WorldWideScience

Sample records for clinical intervention system

  1. Multi-scale Modeling of the Cardiovascular System: Disease Development, Progression, and Clinical Intervention.

    Science.gov (United States)

    Zhang, Yanhang; Barocas, Victor H; Berceli, Scott A; Clancy, Colleen E; Eckmann, David M; Garbey, Marc; Kassab, Ghassan S; Lochner, Donna R; McCulloch, Andrew D; Tran-Son-Tay, Roger; Trayanova, Natalia A

    2016-09-01

    Cardiovascular diseases (CVDs) are the leading cause of death in the western world. With the current development of clinical diagnostics to more accurately measure the extent and specifics of CVDs, a laudable goal is a better understanding of the structure-function relation in the cardiovascular system. Much of this fundamental understanding comes from the development and study of models that integrate biology, medicine, imaging, and biomechanics. Information from these models provides guidance for developing diagnostics, and implementation of these diagnostics to the clinical setting, in turn, provides data for refining the models. In this review, we introduce multi-scale and multi-physical models for understanding disease development, progression, and designing clinical interventions. We begin with multi-scale models of cardiac electrophysiology and mechanics for diagnosis, clinical decision support, personalized and precision medicine in cardiology with examples in arrhythmia and heart failure. We then introduce computational models of vasculature mechanics and associated mechanical forces for understanding vascular disease progression, designing clinical interventions, and elucidating mechanisms that underlie diverse vascular conditions. We conclude with a discussion of barriers that must be overcome to provide enhanced insights, predictions, and decisions in pre-clinical and clinical applications. PMID:27138523

  2. Initial clinical experience using the Echo Navigator~-system during structural heart disease interventions

    Institute of Scientific and Technical Information of China (English)

    Jan; Balzer; Tobias; Zeus; Katharina; Hellhammer; Verena; Veulemans; Silke; Eschenhagen; Eva; Kehmeier; Christian; Meyer; Tienush; Rassaf; Malte; Kelm

    2015-01-01

    AIM: To present our initial clinical experience using this innovative software solution for guidance of percutaneous structural heart disease interventions.METHODS: Left atrial appendage, atrial septal defect and paravalvular leak closure, transaortic valve repair and Mitra Clip procedures were performed in the catheter laboratory under fluoroscopic and echocardiographic guidance. The two-dimensional and three-dimensional images generated by the transesophageal echocardiography probe were interfaced with the fluoroscopic images in real-time using the Echo Navigator-system.RESULTS:The application of the novel image fusion technology was safe and led to a better appreciation of multimodality imaging guidance due to improved visualization of the complex relationship between catheter devices and anatomical structures.CONCLUSION:The Echo Navigator-system is a feasible and safe tool for guidance of interventional procedures in structural heart disease.This innovative technology may improve confidence of interventional cardiologists in targeting and positioning interventional devices in order to increase safety,accuracy,and efficacy of percutaneous interventions in the catheter laboratory.

  3. Electromagnetic tracking system for minimal invasive interventions using a C-arm system with CT option: first clinical results

    Science.gov (United States)

    Nagel, Markus; Hoheisel, Martin; Bill, Ulrich; Klingenbeck-Regn, Klaus; Kalender, Willi A.; Petzold, Ralf

    2008-03-01

    To ensure precise needle placement in soft tissue of a patient for e.g. biopsies, the intervention is normally carried out image-guided. Whereas there are several imaging modalities such as computed tomography, magnetic resonance tomography, ultrasound, or C-arm X-ray systems with CT-option, navigation systems for such minimally invasive interventions are still quite rare. However, prototypes and also first commercial products of optical and electromagnetic tracking systems demonstrated excellent clinical results. Such systems provide a reduction of control scans, a reduction of intervention time, and an improved needle positioning accuracy specially for deep and double oblique access. Our novel navigation system CAPPA IRAD EMT with electromagnetic tracking for minimally invasive needle applications is connected to a C-arm imaging system with CT-option. The navigation system was investigated in clinical interventions by different physicians and with different clinical applications. First clinical results demonstrated a high accuracy during needle placement and a reduction of control scans.

  4. Care and feeding of the endocannabinoid system: a systematic review of potential clinical interventions that upregulate the endocannabinoid system.

    Directory of Open Access Journals (Sweden)

    John M McPartland

    Full Text Available BACKGROUND: The "classic" endocannabinoid (eCB system includes the cannabinoid receptors CB1 and CB2, the eCB ligands anandamide (AEA and 2-arachidonoylglycerol (2-AG, and their metabolic enzymes. An emerging literature documents the "eCB deficiency syndrome" as an etiology in migraine, fibromyalgia, irritable bowel syndrome, psychological disorders, and other conditions. We performed a systematic review of clinical interventions that enhance the eCB system--ways to upregulate cannabinoid receptors, increase ligand synthesis, or inhibit ligand degradation. METHODOLOGY/PRINCIPAL FINDINGS: We searched PubMed for clinical trials, observational studies, and preclinical research. Data synthesis was qualitative. Exclusion criteria limited the results to 184 in vitro studies, 102 in vivo animal studies, and 36 human studies. Evidence indicates that several classes of pharmaceuticals upregulate the eCB system, including analgesics (acetaminophen, non-steroidal anti-inflammatory drugs, opioids, glucocorticoids, antidepressants, antipsychotics, anxiolytics, and anticonvulsants. Clinical interventions characterized as "complementary and alternative medicine" also upregulate the eCB system: massage and manipulation, acupuncture, dietary supplements, and herbal medicines. Lifestyle modification (diet, weight control, exercise, and the use of psychoactive substances--alcohol, tobacco, coffee, cannabis also modulate the eCB system. CONCLUSIONS/SIGNIFICANCE: Few clinical trials have assessed interventions that upregulate the eCB system. Many preclinical studies point to other potential approaches; human trials are needed to explore these promising interventions.

  5. Care and Feeding of the Endocannabinoid System: A Systematic Review of Potential Clinical Interventions that Upregulate the Endocannabinoid System

    OpenAIRE

    McPartland, John M.; Guy, Geoffrey W.; Vincenzo Di Marzo

    2014-01-01

    BACKGROUND: The "classic" endocannabinoid (eCB) system includes the cannabinoid receptors CB1 and CB2, the eCB ligands anandamide (AEA) and 2-arachidonoylglycerol (2-AG), and their metabolic enzymes. An emerging literature documents the "eCB deficiency syndrome" as an etiology in migraine, fibromyalgia, irritable bowel syndrome, psychological disorders, and other conditions. We performed a systematic review of clinical interventions that enhance the eCB system--ways to upregulate cannabinoid ...

  6. Kyphoplasty interventions using a navigation system and C-arm CT data: first clinical results

    Science.gov (United States)

    Hoheisel, Martin; Skalej, Martin; Beuing, Oliver; Bill, Ulrich; Klingenbeck-Regn, Klaus; Petzold, Ralf; Nagel, Markus H.

    2009-02-01

    This study evaluates new applications using a novel navigation system with electromagnetic (EM) tracking in clinical routine. The navigation system (iGuide CAPPA, CAS innovations, Erlangen, Germany) consists of a PC with dedicated navigation software, the AURORA tracking system (NDI, Waterloo Ontario, Canada; needles equipped with small coils in their tips for EM navigation. After patient positioning a 3D C-arm data set of the spine region of interest is acquired. The images are reconstructed and the 3D data set is directly transferred to the navigation system. Image loading and image to patient registration are performed automatically by the navigation system. For image acquisition a C-arm system with DynaCT option (AXIOM Artis, Siemens Healthcare, Forchheim, Germany) was used. As new clinical applications we performed kyphoplasty for reconstruction of collapsed vertebrae. All interventions were carried out without any complication. After a single planning scan the radiologists were able to place the needle in the designated vertebra. During needle driving 2D imaging was performed just in a few cases for control reasons. The time between planning and final needle positioning was reduced in all cases compared to conventional methods. Moreover, the number of control scans could be markedly reduced. The deviation of the needle to the planned target was less than 2 mm. The use of DynaCT images in combination with electromagnetic tracking-based navigation systems allows a precise needle positioning for kyphoplasty.

  7. Costing nursing care: using the clinical care classification system to value nursing intervention in an acute-care setting.

    Science.gov (United States)

    Moss, Jacqueline; Saba, Virginia

    2011-08-01

    The purpose of this study was to combine an established methodology for coding nursing interventions and action types using the Clinical Care Classification System with a reliable formula (relative value units) to cost nursing services. Using a flat per-diem rate to cost nursing care greatly understates the actual costs and fails to address the high levels of variability within and across units. We observed nurses performing commonly executed nursing interventions and recorded these into an electronic database with corresponding Clinical Care Classification System codes. The duration of these observations was used to calculate intervention costs using relative value unit calculation formulas. The costs of the five most commonly executed interventions were nursing care coordination/manage-refer ($2.43), nursing status report/assess-monitor ($4.22), medication treatment/perform-direct ($6.33), physical examination/assess-monitor ($3.20), and universal precautions/perform-direct ($1.96). Future studies across a variety of nursing specialties and units are needed to validate the relative value unit for Clinical Care Classification System action types developed for use with the Clinical Care Classification System nursing interventions as a method to cost nursing care.

  8. Nonverbal Interventions in Clinical Groups.

    Science.gov (United States)

    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)

  9. Positive interventions in clinical practice.

    Science.gov (United States)

    Rashid, Tayyab

    2009-05-01

    Mainstream psychotherapy has made huge strides in treating symptoms and disorders, but it has largely overlooked happiness as a therapeutic goal despite frequently hearing from clients, "Doctor, I want to be happy." This issue of Journal of Clinical Psychology: In Session describes a number of positive interventions for specific clinical problems, such as depression, anxiety, schizophrenia, loss, grief, and relationship distress. Although the name may suggest it, positive interventions do not imply that rest of psychotherapies are negative. Neither are negatives denied nor minimized. Distinct from self-help recipes proffering instant changes, positive psychology interventions refer to systematic approaches to overcome challenges by using clients' strengths and assets. A hybrid psychotherapy-coaching model and strength-based assessment can ask a client "What is right with you?" All articles are supplemented with rich case illustrations. PMID:19294745

  10. Bias in clinical intervention research

    DEFF Research Database (Denmark)

    Gluud, Lise Lotte

    2006-01-01

    Research on bias in clinical trials may help identify some of the reasons why investigators sometimes reach the wrong conclusions about intervention effects. Several quality components for the assessment of bias control have been suggested, but although they seem intrinsically valid, empirical...

  11. The impact of childhood maltreatment on biological systems: Implications for clinical interventions.

    Science.gov (United States)

    Gonzalez, Andrea

    2013-10-01

    Childhood maltreatment represents a significant risk factor for the development of a number of mental and physical health outcomes. Converging evidence suggests that early adversity induces significant and persistent biological changes in individuals ('biological embedding'). The present review focuses on the impact of childhood maltreatment on the hypothalamic-pituitary-adrenal axis and immune system function in both children and adults. Research suggests that childhood maltreatment is associated with hypothalamic-pituitary-adrenal axis dysregulation and diurnal cortisol profiles, as well as stress reactivity. Furthermore, childhood maltreatment is associated with disruptions in various immune system markers including pro- and anti-inflammatory substances, and markers of cell-mediated immunity. The potential of interventions to reduce these negative biological effects in maltreated children is also discussed.

  12. Clinical analysis of long-term outcomes of re-intervention of transjugular intrahepatic porto-systemic shunt

    International Nuclear Information System (INIS)

    Objective: To evaluate the safety,effectiveness and clinical factors of re-intervention of transjugular intrahepatic porto-systemic shunt (TIPS). Methods: A retrospective study of safety and long-term outcomes of TIPS was made in 771 patients from August 1994 to August 2010. The 625 patients had follow-up data.The patients who received TIPS once, twice, and more than twice were divided into group 1, group 2 and group 3, respectively. Clinical symptoms, survival rate and restenosis rate of each group were analyzed. Clinical influencing factors of re-intervention effect were discussed. Results: The success rate of first intervention was 98.2% (757/771), the death rate was 0.7% (5/757) and severe complication rate was 2.5% (19/757). The success rate of re-intervention was 98.7% (457/463), no death and severe complications occurred. The restenosis rate in group 3 decreased significantly than group 1 (χ2=7.908, P<0.05) in the first year of TIPS. The restenosis rates in group 2 and group 3 were lower than group 1 from 2 to 5 years of TIPS (χ2 values were 27.046, 25.724, 37.002 and 19.046, respectively, P<0.05). The survival rate in group 3 was higher than group 1 (χ2=9.114, P<0.05)and group 2 was higher than group 1 (χ2=4.929, P<0.05) in the first year of TIPS, while there was no statistical difference between group 2 and group 3 (χ2=2.678, P>0.05). The patients in group 2 and group 3 also had higher survival rates than group 1 from 2 to 5 years of TIPS (χ2 value were 41.314, 26.920, 13.692 and 6.713, respectively, P<0.05). 19.4% (79/406) of patients who received re-intervention had symptom recurrence and shunt stenosis or occlusion. 11.6% (47/406) of patients had symptom recurrence with portal hypertension signs, 62.8% (255/406) had shunt stenosis or occlusion with portal hypertension signs. Conclusions: Restenosis or occlusion of TIPS, symptom recurrence and portal hypertension signs were important factors for re-intervention. Re-intervention of TIPS was safe and

  13. Super-selective interventional chemotherapy combined with systemic chemotherapy for the treatment of postoperative gliomas:a clinical study

    International Nuclear Information System (INIS)

    Objective: To evaluate super-selective interventional chemotherapy combined with systemic chemotherapy in treating postoperative gliomas. Methods: During the period of 2005-2009, a total of 46 patients with glioma were encountered in our hospital. According to the principle of patient's free will the involved patients were divided into two groups. Study group (n = 25): after operation the patients received routine radiotherapy, which was followed by super-selective interventional chemotherapy combined simultaneously with systemic chemotherapy. Control group (n = 21): after operation the patients received routine radiotherapy, which was followed by systemic chemotherapy only. The patients were regularly followed up. Cranial CT checkups were made to determine the tumor size, and the results were evaluated with Karnofsky scores. The clinical data were analyzed and compared between two groups. Results: In the study group, the side-effects and complications included epileptic seizures (n = 3), eye pain (n = 5), headache (n = 9), nausea and vomiting (n = 8) and thrombopenia (n = 1). In the control group,the side-effects and complications were as follows: epileptic seizures (n = 1), headache (n = 7), nausea and vomiting (n = 6) and thrombopenia(n = 3). No death occurred in either of the two groups. The patients were followed up for an average period of 2.3 years. Before chemotherapy no statistically significant difference in tumor size existed between two groups (P > 0.05). One year after the chemotherapy, the tumor volume in study group was reduced by 67.11%, while it was 45.79% in control group. By using independent sample t test analysis, the difference between two groups was of statistical significance (P < 0.05). Wilcoxon rank sum test and Karnofsky prognostic score analysis indicated that the prognosis of study group was much better than that of control group (P < 0.05). Conclusion: In comparison with routine radiotherapy plus simple systemic chemotherapy, routine

  14. Loneliness: clinical import and interventions.

    Science.gov (United States)

    Cacioppo, Stephanie; Grippo, Angela J; London, Sarah; Goossens, Luc; Cacioppo, John T

    2015-03-01

    In 1978, when the Task Panel report to the US President's Commission on Mental Health emphasized the importance of improving health care and easing the pain of those suffering from emotional distress syndromes including loneliness, few anticipated that this issue would still need to be addressed 40 years later. A meta-analysis (Masi et al., 2011) on the efficacy of treatments to reduce loneliness identified a need for well-controlled randomized clinical trials focusing on the rehabilitation of maladaptive social cognition. We review assessments of loneliness and build on this meta-analysis to discuss the efficacy of various treatments for loneliness. With the advances made over the past 5 years in the identification of the psychobiological and pharmaceutical mechanisms associated with loneliness and maladaptive social cognition, there is increasing evidence for the potential efficacy of integrated interventions that combine (social) cognitive behavioral therapy with short-term adjunctive pharmacological treatments.

  15. Placebo interventions, placebo effects and clinical practice

    OpenAIRE

    Linde, Klaus; Fässler, Margrit; Meissner, Karin

    2011-01-01

    This article reviews the role of placebo interventions and placebo effects in clinical practice. We first describe the relevance of different perspectives among scientists, physicians and patients on what is considered a placebo intervention in clinical practice. We then summarize how placebo effects have been investigated in randomized controlled trials under the questionable premise that such effects are produced by placebo interventions. We further discuss why a shift of focus from the pla...

  16. Effectiveness of an Adaptation of the Project Connect Health Systems Intervention: Youth and Clinic-Level Findings

    Science.gov (United States)

    Loosier, Penny S.; Doll, Shelli; Lepar, Danielle; Ward, Kristin; Gamble, Ginger; Dittus, Patricia J.

    2016-01-01

    Background: The Project Connect Health Systems Intervention (Project Connect) uses a systematic process of collecting community and healthcare infrastructure information to craft a referral guide highlighting local healthcare providers who provide high quality sexual and reproductive healthcare. Previous self-report data on healthcare usage…

  17. Importance of training on clinical thinking and clinical competence to interventional radiologists

    International Nuclear Information System (INIS)

    Although the history of Interventional Radiology is no longer than 50 years, interventional techniques have been dramatically developed. Interventional radiologists have been responsible for much of the medical innovations and development of the minimally invasive procedures that are commonplace today to treat many complicated diseases as physicians. But the education backgrounds of interventional radiologist in China are different. Therefore, we should be aware that the job of an interventional radiologist is totally different from that of a diagnostic radiologist. It is very important to train interventional radiologists for improving their clinical thinking and clinical competence. Herein, we propose our suggestions on how to improve the clinical thinking and clinical competence of interventional radiologists. In this paper we also systemically introduce the accurate and proper treatment procedures which should be strictly followed in clinical work and,meanwhile, the perioperative patients care is emphasized. (authors)

  18. Fetal cardiac interventions: clinical and experimental research.

    Science.gov (United States)

    Yuan, Shi-Min; Humuruola, Gulimila

    2016-01-01

    Fetal cardiac interventions for congenital heart diseases may alleviate heart dysfunction, prevent them evolving into hypoplastic left heart syndrome, achieve biventricular outcome and improve fetal survival. Candidates for clinical fetal cardiac interventions are now restricted to cases of critical aortic valve stenosis with evolving hypoplastic left heart syndrome, pulmonary atresia with an intact ventricular septum and evolving hypoplastic right heart syndrome, and hypoplastic left heart syndrome with an intact or highly restrictive atrial septum as well as fetal heart block. The therapeutic options are advocated as prenatal aortic valvuloplasty, pulmonary valvuloplasty, creation of interatrial communication and fetal cardiac pacing. Experimental research on fetal cardiac intervention involves technical modifications of catheter-based cardiac clinical interventions and open fetal cardiac bypass that cannot be applied in human fetuses for the time being. Clinical fetal cardiac interventions are plausible for midgestation fetuses with the above-mentioned congenital heart defects. The technical success, biventricular outcome and fetal survival are continuously being improved in the conditions of the sophisticated multidisciplinary team, equipment, techniques and postnatal care. Experimental research is laying the foundations and may open new fields for catheter-based clinical techniques. In the present article, the clinical therapeutic options and experimental fetal cardiac interventions are described. PMID:27279868

  19. Loneliness: Clinical Import and Interventions

    OpenAIRE

    Cacioppo, Stephanie; Grippo, Angela J.; London, Sarah; Goossens, Luc; Cacioppo, John T.

    2015-01-01

    In 1978, when the Task Panel report to the US President’s Commission on Mental Health emphasized the importance of improving health care and easing the pain of those suffering from emotional distress syndromes including loneliness, few anticipated that this issue would still need to be addressed 40 years later. A meta-analysis (Masi et al., 2011) on the efficacy of treatments to reduce loneliness identified a need for well-controlled randomized clinical trials focusing on the rehabilitation o...

  20. Placebo interventions for all clinical conditions

    DEFF Research Database (Denmark)

    Hróbjartsson, Asbjørn; Gøtzsche, Peter C

    2010-01-01

    Placebo interventions are often claimed to substantially improve patient-reported and observer-reported outcomes in many clinical conditions, but most reports on effects of placebos are based on studies that have not randomised patients to placebo or no treatment. Two previous versions of this...... review from 2001 and 2004 found that placebo interventions in general did not have clinically important effects, but that there were possible beneficial effects on patient-reported outcomes, especially pain. Since then several relevant trials have been published....

  1. Mapping and assessing clinical handover training interventions

    NARCIS (Netherlands)

    Stoyanov, Slavi; Boshuizen, Els; Groene, Oliver; Van der Klink, Marcel; Kicken, Wendy; Drachsler, Hendrik; Barach, Paul

    2013-01-01

    Stoyanov, S., Boshuizen, H. P. A., Groene, O., Van der Klink, M., Kicken, W., Drachsler, H., & Barach, P. (2012). Mapping and assessing clinical handover training interventions. British Medical Journal Quality & Safety, 21, i50-i57. doi:10.1136/bmjqs-2012-001169

  2. A computer-assisted protocol for endovascular target interventions using a clinical MRI system for controlling untethered microdevices and future nanorobots.

    Science.gov (United States)

    Martel, Sylvain; Mathieu, Jean-Baptiste; Felfoul, Ouajdi; Chanu, Arnaud; Aboussouan, Eric; Tamaz, Samer; Pouponneau, Pierre; Yahia, L'Hocine; Beaudoin, Gilles; Soulez, Gilles; Mankiewicz, Martin

    2008-11-01

    The possibility of automatically navigating untethered microdevices or future nanorobots to conduct target endovascular interventions has been demonstrated by our group with the computer-controlled displacement of a magnetic sphere along a pre-planned path inside the carotid artery of a living swine. However, although the feasibility of propelling, tracking and performing real-time closed-loop control of an untethered ferromagnetic object inside a living animal model with a relatively close similarity to human anatomical conditions has been validated using a standard clinical Magnetic Resonance Imaging (MRI) system, little information has been published so far concerning the medical and technical protocol used. In fact, such a protocol developed within technological and physiological constraints was a key element in the success of the experiment. More precisely, special software modules were developed within the MRI software environment to offer an effective tool for experimenters interested in conducting such novel interventions. These additional software modules were also designed to assist an interventional radiologist in all critical real-time aspects that are executed at a speed beyond human capability, and include tracking, propulsion, event timing and closed-loop position control. These real-time tasks were necessary to avoid a loss of navigation control that could result in serious injury to the patient. Here, additional simulation and experimental results for microdevices designed to be targeted more towards the microvasculature have also been considered in the identification, validation and description of a specific sequence of events defining a new computer-assisted interventional protocol that provides the framework for future target interventions conducted in humans.

  3. Developmental intervention: a pediatric clinical review.

    Science.gov (United States)

    Casey, P H; Bradley, R H; Caldwell, B M; Edwards, D R

    1986-08-01

    We have attempted to review developmental intervention for pediatricians in a way that is of clinical relevance to primary care pediatricians. In so doing, we chose not to evaluate certain topics such as therapeutic intervention for handicapped children or center-based educational programs because these have been adequately addressed elsewhere. It is clear that pediatricians have a unique and important role to play in developmental intervention for the following reasons: pediatricians have easy and routinely accepted access to infants and families in the prenatal, perinatal, and preschool periods: pediatricians possess a socially accepted role of authority; and pediatricians can integrate understanding of the child's health and developmental status within the context of the family and social environment to make clinical interpretation regarding the child's developmental status and prognosis. Pediatricians are thus in the best position to convince parents of their impact on their child's development. The following general roles have been identified for pediatricians. First, pediatricians should be aware of the child's biologic status and family environmental situation and the relative degree of risk for developmental problems. This clinical awareness, in combination with the use of appropriate screening instruments of the child's development and family environment, will allow clinical judgment regarding the frequency and type of child health supervision, the need for further diagnostic evaluation, and the need for referral to intervention programs and other resources. Second, the pediatrician should develop an approach for developmental intervention for all children, whatever their degree of biological risk. This review of medical, educational, and psychological literature demonstrate the following recurring important themes as goals for primary intervention: Improve parental understanding of normal child development and developmental expectations. Assist parent

  4. Integrated clinical information system.

    Science.gov (United States)

    Brousseau, G

    1995-01-01

    SIDOCI (Système Informatisé de DOnnées Cliniques Intégrées) is a Canadian joint venture introducing newly-operating paradigms into hospitals. The main goal of SIDOCI is to maintain the quality of care in todayUs tightening economy. SIDOCI is a fully integrated paperless patient-care system which automates and links all information about a patient. Data is available on-line and instantaneously to doctors, nurses, and support staff in the format that best suits their specific requirements. SIDOCI provides a factual and chronological summary of the patient's progress by drawing together clinical information provided by all professionals working with the patient, regardless of their discipline, level of experience, or physical location. It also allows for direct entry of the patient's information at the bedside. Laboratory results, progress notes, patient history and graphs are available instantaneously on screen, eliminating the need for physical file transfers. The system, incorporating a sophisticated clinical information database, an intuitive graphical user interface, and customized screens for each medical discipline, guides the user through standard procedures. Unlike most information systems created for the health care industry, SIDOCI is longitudinal, covering all aspects of the health care process through its link to various vertical systems already in place. A multidisciplinary team has created a clinical dictionary that provides the user with most of the information she would normally use: symptoms, signs, diagnoses, allergies, medications, interventions, etc. This information is structured and displayed in such a manner that health care professionals can document the clinical situation at the touch of a finger. The data is then encoded into the patient's file. Once encoded, the structured data is accessible for research, statistics, education, and quality assurance. This dictionary complies with national and international nomenclatures. It also

  5. Clinical Prediction Rules for Physical Therapy Interventions: A Systematic Review

    OpenAIRE

    Beneciuk, Jason M.; Bishop, Mark D; George, Steven Z.

    2009-01-01

    Background and Purpose: Clinical prediction rules (CPRs) involving physical therapy interventions have been published recently. The quality of the studies used to develop the CPRs was not previously considered, a fact that has potential implications for clinical applications and future research. The purpose of this systematic review was to determine the quality of published CPRs developed for physical therapy interventions.

  6. Admission Privileges and Clinical Responsibilities for Interventional Radiologists

    Energy Technology Data Exchange (ETDEWEB)

    Al-Kutoubi, Aghiad, E-mail: mk00@aub.edu.lb [The American University of Beirut Medical Center, IR Division, The Department of Diagnostic Radiology (Lebanon)

    2015-04-15

    Although clinical involvement by interventional radiologists in the care of their patients was advocated at the inception of the specialty, the change into the clinical paradigm has been slow and patchy for reasons related to pattern of practice, financial remuneration or absence of training. The case for the value of clinical responsibilities has been made in a number of publications and the consequences of not doing so have been manifest in the erosion of the role of the interventional radiologists particularly in the fields of peripheral vascular and neuro intervention. With the recent recognition of interventional radiology (IR) as a primary specialty in the USA and the formation of IR division in the Union of European Medical Specialists and subsequent recognition of the subspecialty in many European countries, it is appropriate to relook at the issue and emphasize the need for measures to promote the clinical role of the interventional radiologist.

  7. Admission Privileges and Clinical Responsibilities for Interventional Radiologists

    International Nuclear Information System (INIS)

    Although clinical involvement by interventional radiologists in the care of their patients was advocated at the inception of the specialty, the change into the clinical paradigm has been slow and patchy for reasons related to pattern of practice, financial remuneration or absence of training. The case for the value of clinical responsibilities has been made in a number of publications and the consequences of not doing so have been manifest in the erosion of the role of the interventional radiologists particularly in the fields of peripheral vascular and neuro intervention. With the recent recognition of interventional radiology (IR) as a primary specialty in the USA and the formation of IR division in the Union of European Medical Specialists and subsequent recognition of the subspecialty in many European countries, it is appropriate to relook at the issue and emphasize the need for measures to promote the clinical role of the interventional radiologist

  8. Clinical applications: percutaneous coronary intervention - a review

    Energy Technology Data Exchange (ETDEWEB)

    Meier, B. [Swiss Cardiovascular Center Bern, Univ. Hospital, Bern (Switzerland)

    2006-07-01

    Following a brief review of the early days of coronary angiography, this article traces the development of percutaneous coronary intervention from the pioneering work of Dotter and Gruentzig up to the latest procedures for coronary angioplasty. (orig.)

  9. Choosing a control intervention for a randomised clinical trial

    Directory of Open Access Journals (Sweden)

    Djulbegovic Benjamin

    2003-04-01

    Full Text Available Abstract Background Randomised controlled clinical trials are performed to resolve uncertainty concerning comparator interventions. Appropriate acknowledgment of uncertainty enables the concurrent achievement of two goals : the acquisition of valuable scientific knowledge and an optimum treatment choice for the patient-participant. The ethical recruitment of patients requires the presence of clinical equipoise. This involves the appropriate choice of a control intervention, particularly when unapproved drugs or innovative interventions are being evaluated. Discussion We argue that the choice of a control intervention should be supported by a systematic review of the relevant literature and, where necessary, solicitation of the informed beliefs of clinical experts through formal surveys and publication of the proposed trial's protocol. Summary When clinical equipoise is present, physicians may confidently propose trial enrollment to their eligible patients as an act of therapeutic beneficence.

  10. A brief simulation intervention increasing basic science and clinical knowledge

    OpenAIRE

    Sheakley, Maria L.; Gilbert, Gregory E.; Leighton, Kim; Hall, Maureen; Callender, Diana; Pederson, David

    2016-01-01

    Background: The United States Medical Licensing Examination (USMLE) is increasing clinical content on the Step 1 exam; thus, inclusion of clinical applications within the basic science curriculum is crucial. Including simulation activities during basic science years bridges the knowledge gap between basic science content and clinical application.Purpose: To evaluate the effects of a one-off, 1-hour cardiovascular simulation intervention on a summative assessment after adjusting for relevant d...

  11. A triadic neurocognitive approach to addiction for clinical interventions.

    Science.gov (United States)

    Noël, Xavier; Brevers, Damien; Bechara, Antoine

    2013-12-27

    According to the triadic neurocognitive model of addiction to drugs (e.g., cocaine) and non-drugs (e.g., gambling), weakened "willpower" associated with these behaviors is the product of an abnormal functioning in one or more of three key neural and cognitive systems: (1) an amygdala-striatum dependent system mediating automatic, habitual, and salient behaviors; (2) a prefrontal cortex dependent system important for self-regulation and forecasting the future consequences of a behavior; and (3) an insula dependent system for the reception of interoceptive signals and their translation into feeling states (such as urge and craving), which in turn plays a strong influential role in decision-making and impulse control processes related to uncertainty, risk, and reward. The described three-systems account for poor decision-making (i.e., prioritizing short-term consequences of a decisional option) and stimulus-driven actions, thus leading to a more elevated risk for relapse. Finally, this article elaborates on the need for "personalized" clinical model-based interventions targeting interactions between implicit processes, interoceptive signaling, and supervisory function aimed at helping individuals become less governed by immediate situations and automatic pre-potent responses, and more influenced by systems involved in the pursuit of future valued goals.

  12. A triadic approach to addiction for clinical interventions

    Directory of Open Access Journals (Sweden)

    Xavier eNoel

    2013-12-01

    Full Text Available According to the triadic neurocognitive model of addiction to drugs (e.g., cocaine and non-drugs (e.g., gambling, weakened willpower associated with these behaviours is the product of an abnormal functioning in one or more of three key neural and cognitive systems: (1 an amygdala-striatum dependent system mediating automatic, habitual, and salient behaviours; (2 a prefrontal cortex dependent system important for self-regulation and forecasting the future consequences of a behaviour and (3 an insula dependent system for the reception of interoceptive signals and their translation into feeling states (such as urge and craving, which in turn plays a strong influential role in decision-making and impulse control processes related to uncertainty, risk, and reward. The described three-systems account for poor decision-making (i.e., prioritizing short-term consequences of a decisional option and stimulus-driven actions, thus leading to a more elevated risk for relapse. Finally, this article elaborates on the need for personalized clinical model-based interventions targeting interactions between implicit processes, interoceptive signalling, and supervisory function aimed at helping individuals become less governed by immediate situations and automatic prepotent responses, and more influenced by systems involved in the pursuit of future valued goals.

  13. Clinical experience of surgical intervention for severe acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Xu Yuan; Shao Qinshu; Yang Jin; Yu Xiaojun; Xu Ji

    2014-01-01

    Background The controversy on the treatment strategy for severe acute pancreatitis (SAP) has never stopped for the past century.Even now surgical procedures play a decisive role in the treatment of SAP,especially in managing the related complications,but the rational indications,timing,and approaches of surgical intervention for SAP are still inconclusive.Methods Clinical data of 308 SAP patients recruited during January 2000-January 2013,including 96 conservatively treated cases plus 212 surgically intervened cases,were comparatively analyzed.Based on the initial surgical intervention time,the surgical intervention group was split into two:early intervention group (within 2 weeks) 103 cases,and late intervention group (after 2 weeks) 109 cases.Results In the conservative treatment group,the cure rate was 82.29% (79/96),the death rate was 13.54% (13/96),and 4 cases self-discharged,while in the surgical intervention group,the cure rate was 84.43% (179/212) and the death rate was 10.85% (23/212) with 10 cases self-discharged.The difference was of no statistical significance between these two groups (P >0.05).In surgical intervention group,the death rate 15.53% (16/103) in the early surgical intervention group was higher than that of late surgical intervention group 6.42% (7/109),and the difference was statistically significant (P <0.05).Conclusions Both conservative treatment and surgical intervention play important roles in the treatment of SAP,and the indication,timing,and procedure should be strictly followed.Surgery earlier than 2 weeks after onset of the disease is not recommended in patients with necrotizing pancreatitis only when there are specific indications,such as multiple organ failure,which does not improve despite active treatment,and in those who develop abdominal compartment syndrome.

  14. Clinical pharmacist interventions to support adherence to thrombopreventive therapy

    DEFF Research Database (Denmark)

    Hedegaard, Ulla

    individualised interventions and team-based care, e.g. integrating a clinical pharmacist with particular focus on patients’ drug-related problems. One approach with growing evidence of improving medication adherence is motivational interviewing (MI). So far, no clinical pharmacist intervention using MI has......-based patient interview and three follow-up telephone calls. There was no difference in the primary outcome, the composite medication possession ratio (MPR) for antiplatelets, anticoagulants and statins during the year after hospitalisation, as assessed by analysing prescription refill records. At 12 months...... to the one in the first study, except that the patient interview was more structured using the Drug Adherence Work-up (DRAW) tool and an adherence questionnaire for identifying potential adherence and lifestyle-related problems. At 12 months, 20.3% of the patients in the intervention group (N=231) were non...

  15. A brief simulation intervention increasing basic science and clinical knowledge

    Science.gov (United States)

    Sheakley, Maria L.; Gilbert, Gregory E.; Leighton, Kim; Hall, Maureen; Callender, Diana; Pederson, David

    2016-01-01

    Background The United States Medical Licensing Examination (USMLE) is increasing clinical content on the Step 1 exam; thus, inclusion of clinical applications within the basic science curriculum is crucial. Including simulation activities during basic science years bridges the knowledge gap between basic science content and clinical application. Purpose To evaluate the effects of a one-off, 1-hour cardiovascular simulation intervention on a summative assessment after adjusting for relevant demographic and academic predictors. Methods This study was a non-randomized study using historical controls to evaluate curricular change. The control group received lecture (nl=515) and the intervention group received lecture plus a simulation exercise (nl+s=1,066). Assessment included summative exam questions (n=4) that were scored as pass/fail (≥75%). USMLE-style assessment questions were identical for both cohorts. Descriptive statistics for variables are presented and odds of passage calculated using logistic regression. Results Undergraduate grade point ratio, MCAT-BS, MCAT-PS, age, attendance at an academic review program, and gender were significant predictors of summative exam passage. Students receiving the intervention were significantly more likely to pass the summative exam than students receiving lecture only (P=0.0003). Discussion Simulation plus lecture increases short-term understanding as tested by a written exam. A longitudinal study is needed to assess the effect of a brief simulation intervention on long-term retention of clinical concepts in a basic science curriculum. PMID:27060102

  16. A brief simulation intervention increasing basic science and clinical knowledge

    Directory of Open Access Journals (Sweden)

    Maria L. Sheakley

    2016-04-01

    Full Text Available Background: The United States Medical Licensing Examination (USMLE is increasing clinical content on the Step 1 exam; thus, inclusion of clinical applications within the basic science curriculum is crucial. Including simulation activities during basic science years bridges the knowledge gap between basic science content and clinical application. Purpose: To evaluate the effects of a one-off, 1-hour cardiovascular simulation intervention on a summative assessment after adjusting for relevant demographic and academic predictors. Methods: This study was a non-randomized study using historical controls to evaluate curricular change. The control group received lecture (n l=515 and the intervention group received lecture plus a simulation exercise (nl+s=1,066. Assessment included summative exam questions (n=4 that were scored as pass/fail (≥75%. USMLE-style assessment questions were identical for both cohorts. Descriptive statistics for variables are presented and odds of passage calculated using logistic regression. Results: Undergraduate grade point ratio, MCAT-BS, MCAT-PS, age, attendance at an academic review program, and gender were significant predictors of summative exam passage. Students receiving the intervention were significantly more likely to pass the summative exam than students receiving lecture only (P=0.0003. Discussion: Simulation plus lecture increases short-term understanding as tested by a written exam. A longitudinal study is needed to assess the effect of a brief simulation intervention on long-term retention of clinical concepts in a basic science curriculum.

  17. Texting Teens in Transition: The Use of Text Messages in Clinical Intervention Research

    OpenAIRE

    Rempel, Gwen R; Ballantyne, Ross T; Magill-Evans, Joyce; Nicholas, David B; Mackie, Andrew S

    2014-01-01

    Background The rapidly growing population of young adults living with congenital heart disease (CHD), currently challenging ill-prepared cardiac care systems, presents a novel population in which to consider the use of mHealth. This methodological study was part of a larger study that tested the effectiveness of a clinic-based nursing intervention to prepare teens for transfer from pediatric to adult cardiology care. The intervention included creation of a MyHealth Passport and subsequently S...

  18. Systemic Therapy: A New Brief Intervention Model.

    Science.gov (United States)

    Searight, H. Russell; Openlander, Patrick

    1984-01-01

    Describes a newly developing mode of problem-oriented brief therapy. The systemic therapy model emphasizes the interactional context of clients' problems and represents an efficient intervention paradigm. (Author/JAC)

  19. Performance of interventional procedures in a day-hospital system

    Energy Technology Data Exchange (ETDEWEB)

    Bae, Jae Ik; Park, Auh Whan; Cho, Hye Seon; Park, Eun Hee; Choi, Gap Suk; Lee, Seon Ju; Kim, Yong Woo; Juhn, Je Ryang [Busan Paik Hospital, Inje University College of Medicine, Busan (Korea, Republic of)

    2007-01-15

    We wanted to describe the practice and results of applying the day-hospital system in an interventional radiology clinic. From Oct. 2004 to Dec. 2005, the day-hospital system was applied to various interventional procedures with using a part of the recovery room of an angiography suite as a facility for hospital admission. The study included 91 cases in 73 patients. The source of the patient referral, the procedures, hospital courses and complications were analyzed and questionnaire surveys were conducted for the available 55 patients. Among the patients, 70% (n=64) were referred form other departments, 5% (n=5) from other hospitals, 5% (n=4) were new patients and 20% (n=18) were re-admissions. The procedures included gastrointestinal, biliary, urinary, hemodialysis related-and implantable port related interventions. 96% (n=87) of the patients were successfully discharged in a day and admission to the general ward was only 4% (n=4). Minor complications occurred after discharges in 3% (n=3). The questionnaire survey revealed that 96% (n=53) of the patients were satisfied with the service and they were not anxious after discharge. Most of common interventional procedures were safely done under the day-hospital system with the patients being highly satisfied. The day-hospital system can be a good tool for establishing admitting privileges for an interventional radiology clinic.

  20. Preliminary clinical experience with a dedicated interventional robotic system for CT-guided biopsies of lung lesions: a comparison with the conventional manual technique

    Energy Technology Data Exchange (ETDEWEB)

    Anzidei, Michele; Argiro, Renato; Porfiri, Andrea; Boni, Fabrizio; Zaccagna, Fulvio; Napoli, Alessandro; Leonardi, Andrea; Bezzi, Mario; Catalano, Carlo [University of Rome, Department of Radiological, Oncological and Anatomopathological Sciences - Radiology - Sapienza, Rome (Italy); Anile, Marco; Venuta, Federico [University of Rome, Department of Thoracic Surgery - Sapienza, Rome (Italy); Vitolo, Domenico [University of Rome, Department of Radiological, Oncological and Anatomopathological Sciences - Pathology - Sapienza, Rome (Italy); Saba, Luca [Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari-Polo di Monserrato, Monserrato (Italy); Longo, Flavia [University of Rome, Department of Radiological, Oncological and Anatomopathological Sciences - Oncology - Sapienza, Rome (Italy)

    2015-05-01

    Evaluate the performance of a robotic system for CT-guided lung biopsy in comparison to the conventional manual technique. One hundred patients referred for CT-guided lung biopsy were randomly assigned to group A (robot-assisted procedure) or group B (conventional procedure). Size, distance from entry point and position in lung of target lesions were evaluated to assess homogeneity differences between the two groups. Procedure duration, dose length product (DLP), precision of needle positioning, diagnostic performance of the biopsy and rate of complications were evaluated to assess the clinical performance of the robotic system as compared to the conventional technique. All biopsies were successfully performed. The size (p = 0.41), distance from entry point (p = 0.86) and position in lung (p = 0.32) of target lesions were similar in both groups (p = 0.05). Procedure duration and radiation dose were significantly reduced in group A as compared to group B (p = 0.001). Precision of needle positioning, diagnostic performance of the biopsy and rate of complications were similar in both groups (p = 0.05). Robot-assisted CT-guided lung biopsy can be performed safely and with high diagnostic accuracy, reducing procedure duration and radiation dose in comparison to the conventional manual technique. (orig.)

  1. Preliminary clinical experience with a dedicated interventional robotic system for CT-guided biopsies of lung lesions: a comparison with the conventional manual technique

    International Nuclear Information System (INIS)

    Evaluate the performance of a robotic system for CT-guided lung biopsy in comparison to the conventional manual technique. One hundred patients referred for CT-guided lung biopsy were randomly assigned to group A (robot-assisted procedure) or group B (conventional procedure). Size, distance from entry point and position in lung of target lesions were evaluated to assess homogeneity differences between the two groups. Procedure duration, dose length product (DLP), precision of needle positioning, diagnostic performance of the biopsy and rate of complications were evaluated to assess the clinical performance of the robotic system as compared to the conventional technique. All biopsies were successfully performed. The size (p = 0.41), distance from entry point (p = 0.86) and position in lung (p = 0.32) of target lesions were similar in both groups (p = 0.05). Procedure duration and radiation dose were significantly reduced in group A as compared to group B (p = 0.001). Precision of needle positioning, diagnostic performance of the biopsy and rate of complications were similar in both groups (p = 0.05). Robot-assisted CT-guided lung biopsy can be performed safely and with high diagnostic accuracy, reducing procedure duration and radiation dose in comparison to the conventional manual technique. (orig.)

  2. The preparation of teaching simulation system of endovascular intervention

    International Nuclear Information System (INIS)

    Objective: To establish a teaching simulation system of endovascular intervention and to evaluate its application in clinical teaching practice. Methods: The vascular model, which had quite similar diameter and length to that of human arteries, was prepared with glass tubes of different diameters. Stainless steel tubes were cut and welded to manufacture the brackets of an operation bed and a C-arm, and then the above parts together with flat were assembled into the operation bed module. Fixed camera, computer and footswitch were assembled into the image module. The above three modules were integrated into the teaching simulation system of endovascular intervention. With the help of this system, the principal endovascular intervention manipulations were imitatively exercised. Results: The vascular model had the same proportions as in normal human subjects. The operation bed module could be moved in two dimensions. The image module could capture multiple and differently formatted images as well as dynamic images in different sizes. Also, this system carried the image-frozen function, which was just the same as last image hold function of DSA. This simulation system could imitate the basic manipulations of many kinds of endovascular interventions, such as the hepatic artery catheterization, carotid artery catheterization, the performing of looping-technique in uterine artery, etc. Conclusion: The simulation system can imitate many principal endovascular manipulations, and can distinctly display the relationship of the vascular anatomy and interventional instruments with their imaging shadows. Therefore, this simulation system has a promising prospect of being able to be used in the clinical teaching program concerning vascular interventional manipulations. (authors)

  3. Clinical study of interventional therapy for acute cerebral infarction

    International Nuclear Information System (INIS)

    Objective: To evaluate the clinical efficacy and safety of interventional therapy for acute cerebral infarction. Method: Using urokinase, 35 patients with acute cerebral infarction within 24 hours were treated by intra-artery thrombolytic therapy. Europe stroke scale (ESS), Barthel index (BI) were used to evaluate the recovery of neurological functions. Result: ESS score increase rapidly after thrombolytisis, and there were significant difference between the two teams. Thirteen of 13 cases treated within 6 hours from onset showed complete/partial recanalization in cerebral angiography and intraparenchymal hemorrhagic rate were 0%, twenty-six of 35 cases treated within 24 hours showed complete/partial recanalization and intraparenchymal hemorrhagic rate were 5.71%. Conclusion: Interventional therapy for acute cerebral infarction within 6h were safe and effective. (authors)

  4. A wireless communication system for interventional MRI

    International Nuclear Information System (INIS)

    The available MR-compatible communication systems, which are typically designed for diagnostic exams, are mostly based on tubular sound transmission. In other settings, modern commercially available communication systems with ear protection allow wireless communication in noisy environments. The application of MR-compatible wireless headsets in interventional radiology precludes tube contact with sterile surfaces and hindrance of the interventionalist's range of motion. The system introduced here allows wireless communication within the scanner room without influencing MR image quality. (orig.)

  5. Prospects for a clinical science of mindfulness-based intervention.

    Science.gov (United States)

    Dimidjian, Sona; Segal, Zindel V

    2015-10-01

    Mindfulness-based interventions (MBIs) are at a pivotal point in their future development. Spurred on by an ever-increasing number of studies and breadth of clinical application, the value of such approaches may appear self-evident. We contend, however, that the public health impact of MBIs can be enhanced significantly by situating this work in a broader framework of clinical psychological science. Utilizing the National Institutes of Health stage model (Onken, Carroll, Shoham, Cuthbert, & Riddle, 2014), we map the evidence base for mindfulness-based cognitive therapy and mindfulness-based stress reduction as exemplars of MBIs. From this perspective, we suggest that important gaps in the current evidence base become apparent and, furthermore, that generating more of the same types of studies without addressing such gaps will limit the relevance and reach of these interventions. We offer a set of 7 recommendations that promote an integrated approach to core research questions, enhanced methodological quality of individual studies, and increased logical links among stages of clinical translation in order to increase the potential of MBIs to impact positively the mental health needs of individuals and communities. PMID:26436311

  6. The clinical practice of interventional radiology: a European perspective.

    LENUS (Irish Health Repository)

    Keeling, Aoife N

    2009-05-01

    The purpose of this study was to determine the current clinical environment in which interventional radiology (IR) is practiced throughout Europe. A survey, comprising 12 questions on IR clinical practice, was sent to 1800 CIRSE members. Members were asked to return one survey per department. Two hundred seventy-four departments returned completed questionnaires, 22% from the United Kingdom (n = 60), 11% from Germany (n = 30), 8% from Austria (n = 23), and the remainder spread over Europe. Experts, with more than 10 years of IR experience, comprised 74% of the survey group. Almost one-third of the radiologists dedicated more than 80% of their clinical sessions to IR alone (27%; n = 75), with two-thirds practicing in a university teaching hospital setting (66%; n = 179). Few institutions have dedicated IR inpatient hospital beds (17%; n = 46), however, to compensate, day case beds are available (31%), IR admitting rights are in place (64% overall, 86% for in-patients, and 89% for day cases), and elective IR admissions can be made through other clinicians (87%). IR outpatient clinics are run at 26% of departments, with an average of two sessions per week. Dedicated nurses staff the majority of IR suites (82%), but clinical junior doctors are lacking (46%). Hospital management\\'s refusing access to beds was the most commonly cited reason for not developing a clinical IR service (41%). In conclusion, there is marked variation across European centers in the current practice of IR. Half do not have dedicated junior doctors and only a small minority have inpatient hospital beds. If IR is to be maintained as a dedicated clinical specialty, these issues need to be addressed urgently.

