloch. The degree zero group agrees with the arithmetic Chow groups of Burgos. Our new construction is shown to be a contravariant functor and is endowed with a product structure, which is commutative and associative.

  6. Clinical photography.

    Science.gov (United States)

    Jakowenko, Janelle

    2009-01-01

    Digital cameras, when used correctly, can provide the basis for telemedicine services. The increasing sophistication of digital cameras, combined with the improved speed and availability of the Internet, make them an instrument that every health-care professional should be familiar with. Taking satisfactory images of patients requires clinical photography skills. Photographing charts, monitors, X-ray films and specimens also requires expertise. Image capture using digital cameras is often done with insufficient attention, which can lead to inaccurate study results. The procedures in clinical photography should not vary from camera to camera, or from country to country. Taking a photograph should be a standardised process. There are seven main scenarios in clinical photography and health professionals who use cameras should be familiar with all of them. Obtaining informed consent prior to photography should be a normal part of the clinical photography routine.

  7. Clinical supervision.

    Science.gov (United States)

    Goorapah, D

    1997-05-01

    The introduction of clinical supervision to a wider sphere of nursing is being considered from a professional and organizational point of view. Positive views are being expressed about adopting this concept, although there are indications to suggest that there are also strong reservations. This paper examines the potential for its success amidst the scepticism that exists. One important question raised is whether clinical supervision will replace or run alongside other support systems.

  8. Group B streptococcus - pregnancy

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/patientinstructions/000511.htm Group B streptococcus - pregnancy To use the sharing features on this page, please enable JavaScript. Group B streptococcus (GBS) is a type of bacteria that ...

  9. Fast Overlapping Group Lasso

    CERN Document Server

    Liu, Jun

    2010-01-01

    The group Lasso is an extension of the Lasso for feature selection on (predefined) non-overlapping groups of features. The non-overlapping group structure limits its applicability in practice. There have been several recent attempts to study a more general formulation, where groups of features are given, potentially with overlaps between the groups. The resulting optimization is, however, much more challenging to solve due to the group overlaps. In this paper, we consider the efficient optimization of the overlapping group Lasso penalized problem. We reveal several key properties of the proximal operator associated with the overlapping group Lasso, and compute the proximal operator by solving the smooth and convex dual problem, which allows the use of the gradient descent type of algorithms for the optimization. We have performed empirical evaluations using the breast cancer gene expression data set, which consists of 8,141 genes organized into (overlapping) gene sets. Experimental results demonstrate the eff...

  10. Gestalt Interactional Groups

    Science.gov (United States)

    Harman, Robert L.; Franklin, Richard W.

    1975-01-01

    Gestalt therapy in groups is not limited to individual work in the presence of an audience. Describes several ways to involve gestalt groups interactionally. Interactions described focus on learning by doing and discovering, and are noninterpretive. (Author/EJT)

  11. Group Wage Curves

    OpenAIRE

    Bartik, Timothy J.

    2000-01-01

    Using panel data on U.S. MSAs, this paper estimates how a typical MSA's wages of different demographic groups, and prices, are affected by overall MSA unemployment, the distribution of unemployment among different groups, and national prices and wages. MSA unemployment has strong effects on MSA wages and prices, but the distribution of unemployment among different groups has weak effects on wages and prices. Using these estimates, simulations show that targeting high-unemployment groups for u...

  12. Introduction to quantum groups

    OpenAIRE

    Podles, P.; Muller, E.

    1997-01-01

    We give an elementary introduction to the theory of algebraic and topological quantum groups (in the spirit of S. L. Woronowicz). In particular, we recall the basic facts from Hopf (*-) algebra theory, theory of compact (matrix) quantum groups and the theory of their actions on compact quantum spaces. We also provide the most important examples, including the classification of quantum SL(2)-groups, their real forms and quantum spheres. We also consider quantum SL_q(N)-groups and quantum Loren...

  13. Multicultural group work

    DEFF Research Database (Denmark)

    Hansen, Annette Skovsted

    2014-01-01

    Motivation for the activity I use this strategy for forming groups to ensure diverse/multicultural groups that combine a variety of different strengths and resources based on student's academic, disciplinary, linguistic, national, personal and work backgrounds.......Motivation for the activity I use this strategy for forming groups to ensure diverse/multicultural groups that combine a variety of different strengths and resources based on student's academic, disciplinary, linguistic, national, personal and work backgrounds....