  7. The Clinical Practice of Interventional Radiology: A European Perspective

    International Nuclear Information System (INIS)

    The purpose of this study was to determine the current clinical environment in which interventional radiology (IR) is practiced throughout Europe. A survey, comprising 12 questions on IR clinical practice, was sent to 1800 CIRSE members. Members were asked to return one survey per department. Two hundred seventy-four departments returned completed questionnaires, 22% from the United Kingdom (n = 60), 11% from Germany (n = 30), 8% from Austria (n = 23), and the remainder spread over Europe. Experts, with more than 10 years of IR experience, comprised 74% of the survey group. Almost one-third of the radiologists dedicated more than 80% of their clinical sessions to IR alone (27%; n = 75), with two-thirds practicing in a university teaching hospital setting (66%; n = 179). Few institutions have dedicated IR inpatient hospital beds (17%; n = 46), however, to compensate, day case beds are available (31%), IR admitting rights are in place (64% overall, 86% for in-patients, and 89% for day cases), and elective IR admissions can be made through other clinicians (87%). IR outpatient clinics are run at 26% of departments, with an average of two sessions per week. Dedicated nurses staff the majority of IR suites (82%), but clinical junior doctors are lacking (46%). Hospital management's refusing access to beds was the most commonly cited reason for not developing a clinical IR service (41%). In conclusion, there is marked variation across European centers in the current practice of IR. Half do not have dedicated junior doctors and only a small minority have inpatient hospital beds. If IR is to be maintained as a dedicated clinical specialty, these issues need to be addressed urgently.

  8. Improving patient access to an interventional US clinic.

    Science.gov (United States)

    Steele, Joseph R; Clarke, Ryan K; Terrell, John A; Brightmon, Tonya R

    2014-01-01

    A continuous quality improvement project was conducted to increase patient access to a neurointerventional ultrasonography (US) clinic. The clinic was experiencing major scheduling delays because of an increasing patient volume. A multidisciplinary team was formed that included schedulers, medical assistants, nurses, technologists, and physicians. The team created an Ishikawa diagram of the possible causes of the long wait time to the next available appointment and developed a flowchart of the steps involved in scheduling and completing a diagnostic US examination and biopsy. The team then implemented a staged intervention that included adjustments to staffing and room use (stage 1); new procedures for scheduling same-day add-on appointments (stage 2); and a lead technician rotation to optimize patient flow, staffing, and workflow (stage 3). Six months after initiation of the intervention, the mean time to the next available appointment had decreased from 25 days at baseline to 1 day, and the number of available daily appointments had increased from 38 to 55. These improvements resulted from a coordinated provider effort and had a net present value of more than $275,000. This project demonstrates that structural changes in staffing, workflow, and room use can substantially reduce scheduling delays for critical imaging procedures.

  9. 预防针刺伤系统干预在临床护生带教中的应用%Flu shot stabbed system intervention in clinical nursing students to teach with the application

    Institute of Scientific and Technical Information of China (English)

    冯美静; 张辉

    2012-01-01

    Pricking wound is common adverse event for nursing intern during clinical practice.Before clinical practice.nursing interns have less awareness of the adverse events,such as nosocomial infection,lack of security knowledge and prevention of pricking wound. By means of several measures of prevention of pricking wound system intervention,for instance,setting up health physical examination file,concentrating pre-work training,drawing and implementing special plans,selecting and training excellent teachers,strengthening administrative intervention etc,the nursing;interns have made a good progress in preventing and control of nosocomial infection, standardizing nursing manipu latio n,preventing pricking wound and so on.Prevention and control of nosocomial infection is the most important part of the hospital work.nursing interns could improve knowledge level,being aware of prevention and control of nosocomial, reduce the pricking wound occurrence rate by preventing pricking wound system intervention.to maintenance patients and their own interests,improve clinical practice effect and lay a stable foundation for future clinical nursing work.%针刺伤是护生在临床实习过程中发生的较常见的不良事件.护生进入临床生产实习前,医院感染、安全知识缺乏,防范针刺伤等不良事件意识淡薄.通过开展包括入院体检建立健康档案、岗前集中培训、制定专项带教计划、选择培训优秀带教老师、切实落实各项带教计划、加强行政管理干预等多项措施的预防针刺伤系统干预,实习护生在院感防控、规范护理操作、预防针刺伤等方面成效明显.院感防控工作是医院工作中的重要部分,运用预防针刺伤系统干预的方法可使护生多途径、多种方式提高认知程度,自觉培养防范和控制医院感染的意识,降低针刺伤不良事件发生率,维护患者及自身权益,提高临床生产实习效果,为以后的临床护理工作奠定良好的基础.

  10. 经肝动脉介入诊疗模拟系统在教学中的应用评价%Transhepatic artery interventional catheterization simulation system: its application in clinical teaching

    Institute of Scientific and Technical Information of China (English)

    曹莉明; 王杰; 李依明; 施海彬; 赵林波; 刘圣; 周卫忠

    2012-01-01

    Objective To discuss the application of transhepatic artery interventional catheterization simulation syste'm in clinical teaching. Methods The participant was asked to complete the initial test according to hepatic artery catheterization procedure, and the time used by the participant was recorded. After practicing on the simulation system for 30 times, the participant was asked to perform the terminal test and the time used by him was recorded again. The initial and terminal test time was statistically analyzed. Finally, participants were asked to complete the questionnaire form to determine the subjects' self-assessment of their performance. Results A total of forty-three subjects fully participated in the study. All the subjects made no mistakes in performing the procedure. The mean time of initial and terminal test was (384.70 ± 200.4) seconds and (214.93 ± 115.4) seconds, respectively. The difference in used time between the initial and terminal test was statistically significant (P < 0.01). After practicing on the simulation system for 30 times, the used time for hepatic artery catheterization was significantly reduced. The analysis of the questionnaire indicated that all the participants firmly believed that after practicing on the simulation system their skill in interventional manipulation was markedly improved. Conclusion Teaching training with transhepatic artery interventional simulation system is of great value in improving the beginner's interventional manipulation skill.%目的 评价经肝动脉介入诊疗模拟系统在教学中的应用价值.方法 测试者在模拟系统用RH肝管完成经肝动脉插管初试后记录时间,通过模拟系统练习30次后,进行终试并记录时间,将初试及终试时间进行统计学分析,测试结束后填写调查问卷.结果 共有43位测试者参加实验,全部完成初试、插管练习和终试,均未出现错误操作,总合格率为100%.初试和终试总用时分别为(384.70±200

  11. Student Pharmacists’ Clinical Interventions in Advanced Pharmacy Practice Experiences at a Community Nonteaching Hospital

    OpenAIRE

    Shogbon, Angela O.; Lundquist, Lisa M.

    2014-01-01

    Objective. To assess student pharmacists’ clinical interventions in advanced pharmacy practice experiences (APPEs) at a community nonteaching hospital and evaluate completed interventions based on the type of documentation method used.

  12. Clinical and Angiographic Factors Associated With Asymptomatic Restenosis After Percutaneous Coronary Intervention

    NARCIS (Netherlands)

    P.N. Ruygrok (Peter); M.W.I. Webster (Mark); V. de Valk (Vincent); G.A. van Es (Gerrit Anne); J.A. Ormiston (John); M-A.M. Morel (Marie-Angèle); P.W.J.C. Serruys (Patrick)

    2001-01-01

    textabstractBACKGROUND: Angiographic restenosis after percutaneous coronary interventional procedures is more common than recurrent angina. Clinical and angiographic factors associated with asymptomatic versus symptomatic restenosis after percutaneous coronary intervention were compared. METHODS AND

  13. Clinical Trials Infrastructure as a Quality Improvement Intervention in Low- and Middle-Income Countries.

    Science.gov (United States)

    Denburg, Avram; Rodriguez-Galindo, Carlos; Joffe, Steven

    2016-06-01

    Mounting evidence suggests that participation in clinical trials confers neither advantage nor disadvantage on those enrolled. Narrow focus on the question of a "trial effect," however, distracts from a broader mechanism by which patients may benefit from ongoing clinical research. We hypothesize that the existence of clinical trials infrastructure-the organizational culture, systems, and expertise that develop as a product of sustained participation in cooperative clinical trials research-may function as a quality improvement lever, improving the quality of care and outcomes of all patients within an institution or region independent of their individual participation in trials. We further contend that this "infrastructure effect" can yield particular benefits for patients in low- and middle-income countries (LMICs). The hypothesis of an infrastructure effect as a quality improvement intervention, if correct, justifies enhanced research capacity in LMIC as a pillar of health system development. PMID:27216089

  14. Integrating Transgenic Vector Manipulation with Clinical Interventions to Manage Vector-Borne Diseases.

    Directory of Open Access Journals (Sweden)

    Kenichi W Okamoto

    2016-03-01

    Full Text Available Many vector-borne diseases lack effective vaccines and medications, and the limitations of traditional vector control have inspired novel approaches based on using genetic engineering to manipulate vector populations and thereby reduce transmission. Yet both the short- and long-term epidemiological effects of these transgenic strategies are highly uncertain. If neither vaccines, medications, nor transgenic strategies can by themselves suffice for managing vector-borne diseases, integrating these approaches becomes key. Here we develop a framework to evaluate how clinical interventions (i.e., vaccination and medication can be integrated with transgenic vector manipulation strategies to prevent disease invasion and reduce disease incidence. We show that the ability of clinical interventions to accelerate disease suppression can depend on the nature of the transgenic manipulation deployed (e.g., whether vector population reduction or replacement is attempted. We find that making a specific, individual strategy highly effective may not be necessary for attaining public-health objectives, provided suitable combinations can be adopted. However, we show how combining only partially effective antimicrobial drugs or vaccination with transgenic vector manipulations that merely temporarily lower vector competence can amplify disease resurgence following transient suppression. Thus, transgenic vector manipulation that cannot be sustained can have adverse consequences-consequences which ineffective clinical interventions can at best only mitigate, and at worst temporarily exacerbate. This result, which arises from differences between the time scale on which the interventions affect disease dynamics and the time scale of host population dynamics, highlights the importance of accounting for the potential delay in the effects of deploying public health strategies on long-term disease incidence. We find that for systems at the disease-endemic equilibrium, even

  15. 全身炎症反应综合征发生机制及临床干预%Pathogenesis and clinical intervention of systemic inflammatory response syndrome

    Institute of Scientific and Technical Information of China (English)

    马朋林

    2006-01-01

    全身炎症反应综合征(systemic Inflammatory Response Syndrome,简称SIRS)是机体遭遇伤害刺激(如感染、创伤、休克、烧伤等)时宿主防御反应不断扩大,超出机体正常代偿能力,导致广泛组织细胞损伤的病理生理学过程。被认为是各种原因引起多器官功能障碍综合征(MODS)的共同通路。自20世纪80年代认识SIRS,90年代初期正式提出SIRS概念和诊断标准,到今天对SIRS开展全球、不同层面的广泛研究,临床医学及医学生物学研究人员走过了漫长而艰辛的历程。然而遗憾的是,到目前为止,关于SIRS病理生理过程的认识仍处于初级阶段,其相应的临床干预对策缺乏有效性和特异性。因此,对该课题的探讨仍是当今危重病医学面临的巨大挑战。

  16. Rationale and clinical data supporting nutritional intervention in Alzheimer's disease.

    Science.gov (United States)

    Engelborghs, S; Gilles, C; Ivanoiu, A; Vandewoude, M

    2014-01-01

    Adequate nutrition plays an important role in the maintenance of cognitive function, particularly during aging. Malnutrition is amongst the risk factors for developing mild cognitive impairment (MCI) and Alzheimer's disease (AD). Epidemiological studies have associated deficiencies in some nutrients with a higher risk of cognitive dysfunction and/or AD. Cognitive decline in AD is correlated with synaptic loss and many of the components required to maintain optimal synaptic function are derived from dietary sources. As synapses are part of the neuronal membrane and are continuously being remodelled, the availability of sufficient levels of nutritional precursors (mainly uridine monophosphate, choline and omega-3 fatty acids) to make the phospholipids required to build neuronal membranes may have beneficial effects on synaptic degeneration in AD. In addition, B-vitamins, phospholipids and other micronutrients act as cofactors to enhance the supply of precursors required to make neuronal membranes and synapses. Despite this, no randomized controlled trial has hitherto provided evidence that any single nutrient has a beneficial effect on cognition or lowers the risk for AD. However, a multi-target approach using combinations of (micro)nutrients might have beneficial effects on cognitive function in neurodegenerative brain disorders like AD leading to synaptic degeneration. Here we review the clinical evidence for supplementation, based on a multi-target approach with a focus on key nutrients with a proposed role in synaptic dysfunction. Based on preclinical evidence, a nutrient mixture, Souvenaid(®) (Nutricia N.V., Zoetermeer, The Netherlands) was developed. Clinical trials with Souvenaid(®) have shown improved memory performance in patients with mild AD. Further clinical trials to evaluate the effects of nutritional intervention in MCI and early dementia due to AD are on-going. PMID:24635394

  17. Clinical outcomes resulting from telemedicine interventions: a systematic review

    Directory of Open Access Journals (Sweden)

    Kraemer Dale

    2001-11-01

    Full Text Available Abstract Background The use of telemedicine is growing, but its efficacy for achieving comparable or improved clinical outcomes has not been established in many medical specialties. The objective of this systematic review was to evaluate the efficacy of telemedicine interventions for health outcomes in two classes of application: home-based and office/hospital-based. Methods Data sources for the study included deports of studies from the MEDLINE, EMBASE, CINAHL, and HealthSTAR databases; searching of bibliographies of review and other articles; and consultation of printed resources as well as investigators in the field. We included studies that were relevant to at least one of the two classes of telemedicine and addressed the assessment of efficacy for clinical outcomes with data of reported results. We excluded studies where the service did not historically require face-to-face encounters (e.g., radiology or pathology diagnosis. All included articles were abstracted and graded for quality and direction of the evidence. Results A total of 25 articles met inclusion criteria and were assessed. The strongest evidence for the efficacy of telemedicine in clinical outcomes comes from home-based telemedicine in the areas of chronic disease management, hypertension, and AIDS. The value of home glucose monitoring in diabetes mellitus is conflicting. There is also reasonable evidence that telemedicine is comparable to face-to-face care in emergency medicine and is beneficial in surgical and neonatal intensive care units as well as patient transfer in neurosurgery. Conclusions Despite the widespread use of telemedicine in virtually all major areas of health care, evidence concerning the benefits of its use exists in only a small number of them. Further randomized controlled trials must be done to determine where its use is most effective.

  18. Active ultrasound pattern injection system (AUSPIS for interventional tool guidance.

    Directory of Open Access Journals (Sweden)

    Xiaoyu Guo

    Full Text Available Accurate tool tracking is a crucial task that directly affects the safety and effectiveness of many interventional medical procedures. Compared to CT and MRI, ultrasound-based tool tracking has many advantages, including low cost, safety, mobility and ease of use. However, surgical tools are poorly visualized in conventional ultrasound images, thus preventing effective tool tracking and guidance. Existing tracking methods have not yet provided a solution that effectively solves the tool visualization and mid-plane localization accuracy problem and fully meets the clinical requirements. In this paper, we present an active ultrasound tracking and guiding system for interventional tools. The main principle of this system is to establish a bi-directional ultrasound communication between the interventional tool and US imaging machine within the tissue. This method enables the interventional tool to generate an active ultrasound field over the original imaging ultrasound signals. By controlling the timing and amplitude of the active ultrasound field, a virtual pattern can be directly injected into the US machine B mode display. In this work, we introduce the time and frequency modulation, mid-plane detection, and arbitrary pattern injection methods. The implementation of these methods further improves the target visualization and guiding accuracy, and expands the system application beyond simple tool tracking. We performed ex vitro and in vivo experiments, showing significant improvements of tool visualization and accurate localization using different US imaging platforms. An ultrasound image mid-plane detection accuracy of ±0.3 mm and a detectable tissue depth over 8.5 cm was achieved in the experiment. The system performance is tested under different configurations and system parameters. We also report the first experiment of arbitrary pattern injection to the B mode image and its application in accurate tool tracking.

  19. Active ultrasound pattern injection system (AUSPIS) for interventional tool guidance.

    Science.gov (United States)

    Guo, Xiaoyu; Kang, Hyun-Jae; Etienne-Cummings, Ralph; Boctor, Emad M

    2014-01-01

    Accurate tool tracking is a crucial task that directly affects the safety and effectiveness of many interventional medical procedures. Compared to CT and MRI, ultrasound-based tool tracking has many advantages, including low cost, safety, mobility and ease of use. However, surgical tools are poorly visualized in conventional ultrasound images, thus preventing effective tool tracking and guidance. Existing tracking methods have not yet provided a solution that effectively solves the tool visualization and mid-plane localization accuracy problem and fully meets the clinical requirements. In this paper, we present an active ultrasound tracking and guiding system for interventional tools. The main principle of this system is to establish a bi-directional ultrasound communication between the interventional tool and US imaging machine within the tissue. This method enables the interventional tool to generate an active ultrasound field over the original imaging ultrasound signals. By controlling the timing and amplitude of the active ultrasound field, a virtual pattern can be directly injected into the US machine B mode display. In this work, we introduce the time and frequency modulation, mid-plane detection, and arbitrary pattern injection methods. The implementation of these methods further improves the target visualization and guiding accuracy, and expands the system application beyond simple tool tracking. We performed ex vitro and in vivo experiments, showing significant improvements of tool visualization and accurate localization using different US imaging platforms. An ultrasound image mid-plane detection accuracy of ±0.3 mm and a detectable tissue depth over 8.5 cm was achieved in the experiment. The system performance is tested under different configurations and system parameters. We also report the first experiment of arbitrary pattern injection to the B mode image and its application in accurate tool tracking.

  20. Beyond clinical engagement: a pragmatic model for quality improvement interventions, aligning clinical and managerial priorities.

    Science.gov (United States)

    Pannick, Samuel; Sevdalis, Nick; Athanasiou, Thanos

    2016-09-01

    Despite taking advantage of established learning from other industries, quality improvement initiatives in healthcare may struggle to outperform secular trends. The reasons for this are rarely explored in detail, and are often attributed merely to difficulties in engaging clinicians in quality improvement work. In a narrative review of the literature, we argue that this focus on clinicians, at the relative expense of managerial staff, has proven counterproductive. Clinical engagement is not a universal challenge; moreover, there is evidence that managers-particularly middle managers-also have a role to play in quality improvement. Yet managerial participation in quality improvement interventions is often assumed, rather than proven. We identify specific factors that influence the coordination of front-line staff and managers in quality improvement, and integrate these factors into a novel model: the model of alignment. We use this model to explore the implementation of an interdisciplinary intervention in a recent trial, describing different participation incentives and barriers for different staff groups. The extent to which clinical and managerial interests align may be an important determinant of the ultimate success of quality improvement interventions.

  1. Beyond clinical engagement: a pragmatic model for quality improvement interventions, aligning clinical and managerial priorities.

    Science.gov (United States)

    Pannick, Samuel; Sevdalis, Nick; Athanasiou, Thanos

    2016-09-01

    Despite taking advantage of established learning from other industries, quality improvement initiatives in healthcare may struggle to outperform secular trends. The reasons for this are rarely explored in detail, and are often attributed merely to difficulties in engaging clinicians in quality improvement work. In a narrative review of the literature, we argue that this focus on clinicians, at the relative expense of managerial staff, has proven counterproductive. Clinical engagement is not a universal challenge; moreover, there is evidence that managers-particularly middle managers-also have a role to play in quality improvement. Yet managerial participation in quality improvement interventions is often assumed, rather than proven. We identify specific factors that influence the coordination of front-line staff and managers in quality improvement, and integrate these factors into a novel model: the model of alignment. We use this model to explore the implementation of an interdisciplinary intervention in a recent trial, describing different participation incentives and barriers for different staff groups. The extent to which clinical and managerial interests align may be an important determinant of the ultimate success of quality improvement interventions. PMID:26647411

  2. An exploration of clinical interventions provided by pharmacists within a complex asthma service

    Directory of Open Access Journals (Sweden)

    LeMay KS

    2015-03-01

    Full Text Available Background: Pharmacists in Australia are accessible health care professionals, and their provision of clinical pharmacy interventions in a range of areas has been proven to improve patient outcomes. Individual clinical pharmacy interventions in the area of asthma management have been very successful. An understanding of the nature of these interventions will inform future pharmacy services. What we do not know is when pharmacists provide a complex asthma service, what elements of that service (interventions they choose to deliver. Objective: To explore the scope and frequency of asthma-related clinical interventions provided by pharmacists to patients in an evidence-based complex asthma service. Methods: Pharmacists from 4 states/territories of Australia were trained in asthma management. People with asthma had 3 or 4 visits to the pharmacy. Guided by a structured patient file, the pharmacist assessed the patient’s asthma and management and provided interventions where and when considered appropriate, based on their clinical decision making skills. The interventions were recorded in a checklist in the patient file. They were then analysed descriptively and thematically. Results: Pharmacists provided 22,909 clinical pharmacy interventions over the service to 570 patients (398 of whom completed the service. The most frequently delivered interventions were in the themes ‘Education on asthma’, ‘Addressing trigger factors’, ‘Medications – safe and effective use’ and ‘Explore patient perspectives’. The patients had a high and ongoing need for interventions. Pharmacists selected interventions based on their assessment of perceived need then revisited and reinforced these interventions. Conclusion: Pharmacists identified a number of areas in which patients required interventions to assist with their asthma management. Many of these were perceived to require continuing reinforcement over the duration of the service. Pharmacists were

  3. Music intervention as system: reversing hyper systemising in autism spectrum disorders to the comprehension of music as intervention.

    Science.gov (United States)

    Jaschke, Artur C

    2014-01-01

    This paper seeks to combine the notion of the Empathising-Systemising (E-S) theory and the resulting twist from the executive dysfunction theory in autism spectrum conditions (ASC) in light of music intervention as system. To achieve these points it will be important to re-visit, nonetheless briefly, the above mentioned theories and re-define music intervention in the light of these. Furthermore there is the need to adjust the executive dysfunction theory to a theory of dysfunctioning executive functions. These notions will create a different understanding of music intervention in this context, allowing the development of future and existing music intervention programs applied clinically. These applications will evolve around a structuralised approach to music intervention as system, proposing five consecutive systems. It will therefore argue the aspects of expanding existing theories in ASC together with the call for generalised interventions to better assess autism from a theoretical point of view. Theories have to be updated in a time of fast and ever-changing development.

  4. The Kinect as an interventional tracking system

    Science.gov (United States)

    Wang, Xiang L.; Stolka, Philipp J.; Boctor, Emad; Hager, Gregory; Choti, Michael

    2012-02-01

    This work explores the suitability of low-cost sensors for "serious" medical applications, such as tracking of interventional tools in the OR, for simulation, and for education. Although such tracking - i.e. the acquisition of pose data e.g. for ultrasound probes, tissue manipulation tools, needles, but also tissue, bone etc. - is well established, it relies mostly on external devices such as optical or electromagnetic trackers, both of which mandate the use of special markers or sensors attached to each single entity whose pose is to be recorded, and also require their calibration to the tracked entity, i.e. the determination of the geometric relationship between the marker's and the object's intrinsic coordinate frames. The Microsoft Kinect sensor is a recently introduced device for full-body tracking in the gaming market, but it was quickly hacked - due to its wide range of tightly integrated sensors (RGB camera, IR depth and greyscale camera, microphones, accelerometers, and basic actuation) - and used beyond this area. As its field of view and its accuracy are within reasonable usability limits, we describe a medical needle-tracking system for interventional applications based on the Kinect sensor, standard biopsy needles, and no necessary attachments, thus saving both cost and time. Its twin cameras are used as a stereo pair to detect needle-shaped objects, reconstruct their pose in four degrees of freedom, and provide information about the most likely candidate.

  5. Application of Balanced Scorecard in the Evaluation of a Complex Health System Intervention: 12 Months Post Intervention Findings from the BHOMA Intervention: A Cluster Randomised Trial in Zambia

    Science.gov (United States)

    Mutale, Wilbroad; Stringer, Jeffrey; Chintu, Namwinga; Chilengi, Roma; Mwanamwenge, Margaret Tembo; Kasese, Nkatya; Balabanova, Dina; Spicer, Neil; Lewis, James; Ayles, Helen

    2014-01-01

    Introduction In many low income countries, the delivery of quality health services is hampered by health system-wide barriers which are often interlinked, however empirical evidence on how to assess the level and scope of these barriers is scarce. A balanced scorecard is a tool that allows for wider analysis of domains that are deemed important in achieving the overall vision of the health system. We present the quantitative results of the 12 months follow-up study applying the balanced scorecard approach in the BHOMA intervention with the aim of demonstrating the utility of the balanced scorecard in evaluating multiple building blocks in a trial setting. Methods The BHOMA is a cluster randomised trial that aims to strengthen the health system in three rural districts in Zambia. The intervention aims to improve clinical care quality by implementing practical tools that establish clear clinical care standards through intensive clinic implementations. This paper reports the findings of the follow-up health facility survey that was conducted after 12 months of intervention implementation. Comparisons were made between those facilities in the intervention and control sites. STATA version 12 was used for analysis. Results The study found significant mean differences between intervention(I) and control (C) sites in the following domains: Training domain (Mean I:C; 87.5.vs 61.1, mean difference 23.3, p = 0.031), adult clinical observation domain (mean I:C; 73.3 vs.58.0, mean difference 10.9, p = 0.02 ) and health information domain (mean I:C; 63.6 vs.56.1, mean difference 6.8, p = 0.01. There was no gender differences in adult service satisfaction. Governance and motivation scores did not differ between control and intervention sites. Conclusion This study demonstrates the utility of the balanced scorecard in assessing multiple elements of the health system. Using system wide approaches and triangulating data collection methods seems to be key to successful

  6. Mapping the Early Intervention System in Ontario, Canada

    Science.gov (United States)

    Underwood, Kathryn

    2012-01-01

    This study documents the wide range of early intervention services across the province of Ontario. The services are mapped across the province showing geographic information as well as the scope of services (clinical, family-based, resource support, etc.), the range of early intervention professionals, sources of funding and the populations served…

  7. Evaluation of pharmacy students’ clinical interventions on a general medicine practice experience

    Directory of Open Access Journals (Sweden)

    Jones JD

    2011-03-01

    Full Text Available As colleges of pharmacy prepare a new generation of practitioners, it is important that during practice experiences students learn the impact of clinical interventions. For over ten years, pharmacy students have been a vital part of the multidisciplinary team at the military treatment facility. The overall impact of the student interventions on patient care has not been evaluated. To evaluate the impact, the students began documenting their clinical interventions in Medkeeper RxInterventions™, an online database. The program is used to document faculty and fourth year pharmacy students’ pharmaceutical interventions.Objective: The objective of this study was to analyze the interventions completed by fourth year pharmacy students during a general medicine advanced pharmacy practice experience at a military treatment facility.Methods: The students completing their general medicine advanced pharmacy practice experience at the military treatment facility are responsible for self reporting all interventions made during clinical rounds into the Medkeeper RxIntervention™ database. The researchers retrospectively collected and analyzed interventions made from June 2008 to June 2009.Results: The total number of interventions recorded by 8 fourth year pharmacy students was 114. Students averaged a number of 14.3 interventions during an eight week practice experience. Students spent an average of 5 minutes per intervention. Ninety- five percent of the interventions were accepted.Conclusion: Fourth year pharmacy students’ recommendations were accepted at a high rate by resident physicians. The high acceptance rate may have the ability to positively impact patient care.

  8. Impact of diabets on clinical outcomes following multivessel percutaneous interventions

    Institute of Scientific and Technical Information of China (English)

    乔岩

    2013-01-01

    Objective To compare the rates of mortality,mycardial infarction (MI) ,repeat revascularization and stent thrombosis after percutaneous coronary intervention (PCI) with implantation of stents for diabetics versus nondiabetics with multivessel disease to evaluate the im-

  9. Clinical Information Support System (CISS)

    Data.gov (United States)

    Department of Veterans Affairs — Clinical Information Support System (CISS) is a web-based portal application that provides a framework of services for the VA enterprise and supplies an integration...

  10. Continuous-time system identification of a smoking cessation intervention

    Science.gov (United States)

    Timms, Kevin P.; Rivera, Daniel E.; Collins, Linda M.; Piper, Megan E.

    2014-07-01

    Cigarette smoking is a major global public health issue and the leading cause of preventable death in the United States. Toward a goal of designing better smoking cessation treatments, system identification techniques are applied to intervention data to describe smoking cessation as a process of behaviour change. System identification problems that draw from two modelling paradigms in quantitative psychology (statistical mediation and self-regulation) are considered, consisting of a series of continuous-time estimation problems. A continuous-time dynamic modelling approach is employed to describe the response of craving and smoking rates during a quit attempt, as captured in data from a smoking cessation clinical trial. The use of continuous-time models provide benefits of parsimony, ease of interpretation, and the opportunity to work with uneven or missing data.

  11. Ubiquitous Multicriteria Clinic Recommendation System.

    Science.gov (United States)

    Chen, Toly

    2016-05-01

    Advancements in information, communication, and sensor technologies have led to new opportunities in medical care and education. Patients in general prefer visiting the nearest clinic, attempt to avoid waiting for treatment, and have unequal preferences for different clinics and doctors. Therefore, to enable patients to compare multiple clinics, this study proposes a ubiquitous multicriteria clinic recommendation system. In this system, patients can send requests through their cell phones to the system server to obtain a clinic recommendation. Once the patient sends this information to the system, the system server first estimates the patient's speed according to the detection results of a global positioning system. It then applies a fuzzy integer nonlinear programming-ordered weighted average approach to assess four criteria and finally recommends a clinic with maximal utility to the patient. The proposed methodology was tested in a field experiment, and the experimental results showed that it is advantageous over two existing methods in elevating the utilities of recommendations. In addition, such an advantage was shown to be statistically significant.

  12. Ubiquitous Multicriteria Clinic Recommendation System.

    Science.gov (United States)

    Chen, Toly

    2016-05-01

    Advancements in information, communication, and sensor technologies have led to new opportunities in medical care and education. Patients in general prefer visiting the nearest clinic, attempt to avoid waiting for treatment, and have unequal preferences for different clinics and doctors. Therefore, to enable patients to compare multiple clinics, this study proposes a ubiquitous multicriteria clinic recommendation system. In this system, patients can send requests through their cell phones to the system server to obtain a clinic recommendation. Once the patient sends this information to the system, the system server first estimates the patient's speed according to the detection results of a global positioning system. It then applies a fuzzy integer nonlinear programming-ordered weighted average approach to assess four criteria and finally recommends a clinic with maximal utility to the patient. The proposed methodology was tested in a field experiment, and the experimental results showed that it is advantageous over two existing methods in elevating the utilities of recommendations. In addition, such an advantage was shown to be statistically significant. PMID:26984357

  13. Alzheimer’s disease multiple intervention trial (ADMIT: study protocol for a randomized controlled clinical trial

    Directory of Open Access Journals (Sweden)

    Callahan Christopher M

    2012-06-01

    Full Text Available Abstract Background Given the current lack of disease-modifying therapies, it is important to explore new models of longitudinal care for older adults with dementia that focus on improving quality of life and delaying functional decline. In a previous clinical trial, we demonstrated that collaborative care for Alzheimer’s disease reduces patients’ neuropsychiatric symptoms as well as caregiver stress. However, these improvements in quality of life were not associated with delays in subjects’ functional decline. Trial design Parallel randomized controlled clinical trial with 1:1 allocation. Participants A total of 180 community-dwelling patients aged ≥45 years who are diagnosed with possible or probable Alzheimer’s disease; subjects must also have a caregiver willing to participate in the study and be willing to accept home visits. Subjects and their caregivers are enrolled from the primary care and geriatric medicine practices of an urban public health system serving Indianapolis, Indiana, USA. Interventions All patients receive best practices primary care including collaborative care by a dementia care manager over two years; this best practices primary care program represents the local adaptation and implementation of our prior collaborative care intervention in the urban public health system. Intervention patients also receive in-home occupational therapy delivered in twenty-four sessions over two years in addition to best practices primary care. The focus of the occupational therapy intervention is delaying functional decline and helping both subjects and caregivers adapt to functional impairments. The in-home sessions are tailored to the specific needs and goals of each patient-caregiver dyad; these needs are expected to change over the course of the study. Objective To determine whether best practices primary care plus home-based occupational therapy delays functional decline among patients with Alzheimer’s disease compared

  14. From orphan drugs to adopted therapies: Advancing C3-targeted intervention to the clinical stage.

    Science.gov (United States)

    Mastellos, Dimitrios C; Reis, Edimara S; Yancopoulou, Despina; Hajishengallis, George; Ricklin, Daniel; Lambris, John D

    2016-10-01

    Complement dysregulation is increasingly recognized as an important pathogenic driver in a number of clinical disorders. Complement-triggered pathways intertwine with key inflammatory and tissue destructive processes that can either increase the risk of disease or exacerbate pathology in acute or chronic conditions. The launch of the first complement-targeted drugs in the clinic has undeniably stirred the field of complement therapeutic design, providing new insights into complement's contribution to disease pathogenesis and also helping to leverage a more personalized, comprehensive approach to patient management. In this regard, a rapidly expanding toolbox of complement therapeutics is being developed to address unmet clinical needs in several immune-mediated and inflammatory diseases. Elegant approaches employing both surface-directed and fluid-phase inhibitors have exploited diverse components of the complement cascade as putative points of therapeutic intervention. Targeting C3, the central hub of the system, has proven to be a promising strategy for developing biologics as well as small-molecule inhibitors with clinical potential. Complement modulation at the level of C3 has recently shown promise in preclinical primate models, opening up new avenues for therapeutic intervention in both acute and chronic indications fueled by uncontrolled C3 turnover. This review highlights recent developments in the field of complement therapeutics, focusing on C3-directed inhibitors and alternative pathway (AP) regulator-based approaches. Translational perspectives and considerations are discussed, particularly with regard to the structure-guided drug optimization and clinical advancement of a new generation of C3-targeted peptidic inhibitors. PMID:27353192

  15. Clinical observation of interventional treatment for tubal pregnancy

    International Nuclear Information System (INIS)

    Objective: To investigate a new method to of conservative treatment of treat tubal pregnancy. Methods: 20 cases of tubal pregnancy were treated by two conservative methods. Among them, 10 cases received single dose 5-fluorouracil perfusion through the super selective catheterization for uterus artery. Others took RU486 orally and received intra-muscular injection of testosterone. Results: Hospitalization was shorter, less salpingectomy was recommended, and blood HCG decreased faster in interventional group, than in control group. Conclusion: The 5-fluorouracil interventional treatment had its advantages for tubal pregnancy

  16. Minimal intervention dentistry - a new frontier in clinical dentistry.

    Science.gov (United States)

    Mm, Jingarwar; Nk, Bajwa; A, Pathak

    2014-07-01

    Minimally invasive procedures are the new paradigm in health care. Everything from heart bypasses to gall bladder, surgeries are being performed with these dynamic new techniques. Dentistry is joining this exciting revolution as well. Minimally invasive dentistry adopts a philosophy that integrates prevention, remineralisation and minimal intervention for the placement and replacement of restorations. Minimally invasive dentistry reaches the treatment objective using the least invasive surgical approach, with the removal of the minimal amount of healthy tissues. This paper reviews in brief the concept of minimal intervention in dentistry.

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

    Science.gov (United States)

    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…

  18. A Marginal Structural Model Analysis for Loneliness: Implications for Intervention Trials and Clinical Practice

    Science.gov (United States)

    VanderWeele, Tyler J.; Hawkley, Louise C.; Thisted, Ronald A.; Cacioppo, John T.

    2011-01-01

    Objective: Clinical scientists, policymakers, and individuals must make decisions concerning effective interventions that address health-related issues. We use longitudinal data on loneliness and depressive symptoms and a new class of causal models to illustrate how empirical evidence can be used to inform intervention trial design and clinical…

  19. Evaluation of clinical pharmacist interventions on drug interactions in outpatient pharmaceutical HIV-care

    NARCIS (Netherlands)

    de Maat, M M R; de Boer, A; Koks, C H W; Mulder, J W; Meenhorst, P L; van Gorp, E C M; Mairuhu, A T A; Huitema, A D R; Beijnen, J H

    2004-01-01

    OBJECTIVE: To evaluate the usefulness of intervention in drug interactions of antiretroviral drugs with coadministered agents by a clinical pharmacist in outpatient HIV-treatment. METHODS: The study design included two intervention arms (A and B), which were both preceded by a control observation pe

  20. Evaluation of clinical pharmacist interventions on drug interactions in outpatient pharmaceutical HIV-care.

    NARCIS (Netherlands)

    Maat, M.M. de; Boer, A.T. den; Koks, C.H.W.; Mulder, J.W.; Meenhorst, P.L.; Gorp, E. van; Mairuhu, A.T.; Huitema, A.D.; Beijnen, J.H.

    2004-01-01

    OBJECTIVE: To evaluate the usefulness of intervention in drug interactions of antiretroviral drugs with coadministered agents by a clinical pharmacist in outpatient HIV-treatment. METHODS: The study design included two intervention arms (A and B), which were both preceded by a control observation pe

  1. Impact of Pharmacy Student Interventions in an Urban Family Medicine Clinic

    OpenAIRE

    Ginzburg, Regina

    2014-01-01

    Objectives. To determine the number of interventions made by pharmacy students at an urban family medicine clinic and the acceptance rate of these recommendations by the healthcare providers. The secondary objective was to investigate the cost avoidance value of the interventions.

  2. From cell culture to population enquiry: Experimental, clinical and epidemiological studies on restenosis post coronary intervention

    NARCIS (Netherlands)

    A.G. Violaris (Andonis)

    1998-01-01

    textabstractPercutaneous coronary intervention is widely used in the treatment of coronaty artery disease but currently limited by restenosis in a proportion of cases. We investigated the restenosis problem using complimentary experimental, clinical and epidemiological approaches.

  3. A proposed staging system and stage-specific interventions for familial adenomatous polyposis

    DEFF Research Database (Denmark)

    Lynch, Patrick M; Morris, Jeffrey S; Wen, Sijin;

    2016-01-01

    scores were within ±1 stage of the mode. Sixty percent agreed on the intervention, and 86% chose an intervention within ±1 level of the mode. CONCLUSIONS: The proposed FAP colon polyposis staging system and stage-specific intervention is based on a high degree of agreement on the part of experts in the...... polyp burden as a sufficient chemoprevention trial treatment endpoint requiring a measure of "clinical-benefit." To develop endpoints for future industry-sponsored chemopreventive trials, the International Society for Gastrointestinal Hereditary Tumors (InSIGHT) developed an FAP staging and intervention...... classification scheme for lower GI tract polyposis. METHODS: Twenty-four colonoscopy or sigmoidoscopy videos were reviewed by 26 clinicians familiar with diagnosis and treatment of FAP. The reviewers independently assigned a stage to a case using the proposed system and chose a stage-specific intervention for...

  4. Dimensions of socioeconomic status and clinical outcome after primary percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Jakobsen, Lars; Niemann, Troels; Thorsgaard, Niels;

    2012-01-01

    The association between low socioeconomic status (SES) and high mortality from coronary heart disease is well-known. However, the role of SES in relation to the clinical outcome after primary percutaneous coronary intervention remains poorly understood.......The association between low socioeconomic status (SES) and high mortality from coronary heart disease is well-known. However, the role of SES in relation to the clinical outcome after primary percutaneous coronary intervention remains poorly understood....

  5. Interventional multispectral photoacoustic imaging with a clinical linear array ultrasound probe for guiding nerve blocks

    Science.gov (United States)

    Xia, Wenfeng; West, Simeon J.; Nikitichev, Daniil I.; Ourselin, Sebastien; Beard, Paul C.; Desjardins, Adrien E.

    2016-03-01

    Accurate identification of tissue structures such as nerves and blood vessels is critically important for interventional procedures such as nerve blocks. Ultrasound imaging is widely used as a guidance modality to visualize anatomical structures in real-time. However, identification of nerves and small blood vessels can be very challenging, and accidental intra-neural or intra-vascular injections can result in significant complications. Multi-spectral photoacoustic imaging can provide high sensitivity and specificity for discriminating hemoglobin- and lipid-rich tissues. However, conventional surface-illumination-based photoacoustic systems suffer from limited sensitivity at large depths. In this study, for the first time, an interventional multispectral photoacoustic imaging (IMPA) system was used to image nerves in a swine model in vivo. Pulsed excitation light with wavelengths in the ranges of 750 - 900 nm and 1150 - 1300 nm was delivered inside the body through an optical fiber positioned within the cannula of an injection needle. Ultrasound waves were received at the tissue surface using a clinical linear array imaging probe. Co-registered B-mode ultrasound images were acquired using the same imaging probe. Nerve identification was performed using a combination of B-mode ultrasound imaging and electrical stimulation. Using a linear model, spectral-unmixing of the photoacoustic data was performed to provide image contrast for oxygenated and de-oxygenated hemoglobin, water and lipids. Good correspondence between a known nerve location and a lipid-rich region in the photoacoustic images was observed. The results indicate that IMPA is a promising modality for guiding nerve blocks and other interventional procedures. Challenges involved with clinical translation are discussed.

  6. The Radiologist Will See You Now: Patients' Perceptions of an Outpatient Interventional Clinic.

    Science.gov (United States)

    Abboud, Salim; Partovi, Sasan; Nakamoto, Dean; Azar, Nami

    2016-01-01

    Patient satisfaction is becoming an increasingly important part of America's healthcare system. Patient satisfaction is now a metric assessed for value-based incentive payments by the Center for Medicare and Medicaid Services, and the healthcare market is becoming increasingly consumer-driven as patients are provided with more options regarding where they receive care as well as improved access to medical information. Radiologists, while less involved with direct patient care than other medical specialties, are not immune to the changing medical landscape and need to adapt to a progressively value- and patient-oriented healthcare system. At our institution, first-year radiology residents take an active role in our outpatient interventional radiology clinic by performing clinical histories and physical exams in a dedicated radiology clinic examination rooms. Stressing the various opportunities for patient interaction and the potential benefits of patient- centered radiology in the evolving healthcare system may increase its perceived value among both radiology residents as well as practicing radiologists. ​Directly engaging patients may be unfamiliar territory for the practicing radiologist and an unexpected prospect for current residents, but available data suggests that patients do value direct interaction with radiologists during the course of their care. PMID:26596560

  7. Subclinical hepatic encephalopathy: diagnosis, clinical implications, and intervention

    NARCIS (Netherlands)

    J.C. Guero Guillen

    1997-01-01

    textabstractHepatic encephalopathy (HE) is traditionally graded into four clinical stages of severity, ranging from lethargy, sleep and memory disturbances (grade 1) to coma (grade 4). In addition to the clinical grading of HE, a subclinical stage has been described. In subclinical hepatic encephalo

  8. Safe in the city: developing an effective video-based intervention for STD clinic waiting rooms.

    Science.gov (United States)

    Myint-U, Athi; Bull, Sheana; Greenwood, Gregory L; Patterson, Jocelyn; Rietmeijer, Cornelis A; Vrungos, Shelley; Warner, Lee; Moss, Jesse; O'Donnell, Lydia N

    2010-05-01

    There is a strong need for inexpensive, easily administered HIV and STD prevention interventions that are highly replicable and appealing to diverse clinic audiences. This article describes the four-step iterative and collaborative process used by the Safe City Study Group to design and develop a brief video-based intervention: Safe in the City. Step 1 involves identification of an appropriate intervention medium, a theoretical framework, and key messages; Step 2, collaboration with a film company to integrate the framework and key messages into an entertaining product; Step 3, facilitation of a multistep participatory process involving input from members of the priority audience (clinic patients), clinic staff, and community reviewers; and Step 4, pilot-testing to determine structural barriers to patients' viewing the video in clinic waiting rooms. Safe in the City has been demonstrated to reduce incident STDs among clinic patients in three cities in the United States.

  9. Expert systems in clinical microbiology.

    Science.gov (United States)

    Winstanley, Trevor; Courvalin, Patrice

    2011-07-01

    This review aims to discuss expert systems in general and how they may be used in medicine as a whole and clinical microbiology in particular (with the aid of interpretive reading). It considers rule-based systems, pattern-based systems, and data mining and introduces neural nets. A variety of noncommercial systems is described, and the central role played by the EUCAST is stressed. The need for expert rules in the environment of reset EUCAST breakpoints is also questioned. Commercial automated systems with on-board expert systems are considered, with emphasis being placed on the "big three": Vitek 2, BD Phoenix, and MicroScan. By necessity and in places, the review becomes a general review of automated system performances for the detection of specific resistance mechanisms rather than focusing solely on expert systems. Published performance evaluations of each system are drawn together and commented on critically.

  10. Nursing on empty: compassion fatigue signs, symptoms, and system interventions.

    Science.gov (United States)

    Harris, Chelsia; Griffin, Mary T Quinn

    2015-01-01

    Few healthcare organizations acknowledge, discuss, or provide interventions for assisting with compassion fatigue. Yet, it is an important concept due to its individual, professional, and financial costs. This article defines compassion fatigue, differentiates it from burnout, and offers system interventions for supporting nurses and reducing compassion fatigue. PMID:25898441

  11. Genetics, pathogenesis and clinical interventions in type 1 diabetes

    Science.gov (United States)

    Bluestone, Jeffrey A.; Herold, Kevan; Eisenbarth, George

    2016-01-01

    Type 1 diabetes is an autoimmune disorder afflicting millions of people worldwide. Once diagnosed, patients require lifelong insulin treatment and can experience numerous disease-associated complications. The last decade has seen tremendous advances in elucidating the causes and treatment of the disease based on extensive research both in rodent models of spontaneous diabetes and in humans. Integrating these advances has led to the recognition that the balance between regulatory and effector T cells determines disease risk, timing of disease activation, and disease tempo. Here we describe current progress, the challenges ahead and the new interventions that are being tested to address the unmet need for preventative or curative therapies. PMID:20432533

  12. Yoga & cancer interventions: a review of the clinical significance of patient reported outcomes for cancer survivors.