  14. Higher arithmetic Chow groups

    DEFF Research Database (Denmark)

    Gil, J. I. Burgos; Feliu, Elisenda

    2012-01-01

    We give a new construction of higher arithmetic Chow groups for quasi-projective arithmetic varieties over a field. Our definition agrees with the higher arithmetic Chow groups defined by Goncharov for projective arithmetic varieties over a field. These groups are the analogue, in the Arakelov co...... and is endowed with a product structure, which is commutative and associative....

  15. Xeroderma pigmentosum groups C and F

    International Nuclear Information System (INIS)

    The differential bead-labelling method for heterodikaryon complementation enabled us to allocate xeroderma pigmentosum patients XP40KO and XP38KO to complementation groups C and F, respectively. Group C XP40KO cells exhibited 15 % UDS and the 5 and 1.5-fold hypersensitivities to UV and 4-nitroquinoline-1-oxide (4NQO) killings, respectively, while group F XP38KO cells showed a higher residual level of 20 - 25 % UDS and a less UV/4NQO hypersensitivity than did the previously assigned group F strains. We reviewed the thus far assigned Japanese groups C and F subjects for the repair and clinical characteristics. The present group C XP40KO was typical, while XP38KO was heterogrnous within group F with respect to repair. (author)

  16. CHAOTIC GROUP ACTIONS

    Institute of Scientific and Technical Information of China (English)

    ShiEnhui; ZhouLizhen; ZhouYoucheng

    2003-01-01

    It is proved that there is no chaotic group actions on any topological space with free arc.In this paper the chaotic actions of the group like G×F,where F is a finite group,are studied.In particular,under a suitable assumption ,if F is a cyclic group,then the topological space which admits a chaotic action of Z×F must admit a chatotic homeomorphism.A topological space which admits a chaotic group action but admits no chaotic horneomorphism is constructed.

  17. Group theory I essentials

    CERN Document Server

    Milewski, Emil G

    2012-01-01

    REA's Essentials provide quick and easy access to critical information in a variety of different fields, ranging from the most basic to the most advanced. As its name implies, these concise, comprehensive study guides summarize the essentials of the field covered. Essentials are helpful when preparing for exams, doing homework and will remain a lasting reference source for students, teachers, and professionals. Group Theory I includes sets and mapping, groupoids and semi-groups, groups, isomorphisms and homomorphisms, cyclic groups, the Sylow theorems, and finite p-groups.

  18. Splittings of knot groups

    OpenAIRE

    Friedl, Stefan; Silver, Daniel S.; Williams, Susan G.

    2013-01-01

    Let K be a knot of genus g. If K is fibered, then it is well known that the knot group pi(K) splits only over a free group of rank 2g. We show that if K is not fibered, then pi(K) splits over non-free groups of arbitrarily large rank. Furthermore, if K is not fibered, then pi(K) splits over every free group of rank at least 2g. However, pi(K) cannot split over a group of rank less than 2g. The last statement is proved using the recent results of Agol, Przytycki-Wise and Wise.

  19. Grouped exposed metal heaters

    Energy Technology Data Exchange (ETDEWEB)

    Vinegar, Harold J. (Bellaire, TX); Coit, William George (Bellaire, TX); Griffin, Peter Terry (Brixham, GB); Hamilton, Paul Taylor (Houston, TX); Hsu, Chia-Fu (Granada Hills, CA); Mason, Stanley Leroy (Allen, TX); Samuel, Allan James (Kular Lumpar, MY); Watkins, Ronnie Wade (Cypress, TX)

    2010-11-09

    A system for treating a hydrocarbon containing formation is described. The system includes two or more groups of elongated heaters. The group includes two or more heaters placed in two or more openings in the formation. The heaters in the group are electrically coupled below the surface of the formation. The openings include at least partially uncased wellbores in a hydrocarbon layer of the formation. The groups are electrically configured such that current flow through the formation between at least two groups is inhibited. The heaters are configured to provide heat to the formation.

  20. Grouped exposed metal heaters

    Energy Technology Data Exchange (ETDEWEB)

    Vinegar, Harold J. (Bellaire, TX); Coit, William George (Bellaire, TX); Griffin, Peter Terry (Brixham, GB); Hamilton, Paul Taylor (Houston, TX); Hsu, Chia-Fu (Granada Hills, CA); Mason, Stanley Leroy (Allen, TX); Samuel, Allan James (Kular Lumpar, ML); Watkins, Ronnie Wade (Cypress, TX)

    2012-07-31

    A system for treating a hydrocarbon containing formation is described. The system includes two or more groups of elongated heaters. The group includes two or more heaters placed in two or more openings in the formation. The heaters in the group are electrically coupled below the surface of the formation. The openings include at least partially uncased wellbores in a hydrocarbon layer of the formation. The groups are electrically configured such that current flow through the formation between at least two groups is inhibited. The heaters are configured to provide heat to the formation.