    Science.gov (United States)

    Culos-Reed, S Nicole; Mackenzie, Michael J; Sohl, Stephanie J; Jesse, Michelle T; Zahavich, Ashley N Ross; Danhauer, Suzanne C

    2012-01-01

    Limited research suggests yoga may be a viable gentle physical activity option with a variety of health-related quality of life, psychosocial and symptom management benefits. The purpose of this review was to determine the clinical significance of patient-reported outcomes from yoga interventions conducted with cancer survivors. A total of 25 published yoga intervention studies for cancer survivors from 2004-2011 had patient-reported outcomes, including quality of life, psychosocial or symptom measures. Thirteen of these studies met the necessary criteria to assess clinical significance. Clinical significance for each of the outcomes of interest was examined based on 1 standard error of the measurement, 0.5 standard deviation, and relative comparative effect sizes and their respective confidence intervals. This review describes in detail these patient-reported outcomes, how they were obtained, their relative clinical significance and implications for both clinical and research settings. Overall, clinically significant changes in patient-reported outcomes suggest that yoga interventions hold promise for improving cancer survivors' well-being. This research overview provides new directions for examining how clinical significance can provide a unique context for describing changes in patient-reported outcomes from yoga interventions. Researchers are encouraged to employ indices of clinical significance in the interpretation and discussion of results from yoga studies. PMID:23125870

  13. Yoga & Cancer Interventions: A Review of the Clinical Significance of Patient Reported Outcomes for Cancer Survivors

    Directory of Open Access Journals (Sweden)

    S. Nicole Culos-Reed

    2012-01-01

    Full Text Available Limited research suggests yoga may be a viable gentle physical activity option with a variety of health-related quality of life, psychosocial and symptom management benefits. The purpose of this review was to determine the clinical significance of patient-reported outcomes from yoga interventions conducted with cancer survivors. A total of 25 published yoga intervention studies for cancer survivors from 2004–2011 had patient-reported outcomes, including quality of life, psychosocial or symptom measures. Thirteen of these studies met the necessary criteria to assess clinical significance. Clinical significance for each of the outcomes of interest was examined based on 1 standard error of the measurement, 0.5 standard deviation, and relative comparative effect sizes and their respective confidence intervals. This review describes in detail these patient-reported outcomes, how they were obtained, their relative clinical significance and implications for both clinical and research settings. Overall, clinically significant changes in patient-reported outcomes suggest that yoga interventions hold promise for improving cancer survivors' well-being. This research overview provides new directions for examining how clinical significance can provide a unique context for describing changes in patient-reported outcomes from yoga interventions. Researchers are encouraged to employ indices of clinical significance in the interpretation and discussion of results from yoga studies.

  14. Why Economic Analysis of Health System Improvement Interventions Matters

    Science.gov (United States)

    Broughton, Edward Ivor; Marquez, Lani

    2016-01-01

    There is little evidence to direct health systems toward providing efficient interventions to address medical errors, defined as an unintended act of omission or commission or one not executed as intended that may or may not cause harm to the patient but does not achieve its intended outcome. We believe that lack of guidance on what is the most efficient way to reduce medical errors and improve the quality of health-care limits the scale-up of health system improvement interventions. Challenges to economic evaluation of these interventions include defining and implementing improvement interventions in different settings with high fidelity, capturing all of the positive and negative effects of the intervention, using process measures of effectiveness rather than health outcomes, and determining the full cost of the intervention and all economic consequences of its effects. However, health system improvement interventions should be treated similarly to individual medical interventions and undergo rigorous economic evaluation to provide actionable evidence to guide policy-makers in decisions of resource allocation for improvement activities among other competing demands for health-care resources.

  15. Prime time: 18-month violence outcomes of a clinic-linked intervention.

    Science.gov (United States)

    Sieving, Renee E; McMorris, Barbara J; Secor-Turner, Molly; Garwick, Ann W; Shlafer, Rebecca; Beckman, Kara J; Pettingell, Sandra L; Oliphant, Jennifer A; Seppelt, Ann M

    2014-08-01

    Prime Time, a youth development intervention, aims to reduce multiple risk behaviors among adolescent girls seeking clinic services who are at high risk for pregnancy. The purpose of the current study was to examine whether Prime Time involvement produced changes in relational aggression, physical violence, and related psychosocial and behavioral outcomes. Qualitative case exemplars illustrated social contexts of intervention participants with differing longitudinal patterns of relational aggression and physical violence. Data were from a randomized efficacy trial with 13-17 year-old girls (n = 253) meeting specified risk criteria. Intervention participants were involved in Prime Time and usual clinic services for 18 months, control participants received usual clinic services. Participants in the current study completed self-report surveys at baseline and 18 months following enrollment. Outcomes analyses revealed significantly lower levels of relational aggression perpetration in the intervention group versus controls. In contrast, Prime Time involvement did not result in significant reductions in physical violence. Exploratory dose-response analyses indicated that reductions in relational aggression may have been most pronounced among girls actively involved in Prime Time case management and peer leadership activities. Qualitative findings suggested that the intervention's emphasis on modeling and building supportive relationships contributed to reductions in relational aggression. This study contributes to what has been a very limited evidence base regarding effective approaches to preventing violence among high-risk adolescent girls. Findings suggest that offering youth development interventions through clinic settings hold promise in reducing violence risk among vulnerable youth. PMID:23543359

  16. Effect of a system-oriented intervention on compliance problems in schizophrenia

    DEFF Research Database (Denmark)

    Skarsholm, Hanne; Støvring, Henrik; Nielsen, Bent

    2014-01-01

    individually due to inappropriate behavior in the patient. We conducted a pragmatic controlled trial with a system-oriented approach, to provide a new perspective on compliance and test the efficacy of a multifactorial intervention at the system level in a routine clinical setting, an approach that has...... estimates. This was reflected by significant differences found in an analysis based on a last observation carried forward approach. Conclusion. This study suggests that compliance problems are better solved by a multifactorial intervention at the system level than at the individual level....

  17. Counseling for HIV Prevention: Clinical Interventions and HIV Antibody Testing.

    Science.gov (United States)

    Craig, Donald H.; And Others

    1996-01-01

    Describes some developmental foundations for HIV counseling. Asserts that, in both formal sessions and moments of opportunity, educators, clinicians, and counselors can use the counseling relationship to promote healthy behavior change. This clinical process depends on careful self-appraisal, good counseling skills, and responsiveness to the…

  18. Evaluation of pharmacist clinical interventions in a Dutch hospital setting

    NARCIS (Netherlands)

    Bosma, Liesbeth; Jansman, Frank G. A.; Franken, Anton M.; Harting, Johannes W.; Van den Bemt, Patricia M. L. A.

    2008-01-01

    Objective Assessing the relevance of a clinically active pharmacist method compared to the traditional working method. Method The study was carried out in a general internal/gastro-enterology unit during two 8-weeks periods in 2004. It was an observational, non-randomized prospective study. Outcome

  19. Active Interventions in Clinical Practice: Contributions of Gestalt Therapy.

    Science.gov (United States)

    Lammert, Marilyn; Dolan, Mary M.

    1983-01-01

    Describes two dimensions of Gestalt therapy that can enhance clinical practice--orientation to the present and active-experimental style--and examines them in relation to some traditional principles of practice. Gestalt theory offers a method of discovery that is a combination of phenomenology and behaviorism. (JAC)

  20. An intervention program to reduce the number of hospitalizations of elderly patients in a primary care clinic

    Directory of Open Access Journals (Sweden)

    Asher Maya

    2008-02-01

    Full Text Available Abstract Background The elderly population consumes a large share of medical resources in the western world. A significant portion of the expense is related to hospitalizations. Objectives To evaluate an intervention program designed to reduce the number of hospitalization of elderly patients by a more optimal allocation of resources in primary care. Methods A multidimensional intervention program was conducted that included the re-engineering of existing work processes with a focus on the management of patient problems, improving communication with outside agencies, and the establishment of a system to monitor quality of healthcare parameters. Data on the number of hospitalizations and their cost were compared before and after implementation of the intervention program. Results As a result of the intervention the mean expenditure per elderly patient was reduced by 22.5%. The adjusted number of hospitalizations/1,000 declined from 15.1 to 10.7 (29.3%. The number of adjusted hospitalization days dropped from 132 to 82 (37.9% and the mean hospitalization stay declined from 8.2 to 6.7 days (17.9%. The adjusted hospitalization cost ($/1,000 patients dropped from $32,574 to $18,624 (42.8%. The overall clinic expense, for all age groups, dropped by 9.9%. Conclusion Implementation of the intervention program in a single primary care clinic led to a reduction in hospitalizations for the elderly patient population and to a more optimal allocation of healthcare resources.

  1. Clinic-based intervention projects: STD and family planning programs get involved. Intervention model.

    Science.gov (United States)

    Finger, W R

    1991-06-01

    The sexually transmitted disease (STD) program in Udorn, a popular Thai tourist city, has worked closely with 750 prostitutes for 15 years, incorporating the concerns of brothel managers and prostitutes into service delivery. The program in Udorn is part of a nationwide network of STD clinics. The level of person-to-person interaction was increased once it was determined by 1989 that HIV had infected 6% of prostitutes in the city's brothels. Outreach educators were recruited and trained to ensure that all prostitutes in Udorn had the basic facts about HIV and AIDS. Over the last 2 years, the STD program has trained outreach educators to work in 8 brothels, started a local AIDS prevention foundation supported by local businessmen, and taken other steps to incorporate AIDS prevention into its clinic structure. Such clinic-based programs are an important way of targeting groups at high risk of HIV transmission. PMID:12316886

  2. Postgraduate Clinical Psychology Students' Perceptions of an Acceptance and Commitment Therapy Stress Management Intervention and Clinical Training

    Science.gov (United States)

    Pakenham, Kenneth I.; Stafford-Brown, Johanna

    2013-01-01

    Background: Research into stress management interventions for clinical psychology trainees (CPTs) is limited, despite evidence indicating that these individuals are at risk for elevated stress, which can negatively impact personal and professional functioning. This study explored: (1) CPTs' perceptions of a previously evaluated Acceptance and…

  3. Development of Detailed Clinical Models for Nursing Assessments and Nursing Interventions

    OpenAIRE

    Park, Hyeoun-Ae; Min, Yul Ha; Kim, Younglan; Lee, Myung Kyung; Lee, Youngji

    2011-01-01

    Objectives The aim of this study was to develop and validate Detailed Clinical Models (DCMs) for nursing assessments and interventions. Methods First, we identified the nursing assessment and nursing intervention entities. Second, we identified the attributes and the attribute values in order to describe the entities in more detail. The data type and optionality of the attributes were then defined. Third, the entities, attributes and value sets in the DCMs were mapped to the International Cla...

  4. 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

  5. Recent advances of ventilation-perfusion scintigraphy in clinical diagnosis and interventional treatment of pulmonary embolism

    International Nuclear Information System (INIS)

    Ventilation-perfusion scintigraphy can reflect the pulmonary function of ventilation and perfusion, then, indirectly assess the distribution of embolism. This technique is especially valuable in evaluating hemodynamic stability in patients with suspected pulmonary embolism. Ventilation-perfusion scintigraphy is superior to other imaging means in clinical practice as it is non-invasive and carries high specificity in detecting sub-segmental embolism. Furthermore, the advantages of interventional therapy are of significant clinical value in treating pulmonary embolism. This paper aims to make a comprehensive review for the ventilation-perfusion scintigraphy diagnosis, as well as the interventional treatment, of pulmonary embolism. (authors)

  6. Notes on financial system development and political intervention

    OpenAIRE

    Song, Fenghua; Thakor, Anjan

    2013-01-01

    The paper studies the impact of political intervention on a financial system that consists of banks and financial markets and develops over time. In this financial system, banks and markets exhibit three forms of interaction: they compete, they complement each other, and they co-evolve. Coevolution is generated by two new ingredients of financial system architecture relative to the existin...

  7. Expert systems in clinical practice

    International Nuclear Information System (INIS)

    The first expert systems prototypes intended for advising physicians on diagnosis or therapy selection have been designed more than ten years ago. However, a few of them are already in use in clinical practice after years of research and development efforts. The capabilities of these systems to reason symbolically and to mimic the hypothetico-deductive processes used by physicians distinguishes them from conventional computer programs. Their power comes from their knowledge-base which embeds a large quantity of high-level, specialized knowledge captured from medical experts. Common methods for knowledge representation include production rules and frames. These methods also provide a mean for organizing and structuring the knowledge according to hierarchical or causal links. The best expert-systems perform at the level of the experts. They are easy to learn and use, and can communicate with the user in pseudo-natural language. Moreover they are able to explain their line of reasoning. These capabilities make them potentially useful, usable and acceptable by physicians. However if the problems related to difficulties and costs in building expert-systems are on the way to be solved within the next few years, forensic and ethical issues should have to be addressed before one can envisage their routine use in clinical practice

  8. Extracellular vesicles: masters of intercellular communication and potential clinical interventions.

    Science.gov (United States)

    Pitt, Jonathan M; Kroemer, Guido; Zitvogel, Laurence

    2016-04-01

    Intercellular signaling via extracellular vesicles (EVs) is an underappreciated modality of cell-cell crosstalk that enables cells to convey packages of complex instructions to specific recipient cells. EVs transmit these instructions through their cargoes of multiple proteins, nucleic acids, and specialized lipids, which are derived from their cells of origin and allow for combinatorial effects upon recipient cells. This Review series brings together the recent progress in our understanding of EV signaling in physiological and pathophysiological conditions, highlighting how certain EVs, particularly exosomes, can promote or regulate infections, host immune responses, development, and various diseases - notably cancer. Given the diverse nature of EVs and their abilities to profoundly modulate host cells, this series puts particular emphasis on the clinical applications of EVs as therapeutics and as diagnostic biomarkers.

  9. Bibliometric Analysis: Mirror Therapy as an Occupational Therapy Intervention Strategy in the Clinical Setting

    Directory of Open Access Journals (Sweden)

    Elvis Siprián Castro Alzate

    2016-01-01

    Full Text Available Objective: To determine the national and international scientific evidence regarding the use of mirror therapy, as an occupational therapy intervention tool in the clinical setting, in order to acquire knowledge and implement this strategy in professional practice. Materials and methods: A descriptive study was conducted in which the research strategy was held through medical subject headings (MeSH, such as “mirror neuron”, ”occupational therapy”, “physical rehabilitation” and “motor imagery”. Through the use of the bolean and combinations in five different databases were performed: Embase, Ebsco, OTseeker, Science Direct and Medline. The analysis was elaborated by establishing frequencies of different variables such as journal, country, study type and publish­ing year. Conclusions: In the evidence analysis it was found that mirror therapy is an interven­tion modality recently used by different rehabilitation professionals. Since 2004, an increase in the generation of high impact scientific evidence about this subject has been recognized, due in part to the reported effectiveness in clinical practices, mainly the treatment of health conditions secondary to stroke, limb amputations, chronic pain syndromes, and post-surgical rehabilitation. During the reviewed period, an increase in high level academic evidence was observed: 35.7 % of the analyzed publications correspond to randomized controlled trials and 42.9 % are system­atic reviews. The use of mirror therapy in occupational therapy is an intervention modality that facilitates functional rehabilitation processes, promotes independence in performing activities of daily living (adl and allows social participation and environment adaptation processes to happen.

  10. Improving Decision Making about Genetic Testing in the Clinic: An Overview of Effective Knowledge Translation Interventions

    Science.gov (United States)

    Légaré, France; Robitaille, Hubert; Gane, Claire; Hébert, Jessica; Labrecque, Michel; Rousseau, François

    2016-01-01

    Background Knowledge translation (KT) interventions are attempts to change behavior in keeping with scientific evidence. While genetic tests are increasingly available to healthcare consumers in the clinic, evidence about their benefits is unclear and decisions about genetic testing are thus difficult for all parties. Objective We sought to identify KT interventions that involved decisions about genetic testing in the clinical context and to assess their effectiveness for improving decision making in terms of behavior change, increased knowledge and wellbeing. Methods We searched for trials assessing KT interventions in the context of genetic testing up to March 2014 in all systematic reviews (n = 153) published by two Cochrane review groups: Effective Practice and Organisation of Care (EPOC) and Consumers and Communication. Results We retrieved 2473 unique trials of which we retained only 28 (1%). Two EPOC reviews yielded two trials of KT interventions: audit and feedback (n = 1) and educational outreach (n = 1). Both targeted health professionals and the KT intervention they assessed was found to be effective. Four Consumers and Communication reviews yielded 26 trials: decision aids (n = 15), communication of DNA-based disease risk estimates (n = 7), personalized risk communication (n = 3) and mobile phone messaging (n = 1). Among these, 25 trials targeted only health consumers or patients and the KT interventions were found to be effective in four trials, partly effective in seven, and ineffective in four. Lastly, only one trial targeted both physicians and patients and was found to be effective. Conclusions More research on the effectiveness of KT interventions regarding genetic testing in the clinical context may contribute to patients making informed value-based decisions and drawing the maximum benefit from clinical applications of genetic and genomic innovations. PMID:26938633

  11. Development of a Web-Based Clinical Decision Support System for Drug Prescription: Non-Interventional Naturalistic Description of the Antipsychotic Prescription Patterns in 4345 Outpatients and Future Applications

    Science.gov (United States)

    Berrouiguet, Sofian; Barrigón, Maria Luisa; Brandt, Sara A.; Ovejero-García, Santiago; Álvarez-García, Raquel; Carballo, Juan Jose; Lenca, Philippe; Courtet, Philippe; Baca-García, Enrique

    2016-01-01

    Purpose The emergence of electronic prescribing devices with clinical decision support systems (CDSS) is able to significantly improve management pharmacological treatments. We developed a web application available on smartphones in order to help clinicians monitor prescription and further propose CDSS. Method A web application (www.MEmind.net) was developed to assess patients and collect data regarding gender, age, diagnosis and treatment. We analyzed antipsychotic prescriptions in 4345 patients attended in five Psychiatric Community Mental Health Centers from June 2014 to October 2014. The web-application reported average daily dose prescribed for antipsychotics, prescribed daily dose (PDD), and the PDD to defined daily dose (DDD) ratio. Results The MEmind web-application reported that antipsychotics were used in 1116 patients out of the total sample, mostly in 486 (44%) patients with schizophrenia related disorders but also in other diagnoses. Second generation antipsychotics (quetiapine, aripiprazole and long-acting paliperidone) were preferably employed. Low doses were more frequently used than high doses. Long acting paliperidone and ziprasidone however, were the only two antipsychotics used at excessive dosing. Antipsychotic polypharmacy was used in 287 (26%) patients with classic depot drugs, clotiapine, amisulpride and clozapine. Conclusions In this study we describe the first step of the development of a web application that is able to make polypharmacy, high dose usage and off label usage of antipsychotics visible to clinicians. Current development of the MEmind web application may help to improve prescription security via momentary feedback of prescription and clinical decision support system. PMID:27764107

  12. Update on Melanocortin Interventions for Cachexia: Progress Toward Clinical Application

    OpenAIRE

    DeBoer, Mark Daniel

    2009-01-01

    Cachexia is a devastating syndrome of body wasting that is associated with multiple common chronic diseases including cancer, chronic kidney disease, and chronic heart failure. These underlying diseases are associated with increased levels of inflammatory cytokines and result in anorexia, increased resting energy expenditure and loss of fat and lean body mass. Prior experiments have implicated the central melanocortin system in the hypothalamus with the propagation of these symptoms of cachex...

  13. Adherence to yoga and exercise interventions in a 6-month clinical trial

    Directory of Open Access Journals (Sweden)

    Haas M

    2007-11-01

    Full Text Available Abstract Background To determine factors that predict adherence to a mind-body intervention in a randomized trial. Design We analyzed adherence data from a 3-arm trial involving 135 generally healthy seniors 65–85 years of age randomized to a 6-month intervention consisting of: an Iyengar yoga class with home practice, an exercise class with home practice, or a wait-list control group. Outcome measures included cognitive function, mood, fatigue, anxiety, health-related quality of life, and physical measures. Adherence to the intervention was obtained by class attendance and biweekly home practice logs. Results The drop-out rate was 13%. Among the completers of the two active interventions, average yoga class attendance was 77% and home practice occurred 64% of all days. Average exercise class attendance was 69% and home exercise occurred 54% of all days. There were no clear effects of adherence on the significant study outcomes (quality of life and physical measures. Class attendance was significantly correlated with baseline measures of depression, fatigue, and physical components of health-related quality of life. Significant differences in baseline measures were also found between study completers and drop-outs in the active interventions. Adherence was not related to age, gender, or education level. Conclusion Healthy seniors have good attendance at classes with a physically active intervention. Home practice takes place over half of the time. Decreased adherence to a potentially beneficial intervention has the potential to decrease the effect of the intervention in a clinical trial because subjects who might sustain the greatest benefit will receive a lower dose of the intervention and subjects with higher adherence rates may be functioning closer to maximum ability before the intervention. Strategies to maximize adherence among subjects at greater risk for low adherence will be important for future trials, especially complementary

  14. The importance of pre-clinical animal testing in interventional cardiology.

    Science.gov (United States)

    Suzuki, Yoriyasu; Yeung, Alan C; Ikeno, Fumiaki

    2008-11-01

    The treatment of cardiovascular disease has changed dramatically over the past 2 decades, allowing patients to live longer and better quality lives. The introduction of new therapies has contributed much to this success. Nowhere has this been more evident than in interventional cardiology, where percutaneous cardiovascular intervention has evolved in the past 2 decades from a quirky experimental procedure to a therapeutic cornerstone for patients with symptomatic cardiovascular disease. The development of these technologies from the earliest stages requires preclinical experiments using animal models. Once introduced into the clinical arena, an understanding of therapeutic mechanisms of these devices can be ascertained through comparisons of animal model research findings with clinical pathological specimens. This review provides an overview of the emerging role, results of preclinical studies and development, and evaluation of animal models for percutaneous cardiovascular intervention technologies for patients with symptomatic cardiovascular disease. PMID:19142381

  15. CLINICAL CASE HISTORY OF EPTIFIBATIDE USE DURING CORONARY INTERVENTION IN PATIENT WITH CORONARY FAILURE

    Directory of Open Access Journals (Sweden)

    K. A. Kireev

    2015-01-01

    Full Text Available Clinical case history of endovascular intervention in infarct related coronary artery with 4 sirolimus-eluting stents implantation and their further thrombosis during early postoperative period is described. Percutaneous coronary intervention was successful after the balanced medication with 2 antiplatelet drugs (acetylsalicylic acid and clopidogrel and heparin. There were not any reasons for additional prescription of antiplatelet medicine. It seems that one of the main reasons of the stent thrombosis was the extended area of 4 sirolimus-eluting stents implantation into the affected vessel. After the analysis of our clinical case history we propose that for stent thrombosis prevention in multistent (≥4 drugeluting stents interventions it is necessary to apply additional antiplatelet drug – glycoprotein IIb/IIIa inhibitor eptifibatide.

  16. From computer-assisted intervention research to clinical impact: The need for a holistic approach.

    Science.gov (United States)

    Ourselin, Sébastien; Emberton, Mark; Vercauteren, Tom

    2016-10-01

    The early days of the field of medical image computing (MIC) and computer-assisted intervention (CAI), when publishing a strong self-contained methodological algorithm was enough to produce impact, are over. As a community, we now have substantial responsibility to translate our scientific progresses into improved patient care. In the field of computer-assisted interventions, the emphasis is also shifting from the mere use of well-known established imaging modalities and position trackers to the design and combination of innovative sensing, elaborate computational models and fine-grained clinical workflow analysis to create devices with unprecedented capabilities. The barriers to translating such devices in the complex and understandably heavily regulated surgical and interventional environment can seem daunting. Whether we leave the translation task mostly to our industrial partners or welcome, as researchers, an important share of it is up to us. We argue that embracing the complexity of surgical and interventional sciences is mandatory to the evolution of the field. Being able to do so requires large-scale infrastructure and a critical mass of expertise that very few research centres have. In this paper, we emphasise the need for a holistic approach to computer-assisted interventions where clinical, scientific, engineering and regulatory expertise are combined as a means of moving towards clinical impact. To ensure that the breadth of infrastructure and expertise required for translational computer-assisted intervention research does not lead to a situation where the field advances only thanks to a handful of exceptionally large research centres, we also advocate that solutions need to be designed to lower the barriers to entry. Inspired by fields such as particle physics and astronomy, we claim that centralised very large innovation centres with state of the art technology and health technology assessment capabilities backed by core support staff and open

  17. European clinical guidelines for Tourette Syndrome and other tic disorders. Part III : behavioural and psychosocial interventions

    NARCIS (Netherlands)

    Verdellen, Cara; van de Griendt, Jolande; Hartmann, Andreas; Murphy, Tara

    2011-01-01

    This clinical guideline provides recommendations for the behavioural and psychosocial interventions (BPI) of children and adolescents with tic disorders prepared by a working group of the European Society for the Study of Tourette Syndrome (ESSTS). A systematic literature search was conducted to obt

  18. The impact of IPTi and IPTc interventions on malaria clinical burden - in silico perspectives.

    Directory of Open Access Journals (Sweden)

    Ricardo Aguas

    Full Text Available BACKGROUND: Clinical management of malaria is a major health issue in sub-Saharan Africa. New strategies based on intermittent preventive treatment (IPT can tackle disease burden by simultaneously reducing frequency of infections and life-threatening illness in infants (IPTi and children (IPTc, while allowing for immunity to build up. However, concerns as to whether immunity develops efficiently in treated individuals, and whether there is a rebound effect after treatment is halted, have made it imperative to define the effects that IPTi and IPTc exert on the clinical malaria scenario. METHODS AND FINDINGS: Here, we simulate several schemes of intervention under different transmission settings, while varying immunity build up assumptions. Our model predicts that infection risk and effectiveness of acquisition of clinical immunity under prophylactic effect are associated to intervention impact during treatment and follow-up periods. These effects vary across regions of different endemicity and are highly correlated with the interplay between the timing of interventions in age and the age dependent risk of acquiring an infection. However, even when significant rebound effects are predicted to occur, the overall intervention impact is positive. CONCLUSIONS: IPTi is predicted to have minimal impact on the acquisition of clinical immunity, since it does not interfere with the occurrence of mild infections, thus failing to reduce the underlying force of infection. On the contrary, IPTc has a significant potential to reduce transmission, specifically in areas where it is already low to moderate.

  19. Children and Youth with Fetal Alcohol Spectrum Disorders: Summary of Intervention Recommendations after Clinical Diagnosis

    Science.gov (United States)

    Jirikowic, Tracy; Gelo, Julie; Astley, Susan

    2010-01-01

    Children with fetal alcohol spectrum disorders (FASDs) present with a wide range of developmental disabilities; however, clinical standards of care after a diagnosis are not well established. This retrospective review summarizes the types of intervention recommendations generated by an interdisciplinary FASD diagnostic team for 120 children ages…

  20. The matching quality of experimental and control interventions in blinded pharmacological randomised clinical trials

    DEFF Research Database (Denmark)

    Bello, Segun; Wei, Maoling; Hilden, Jørgen;

    2016-01-01

    Background: Blinding is a pivotal method to avoid bias in randomised clinical trials. In blinded drug trials, experimental and control interventions are often designed to be matched, i.e. to appear indistinguishable. It is unknown how often matching procedures are inadequate, so we decided...

  1. A Randomized Clinical Trial of Alternative Stress Management Interventions in Persons with HIV Infection

    Science.gov (United States)

    McCain, Nancy L.; Gray, D. Patricia; Elswick, R. K., Jr.; Robins, Jolynne W.; Tuck, Inez; Walter, Jeanne M.; Rausch, Sarah M.; Ketchum, Jessica McKinney

    2008-01-01

    Research in psychoneuroimmunology suggests that immunosuppression associated with perceived stress may contribute to disease progression in persons with HIV infection. While stress management interventions may enhance immune function, few alternative approaches have yet been tested. This randomized clinical trial was conducted to test effects of…

  2. Patient preference regarding assessment of clinical follow-up after percutaneous coronary intervention: the PAPAYA study

    NARCIS (Netherlands)

    Kok, M.; Birgelen, von C.; Lam, M.K.; Lowik, M.; Houwelingen, van G.; Stoel, M.; Louwerenburg, H.; Man, de F.H.; Hartmann, M.; Doggen, C.J.; Til, van J.A.; IJzerman, M.J.

    2015-01-01

    Aims: To keep patients in long-term clinical follow-up programmes after percutaneous coronary intervention (PCI), knowledge of the patient-preferred mode for follow-up assessment is crucial. We systematically assessed patient preference, and explored potential relationships with age and gender.Metho

  3. Patient preference regarding assessment of clinical follow-up after percutaneous coronary intervention: the PAPAYA study

    NARCIS (Netherlands)

    Kok, Marlies M.; Birgelen, von Clemens; Lam, Ming Kai; Löwik, Marije M.; Houwelingen, van K. Gert; Stoel, Martin G.; Louwerenburg, J. (Hans) W.; Man, de Frits H.A.F.; Hartmann, Marc; Doggen, Carine J.M.; Til, van Janine A.; IJzerman, Maarten J.

    2016-01-01

    Aims: To keep patients in long-term clinical follow-up programmes after percutaneous coronary intervention (PCI), knowledge of the patient-preferred mode for follow-up assessment is crucial. We systematically assessed patient preference, and explored potential relationships with age and gender.Metho

  4. Positive Family Intervention for Severe Challenging Behavior I: A Multisite Randomized Clinical Trial

    Science.gov (United States)

    Durand, V. Mark; Hieneman, Meme; Clarke, Shelley; Wang, Mo; Rinaldi, Melissa L.

    2013-01-01

    The present study was a multisite randomized clinical trial assessing the effects of adding a cognitive-behavioral intervention to positive behavior support (PBS). Fifty-four families who met the criteria of (a) having a child with a developmental disability, (b) whose child displayed serious challenging behavior (e.g., aggression, self-injury,…

  5. Clinical prediction of the need for interventions for the control of myopia.

    Science.gov (United States)

    McMonnies, Charles W

    2015-11-01

    The prevalence of myopia is increasing in Western populations but in East Asian countries, it is increasing to epidemic levels, where there are also markedly increased rates of progression to pathological myopia. Measures to more effectively control the development and progression of myopia are urgently needed. Notwithstanding a large volume of research, especially regarding the different mechanisms for the development of myopia and the efficacy of particular methods of intervention, there is still a great need and scope for improvements in clinical efforts to prevent and/or control myopic progression. Too often clinical efforts may involve only one method of intervention; however, the heterogenous nature of myopia suggests that clinical intervention may be more successful when interventions are employed in combination. The decision to prescribe interventions for the control of myopia in children, especially prior to onset, may be better framed by a comprehensive estimation of the degree of risk for the development and/or progression of myopia. For example, rather than ascribing equal weight to any degree of parental myopia, more accurate estimates may be obtained, if risk is judged to increase with the degree of parental myopia and the extent of any associated degenerative pathology. Risk estimates may be limited to broad mild, moderate and severe classifications due to lack of accurate weighting of risk factors. Nevertheless, comprehensive assessment of risk factors appears likely to better inform a prognosis and discussions with parents. Consideration of numerous environmental influences, for example, such as continuity and intensity of near work and time spent outdoors, may contribute to better risk estimation. Family-based practice appears to be ideally suited for risk estimation and the clinical application of approaches to control myopia. A proactive approach to estimating risk of developing myopia prior to its onset may be beneficial. Earlier implementation

  6. What's the Point?: A Review of Reward Systems Implemented in Gamification Interventions.

    Science.gov (United States)

    Lewis, Zakkoyya H; Swartz, Maria C; Lyons, Elizabeth J

    2016-04-01

    Rewards are commonly used in interventions to change behavior, but they can inhibit development of intrinsic motivation, which is associated with long-term behavior maintenance. Gamification is a novel intervention strategy that may target intrinsic motivation through fun and enjoyment. Before the effects of gamified interventions on motivation can be determined, there must be an understanding of how gamified interventions operationalize rewards, such as point systems. The purpose of this review is to determine the prevalence of different reward types, specifically point systems, within gamified interventions. Electronic databases were searched for relevant articles. Data sources included Medline OVID, Medline PubMed, Web of Science, CINAHL, Cochrane Central, and PsycINFO. Out of the 21 articles retrieved, 18 studies described a reward system and were included in this review. Gamified interventions were designed to target a myriad of clinical outcomes across diverse populations. Rewards included points (n = 14), achievements/badges/medals (n = 7), tangible rewards (n = 7), currency (n = 4), other unspecified rewards (n = 3), likes (n = 2), animated feedback (n = 1), and kudos (n = 1). Rewards, and points in particular, appear to be a foundational component of gamified interventions. Despite their prevalence, authors seldom described the use of noncontingent rewards or how the rewards interacted with other game features. The reward systems relying on tangible rewards and currency may have been limited by inhibited intrinsic motivation. As gamification proliferates, future research should explicitly describe how rewards were operationalized in the intervention and evaluate the effects of gamified rewards on motivation across populations and research outcomes. PMID:26812253

  7. Interventional treatment of biliary stent restenosis: recent progress in clinical management

    International Nuclear Information System (INIS)

    Malignant obstructive jaundice is biliary obstruction disorders which are caused by various malignant tumors. Usually the disease is at its advanced stage and is inoperable when the diagnosis is confirmed. At present, percutaneous transhepatic biliary drainage (PTCD) and endoscopic or interventional implantation of plastic or self-expanding metal stent (SEMS) are the main managements in clinical practice. Due to the improved survival time, biliary stent restenosis has become a quite common clinical problem. Photodynamic therapy (PDT) and biliary tract radiofrequency ablation (RFA) have provided new therapeutic means for clinical use. Especially, with its development in technology and equipment, RFA has played more and more important role in treating biliary stent restenosis. (authors)

  8. Bioeconomic modeling of intervention against clinical mastitis caused by contagious pathogens

    DEFF Research Database (Denmark)

    Hisham Beshara Halasa, Tariq

    2012-01-01

    , and Streptococcus dysgalactiae, and an environmental spread of Escherichia coli IMI in a 100-cow dairy herd during 1 quota year. The costs of clinical IMI, subclinical IMI, and intervention were calculated into the total annual net costs of IMI during lactation per scenario and compared with a default scenario......The objective of this study was to assess the epidemiologic and economic consequences of intervention against contagious clinical mastitis during lactation. A bioeconomic model of intramammary infections (IMI) was used to simulate contagious spread of Staphylococcus aureus, Streptococcus uberis...... transmission, number of IMI cases, and persistent subclinical IMI cases. Nonetheless, the high associated costs of culling bacteriologically unrecovered clinical IMI cows made the other scenarios with a long and intensive antibiotic treatment, but without culling, the most cost effective. The model...

  9. A decision support system for AIDS intervention and prevention.

    Science.gov (United States)

    Xu, L D

    1994-08-01

    In recent years, the importance of information systems has been identified as a vital issue to continuing success in AIDS intervention and prevention (AIP). The advances in information technology have resulted in integrative information systems including decision support systems (DSS). The concept of DSS for AIP was created at the intersection of two trends. The first trend was a growing belief that AIP information systems are successful in automating operations in AIP programs. The second was a continuing improvement in modeling and software development in the AIP area. This paper presents an integrated DSS for AIP. The system is integrated with a database and achieves its efficiency by incorporating various algorithms and models to support AIP decision processes. The application examples include screening AIDS-risky behaviors, evaluating educational interventions, and scheduling AIP sessions. The implementation results present evidence of the usefulness of the system in AIP.

  10. Clinical significance of serum alanine aminotransferase and lifestyle intervention in children with nonalcoholic fatty liver disease

    Science.gov (United States)

    Kwon, Kyoung Ah; Chun, Peter

    2016-01-01

    Purpose This study aimed to investigate the clinical significance of serum alanine aminotransferase (ALT) levels in children with nonalcoholic fatty liver disease (NAFLD) and the effect of lifestyle intervention on NAFLD. Methods The clinical data of 86 children diagnosed with NAFLD were reviewed retrospectively. Forty-six patients belonged to the elevated ALT group and 40 to the normal ALT group. The clinical parameters of patients with NAFLD were also compared based on the status of ALT levels after lifestyle intervention. Results Patients with elevated ALT had significantly higher body mass index (BMI) scores than those with normal ALT (P<0.05). Of all the patients with elevated ALT, 89% exhibited moderate or severe degree of fatty change in the liver on ultrasonographic examination, whereas most patients with normal ALT exhibited mild or moderate degree changes. Liver biopsy was performed in 15 children with elevated ALT and all showed mild histological changes. Of all patients with elevated ALT, 49% achieved normal ALT levels after lifestyle intervention. Those with more severe histological changes tended to have continuously increasing ALT levels. There was no correlation between the normalization of posttreatment ALT level and BMI, as well as ultrasonographic findings at diagnosis. Conclusion ALT elevation in NAFLD is highly associated with higher BMI scores and more severe degree of fatty changes on ultrasonographic examination. Lifestyle intervention can significantly improve ALT in children with NAFLD. The degree of histologic changes appears to be a predictor of the treatment response to NAFLD.

  11. Measures of clinical malaria in field trials of interventions against Plasmodium falciparum

    Directory of Open Access Journals (Sweden)

    Smith Thomas A

    2007-05-01

    Full Text Available Abstract Background Standard methods for defining clinical malaria in intervention trials in endemic areas do not guarantee that efficacy estimates will be unbiased, and do not indicate whether the intervention has its effect by modifying the force of infection, the parasite density, or the risk of pathology at given parasite density. Methods Three different sets, each of 500 Phase IIb or III malaria vaccine trials were simulated corresponding to each of a pre-erythrocytic, blood stage, and anti-disease vaccine, each in a population with 80% prevalence of patent malaria infection. Simulations considered only the primary effects of vaccination in a homogeneous trial population. The relationships between morbidity and parasite density and the performance of different case definitions for clinical malaria were analysed using conventional likelihood ratio tests to compare incidence of episodes defined using parasite density cut-offs. Bayesian latent class models were used to compare the overall frequencies of clinical malaria episodes in analyses that did not use diagnostic cut-offs. Results The different simulated interventions led to different relationships between clinical symptoms and parasite densities. Consequently, the operating characteristics of parasitaemia cut-offs in general differ between vaccine and placebo arms of the simulated trials, leading to different patterns of bias in efficacy estimates depending on the type of intervention effect. Efficacy was underestimated when low parasitaemia cut-offs were used but the efficacy of an asexual blood stage vaccine was overestimated when a high parasitaemia cut-off was used. The power of a trial may be maximal using case definitions that are associated with substantial bias in efficacy. Conclusion Secondary analyses of the data of malaria intervention trials should consider the relationship between clinical symptoms and parasite density, and attempt to estimate overall numbers of clinical

  12. Clinical Decision Support Tools for Selecting Interventions for Patients with Disabling Musculoskeletal Disorders: A Scoping Review.

    Science.gov (United States)

    Gross, Douglas P; Armijo-Olivo, Susan; Shaw, William S; Williams-Whitt, Kelly; Shaw, Nicola T; Hartvigsen, Jan; Qin, Ziling; Ha, Christine; Woodhouse, Linda J; Steenstra, Ivan A

    2016-09-01

    Purpose We aimed to identify and inventory clinical decision support (CDS) tools for helping front-line staff select interventions for patients with musculoskeletal (MSK) disorders. Methods We used Arksey and O'Malley's scoping review framework which progresses through five stages: (1) identifying the research question; (2) identifying relevant studies; (3) selecting studies for analysis; (4) charting the data; and (5) collating, summarizing and reporting results. We considered computer-based, and other available tools, such as algorithms, care pathways, rules and models. Since this research crosses multiple disciplines, we searched health care, computing science and business databases. Results Our search resulted in 4605 manuscripts. Titles and abstracts were screened for relevance. The reliability of the screening process was high with an average percentage of agreement of 92.3 %. Of the located articles, 123 were considered relevant. Within this literature, there were 43 CDS tools located. These were classified into 3 main areas: computer-based tools/questionnaires (n = 8, 19 %), treatment algorithms/models (n = 14, 33 %), and clinical prediction rules/classification systems (n = 21, 49 %). Each of these areas and the associated evidence are described. The state of evidentiary support for CDS tools is still preliminary and lacks external validation, head-to-head comparisons, or evidence of generalizability across different populations and settings. Conclusions CDS tools, especially those employing rapidly advancing computer technologies, are under development and of potential interest to health care providers, case management organizations and funders of care. Based on the results of this scoping review, we conclude that these tools, models and systems should be subjected to further validation before they can be recommended for large-scale implementation for managing patients with MSK disorders. PMID:26667939

  13. Clinical correlates of weight loss and attrition during a 10-week dietary intervention study

    DEFF Research Database (Denmark)

    Handjieva-Darlenska, Teodora; Holst, Claus; Grau, Katrine;

    2012-01-01

    Objective: The aim of this study was to identify the pre-treatment subject characteristics and weight loss changes as determinants of weight loss and attrition during a 10-week dietary intervention study. Methods: A total of 771 obese subjects (BMI 35.6 kg/m(2)) of both genders were included from 8...... clinical centres in 7 European countries, who underwent a 10-week dietary intervention study comparing two hypo-energetic (-600 kcal/day) diets varying in fat content. Results: The multiple regression model showed that weight loss at week 10 was predicted by: 6.55 + 1.27 × early weight loss (kg) at week 1...

  14. Mega clinical trials which have shaped the RAS intervention clinical practice.

    Science.gov (United States)

    Düsing, Rainer

    2016-06-01

    Following extensive clinical research, drugs affecting the renin-angiotensin system have been used for the treatment of patients with congestive heart failure, myocardial infarction, hypertension, diabetic nephropathy, chronic renal failure and for reducing the risk of developing major cardiovascular (CV) events. This review examines all mega trials (those involving >1000 patients) and smaller pivotal trials involving angiotensin-converting enzyme inhibitors (ACE-Is; 25 mega trials) and angiotensin receptor blockers (ARBs; 27 mega trials) to provide perspective on the huge database of evidence that has accumulated on the use of these drugs. Our review demonstrates that ACE-Is and ARBs are generally as effective as conventional therapies in the treatment of hypertension, but offer additional cardioprotective benefits in patients with heart failure, and in those who have experienced myocardial infarction. Also, both ACE-Is and ARBs are capable of renal protection in addition to their blood-pressure-lowering effects. Although ACE-Is and ARBs provide major benefits to CV patients, doubts remain over the concept of blood-pressure-independent CV protection offered by both classes of drugs. ACE-Is and ARBs appear to be equally effective with respect to morbidity and mortality endpoints, but ARBs are better tolerated. Considering the available evidence, the combined use of an ACE-I and ARB should be avoided and full doses of either ACE-I or ARB should be aimed for as evidence suggests they provide a greater prognostic benefit. PMID:27271312

  15. Advanced Knowledge Work and Stress-related Symptoms : Epidemiology and Clinical Intervention Studies

    OpenAIRE

    Wiholm, Clairy

    2006-01-01

    Well educated knowledge workers are a growing group of the work force. Little research has been conducted on this group regarding possible work-related health symptoms, as well as interventions in order to reduce work-related stress. This thesis describes the current work-related symptoms and potential risk and salutogenic, i.e. protective factors, associated with these symptoms among software and system designers in a high tech company in Sweden. A stress management intervention program was...

  16. Investigating combination HIV prevention: isolated interventions or complex system

    Directory of Open Access Journals (Sweden)

    Graham Brown

    2015-12-01

    Full Text Available Introduction: Treatment as prevention has mobilized new opportunities in preventing HIV transmission and has led to bold new UNAIDS targets in testing, treatment coverage and transmission reduction. These will require not only an increase in investment but also a deeper understanding of the dynamics of combining behavioural, biomedical and structural HIV prevention interventions. High-income countries are making substantial investments in combination HIV prevention, but is this investment leading to a deeper understanding of how to combine interventions? The combining of interventions involves complexity, with many strategies interacting with non-linear and multiplying rather than additive effects. Discussion: Drawing on a recent scoping study of the published research evidence in HIV prevention in high-income countries, this paper argues that there is a gap between the evidence currently available and the evidence needed to guide the achieving of these bold targets. The emphasis of HIV prevention intervention research continues to look at one intervention at a time in isolation from its interactions with other interventions, the community and the socio-political context of their implementation. To understand and evaluate the role of a combination of interventions, we need to understand not only what works, but in what circumstances, what role the parts need to play in their relationship with each other, when the combination needs to adapt and identify emergent effects of any resulting synergies. There is little development of evidence-based indicators on how interventions in combination should achieve that strategic advantage and synergy. This commentary discusses the implications of this ongoing situation for future research and the required investment in partnership. We suggest that systems science approaches, which are being increasingly applied in other areas of public health, could provide an expanded vocabulary and analytic tools for

  17. The Spinal Cord Injury-Interventions Classification System

    NARCIS (Netherlands)

    van Langeveld, A.H.B.

    2010-01-01

    Title: The Spinal Cord Injury-Interventions Classification System: development and evaluation of a documentation tool to record therapy to improve mobility and self-care in people with spinal cord injury. Background: Many rehabilitation researchers have emphasized the need to examine the actual cont

  18. Designing a Clinical Framework to Guide Gross Motor Intervention Decisions for Infants and Young Children with Hypotonia

    Science.gov (United States)

    Darrah, Johanna; O'Donnell, Maureen; Lam, Joyce; Story, Maureen; Wickenheiser, Diane; Xu, Kaishou; Jin, Xiaokun

    2013-01-01

    Clinical practice frameworks are a valuable component of clinical education, promoting informed clinical decision making based on the best available evidence and/or clinical experience. They encourage standardized intervention approaches and evaluation of practice. Based on an international project to support the development of an enhanced service…

  19. Expanding the scope and relevance of health interventions: Moving beyond clinical trials and behavior change models

    Directory of Open Access Journals (Sweden)

    Khary K. Rigg

    2014-07-01

    Full Text Available An overemphasis on clinical trials and behavior change models has narrowed the knowledge base that can be used to design interventions. The overarching point is that the process of overanalyzing variables is impeding the process of gaining insight into the everyday experiences that shape how people define health and seek treatment. This claim is especially important to health decision-making and behavior change because subtle interpretations often influence the decisions that people make. This manuscript provides a critique of traditional approaches to developing health interventions, and theoretically justifies what and why changes are warranted. The limited scope of these models is also discussed, and an argument is made to adopt a strategy that includes the perceptions of people as necessary for understanding health and health-related decision-making. Three practical strategies are suggested to be used with the more standard approaches to assessing the effectiveness and relevance of health interventions.

  20. Balanced intervention for adolescents and adults with language impairment: a clinical framework.

    Science.gov (United States)

    Fallon, Karen A; Katz, Lauren A; Carlberg, Rachel

    2015-02-01

    Providing effective intervention services for adolescents and adults who struggle with spoken and written language presents a variety of unique challenges. This article discusses the 5S Framework (skills, strategies, school, student buy-in, and stakeholders) for designing and implementing balanced spoken and written language interventions for adolescents and adults. An in-depth case illustration highlights the usefulness of the framework for targeting the language and literacy skills of adolescents and young adults. By describing and illustrating the five key components of the intervention framework, the article provides a useful clinical tool to help guide clinicians and educators who serve the needs of adolescents and adults who struggle with spoken and written language. PMID:25633140

  1. 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

  2. Clinical trials in Huntington's disease: Interventions in early clinical development and newer methodological approaches.

    Science.gov (United States)

    Sampaio, Cristina; Borowsky, Beth; Reilmann, Ralf

    2014-09-15

    Since the identification of the Huntington's disease (HD) gene, knowledge has accumulated about mechanisms directly or indirectly affected by the mutated Huntingtin protein. Transgenic and knock-in animal models of HD facilitate the preclinical evaluation of these targets. Several treatment approaches with varying, but growing, preclinical evidence have been translated into clinical trials. We review major landmarks in clinical development and report on the main clinical trials that are ongoing or have been recently completed. We also review clinical trial settings and designs that influence drug-development decisions, particularly given that HD is an orphan disease. In addition, we provide a critical analysis of the evolution of the methodology of HD clinical trials to identify trends toward new processes and endpoints. Biomarker studies, such as TRACK-HD and PREDICT-HD, have generated evidence for the potential usefulness of novel outcome measures for HD clinical trials, such as volumetric imaging, quantitative motor (Q-Motor) measures, and novel cognitive endpoints. All of these endpoints are currently applied in ongoing clinical trials, which will provide insight into their reliability, sensitivity, and validity, and their use may expedite proof-of-concept studies. We also outline the specific opportunities that could provide a framework for a successful avenue toward identifying and efficiently testing and translating novel mechanisms of action in the HD field.

  3. Clinical trials in Huntington's disease: Interventions in early clinical development and newer methodological approaches.

    Science.gov (United States)

    Sampaio, Cristina; Borowsky, Beth; Reilmann, Ralf

    2014-09-15

    Since the identification of the Huntington's disease (HD) gene, knowledge has accumulated about mechanisms directly or indirectly affected by the mutated Huntingtin protein. Transgenic and knock-in animal models of HD facilitate the preclinical evaluation of these targets. Several treatment approaches with varying, but growing, preclinical evidence have been translated into clinical trials. We review major landmarks in clinical development and report on the main clinical trials that are ongoing or have been recently completed. We also review clinical trial settings and designs that influence drug-development decisions, particularly given that HD is an orphan disease. In addition, we provide a critical analysis of the evolution of the methodology of HD clinical trials to identify trends toward new processes and endpoints. Biomarker studies, such as TRACK-HD and PREDICT-HD, have generated evidence for the potential usefulness of novel outcome measures for HD clinical trials, such as volumetric imaging, quantitative motor (Q-Motor) measures, and novel cognitive endpoints. All of these endpoints are currently applied in ongoing clinical trials, which will provide insight into their reliability, sensitivity, and validity, and their use may expedite proof-of-concept studies. We also outline the specific opportunities that could provide a framework for a successful avenue toward identifying and efficiently testing and translating novel mechanisms of action in the HD field. PMID:25216371

  4. Anesthesia Practice and Clinical Trends in Interventional Radiology: A European Survey

    International Nuclear Information System (INIS)

    Purpose: To determine current European practice in interventional radiology regarding nursing care, anesthesia, and clinical care trends.Methods: A survey was sent to 977 European interventional radiologists to assess the use of sedoanalgesia, nursing care, monitoring equipment, pre- and postprocedural care, and clinical trends in interventional radiology. Patterns of sedoanalgesia were recorded for both vascular and visceral interventional procedures. Responders rated their preferred level of sedoanalgesia for each procedure as follows: (a) awake/alert, (b) drowsy/arousable, (c) asleep/arousable, (d) deep sedation, and (e) general anesthesia. Sedoanalgesic drugs and patient care trends were also recorded. A comparison was performed with data derived from a similar survey of interventional practice in the United States.Results: Two hundred and forty-three of 977 radiologists responded (25%). The total number of procedures analyzed was 210,194. The majority (56%) of diagnostic and therapeutic vascular procedures were performed at the awake/alert level of sedation, 32% were performed at the drowsy/arousable level, and 12% at deeper levels of sedation. The majority of visceral interventional procedures were performed at the drowsy/arousable level of sedation (41%), 29% were performed at deeper levels of sedation, and 30% at the awake/alert level. In general, more sedoanalgesia is used in the United States. Eighty-three percent of respondents reported the use of a full-time radiology nurse, 67% used routine blood pressure/pulse oximetry monitoring, and 46% reported the presence of a dedicated recovery area. Forty-nine percent reported daily patient rounds, 30% had inpatient hospital beds, and 51% had day case beds.Conclusion: This survey shows clear differences in the use of sedation for vascular and visceral interventional procedures. Many, often complex, procedures are performed at the awake/alert level of sedation in Europe, whereas deeper levels of sedation are

  5. Impact of a multifaceted intervention to improve the clinical management of osteoporosis. The ESOSVAL-F study

    Directory of Open Access Journals (Sweden)

    Pascual de la Torre Manuel

    2010-10-01

    Full Text Available Abstract Background A study to evaluate the impact of a combined intervention (in-class and on-line training courses, a practicum and economic incentives to improve anti-osteoporosis treatment and to improve recordkeeping for specific information about osteoporosis. Methods/design A before/after study with a non-equivalent control group to evaluate the impact of the interventions associated with participation in the ESOSVAL-R cohort study (intervention group compared to a group receiving no intervention (control group. The units of analysis are medical practices identified by a Healthcare Position Code (HPC referring to a specific medical position in primary care general medicine in a Healthcare Department of the Region of Valencia, Spain. The subjects of the study are the 400 participating "practices" (population assigned to health care professionals, doctors and/or nurses selected by the Healthcare Departments of the Valencia Healthcare Agency for participation as associate researchers in the ESOSVAL-R study (intervention group, compared to 400 participating "practices" assigned to primary care professionals NOT selected for participation as associate researchers in the ESOSVAL-R study, who are selected on the basis of their working in the same Healthcare Centers as the practices receiving the interventions (control group. The study's primary endpoint is the appropriateness of treatment according by the Spanish National Health System guide (2010 and the National Osteoporosis Foundation (NOF, 2008 and International Osteoporosis Foundation guidance (IOF, 2008. The study will also evaluate a series of secondary and tertiary endpoints. The former are the suitability of treatment and evaluation of the risk of fracture; and the latter are the volume of information registered in the electronic clinical records, and the evaluation of risks and the suitability of treatment.

  6. Developing an Interactive Intervention Planner - A Systems Engineering Perspective

    Directory of Open Access Journals (Sweden)

    Thomas Fabry

    2013-09-01

    Full Text Available Intervention planning is crucial for maintenance operations in particle accelerator environments with ionizing radiation, during which the radiation dose received by maintenance workers should be reduced to a minimum. In this context, we discuss the development of a new software tool and the entailed methodology, including the visualization aspects. The software tool integrates interactive exploration of a scene depicting an accelerator facility augmented with residual radiation level simulations, with the visualization of intervention data such as the followed trajectory and maintenance tasks. Its conception allows for future inclusion of measurements performed by mobile robotic devices. In this work, we explore the systems engineering life cycle of the development process of an interactive intervention planner, which includes the needs analysis, specification explicitation, conceptual mathematical modelling, iterative implementation, design and prototype testing and usability testing.

  7. Designing a Computer Vision System for Underwater Robotic Interventions

    OpenAIRE

    Oleari, Fabio

    2016-01-01

    This thesis deals with the challenging problem of designing systems able to perceive objects in underwater environments. In the last few decades research activities in robotics have advanced the state of art regarding intervention capabilities of autonomous systems. State of art in fields such as localization and navigation, real time perception and cognition, safe action and manipulation capabilities, applied to ground environments (both indoor and outdoor) has now reached such a readiness l...

  8. Classical interventions in quantum systems; 1, The measuring process

    CERN Document Server

    Peres, A

    2000-01-01

    The measuring process is an external intervention in the dynamics of a quantum system. It involves a unitary interaction of that system with a measuring apparatus, a further interaction of both with an unknown environment causing decoherence, and then the deletion of a subsystem. No ancilla is needed. The final result is represented by a completely positive map of the quantum state $\\rho$ (possibly with a change of the dimensions of $\\rho$). A continuous limit of this process leads to the Lindblad equation.

  9. OARSI Clinical Trials Recommendations: Design and conduct of clinical trials of rehabilitation interventions for osteoarthritis.

    Science.gov (United States)

    Fitzgerald, G K; Hinman, R S; Zeni, J; Risberg, M A; Snyder-Mackler, L; Bennell, K L

    2015-05-01

    A Task Force of the Osteoarthritis Research Society International (OARSI) has previously published a set of guidelines for the conduct of clinical trials in osteoarthritis (OA) of the hip and knee. Limited material available on clinical trials of rehabilitation in people with OA has prompted OARSI to establish a separate Task Force to elaborate guidelines encompassing special issues relating to rehabilitation of OA. The Task Force identified three main categories of rehabilitation clinical trials. The categories included non-operative rehabilitation trials, post-operative rehabilitation trials, and trials examining the effectiveness of devices (e.g., assistive devices, bracing, physical agents, electrical stimulation, etc.) that are used in rehabilitation of people with OA. In addition, the Task Force identified two main categories of outcomes in rehabilitation clinical trials, which include outcomes related to symptoms and function, and outcomes related to disease modification. The guidelines for rehabilitation clinical trials provided in this report encompass these main categories. The report provides guidelines for conducting and reporting on randomized clinical trials. The topics include considerations for entering patients into trials, issues related to conducting trials, considerations for selecting outcome measures, and recommendations for statistical analyses and reporting of results. The focus of the report is on rehabilitation trials for hip, knee and hand OA, however, we believe the content is broad enough that it could be applied to rehabilitation trials for other regions as well.

  10. [Management of acute and subacute clinical situations by interventional radiology: non-vascular interventions and treatment for hemoptysis].

    Science.gov (United States)

    Nemes, Balázs; Doros, Attila

    2015-04-26

    Interventional radiology provides fast, straightforward and tolerable solutions for many medical problems including acute and subacute situations. Aspiration and drainage of fluid collections, biliary and endourologic interventions and gastrointestinal interventions are parts of non-vascular interventions. In addition, the authors discuss in detail interventional radiological treatment options in patients with hemoptysis. In acute cases interventions must be performed within 12-24 hours. For background, an everyday 24 hours service should be provided with well-trained personnel, high quality equipment and devices, and a reasonable financial reimbursement should be included, too. Multidisciplinary teamwork, consultations, consensus in indications and structured education should make these centers function most effectively. PMID:26047152

  11. [Developing early intervention and follow-up system for premature infants of brain injury ].

    Science.gov (United States)

    Luo, Rong; De-Zhi, Mu

    2013-03-01

    As the increasing trend of survival rate for premature birth, especially in early preterm infants, it calls more and more attention to neurologic sequelae of premature birth. Besides cerebral palsy, there are high incidences of neuropsychological disorders in premature infants, such as learning and social communication problems, which sometimes remain a challenge for the quality of life even in their adulthood. In order to solve these difficult situation and problems, more and more medical research and clinical efforts have being focused on the mechanism of brain injury, neurological sequelae of premature birth, early intervention and follow-up for premature. Hereby we are discussing our works for brain injury in preterm the mechanism of neurological sequelae, assessment methods and early intervention, to provide rationale for the establishment of early intervention and follow-up system for premature infants with brain injury. PMID:23745269

  12. Contributions to clinical Occupational Therapy in the area of early intervention in interdisciplinary team

    Directory of Open Access Journals (Sweden)

    Dani Laura Peruzzolo

    2015-07-01

    Full Text Available Introduction: Specialized care for infants considers that the sooner the intervention in risk and symptoms occurs, the greater the possibility of obtaining better results. Aims: To describe the process of early intervention provided by an extension program of graduate studies in Occupational Therapy and Hearing, Speech and Languages Science courses and also discuss the theoretical and practical paths in the care for infants and in the Occupational Therapy area. Method: Case report with convenience sample. The study was carried out through an assessment interpreted in light of psychomotor, occupational therapeutic, and speech, hearing and language contributions. The intervention was under the responsibility of an occupational therapist supported by an interdisciplinary team. It occurred once a week from August 2011 to January 2012 and from March 2012 to July 2012. Data analysis was carried out by comparing the entry assessment test and the final assessment test. Results: The boy had not developed concepts of body schema and body image that could sustain his relationship with objects, space and other persons. He presented little linguistic evolution. Considering the contributions of occupational therapy in psychomotor clinic, the boy reconstructed his family place in early intervention. The possibility of language functioning connected to the boy’s demands allowed access to symbolism. Conclusion: The proposal of early occupational therapy intervention with a single therapist supported by an interdisciplinary team was able to overcome the structural and instrumental obstacles to the boy’s development.

  13. Improving the Dictation in Attention Deficit Hyperactivity Disorder by Using Computer Based Interventions: A Clinical Trial

    OpenAIRE

    Mahdi Tehranidoost; Anahita Basirnia; Shervin Assari; Mohammad Reza Mohammadi; Mostafa Najafi; Javad Alaghband-rad

    2006-01-01

    Objective: The aim of the current study was to assess the impact of computer games and computer-assisted type instruction on dictation scores of elementary school children with attention deficit – hyperactivity disorder (ADHD). Method: In this single-blind clinical trial, 37 elementary school children with ADHD, selected by convenience sampling and divided into group I (n=17) and group II (n=20), underwent eight one-hour sessions (3 sessions per week) of intervention by computer games versus ...

  14. Cognitive Behavioral Interventions with Older Adults: Integrating Clinical and Gerontological Research

    OpenAIRE

    Satre, Derek; Knight, Bob G.; David, Steven

    2006-01-01

    Psychotherapeutic interventions utilizing cognitive–behavioral strategies have been used widely with older adults. To appropriately adapt these techniques, characteristics unique to older adults must be taken into account. These factors include aspects of the social environment, cohort effects, cognitive changes with aging, personality, and emotional development, which have been described in an emerging body of research literature from the field of gerontology. In addition, clinical studies h...

  15. Bibliometric Analysis: Mirror Therapy as an Occupational Therapy Intervention Strategy in the Clinical Setting

    OpenAIRE

    Elvis Siprián Castro Alzate; Karen Aguía Rojas; Leidy Vanessa Linares Murcia; Laura Yanquén Castro; Vanessa Reyes Villanueva

    2016-01-01

    Objective: To determine the national and international scientific evidence regarding the use of mirror therapy, as an occupational therapy intervention tool in the clinical setting, in order to acquire knowledge and implement this strategy in professional practice. Materials and methods: A descriptive study was conducted in which the research strategy was held through medical subject headings (MeSH), such as “mirror neuron”, ”occupational therapy”, “physical rehabilitation” and “motor imagery...

  16. Smoking cessation, physicians, and medical office staff. Clinical tobacco intervention in Prince Edward Island.

    OpenAIRE

    Rowan, M S; Coambs, R. B.; Jensen, P.; Balderston, M.; MacKenzie, D; Kothari, A.

    1998-01-01

    OBJECTIVE: To assess attitudes and self-reported behaviours of physicians and medical office staff in Prince Edward Island concerning clinical tobacco intervention (CTI). DESIGN: Mail survey of PEI primary care physicians and their medical office staff. Most surveys were not mailed back but picked up in person by research staff. SETTING: Primary care settings in PEI. PARTICIPANTS: All active primary care physicians in PEI identified in the Canadian Medical Association database and medical off...

  17. The Effect of Educational and Modifying Intervention on Asthma Control among Adolescents: a Randomized Clinical Trial

    OpenAIRE

    Zarei, Soheila; Valizadeh, Leila; BILAN, Nemat

    2013-01-01

    Introduction: Controlling over allergens and environmental irritants is one of the essential elements of controlling asthma. Asthma control in adolescents is a challenge. The current study was performed with the goal of investigating the effect of an educational and modifying intervention about asthma triggers on asthma control among adolescents. Methods: The current study was a randomized clinical trial. 60 adolescents of 12-18 years of age participated in this study. The p...

  18. Is diagnosis enough to guide interventions in mental health? Using case formulation in clinical practice

    Directory of Open Access Journals (Sweden)

    Macneil Craig A

    2012-09-01

    Full Text Available Abstract While diagnosis has traditionally been viewed as an essential concept in medicine, particularly when selecting treatments, we suggest that the use of diagnosis alone may be limited, particularly within mental health. The concept of clinical case formulation advocates for collaboratively working with patients to identify idiosyncratic aspects of their presentation and select interventions on this basis. Identifying individualized contributing factors, and how these could influence the person's presentation, in addition to attending to personal strengths, may allow the clinician a deeper understanding of a patient, result in a more personalized treatment approach, and potentially provide a better clinical outcome.

  19. [Clinical and preventive intervention in eating behaviour: a dialogue between psychology and nutritional sciences].

    Science.gov (United States)

    Tinoco, Rui; Paiva, Isabel

    2011-12-01

    The eating habits modification is a clinical challenge, both on therapeutic and preventive levels, which requires tools from various areas of health, such as psychology and nutrition. In the structured work in these areas, that includes the referral to specialist consultants, there is a need of a first intervention in Primary Health Care, in clinical and community levels. In this paper, we attempt to systematize useful information for intervention. We will start by reviewing some important interviewing skills, some models of motivational interviewing, and we will make a brief reflection about the client. Then we will analyse an individual case structured in two complementary levels of interpretation: a closer look in general factors and another that reflect the antecedents, consequences and the description of the behaviour problem. We will also tackle issues related to the context in which the individual moves. We will analyse some group intervention programs within a clinical and preventive perspectives. Finally, we will discuss some concepts related to therapeutic adherence.

  20. Behavioural and developmental interventions for autism spectrum disorder: a clinical systematic review.

    Directory of Open Access Journals (Sweden)

    Maria B Ospina

    Full Text Available BACKGROUND: Much controversy exists regarding the clinical efficacy of behavioural and developmental interventions for improving the core symptoms of autism spectrum disorders (ASD. We conducted a systematic review to summarize the evidence on the effectiveness of behavioural and developmental interventions for ASD. METHODS AND FINDINGS: Comprehensive searches were conducted in 22 electronic databases through May 2007. Further information was obtained through hand searching journals, searching reference lists, databases of theses and dissertations, and contacting experts in the field. Experimental and observational analytic studies were included if they were written in English and reported the efficacy of any behavioural or developmental intervention for individuals with ASD. Two independent reviewers made the final study selection, extracted data, and reached consensus on study quality. Results were summarized descriptively and, where possible, meta-analyses of the study results were conducted. One-hundred-and-one studies at predominantly high risk of bias that reported inconsistent results across various interventions were included in the review. Meta-analyses of three controlled clinical trials showed that Lovaas treatment was superior to special education on measures of adaptive behaviour, communication and interaction, comprehensive language, daily living skills, expressive language, overall intellectual functioning and socialization. High-intensity Lovaas was superior to low-intensity Lovaas on measures of intellectual functioning in two retrospective cohort studies. Pooling the results of two randomized controlled trials favoured developmental approaches based on initiative interaction compared to contingency interaction in the amount of time spent in stereotyped behaviours and distal social behaviour, but the effect sizes were not clinically significant. No statistically significant differences were found for: Lovaas versus special

  1. Falls Assessment Clinical Trial (FACT: design, interventions, recruitment strategies and participant characteristics

    Directory of Open Access Journals (Sweden)

    Lawton Beverley

    2007-07-01

    Full Text Available Abstract Background Guidelines recommend multifactorial intervention programmes to prevent falls in older adults but there are few randomised controlled trials in a real life health care setting. We describe the rationale, intervention, study design, recruitment strategies and baseline characteristics of participants in a randomised controlled trial of a multifactorial falls prevention programme in primary health care. Methods Participants are patients from 19 primary care practices in Hutt Valley, New Zealand aged 75 years and over who have fallen in the past year and live independently. Two recruitment strategies were used – waiting room screening and practice mail-out. Intervention participants receive a community based nurse assessment of falls and fracture risk factors, home hazards, referral to appropriate community interventions, and strength and balance exercise programme. Control participants receive usual care and social visits. Outcome measures include number of falls and injuries over 12 months, balance, strength, falls efficacy, activities of daily living, quality of life, and physical activity levels. Results 312 participants were recruited (69% women. Of those who had fallen, 58% of people screened in the practice waiting rooms and 40% when screened by practice letter were willing to participate. Characteristics of participants recruited using the two methods are similar (p > 0.05. Mean age of all participants was 81 years (SD 5. On average participants have 7 medical conditions, take 5.5 medications (29% on psychotropics with a median of 2 falls (interquartile range 1, 3 in the previous year. Conclusion The two recruitment strategies and the community based intervention delivery were feasible and successful, identifying a high risk group with multiple falls. Recruitment in the waiting room gave higher response rates but was less efficient than practice mail-out. Testing the effectiveness of an evidence based intervention in a

  2. Effect of Three Interventions on Contact Lens Comfort in Symptomatic Wearers: A Randomized Clinical Trial.

    Directory of Open Access Journals (Sweden)

    Maria Navascues-Cornago

    Full Text Available To investigate whether carrying out various interventions part way through the day influences comfort in symptomatic daily disposable (DD contact lens wearers.A subject-masked, randomized, controlled clinical trial was conducted in thirty symptomatic soft lens wearers who wore their habitual DD contact lenses bilaterally for 12 h on two separate days. Five hours after lens application, one of the following three interventions or a control was performed on each eye: replacing the existing lens with a new lens; removing and reapplying the same lens; performing a 'scleral swish'; and no action (control. Comfort scores were recorded using SMS text messages every hour following lens application using a 0 (causes pain to 100 (excellent comfort scale. Comfort scores before lens application, at 6 mins post-application, and at 6 mins post-intervention were also recorded.There was a significant reduction in comfort from pre-lens application to 6 mins post-application for all groups (all p0.05. After the intervention, comfort continued to decline (p<0.0001 with slightly lower mean scores for the control group compared to the new lens group (p = 0.003. Change in comfort relative to pre-intervention (5 h was similar for all groups (p = 0.81. There was no difference in comfort at 12 h between groups (p = 0.83.This work has confirmed that comfort shows a continual and significant decline over a 12-h wearing period in symptomatic DD contact lens wearers. None of the interventions investigated had any significant impact on end-of-day comfort. These data suggest discomfort in lens wearers is more heavily influenced by changes to the ocular environment rather than to the lens itself.Controlled-Trials.com ISRCTN10419752 http://www.controlled-trials.com/ISRCTN10419752.

  3. Can teaching agenda-setting skills to physicians improve clinical interaction quality? A controlled intervention

    Directory of Open Access Journals (Sweden)

    Rogers William H

    2008-01-01

    Full Text Available Abstract Background Physicians and medical educators have repeatedly acknowledged the inadequacy of communication skills training in the medical school curriculum and opportunities to improve these skills in practice. This study of a controlled intervention evaluates the effect of teaching practicing physicians the skill of "agenda-setting" on patients' experiences with care. The agenda-setting intervention aimed to engage clinicians in the practice of initiating patient encounters by eliciting the full set of concerns from the patient's perspective and using that information to prioritize and negotiate which clinical issues should most appropriately be dealt with and which (if any should be deferred to a subsequent visit. Methods Ten physicians from a large physician organization in California with baseline patient survey scores below the statewide 25th percentile participated in the agenda-setting intervention. Eleven physicians matched on baseline scores, geography, specialty, and practice size were selected as controls. Changes in survey summary scores from pre- and post-intervention surveys were compared between the two groups. Multilevel regression models that accounted for the clustering of patients within physicians and controlled for respondent characteristics were used to examine the effect of the intervention on survey scale scores. Results There was statistically significant improvement in intervention physicians' ability to "explain things in a way that was easy to understand" (p = 0.02 and marginally significant improvement in the overall quality of physician-patient interactions (p = 0.08 compared to control group physicians. Changes in patients' experiences with organizational access, care coordination, and office staff interactions did not differ by experimental group. Conclusion A simple and modest behavioral training for practicing physicians has potential to positively affect physician-patient relationship interaction quality

  4. A Concept Annotation System for Clinical Records

    CERN Document Server

    Kang, Ning; Afzal, Zubair; Singh, Bharat; Schuemie, Martijn J; van Mulligen, Erik M; Kors, Jan A

    2010-01-01

    Unstructured information comprises a valuable source of data in clinical records. For text mining in clinical records, concept extraction is the first step in finding assertions and relationships. This study presents a system developed for the annotation of medical concepts, including medical problems, tests, and treatments, mentioned in clinical records. The system combines six publicly available named entity recognition system into one framework, and uses a simple voting scheme that allows to tune precision and recall of the system to specific needs. The system provides both a web service interface and a UIMA interface which can be easily used by other systems. The system was tested in the fourth i2b2 challenge and achieved an F-score of 82.1% for the concept exact match task, a score which is among the top-ranking systems. To our knowledge, this is the first publicly available clinical record concept annotation system.

  5. Interventional radiology as clinical specialty and how this affects the radiology specialty as a whole

    International Nuclear Information System (INIS)

    Full text: Interventional Radiologists (IRs) are medical doctors who are trained in imaging but have undergone additional specialist training in highly demanding image-guided techniques. For this reason they play an increasingly important clinical role which is expanding beyond IR/angiography suite. As IR practice is fundamentally different from diagnostic imaging, the Radiology departments should be adapted to facilitate this special task. Interventional Radiologists should be able to fulfil their task as patient’s primary doctor and exert direct clinical responsibility for the patient under their care. They should be able to clinically assess and counsel patients before a procedure, inform them about the risks of the procedure and possible alternative treatment options, obtain valid consent and follow-up them after the procedure. they should also effectively communicate with referring physicians and develop strategies to deal with complex clinical situations and difficult clinical scenarios. In this context it is imperative for IRs to participate regularly in multidisciplinary clinical meetings and multidisciplinary forums to ensure optimum care. As clinicians, IR’s must be involved with the day to day management of their patients’ care to ensure optimal outcomes for patients. This may involve shared care with a broad range of specialists, however IR’s should aim to have direct access to inpatients beds where they can admit and discharge patients as necessary, with sufficient time allocated for this activity. As the number and demand of IR day cases steadily increases, IR units should organize day case facilities staffed with nursing and clerical staff which can result in major cost savings to hospitals. In this context the Head of Radiology department should convince hospital authorities to establish outpatient clinic facilities with nursing and clerical support where referred patients can be counselled and reviewed in a quiet environment. In order to

  6. Clinical Observation on Combined Tuina and Medicated Bath for Early Intervention of Neonatal Brain Injuries

    Institute of Scientific and Technical Information of China (English)

    刘振寰; 丁建英; 韩丑萍

    2010-01-01

    目的:观察推拿、药浴等中医疗法早期干预对婴儿脑损伤的临床疗效.方法:对60例中重度脑损伤婴儿进行小儿健脑推拿及中药浴式水疗,同时配合中医传统五行音乐聆听及运动疗法等治疗.分别于治疗前、治疗3个月后采用Gesell测查法进行发育商(Development Quotient,DQ)评估,并在治疗1年半后进行远期随访.结果:治疗前、治疗3个月及一年半后发育商分别为(34.98±28.94),(66.17±14.91)和(75.40±14.69),与治疗前比较,治疗3个月及一年半后发育商各指标均有显著提高(P=0.000).结论:对脑损伤婴儿进行推拿中医早期干预可促进大脑发育,修复神经损伤,促进运动、认知的发育,有效预防神经系统后遗症的发生.%Objective: To observe the clinical effect of early intervention of combined tuina with medicated bath for neonatal brain injuries.Methods: Brain-benefiting tuina manipulations,medicated bath and music plus exercise therapies were employed in 60 infants with medium or severe brain injuries.The Gesell measurement methods were adopted prior to and 3 months after treatment to evaluate the development quotient(DQ).In addition,the long-term follow-up was made after one and a half years.Result: The scores of DQ prior to treatment,3 month after treatment and 1.5 years after treatment were(34.98±28.94),(66.17±14.91)and(75.40±14.69)respectively,showing a marked improvement after 3months and 1.5 years of treatment(P=0.000).Conclusion: Early intervention using tuina manipulations could enhance the brain development,repair the nerve injury,improve the motion and cognitive ability and prevent the sequela of the nervous system.

  7. Childhood exposure to violence and lifelong health: Clinical intervention science and stress biology research join forces

    Science.gov (United States)

    Moffitt, Terrie E.

    2013-01-01

    Many young people who are mistreated by an adult, victimized by bullies, criminally assaulted, or who witness domestic violence react to this violence exposure by developing behavioral, emotional, or learning problems. What is less well known is that adverse experiences like violence exposure can lead to hidden physical alterations inside a child’s body, alterations which may have adverse effects on life-long health. We discuss why this is important for the field of developmental psychopathology and for society, and we recommend that stress-biology research and intervention science join forces to tackle the problem. We examine the evidence base in relation to stress-sensitive measures for the body (inflammatory reactions, telomere erosion, epigenetic methylation, and gene expression) and brain (mental disorders, neuroimaging, and neuropsychological testing). We also review promising interventions for families, couples, and children that have been designed to reduce the effects of childhood violence exposure. We invite intervention scientists and stress-biology researchers to collaborate in adding stress-biology measures to randomized clinical trials of interventions intended to reduce effects of violence exposure and other traumas on young people. PMID:24342859

  8. School based oral health promotional intervention: Effect on knowledge, practices and clinical oral health related parameters

    Directory of Open Access Journals (Sweden)

    Arjun Gauba

    2013-01-01

    Full Text Available Background: No organized school oral health program is existent in India. Aim: The aim of this study is to test the feasibility and efficacy of an economical school oral health promotional intervention with educational and preventive components. Settings and Design: School oral health promotional intervention carried out in one of the randomly selected school and evaluated through short duration prospective model. Materials and Methods: A total of 100 children with an age range of 10-12 years with no previous history of dental intervention were enrolled. Interventions comprised of oral health education (delivered through lecture and demonstrations by an undergraduate dental student and topical antibacterial therapy (fluoride varnish and povidone iodine. Outcomes consisted of Knowledge and practices (KAP regarding oral health, clinical oral health related parameters such as plaque index (PI, gingival index (GI and caries activity as per Modified Snyder′s test. These were reported at baseline, 3 weeks and 6 months follow-up examination by a calibrated examiner. Statistical Analysis: McNemar Bowker′s test, Student′s t-test, Pearson Chi-square tests were used. Results: Highly significant (P < 0.001 improvements in KAP scores, PI scores, GI scores and caries activity were reported at 3 weeks and 6 months follow-up examination. Conclusion: This small economical school oral health program positively influenced oral health related practices and parameters of oral health such as oral cleanliness, gingival health and caries activity.

  9. Retesting for genital Chlamydia trachomatis among visitors of a sexually transmitted infections clinic : randomized intervention trial of home- versus clinic-based recall

    NARCIS (Netherlands)

    Gotz, Hannelore M.; Wolfers, Mireille E. G.; Luijendijk, Ad; van den Broek, Ingrid V. F.

    2013-01-01

    Background: Reinfections of Chlamydia trachomatis (Ct) are common. In a two-armed intervention study at an urban STI clinic in the Netherlands, heterosexual Ct-positive visitors received an invitation for retesting after 4-5 months. Interventions were either home-based sampling by mailed test-kit, o

  10. Retesting for genital Chlamydia trachomatis among visitors of a sexually transmitted infections clinic: Randomized intervention trial of home- versus clinic-based recall

    NARCIS (Netherlands)

    H.M. Götz (Hannelore); M.E.G. Wolfers (Mireille); A. Luijendijk (Ad); I.V.F. van den Broek (Ingrid)

    2013-01-01

    textabstractBackground: Reinfections of Chlamydia trachomatis (Ct) are common. In a two-armed intervention study at an urban STI clinic in the Netherlands, heterosexual Ct-positive visitors received an invitation for retesting after 4-5 months. Interventions were either home-based sampling by mailed

  11. Clinical Productivity System - A Decision Support Model

    CERN Document Server

    Bennett, Casey C

    2012-01-01

    Purpose: This goal of this study was to evaluate the effects of a data-driven clinical productivity system that leverages Electronic Health Record (EHR) data to provide productivity decision support functionality in a real-world clinical setting. The system was implemented for a large behavioral health care provider seeing over 75,000 distinct clients a year. Design/methodology/approach: The key metric in this system is a "VPU", which simultaneously optimizes multiple aspects of clinical care. The resulting mathematical value of clinical productivity was hypothesized to tightly link the organization's performance to its expectations and, through transparency and decision support tools at the clinician level, affect significant changes in productivity, quality, and consistency relative to traditional models of clinical productivity. Findings: In only 3 months, every single variable integrated into the VPU system showed significant improvement, including a 30% rise in revenue, 10% rise in clinical percentage, a...

  12. The transjugular portosystemic stent shunt (TIPSS) as an intervention in clinical complication of portal hypertension

    International Nuclear Information System (INIS)

    Most frequent complications in patients with liver cirrhosis are due to portal hypertension. Beside ascites circumvent vessles formate with vasodilatation. Due to counterregulation a secondary hyperaldosteronism develops with release of vasocontrictive agents. If conservative and endoscopic methods fail, indication for building a portosystemic shunt is given. The TIPSS procedure is less invasive than the surgical method of Warren-Shunt, so the radiological intervention has replaced surgery. Reducing the portal pressure by the shunt, the clinical complications change for the better. Still problems are defined as hepatic encephalopathy and right ventricular heart failure. Regular follow up investigations have to be performed to detect complications in the shunt. Using regular clinical and radiological check up TIPSS is of clinical benefit with good long term results. (orig.)

  13. Smoking cessation via the internet: a randomized clinical trial of an internet intervention as adjuvant treatment in a smoking cessation intervention.

    Science.gov (United States)

    Japuntich, Sandra J; Zehner, Mark E; Smith, Stevens S; Jorenby, Douglas E; Valdez, José A; Fiore, Michael C; Baker, Timothy B; Gustafson, David H

    2006-12-01

    Internet interventions for smoking cessation are ubiquitous. Yet, to date, there are few randomized clinical trials that gauge their efficacy. This study is a randomized clinical trial (N= 284, n= 140 in the treatment group, n= 144 in the control group) of an Internet smoking cessation intervention. Smokers were randomly assigned to receive either bupropion plus counseling alone, or bupropion and counseling in addition to 12 weeks of access to the Comprehensive Health Enhancement Support System for Smoking Cessation and Relapse Prevention (CHESS SCRP; a Web site which provided information on smoking cessation as well as support). We found that access to CHESS SCRP was not significantly related to abstinence at the end of the treatment period (OR= 1.13, 95% CI 0.66-2.62) or at 6 months postquit (OR= 1.48, 95% CI 0.66-2.62). However, the number of times participants used CHESS SCRP per week was related to abstinence at both end of treatment (OR= 1.79, 95% CI 1.25-2.56) and at the 6-month follow-up (OR= 1.59, 95% CI 1.06-2.38). Participants with access to CHESS SCRP logged in an average of 33.64 times (SD=30.76) over the 90-day period of access. Rates of CHESS SCRP use did not differ by ethnicity, level of education or gender (all p>.05). In sum, results suggest that participants used CHESS SCRP frequently, CHESS SCRP use was related to success, but the effects in general did not yield intergroup effects. PMID:17491172

  14. Clinical effect and necessity of interventional treatment in diabetic foot before and after amputation

    International Nuclear Information System (INIS)

    Objective: To assess the clinical effect and necessity of interventional treatment in diabetic foot before and after amputation. Methods: Combined intravascular angioplasty with intraarterial medicine perfusing were carried out in fourteen patients with diabetic foot including 10 patients treated before amputation and 4 after amputation involving superficial femoral, deep femoral, tibial and fitular arteries. Among them seventeen vessels with irregular stenosis and obstruction were treated by intravascular angioplasty through balloon dilation. Results: The technical successful rate was 100%, no complication happened. The symptoms were relieved in all patients after treatment, including promotion of lower extremity arterial blood perfusion, reducing range of amputation and wound healing after amputation. Conclusions: Intravascular interventional treatment is safe, effective and valuable in diabetic foot before and after amputation. (authors)

  15. European clinical guidelines for Tourette syndrome and other tic disorders. Part III: behavioural and psychosocial interventions

    DEFF Research Database (Denmark)

    Verdellen, Cara; van de Griendt, Jolande; Hartmann, Andreas;

    2011-01-01

    This clinical guideline provides recommendations for the behavioural and psychosocial interventions (BPI) of children and adolescents with tic disorders prepared by a working group of the European Society for the Study of Tourette Syndrome (ESSTS). A systematic literature search was conducted...... to obtain an update on the efficacy of BPI for tics. Relevant studies were identified using computerised searches of the Medline and PsycINFO databases and the Cochrane Library for the years 1950-2010. The search identified no meta-analyses, yet twelve (systematic) reviews and eight randomised controlled...... trials provided evidence for the current review. Most evidence was found for habit reversal training (HRT) and the available but smaller evidence also supports the efficacy of exposure with response prevention (ERP). Both interventions are considered first line behavioural treatments for tics for both...

  16. Psychological interventions for terroristic trauma: prevention, crisis management, and clinical treatment strategies.

    Science.gov (United States)

    Miller, Laurence

    2011-01-01

    Terrorist attacks combine features of a criminal assault, a mass casualty disaster and an act of war Accordingly, this article presents a model for prevention, response and recovery from the psychological impact of a terror attack. The nature of terrorism is delineated and the various psychological effects are described, including diagnostic clinical syndromes, as well as individual reactions. Interventions in the immediate aftermath of a terrorist attack include on-scene crisis intervention, short-term psychological stabilization, and longer-term psychotherapeutic approaches. Special techniques are described for individuals, families, children, and large groups of survivors and responders. Finally, the ways that mental health clinicians can serve as valuable consultants to community recovery efforts are discussed. PMID:21957724

  17. The effect of systematic clinical interventions with cigarette smokers on quit status and the rates of smoking-related primary care office visits.

    Directory of Open Access Journals (Sweden)

    Thomas G Land

    Full Text Available BACKGROUND: The United States Public Health Service (USPHS Guideline for Treating Tobacco Use and Dependence includes ten key recommendations regarding the identification and the treatment of tobacco users seen in all health care settings. To our knowledge, the impact of system-wide brief interventions with cigarette smokers on smoking prevalence and health care utilization has not been examined using patient population-based data. METHODS AND FINDINGS: Data on clinical interventions with cigarette smokers were examined for primary care office visits of 104,639 patients at 17 Harvard Vanguard Medical Associates (HVMA sites. An operational definition of "systems change" was developed. It included thresholds for intervention frequency and sustainability. Twelve sites met the criteria. Five did not. Decreases in self-reported smoking prevalence were 40% greater at sites that achieved systems change (13.6% vs. 9.7%, p<.01. On average, the likelihood of quitting increased by 2.6% (p<0.05, 95% CI: 0.1%-4.6% per occurrence of brief intervention. For patients with a recent history of current smoking whose home site experienced systems change, the likelihood of an office visit for smoking-related diagnoses decreased by 4.3% on an annualized basis after systems change occurred (p<0.05, 95% CI: 0.5%-8.1%. There was no change in the likelihood of an office visit for smoking-related diagnoses following systems change among non-smokers. CONCLUSIONS: The clinical practice data from HVMA suggest that a systems approach can lead to significant reductions in smoking prevalence and the rate of office visits for smoking-related diseases. Most comprehensive tobacco intervention strategies focus on the provider or the tobacco user, but these results argue that health systems should be included as an integral component of a comprehensive tobacco intervention strategy. The HVMA results also give us an indication of the potential health impacts when meaningful use core

  18. Screening, Brief Intervention, and Referral to Treatment in a rural Ryan White Part C HIV clinic.

    Science.gov (United States)

    Graham, Lucy J; Davis, Amy L; Cook, Paul F; Weber, Mary

    2016-01-01

    About 24% of people living with HIV nationally are identified as needing treatment for alcohol or illicit drug use. Screening, Brief Intervention, and Referral to Treatment (SBIRT) has evolved as a strategy to assess and intervene with substance abuse behaviors in various clinical settings. However, less is known about the processes and outcomes of using the SBIRT intervention in outpatient HIV clinics. This paper presents a descriptive analysis of de-identified existing SBIRT results data from an outpatient HIV clinic located in western Colorado. From 2008 to 2013, a total of 1616 SBIRT evaluations were done, which included duplicate patients because some individual patients were screened more than once in a given year. Over this time period, 37-49% of encounters per year were notable for tobacco use, 8-21% for alcohol use, 6-16% for marijuana use, 3-9% for amphetamine use, and 0-2% for illicit opioid use. Unique, unduplicated patient data from 2013 revealed 40% of patients used tobacco, 16% used alcohol, and 11% used methamphetamine. Analyses highlighted that the majority of our patient population (58% in 2013) used and/or abused tobacco, alcohol, and/or illicit substances. An alarming finding was the increase in methamphetamine use over time with more than 50-fold prevalence of use in our population compared to national rates. PMID:26548426

  19. Screening, Brief Intervention, and Referral to Treatment in a rural Ryan White Part C HIV clinic.

    Science.gov (United States)

    Graham, Lucy J; Davis, Amy L; Cook, Paul F; Weber, Mary

    2016-01-01

    About 24% of people living with HIV nationally are identified as needing treatment for alcohol or illicit drug use. Screening, Brief Intervention, and Referral to Treatment (SBIRT) has evolved as a strategy to assess and intervene with substance abuse behaviors in various clinical settings. However, less is known about the processes and outcomes of using the SBIRT intervention in outpatient HIV clinics. This paper presents a descriptive analysis of de-identified existing SBIRT results data from an outpatient HIV clinic located in western Colorado. From 2008 to 2013, a total of 1616 SBIRT evaluations were done, which included duplicate patients because some individual patients were screened more than once in a given year. Over this time period, 37-49% of encounters per year were notable for tobacco use, 8-21% for alcohol use, 6-16% for marijuana use, 3-9% for amphetamine use, and 0-2% for illicit opioid use. Unique, unduplicated patient data from 2013 revealed 40% of patients used tobacco, 16% used alcohol, and 11% used methamphetamine. Analyses highlighted that the majority of our patient population (58% in 2013) used and/or abused tobacco, alcohol, and/or illicit substances. An alarming finding was the increase in methamphetamine use over time with more than 50-fold prevalence of use in our population compared to national rates.

  20. Structural Competency in the U.S. Healthcare Crisis: Putting Social and Policy Interventions Into Clinical Practice.

    Science.gov (United States)

    Hansen, H; Metzl, J

    2016-06-01

    This symposium of the Journal of Bioethical Inquiry illustrates structural competency: how clinical practitioners can intervene on social and institutional determinants of health. It will require training clinicians to see and act on structural barriers to health, to adapt imaginative structural approaches from fields outside of medicine, and to collaborate with disciplines and institutions outside of medicine. Case studies of effective work on all of these levels are presented in this volume. The contributors exemplify structural competency from many angles, from the implications of epigenetics for environmental intervention in personalized medicine to the ways clinicians can act on fundamental causes of disease, address abuses of power in clinical training, racially desegregate cities to reduce health disparities, address the systemic causes of torture by police, and implement harm-reduction programs for addiction in the face of punitive drug laws. Together, these contributors demonstrate the unique roles that clinicians can play in breaking systemic barriers to health and the benefit to the U.S. healthcare system of adopting innovations from outside of the United States and outside of clinical medicine. PMID:27178191

  1. Training-Based Interventions in Motor Rehabilitation after Stroke: Theoretical and Clinical Considerations

    Directory of Open Access Journals (Sweden)

    Annette Sterr

    2004-01-01

    Full Text Available Basic neuroscience research on brain plasticity, motor learning and recovery has stimulated new concepts in neurological rehabilitation. Combined with the development of set methodological standards in clinical outcome research, these findings have led to a double-paradigm shift in motor rehabilitation: (a the move towards evidence-based procedures for the assessment of clinical outcome & the employment of disablement models to anchor outcome parameters, and (b the introduction of practice-based concepts that are derived from testable models that specify treatment mechanisms. In this context, constraint-induced movement therapy (CIT has played a catalytic role in taking motor rehabilitation forward into the scientific arena. As a theoretically founded and hypothesis-driven intervention, CIT research focuses on two main issues. The first issue is the assessment of long-term clinical benefits in an increasing range of patient groups, and the second issue is the investigation of neuronal and behavioural treatment mechanisms and their interactive contribution to treatment success. These studies are mainly conducted in the research environment and will eventually lead to increased treatment benefits for patients in standard health care. However, gradual but presumably more immediate benefits for patients may be achieved by introducing and testing derivates of the CIT concept that are more compatible with current clinical practice. Here, we summarize the theoretical and empirical issues related to the translation of research-based CIT work into the clinical context of standard health care.

  2. Educational interventions to improve the effectiveness in clinical competence of general practitioners: problem-based versus critical reading-based learning

    Directory of Open Access Journals (Sweden)

    Gongora-Ortega Javier

    2012-07-01

    Full Text Available Abstract Background Evidence suggests that continuing medical education improves the clinical competence of general practitioners and the quality of health care services. Thus, we evaluated the relative impact of two educational strategies, critical reading (CR and problem based learning (PBL, on the clinical competence of general practitioners in a healthcare system characterized by excessive workload and fragmentation into small primary healthcare centers. Methods Clinical competence was evaluated in general practitioners assigned to three groups based on the educational interventions used: 1 critical reading intervention; 2 problem based learning intervention; and 3 no intervention (control group, which continued clinical practice as normal. The effect on the clinical competence of general practitioners was evaluated in three dimensions: the cognitive dimension, via a self-administered questionnaire; the habitual behavioral dimension, via information from patient’s medical records; and the affective dimension, through interviews with patients. A paired Student´s t-test was used to evaluate the changes in the mean clinical competence scores before and after the intervention, and a 3 x 2 ANOVA was used to analyze groups, times and their interaction. Results Nine general practitioners participated in the critical reading workshop, nine in the problem-based learning workshop, and ten were assigned to the control group. The participants exhibited no significant differences in clinical competence measures at baseline, or in socio-demographic or job characteristics (p > 0.05. Significant improvements in all three dimensions (cognitive, 45.67 vs 54.89; habitual behavioral, 53.78 vs 82.33; affective, 4.16 vs 4.76 were only observed in the problem-based learning group after the intervention (p > 0.017. Conclusions While no differences in post-intervention scores were observed between groups, we conclude that problem-based learning can be

  3. Couples Counseling in Alzheimer's Disease: Additional Clinical Findings from a Novel Intervention Study.

    Science.gov (United States)

    Auclair, Ursula; Epstein, Cynthia; Mittelman, Mary

    2009-04-01

    This article describes the clinical findings of a study designed to assess the benefit of counseling for couples, one of whom is in the early stage of Alzheimer's disease (AD). We previously reported our findings based on the first 12 couples that enrolled in the study. Based on the treatment of 30 additional couples, we have refined our treatment strategy to include concepts of Gestalt Therapy and Transactional Analysis and identified prevalent issues of concern to this cohort. The study design has remained as described in the earlier article (Epstein et al., 2006), and has proven to be appropriate to meet the goals of this intervention as indicated by our clinical experience and feedback from the participating couples. Case vignettes demonstrate how to conduct the sessions so that the experience of each member of the dyad is validated, while acknowledging the differential impact of the disease on them. PMID:19865591

  4. Clinical analysis of the early comprehensive intervention on hypoxic ischemic encephalopathy

    Institute of Scientific and Technical Information of China (English)

    Xu-E Li; Yi-MinDu; Yan-JuGuo; Zhi-QingWu; Su-GeHao

    2015-01-01

    Objective:To explore the clinical efficacy of the early comprehensive intervention on hypoxic ischemic encephalopathy (HIE).Methods:HIE children who were admitted in our department from March, 2014 to May, 2015 were included in the study and randomized into the observation group and the control group. The patients in the control group were given routine fluid infusion, electrolyte disturbance correcting, blood sugar maintaining, convulsion controlling, intracranial pressure reducing, hormone, mannitol, vitamins, infection preventing, and other treatments. Based on the treatments given in the control group, the patients in the observation group were given the comprehensive intervention. After treatment, the serum related indicators, NBNA, and DQ in the two groups were observed.Results:The levels of serum AST, LDH, CK, and CK-MB in the observation group were significantly lower than those in the control group (P0.05). NBNA score in the observation group was significantly superior to that in the control group (P<0.05). DQ values at 3, 6, 12, 18, and 24 months in the observation group were significantly higher than those in the control group (P<0.05).Conclusions:Early comprehensive intervention on HIE patients can effectively reduce the serum cardiac enzyme levels, increase the therapeutic effect, improve the intelligence and motor development levels and DQ in order to enhance the living qualities.