  1. On -nilpotent abelian groups

    Indian Academy of Sciences (India)

    Mohammad Mehdi Nasrabadi; Ali Gholamian

    2014-11-01

    Let be a group and $A = \\text{Aut}(G)$ be the group of automorphisms of . Then, the element $[g, ] = g^{-1}(g)$ is an autocommutator of $g \\in G$ and $ \\in A$. Hence, for any natural number the -th autocommutator subgroup of is defined as $K_{m}(G)=\\langle [g,_{1},\\ldots,_{m}]|g\\in G,_{1},\\ldots,_{m}\\in A\\rangle$, where $[g, _{1}, _{2},\\ldots, _{m}] = [[g,_{1},\\ldots,_{m−1}], _{m}]$. In this paper, we introduce the new notion of -nilpotent groups and classify all abelian groups which are -nilpotent groups.

  2. [Group psychotherapy. Operative groups at the Instituto del servico de seguridad Social de los Trabajadores del Estado (ISSSTE)].

    Science.gov (United States)

    Margolis, J

    1977-01-01

    An operational group is defined; how operational groups theory was applied at an ISSSTE clinic is described. It is underlined how operational groups promote change around the corerstone of a "task". The vicissitudes of an operational group with four psychiatrists who worked in community psychiatry at the ISSSTE, are described.

  3. Toleration, Groups, and Multiculturalism

    DEFF Research Database (Denmark)

    Lægaard, Sune

    2014-01-01

    to the political and social relationship between the subject and the objects of toleration. Finally, toleration is often argued to be a normative requirement on the basis of the way it affects the object or receiver of toleration, e.g. on the basis of the good of or right to freedom from non-interference which....... The chapter relates the different possible meanings of groups toleration to widespread criticisms of multiculturalism for being excessively 'groupist' (e.g. to essentialise or reify groups), to promote group rights over individual rights, or to deny or ignore the internal heterogeneity of groups...... or the multiple identity affiliations of individuals. The chapter suggests that some of these standard criticisms of multiculturalism for being overly tolerant of minority groups, or being so in a way elevating groups over individuals, are less pressing on some understandings of the meaning of 'group...

  4. E-groups training

    CERN Multimedia

    HR Department

    2012-01-01

    There will be an e-groups training course on 16 March 2012 which will cover the main e-groups functionalities i.e.: creating and managing e-groups, difference between static and dynamic e-groups, configuring posting restrictions and archives, examples of where e-groups can be used in daily work. Even if you have already worked with e-groups, this may be a good opportunity to learn about the best practices and security related recommendations when using e-groups. You can find more details as well as enrolment form for the training (it’s free) here. The number of places is limited, so enrolling early is recommended.   Technical Training Tel. 72844

  5. Antibacterial resistance leadership group: open for business.

    Science.gov (United States)

    Chambers, Henry F; Bartlett, John G; Bonomo, Robert A; Chiou, Christine; Cosgrove, Sara E; Cross, Heather R; Daum, Robert S; Downing, Michele; Evans, Scott R; Knisely, Jane; Kreiswirth, Barry N; Lautenbach, Ebbing; Mickley, Brenda S; Patel, Robin; Pettigrew, Melinda M; Rodvold, Keith A; Spellberg, Brad; Fowler, Vance G

    2014-06-01

    Funded by the National Institute of Allergy and Infectious Diseases, the Antibacterial Resistance Leadership Group (ARLG) is tasked with developing a clinical research agenda and conducting clinical studies to address the growing public health threat of antibacterial resistance. The ARLG has identified 4 high-priority areas of research: infections caused by gram-negative bacteria, infections caused by gram-positive bacteria, antimicrobial stewardship and infection prevention, and diagnostics. The ARLG will be accepting proposals from the scientific community for clinical research that addresses 1 or more of these high-priority areas. These studies should have the potential to transform medical practice and be unlikely to occur without ARLG support. The purpose of this article is to make interested parties aware of clinical research opportunities made available by ARLG and to encourage submission of clinical research proposals that address the problem of antibacterial resistance.

  6. CME ON CLINICAL RESEARCH

    Directory of Open Access Journals (Sweden)

    Suneel. I. Majagi

    2012-06-01

    Full Text Available Safety and efficacy are the two major concerns for any drug therapy. Globally clinical research plays an inevitable role in bringing a new molecule into the market after its synthesis by the pharmaceutical industries. Availability of large patient population, highly educated and skilled manpower, wide spectrum of diseases and favorable economic environment imply India’s potential as a global hub for clinical research. Pharmaceutical companies and Clinical Research Organization (CROs will require many trained personnel to carry out the clinical research. Keeping in mind these facts a CME with the theme of “Clinical research” had been jointly organized by the Dept of pharmacology, K.L.E University’s J.N.M.C, Belgaum and Indian Pharmacological Society (I.P.S, Belgaum branch on 20th February 2010. In the first scientific session, Dr.P.A.Patil (JNMC spoke on “Preclinical studies”. In vitro and in vivo experiments of various doses of ‘study drug’ can obtain preliminary efficacy, toxicity and pharmacokinetic information suggesting the scientific merit for further development as an investigational new drug (IND. Local or systemic toxicity studies can be conducted (ex: urine analysis, blood biochemical assay, gross and microscopic pathology etc. Dr. B.J. Mahendra Kumar (KLE University’s College of pharmacy talked on “Role of Drug Controller General of India (DCGI in Clinical Trials”. He explained about Drug and cosmetic acts/rules, requirements/guidelines for permission to import and/or to manufacture new drugs or to undertake clinical trials i.e. Schedule Y and its appendices. Dr.N.M.Patil (JNMC elaborated about “Ethical issues in clinical trials”. Ethics is required to: avoid exploitation of the subjects (maintain safety and wellbeing, protect vulnerable groups, children, disabled, elderly etc. Independent Ethics Committees (IEC and Institutional Review Boards (IRB are concerned with medical ethics. IECs review, regulate

  7. Stochastic Lie group integrators

    CERN Document Server

    Malham, Simon J A

    2007-01-01

    We present Lie group integrators for nonlinear stochastic differential equations with non-commutative vector fields whose solution evolves on a smooth finite dimensional manifold. Given a Lie group action that generates transport along the manifold, we pull back the stochastic flow on the manifold to the Lie group via the action, and subsequently pull back the flow to the corresponding Lie algebra via the exponential map. We construct an approximation to the stochastic flow in the Lie algebra via closed operations and then push back to the Lie group and then to the manifold, thus ensuring our approximation lies in the manifold. We call such schemes stochastic Munthe-Kaas methods after their deterministic counterparts. We also present stochastic Lie group integration schemes based on Castell--Gaines methods. These involve using an underlying ordinary differential integrator to approximate the flow generated by a truncated stochastic exponential Lie series. They become stochastic Lie group integrator schemes if...

  8. Group therapy for adolescents

    OpenAIRE

    Nada Hribar

    2001-01-01

    The group included adolescents from secondary school and some students. The group had weekly sessions or twice on mounth. The adolescents had varied simptoms: depressive, anxiety, psychosomatic disorders, learning difficulties, cunduct problems. All of adolescents were common on many problems in social interactions. The goal of therapeutic work were: to increase assertiveness skills and to reduce the anxious in social situations. The adolescents in group raised a self-esteem and developed som...

  9. Group Problem Solving

    CERN Document Server

    Laughlin, Patrick R

    2011-01-01

    Experimental research by social and cognitive psychologists has established that cooperative groups solve a wide range of problems better than individuals. Cooperative problem solving groups of scientific researchers, auditors, financial analysts, air crash investigators, and forensic art experts are increasingly important in our complex and interdependent society. This comprehensive textbook--the first of its kind in decades--presents important theories and experimental research about group problem solving. The book focuses on tasks that have demonstrably correct solutions within mathematical

  10. Bayesian Group Factor Analysis

    OpenAIRE

    Virtanen, Seppo; Klami, Arto; Khan, Suleiman A; Kaski, Samuel

    2011-01-01

    We introduce a factor analysis model that summarizes the dependencies between observed variable groups, instead of dependencies between individual variables as standard factor analysis does. A group may correspond to one view of the same set of objects, one of many data sets tied by co-occurrence, or a set of alternative variables collected from statistics tables to measure one property of interest. We show that by assuming group-wise sparse factors, active in a subset of the sets, the variat...