  5. Clinical significance of post-interventional cerebral hyperdensities after endovascular mechanical thrombectomy in acute ischaemic stroke

    Energy Technology Data Exchange (ETDEWEB)

    Nikoubashman, Omid [Uniklinik Aachen, Klinik fuer Diagnostische und Interventionelle Neuroradiologie, Aachen (Germany); Uniklinik Aachen, Klinik fuer Neurologie, Aachen (Germany); Reich, Arno; Gindullis, Mirco; Schulz, Joerg B. [Uniklinik Aachen, Klinik fuer Neurologie, Aachen (Germany); Frohnhofen, Katharina; Pjontek, Rastislav; Brockmann, Marc-Alexander; Wiesmann, Martin [Uniklinik Aachen, Klinik fuer Diagnostische und Interventionelle Neuroradiologie, Aachen (Germany)

    2014-01-15

    This study aims to investigate the clinical significance of post-interventional cerebral hyperdensities (PCHD) after endovascular mechanical thrombectomy in acute ischaemic stroke. Data of 102 consecutive patients who received post-interventional CT scans within 4.5 h after mechanical thrombectomy were analysed retrospectively. Sixty-two of 102 patients (60.8 %) had PCHD on their post-interventional CT scans. The most common site of PCHD was the basal ganglia. PCHD were persisting in 13 of 62 patients (21.0 %), and transient in the remaining 49 patients (79.0 %) within 24 h. Four patients with PCHD and four patients without PCHD suffered from parenchymal haemorrhage. Neither ASA nor Clopidogrel, Tirofiban or rtPA were risk factors for PCHD. Final infarction size was congruent with or bigger than areas of PCHD in 93.3 % of cases in our series. PCHD was not a risk factor for parenchymal haemorrhage in our series. The occurrence of PCHD was strongly related to the prior presence of infarction. PCHD was also a strong predictor for final infarction size. (orig.)

  6. Safe medication use based on knowledge of information about contraindications concerning cross allergy and comprehensive clinical intervention

    Directory of Open Access Journals (Sweden)

    Li W

    2013-02-01

    Full Text Available Wei Li,1 Ling-Ling Zhu,2 Quan Zhou31Division of Medical Affairs, 2Cadre Department, Division of Nursing, 3Department of Pharmacy, Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang, People's Republic of ChinaBackground: An investigation of safety issues regarding information on contraindications related to cross allergy was conducted to promote clinical awareness and prevent medical errors in a 2200-bed tertiary care teaching hospital.Methods: Prescribing information on contraindications concerning cross allergy was collected from an information system and package inserts. Data mining and descriptive analysis were performed. A risk register was used for project management and risk assessment. A Plan, Do, Check, Act cycle was used as part of continuous quality improvement. Records of drug counseling and medical errors were collected from an online reporting system. A pharmacist-led multidisciplinary team initiated an intervention program on cross allergy in August 2008.Results: Four years of risk management at our hospital achieved successful outcomes, ie, the number of medical errors related to cross allergies decreased by 97% (10 cases monthly before August 2008 versus three cases yearly in 2012 and risk rating decreased significantly [initial risk rating:25 (high-risk before August 2008 versus final risk rating:6 (medium-risk in December 2012].Conclusion: We conclude that comprehensive clinical interventions are very effective through team cooperation. Medication use has potential for safety risks if sufficient attention is not paid to contraindications concerning cross allergy. The potential for cross allergy involving drugs which belong to completely different pharmacological classes is easily overlooked and can be dangerous. Pharmacists can play an important role in reducing the risk of cross allergy as well as recommending therapeutic alternatives.Keywords: clinical pharmacy, contraindications, cross allergy

  7. Design and development of a mobile image overlay system for needle interventions.

    Science.gov (United States)

    Anand, M; King, F; Ungi, T; Lasso, A; Rudan, J; Jayender, J; Fritz, J; Carrino, J A; Jolesz, F A; Fichtinger, G

    2014-01-01

    Previously, a static and adjustable image overlay systems were proposed for aiding needle interventions. The system was either fixed to a scanner or mounted over a large articulated counterbalanced arm. Certain drawbacks associated with these systems limited the clinical translation. In order to minimize these limitations, we present the mobile image overlay system with the objective of reduced system weight, smaller dimension, and increased tracking accuracy. The design study includes optimal workspace definition, selection of display device, mirror, and laser source. The laser plane alignment, phantom design, image overlay plane calibration, and system accuracy validation methods are discussed. The virtual image is generated by a tablet device and projected into the patient by using a beamsplitter mirror. The viewbox weight (1.0 kg) was reduced by 8.2 times and image overlay plane tracking precision (0.21 mm, STD = 0.05) was improved by 5 times compared to previous system. The automatic self-calibration of the image overlay plane was achieved in two simple steps and can be done away from patient table. The fiducial registration error of the physical phantom to scanned image volume registration was 1.35 mm (STD = 0.11). The reduced system weight and increased accuracy of optical tracking should enable the system to be hand held by the physician and explore the image volume over the patient for needle interventions.

  8. Remote-operated systems for interventions in civil nuclear facilities

    International Nuclear Information System (INIS)

    This short paper is a presentation of the aerial and terrestrial means developed by the Intra Group specialized in interventions in the case of nuclear accidents and incidents. The aerial means consist in a airborne system called Helinuc and which can perform spectro-gamma measurements over surfaces of about 15 km2 using an 'Ecureuil'-type helicopter. The terrestrial means comprise different types of robots for surveys, sampling, manipulation, various works etc.. and remote-controlled caterpillar tractors, shovels and dumper trucks. (J.S.)

  9. Circadian disruption: New clinical perspective of disease pathology and basis for chronotherapeutic intervention.

    Science.gov (United States)

    Smolensky, Michael H; Hermida, Ramon C; Reinberg, Alain; Sackett-Lundeen, Linda; Portaluppi, Francesco

    2016-01-01

    pressure 24 h patterns (nocturnal hypertension); delayed sleep phase syndrome, non-24 h sleep/wake disorder; recurrent hypersomnia; SW intolerance; delirium; peptic ulcer disease; kidney failure; depression; mania; bipolar disorder; Parkinson's disease; Smith-Magenis syndrome; fatal familial insomnia syndrome; autism spectrum disorder; asthma; byssinosis; cancers; hand, foot and mouth disease; post-operative state; and ICU outcome. Poorly conceived medical interventions, for example nighttime dosing of synthetic corticosteroids and certain β-antagonists and cyclic nocturnal enteral or parenteral nutrition, plus lifestyle habits, including atypical eating times and chronic alcohol consumption, also can be causal of CD. Just as surprisingly are the many proven chronotherapeutic strategies available today to manage the CD of several of these medical conditions. In clinical medicine, CD seems to be a common, yet mostly unrecognized, pathologic mechanism of human disease as are the many effective chronotherapeutic interventions to remedy it. PMID:27308960

  10. The Prognosis of Primary Percutaneous Coronary Intervention after One Year Clinical Follow Up

    Directory of Open Access Journals (Sweden)

    Yahya Dadjoo

    2013-03-01

    Full Text Available Objectives: The aim of this study was to evaluate the clinical outcomes, one year after primary percutaneous coronary intervention(PCI. Patients and Methods: From September 2009 to March 2012, primary PCI was performed on 70 cases, and the data relating to their catheterization were recorded. Peri-interventional treatment data included PCI with drug-eluting or bare-metal stent or balloon angioplasty alone. Results: The mean age of the patients was 61.34+11.31 years, and 72.9% of them were males. The ratios of patients with diabetes, hypertension and, hyperlipidemia were 61.4%, 71.4%, and 52.9% respectively. In clinical follow-up, total incidence of death was 4.3%, with no death occurring during 30 days. However, 3 patients died after one-year, of which one patient (1.4% had cardiac problem and the other 2 (2.9% died because of non-cardiac reasons. Target vessel revascularization, reinfarction within 30 days, and mechanical complication or stroke were not found in any of the patients. Patients with hypertension (6% and those with LAD ST-elevation myocardial infarction (5% died after one year (P= 0.263 and P= 0.319 respectively. However, no mortality was reported in patients with RCA and LCX ST-elevation myocardial infarction. Of subjects with multivessel disease, 7% died after one-year (P= 0.161, but there was no reported mortality in those with single vessel disease.

  11. 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...

  12. Improving the Dictation in Attention Deficit Hyperactivity Disorder by Using Computer Based Interventions: A Clinical Trial

    Directory of Open Access Journals (Sweden)

    Mahdi Tehranidoost

    2006-07-01

    Full Text Available Objective: The aim of the current study was to assess the impact of computer games and computer-assisted type instruction on dictation scores of elementary school children with attention deficit – hyperactivity disorder (ADHD. Method: In this single-blind clinical trial, 37 elementary school children with ADHD, selected by convenience sampling and divided into group I (n=17 and group II (n=20, underwent eight one-hour sessions (3 sessions per week of intervention by computer games versus computer-assisted type instruction, respectively. 12 school dictation scores were considered: 4 scores preintervention, 4 scores during interventions, and 4 scores post-intervention. Dictation test was taken during each session. Data was analyzed using repeated measure ANOVA. Results: Two groups were matched for age, gender, school grade, medication, IQ, parent’s and teacher’s Conners’ scale scores, having computer at home, history of working with computer, and mean dictation scores. There was no significant difference in dictation scores before and after interventions and also between the study groups. The improvement in school dictation scores had no significant correlation with age, gender, Ritalin use, owning a computer at home and past history of computer work, baseline dictation scores, Ritalin dose, educational status, IQ, and the total score of parent’s and teacher’s Conners’ rating scale. Conclusion: Absence of significant improvement in dictation scores in study groups may be due to the confounding effect of other variables with known impact on dictation scores. Further studies in this field should also assess the change of attention and memory.

  13. Interventions geared towards strengthening the health system of Namibia through the integration of palliative care.

    Science.gov (United States)

    Freeman, Rachel; Luyirika, Emmanuel Bk; Namisango, Eve; Kiyange, Fatia

    2016-01-01

    The high burden of non-communicable diseases and communicable diseases in Africa characterised by late presentation and diagnosis makes the need for palliative care a priority from the point of diagnosis to death and through bereavement. Palliative care is an intervention that requires a multidisciplinary team to address the multifaceted needs of the patient and family. Thus, its development takes a broad approach that involves engaging all key stakeholders ranging from policy makers, care providers, educators, the public, patients, and families. The main focus of stakeholder engagement should address some core interventions geared towards improving knowledge and awareness, strengthening skills and attitudes about palliative care. These interventions include educating health and allied healthcare professionals on the palliative care-related problems of patients and best practices for care, explaining palliative care as a clinical and holistic discipline and demonstrating its effectiveness, the need to include palliative care into national policies, strategic plans, training curriculums of healthcare professionals and the engagement of patients, families, and communities. Interventions from a five-year programme that was aimed at strengthening the health system of Namibia through the integration of palliative care for people living with HIV and AIDS and cancer in Namibia are shared. This article illustrates how a country can implement the World Health Organisation's public health strategy for developing palliative care services, which recommends four pillars: government policy, education, drug availability, and implementation. PMID:27563348

  14. Interventions geared towards strengthening the health system of Namibia through the integration of palliative care

    Science.gov (United States)

    Freeman, Rachel; Luyirika, Emmanuel BK; Namisango, Eve; Kiyange, Fatia

    2016-01-01

    The high burden of non-communicable diseases and communicable diseases in Africa characterised by late presentation and diagnosis makes the need for palliative care a priority from the point of diagnosis to death and through bereavement. Palliative care is an intervention that requires a multidisciplinary team to address the multifaceted needs of the patient and family. Thus, its development takes a broad approach that involves engaging all key stakeholders ranging from policy makers, care providers, educators, the public, patients, and families. The main focus of stakeholder engagement should address some core interventions geared towards improving knowledge and awareness, strengthening skills and attitudes about palliative care. These interventions include educating health and allied healthcare professionals on the palliative care-related problems of patients and best practices for care, explaining palliative care as a clinical and holistic discipline and demonstrating its effectiveness, the need to include palliative care into national policies, strategic plans, training curriculums of healthcare professionals and the engagement of patients, families, and communities. Interventions from a five-year programme that was aimed at strengthening the health system of Namibia through the integration of palliative care for people living with HIV and AIDS and cancer in Namibia are shared. This article illustrates how a country can implement the World Health Organisation’s public health strategy for developing palliative care services, which recommends four pillars: government policy, education, drug availability, and implementation.

  15. Clinical Decision Support Systems: A Useful Tool in Clinical Practice

    Directory of Open Access Journals (Sweden)

    Kolostoumpis G.

    2012-01-01

    Full Text Available The possibility of supporting in decision – making shows an increase in recent years. Based on mathematic simulation tools, knowledge databases, processing methods, medical data and methods, artificial intelligence for coding of the available knowledge and for resolving complex problems arising into clinical practice. Aim: the aim of this review is to present the development of new methods and modern services, in clinical practice and the emergence in their implementation. Data and methods: the methodology that was followed included research of articles that referred to health sector and modern technologies, at the electronic data bases “pubmed” and “medline”. Results: Is a useful tool for medical experts using characteristics and medical data used by the doctors. Constitute innovation for the medical community, and ensure the support of clinical decisions with an overall way by providing a comprehensive solution in the light of the integration of computational decision support systems into clinical practice. Conclusions: Decision Support Systems contribute to improving the quality of health services with simultaneous impoundment of costs (i.e. avoid medical errors

  16. Health-system-based interventions to improve care in pediatric and adolescent type 1 diabetes.

    Science.gov (United States)

    Corathers, Sarah D; Schoettker, Pamela J; Clements, Mark A; List, Betsy A; Mullen, Deborah; Ohmer, Amy; Shah, Avni; Lee, Joyce

    2015-11-01

    Despite significant advances in pharmacology and technology, glycemic targets are difficult to achieve for patients with type 1 diabetes (T1D) and management remains burdensome for patients and their families. Quality improvement (QI) science offers a methodology to identify an aim, evaluate complex contributors to the goal, and test potential interventions to achieve outcomes of interest. Day-to-day management of diabetes is often an iterative process but interventions exist at all care levels: individual patient and family, clinic, and larger population and health system. This article reviews current literature and proposes novel QI interventions for enhancing health outcomes, with attention to essential determinants or drivers of improved glycemic control and patient experience for pediatric T1D in the context of the Chronic Care Model. In-depth consideration of key drivers of successful T1D care, including self-management and integration of technology, are explored, and examples of larger health systems with improved outcomes, including Learning Health Systems are highlighted. PMID:26374568

  17. Telehealth: Acceptability, clinical interventions and quality of life in peritoneal dialysis

    Science.gov (United States)

    Dey, Vishal; Jones, Audrey; Spalding, Elaine M

    2016-01-01

    Introduction: Telehealth technologies are being widely adopted across the globe for management of long-term conditions. There are limited data on its use, effectiveness and patient experience in end-stage renal disease. The aim of this pilot project was to explore patient acceptability of technology and evaluate its effect on clinical interventions and quality of life in patients undergoing peritoneal dialysis. Methods: Peritoneal dialysis patients were provided with computer tablets (PODs). PODs contained a knowledge database with treatment- and symptom-based questionnaires that generated alerts for the clinical team. Alerts were reviewed daily and followed up by a telephone call or clinic visit. Interventions were at the discretion of clinicians. Data were recorded prospectively and quality of life and Quebec User Evaluation of Satisfaction with assistive Technology questionnaires evaluated at the start and end of the programme. Results: In all, 22 patients have participated over 15 months. The mean age was 61.6 years and PODs were utilised for an average of 341.9 days with 59.1% choosing to continue beyond the study period. We received a total of 1195 alerts with an average of 2.6 alerts per day. A total of 36 admissions were avoided and patients supported to self-manage on 154 occasions. Quebec User Evaluation of Satisfaction with assistive Technology scores remained high throughout the programme although no improvement in quality of life was seen. Discussion: Telehealth is useful to monitor patients with renal failure on peritoneal dialysis. It is acceptable across age groups and provides an additional resource for patients to self-manage. Satisfaction scores and retention rates suggest a high level of acceptability.

  18. Engaging nurses in research for a randomized clinical trial of a behavioral health intervention.

    Science.gov (United States)

    Roll, Lona; Stegenga, Kristin; Hendricks-Ferguson, Verna; Barnes, Yvonne J; Cherven, Brooke; Docherty, Sharron L; Robb, Sheri L; Haase, Joan E

    2013-01-01

    Nurse involvement in research is essential to the expansion of nursing science and improved care for patients. The research participation challenges encountered by nurses providing direct care (direct care nurses) include balancing patient care demands with research, adjusting to fluctuating staff and patient volumes, working with interdisciplinary personnel, and feeling comfortable with their knowledge of the research process. The purpose of this paper is to describe efforts to engage nurses in research for the Stories and Music for Adolescent/Young Adult Resilience during Transplant (SMART) study. SMART was an NIH-funded, multisite, randomized, behavioral clinical trial of a music therapy intervention for adolescents/young adults (AYA) undergoing stem cell transplant for an oncology condition. The study was conducted at 8 sites by a large multidisciplinary team that included direct care nurses, advanced practice nurses, and nurse researchers, as well as board-certified music therapists, clinical research coordinators, and physicians. Efforts to include direct care nurses in the conduct of this study fostered mutual respect across disciplines in both academic and clinical settings. PMID:24102024

  19. Engaging Nurses in Research for a Randomized Clinical Trial of a Behavioral Health Intervention

    Directory of Open Access Journals (Sweden)

    Lona Roll

    2013-01-01

    Full Text Available Nurse involvement in research is essential to the expansion of nursing science and improved care for patients. The research participation challenges encountered by nurses providing direct care (direct care nurses include balancing patient care demands with research, adjusting to fluctuating staff and patient volumes, working with interdisciplinary personnel, and feeling comfortable with their knowledge of the research process. The purpose of this paper is to describe efforts to engage nurses in research for the Stories and Music for Adolescent/Young Adult Resilience during Transplant (SMART study. SMART was an NIH-funded, multisite, randomized, behavioral clinical trial of a music therapy intervention for adolescents/young adults (AYA undergoing stem cell transplant for an oncology condition. The study was conducted at 8 sites by a large multidisciplinary team that included direct care nurses, advanced practice nurses, and nurse researchers, as well as board-certified music therapists, clinical research coordinators, and physicians. Efforts to include direct care nurses in the conduct of this study fostered mutual respect across disciplines in both academic and clinical settings.

  20. Percutaneous coronary intervention in asians- are there differences in clinical outcome?

    Directory of Open Access Journals (Sweden)

    Chua Terrance S

    2011-05-01

    Full Text Available Abstract Background Ethnic differences in clinical outcome after percutaneous coronary intervention (PCI have been reported. Data within different Asian subpopulations is scarce. We aim to explore the differences in clinical profile and outcome between Chinese, Malay and Indian Asian patients who undergo PCI for coronary artery disease (CAD. Methods A prospective registry of consecutive patients undergoing PCI from January 2002 to December 2007 at a tertiary care center was analyzed. Primary endpoint was major adverse cardiovascular events (MACE of myocardial infarction (MI, repeat revascularization and all-cause death at six months. Results 7889 patients underwent PCI; 7544 (96% patients completed follow-up and were included in the analysis (79% males with mean age of 59 years ± 11. There were 5130 (68% Chinese, 1056 (14% Malays and 1001 (13.3% Indian patients. The remaining 357 (4.7% patients from other minority ethnic groups were excluded from the analysis. The primary end-point occurred in 684 (9.1% patients at six months. Indians had the highest rates of six month MACE compared to Chinese and Malays (Indians 12% vs. Chinese 8.2% vs. Malays 10.7%; OR 1.55 95%CI 1.24-1.93, p Conclusion These data indicate that ethnic variations in clinical outcome exist following PCI. In particular, Indian patients have higher six month event rates compared to Chinese and Malays. Future studies are warranted to elucidate the underlying mechanisms behind these variations.

  1. Fluoroscopic image-guided intervention system for transbronchial localization

    Science.gov (United States)

    Rai, Lav; Keast, Thomas M.; Wibowo, Henky; Yu, Kun-Chang; Draper, Jeffrey W.; Gibbs, Jason D.

    2012-02-01

    Reliable transbronchial access of peripheral lung lesions is desirable for the diagnosis and potential treatment of lung cancer. This procedure can be difficult, however, because accessory devices (e.g., needle or forceps) cannot be reliably localized while deployed. We present a fluoroscopic image-guided intervention (IGI) system for tracking such bronchoscopic accessories. Fluoroscopy, an imaging technology currently utilized by many bronchoscopists, has a fundamental shortcoming - many lung lesions are invisible in its images. Our IGI system aligns a digitally reconstructed radiograph (DRR) defined from a pre-operative computed tomography (CT) scan with live fluoroscopic images. Radiopaque accessory devices are readily apparent in fluoroscopic video, while lesions lacking a fluoroscopic signature but identifiable in the CT scan are superimposed in the scene. The IGI system processing steps consist of: (1) calibrating the fluoroscopic imaging system; (2) registering the CT anatomy with its depiction in the fluoroscopic scene; (3) optical tracking to continually update the DRR and target positions as the fluoroscope is moved about the patient. The end result is a continuous correlation of the DRR and projected targets with the anatomy depicted in the live fluoroscopic video feed. Because both targets and bronchoscopic devices are readily apparent in arbitrary fluoroscopic orientations, multiplane guidance is straightforward. The system tracks in real-time with no computational lag. We have measured a mean projected tracking accuracy of 1.0 mm in a phantom and present results from an in vivo animal study.

  2. A brief conversation analytic communication intervention can change history-taking in the seizure clinic.

    Science.gov (United States)

    Jenkins, Laura; Cosgrove, Jeremy; Ekberg, Katie; Kheder, Ammar; Sokhi, Dilraj; Reuber, Markus

    2015-11-01

    Question design during history-taking has clear implications for patients' ability to share their concerns in general and their seizure experiences in particular. Studies have shown that unusually open questions at the start of the consultation enable patients to display interactional and linguistic markers which may help with the otherwise challenging differentiation of epileptic from nonepileptic seizures (NES). In this study, we compared the problem presentation approach taken by trainee neurologists in outpatient encounters with new patients before and after a one-day conversation analytic training intervention in which doctors were taught to adopt an open format of question design and recognize diagnostically relevant linguistic features. We audio/video-recorded clinical encounters between ten doctors, their patients, and accompanying persons; transcribed the interactions; and carried out quantitative and qualitative analyses. We studied 39 encounters before and 55 after the intervention. Following the intervention, doctors were significantly more likely to use nondirective approaches to soliciting patient accounts of their presenting complaints that invited the patient to describe their problems from their own point of view and gave them better opportunity to determine the initial agenda of the encounter. The time to first interruption by the doctor increased (from 52 to 116 s, p<.001). While patients were given more time to describe their seizure experiences, the overall appointment length did not increase significantly (19 vs 21 min, n.s.). These changes gave patients more conversational space to express their concerns and, potentially, to demonstrate the interactional and linguistic features previously found to help differentiate between epilepsy and NES, without impacting the length of the consultations. PMID:26409131

  3. Expert systems for clinical pathology reporting.

    Science.gov (United States)

    Edwards, Glenn A

    2008-08-01

    * Conventional automated interpretative reporting systems use standard or "canned" comments for patient reports. These are result-specific and do not generally refer to the patient context. * Laboratory information systems (LIS) are limited in their application of patient-specific content of reporting. * Patient-specific interpretation requires extensive cross-referencing to other information contained in the LIS such as previous test results, other related tests, and clinical notes, both current and previous. * Expert systems have the potential to improve reporting quality by enabling patient-specific reporting in clinical laboratories.

  4. Clinical investigation study on occupational exposure of operators during cardiovascular intervention

    International Nuclear Information System (INIS)

    Objective: To investigate the personal effective dose of the operator in cardiovascular intervention. Methods: Lithium fluoride (LiF) thermoluminescent dosimeters (TLD) were used to carry out personal dose monitoring for the operator. Effective doses of the operator were evaluated in 28 clinical operations. Results: The average fluoroscopy time for 24 Coronary angiography (CA), percutaneous transluminal coronary angioplasty (PTCA) and percutaneous intracoronary arterial stenting (PICAS) procedures was 19.2±6.3 min, and the average effective dose of the operator per procedure was 4.1±0.9 μSv (under protection) and 52.2±15.5 μSv (without protection). However, for 4 PT procedures, average fluoroscopy time was 14.1±4.6 min, and the average effective dose of the operator per operation was 5.5±1.4 μSv (under protection) and 220±42 μSv (without protection). Conclusions: Reducing fluoroscopy time, femoral artery access to the patients are recommended during interventional procedures. In order to decrease the radiation risk to the lowest level, more advanced equipment should be applied and radiation protection should be fully managed. (authors)

  5. Clinical Use of an Autovideography Intervention to Support Recovery in Individuals with Severe Mental Illness.

    Science.gov (United States)

    Linz, Sheila; Hanrahan, Nancy P; DeCesaris, Marissa; Petros, Ryan; Solomon, Phyllis

    2016-05-01

    The current authors introduced an innovative autovideography intervention asking mental health consumers to use video cameras for 1 month to tell about their recovery. The research approach was based on a participatory research model with workers and consumers of a recovery education center fully involved with the study design and implementation. Twelve individuals who had graduated from a recovery program participated. The participant-produced videos were qualitatively analyzed using thematic analysis. The use of autovideography was found to be feasible and can be used clinically to support the process of recovery by providing opportunities for reciprocity, self-reflection, and advocacy. Consumer-produced videos provide a voice to inform others with and without mental illness about the concerns of individuals with mental illness and the process of recovery. [Journal of Psychosocial Nursing and Mental Health Services, 54(5), 33-40.]. PMID:27135892

  6. Hypertension Education Intervention with Ugandan Nurses Working in Hospital Outpatient Clinic: A Pilot Study

    Directory of Open Access Journals (Sweden)

    Godfrey Katende

    2014-01-01

    Full Text Available Noncommunicable diseases (NCDs pose a significant global burden in both developed and developing countries. It is estimated that, by 2025, 41.7% of males and 38.7% of females in Sub-Saharan Africa will develop high blood pressure (HBP. This is particularly true in Uganda with hypertensive prevalence rates estimated to range from 22.5% to 30.5%. Coupled with low levels of detection, treatment, and control, hypertension represents a Ugandan public health crisis. An innovative WHO-ISH education program culturally was adapted in a pilot study and focused on knowledge, skills, and attitudes (KSA of nurses caring for hypertensive patients in an outpatient clinic. Pre-post intervention data was collected and analyzed in which significant improvements were noted on all the three outcome measures. This pilot study demonstrated that nurses’ knowledge, skills, and attitudes could be significantly improved with a multimodal education program implemented in a low resource environment.

  7. Links between clinical audit and contracting systems.

    Science.gov (United States)

    Lord, J; Littlejohns, P

    1995-01-01

    In 1989, a programme of clinical audit was introduced throughout the UK National Health Service (NHS), in an attempt to improve care through the application of quality methodology to clinical issues. However, the role of clinical audit in the new NHS "internal market" is unclear. Reviews evidence on the development of audit and concludes that it has operated largely in isolation, under professional control. Central policy is now advocating greater purchaser and provider management involvement in audit, enabling feedback from and to service provision and management decisions. Where there are constructive local relationships the opening up of audit should be beneficial, but these do not always exist. Discusses a range of models for the interaction of clinical audit with wider NHS management systems. Recommends a split system of professionally controlled background audit and collaborative shared audits to balance conflicting goals. PMID:10143993

  8. Health-related restrictions of choices and choosing: implications for quality of life and clinical interventions

    Directory of Open Access Journals (Sweden)

    Barry J Gurland

    2010-08-01

    Full Text Available Barry J Gurland1, Huai Cheng2, Mathew S Maurer31Columbia University Department of Psychiatry, Stroud Center for Study of Quality of Life, New York, NY, USA; 2Anderson Cancer Center, Houston, TX, USA; 3Columbia Presbyterian Medical Center, New York, NY, USABackground: The process of “accessing choices and choosing among them” (c-c has been proposed as a model for understanding, evaluating, and assisting a patient’s management of quality of life. If desired choices are freely accessible, and the act of choosing is efficient and unconstrained, then the outcome is optimized quality of life. The c-c model fits many clinical situations where improved quality of life is a goal, and interventions may be aimed at relieving health-related restrictions of the patient’s desired activities. Aims: To determine the impact of health restrictions of choices and choosing on indicators and outcomes reflecting quality of life. Method: Secondary analysis of a community-based health survey of three ethnic groups, 65 years and older (n = 2,130, repeated after 18 months, with mortality over 6 years. Findings: Complaints of health restrictions of desired activities accounted for about half the variance of all determinants of a quality of life proxy indicator, and had a high frequency. Such complaints also predicted declines in mood and function, higher death rates, and increased service use.Conclusions: Clinical trials are warranted of the efficacy for quality of life improvement of interventions that focus on the relief of health-induced restrictions of desired activities.Keywords: choice, quality of life, aging, health restrictions

  9. High resolution multimodal clinical ophthalmic imaging system

    OpenAIRE

    Mujat, Mircea; Ferguson, R. Daniel; Patel, Ankit H.; Iftimia, Nicusor; Lue, Niyom; Hammer, Daniel X.

    2010-01-01

    We developed a multimodal adaptive optics (AO) retinal imager which is the first to combine high performance AO-corrected scanning laser ophthalmoscopy (SLO) and swept source Fourier domain optical coherence tomography (SSOCT) imaging modes in a single compact clinical prototype platform. Such systems are becoming ever more essential to vision research and are expected to prove their clinical value for diagnosis of retinal diseases, including glaucoma, diabetic retinopathy (DR), age-related m...

  10. The aging of a clinical information system.

    Science.gov (United States)

    Rada, Roy; Finley, Scott

    2004-10-01

    The senescence of a clinical information system is more likely to have administrative than technical bases. Supporting this claim is a case study of one aging oncology information system. The case study is qualitative, as behooves the subject matter. Content analysis of several documents suggests that the change in job description of the data coordinator led to a workflow breakdown. Next, twenty-two individuals were interviewed. Notes from the interviews were coded, and the resulting patterns led to partial support for the workflow breakdown conjecture, refutation of the hypothesis that users disliked the character-based, human-computer interface, support of the conjecture that political rather than technical factors drive the usage patterns of the system, and evidence that 'political' activity will determine the future of the information system. A stakeholder matrix is proposed that addresses administrative concerns. Also, the issue of the uniqueness of any oncology clinical information system is linked to the plans for this legacy system. PMID:15488746

  11. Service-based Systems in Clinical Environments

    OpenAIRE

    Stantchev, Vladimir

    2008-01-01

    In this report we present an architectural approach to add quality-of-service (QoS) assurance and location awareness to service-based systems within existing clinical infrastructures. To address typical design requirements of such systems (e.g., cooperating services, performance and availability) the work proposes a service-oriented architecture (SOA) as architectural concept and architectural translucency to provide stable QoS. We evaluate position sensing systems, QoS assurance approaches a...

  12. [The practical clinical guidelines of the Sociedad Española de Cardiología on interventional cardiology: coronary angioplasty and other technics].

    Science.gov (United States)

    Esplugas, E; Alfonso, F; Alonso, J J; Asín, E; Elizaga, J; Iñiguez, A; Revuelta, J M

    2000-02-01

    Interventional cardiology has had an extraordinary expansion in last years. This clinical guideline is a review of the scientific evidence of the techniques in relation to clinical and anatomic findings. The review includes: 1. Coronary arteriography. 2. Coronary balloon angioplasty. 3. Coronary stents. 4. Other techniques: directional atherectomy, rotational atherectomy, transluminal extraction atherectomy, cutting balloon, laser angioplasty and transmyocardial laser and endovascular radiotherapy. 5. Platelet glycoprotein IIb/IIIa inhibitors. 6. New diagnostic techniques: intravascular ultrasound, coronary angioscopy, Doppler and pressure wire. For the recommendations we have used the classification system: class I, IIa, IIb, III like in the guidelines of the American College of Cardiology and the American Heart Association.

  13. Self-Reported Low Self-Esteem. Intervention and Follow-Up in a Clinical Setting

    Directory of Open Access Journals (Sweden)

    Søren Ventegodt

    2007-01-01

    Full Text Available At the Research Clinic for Holistic Medicine in Copenhagen, 43 patients who presented with low or very low self-esteem were treated with psychodynamic short-term therapy complemented with bodywork. They received an average of 20 sessions at a cost of 1,600 EURO. The bodywork helped the patients to confront old emotional pain from childhood trauma repressed to the body-mind. Results showed that 60.5% recovered from low selfesteem (95% CI: 44.41–75.02%. Calculated from this, we have NNT = 1.33–2.25. Almost all aspects of life improved at the same time (p < 0.01: physical health, mental health, quality of life, and ability to function in a number of important areas (partner, friends, sexually, and socially. This indicated that we had successfully induced existential healing (Antonovsky salutogenesis. The strategy of improving self-esteem can be the key to a new life for patients presenting with low quality of life, poor health (physical and/omental, and poor ability to function. The patients were strongly motivated and willing to endure strong emotional pain provoked by the therapy. The rate of recovery is comparable to the most successful interventions with psychological and psychiatric treatment. Clinical holistic treatment has many advantages: efficiency, low cost, lack of negative side effects, lasting results, lack of use of psychopharmacological drugs (often with side effects, and an important preventive dimension.

  14. The Efficacy of Oral Nutritional Intervention in Malnourished Cancer Patients: a Systemic Review

    Science.gov (United States)

    2016-01-01

    Cancer is currently a leading cause of deaths worldwide and the number of new cases is growing rapidly in both, developed and developing countries. Nutritional management during and after cancer treatment affects treatment efficacy and patient quality of life (QOL). This review systemically examined the effect of oral nutritional interventions on nutritional and clinical outcomes in cancer patients. We especially focused on outcomes such as nutritional status indices, immune-associated biochemical markers, and QOL assessments to provide insights on the applicability of different outcomes. A total of 28 papers were selected for systematic review. The nutritional composition of oral nutritional supplements (ONS), outcome measures, and efficacy of the oral nutritional interventions were summarized and discussed. Most ONS contain 1 or more functional components in addition to basic nutrients. Each study used various outcome measures and significant efficacy was observed for a limited number of measures. Nutritional status indices, QOL measures, and the duration of hospital stay improved in about 40% of the studies. One or more markers of immune function and inflammatory responses were improved by ONS in 65% of the selected studies. These results suggest that appropriate use of ONS may be an ideal way to improve treatment efficacy; however, additional intervention trials are required to confirm these findings. PMID:27812512

  15. The effectiveness of family therapy and systemic interventions for child-focused problems

    OpenAIRE

    Carr, Alan.

    2009-01-01

    This review updates a similar paper published in the Journal of Family Therapy in 2001. It presents evidence from meta-analyses, systematic literature reviews and controlled trials for the effectiveness of systemic interventions for families of children and adolescents with various difficulties. In this context, systemic interventions include both family therapy and other family-based approaches such as parent training. The evidence supports the effectiveness of systemic interventions either ...

  16. Toxin-Antitoxin Systems in Clinical Pathogens

    Science.gov (United States)

    Fernández-García, Laura; Blasco, Lucia; Lopez, Maria; Bou, German; García-Contreras, Rodolfo; Wood, Thomas; Tomas, María

    2016-01-01

    Toxin-antitoxin (TA) systems are prevalent in bacteria and archaea. Although not essential for normal cell growth, TA systems are implicated in multiple cellular functions associated with survival under stress conditions. Clinical strains of bacteria are currently causing major human health problems as a result of their multidrug resistance, persistence and strong pathogenicity. Here, we present a review of the TA systems described to date and their biological role in human pathogens belonging to the ESKAPE group (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacter spp.) and others of clinical relevance (Escherichia coli, Burkholderia spp., Streptococcus spp. and Mycobacterium tuberculosis). Better understanding of the mechanisms of action of TA systems will enable the development of new lines of treatment for infections caused by the above-mentioned pathogens. PMID:27447671

  17. Religious and spiritual interventions in mental health care: a systematic review and meta-analysis of randomized controlled clinical trials

    OpenAIRE

    Gonçalves, J. P. B.; G. Lucchetti; Menezes, P. R.; Vallada, H.

    2015-01-01

    Background. Despite the extensive literature assessing associations between religiosity/spirituality and health, few studies have investigated the clinical applicability of this evidence. The purpose of this paper was to assess the impact of religious/spiritual interventions (RSI) through randomized clinical trials (RCTs). Method. A systematic review was performed in the following databases: PubMed, Scopus, Web of Science, PsycINFO, Cochrane Collaboration, Embase and SciELO. Through the use o...

  18. Promoting Early Presentation of Breast Cancer in Older Women: Implementing an Evidence-Based Intervention in Routine Clinical Practice

    Directory of Open Access Journals (Sweden)

    Lindsay J. L. Forbes

    2012-01-01

    Full Text Available Background. Women over 70 with breast cancer have poorer one-year survival and present at a more advanced stage than younger women. Promoting early symptomatic presentation in older women may reduce stage cost effectively and is unlikely to lead to overdiagnosis. After examining efficacy in a randomised controlled trial, we piloted a brief health professional-delivered intervention to equip women to present promptly with breast symptoms, as an integral part of the final invited mammogram at age ~70, in the English National Health Service Breast Screening Programme. Methods. We trained mammographers, who then offered the intervention to older women in four breast screening services. We examined breast cancer awareness at baseline and one month in women receiving the intervention, and also in a service where the intervention was not offered. Results. We trained 27 mammographers to deliver the intervention confidently to a high standard. Breast cancer awareness increased 7-fold at one month in women receiving the intervention compared with 2-fold in the comparison service (odds ratio 15.2, 95% confidence interval 10.0 to 23.2. Conclusions. The PEP Intervention can be implemented in routine clinical practice with a potency similar to that achieved in a randomised controlled trial. It has the potential to reduce delay in diagnosis for breast cancer in older women.

  19. PRIME – PRocess modelling in ImpleMEntation research: selecting a theoretical basis for interventions to change clinical practice

    Directory of Open Access Journals (Sweden)

    Pitts Nigel

    2003-12-01

    Full Text Available Abstract Background Biomedical research constantly produces new findings but these are not routinely translated into health care practice. One way to address this problem is to develop effective interventions to translate research findings into practice. Currently a range of empirical interventions are available and systematic reviews of these have demonstrated that there is no single best intervention. This evidence base is difficult to use in routine settings because it cannot identify which intervention is most likely to be effective (or cost effective in a particular situation. We need to establish a scientific rationale for interventions. As clinical practice is a form of human behaviour, theories of human behaviour that have proved useful in other similar settings may provide a basis for developing a scientific rationale for the choice of interventions to translate research findings into clinical practice. The objectives of the study are: to amplify and populate scientifically validated theories of behaviour with evidence from the experience of health professionals; to use this as a basis for developing predictive questionnaires using replicable methods; to identify which elements of the questionnaire (i.e., which theoretical constructs predict clinical practice and distinguish between evidence compliant and non-compliant practice; and on the basis of these results, to identify variables (based on theoretical constructs that might be prime targets for behaviour change interventions. Methods We will develop postal questionnaires measuring two motivational, three action and one stage theory to explore five behaviours with 800 general medical and 600 general dental practitioners. We will collect data on performance for each of the behaviours. The relationships between predictor variables (theoretical constructs and outcome measures (data on performance in each survey will be assessed using multiple regression analysis and structural equation

  20. Health record systems that meet clinical needs

    Directory of Open Access Journals (Sweden)

    Gabriella Negrini

    2012-10-01

    Full Text Available Introduction Increased attention has recently been focused on health record systems as a result of accreditation programs, a growing emphasis on patient safety, and the increase in lawsuits involving allegations of malpractice. Health-care professionals frequently express dissatisfaction with the health record systems and complain that the data included are neither informative nor useful for clinical decision making. This article reviews the main objectives of a hospital health record system, with emphasis on its roles in communication and exchange among clinicians, patient safety, and continuity of care, and asks whether current systems have responded to the recent changes in the Italian health-care system.Discussion If health records are to meet the expectations of all health professionals, the overall information need must be carefully analyzed, a common data set must be created, and essential specialist contributions must be defined. Working with health-care professionals, the hospital management should define how clinical information is to be displayed and organized, identify a functionally optimal layout, define the characteristics of ongoing patient assessment in terms of who will be responsible for these activities and how often they will be performed. Internet technology can facilitate data retrieval and meet the general requirements of a paper-based health record system, but it must also ensure focus on clinical information, business continuity, integrity, security, and privacy.Conclusions The current health records system needs to be thoroughly revised to increase its accessibility, streamline the work of health-care professionals who consult it, and render it more useful for clinical decision making—a challenging task that will require the active involvement of the many professional classes involved.

  1. "Do I Know What I Need to Do?" A Social Communication Intervention for Children with Complex Clinical Profiles

    Science.gov (United States)

    Timler, Geralyn R.; Olswang, Lesley B.; Coggins, Truman E.

    2005-01-01

    Purpose: Speech-language pathologists frequently address social communication difficulties in children with diverse clinical profiles. The purpose of this study was to investigate the feasibility of a social communication intervention for a school-age child with a complex cognitive and behavioral profile secondary to diagnosis of a fetal alcohol…

  2. Comparison of Explicit Forgiveness Interventions with an Alternative Treatment: A Randomized Clinical Trial

    Science.gov (United States)

    Wade, Nathaniel G.; Worthington, Everett L.; Haake, Shawn

    2009-01-01

    Forgiveness interventions can help people forgive past offenses. However, few studies have compared forgiveness interventions with genuine alternative treatments. The authors compared forgiveness interventions with a therapeutic alternative treatment. Participants reduced unforgiveness and increased forgiveness regardless of treatment condition.…

  3. Development of a Multilevel Intervention to Increase HIV Clinical Trial Participation among Rural Minorities

    Science.gov (United States)

    Corbie-Smith, Giselle; Odeneye, Ebun; Banks, Bahby; Shandor Miles, Margaret; Roman Isler, Malika

    2013-01-01

    Minorities are disproportionately affected by HIV/AIDS in the rural Southeast; therefore, it is important to develop targeted, culturally appropriate interventions to support rural minority participation in HIV/AIDS research. Using intervention mapping, we developed a comprehensive multilevel intervention for service providers (SPs) and people…

  4. The First Intervention Study in Elder Self-Neglect: A Randomized Clinical Trial to Improve Vitamin D Levels

    Science.gov (United States)

    Burnett, Jason; Hochschild, Ann; Smith, Scott M.; Diamond, Pam; Stotts, Angela; Dyer, Carmel

    2011-01-01

    Despite high mortality rates, elder self-neglect is characterized by refusal of medical and social interventions. To date there have been no tested clinical interventions in elders who self-neglect. Previous research from the TEAM Institute has shown significantly low vitamin D levels in this population. This study aimed to determine the feasibility of a clinical intervention. Replacement of vitamin D was chosen because of its ease of administration and favorable safety profile. Methods: A randomized clinical trial using directly observed therapy of vitamin D was conducted using 50 elders, >65 years of age, with Adult Protective Services (APS) validated self-neglect. A staggered intervention with waiting controls was used to maximize statistical power. One-third (n=17) of the group was administered 50,000 IU vitamin D2 (ergocalciferol) monthly and the remainder (n=33) were administered 400 IU monthly. Serum 25-OH vitamin D was assessed at baseline and 5-months. Results: 69% agreed to participate in the study and of those n=40 (80%) remained at 5-months. At baseline, 12% (n=7) were deficient in vitamin D (vitamin D levels (vitamin D level was 59 nmol/L +25 (mean SD), and increased significantly to 72nmol/L +21 nmol/L at 5-months. Conclusion: These data are the first to provide evidence that clinical interventions are feasible in elders who self-neglect. The increase in vitamin D levels confirmed that the study personnel were able to successfully intervene community-dwelling elders with self-neglect. This study sets the precedent for future intervention and prevention studies

  5. Health-related quality of life following a clinical weight loss intervention among overweight and obese adults: intervention and 24 month follow-up effects

    Directory of Open Access Journals (Sweden)

    Ruggiero Laurie

    2006-07-01

    Full Text Available Abstract Background Despite a growing literature on the efficacy of behavioral weight loss interventions, we still know relatively little about the long terms effects they have on HRQL. Therefore, we conducted a study to investigate the immediate post-intervention (6 months and long-term (12 and 24 months effects of clinically based weight management programs on HRQL. Methods We conducted a randomized clinical trial in which all participants completed a 6 month clinical weight loss program and were randomized into two 6-month extended care groups. Participants then returned at 12 and 24 months for follow-up assessments. A total of 144 individuals (78% women, M age = 50.2 (9.2 yrs, M BMI = 32.5 (3.8 kg/m2 completed the 6 month intervention and 104 returned at 24 months. Primary outcomes of weight and HRQL using the SF-36 were analyzed using multivariate repeated measures analyses. Results There was complete data on 91 participants through the 24 months of the study. At baseline the participants scored lower than U.S. age-specific population norms for bodily pain, vitality, and mental health. At the completion of the 6 month clinical intervention there were increases in the physical and mental composite measures as well as physical functioning, general health, vitality, and mental health subscales of the SF-36. Despite some weight regain, the improvements in the mental composite scale as well as the physical functioning, vitality, and mental health subscales were maintained at 24 months. There were no significant main effects or interactions by extended care treatment group or weight loss group (whether or not they maintained 5% loss at 24 months. Conclusion A clinical weight management program focused on behavior change was successful in improving several factors of HRQL at the completion of the program and many of those improvements were maintained at 24 months. Maintaining a significant weight loss (> 5% was not necessary to have and maintain

  6. Using systems thinking to support clinical system transformation.

    Science.gov (United States)

    Best, Allan; Berland, Alex; Herbert, Carol; Bitz, Jennifer; van Dijk, Marlies W; Krause, Christina; Cochrane, Douglas; Noel, Kevin; Marsden, Julian; McKeown, Shari; Millar, John

    2016-05-16

    Purpose - The British Columbia Ministry of Health's Clinical Care Management initiative was used as a case study to better understand large-scale change (LSC) within BC's health system. Using a complex system framework, the purpose of this paper is to examine mechanisms that enable and constrain the implementation of clinical guidelines across various clinical settings. Design/methodology/approach - Researchers applied a general model of complex adaptive systems plus two specific conceptual frameworks (realist evaluation and system dynamics mapping) to define and study enablers and constraints. Focus group sessions and interviews with clinicians, executives, managers and board members were validated through an online survey. Findings - The functional themes for managing large-scale clinical change included: creating a context to prepare clinicians for health system transformation initiatives; promoting shared clinical leadership; strengthening knowledge management, strategic communications and opportunities for networking; and clearing pathways through the complexity of a multilevel, dynamic system. Research limitations/implications - The action research methodology was designed to guide continuing improvement of implementation. A sample of initiatives was selected; it was not intended to compare and contrast facilitators and barriers across all initiatives and regions. Similarly, evaluating the results or process of guideline implementation was outside the scope; the methods were designed to enable conversations at multiple levels - policy, management and practice - about how to improve implementation. The study is best seen as a case study of LSC, offering a possible model for replication by others and a tool to shape further dialogue. Practical implications - Recommended action-oriented strategies included engaging local champions; supporting local adaptation for implementation of clinical guidelines; strengthening local teams to guide implementation; reducing

  7. Beyond the SYNTAX score--advantages and limitations of other risk assessment systems in left main percutaneous coronary intervention.