  11. Semisimple Metacyclic Group Algebras

    Indian Academy of Sciences (India)

    Gurmeet K Bakshi; Shalini Gupta; Inder Bir S Passi

    2011-11-01

    Given a group of order $p_1p_2$, where $p_1,p_2$ are primes, and $\\mathbb{F}_q$, a finite field of order coprime to $p_1p_2$, the object of this paper is to compute a complete set of primitive central idempotents of the semisimple group algebra $\\mathbb{F}_q[G]$. As a consequence, we obtain the structure of $\\mathbb{F}_q[G]$ and its group of automorphisms.

  12. Incentives and group identity

    OpenAIRE

    MASELLA, Paolo; Meier, Stephan; Zahn, Philipp

    2012-01-01

    This paper investigates in a principal-agent environment whether and how group membership influences the effectiveness of incentives and when incentives can have “hidden costs”, i.e., a detrimental effect. We show experimentally that in all interactions control mechanisms can have hidden costs for reasons specific to group membership. In within-group interactions control has detrimental effects because the agent does not expect to be controlled and reacts negatively when being controlled. In ...

  13. Presentations of groups

    CERN Document Server

    Johnson, D L

    1997-01-01

    The aim of this book is to provide an introduction to combinatorial group theory. Any reader who has completed first courses in linear algebra, group theory and ring theory will find this book accessible. The emphasis is on computational techniques but rigorous proofs of all theorems are supplied. This new edition has been revised throughout, including new exercises and an additional chapter on proving that certain groups are infinite.

  14. Explosive Technology Group

    Data.gov (United States)

    Federal Laboratory Consortium — The Explosive Technology Group (ETG) provides diverse technical expertise and an agile, integrated approach to solve complex challenges for all classes of energetic...

  15. CLASSIFICATION OF CRIMINAL GROUPS

    Directory of Open Access Journals (Sweden)

    Natalia Romanova

    2013-06-01

    Full Text Available New types of criminal groups are emerging in modern society.  These types have their special criminal subculture. The research objective is to develop new parameters of classification of modern criminal groups, create a new typology of criminal groups and identify some features of their subculture. Research methodology is based on the system approach that includes using the method of analysis of documentary sources (materials of a criminal case, method of conversations with themembers of the criminal group, method of testing the members of the criminal group and method of observation. As a result of the conducted research, we have created a new classification of criminal groups. The first type is a lawful group in its form and criminal according to its content (i.e., its target is criminal enrichment. The second type is a criminal organization which is run by so-called "white-collars" that "remain in the shadow". The third type is traditional criminal groups.  The fourth type is the criminal group, which openly demonstrates its criminal activity.

  16. Clinical cases

    International Nuclear Information System (INIS)

    This presentation is about clinical cases and the contribution of the PET - CT Fag application in the diagnosis and treatment of different types of cancer. The cases presented were: neck diseases, epidermoid carcinoma, liver damage and metastasize, lymphoma, thrombosis, colonic cancer and lung disease

  17. [Clinical pathology].

    Science.gov (United States)

    Dimitrijević, Jovan

    2006-05-01

    This work describes the basic elements of pathology used in clinical practice. Pathology plays an important role in clinical and scientific work, but only a few areas of pathology will be covered. Although the contribution of oncological and surgical pathology to therapy is the most well known, the cases chosen here will involve infectious pathology, diseases of the kidney and the liver, autoimmune diseases, as well as organ transplantation. Especially important is the description of methods that enable more accurate morphological diagnoses, such as histochemistry, immunohistochemistry, immunofluorescence, and electronic microscopy. Previous experience and joint work with clinical doctors have enabled the definition of significant morphological elements as well as of essential methods of pathohistological diagnosis. Besides, as is often the case, although disease symptoms are difficult to discern and biochemical results do not show significant changes compared to normal values, the results of biopsy come as a surprise to clinical doctors. For example, in virus hepatitis B involving so-called asymptomatic HBsAg carriers, we discovered every morphological form of hepatitis, from minimal lesions to chronic, persistent, and active hepatitis. With hepatitis C, certain morphological lesions point to the etiopathogenesis of this disease and thus help to confirm the diagnosis and to instigate therapy on time. Another significant experience involves kidney biopsies in cases when clinical findings are asymptomatic. Often, in such cases, morphological findings point to glomerulonephritis and glomerulopathy at different stages. Timely and subtle morphological diagnostics offer a more precise explanation for the pathological injury of tissues than other diagnostic methods. In this way, by adopting new methods, the work of pathologists is included more and more in everyday clinical practice. The inclusion of pathologists in a transplantation team makes sure a proper selection of

  18. Clinical Research Methodology 2: Observational Clinical Research.

    Science.gov (United States)

    Sessler, Daniel I; Imrey, Peter B

    2015-10-01

    Case-control and cohort studies are invaluable research tools and provide the strongest feasible research designs for addressing some questions. Case-control studies usually involve retrospective data collection. Cohort studies can involve retrospective, ambidirectional, or prospective data collection. Observational studies are subject to errors attributable to selection bias, confounding, measurement bias, and reverse causation-in addition to errors of chance. Confounding can be statistically controlled to the extent that potential factors are known and accurately measured, but, in practice, bias and unknown confounders usually remain additional potential sources of error, often of unknown magnitude and clinical impact. Causality-the most clinically useful relation between exposure and outcome-can rarely be definitively determined from observational studies because intentional, controlled manipulations of exposures are not involved. In this article, we review several types of observational clinical research: case series, comparative case-control and cohort studies, and hybrid designs in which case-control analyses are performed on selected members of cohorts. We also discuss the analytic issues that arise when groups to be compared in an observational study, such as patients receiving different therapies, are not comparable in other respects.

  19. 严重烧伤患者外周血高迁移率族蛋白B-1水平的检测及其临床意义%Detection of plasma high mobility group box-1 protein in severely burned patients and its clinical significance

    Institute of Scientific and Technical Information of China (English)

    肖锦华; 王亚萍; 朱华燕; 潘宇红; 黄璇

    2012-01-01

    目的 检测严重烧伤后患者血浆高迁移率族蛋白B-1 (HMGB1)水平的变化并探讨其临床意义.方法 用酶联免疫吸附试验法检测77例严重烧伤患者血浆HMGB1水平,同步检测肿瘤坏死因子-α(TNF-α)含量,并与30名健康对照组进行比较.结果 77例严重烧伤患者按烧伤面积分为3组,A组31例,烧伤总面积30%~49%,B组25例,烧伤总面积50%~69%,C组21例,烧伤总面积70%~95%;烧伤患者血浆HMGB1及TNF-α水平在A组为(22.15±6.34) ng/ml、(89.26±21.41)pg/ml,B组为(26.24±9.71)ng/ml、( 132.45±76.32)pg/ml,C组为(36.45±11.63)ng/ml、(213.61±87.45) pg/ml,对照组为(2.17±1.13)ng/ml、(45.32±13.84)pg/m1,烧伤各组HMGB1及TNF-α水平明显高于对照组(P<0.01);24例特大面积烧伤患者根据预后情况分为生存组和死亡组进行动态观察,两组患者血浆HMGB1水平在伤后第1天即显著升高(P<0.01),在伤后3~21 d,死亡组明显高于生存组(P<0.05),而TNF-α含量在伤后第3~7 d达高峰,以后逐渐下降,到21d时生存组与死亡组相比已差异无统计学意义.结论 严重烧伤后HMGB1的表达异常升高,HMGB1作为重要的晚期炎症介质和TNF-α相互诱生相互作用,参与严重烧伤后全身炎症反应综合征的病理生理过程,动态观察其水平变化有助于烧伤患者病程监测及预后判断.%OBJECTIVE To investigate the changes of plasma high mobility group box-1 protein ( HMGB1) in severely burned patients and its clinical significance. METHODS The plasma HMGB1 and TNF-α levels were measured by enzyme linked immunosorbent assay(ELISA) simultaneously in all patients and were compared with 30 healthy control subjects. RESULTS Totally 77 burned patients were involved in this study, and they were divided into three burn size groups: 30%-49% total body surface area(TBSA) burn(group A, n = 31), 50% - 69% TBSA burn (group B, n = 25) and 70%-95% TBSA burn(group C, n = 21). The levels of HMGB2 and TNF

  20. Grouping for Inequity

    Science.gov (United States)

    Macqueen, Suzanne Elizabeth

    2013-01-01

    The inequity of streaming as a method of organising classes was established by research conducted in the 1960s and 1970s. While the practice produces small advantages for limited groups of students, it hinders the academic and social advancement of the majority. Although streaming has declined, new forms of achievement grouping have emerged, with…