    Science.gov (United States)

    Capodanno, Davide

    2013-01-01

    Risk stratification is an emerging topic in the modern management of patients with left main disease referred for percutaneous coronary intervention (PCI). Recent years have witnessed an explosive multiplication of risk models for prognostic stratification in complex PCI. Many of this models deal with modification of the angiographic SYNTAX score, or seek to overcome its known pitfalls and limitations, including lack of clinical and functional information, inter- and intra-observer variabilities, and poor calibration. Risk scoring systems beyond the SYNTAX score may be classified into angiographic (residual SYNTAX score, coronary artery bypass grafting SYNTAX score), clinical (EuroSCORE I and II, ACEF score and modified ACEF scores), combined clinical and angiographic (Global Risk Classification, Clinical SYNTAX score, logistic Clinical SYNTAX score, SYNTAX score II) and functional (Functional SYNTAX score). This article reviews current concepts in risk modeling and explores the advantages and limitations of the alternatives to the SYNTAX score in patients undergoing left main PCI. 

  8. Performances of 27 MEDLINE systems tested by searches with clinical questions.

    OpenAIRE

    Haynes, R B; Walker, C J; McKibbon, K. A.; Johnston, M. E.; Willan, A R

    1994-01-01

    OBJECTIVE: To compare the performances of online and compact-disc (CD-ROM) versions of the National Library of Medicine's (NLM) MEDLINE database. DESIGN: Analytic survey. INTERVENTION: Clinical questions were drawn from 18 searches originally conducted spontaneously by clinicians from wards and clinics who had used Grateful Med Version 4.0. Clinicians' search strategies were translated to meet the specific requirements of 13 online and 14 CD-ROM MEDLINE systems. A senior librarian and vendors...

  9. Radiation dose optimization in coronary angiography and percutaneous coronary intervention (PCI). II. Clinical evaluation

    International Nuclear Information System (INIS)

    In a previous part of this study, the fluoroscopy dose rate was reduced in a cardiac catheterization laboratory. The objectives of the present study were to evaluate the effects in a clinical population undergoing percutaneous coronary intervention (PCI) of the dose-reducing measures detailed previously. Kerma area-product (KAP) values were first recorded for 154 patients undergoing PCI. Then, the fluoroscopy KAP rate was reduced from 44 to 16 mGy cm2/s by increasing filtration and reducing the image intensifier dose request. After this optimization, KAP was recorded for another 138 PCI procedures. After adjustment for differing proportions of combined procedures (coronary angiography+PCI), the total KAP was reduced to 67% of the original value with a 95% confidence interval from 57 to 78%, statistically significant. The mean total KAP values were 93.6 Gy cm2 before and 69.1 Gy cm2 after optimization. The KAP for digital acquisition did not change significantly. It is possible to make a large dose reduction in PCI by reducing the fluoroscopy dose rate. This dose reduction is beneficial for both patients and staff. (orig.)

  10. Radiation dose optimization in coronary angiography and percutaneous coronary intervention (PCI). II. Clinical evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Geijer, Haakan; Andersson, Torbjoern [Department of Radiology, Oerebro University Hospital, 701 85 Oerebro (Sweden); Beckman, Karl-Wilhelm; Persliden, Jan [Department of Medical Physics, Oerebro University Hospital, 701 85 Oerebro (Sweden)

    2002-11-01

    In a previous part of this study, the fluoroscopy dose rate was reduced in a cardiac catheterization laboratory. The objectives of the present study were to evaluate the effects in a clinical population undergoing percutaneous coronary intervention (PCI) of the dose-reducing measures detailed previously. Kerma area-product (KAP) values were first recorded for 154 patients undergoing PCI. Then, the fluoroscopy KAP rate was reduced from 44 to 16 mGy cm{sup 2}/s by increasing filtration and reducing the image intensifier dose request. After this optimization, KAP was recorded for another 138 PCI procedures. After adjustment for differing proportions of combined procedures (coronary angiography+PCI), the total KAP was reduced to 67% of the original value with a 95% confidence interval from 57 to 78%, statistically significant. The mean total KAP values were 93.6 Gy cm{sup 2} before and 69.1 Gy cm{sup 2} after optimization. The KAP for digital acquisition did not change significantly. It is possible to make a large dose reduction in PCI by reducing the fluoroscopy dose rate. This dose reduction is beneficial for both patients and staff. (orig.)

  11. Interventional MRI: update

    Energy Technology Data Exchange (ETDEWEB)

    Lufkin, R.B. [Department of Radiology, University of California Los Angeles, School of Medicine, 10 833 Le Comte Avenue, Los Angeles, CA 90024-1721 (United States); Gronemeyer, D.H.W.; Seibel, R.M.M. [Institute of Diagnostic and Interventional Radiology, Medical Computerscience, University Witten/Herdecke (Germany)

    1997-12-31

    Interventional MRI is in its early stages of development. Nevertheless, the design of new interventional MRI scanners that allow maximum direct access to the patient combined with the development of new interventional MRI pulse sequences and localization systems, means that the archetypal operating rooms of the 21st century may well contain dedicated interventional MRI units for combined radiological and surgical procedures. The present article looks at the state of interventional MRI today and looks ahead to what may be forthcoming in the not-too-distant future. After briefly discussing the instrumentation necessary for practical interventional MRI, the article will go on to describe a number of different approaches to, and clinical applications for, interventional MRI. The use of MRI in guiding and controlling tumor ablation, aspiration cytology and surgical biopsy of different body parts is described. (orig.) With 13 figs., 1 tab., 114 refs.

  12. A Fully Sensorized Cooperative Robotic System for Surgical Interventions

    Science.gov (United States)

    Tovar-Arriaga, Saúl; Vargas, José Emilio; Ramos, Juan M.; Aceves, Marco A.; Gorrostieta, Efren; Kalender, Willi A.

    2012-01-01

    In this research a fully sensorized cooperative robot system for manipulation of needles is presented. The setup consists of a DLR/KUKA Light Weight Robot III especially designed for safe human/robot interaction, a FD-CT robot-driven angiographic C-arm system, and a navigation camera. Also, new control strategies for robot manipulation in the clinical environment are introduced. A method for fast calibration of the involved components and the preliminary accuracy tests of the whole possible errors chain are presented. Calibration of the robot with the navigation system has a residual error of 0.81 mm (rms) with a standard deviation of ±0.41 mm. The accuracy of the robotic system while targeting fixed points at different positions within the workspace is of 1.2 mm (rms) with a standard deviation of ±0.4 mm. After calibration, and due to close loop control, the absolute positioning accuracy was reduced to the navigation camera accuracy which is of 0.35 mm (rms). The implemented control allows the robot to compensate for small patient movements. PMID:23012551

  13. A Fully Sensorized Cooperative Robotic System for Surgical Interventions

    Directory of Open Access Journals (Sweden)

    Saúl Tovar-Arriaga

    2012-07-01

    Full Text Available In this research a fully sensorized cooperative robot system for manipulation of needles is presented. The setup consists of a DLR/KUKA Light Weight Robot III especially designed for safe human/robot interaction, a FD-CT robot-driven angiographic C-arm system, and a navigation camera. Also, new control strategies for robot manipulation in the clinical environment are introduced. A method for fast calibration of the involved components and the preliminary accuracy tests of the whole possible errors chain are presented. Calibration of the robot with the navigation system has a residual error of 0.81 mm (rms with a standard deviation of ±0.41 mm. The accuracy of the robotic system while targeting fixed points at different positions within the workspace is of 1.2 mm (rms with a standard deviation of ±0.4 mm. After calibration, and due to close loop control, the absolute positioning accuracy was reduced to the navigation camera accuracy which is of 0.35 mm (rms. The implemented control allows the robot to compensate for small patient movements.

  14. The Effects of Music Intervention on Background Pain and Anxiety in Burn Patients: Randomized Controlled Clinical Trial.

    Science.gov (United States)

    Najafi Ghezeljeh, Tahereh; Mohades Ardebili, Fatimah; Rafii, Forough; Haghani, Hamid

    2016-01-01

    This study aimed to investigate the effect of music on the background pain, anxiety, and relaxation levels in burn patients. In this pretest-posttest randomized controlled clinical trial, 100 hospitalized burn patients were selected through convenience sampling. Subjects randomly assigned to music and control groups. Data related to demographic and clinical characteristics, analgesics, and physiologic measures were collected by researcher-made tools. Visual analog scale was used to determine pain, anxiety, and relaxation levels before and after the intervention in 3 consecutive days. Patients' preferred music was offered once a day for 3 days. The control group only received routine care. Data were analyzed using SPSS-PC (V. 20.0). According to paired t-test, there were significant differences between mean scores of pain (P music group. Independent t-test indicated a significant difference between the mean scores of changes in pain, anxiety, and relaxation levels before and after intervention in music and control groups (P music intervention. Music is an inexpensive, appropriate, and safe intervention for applying to burn patients with background pain and anxiety at rest. To produce more effective comfort for patients, it is necessary to compare different types and time lengths of music intervention to find the best approach. PMID:26132048

  15. Radiation dose reduction and new image modalities development for interventional C-arm imaging system

    Science.gov (United States)

    Niu, Kai

    Cardiovascular disease and stroke are the leading health problems and causes of death in the US. Due to the minimally invasive nature of the evolution of image guided techniques, interventional radiological procedures are becoming more common and are preferred in treating many cardiovascular diseases and strokes. In addition, with the recent advances in hardware and device technology, the speed and efficacy of interventional treatment has significantly improved. This implies that more image modalities can be developed based on the current C-arm system and patients treated in interventional suites can potentially experience better health outcomes. However, during the treatment patients are irradiated with substantial amounts of ionizing radiation with a high dose rate (digital subtraction angiography (DSA) with 3muGy/frame and 3D cone beam CT image with 0.36muGy/frame for a Siemens Artis Zee biplane system) and/or a long irradiation time (a roadmapping image sequence can be as long as one hour during aneurysm embolization). As a result, the patient entrance dose is extremely high. Despite the fact that the radiation dose is already substantial, image quality is not always satisfactory. By default a temporal average is used in roadmapping images to overcome poor image quality, but this technique can result in motion blurred images. Therefore, reducing radiation dose while maintaining or even improving the image quality is an important area for continued research. This thesis is focused on improving the clinical applications of C-arm cone beam CT systems in two ways: (1) Improve the performance of current image modalities on the C-arm system. (2) Develop new image modalities based on the current system. To be more specific, the objectives are to reduce radiation dose for current modalities (e.g., DSA, fluoroscopy, roadmapping, and cone beam CT) and enable cone beam CT perfusion and time resolved cone beam CT angiography that can be used to diagnose and triage acute

  16. Multispectral photoacoustic imaging of nerves with a clinical ultrasound system

    Science.gov (United States)

    Mari, Jean Martial; West, Simeon; Beard, Paul C.; Desjardins, Adrien E.

    2014-03-01

    Accurate and efficient identification of nerves is of great importance during many ultrasound-guided clinical procedures, including nerve blocks and prostate biopsies. It can be challenging to visualise nerves with conventional ultrasound imaging, however. One of the challenges is that nerves can have very similar appearances to nearby structures such as tendons. Several recent studies have highlighted the potential of near-infrared optical spectroscopy for differentiating nerves and adjacent tissues, as this modality can be sensitive to optical absorption of lipids that are present in intra- and extra-neural adipose tissue and in the myelin sheaths. These studies were limited to point measurements, however. In this pilot study, a custom photoacoustic system with a clinical ultrasound imaging probe was used to acquire multi-spectral photoacoustic images of nerves and tendons from swine ex vivo, across the wavelength range of 1100 to 1300 nm. Photoacoustic images were processed and overlaid in colour onto co-registered conventional ultrasound images that were acquired with the same imaging probe. A pronounced optical absorption peak centred at 1210 nm was observed in the photoacoustic signals obtained from nerves, and it was absent in those obtained from tendons. This absorption peak, which is consistent with the presence of lipids, provides a novel image contrast mechanism to significantly enhance the visualization of nerves. In particular, image contrast for nerves was up to 5.5 times greater with photoacoustic imaging (0.82 +/- 0.15) than with conventional ultrasound imaging (0.148 +/- 0.002), with a maximum contrast of 0.95 +/- 0.02 obtained in photoacoustic mode. This pilot study demonstrates the potential of photoacoustic imaging to improve clinical outcomes in ultrasound-guided interventions in regional anaesthesia and interventional oncology.

  17. Cancer and Anorexia Nervosa in the Adolescence: A Family-Based Systemic Intervention

    Directory of Open Access Journals (Sweden)

    Gabriella De Benedetta

    2011-01-01

    Full Text Available Objective. Anorexia nervosa is difficult to diagnose in cancer patients since weight loss, aversion for food, and eating disturbances are frequent in patients undergoing chemotherapy and radiotherapy. Nevertheless, efforts are mandatory to recognize and manage this condition which may occur also in cancer patients with a special regard to adolescents. Methods. Through the clinical history of Anna, a 15-year-old adolescent with advanced cancer, we describe the effectiveness of a family-based systemic intervention to manage anorexia nervosa occurring in concomitance to osteosarcoma. Results. Through a two-year psychotherapy period involving different techniques applied to the whole family such as family genogram, family collage, and sculpture of family time, Anna was relieved from her condition. Conclusions. Upon early diagnosis and appropriate treatment, anorexia nervosa can be effectively approached in adolescent cancer patients. The presence of a life-threatening medical condition such as cancer may provide motivation for a patient to control disordered eating behavior in the context of an appropriate family-based systemic intervention. The general frame of anorexia occurring in cancer-bearing adolescents is reviewed and discussed.

  18. Reduction of hypoglycaemic events with a behavioural intervention: a randomized clinical trial for paediatric patients with Type 1 diabetes mellitus

    Science.gov (United States)

    Gee, B. T.; Nansel, T. R.; Liu, A.

    2015-01-01

    Aims To determine if a low-intensity, clinic-integrated behavioural intervention reduced the incidence of hypoglycaemic events in children with Type 1 diabetes. Methods A total of 390 families with children with Type 1 diabetes were enrolled in a 2-year, randomized clinical trial of a behavioural intervention. The intervention was designed to improve diabetes management practices by targeting the family’s diabetes problem-solving skills. Hypoglycaemic events were categorized in two groups: those treated by oral ingestion and those treated by parenteral therapy. Events were self-reported by participants at each clinic visit, which occurred approximately every 3–4 months. Analyses included two-sample t-tests, the mean cumulative function test, and the Cox proportional hazards model for recurrent events to compare the incidence between groups. Results Across the entire 2-year study period, the incidence of hypoglycaemic events treated by oral ingestion of glucose-rich foods and events requiring parenteral therapy did not significantly differ between study conditions; however, during the second year of participant enrolment, the incidence of events treated by oral ingestion in the intervention group was 13.6 per 100 person-years compared with 27.3 per 100 patient-years in the control group (P = 0.02). The hazard ratio of these events during the second year was 0.49 (95% CI 0.27–0.90; P = 0.02). Conclusions Our findings suggest the need for a long-term (> 1 year) focus on the implementation of interventions targeting diabetes management in young people. Behavioural interventions targeting problem-solving skills could be considered as practical, non-pharmacological strategies to reduce hypoglycaemia in adolescents with Type 1 diabetes. PMID:25763988

  19. Clinical and subclinical mastitis in smallholder dairy farms in Tanzania: risk, intervention and knowledge transfer.

    Science.gov (United States)

    Karimuribo, E D; Fitzpatrick, J L; Bell, C E; Swai, E S; Kambarage, D M; Ogden, N H; Bryant, M J; French, N P

    2006-04-17

    In a cross-sectional study of 400 randomly selected smallholder dairy farms in the Tanga and Iringa regions of Tanzania, 14.2% (95% confidence interval (CI)=11.6-17.3) of cows had developed clinical mastitis during the previous year. The point prevalence of subclinical mastitis, defined as a quarter positive by the California Mastitis Test (CMT) or by bacteriological culture, was 46.2% (95% CI=43.6-48.8) and 24.3% (95% CI=22.2-26.6), respectively. In a longitudinal disease study in Iringa, the incidence of clinical mastitis was 31.7 cases per 100 cow-years. A randomised intervention trial indicated that intramammary antibiotics significantly reduced the proportion of bacteriologically positive quarters in the short-term (14 days post-infusion) but teat dipping had no detectable effect on bacteriological infection and CMT positive quarters. Other risk and protective factors were identified from both the cross-sectional and longitudinal included animals with Boran breeding (odds ratio (OR)=3.40, 95% CI=1.00-11.57, Pmastitis, and OR=3.51, 95% CI=1.29-9.55, PCMT positive quarter), while the practice of residual calf suckling was protective for a bacteriologically positive quarter (OR=0.63, 95% CI=0.48-0.81, PCMT positive quarter (OR=0.69, 95% CI=0.63-0.75, Pmastitis training course for farmers and extension officers was held, and the knowledge gained and use of different methods of dissemination were assessed over time. In a subsequent randomised controlled trial, there were strong associations between knowledge gained and both the individual question asked and the combination of dissemination methods (village meeting, video and handout) used. This study demonstrated that both clinical and subclinical mastitis is common in smallholder dairying in Tanzania, and that some of the risk and protective factors for mastitis can be addressed by practical management of dairy cows following effective knowledge transfer. PMID:16488030

  20. Review of VA/DOD Clinical Practice Guideline on management of acute stress and interventions to prevent posttraumatic stress disorder

    Directory of Open Access Journals (Sweden)

    William P. Nash, MD

    2012-06-01

    Full Text Available This article summarizes the recommendations of the Department of Veterans Affairs (VA/Department of Defense (DOD VA/DOD Clinical Practice Guideline for Management of Post-Traumatic Stress that pertain to acute stress and the prevention of posttraumatic stress disorder, including screening and early interventions for acute stress states in various settings. Recommended interventions during the first 4 days after a potentially traumatic event include attending to safety and basic needs and providing access to physical, emotional, and social resources. Psychological first aid is recommended for management of acute stress, while psychological debriefing is discouraged. Further medical and psychiatric assessment and provision of brief, trauma-focused cognitive-behavioral therapy are warranted if clinically significant distress or functional impairment persists or worsens after 2 days or if the criteria for a diagnosis of acute stress disorder are met. Follow-up monitoring and rescreening are endorsed for at least 6 months for everyone who experiences significant acute posttraumatic stress. Four interventions that illustrate early intervention principles contained in the VA/DOD Clinical Practice Guideline are described.

  1. Effect of the “spiritual support” Intervention on spirituality and the clinical parameters of women who have undergone mastectomy: a pilot study

    OpenAIRE

    Caroline Guilherme; Gabriela Roberta Ribeiro; Sílvia Caldeira; Cristina Mara Zamarioli; Ana Railka de Souza Oliveira-Kumakura; Ana Maria de Almeida; Emilia Campos de Carvalho

    2016-01-01

    This study aimed to evaluate the effect of the spiritual support intervention on spirituality and the clinical parameters of women who have undergone mastectomy. This is a pilot study of a randomized clinical trial. The spiritual support intervention was composed of meditation, guided imagery, music, and respiratory relaxation. The outcomes were: spirituality, blood pressure, heart rate, and oxygen saturation. A total of 27 patients were recruited for the study (intervention group, n = 13; co...

  2. Integration of priority population, health and nutrition interventions into health systems: systematic review

    Directory of Open Access Journals (Sweden)

    Adeyi Olusoji

    2011-10-01

    Full Text Available Abstract Background Objective of the study was to assess the effects of strategies to integrate targeted priority population, health and nutrition interventions into health systems on patient health outcomes and health system effectiveness and thus to compare integrated and non-integrated health programmes. Methods Systematic review using Cochrane methodology of analysing randomised trials, controlled before-and-after and interrupted time series studies. We defined specific strategies to search PubMed, CENTRAL and the Cochrane Effective Practice and Organisation of Care Group register, considered studies published from January 1998 until September 2008, and tracked references and citations. Two reviewers independently agreed on eligibility, with an additional arbiter as needed, and extracted information on outcomes: primary (improved health, financial protection, and user satisfaction and secondary (improved population coverage, access to health services, efficiency, and quality using standardised, pre-piloted forms. Two reviewers in the final stage of selection jointly assessed quality of all selected studies using the GRADE criteria. Results Of 8,274 citations identified 12 studies met inclusion criteria. Four studies compared the benefits of Integrated Management of Childhood Illnesses in Tanzania and Bangladesh, showing improved care management and higher utilisation of health facilities at no additional cost. Eight studies focused on integrated delivery of mental health and substance abuse services in the United Kingdom and United States of America. Integrated service delivery resulted in better clinical outcomes and greater reduction of substance abuse in specific sub-groups of patients, with no significant difference found overall. Quality of care, patient satisfaction, and treatment engagement were higher in integrated delivery models. Conclusions Targeted priority population health interventions we identified led to improved health

  3. Development of a Multilevel Intervention to Increase HIV Clinical Trial Participation among Rural Minorities

    OpenAIRE

    Corbie-Smith, Giselle; Odeneye, Ebun; Banks, Bahby; Miles, Margaret Shandor; Isler, Malika Roman

    2012-01-01

    Minorities are disproportionately affected by HIV/AIDS in the rural Southeast; therefore, it is important to develop targeted, culturally appropriate interventions to support rural minority participation in HIV/AIDS research. Using Intervention Mapping, we developed a comprehensive multilevel intervention for service providers (SPs) and people living with HIV/AIDS (PLWHA). We collected data from both groups through 11 focus groups and 35 individual interviews. Resultant data were used to deve...

  4. Progression to multi-scale models and the application to food system intervention strategies.

    Science.gov (United States)

    Gröhn, Yrjö T

    2015-02-01

    The aim of this article is to discuss how the systems science approach can be used to optimize intervention strategies in food animal systems. It advocates the idea that the challenges of maintaining a safe food supply are best addressed by integrating modeling and mathematics with biological studies critical to formulation of public policy to address these challenges. Much information on the biology and epidemiology of food animal systems has been characterized through single-discipline methods, but until now this information has not been thoroughly utilized in a fully integrated manner. The examples are drawn from our current research. The first, explained in depth, uses clinical mastitis to introduce the concept of dynamic programming to optimize management decisions in dairy cows (also introducing the curse of dimensionality problem). In the second example, a compartmental epidemic model for Johne's disease with different intervention strategies is optimized. The goal of the optimization strategy depends on whether there is a relationship between Johne's and Crohn's disease. If so, optimization is based on eradication of infection; if not, it is based on the cow's performance only (i.e., economic optimization, similar to the mastitis example). The third example focuses on food safety to introduce risk assessment using Listeria monocytogenes and Salmonella Typhimurium. The last example, practical interventions to effectively manage antibiotic resistance in beef and dairy cattle systems, introduces meta-population modeling that accounts for bacterial growth not only in the host (cow), but also in the cow's feed, drinking water and the housing environment. Each example stresses the need to progress toward multi-scale modeling. The article ends with examples of multi-scale systems, from food supply systems to Johne's disease. Reducing the consequences of foodborne illnesses (i.e., minimizing disease occurrence and associated costs) can only occur through an

  5. Clinical decision support system in dental implantology

    Directory of Open Access Journals (Sweden)

    Alexandra Polášková

    2013-06-01

    Full Text Available Implantology is rapidly developing interdisciplinary field providing enormous amounts of data to be classified, evaluated and interpreted. The analysis of clinical data remains a big challenge, because each new system has specific requirements. The aim of study was prepare specific tool for treatment planning. Decision support system is built on Expert system. It is interactive software which provides clinical recommendations and treatment planning. Expert systems are knowledge-based computer programs designed to provide assistance in diagnosis and treatment planning. These systems are used for health care (dentistry, medicine, pharmacy etc.. The application contained the medical history analysis to obtaining information useful in formulating a diagnosis and providing implant insertion and prosthetic reconstruction to the patient; the diagnostic examination of dental implant procedure; implant positioning diagnosis – 3-D measurement; diagnostic information for treatment planning; treatment plan in the form of objective measurement of implant placement that helps surgeon and prosthodontics. The decision algorithm implemented by programming language is used. Core of program is an expert knowledge programming like a decision tree. The analysis of the decision-making process for implant treatment in general practice is prepared and analyzed.

  6. Low omega-6 vs. low omega-6 plus high omega-3 dietary intervention for Chronic Daily Headache: Protocol for a randomized clinical trial

    Directory of Open Access Journals (Sweden)

    Smith Sunyata

    2011-04-01

    Full Text Available Abstract Background Targeted analgesic dietary interventions are a promising strategy for alleviating pain and improving quality of life in patients with persistent pain syndromes, such as chronic daily headache (CDH. High intakes of the omega-6 (n-6 polyunsaturated fatty acids (PUFAs, linoleic acid (LA and arachidonic acid (AA may promote physical pain by increasing the abundance, and subsequent metabolism, of LA and AA in immune and nervous system tissues. Here we describe methodology for an ongoing randomized clinical trial comparing the metabolic and clinical effects of a low n-6, average n-3 PUFA diet, to the effects of a low n-6 plus high n-3 PUFA diet, in patients with CDH. Our primary aim is to determine if: A both diets reduce n-6 PUFAs in plasma and erythrocyte lipid pools, compared to baseline; and B the low n-6 plus high n-3 diet produces a greater decline in n-6 PUFAs, compared to the low n-6 diet alone. Secondary clinical outcomes include headache-specific quality-of-life, and headache frequency and intensity. Methods Adults meeting the International Classification of Headache Disorders criteria for CDH are included. After a 6-week baseline phase, participants are randomized to a low n-6 diet, or a low n-6 plus high n-3 diet, for 12 weeks. Foods meeting nutrient intake targets are provided for 2 meals and 2 snacks per day. A research dietitian provides intensive dietary counseling at 2-week intervals. Web-based intervention materials complement dietitian advice. Blood and clinical outcome data are collected every 4 weeks. Results Subject recruitment and retention has been excellent; 35 of 40 randomized participants completed the 12-week intervention. Preliminary blinded analysis of composite data from the first 20 participants found significant reductions in erythrocyte n-6 LA, AA and %n-6 in HUFA, and increases in n-3 EPA, DHA and the omega-3 index, indicating adherence. Trial Registration ClinicalTrials.gov (NCT01157208

  7. Peer assisted learning in the clinical setting: an activity systems analysis.

    Science.gov (United States)

    Bennett, Deirdre; O'Flynn, Siun; Kelly, Martina

    2015-08-01

    Peer assisted learning (PAL) is a common feature of medical education. Understanding of PAL has been based on processes and outcomes in controlled settings, such as clinical skills labs. PAL in the clinical setting, a complex learning environment, requires fresh evaluation. Socio-cultural theory is proposed as a means to understand educational interventions in ways that are practical and meaningful. We describe the evaluation of a PAL intervention, introduced to support students' transition into full time clinical attachments, using activity theory and activity systems analysis (ASA). Our research question was How does PAL transfer to the clinical environment? Junior students on their first clinical attachments undertook a weekly same-level, reciprocal PAL activity. Qualitative data was collected after each session, and focus groups (n = 3) were held on completion. Data was analysed using ASA. ASA revealed two competing activity systems on clinical attachment; Learning from Experts, which students saw as the primary function of the attachment and Learning with Peers, the PAL intervention. The latter took time from the first and was in tension with it. Tensions arose from student beliefs about how learning takes place in clinical settings, and the importance of social relationships, leading to variable engagement with PAL. Differing perspectives within the group were opportunities for expansive learning. PAL in the clinical environment presents challenges specific to that context. Using ASA helped to describe student activity on clinical attachment and to highlight tensions and contradictions relating PAL in that setting. Planning learning opportunities on clinical placements, must take account of how students learn in workplaces, and the complexity of the multiple competing activity systems related to learning and social activities.

  8. Brief intervention for alcohol misuse in people attending sexual health clinics: study protocol for a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Sanatinia Rahil

    2012-08-01

    Full Text Available Abstract Background Over the last 30 years the number of people who drink alcohol at harmful levels has increased in many countries. There have also been large increases in rates of sexually transmitted infections. Available evidence suggests that excessive alcohol consumption and poor sexual health may be linked. The prevalence of harmful alcohol use is higher among people attending sexual health clinics than in the general population, and a third of those attending clinics state that alcohol use affects whether they have unprotected sex. Previous research has demonstrated that brief intervention for alcohol misuse in other medical settings can lead to behavioral change, but the clinical- and cost-effectiveness of this intervention on sexual behavior have not been examined. Methods We will conduct a two parallel-arm, randomized trial. A consecutive sample of people attending three sexual health clinics in London and willing to participate in the study will be screened for excessive alcohol consumption. Participants identified as drinking excessively will then be allocated to either active treatment (Brief Advice and referral for Brief Intervention or control treatment (a leaflet on healthy living. Randomization will be via an independent and remote telephone randomization service and will be stratified by study clinic. Brief Advice will comprise feedback on the possible health consequences of excessive alcohol consumption, written information about alcohol and the offer of an appointment for further assessment and Brief Intervention. Follow-up data on alcohol use, sexual behavior, health related quality of life and service use will be collected by a researcher masked to allocation status six months later. The primary outcome for the study is mean weekly alcohol consumption during the previous three months, and the main secondary outcome is the proportion of participants who report unprotected sex during this period. Discussion Opportunistic

  9. Obstructive sleep apnea affects the clinical outcomes of patients undergoing percutaneous coronary intervention

    Science.gov (United States)

    Zhang, Jun-jie; Gao, Xiao-fei; Ge, Zhen; Jiang, Xiao-Min; Xiao, Ping-xi; Tian, Nai-liang; Kan, Jing; Lee, Chi-Hang; Chen, Shao-Liang

    2016-01-01

    Background There is a paucity of evidence regarding the association between obstructive sleep apnea (OSA) and patients undergoing percutaneous coronary intervention (PCI) for coronary artery disease. We sought to investigate whether OSA affects the clinical outcomes of patients undergoing PCI. Patients and methods All enrolled individuals treated with PCI were evaluated for OSA by polysomnography. The primary end point was defined as major adverse cardiac events (MACEs) at 2 years, including cardiac death, myocardial infarction (MI), and/or target vessel revascularization. Results A total of 340 consecutive patients undergoing PCI were assigned to the OSA (n=152, apnea–hypopnea index ≥15) and non-OSA (n=188, apnea–hypopnea index <15) groups. The incidence of OSA in patients with coronary artery disease undergoing PCI was 44.7%. Patients in the OSA group had more three-vessel disease (34.9%), increased number of total implanted stents (3.3±2.0), and longer total stent length (83.8±53.1 mm) when compared to the non-OSA group (23.4%, P=0.020; 2.8±1.9, P=0.007; 68.7±48.4, P=0.010). After a median follow-up of 2 years, the incidence of MACEs was significantly higher in patients with OSA (25.0% vs 16.0%, P=0.038), mainly driven by the increased periprocedural MI (19.2% vs 11.2%, P=0.038) in the OSA group. By Cox regression multivariable analysis, the independent predictor of MACEs was OSA (hazard ratio: 1.962, 95% confidence interval: 1.036–3.717, P=0.039). Conclusion There was a high prevalence of moderate-to-severe OSA in patients undergoing PCI, and OSA was associated with significantly increased MACE rate, mainly due to the increase in periprocedural MI rate. PMID:27284240

  10. System for clinical photometric stereo endoscopy

    Science.gov (United States)

    Durr, Nicholas J.; González, Germán.; Lim, Daryl; Traverso, Giovanni; Nishioka, Norman S.; Vakoc, Benjamin J.; Parot, Vicente

    2014-02-01

    Photometric stereo endoscopy is a technique that captures information about the high-spatial-frequency topography of the field of view simultaneously with a conventional color image. Here we describe a system that will enable photometric stereo endoscopy to be clinically evaluated in the large intestine of human patients. The clinical photometric stereo endoscopy system consists of a commercial gastroscope, a commercial video processor, an image capturing and processing unit, custom synchronization electronics, white light LEDs, a set of four fibers with diffusing tips, and an alignment cap. The custom pieces that come into contact with the patient are composed of biocompatible materials that can be sterilized before use. The components can then be assembled in the endoscopy suite before use. The resulting endoscope has the same outer diameter as a conventional colonoscope (14 mm), plugs into a commercial video processor, captures topography and color images at 15 Hz, and displays the conventional color image to the gastroenterologist in real-time. We show that this system can capture a color and topographical video in a tubular colon phantom, demonstrating robustness to complex geometries and motion. The reported system is suitable for in vivo evaluation of photometric stereo endoscopy in the human large intestine.

  11. 交叉过敏的临床药学干预%Clinical Pharmacological Intervention on Cross Allergy

    Institute of Scientific and Technical Information of China (English)

    严磊; 寿军; 周权; 王华芬

    2012-01-01

    OBJECTIVE To promote the clinical awareness of cross allergy and prevent the occurrence of medical errors. METHODS Prescribing information on cross allergy in "Contraindications" was derived from a software. Records of drug counseling, cases of medical errors and near misses in an online reporting system were analyzed. Data mining was performed. Clinical pharmacological interventions were conducted and the effects were evaluated. RESULTS Besides 27 kinds of drugs within pharmacologically similar class involving cross allergy, there were seven kinds of drugs with complete different pharmacological effects. Similarity in chemical structures was the main case of cross allergy. Excipients were related with cross allergy. Prescribing information in some drugs had unscientific descriptions on cross allergy associated contraindications, lacking clinical value in guiding safe use of medication. There were difference in descriptions on cross allergy in some drugs within pharmacologically similar clas, and some domestic and imported products. The problem of cross allergy of drugs involving different pharmacological effects was dangerous and not easy to be detected. After pharmacological interventions, awareness was greatly increased and the occurrence rate of medical errors and similar mistake decreased by 97%. CONCLISION Severe potential safety hazard might exist if more attentions are not paid to cross allergy aspect. The comprehensive pharmacological interventions are very effective. Applications of information technology and data maintenance are pivotal for continuous quality improvement in cross allergy aspect.%目的 促进临床医护人员对药物交叉过敏的意识,防范用药失误发生.方法 对药物说明书禁忌症中有关交叉过敏的描述进行信息分析和数据挖掘.对药物咨询、用药失误和近似错误在线呈报系统记录进行分析.实施临床药学综合性干预措施,并评估干预效果.结果 除药理作用相似的27

  12. 交叉过敏的临床药学干预%Clinical pharmacological intervention on cross allergy

    Institute of Scientific and Technical Information of China (English)

    刘玉根

    2013-01-01

    Objective To strengthen the clinical awareness of cross allergy and to reduce the incidence rate of incorrect uses of medicines.Methods The previous records of medication counseling,incorrect uses of medicines,and approximation errors in the online reporting system were analyzed.Data mining was performed.Prescribing information on cross allergy in "contraindications" was derived from a software.Clinical pharmacological interventions were conducted and the effects were evaluated.Results Similarity in chemical structures was the main cause of cross allergy.Besides 27 kinds of medications within pharmacologically similar class involving cross allergy,there were seven sorts with complete different pharmacological effects.Prescribing information on some medications had unscientific descriptions on cross allergy associated contraindications,lacking clinical value in guiding safe use of medication.There were difference in descriptions on cross allergy in some drugs within pharmacologically similar class,and some domesic and imported products.After pharmacological interventions,awareness was greatly increased; the occurrence rate of incorrect uses of medicines and approximation errors decreased.Conclusions Comprehensive pharmacological interventions is of very important significance in cross allergy.%目的 提高医务人员对于临床药物交叉过敏的防范意识,降低用药差错的发生率.方法 对用药咨询、用药失误以及近似错误的在线报告系统的以往记录进行统计分析,对药品说明书中禁忌症项关于交叉过敏症状的描述进行数据挖掘以及信息分析,并对医院实行临床药学干预的效果进行评估.结果 药物的化学结构相似是造成交叉过敏的主要因素.临床上易发生交叉过敏的药物除了27类药理作用相似的同类药品外,还有7类涉及多种药理作用类别的药物.有部分药物的禁忌症与交叉过敏有关的描述缺乏科学性,没有临床指导意义,部

  13. A new method of real-time skin dose visualization. Clinical evaluation of fluoroscopically guided interventions

    International Nuclear Information System (INIS)

    We have conducted a prospective study to clinically evaluate a new radiation dose observing tool that displays patient's peak skin dose (PSD) map in real time. The skin dose map (SDM) prototype quantifies the air kerma based on exposure parameters from the X-ray system. The accuracy of this prototype was evaluated with radiochromic films, which were used as a mean for PSD measurement. The SDM is a reliable tool that provides an accurate PSD estimation and location. SDM also has many advantages over the radiochromic films, such as real-time dose evaluation and easy access to critical operational parameters for physicians and technicians. (orig.)

  14. 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…

  15. Influence of Clinical and Sociodemographic Characteristics on Early Intervention Enrollment after NICU Discharge

    Science.gov (United States)

    Litt, Jonathan S.; Perrin, James M.

    2014-01-01

    This study aims to characterize participation of neonatal intensive care unit (NICU) graduates in early intervention (EI). We used data from the National Early Intervention Longitudinal Study. We fit models of days from referral to Individualized Family Service Plan creation (plan time), days from referral to initiation of services (service time),…

  16. EPA guidance on the early intervention in clinical high risk states of psychoses

    DEFF Research Database (Denmark)

    Schmidt, S J; Schultze-Lutter, F; Schimmelmann, B G;

    2015-01-01

    -analysis of current empirical evidence on the efficacy of psychological and pharmacological interventions in CHR samples. Eligible studies had to investigate conversion rate and/or functioning as a treatment outcome in CHR patients defined by the ultra-high risk and/or basic symptom criteria. Besides analyses...... on treatment effects on conversion rate and functional outcome, age and type of intervention were examined as potential moderators. Based on data from 15 studies (n=1394), early intervention generally produced significantly reduced conversion rates at 6- to 48-month follow-up compared to control conditions...... on conversion rates, but not on functional outcome relative to the control conditions. Early intervention in youth samples was generally less effective than in predominantly adult samples. Seven evidence-based recommendations for early intervention in CHR samples could have been formulated, although more...

  17. 高危儿早期干预临床效果研究%Clinical effect of early intervention on high-risk infants

    Institute of Scientific and Technical Information of China (English)

    林文玉; 陈钰; 热依拉木·玉山江; 杜文亮; 冯泰山

    2013-01-01

    [Objective] To investigate the measures and clinical effect of early intervention on high risk infants. [Methods] A total of 253 high risk infants, who were treated in Maternity and Children Health Care Hospital between December 2008 and June 2010,were divided into invention group (125) and non-intervention group (128). Meanwhile,another (105) healthy children form a control group. The invention group of high risk infants was given regular medical examination and intelligence test as early intervention. [Results] The intelligence and motor development in intervention group of high-risk infants were significantly higher than those in non-intervention group, and the sequela incidence in intervention group was significantly lower than that in non-intervention group. These differences had statistical significances (P0. 05). [Conclusions] Early intervention in risky children helps their intelligence development,reducing the sequela incidence of nervous system and improving the patient's life quality. Early intervention pattern is family-centered,simply operated and acceptable.%[目的] 探讨高危儿早期干预措施及其临床疗效. [方法] 将2008年12月-2010年06月就诊的253例高危儿随机分为干预组(125例)和未干预组(128例),并设立正常儿对照组(105例);对干预组高危儿实施早期干预,定期进行体格检查及智能发育测试. [结果] 干预组高危儿的智能发育及运动发育均明显高于未干预组,后遗症的发生率明显低于未干预组,差异均有统计学意义(P<0.05).干预组高危儿的智力发育及运动发育、后遗症的发生率与正常儿对照组比较差异均无统计学意义(P>0.05). [结论] 早期干预对高危儿的智能发育有明显的促进作用,并可减少神经系统后遗症的发生率,提高患儿的生活质量.早期干预模式以家庭为中心,方法简单、易行,易于接受.

  18. Responsiveness-to-Intervention: A "Systems" Approach to Instructional Adaptation

    Science.gov (United States)

    Fuchs, Douglas; Fuchs, Lynn S.

    2016-01-01

    Classroom research on adaptive teaching indicates few teachers modify instruction for at-risk students in a manner that benefits them. Responsiveness-To-Intervention, with its tiers of increasingly intensive instruction, represents an alternative approach to adaptive instruction that may prove more workable in today's schools.

  19. Great attention to the standard training and certification system for interventional neuroradiologist

    International Nuclear Information System (INIS)

    During the past decades, interventional neuroradiology has become one of the most important modalities for treatment of cerebral vascular diseases. Chinese doctors have made great progress in this field, and their diagnosis and treament have also reached the international level in some territories. Following the need of specialized development for interventional neuroradiology, more and more problems have arisen and even caused argument in this field. To resolve the issue and promote the healthy and fast development of interventional neuroradiology, it is time for us to formulate the standard training and certification system for interventional neuroradiologist. (authors)

  20. Improving understanding of clinical trial procedures among low literacy populations: an intervention within a microbicide trial in Malawi

    Directory of Open Access Journals (Sweden)

    Ndebele Paul M

    2012-11-01

    Full Text Available Abstract Background The intervention reported in this paper was a follow up to an empirical study conducted in Malawi with the aim of assessing trial participants’ understanding of randomisation, double-blinding and placebo use. In the empirical study, the majority of respondents (61.1%; n=124 obtained low scores (lower than 75% on understanding of all three concepts under study. Based on these findings, an intervention based on a narrative which included all three concepts and their personal implications was designed. The narrative used daily examples from the field of Agriculture because Malawi has an agro-based economy. Methods The intervention was tested using a sample of 36 women who had been identified as low scorers during the empirical study. The 36 low scorers were randomly assigned to control (n=18 and intervention arms (n=18. The control arm went through a session in which they were provided with standard informed consent information for the microbicide trial. The intervention arm went through a session in which they were provided with a narrative in ChiChewa, the local language, with the assistance of a power point presentation which included pictures as well as discussions on justification and personal implications of the concepts under study. Results The findings on the efficacy of the intervention suggest that the 3 scientific concepts and their personal implications can be understood by low literacy populations using simple language and everyday local examples. The findings also suggest that the intervention positively impacted on understanding of trial procedures under study, as 13 of the 18 women in the intervention arm, obtained high scores (above 75% during the post intervention assessment and none of the 18 in the control arm obtained a high score. Using Fischer’s exact test, it was confirmed that the effect of the intervention on understanding of the three procedures was statistically significant (p=0.0001. Conclusions

  1. Moderators of Efficacy for a Computer-Assisted Career Guidance System (CACGS) Intervention

    Science.gov (United States)

    McLaren, Molly Rae

    2013-01-01

    Research investigating career intervention efficacy has inadequately investigated the identification of important client factors which might moderate the effects of various career interventions. The current study had two aims. First it examined the efficacy of a newly developed Computer-Assisted Career Guidance System (CACGS) used alone, and the…

  2. Young Children with Disabilities in Israel: System of Early Intervention Service Delivery

    Science.gov (United States)

    Shulman, Cory; Meadan, Hedda; Sandhaus, Yoram

    2012-01-01

    This article aims to analyze early intervention programs in Israel according to the Developmental Systems Model (Guralnick, 2001), in an attempt to identify strengths and areas for further development for service delivery for young children with disabilities in Israel. Early intervention in Israel is part of a comprehensive healthcare model…

  3. ITI-system. Basic and clinical procedures.

    Science.gov (United States)

    Schroeder, A; Buser, D A

    1989-10-01

    Future development in implant prosthodontics should be based on the fundamentals of sound research and reliable clinical implementation. The goals should be to research the safety and efficacy of implants with regard to materials, host receptor site and interfacial zone; to develop acceptable uniform standards of evaluation; and to submit findings to scientific methods of analysis in determining benefit-to-risk factors. This presentation will offer a glimpse at some current developments in basic and clinical research focusing on studies in biocompatibility and host acceptance; the implant-tissue interface; processes in osteogenesis related to vascularization of host sites; and bioengineering studies related to stress analysis and dimensional accuracy of impression systems for implants. The presentation will further describe future directions in research, training and implementation of services through development of an interdisciplinary team. A center is proposed to address the need for combined efforts in clinical++ and basic science research, the broad scope of implant utilization, and the teaching of implant procedures within an academic setting and to our colleagues. PMID:2489296

  4. [Computerized system validation of clinical researches].

    Science.gov (United States)

    Yan, Charles; Chen, Feng; Xia, Jia-lai; Zheng, Qing-shan; Liu, Daniel

    2015-11-01

    Validation is a documented process that provides a high degree of assurance. The computer system does exactly and consistently what it is designed to do in a controlled manner throughout the life. The validation process begins with the system proposal/requirements definition, and continues application and maintenance until system retirement and retention of the e-records based on regulatory rules. The objective to do so is to clearly specify that each application of information technology fulfills its purpose. The computer system validation (CSV) is essential in clinical studies according to the GCP standard, meeting product's pre-determined attributes of the specifications, quality, safety and traceability. This paper describes how to perform the validation process and determine relevant stakeholders within an organization in the light of validation SOPs. Although a specific accountability in the implementation of the validation process might be outsourced, the ultimate responsibility of the CSV remains on the shoulder of the business process owner-sponsor. In order to show that the compliance of the system validation has been properly attained, it is essential to set up comprehensive validation procedures and maintain adequate documentations as well as training records. Quality of the system validation should be controlled using both QC and QA means. PMID:26911028

  5. The evidence-base for family therapy and systemic interventions for child-focused problems

    OpenAIRE

    Carr, Alan.

    2014-01-01

    This review updates similar articles published in the Journal of Family Therapy in 2001 and 2009. It presents evidence from meta-analyses, systematic literature reviews and controlled trials for the effectiveness of systemic interventions for families of children and adolescents with various difficulties. In this context, systemic interventions include both family therapy and other family-based approaches such as parent training. The evidence supports the effectiveness of systemic interventio...

  6. [Digital photograph storage systems in clinical dermatology].

    Science.gov (United States)

    Taberner, R; Contestí, T

    2010-05-01

    In recent years, digital photography has consolidated its role in clinical dermatology. In view of the quality and low cost of current equipment and the simplicity of digital storage, almost all dermatologists now use digital photography, which is also extremely versatile and readily applicable to teaching. However, to maximize its full potential, image retrieval must be available at any time and with the patient present. This requires a suitable storage system that may vary according to the characteristics of each center. Dermatologists must also find time to maintain and organize the digital archives. The present article describes current options in digital image storage and retrieval, ranging from multidepartmental picture archiving and communication systems at one end to image management freeware at the other, and also including dedicated dermatology software.

  7. Adherence to yoga and exercise interventions in a 6-month clinical trial

    OpenAIRE

    de Haas M; Zajdel D; Kishiyama S; Flegal KE; BS, Oken

    2007-01-01

    Abstract Background To determine factors that predict adherence to a mind-body intervention in a randomized trial. Design We analyzed adherence data from a 3-arm trial involving 135 generally healthy seniors 65–85 years of age randomized to a 6-month intervention consisting of: an Iyengar yoga class with home practice, an exercise class with home practice, or a wait-list control group. Outcome measures included cognitive function, mood, fatigue, anxiety, health-related quality of life, and ph...

  8. Contributions to clinical Occupational Therapy in the area of early intervention in interdisciplinary team

    OpenAIRE

    Dani Laura Peruzzolo; Luciéle Dias Oliveira; Magali Filheiro; Ana Paula Ramos de Souza

    2015-01-01

    Introduction: Specialized care for infants considers that the sooner the intervention in risk and symptoms occurs, the greater the possibility of obtaining better results. Aims: To describe the process of early intervention provided by an extension program of graduate studies in Occupational Therapy and Hearing, Speech and Languages Science courses and also discuss the theoretical and practical paths in the care for infants and in the Occupational Therapy area. Method: Case report with con...

  9. Pharmacotherapy optimization in older patients by a structured clinical pharmacist assessment and intervention

    OpenAIRE

    O'Sullivan, David

    2014-01-01

    Introduction: Older individuals are particularly vulnerable to potentially inappropriate prescribing (PIP), drug related problems (DRPs) and adverse drug reactions (ADRs). A number of different interventions have been proposed to address these issues. However to-date there is a paucity of well-designed trials examining the impact of such interventions. Therefore the aims of this work were to: (i) establish a baseline PIP prevalence both nationally and internationally using the STOPP, Beers an...

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

    NARCIS (Netherlands)

    Brouwers, JRBJ

    1996-01-01

    Advanced and controlled drug delivery systems are important for clinical disease management. In this review the most important new systems which have reached clinical application are highlighted. Microbiologically controlled drug delivery is important for gastrointestinal diseases like ulcerative co

  11. The immuno-dynamics of conflict intervention in social systems.

    Directory of Open Access Journals (Sweden)

    David C Krakauer

    Full Text Available We present statistical evidence and dynamical models for the management of conflict and a division of labor (task specialization in a primate society. Two broad intervention strategy classes are observed--a dyadic strategy--pacifying interventions, and a triadic strategy--policing interventions. These strategies, their respective degrees of specialization, and their consequences for conflict dynamics can be captured through empirically-grounded mathematical models inspired by immuno-dynamics. The spread of aggression, analogous to the proliferation of pathogens, is an epidemiological problem. We show analytically and computationally that policing is an efficient strategy as it requires only a small proportion of a population to police to reduce conflict contagion. Policing, but not pacifying, is capable of effectively eliminating conflict. These results suggest that despite implementation differences there might be universal features of conflict management mechanisms for reducing contagion-like dynamics that apply across biological and social levels. Our analyses further suggest that it can be profitable to conceive of conflict management strategies at the behavioral level as mechanisms of social immunity.

  12. Preliminary design of the database and registration system for the national malignant tumor interventional therapy

    International Nuclear Information System (INIS)

    Objective: This research is one of the sub-researches of 'The comparative study of the standards of interventional therapies and the evaluation of the long-term and middle-term effects for common malignant tumors', which is one of the National Key Technologies R and D Program in the eleventh five-year plan. Based on the project,the authors need to establish an international standard in order to set up the national tumor interventional therapy database and registration system. Methods: By using the computing programs of downloading software, self-management and automatic integration, the program was written by the JAVA words. Results: The database and registration system for the national tumor interventional therapy was successfully set up, and it could complete both the simple and complex inquiries. The software worked well through the initial debugging. Conclusion: The national tumor interventional therapy database and registration system can not only precisely tell the popularizing rate of the interventional therapy nationwide, compare the results of different methods, provide the latest news concerning the interventional therapy, subsequently promote the academic exchanges between hospitals, but also help us get the information about the distribution of the interventional physicians, the consuming quantity and variety of the interventional materials, so the medical costs can be reduced. (authors)

  13. Health effects of mixed fruit and vegetable concentrates: a systematic review of the clinical interventions.

    Science.gov (United States)

    Esfahani, Amin; Wong, Julia M W; Truan, Jennifer; Villa, Christopher R; Mirrahimi, Arash; Srichaikul, Korbua; Kendall, Cyril W C

    2011-10-01

    Diets rich in fruits and vegetables (FV) have been associated with a reduced risk of chronic disease, including cardiovascular disease. Unfortunately, public health campaigns to increase FV intake have had limited success. A number of mixed concentrated FV products have been studied, which may help certain individuals improve nutrient status. However, the possible health benefits of FV supplements have not been systematically reviewed. We, therefore, undertook a systematic search of MEDLINE and EMBASE to identify clinical interventions that examined the effect of commercially available concentrated mixed FV supplements on cardiovascular disease risk factors. Twenty-two reports, which used commercially available products, were identified. None of the studies reported any serious adverse effects. Overall, daily consumption of FV supplements significantly increased serum concentrations of the major antioxidant provitamins and vitamins found in plant foods (β-carotene, vitamins C and E) and folate. Functional changes, such as reduced serum homocysteine and markers of protein, lipid, and DNA oxidation, were also reported; in addition, the health advantages on markers of inflammation, immunity, and endothelial function are promising. Limitations of the available studies were related to the diversity of studies conducted with respect to design and study population and the variability in the measured outcomes and assays utilized. While mixed FV supplements may serve as an efficacious complement for individuals who have difficulty achieving their daily FV intake requirement, further research on additional retail preparations is warranted. Key teaching points: Mixed fruit and vegetable supplements produced from plant foods may serve as an efficacious complement to the habitual diet in individuals who have suboptimal intake or variety of nutrient-dense fruits and vegetables. Current research indicates that fruit and vegetable concentrates significantly increase serum levels

  14. 介入室X线电视系统下眶内及眶周金属异物摘出术的临床观察%Clinical Observation on the Excisions of Intraorbital and/or Periorbital Metallic Foreign Bodies Under the Teleroentgen System of Interventional Radiology Room

    Institute of Scientific and Technical Information of China (English)

    李杰; 阳艳萍; 毛正兴; 周伟玲; 邓柳燕

    2015-01-01

    Objective:To investigate the clinical effect of excisions of intraorbital and/or periorbital metallic foreign bodies with the help of teleroentgen system.Methods:Selecting 86 cases (86 eyes) of metallic foreign body patients in our hospital from July 2002 to July 2012.Individual surgical methods were made according to the imaging fetures got by teleroentgen system to extract the intraorbital and/or periorbital metallic foreign body through the skin or conjunctiva.Results:Foreign bodies of 86 patients were successfully removed,including 83 cases (96.5%) in one operation,and 3 cases (3.5%) in two operations.Over a period of 2 ~ 18 (9.2± 5.3) months follow-up,there were 62 patients (72.1%) whose eyesight reached the level as that before the operation,21 patients (24.4%) whose eyesight has been improved in the last follow-up.The eye movement disorders were observed in 34 cases (39.5%) and 16 cases (18.6%) in the last preoperative and postoperative follow-up respectively.And the traumatic ptosis were found in 5 cases (5.8%) and 3 cases (3.5%) in the preoperative and postoperative final follow up respectively.Conclusion:The surgical method which excisions ofintraorbital and/or periorbital metallic foreign bodies under the teleroentgen system of interventional radiology room with little intraorbital and periorbital tissue damage,shorter operative time and satisfactory results is easy to operate and worth promoting.%目的:探讨在介入室X线电视系统下摘出眶内及眶周金属异物的临床效果.方法:选择2002年7月至2012年7月我院收治的金属异物患者86例86只眼,在介入室X线电视系统直视引导下,根据影像学特点制定个体化手术方法,经皮肤或结膜进路摘出眶内及眶周金属异物.结果:86例均成功取出异物,其中一次手术取出83例(96.5%),二次手术取出3例(3.5%).随访2~18(9.2±5.3)月.末次随访时视力达术前水平62例(72.1%),视力提高21例(24.4%).术前及

  15. Clinical usefulness of the Vaughan Williams classification system.

    Science.gov (United States)

    Cobbe, S M

    1987-03-01

    The clinical usefulness of the Vaughan Williams classification scheme is limited by the complexity of the mechanisms of arrhythmia formation in man, which offer multiple potential sites for intervention. The properties of antiarrhythmic drugs may be considerably altered in abnormal myocardium. Despite these limitations, however, the classification provides a valuable conceptual framework for the understanding of the clinical electrophysiological properties of antiarrhythmic drugs and for their use.

  16. Clinical Decision Support Tools for Selecting Interventions for Patients with Disabling Musculoskeletal Disorders

    DEFF Research Database (Denmark)

    Gross, Douglas P; Armijo-Olivo, Susan; Shaw, William S;

    2016-01-01

    the research question; (2) identifying relevant studies; (3) selecting studies for analysis; (4) charting the data; and (5) collating, summarizing and reporting results. We considered computer-based, and other available tools, such as algorithms, care pathways, rules and models. Since this research crosses...... multiple disciplines, we searched health care, computing science and business databases. Results Our search resulted in 4605 manuscripts. Titles and abstracts were screened for relevance. The reliability of the screening process was high with an average percentage of agreement of 92.3 %. Of the located...... articles, 123 were considered relevant. Within this literature, there were 43 CDS tools located. These were classified into 3 main areas: computer-based tools/questionnaires (n = 8, 19 %), treatment algorithms/models (n = 14, 33 %), and clinical prediction rules/classification systems (n = 21, 49 %). Each...

  17. Clinical trials to estimate the efficacy of preventive interventions against malaria in paediatric populations: a methodological review

    Directory of Open Access Journals (Sweden)

    Reed Zarifah

    2009-02-01

    Full Text Available Abstract Background Recent years have seen publication of a considerable number of clinical trials of preventive interventions against clinical malaria in children. There has been variability in the specification of end-points, case definitions, analysis methods and reporting and the relative lack of standardization complicates the ability to make comparative evaluations between trials. Methods To prepare for a WHO consultation on design issues in malaria vaccine trials, controlled trials of preventive interventions against malaria in children in endemic countries were identified in which clinical malaria, or death, had been one of the main end-points. Trials were included that evaluated the impact of vaccines, insecticide-treated bed nets (ITN, intermittent presumptive or preventive therapy in infants (IPTi or, in one instance, vitamin A supplementation. Methods that had been used in these trials were summarized and compared in order to identify issues that were directly relevant to the design of malaria vaccine trials. Results 29 controlled trials of preventive malaria interventions were identified, of which eight were vaccine trials. Vaccine trials that were designed to detect an effect on clinical malaria all reported the incidence rate of first episodes of clinical malaria as their primary endpoint. Only one trial of a preventive intervention (of ITN was identified that was designed to detect an effect on severe malaria. A group of larger trials were designed to detect an effect of impregnated bed nets or curtains on all-cause mortality as the primary end-point. Key methodological and reporting differences between trials are noted in the text. Two issues have been identified that are of some concern. Firstly, the choice of primary endpoint is not stated in the reports of a number of the trials and, secondly, the relationship between pre-specified analysis plans and trial reports is rarely made clear. Conclusion This article reports an

  18. Brief Interventions implementation on alcohol from the European health systems perspective

    Directory of Open Access Journals (Sweden)

    Joan eColom

    2014-11-01

    Full Text Available Alcohol related health problems are important public health issues and alcohol remains one of the leading risk factors of chronic health conditions. In addition, only a small proportion of those who need treatment access it, with figures ranging from 1 in 25 to 1 in 7. In this context, Screening and Brief Interventions (SBI have proven to be effective in reducing alcohol consumption and alcohol related problems in primary health care (PHC and are very cost effective, or even cost-saving, in PHC. Even if the widespread implementation of SBI has been prioritized and encouraged by the WHO, in the global alcohol strategy, the evidence on long term and population level effects is still weak. This review study will summarize the SBI programs implemented by six European countries with different socio-economic contexts. Similar components at health professional level but differences at organizational level, especially on the measures to support clinical practice, incentives and monitoring systems developed were adopted. In Italy cost-effectiveness analyses and Internet trials shed new light on limits and facilitators of renewed, evidence-based approaches to better deal with brief intervention in PHC. The majority of the efforts were aimed at overcoming individual barriers and promoting health professionals’ involvement. The population screened have been in general too low to be able to detect any population level effect, with a negative impact on the acceptability of the program to all stakeholders.This paper will present a different point of view based on a strategic broadening of the implemented actions to real inter-sectoriality and a wider holistic approach. Effective alcohol policies should strive for quality provision of Health Services (HS and the empowerment of the individuals in a Health System (HSys approach.

  19. Burnout hazard in teachers results of a clinical-psychological intervention study

    Directory of Open Access Journals (Sweden)

    Wegner Ralf

    2011-12-01

    Full Text Available Abstract Background The study investigates whether established in-patient therapy for teachers with burnout results in long-acting success and whether gender gaps and differences between teachers of different school levels exist. According to our knowledge, our study is the most extensive inpatient intervention study on the burnout of a defined occupational group, i.e., teachers. Methods 200 teachers participated, 150 took part in a later performed katamnestic survey. The Maslach Burnout Inventory (MBI was used and work-related data were recorded. The days of incapacity for work and the percentage of teachers endangered by burnout decreased, which supports the long-term success of the treatment. Results Significant differences between males and females and between teacher levels were found. However, the differences between teacher levels only showed up before treatment. Because males only underwent treatment at a more severe stage, further efforts in persuading males to start therapy earlier are needed. Conclusions The proven and long-term success of the performed intervention could have greater effects if people, especially males, undergo treatment more frequently. Our results are based on selectively high proposition of teachers of advanced age. Thus it is possible that the long term effect of the intervention, particularly on retirement age, is greater when the intervention is started earlier. Regular burnout tests could help to identify risk cases among teachers at an early stage and to offer a therapeutic intervention.

  20. Evidence-based clinical practice guidelines for interventional pain management in cancer pain

    Directory of Open Access Journals (Sweden)

    Sushma Bhatnagar

    2015-01-01

    Full Text Available Intractable cancer pain not amenable to standard oral or parenteral analgesics is a horrifying truth in 10-15% of patients. Interventional pain management techniques are an indispensable arsenal in pain physician′s armamentarium for severe, intractable pain and can be broadly classified into neuroablative and neuromodulation techniques. An array of neurolytic techniques (chemical, thermal, or surgical can be employed for ablation of individual nerve fibers, plexuses, or intrathecalneurolysis in patients with resistant pain and short life-expectancy. Neuraxial administration of drugs and spinal cord stimulation to modulate or alter the pain perception constitutes the most frequently employed neuromodulation techniques. Lately, there is a rising call for early introduction of interventional techniques in carefully selected patients simultaneously or even before starting strong opioids. After decades of empirical use, it is the need of the hour to head towards professionalism and standardization in order to secure credibility of specialization and those practicing it. Even though the interventional management has found a definite place in cancer pain, there is a dearth of evidence-based practice guidelines for interventional therapies in cancer pain. This may be because of paucity of good quality randomized controlled trials (RCTs evaluating their safety and efficacy in cancer pain. Laying standardized guidelines based on existing and emerging evidence will act as a foundation step towards strengthening, credentialing, and dissemination of the specialty of interventional cancer pain management. This will also ensure an improved decision-making and quality of life (QoL of the suffering patients.

  1. Evidence-based Clinical Practice Guidelines for Interventional Pain Management in Cancer Pain.

    Science.gov (United States)

    Bhatnagar, Sushma; Gupta, Maynak

    2015-01-01

    Intractable cancer pain not amenable to standard oral or parenteral analgesics is a horrifying truth in 10-15% of patients. Interventional pain management techniques are an indispensable arsenal in pain physician's armamentarium for severe, intractable pain and can be broadly classified into neuroablative and neuromodulation techniques. An array of neurolytic techniques (chemical, thermal, or surgical) can be employed for ablation of individual nerve fibers, plexuses, or intrathecalneurolysis in patients with resistant pain and short life-expectancy. Neuraxial administration of drugs and spinal cord stimulation to modulate or alter the pain perception constitutes the most frequently employed neuromodulation techniques. Lately, there is a rising call for early introduction of interventional techniques in carefully selected patients simultaneously or even before starting strong opioids. After decades of empirical use, it is the need of the hour to head towards professionalism and standardization in order to secure credibility of specialization and those practicing it. Even though the interventional management has found a definite place in cancer pain, there is a dearth of evidence-based practice guidelines for interventional therapies in cancer pain. This may be because of paucity of good quality randomized controlled trials (RCTs) evaluating their safety and efficacy in cancer pain. Laying standardized guidelines based on existing and emerging evidence will act as a foundation step towards strengthening, credentialing, and dissemination of the specialty of interventional cancer pain management. This will also ensure an improved decision-making and quality of life (QoL) of the suffering patients. PMID:26009665

  2. Childhood exposure to violence and lifelong health: clinical intervention science and stress-biology research join forces.

    Science.gov (United States)

    Moffitt, Terrie E

    2013-11-01

    Many young people who are mistreated by an adult, victimized by bullies, criminally assaulted, or who witness domestic violence react to this violence exposure by developing behavioral, emotional, or learning problems. What is less well known is that adverse experiences like violence exposure can lead to hidden physical alterations inside a child's body, alterations that may have adverse effects on life-long health. We discuss why this is important for the field of developmental psychopathology and for society, and we recommend that stress-biology research and intervention science join forces to tackle the problem. We examine the evidence base in relation to stress-sensitive measures for the body (inflammatory reactions, telomere erosion, epigenetic methylation, and gene expression) and brain (mental disorders, neuroimaging, and neuropsychological testing). We also review promising interventions for families, couples, and children that have been designed to reduce the effects of childhood violence exposure. We invite intervention scientists and stress-biology researchers to collaborate in adding stress-biology measures to randomized clinical trials of interventions intended to reduce effects of violence exposure and other traumas on young people. PMID:24342859

  3. Clinical effects of comprehensive therapy of early psychological intervention and rehabilitation training on neurological rehabilitation of patients with acute stroke

    Institute of Scientific and Technical Information of China (English)

    Duo-Yu Wu; Min Guo; Yun-Suo Gao; Yan-Hai Kang; Jun-Cheng Guo; Xiang-Ling Jiang; Feng Chen; Tao Liu

    2012-01-01

    Objective: To evaluate the clinical effects of comprehensive therapy of psychological intervention and rehabilitation training on the mental health of the patients with acute stroke. Methods: A total of 120 patients with acute stroke were randomly divided into trial group and control group. Both groups were given the corresponding drug therapy, medical basic nursing and convention nursing. Besides, psychological intervention and comprehensive rehabilitation training were added to the trial group. SCL-90, Europ stroke scales (ESS) score were assessed with each patient on day 3 for the first time and on day 21 for the second time;Barthel index was assessed on the day 90. Results: After psychological intervention, SCL-90 declined significantly in the trial group comparing with the control group, there were signicant differences in the somatization, obsession, depression, anxiety, fear, ESS score, Barthel index and other psychological factors between the trial group and control group (P<0.05). Conclusions:Comprehensive therapy of early psychological intervention and rehabilitation training can significantly improve the mental health, limb movement function, stress ability and activity of daily living on the patients with acute stroke.

  4. How countries link REDD+ interventions to drivers in their readiness plans: implications for monitoring systems

    International Nuclear Information System (INIS)

    Countries participating in the REDD+ scheme are in the readiness phase, designing policy interventions to address drivers of deforestation and forest degradation (DD). In order for REDD+ interventions to be effective, it is essential that they take into account the specific drivers that they aim to address. Moreover it is crucial to design systems that monitor the effectiveness of the planned interventions. In this article we provide a comprehensive and comparative assessment of interventions proposed by 43 REDD+ countries in 98 readiness documents. We summarize the types of interventions and assess if they are formulated referring to the drivers of DD that they are aiming to address. Based on this assessment we consider the implications for systems for monitoring effectiveness of proposed interventions. Most countries reviewed link proposed interventions to specific drivers of DD. The majority of the countries making this link have better driver data quality, in particularly those that present their data in ratio or ordinal terms. Proposed interventions focus not only on activities to reduce deforestation, but also on other forest related REDD+ activities such as sustainable forest management, which reduce forest degradation and enhance forest stocks. Moreover, driver-specific interventions often relate to drivers not only inside but also outside the forest sector. Hence we suggest that monitoring systems need to assess not only deforestation rates through remote sensing, but also degradation and other carbon stock changes within the forest, using more detailed ground level surveys and measurements. In addition, the performance of interventions outside the forest need to be monitored, even if the impacts of these cannot be linked to specific changes in forest carbon stock in specific locations. (paper)

  5. Clinical significance of scoring system for systemic inflammatory response syndrome

    Institute of Scientific and Technical Information of China (English)

    HAN Jian; LIANG Hua-ping

    2006-01-01

    The concepts of systemic inflammatory response syndrome (SIRS) and scoring system were defined by the journal of Bone in 1992. SIRS was described as occurrence of two or more clinical criteria in four ones (fever or hypothermia, tachypnea, tachycardia, and leukocytosis).An early diagnosis and estimation of systemic inflammation in patients is helpful for treatment selection. This paper reviews the application of SIRS scoring system, which has been extensively validated for large groups of critical care patients with severe injury and critical surgical diseases.Recent studies have documented SIRS score as a significant predictive parameter of adverse outcome in critical care patients. Furthermore, some studies also give us a suggestion on how to reduce the overload systemic response.

  6. Electrochemical behavior of dental implant system before andafter clinical use

    Institute of Scientific and Technical Information of China (English)

    Chae-Heon CHUNG; Hee-Jung KIM; Yong-Tae JEONG; Mee-Kyoung SON; Yong-Hoon JEONG; Han-Cheol CHOE

    2009-01-01

    Electrochemical behavior of dental implant system before and after clinical use (in vivo and in vitro) was researched by using abutment and titanium fixture. To simulate an oral environment, the samples of clinically used and non-used implant systems as a working electrode were exposed to artificial saliva at (36.5±1) ℃. Electrochemical tests were carried out using a potentiostat. After electrochemical test, the corrosion morphology of each sample was investigated by FE-SEM and EDS. The corrosion potential and pitting potential of clinically used implant system are lower than those of non-used implant system, and clinically used implant system exhibits a lower range of passivation, indicating a less degree of inherent resistance against chloride ion. The polarization resistance decreases in the case of clinically used implant system, whereas, Rp for clinically non-used implant system increases compared with clinically used implant system.

  7. Healthcare information systems: data mining methods in the creation of a clinical recommender system

    Science.gov (United States)

    Duan, L.; Street, W. N.; Xu, E.

    2011-05-01

    Recommender systems have been extensively studied to present items, such as movies, music and books that are likely of interest to the user. Researchers have indicated that integrated medical information systems are becoming an essential part of the modern healthcare systems. Such systems have evolved to an integrated enterprise-wide system. In particular, such systems are considered as a type of enterprise information systems or ERP system addressing healthcare industry sector needs. As part of efforts, nursing care plan recommender systems can provide clinical decision support, nursing education, clinical quality control, and serve as a complement to existing practice guidelines. We propose to use correlations among nursing diagnoses, outcomes and interventions to create a recommender system for constructing nursing care plans. In the current study, we used nursing diagnosis data to develop the methodology. Our system utilises a prefix-tree structure common in itemset mining to construct a ranked list of suggested care plan items based on previously-entered items. Unlike common commercial systems, our system makes sequential recommendations based on user interaction, modifying a ranked list of suggested items at each step in care plan construction. We rank items based on traditional association-rule measures such as support and confidence, as well as a novel measure that anticipates which selections might improve the quality of future rankings. Since the multi-step nature of our recommendations presents problems for traditional evaluation measures, we also present a new evaluation method based on average ranking position and use it to test the effectiveness of different recommendation strategies.

  8. Memory Interventions in the Criminal Justice System: Some Practical Ethical Considerations.

    Science.gov (United States)

    Cabrera, Laura Y; Elger, Bernice S

    2016-03-01

    In recent years, discussion around memory modification interventions has gained attention. However, discussion around the use of memory interventions in the criminal justice system has been mostly absent. In this paper we start by highlighting the importance memory has for human well-being and personal identity, as well as its role within the criminal forensic setting; in particular, for claiming and accepting legal responsibility, for moral learning, and for retribution. We provide examples of memory interventions that are currently available for medical purposes, but that in the future could be used in the forensic setting to modify criminal offenders' memories. In this section we contrast the cases of (1) dampening and (2) enhancing memories of criminal offenders. We then present from a pragmatic approach some pressing ethical issues associated with these types of memory interventions. The paper ends up highlighting how these pragmatic considerations can help establish ethically justified criteria regarding the possibility of interventions aimed at modifying criminal offenders' memories.

  9. 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…

  10. A Parent-Mediated Intervention that Targets Responsive Parental Behaviors Increases Attachment Behaviors in Children with ASD: Results from a Randomized Clinical Trial

    Science.gov (United States)

    Siller, Michael; Swanson, Meghan; Gerber, Alan; Hutman, Ted; Sigman, Marian

    2014-01-01

    The current study is a randomized clinical trial evaluating the efficacy of Focused Playtime Intervention (FPI) in a sample of 70 children with Autism Spectrum Disorder. This parent-mediated intervention has previously been shown to significantly increase responsive parental communication (Siller et al. in "J Autism Dev Disord"…

  11. A Parent-Mediated Intervention to Increase Responsive Parental Behaviors and Child Communication in Children with ASD: A Randomized Clinical Trial

    Science.gov (United States)

    Siller, Michael; Hutman, Ted; Sigman, Marian

    2013-01-01

    Longitudinal research has demonstrated that responsive parental behaviors reliably predict subsequent language gains in children with autism spectrum disorder. To investigate the underlying causal mechanisms, we conducted a randomized clinical trial of an experimental intervention (Focused Playtime Intervention, FPI) that aims to enhance…

  12. Improved clinical outcomes with intracoronary compared to intravenous abciximab in patients with acute coronary syndromes undergoing percutaneous coronary intervention: a systematic review and meta-analysis

    DEFF Research Database (Denmark)

    Hansen, Peter Riis; Iversen, Allan; Abdulla, Jawdat

    2010-01-01

    Intracoronary (IC) administration of abciximab may increase local drug levels by several orders of magnitude compared to intravenous (IV) treatment and may improve clinical outcomes in patients with acute coronary syndromes (ACS) undergoing percutaneous coronary intervention (PCI). In the absence...

  13. Improving awareness of cancer clinical trials among Hispanic patients and families: audience segmentation decisions for a media intervention.

    Science.gov (United States)

    Quinn, Gwendolyn P; McIntyre, Jessica; Gonzalez, Luis E; Antonia, Teresita Muñoz; Antolino, Prado; Wells, Kristen J

    2013-01-01

    Clinical trials hold great promise for cancer treatment; yet, Hispanic cancer patients have low rates of clinical trial participation. Lack of awareness and knowledge of clinical trials and language barriers may account for low participation rates. Patient education through audiovisual materials can improve knowledge of and attitudes toward clinical trials among Hispanic populations. In this study, 36 Hispanic cancer patients/survivors and caregivers in Florida and Puerto Rico participated in focus groups to aid in developing a Spanish-language DVD and booklet intervention designed to increase knowledge about clinical trials. Focus group results showed (a) low levels of knowledge about clinical trials, (b) uncertainty about why a physician would expect a patient to make a choice about treatment, and (c) desire for family participation in decision making. Respondents expressed various preferences for aspects of the DVD such as showing extended family in the DVD and physician explanations about key terms. On the basis of these preferences, the authors developed a creative brief for a DVD. The content of the DVD was reviewed by Hispanic community leaders and key stakeholders. A final DVD was created, in Spanish, using Hispanic patients and physicians, which contained the information deemed important from the focus groups and stakeholder interviews. The DVD is complete with companion booklet and currently undergoing a randomized control trial.

  14. Delivering Prevention Interventions to People Living with HIV in Clinical Care Settings: Results of a Cluster Randomized Trial in Kenya, Namibia, and Tanzania

    Science.gov (United States)

    Kidder, Daniel; Medley, Amy; Pals, Sherri L.; Carpenter, Deborah; Howard, Andrea; Antelman, Gretchen; DeLuca, Nicolas; Muhenje, Odylia; Sheriff, Muhsin; Somi, Geoffrey; Katuta, Frieda; Cherutich, Peter; Moore, Janet

    2016-01-01

    We conducted a group randomized trial to assess the feasibility and effectiveness of a multi-component, clinic-based HIV prevention intervention for HIV-positive patients attending clinical care in Namibia, Kenya, and Tanzania. Eighteen HIV care and treatment clinics (six per country) were randomly assigned to intervention or control arms. Approximately 200 sexually active clients from each clinic were enrolled and interviewed at baseline and 6- and 12-months post-intervention. Mixed model logistic regression with random effects for clinic and participant was used to assess the effectiveness of the intervention. Of 3522 HIV-positive patients enrolled, 3034 (86 %) completed a 12-month follow-up interview. Intervention participants were significantly more likely to report receiving provider-delivered messages on disclosure, partner testing, family planning, alcohol reduction, and consistent condom use compared to participants in comparison clinics. Participants in intervention clinics were less likely to report unprotected sex in the past 2 weeks (OR = 0.56, 95 % CI 0.32, 0.99) compared to participants in comparison clinics. In Tanzania, a higher percentage of participants in intervention clinics (17 %) reported using a highly effective method of contraception compared to participants in comparison clinics (10 %, OR = 2.25, 95 % CI 1.24, 4.10). This effect was not observed in Kenya or Namibia. HIV prevention services are feasible to implement as part of routine care and are associated with a self-reported decrease in unprotected sex. Further operational research is needed to identify strategies to address common operational challenges including staff turnover and large patient volumes. PMID:26995678

  15. Delivering Prevention Interventions to People Living with HIV in Clinical Care Settings: Results of a Cluster Randomized Trial in Kenya, Namibia, and Tanzania.

    Science.gov (United States)

    Bachanas, Pamela; Kidder, Daniel; Medley, Amy; Pals, Sherri L; Carpenter, Deborah; Howard, Andrea; Antelman, Gretchen; DeLuca, Nicolas; Muhenje, Odylia; Sheriff, Muhsin; Somi, Geoffrey; Katuta, Frieda; Cherutich, Peter; Moore, Janet

    2016-09-01

    We conducted a group randomized trial to assess the feasibility and effectiveness of a multi-component, clinic-based HIV prevention intervention for HIV-positive patients attending clinical care in Namibia, Kenya, and Tanzania. Eighteen HIV care and treatment clinics (six per country) were randomly assigned to intervention or control arms. Approximately 200 sexually active clients from each clinic were enrolled and interviewed at baseline and 6- and 12-months post-intervention. Mixed model logistic regression with random effects for clinic and participant was used to assess the effectiveness of the intervention. Of 3522 HIV-positive patients enrolled, 3034 (86 %) completed a 12-month follow-up interview. Intervention participants were significantly more likely to report receiving provider-delivered messages on disclosure, partner testing, family planning, alcohol reduction, and consistent condom use compared to participants in comparison clinics. Participants in intervention clinics were less likely to report unprotected sex in the past 2 weeks (OR = 0.56, 95 % CI 0.32, 0.99) compared to participants in comparison clinics. In Tanzania, a higher percentage of participants in intervention clinics (17 %) reported using a highly effective method of contraception compared to participants in comparison clinics (10 %, OR = 2.25, 95 % CI 1.24, 4.10). This effect was not observed in Kenya or Namibia. HIV prevention services are feasible to implement as part of routine care and are associated with a self-reported decrease in unprotected sex. Further operational research is needed to identify strategies to address common operational challenges including staff turnover and large patient volumes. PMID:26995678

  16. A systematic review of complex system interventions designed to increase recovery from depression in primary care

    Directory of Open Access Journals (Sweden)

    Hegarty Kelsey

    2006-07-01

    Full Text Available Abstract Background Primary care is being encouraged to implement multiprofessional, system level, chronic illness management approaches to depression. We undertook this study to identify and assess the quality of RCTs testing system level depression management interventions in primary care and to determine whether these interventions improve recovery. Method Searches of Medline and Cochrane Controlled Register of Trials. 'System level' interventions included: multi-professional approach, enhanced inter-professional communication, scheduled patient follow-up, structured management plan. Results 11 trials met all inclusion criteria. 10 were undertaken in the USA. Most focussed on antidepressant compliance. Quality of reporting assessed using CONSORT criteria was poor. Eight trials reported an increase in the proportion of patients recovered in favour of the intervention group, yet did not account for attrition rates ranging from 5 to 50%. Conclusion System level interventions implemented in the USA with patients willing to take anti-depressant medication leads to a modest increase in recovery from depression. The relevance of these interventions to countries with strong primary care systems requires testing in a randomised controlled trial.

  17. Effect of preoperative smoking intervention on postoperative complications: a randomised clinical trial

    DEFF Research Database (Denmark)

    Møller, Ann; Villebro, Nete Munk; Pedersen, Tom;

    2002-01-01

    Smokers are at higher risk of cardiopulmonary and wound-related postoperative complications than non-smokers. Our aim was to investigate the effect of preoperative smoking intervention on the frequency of postoperative complications in patients undergoing hip and knee replacement....

  18. Bridging the Gap between Clinical and Classroom Intervention: Keystone Approaches for Students with Challenging Behavior

    Science.gov (United States)

    Ducharme, Joseph M.; Shecter, Carly

    2011-01-01

    Although not trained as treatment providers, teachers are increasingly faced with students who present challenging behavioral issues that require intervention. Teachers often resort to reactive and punitive strategies that have many negative side effects and drawbacks because they lack specific training in managing problem behavior in the…

  19. Clinical impact of intracoronary abciximab in patients undergoing primary percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Piccolo, Raffaele; Gu, Youlan L; Iversen, Allan Zeeberg;

    2012-01-01

    The aim of this study was to perform an individual patient-level pooled analysis of randomised trials, comparing intracoronary versus intravenous abciximab bolus use in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI)....

  20. Electrical impedance tomography: effect of clinical interventions on (regional) lung volume in preterm infants

    NARCIS (Netherlands)

    P.S. van der Burg

    2015-01-01

    Premature infants are at risk for low end-expiratory lung volume (EELV), which may compromise lung function and lead to respiratory failure. Respiratory interventions and nursing procedures are aimed to improve EELV in these infants. In this thesis, Pauline van der Burg has investigated the effects

  1. Positive Psychology Intervention to Alleviate Child Depression and Increase Life Satisfaction: A Randomized Clinical Trial

    Science.gov (United States)

    Kwok, Sylvia Y. C. L.; Gu, Minmin; Kit, Katrina Tong Kai

    2016-01-01

    Purpose: The study aims to examine the effectiveness of a positive psychology group-based intervention program, incorporating elements of hope and gratitude, in decreasing depression and increasing life satisfaction among primary school students in Hong Kong. Method: A total of 68 children, with the Depression score of Chinese Hospital Anxiety and…

  2. Social Learning Theory Parenting Intervention Promotes Attachment-Based Caregiving in Young Children: Randomized Clinical Trial

    Science.gov (United States)

    O'Connor, Thomas G.; Matias, Carla; Futh, Annabel; Tantam, Grace; Scott, Stephen

    2013-01-01

    Parenting programs for school-aged children are typically based on behavioral principles as applied in social learning theory. It is not yet clear if the benefits of these interventions extend beyond aspects of the parent-child relationship quality conceptualized by social learning theory. The current study examined the extent to which a social…

  3. Clinical effects of intracoronary tirofiban on preventing no-reflow during emergency percutaneous coronary intervention

    Institute of Scientific and Technical Information of China (English)

    林杰

    2012-01-01

    Objective To assess the effects of intracoronary tirofiban on preventing no-reflow during emergency percutaneous coronary intervention(PCI) . Methods All 99 cases with acute myocardial infarction who underwent emergency PCI between March 2009 and March 2012 were randomized into test group

  4. Sex- and age-related differences in clinical outcome after primary percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Jakobsen, Lars; Niemann, Troels; Thorsgaard, Niels;

    2012-01-01

    AIMS: To compare the outcome after primary percutaneous coronary intervention (PPCI) according to sex and age, including comparison of sex- and age-specific mortality of PPCI patients with that of the general population. METHODS AND RESULTS: This population-based follow-up study included 7...

  5. Three-year clinical event rates in different age groups after contemporary percutaneous coronary intervention

    NARCIS (Netherlands)

    N. Kukreja (Neville); Y. Onuma (Yosinobu); H.M. Garcia-Garcia (Hector); J.W.I. van Nierop; J. Daemen (Joost); R.T. van Domburg (Ron); P.W.J.C. Serruys (Patrick)

    2011-01-01

    textabstractAims: As the global population ages, elderly patients will form an increasing proportion of those undergoing percutaneous coronary intervention (PCI). We investigated the safety and efficacy of bare metal stents (BMS) and DES in all patients undergoing PCI at our institution, stratified

  6. Clinical application on CT guiding interventional radiology technology%CT导引介人技术的临床应用

    Institute of Scientific and Technical Information of China (English)

    何建华; 彭述文; 米霞

    2011-01-01

    Objective The Computer Tomography (CT) guiding interventional radiology technology already became an extremely adequate technology in the large-scale general hospital, which was brought in since 2008-2009 in our hospital, and it has carried out dozens of cases, we improved it into a new kind of technology suitable for our hospital after summing up and studying it. This technology should be extended for popular use among the primary hospitals. Methods TOSHIBA Activion 16 screw CT scanner was used with the puncture needle Cook19G.After skin lung puncture biopsy 12 cases, after skin kidney puncture 25 cases, after skin liver puncture 7 cases. Results Among 12 cases of lung puncture biopsy, 9 cases are periphery the lung cancer, 2 cases are the pulmonary tuberculoses, 1 cases is pneumonia change in sexuality. 32 cases livers, the kidney puncture biopsy is a cyst, after extracts the pouch fluid to involve the hardened treatment, biggest cyst 11 cm, smallest cyst approximately 6cm, the short-term reexamination cyst obviously reduces approximately, after half year of reexaminations, the cyst disappeared basically or completely. No serious complication occurred. Conclusion The CT guiding interventional radiology technology belongs to the interventional radiology technology category, its application scope is broad, involving the whole body various systems, becoming one of the important methods of clinical diagnosis and treatment domain with characteristics of high security, minimally invasive surgery and less complication, etc. It' s worth to be extended popularly in primary hospitals.%目的 归纳、总结并不断改进我院CT导引介入技术,形成适应本院的一种新技术.方法 使用TOSHIBA Activion 16螺旋CT扫描机.穿刺针为Cook19G.经皮肺穿刺活检12例,经皮肾穿刺25例,经皮肝穿刺7例.结果 12例肺穿刺活检,9例为周围型肺癌,2例为肺结核,1例为肺炎性变.32例肝、肾穿刺活检为囊肿,抽取囊液后介入

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

    DEFF Research Database (Denmark)

    Denton, Christopher P; Krieg, Thomas; Guillevin, Loic;

    2012-01-01

    OBJECTIVES: The Digital Ulcers Outcome (DUO) Registry was designed to describe the clinical and antibody characteristics, disease course and outcomes of patients with digital ulcers associated with systemic sclerosis (SSc). METHODS: The DUO Registry is a European, prospective, multicentre......, observational, registry of SSc patients with ongoing digital ulcer disease, irrespective of treatment regimen. Data collected included demographics, SSc duration, SSc subset, internal organ manifestations, autoantibodies, previous and ongoing interventions and complications related to digital ulcers. RESULTS...

  8. Dissemination of a Multilevel Evidence-Based System of Parenting Interventions with Broad Application to Child Welfare Populations

    Science.gov (United States)

    Prinz, Ron

    2009-01-01

    Parenting interventions are relevant to many touch points of the child welfare system. This paper describes a multilevel system of parenting interventions called "Triple P" that matches intervention intensities to families, builds on a strong scientific base, provides multiple access points for parents, and offers a destigmatized, cost-efficient…

  9. Impact of Simulation and Clinical Experience on Self-efficacy in Nursing Students: Intervention Study.

    Science.gov (United States)

    Kimhi, Einat; Reishtein, Judith L; Cohen, Miri; Friger, Michael; Hurvitz, Nancy; Avraham, Rinat

    2016-01-01

    This study compared the effect of simulation and clinical experience timing on self-confidence/self-efficacy for the nursing process. Using a randomized, double-crossover design, self-efficacy was measured 3 times. Although self-efficacy was significantly higher at time 1 for students who had clinical experience, there was no difference between the groups at the end of the course (time 2). Thus, simulation increased self-confidence/self-efficacy equivalently if placed either before or after clinical experience.

  10. Developing the clinical components of a complex intervention for a glaucoma screening trial: a mixed methods study

    Directory of Open Access Journals (Sweden)

    2011-04-01

    Full Text Available Abstract Background Glaucoma is a leading cause of avoidable blindness worldwide. Open angle glaucoma is the most common type of glaucoma. No randomised controlled trials have been conducted evaluating the effectiveness of glaucoma screening for reducing sight loss. It is unclear what the most appropriate intervention to be evaluated in any glaucoma screening trial would be. The purpose of this study was to develop the clinical components of an intervention for evaluation in a glaucoma (open angle screening trial that would be feasible and acceptable in a UK eye-care service. Methods A mixed-methods study, based on the Medical Research Council (MRC framework for complex interventions, integrating qualitative (semi-structured interviews with 46 UK eye-care providers, policy makers and health service commissioners, and quantitative (economic modelling methods. Interview data were synthesised and used to revise the screening interventions compared within an existing economic model. Results The qualitative data indicated broad based support for a glaucoma screening trial to take place in primary care, using ophthalmic trained technical assistants supported by optometry input. The precise location should be tailored to local circumstances. There was variability in opinion around the choice of screening test and target population. Integrating the interview findings with cost-effectiveness criteria reduced 189 potential components to a two test intervention including either optic nerve photography or screening mode perimetry (a measure of visual field sensitivity with or without tonometry (a measure of intraocular pressure. It would be more cost-effective, and thus acceptable in a policy context, to target screening for open angle glaucoma to those at highest risk but for both practicality and equity arguments the optimal strategy was screening a general population cohort beginning at age forty. Conclusions Interventions for screening for open angle

  11. Traditional clinical risk factors predict clopidogrel hypo-responsiveness in unselected patients undergoing non-emergent percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Ratcovich, Hanna; Holmvang, Lene; Johansson, Pär Inge;

    2016-01-01

    High and low platelet reactivity, HPR and LPR respectively, to clopidogrel and aspirin have previously been associated with adverse events following percutaneous coronary intervention (PCI). The aim is to test the ability of a previously developed clinical risk-score, the PREDICT score, to identify...... of PREDICT score variables and the incidence of HPR for clopidogrel (HPR (ADP)) (p ... = 0.003); 7-9 points OR 9.84 (95% CI 3.49-27.7, p clopidogrel LPR (LPR (ADP)). On the other hand, there was no clear association between PREDICT score and AA response. The PREDICT...

  12. Clinical and economic impact of antimicrobial stewardship interventions with the FilmArray blood culture identification panel.

    Science.gov (United States)

    Pardo, Joe; Klinker, Kenneth P; Borgert, Samuel J; Butler, Brittany M; Giglio, Patricia G; Rand, Kenneth H

    2016-02-01

    The purpose of this study was to evaluate the impact of the FilmArray Blood Culture Identification (BCID) Panel on the management of patients with blood cultures growing gram positive cocci and Candida. We retrospectively compared clinical and economic outcomes between patients during the BCID testing period and a matched historical control group before BCID testing was introduced. A total of 84 BCID patients were matched to 252 historical controls. BCID identification of coagulase negative staphylococci contaminants resulted in shorter post-culture length of stay (P historical controls (P = 0.047). The BCID, coupled with antimicrobial stewardship intervention, was a cost effective tool to improve patient care.

  13. Event Rates in Randomized Clinical Trials Evaluating Cardiovascular Interventions and Devices

    NARCIS (Netherlands)

    Mahmoud, Karim D.; Lennon, Ryan J.; Holmes, David R.

    2015-01-01

    Randomized clinical trials (RCTs) are considered the gold standard for evidence-based medicine. However, an accurate estimation of the event rate is crucial for their ability to test clinical hypotheses. Overestimation of event rates reduces the required sample size but can compromise the statistica

  14. The role of renin angiotensin system intervention in stage B heart failure.

    LENUS (Irish Health Repository)

    Collier, Patrick

    2012-04-01

    This article outlines the link between the renin angiotensin aldosterone system (RAAS) and various forms of cardiomyopathy, and also reviews the understanding of the effectiveness of RAAS intervention in this phase of ventricular dysfunction. The authors focus their discussion predominantly on patients who have had previous myocardial infarction or those who have left ventricular hypertrophy and also briefly discuss the role of RAAS activation and intervention in patients with alcoholic cardiomyopathy.

  15. Methodology of clinical trials aimed at assessing interventions for cutaneous leishmaniasis.

    Directory of Open Access Journals (Sweden)

    Piero Olliaro

    Full Text Available The current evidence-base for recommendations on the treatment of cutaneous leishmaniasis (CL is generally weak. Systematic reviews have pointed to a general lack of standardization of methods for the conduct and analysis of clinical trials of CL, compounded with poor overall quality of several trials. For CL, there is a specific need for methodologies which can be applied generally, while allowing the flexibility needed to cover the diverse forms of the disease. This paper intends to provide clinical investigators with guidance for the design, conduct, analysis and report of clinical trials of treatments for CL, including the definition of measurable, reproducible and clinically-meaningful outcomes. Having unified criteria will help strengthen evidence, optimize investments, and enhance the capacity for high-quality trials. The limited resources available for CL have to be concentrated in clinical studies of excellence that meet international quality standards.

  16. The first year of the Venlo percutaneous coronary intervention program: procedural and 6-month clinical outcomes

    OpenAIRE

    Mol, K.A.; Rahel, B.M.; Eerens, F.; Aydin, S; Troquay, R. P. Th.; Meeder, J.G.

    2013-01-01

    Objectives Analysis of the first results of off-site percutaneous coronary interventions (PCI) and fractional flow reserve (FFR) measurements at VieCuri Medical Centre for Northern Limburg in Venlo. Background Off-site PCI is accepted in the European and American Cardiac Guidelines as the need for PCI increases and it has been proven to be a safe treatment option for acute coronary syndrome. Methods Retrospective cohort study reporting characteristics, PCI and FFR specifications, complication...

  17. Unique Ethical Concerns in Clinical Trials Comparing Psychosocial and Psychopharmalogical Interventions

    OpenAIRE

    Stines, Lisa R.; Feeny, Norah C.

    2008-01-01

    In recent years, there has been a particular emphasis placed on conducting randomized controlled trials (RCTs) that compare the relative efficacy of psychosocial and pharmacological interventions. This article addresses relevant ethical considerations in the conduct of these treatment trials, with a focus on RCTs with children. Ethical concerns, including therapeutic misconception, treatment preference, therapeutic equipoise, structure of treatments, and balancing risks versus benefits, are i...

  18. Reducing occupational stress with a B-vitamin focussed intervention: a randomized clinical trial: study protocol

    OpenAIRE

    Stough, Con; Simpson, Tamara; Lomas, Justine; McPhee, Grace; Billings, Clare; Myers, Stephen; Oliver, Chris; Luke A. Downey

    2014-01-01

    Background Workplace stress in Australia and other western countries has been steadily increasing over the past decade. It can be observed not only in terms of increased compensation claims but also costs due to absenteeism, loss of productivity at work and reduced psychological and physiological health and well-being. Given the cost and pervasive effects of stress in the modern workforce, time efficient and cost-effective interventions capable of reducing occupational stress (or strain) and ...

  19. A randomized clinical trial of the effectiveness of premarital intervention: moderators of divorce outcomes.

    Science.gov (United States)

    Markman, Howard J; Rhoades, Galena K; Stanley, Scott M; Peterson, Kristina M

    2013-02-01

    This study examined the effects of premarital relationship intervention on divorce during the first 8 years of first marriage. Religious organizations were randomly assigned to have couples marrying through them complete the Prevention and Relationship Education Program (PREP) or their naturally occurring premarital services. Results indicated no differences in overall divorce rates between naturally occurring services (n = 44), PREP delivered by clergy at religious organizations (n = 66), or PREP delivered by professionals at a university (n = 83). Three moderators were also tested. Measured premaritally and before intervention, the level of negativity of couples' interactions moderated effects. Specifically, couples observed to have higher levels of negative communication in a video task were more likely to divorce if they received PREP than if they received naturally occurring services; couples with lower levels of premarital negative communication were more likely to remain married if they received PREP. A history of physical aggression in the current relationship before marriage and before intervention showed a similar pattern as a moderator, but the effect was only marginally significant. Family-of-origin background (parental divorce and/or aggression) was not a significant moderator of prevention effects across the two kinds of services. Implications for defining risk, considering divorce as a positive versus negative outcome, the practice of premarital relationship education, and social policy are discussed.

  20. Clinical diagnostic and intervention studies of children with semantic-pragmatic language disorder.

    Science.gov (United States)

    Adams, C

    2001-01-01

    The diagnosis of semantic-pragmatic language disorder (SPLD) has been the subject of a number of research studies over the last two decades. Classification and diagnostic debates, while illuminating, have done little to develop tools to improve services to these children. In this paper, two children whose communication difficulties are suggestive of an SPLD diagnosis but who have differing profiles are studied. Using existing models of psycholinguistics and pragmatics to guide assessment and intervention, the diversity of language and social communicative behaviours that are covered by the label SPLD are exemplified. Consideration is given to whether the term SPLD is appropriate for both children or whether Bishop's revision of the diagnosis to 'pragmatic language impairment' might be more useful. Methods of intervention and evaluation for semantic and pragmatic deficits in these two cases are described. It is argued that existing tools can enable accurate explanation and modelling of the communication of children with SPLD and that there is a role for intervention studies in helping to refine those tools, to improve therapies and to understand the nature of the condition more fully. PMID:11491481

  1. The perioperative nursing care of patients with malignant obstructive jaundice treated with interventional therapy: clinical experience in 71 cases

    International Nuclear Information System (INIS)

    Objective: To summarize the clinical experience of perioperative nursing for patients with malignant obstructive jaundice who were treated with percutaneous transhepatic biliary drainage. Methods: Sufficient preoperative preparation,careful psychological nursing, serious postoperative observation of vital signs, enhancement of the nutritional support,care of the puncture site and drainage tube, maintenance of the electrolyte balance, correct evaluation of the jaundice, etc. were strictly carried out in all 71 patients with malignant obstructive jaundice who received percutaneous transhepatic biliary drainage. Results: Because the sufficient preoperative preparation and postoperative nursing work were seriously carried out,the obstructive jaundice was well relieved in all patients, the liver function and the living quality were markedly improved and the survival time was prolonged. Conclusion: It is of great clinical significance to intensify the perioperative nursing care for patients with malignant obstructive jaundice who are receiving interventional therapy. (authors)

  2. A clinically integrated post-graduate training programme in evidence-based medicine versus 'no intervention' for improving disability evaluations: a cluster randomised clinical trial.

    Directory of Open Access Journals (Sweden)

    Rob Kok

    Full Text Available BACKGROUND: Although several studies have shown that teaching EBM is effective in improving knowledge, at present, there is no convincing evidence that teaching EBM also changes professional behaviour in practice. Therefore, the primary aim of this study was to evaluate the effectiveness of a clinically integrated post-graduate training programme in EBM on evidence-based disability evaluation. METHODS AND FINDINGS: In a cluster randomised controlled trial, fifty-four case-based learning groups consisting of 132 physicians and 1680 patients were randomly assigned to the intervention or control groups. A clinically integrated, post-graduate, 5-day training programme in evidence-based medicine, consisting of (home assignments, peer teaching, interactive training in searching databases, lectures and brainstorming sessions was provided to the intervention group. The control group received no training. The primary outcome was evidence-based disability evaluation, as indicated by the frequency in use of evidence of sufficient quality in disability evaluation reports. There are no general EBM behaviour outcome measures available. Therefore, we followed general guidelines for constructing performance indicators and defined an a priori cut-off for determination of sufficient quality as recommended for evaluating EB training. Physicians trained in EBM performed more evidence-based disability evaluations compared to physicians in the control group (difference in absolute proportion 9.7%, 95% CI 3.5 to 15.9. The primary outcome differences between groups remained significant after both cluster-adjusted analysis and additional sensitivity analyses accounting for subjects lost to follow-up. CONCLUSIONS: A EBM programme successfully improved the use of evidence in a non-hospital based medical specialty. Our findings support the general recommendations to use multiple educational methods to change physician behaviour. In addition, it appeared important that the

  3. Improving Adult ART Clinic Patient Waiting Time by Implementing an Appointment System at Gondar University Teaching Hospital, Northwest Ethiopia

    Directory of Open Access Journals (Sweden)

    Asmamaw Atnafu

    2015-01-01

    Full Text Available Background. Long waiting time has been among the major factors that affect patient satisfaction and health service delivery. The aim of this study was to determine the median waiting time at the Anti-Retroviral Therapy (ART Clinic before and after introduction of an intervention of the systematic appointment system. Methods. Patient waiting time was measured before and after the introduction of an intervention; target population of the study was all adult HIV patients/clients who have visited the outpatient ART Clinic in the study period. 173 patients were included before and after the intervention. Systematic patient appointment system and health education to patients on appointment system were provided as an intervention. The study period was from October 2011 to the end of January 2012. Data were analyzed using SPSS software version 17.0. Independent sample t-test at 95% confidence interval and 5% significance level was used to determine the significance of median waiting time difference between pre- and postintervention periods. Results and Conclusion. The total median waiting time was reduced from 274.8 minutes (IQR 180.6 minutes and 453.6 minutes before intervention to 165 minutes (IQR 120 minutes and 377.4 minutes after intervention (40% decrease, p=0.02. Overall, the study showed that the introduction of the new appointment system significantly reduces patient waiting time.

  4. Quantified self and human movement: a review on the clinical impact of wearable sensing and feedback for gait analysis and intervention.

    Science.gov (United States)

    Shull, Pete B; Jirattigalachote, Wisit; Hunt, Michael A; Cutkosky, Mark R; Delp, Scott L

    2014-01-01

    The proliferation of miniaturized electronics has fueled a shift toward wearable sensors and feedback devices for the mass population. Quantified self and other similar movements involving wearable systems have gained recent interest. However, it is unclear what the clinical impact of these enabling technologies is on human gait. The purpose of this review is to assess clinical applications of wearable sensing and feedback for human gait and to identify areas of future research. Four electronic databases were searched to find articles employing wearable sensing or feedback for movements of the foot, ankle, shank, thigh, hip, pelvis, and trunk during gait. We retrieved 76 articles that met the inclusion criteria and identified four common clinical applications: (1) identifying movement disorders, (2) assessing surgical outcomes, (3) improving walking stability, and (4) reducing joint loading. Characteristics of knee and trunk motion were the most frequent gait parameters for both wearable sensing and wearable feedback. Most articles performed testing on healthy subjects, and the most prevalent patient populations were osteoarthritis, vestibular loss, Parkinson's disease, and post-stroke hemiplegia. The most widely used wearable sensors were inertial measurement units (accelerometer and gyroscope packaged together) and goniometers. Haptic (touch) and auditory were the most common feedback sensations. This review highlights the current state of the literature and demonstrates substantial potential clinical benefits of wearable sensing and feedback. Future research should focus on wearable sensing and feedback in patient populations, in natural human environments outside the laboratory such as at home or work, and on continuous, long-term monitoring and intervention.

  5. Impact of SYNTAX score on 1-year clinical outcomes in patients undergoing percutaneous coronary intervention for unprotected left main coronary artery.

    Science.gov (United States)

    Nozue, Tsuyoshi; Kamijima, Ryo; Iwaki, Taku; Michishita, Ichiro

    2012-01-01

    SYNTAX score is an angiographic scoring system that was developed to quantify the number, complexity, and location of lesions in patients undergoing coronary revascularization. Up to now, the impact of SYNTAX score on clinical outcomes in patients undergoing percutaneous coronary intervention (PCI) for unprotected left main coronary artery (LMCA) lesions has not been fully examined. Therefore, we evaluate the usefulness of the SYNTAX score and identify the cutoff value of this score to predict 1-year clinical outcomes in patients undergoing PCI for unprotected LMCA lesions. This was a single-center retrospective study that included 49 consecutive patients undergoing elective PCI for unprotected LMCA lesions. We calculated the SYNTAX score and examined the correlations between this score and 1-year clinical outcomes. Major adverse cardiac events (MACE) occurred in 12 patients (24%): target lesion revascularization in 9 patients (18%), myocardial infarction in 2 (4%), and cardiac death in 1 (2%). The frequency of MACE was significantly higher in the intermediate (47%) or high score group (50%) than in the low score group (4%). Furthermore, the SYNTAX score was significantly higher in the MACE group than in the non-MACE group (31 vs. 22, p = 0.008). Receiver-operating characteristic curve showed that the SYNTAX score exhibited 83% sensitivity and 76% specificity for predicting the development of MACE at a cutoff value 26. These results demonstrate that the SYNTAX score could be a useful tool to predict 1-year clinical outcomes in patients undergoing elective PCI for unprotected LMCA lesions.

  6. The empathic brain and its dysfunction in psychiatric populations: implications for intervention across different clinical conditions

    Directory of Open Access Journals (Sweden)

    Moriguchi Yoshiya

    2007-11-01

    Full Text Available Abstract Empathy is a concept central to psychiatry, psychotherapy and clinical psychology. The construct of empathy involves not only the affective experience of the other person's actual or inferred emotional state but also some minimal recognition and understanding of another's emotional state. It is proposed, in the light of multiple levels of analysis including social psychology, cognitive neuroscience and clinical neuropsychology, a model of empathy that involves both bottom-up and top-down information processing underpinned by parallel and distributed computational mechanisms. The predictive validity of this model is explored with reference to clinical conditions. As many psychiatric conditions are associated with deficits or even lack of empathy, we discuss a limited number of these disorders including psychopathy/antisocial personality disorders, borderline and narcissistic personality disorders, autistic spectrum disorders, and alexithymia. We argue that future clinical investigations of empathy disorders can only be informative if behavioral, dispositional and biological factors are combined.

  7. Heart failure self-care interventions to reduce clinical events and symptom burden

    OpenAIRE

    Jurgens, Corrine; McGreal,Mary; Hogan,Maureen; Walsh_Irwin,Colleen; Maggio,Nancy

    2014-01-01

    Mary H McGreal,1 Maureen J Hogan,1 Colleen Walsh-Irwin,1 Nancy J Maggio,2 Corrine Y Jurgens1 1School of Nursing, Stony Brook University, Stony Brook, NY, USA; 2School of Nursing, Farmingdale State College, Farmingdale, NY, USA Background: Lack of adherence to prescribed therapies and poor symptom recognition are common reasons for recurring hospitalizations among heart failure (HF) patients. The purpose of this literature review is to examine the effectiveness of HF self-care interventions i...

  8. Risks, Outcomes, and Evidence-Based Interventions for Girls in the US Juvenile Justice System.

    Science.gov (United States)

    Leve, Leslie D; Chamberlain, Patricia; Kim, Hyoun K

    2015-09-01

    The proportion of the juvenile justice population that comprises females is increasing, yet few evidence-based models have been evaluated and implemented with girls in the juvenile justice system. Although much is known about the risk and protective factors for girls who participate in serious delinquency, significant gaps in the research base hamper the development and implementation of theoretically based intervention approaches. In this review, we first summarize the extant empirical work about the predictors and sequelae of juvenile justice involvement for girls. Identified risk and protective factors that correspond to girls' involvement in the juvenile justice system have been shown to largely parallel those of boys, although exposure rates and magnitudes of association sometimes differ by sex. Second, we summarize findings from empirically validated, evidence-based interventions for juvenile justice-involved youths that have been tested with girls. The interventions include Functional Family Therapy, Multisystemic Therapy, Multidimensional Family Therapy, and Treatment Foster Care Oregon (formerly known as Multidimensional Treatment Foster Care). We conclude that existing evidence-based practices appear to be effective for girls. However, few studies have been sufficiently designed to permit conclusions about whether sex-specific interventions would yield any better outcomes for girls than would interventions that already exist for both sexes and that have a strong base of evidence to support them. Third, we propose recommendations for feasible, cost-efficient next steps to advance the research and intervention agendas for this under-researched and underserved population of highly vulnerable youths. PMID:26119215

  9. A Bullying Intervention System: Reducing Risk and Creating Support for Aggressive Students

    Science.gov (United States)

    Allen, Kathleen P.

    2010-01-01

    Involvement in bullying is a contributor to student failure. The author describes a bullying intervention system that has been developed and implemented in a high school that aimed to interrupt bullying, conflict, and aggression before it escalates. A high school tried to reduce student involvement with the school's disciplinary system and…

  10. Psychological Interventions with Refugees.

    Science.gov (United States)

    Butcher, James N.; And Others

    Psychotherapy is an alien concept to many refugees from traditional cultures, since much of psychotherapy is tied to Western thoughts, practices, and belief systems. However, a variety of therapeutic strategies can be effective with refugees if modified to account for cultural factors. Four clinical intervention strategies are discussed with…

  11. Systemic lupus erythematosus: Clinical and experimental aspects

    International Nuclear Information System (INIS)

    This text covers questions related to the history, etiology, pathogenesis, clinical aspects and therapy of systematic lupus erythematosus (SLE). Both animal models and human SLE are considered. With regard to basic science, concise information on cellular immunology, autoantibodies, viral aspects and molecular biology in SLE is provided. Clinical topics then deal with medical, dermatologic, neurologic, radiologic, pathologic, and therapeutic aspects. The book not only presents the most recent information on clinical and experimental insights, but also looks at future aspects related to the diagnosis and therapy of SLE

  12. Systemic lupus erythematosus: Clinical and experimental aspects

    Energy Technology Data Exchange (ETDEWEB)

    Smolen, J.S.

    1987-01-01

    This text covers questions related to the history, etiology, pathogenesis, clinical aspects and therapy of systematic lupus erythematosus (SLE). Both animal models and human SLE are considered. With regard to basic science, concise information on cellular immunology, autoantibodies, viral aspects and molecular biology in SLE is provided. Clinical topics then deal with medical, dermatologic, neurologic, radiologic, pathologic, and therapeutic aspects. The book not only presents the most recent information on clinical and experimental insights, but also looks at future aspects related to the diagnosis and therapy of SLE.

  13. Substance abuse interventions for parents involved in the child welfare system: evidence and implications.

    Science.gov (United States)

    Osterling, Kathy Lemon; Austin, Michael J

    2008-01-01

    As child welfare systems across the country face the problem of parental substance abuse, there is an increasing need to understand the types of treatment approaches that are most effective for substance-abusing parents in the child welfare system-the majority of whom are mothers. This structured review of the literature focuses on evidence related to two areas: (1) individual-level interventions designed to assist mothers and women in addressing their substance abuse problems, and (2) system-level interventions designed to improve collaboration and coordination between the child welfare system and the alcohol and other drug system. Overall, research suggests the following program components may be effective with substance-abusing women with children: (1) Women-centered treatment that involves children, (2) Specialized health and mental health services, (3) Home visitation services, (4) Concrete assistance, (5) Short-term targeted interventions, and (6) Comprehensive programs that integrate many of these components. Research also suggests that promising collaborative models between the child welfare system (CWS) and the alcohol and other drug (AOD) system typically include the following core elements: (1) Out-stationing AOD workers in child welfare offices, (2) Joint case planning, (3) Using official committees to guide collaborative efforts, (4) Training and cross-training, (5) Using protocols for sharing confidential information, and (6) Using dependency drug courts. Although more rigorous research is needed on both individual-level and system-level substance abuse interventions for parents involved in the child welfare system, the integration of individual-level interventions and system-level approaches is a potentially useful practice approach with this vulnerable population.

  14. [The initial trial of the clinical use of FK-1 glue in surgical interventions].

    Science.gov (United States)

    Abzhueva, O V; Rusanov, V M; Zhidkov, I L

    2000-01-01

    The article presents results of a comparative clinical trial of the preparation "fibrinous glue" (FK-1) and "Beriplast" in operations on the lungs for hermetization of the wound and the lung as well as in reconstructive plastic gynecological operations. Intraoperative hermetization in operations on the lungs was obtained in 67% of the cases when using "FK-1" and in 64% with "Beriplast". In all the cases the lung was spread during 12 hours after operation. The visual intraoperative assessment of using "FK-1" and control laparoscopy on the 4th-5th days after operation showed its good effect in gynecological procedures. Clinical trials of the new domestic fibrinous glue "FK-1" in surgical and gynecological clinics confirmed its high medical effectiveness.

  15. Family Counseling Interventions: Understanding Family Systems and the Referral Process.

    Science.gov (United States)

    McWhirter, Ellen Hawley; And Others

    1993-01-01

    This article describes concepts underlying the idea of the "family as a system"; compares and contrasts four approaches to family therapy (those of Virginia Satir, Jay Haley, Murray Bowen, and Salvador Minuchin); and offers suggestions to teachers referring parents for family counseling. (DB)

  16. Exploring links between genotypes, phenotypes, and clinical predictors of response to early intensive behavioural intervention in Autism Spectrum Disorder

    Directory of Open Access Journals (Sweden)

    Valsamma eEapen

    2013-09-01

    Full Text Available Autism Spectrum Disorder (ASD is amongst the most familial of psychiatric disorders. Twin and family studies have demonstrated a monozygotic concordance rate of 70–90%, dizygotic concordance of around 10% and more than a 20-fold increase in risk for first-degree relatives. Despite major advances in the genetics of autism, the relationship between different aspects of the behavioural and cognitive phenotype and their underlying genetic liability is still unclear. This is complicated by the heterogeneity of autism, which exists at both genetic and phenotypic levels. Given this heterogeneity, one method to find homogeneous entities and link these with specific genotypes would be to pursue endophenotypes. Evidence from neuroimaging, eye tracking and electrophysiology studies supports the hypothesis that, building on genetic vulnerability, ASD emerges from a developmental cascade in which a deficit in attention to social stimuli leads to impaired interactions with primary caregivers. This results in abnormal development of the neurocircuitry responsible for social cognition, which in turn adversely affects later behavioural and functional domains dependent on these early processes, such as language development. Such a model begets a heterogeneous clinical phenotype, and is also supported by studies demonstrating better clinical outcomes with earlier treatment. Treatment response following intensive early behavioural intervention in ASD is also distinctly variable; however, relatively little is known about specific elements of the clinical phenotype that may predict response to current behavioural treatments. This paper overviews the literature regarding genotypes, phenotypes and predictors of response to behavioural intervention in ASD and presents suggestions for future research to explore linkages between these that would enable better identification of, and increased treatment efficacy for, ASD.

  17. On the accuracy of judgmental interventions on forecasting support systems

    OpenAIRE

    Nikolopoulos, K.; Lawrence, M.; Goodwin, P; R A Fildes

    2005-01-01

    Forecasting at the Stock Keeping Unit (SKU) disaggregate level in order to support operations management has proved a very difficult task. The levels of accuracy achieved have major consequences for companies at all levels in the supply chain; errors at each stage are amplified resulting in poor service and overly high inventory levels. In most companies, the size and complexity of the forecasting task necessitates the use of Forecasting Support Systems (FSS). The present study examines month...

  18. Comparison of two angiographic systems in paediatric interventional cardiology.

    Science.gov (United States)

    Ubeda, C; Vano, E; Miranda, P; Aguirre, D; Riquelme, N; Guarda, E

    2015-07-01

    The aim of this work was to analyse the radiation dose for patients and staff between X-ray systems, a new biplane with flat-panel detectors (FDs) and a conventional system equipped with image intensifier (II). Entrance surface air kerma (ESAK) and scatter doses were measured on polymethyl methacrylate (PMMA) phantoms of different thicknesses (from 4 to 16 cm). The ESAK values for the different acquisition modes and PMMA thicknesses were higher for the II in comparison with FDs. For the II, the scatter dose rates ranged from 0.67 to 12.2 mSv h(-1) at the eye position of the cardiologist during fluoroscopy and cine modes. At the lower extremities, these values were 1.11 and 24.24 mSv h(-1). In the case of the FDs, these values ranged from 0.24 to 0.67 mSv h(-1) for eye lens and from 0.73 to 2.01 mSv h(-1) for the position of cardiologist's ankle. The newly installed X-ray system showed an average reduction factor of up to 9.7 times for ESAK values. For the staff with an average reduction factor of 15.9 times at the eye position during fluoroscopy and cine modes, no protective tools are used. At the lower extremities, this value was 7.6 times. PMID:25843951

  19. Comparison of two angiographic systems in paediatric interventional cardiology

    International Nuclear Information System (INIS)

    The aim of this work was to analyse the radiation dose for patients and staff between X-ray systems, a new biplane with flat-panel detectors (FDs) and a conventional system equipped with image intensifier (II). Entrance surface air kerma (ESAK) and scatter doses were measured on polymethyl methacrylate (PMMA) phantoms of different thicknesses (from 4 to 16 cm). The ESAK values for the different acquisition modes and PMMA thicknesses were higher for the II in comparison with FDs. For the II, the scatter dose rates ranged from 0.67 to 12.2 mSv h-1 at the eye position of the cardiologist during fluoroscopy and cine modes. At the lower extremities, these values were 1.11 and 24.24 mSv h-1 . In the case of the FDs, these values ranged from 0.24 to 0.67 mSv h-1 for eye lens and from 0.73 to 2.01 mSv h-1 for the position of cardiologist's ankle. The newly installed X-ray system showed an average reduction factor of up to 9.7 times for ESAK values. For the staff with an average reduction factor of 15.9 times at the eye position during fluoroscopy and cine modes, no protective tools are used. At the lower extremities, this value was 7.6 times. (authors)

  20. Infants in Multirisk Families. Case Studies in Preventive Intervention. Clinical Infants Reports Series.

    Science.gov (United States)

    Greenspan, Stanley I., Ed.; And Others

    Work conducted by the Clinical Infant Development Program (CIDP) of the National Institute of Mental Health, involving 47 multirisk families and their infants over a period of several years, is described. Part I contains four detailed case studies by Delise Williams, Euthymia Hibbs, Serena Wieder and others, providing data for comprehensive…

  1. Providing recording of clinical consultation to patients - a highly valued but underutilized intervention: a scoping review

    NARCIS (Netherlands)

    Tsulukidze, M.; Durand, M.A.; Barr, P.J.; Mead, T.; Elwyn, G.

    2014-01-01

    OBJECTIVE: The benefits of providing patients with recorded clinical consultations have been mostly investigated in oncology settings, generally demonstrating positive outcomes. There has been limited synthesis of evidence about the practice in wider context. Our aim was to summarize, in a scoping r

  2. Data for improvement and clinical excellence: protocol for an audit with feedback intervention in home care and supportive living

    Directory of Open Access Journals (Sweden)

    Fraser Kimberly D

    2012-01-01

    Full Text Available Abstract Background Although considerable evidence exists about the effectiveness of audit coupled with feedback, very few audit-with-feedback interventions have been done in either home care or supportive living settings to date. With little history of audit and feedback in home care or supportive living there is potential for greater effects, at least initially. This study extends the work of an earlier study designed to assess the effects of an audit-with-feedback intervention. It will be delivered quarterly over a one-year period in seven home care offices and 11 supportive living sites. The research questions are the same as in the first study but in a different environment. They are as follows: 1. What effects do feedback reports have on processes and outcomes over time? 2. How do different provider groups in home care and supportive living sites respond to feedback reports based on quality indicator data? Methods The research team conducting this study includes researchers and decision makers in continuing care in the province of Alberta, Canada. The intervention consists of quarterly feedback reports in 19 home care offices and supportive living sites across Alberta. Data for the feedback reports are based on the Resident Assessment Instrument Home Care tool, a standardized instrument mandated for use in home care and supportive living environments throughout Alberta. The feedback reports consist of one page, printed front and back, presenting both graphic and textual information. Reports are delivered to all employees working in each site. The primary evaluation uses a controlled interrupted time-series design, both adjusted and unadjusted for covariates. The concurrent process evaluation includes observation, focus groups, and self-reports to assess uptake of the feedback reports. The project described in this protocol follows a similar intervention conducted in our previous study, Data for Improvement and Clinical Excellence

  3. High-quality 3-D coronary artery imaging on an interventional C-arm x-ray system

    Energy Technology Data Exchange (ETDEWEB)

    Hansis, Eberhard; Carroll, John D.; Schaefer, Dirk; Doessel, Olaf; Grass, Michael [Philips Technologie GmbH Forschungslaboratorien, Roentgenstrasse 24-26, 22335 Hamburg (Germany); Department of Medicine, Division of Cardiology, Health Sciences Center, University of Colorado, Denver, Colorado 80262 (United States); Philips Technologie GmbH Forschungslaboratorien, Roentgenstrasse 24-26, 22335 Hamburg (Germany); Institute of Biomedical Engineering, University of Karlsruhe, Kaiserstr. 12, 76131 Karlsruhe (Germany); Philips Technologie GmbH Forschungslaboratorien, Roentgenstrasse 24-26, 22335 Hamburg (Germany)

    2010-04-15

    Purpose: Three-dimensional (3-D) reconstruction of the coronary arteries during a cardiac catheter-based intervention can be performed from a C-arm based rotational x-ray angiography sequence. It can support the diagnosis of coronary artery disease, treatment planning, and intervention guidance. 3-D reconstruction also enables quantitative vessel analysis, including vessel dynamics from a time-series of reconstructions. Methods: The strong angular undersampling and motion effects present in gated cardiac reconstruction necessitate the development of special reconstruction methods. This contribution presents a fully automatic method for creating high-quality coronary artery reconstructions. It employs a sparseness-prior based iterative reconstruction technique in combination with projection-based motion compensation. Results: The method is tested on a dynamic software phantom, assessing reconstruction accuracy with respect to vessel radii and attenuation coefficients. Reconstructions from clinical cases are presented, displaying high contrast, sharpness, and level of detail. Conclusions: The presented method enables high-quality 3-D coronary artery imaging on an interventional C-arm system.

  4. Lutein, zeaxanthin, and meso-zeaxanthin: The basic and clinical science underlying carotenoid-based nutritional interventions against ocular disease.

    Science.gov (United States)

    Bernstein, Paul S; Li, Binxing; Vachali, Preejith P; Gorusupudi, Aruna; Shyam, Rajalekshmy; Henriksen, Bradley S; Nolan, John M

    2016-01-01

    The human macula uniquely concentrates three carotenoids: lutein, zeaxanthin, and meso-zeaxanthin. Lutein and zeaxanthin must be obtained from dietary sources such as green leafy vegetables and orange and yellow fruits and vegetables, while meso-zeaxanthin is rarely found in diet and is believed to be formed at the macula by metabolic transformations of ingested carotenoids. Epidemiological studies and large-scale clinical trials such as AREDS2 have brought attention to the potential ocular health and functional benefits of these three xanthophyll carotenoids consumed through the diet or supplements, but the basic science and clinical research underlying recommendations for nutritional interventions against age-related macular degeneration and other eye diseases are underappreciated by clinicians and vision researchers alike. In this review article, we first examine the chemistry, biochemistry, biophysics, and physiology of these yellow pigments that are specifically concentrated in the macula lutea through the means of high-affinity binding proteins and specialized transport and metabolic proteins where they play important roles as short-wavelength (blue) light-absorbers and localized, efficient antioxidants in a region at high risk for light-induced oxidative stress. Next, we turn to clinical evidence supporting functional benefits of these carotenoids in normal eyes and for their potential protective actions against ocular disease from infancy to old age. PMID:26541886

  5. Effect of a Long-Term Behavioral Weight Loss Intervention on Nephropathy in Overweight or Obese Adults with Type 2 Diabetes: the Look AHEAD Randomized Clinical Trial

    Science.gov (United States)

    Knowler, William C.; Bahnson, Judy L.; Bantle, John P.; Bertoni, Alain G.; Bray, George A.; Chen, Haiying; Cheskin, Lawrence; Clark, Jeanne M.; Egan, Caitlin; Evans, Mary; Foreyt, John P.; Glasser, Stephen P.; Greenway, Frank L.; Gregg, Edward W.; Hazuda, Helen P.; Hill, James O.; Horton, Edward S.; Hubbard, Van S.; Jakicic, John M.; Jeffery, Robert W.; Johnson, Karen C.; Kahn, Steven E.; Kitabchi, Abbas E.; Korytkowski, Mary; Krakoff, Jonathan; Kure, Anne; Lewis, Cora E.; Maschak-Carey, Barbara J.; Michaels, Sara; Montez, Maria G.; Nathan, David M.; Nyenwe, Ebenezer; Patricio, Jennifer; Peters, Anne; Pi-Sunyer, Xavier; Pownall, Henry; Wadden, Thomas A.; Wagenknecht, Lynne E.; Williamson, David F.; Wing, Rena R.; Wyatt, Holly; Yanovski, Susan Z.

    2015-01-01

    Background Long-term effects of behavioral weight loss interventions on diabetes complications are unknown. We assessed whether an intensive lifestyle intervention (ILI) affects the development of nephropathy in Look AHEAD, a multicenter randomized clinical trial in type 2 diabetes. Methods 5145 overweight or obese persons aged 45–76 years with type 2 diabetes were randomized to ILI designed to achieve and maintain weight loss through reduced caloric consumption and increased physical activity or to a diabetes support and education (DSE) group. Randomization to ILI or DSE, in a 1:1 ratio, was implemented in a central web-based data management system, stratified by clinical center, and blocked with random block sizes. Outcomes assessors and laboratory staff were masked to treatment. The interventions ended early because of lack of effect on the primary outcome of cardiovascular disease events. Albuminuria and estimated glomerular filtration rate were prespecified “other” outcomes and were assessed from baseline through 9.6 years (median) of follow-up until the interventions ended. They were combined post-hoc to define the main outcome for this report: very-high-risk chronic kidney disease (CKD) based on the 2013 Kidney Disease Improving Global Outcomes classification. Data were analyzed by intention to treat. The trial is registered as Clinicaltrials.gov NCT00017953. Findings The incidence rate of very-high-risk CKD was 31% lower in ILI than DSE with hazard rates of 0.90 cases/100 person-years in DSE and 0.63 in ILI (difference=0.27 cases/100 person-years, hazard ratio and 95% confidence interval: HR=0.69, 0.55 to 0.87). This effect was partly attributable to reductions in weight, HbA1c, and blood pressure. Interpretation Weight loss should be considered as an adjunct to medical therapies to prevent or delay progression of CKD in overweight or obese persons with type 2 diabetes. Primary Funding National Institute of Diabetes and Digestive and Kidney Diseases

  6. A randomized clinical trial of a peri-operative behavioral intervention to improve physical activity adherence and functional outcomes following total knee replacement

    Directory of Open Access Journals (Sweden)

    Zheng Hua

    2011-10-01

    Full Text Available Abstract Background Total knee replacement (TKR is a common and effective surgical procedure to relieve advanced knee arthritis that persists despite comprehensive medical treatment. Although TKR has excellent technical outcomes, significant variation in patient-reported functional improvement post-TKR exists. Evidence suggests that consistent post-TKR exercise and physical activity is associated with functional gain, and that this relationship is influenced by emotional health. The increasing use of TKR in the aging US population makes it critical to find strategies that maximize functional outcomes. Methods/Design This randomized clinical trial (RCT will test the efficacy of a theory-based telephone-delivered Patient Self-Management Support intervention that seeks to enhance adherence to independent exercise and activity among post- TKR patients. The intervention consists of 12 sessions, which begin prior to surgery and continue for approximately 9 weeks post-TKR. The intervention condition will be compared to a usual care control condition using a randomized design and a probabilistic sample of men and women. Assessments are conducted at baseline, eight weeks, and six- and twelve- months. The project is being conducted at a large healthcare system in Massachusetts. The study was designed to provide greater than 80% power for detecting a difference of 4 points in physical function (SF36/Physical Component Score between conditions (standard deviation of 10 at six months with secondary outcomes collected at one year, assuming a loss to follow up rate of no more than 15%. Discussion As TKR use expands, it is important to develop methods to identify patients at risk for sub-optimal functional outcome and to effectively intervene with the goal of optimizing functional outcomes. If shown efficacious, this peri-TKR intervention has the potential to change the paradigm for successful post-TKR care. We hypothesize that Patient Self-Management Support

  7. Treatment targets in systemic lupus erythematosus: biology and clinical perspective

    OpenAIRE

    Marian, Valentin; Anolik, Jennifer H.

    2012-01-01

    Systemic lupus erythematosus (SLE) is a complex disease characterized by numerous autoantibodies and clinical involvement in multiple organ systems. The immunological events triggering the onset and progression of clinical manifestations are also complex and multi-step, including breach of tolerance in the adaptive immune system, amplification of autoimmunity through innate and adaptive immune system dysregulation, and end-organ damage. Studies of murine genetic manipulations and human risk v...

  8. The Effect of Educational-Spiritual Intervention on The Burnout of The Parents of School Age Children with Cancer: A Randomized Controlled Clinical Trial

    OpenAIRE

    , Nooshin Beheshtipour; Parisa Nasirpour; Shahrzad Yektatalab; Mehran Karimi; Najaf Zare

    2016-01-01

    Background: Parents of children with cancer experience high levels of stress and discomfort. Religious beliefs are important sources of comfort and support for many cancer patients and their families. The present study aimed to assess the effect of educational-spiritual intervention on burnout of the parents of the children with cancer. Methods: In this randomized clinical trial, 135 parents of children with cancer were randomly assigned into intervention and control groups. Data were collect...

  9. What Clinical Interventions Have Been Implemented to Prevent or Reduce Postpartum Hypertension Readmissions? A Clin-IQ

    Science.gov (United States)

    O’Meara, Sara; Lepic, Molly

    2016-01-01

    A literature review was conducted to determine what clinical interventions have been studied and implemented to prevent and/or reduce postpartum hypertension readmissions. Appropriate verbal and printed educational materials should be given to the patient prior to discharge with use of the “teach back” method. Patients and health care providers within the multidisciplinary team should be educated on the warning signs and symptoms of worsening hypertensive disease and when to appropriately involve the obstetrician. The use of text messaging may be useful in preventing hospital readmissions by increasing patient follow-up and compliance and appropriately managing patients in the postpartum period. Treating postpartum patients with furosemide may decrease blood pressure and prevent postpartum hypertension and the need for antihypertensive therapy.

  10. Time-resolved cardiac cone beam CT using an interventional C-arm system

    NARCIS (Netherlands)

    Schomberg, H.

    2012-01-01

    It is both desirable and challenging to make interventional C-arm systems fit for cardiac cone beam CT. A number of methods towards thisgoal have been proposed, some of which even attempt to generate 4Dimages of the beating heart. A promising candidate of this type, proposed earlier by this author,

  11. Program Completion and Re-Arrest in a Batterer Intervention System

    Science.gov (United States)

    Bennett, Larry W.; Stoops, Charles; Call, Christine; Flett, Heather

    2007-01-01

    Objective: The authors examine the effects of batterer intervention program (BIP) completion on domestic violence re-arrest in an urban system of 30 BIPs with a common set of state standards, common program completion criteria, and centralized criminal justice supervision. Method: 899 men arrested for domestic violence were assessed and completed…

  12. Simplified Therapeutic Intervention Scoring System : The TISS-28 items - Results from a multicenter study

    NARCIS (Netherlands)

    Miranda, DR; deRijk, A; Schaufeli, W

    1996-01-01

    Objectives: To validate a simplified version of the Therapeutic Intervention Scoring System, the TISS-28, and to determine the association of TISS-28 with the time spent on scored and nonscored nursing activities. Design: Prospective, multicenter study. Setting: Twenty-two adult medical, surgical, a

  13. Integrating Models of Collaborative Consultation and Systems Change to Implement Forgiveness-Focused Bullying Interventions

    Science.gov (United States)

    Skaar, Nicole R.; Freedman, Suzanne; Carlon, Amy; Watson, Elizabeth

    2016-01-01

    Through collaborative consultation with school staff, school psychologists have increasingly helped schools add bullying prevention and intervention programming to their service delivery systems. As schools search for ways to lessen the impact of bullying on the social-emotional health and academic achievement of students, forgiveness education is…

  14. Early Childhood Intervention in Portugal: An Overview Based on the Developmental Systems Model

    Science.gov (United States)

    Pinto, Ana Isabel; Grande, Catarina; Aguiar, Cecilia; de Almeida, Isabel Chaves; Felgueiras, Isabel; Pimentel, Julia Serpa; Serrano, Ana Maria; Carvalho, Leonor; Brandao, Maria Teresa; Boavida, Tania; Santos, Paula; Lopes-dos-Santos, Pedro

    2012-01-01

    Research studies on early childhood intervention (ECI) in Portugal are diffuse regarding both program components and the geographical area under scrutiny. Since the 1990s, a growing body of knowledge and evidence in ECI is being gathered, based on postgraduate teaching, in-service training, and research. This article draws on the systems theory…

  15. Reduction in Hospital-Wide Clinical Laboratory Specimen Identification Errors following Process Interventions: A 10-Year Retrospective Observational Study

    Science.gov (United States)

    Ning, Hsiao-Chen; Lin, Chia-Ni; Chiu, Daniel Tsun-Yee; Chang, Yung-Ta; Wen, Chiao-Ni; Peng, Shu-Yu; Chu, Tsung-Lan; Yu, Hsin-Ming; Wu, Tsu-Lan

    2016-01-01

    Background Accurate patient identification and specimen labeling at the time of collection are crucial steps in the prevention of medical errors, thereby improving patient safety. Methods All patient specimen identification errors that occurred in the outpatient department (OPD), emergency department (ED), and inpatient department (IPD) of a 3,800-bed academic medical center in Taiwan were documented and analyzed retrospectively from 2005 to 2014. To reduce such errors, the following series of strategies were implemented: a restrictive specimen acceptance policy for the ED and IPD in 2006; a computer-assisted barcode positive patient identification system for the ED and IPD in 2007 and 2010, and automated sample labeling combined with electronic identification systems introduced to the OPD in 2009. Results Of the 2000345 specimens collected in 2005, 1023 (0.0511%) were identified as having patient identification errors, compared with 58 errors (0.0015%) among 3761238 specimens collected in 2014, after serial interventions; this represents a 97% relative reduction. The total number (rate) of institutional identification errors contributed from the ED, IPD, and OPD over a 10-year period were 423 (0.1058%), 556 (0.0587%), and 44 (0.0067%) errors before the interventions, and 3 (0.0007%), 52 (0.0045%) and 3 (0.0001%) after interventions, representing relative 99%, 92% and 98% reductions, respectively. Conclusions Accurate patient identification is a challenge of patient safety in different health settings. The data collected in our study indicate that a restrictive specimen acceptance policy, computer-generated positive identification systems, and interdisciplinary cooperation can significantly reduce patient identification errors. PMID:27494020

  16. Casebook: a system for tracking clinical encounters.

    Science.gov (United States)

    Kahn, J A; Piggins, J; Blewett, D R; Hassan, L; Raila, W; Link, D; Oliver, D E; Barnett, G O

    1991-01-01

    Casebook is a clinically oriented database, written in MUMPS, and designed for recording the clinical encounters of medical students at Harvard Medical School. Its main goals are to 1) increase student use of computer technology, 2) help faculty evaluate the diversity of clinical experiences on their service, 3) provide data to the faculty on the "typical" experience of medical students on their service to aid in the evaluation of the curriculum and, 4) provide report-generation capabilities for the students to improve dialog with their preceptors. Students are able to enter information on "Problems" and "Procedures" selecting from a pop-up menu of medical terms or by entering free text. Casebook is currently in use in the Medicine, OB/GYN, Pediatric and Ambulatory rotations. At sites where the faculty take an active interest in the use of Casebook students perceive it to be valuable and subsequently use it more frequently. It is currently being expanded for use by medical students in their second, third, and fourth years of school. PMID:1807697

  17. A Clinical Trial of Translation of Evidence Based Interventions to Mobile Tablets and Illness Specific Internet Sites

    Science.gov (United States)

    Smith, Carol E; Piamjariyakul, Ubolrat; Werkowitch, Marilyn; Yadrich, Donna Macan; Thompson, Noreen; Hooper, Dedrick; Nelson, Eve-Lynn

    2016-01-01

    This article describes a method to translate an evidence based health care intervention to the mobile environment. This translation assisted patient participants to: avoid life threatening infections; monitor emotions and fatigue; keep involved in healthy activities. The mobile technology also decreased costs by reducing for example travel to visit health care providers. Testing of this translation method and its use by comparison groups of patients adds to the knowledge base for assessing technology for its impact on health outcome measures. The challenges and workflow of designing materials for the mobile format are described. Transitioning clinical trial verified interventions, previously provided in person to patients, onto tablet and internet platforms is an important process that must be evaluated. In this study, our evidence based guide’s intravenous (IV) homeCare interventions (IVhomeCare) were delivered via Apple iPad mini™ tablet audiovisual instruction / discussion sessions and on a website. Each iPad audiovisual session (n = 41), included three to five families, a mental health specialist, and healthcare professionals. Patients and their family caregivers readily learned to use the wireless mobile tablets, and the IVhomeCare interventions, as described here, were successfully translated onto these mobile technology platforms. Using Likert scale responses on a questionnaire (1 = not helpful and 5 = very helpful) participants indicated that they gained problem solving skills for home care through iPad group discussion (M = 4.60, SD = 0.60). The firewall protected videoconferencing in real time with multiple healthcare professionals effectively allowed health history taking and visual inspection of the patient’s IV insertion site for signs of infection. Supportive interactions with peer families on videoconferencing were documented during discussions. Discussion topics included low moods, fatigue, infection worry, how to maintain independence, and

  18. How Transdiagnostic Factors of Personality and Psychopathology Can Inform Clinical Assessment and Intervention.

    Science.gov (United States)

    Rodriguez-Seijas, Craig; Eaton, Nicholas R; Krueger, Robert F

    2015-01-01

    Research suggests that many mental disorders-mood and anxiety, substance use, and personality psychopathology-are related through relatively few latent transdiagnostic factors. With regard to the comorbidity of personality disorders and common mental disorders, factor structures such as internalizing-externalizing have been replicated in numerous samples, across the life span, and around the globe. One critical feature of transdiagnostic factors is that they serve as a point of intersection between personality and psychopathology, making them particularly relevant phenomena for applied clinical work. Although numerous studies have supported the significance of transdiagnostic factors for research and classification purposes, there has been comparatively less articulation of how such factors might be of benefit to practicing assessment clinicians. Herein, we present an overview of transdiagnostic factor research findings, and we apply these findings to the clinical topics of assessment, diagnosis, and treatment. For clinicians as well as researchers, the use of transdiagnostic constructs presents positive implications for efforts to understand, characterize, and ameliorate psychopathology-including its manifestations as personality disorder-in a valid, effective, and efficient way.

  19. Outcomes of Clinical Application of Boomerang Closure Wire System

    Institute of Scientific and Technical Information of China (English)

    Jian-sheng WU; Wen-bin WEI; Yu-jia WANG; Xin-xia ZHANG; Xue-song HU

    2009-01-01

    Objectives To evaluate the efficacy and safety of clinical application of a novel type of vascular closure device named Boomerang closure wire system (BCWS). Methods BCWSs were used in 288 patients (BCWSs group) for hemostasis after transfernoral coronary angiography (CAG) or percutaneous coronary intervention (PCI). Device suc-cess rate, hemostasis success rate, manual compression time, recumbent time, minor peripheral complication rate, se-vere peripheral complication rate and hospital staying time after procedure were analyzed. Results were compared to those from 300 patients (control group) who received manual compression in our hospital during the same period. Results In BCWS group, device success rate was 97.2 %, hemostasis success rate was 95.1%. Manual compression time in CAG subgroup and PCI subgroup was 7.8 min and 11.2 min, respectively. Recumbent time was 136. 3 min in CAG subgroup, 284.6 min in PCI subgroup. Minor peripheral complication rate was 4.5 %, severe peripheral compli-cation rate was 2.4 %. Hospital-staying time after procedure in CAG group and PCI group was 1.8 d and 6.6 d, re-spectively. Compared to control group, manual compression time, recumbent time and hospital-staying time of BCWSs group had statistical significance; hemostasis success rate, minor peripheral complication rate and severe peripheral complication rate of BCWSs group bad no statistical difference. Conclusions BCWS provides satisfied haemostatic effect. Compared to routine manual compression, BCWS shortens manual compression time, recumbent time and hos-pital staying time.

  20. Derivation and validation of the Systemic Lupus International Collaborating Clinics classification criteria for systemic lupus erythematosus

    DEFF Research Database (Denmark)

    Petri, Michelle; Orbai, Ana-Maria; Alarcón, Graciela S;

    2012-01-01

    The Systemic Lupus International Collaborating Clinics (SLICC) group revised and validated the American College of Rheumatology (ACR) systemic lupus erythematosus (SLE) classification criteria in order to improve clinical relevance, meet stringent methodology requirements, and incorporate new kno...

  1. Derivation and validation of the Systemic Lupus International Collaborating Clinics classification criteria for systemic lupus erythematosus

    DEFF Research Database (Denmark)

    Petri, Michelle; Orbai, Ana-Maria; Alarcón, Graciela S;

    2012-01-01

    The Systemic Lupus International Collaborating Clinics (SLICC) group revised and validated the American College of Rheumatology (ACR) systemic lupus erythematosus (SLE) classification criteria in order to improve clinical relevance, meet stringent methodology requirements, and incorporate new...

  2. Targeted and anonymized smartphone-based public health interventions in a participatory sensing system.

    Science.gov (United States)

    Clarke, Andrew; Steele, Robert

    2014-01-01

    Public health interventions comprising information dissemination to affect behavioral adjustment have long been a significant component of public health campaigns. However, there has been limited development of public health intervention systems to make use of advances in mobile computing and telecommunications technologies. Such developments pose significant challenges to privacy and security where potentially sensitive data may be collected. In our previous work we identified and demonstrated the feasibility of using mobile devices as anonymous public health data collection devices as part of a Health Participatory Sensing Network (HPSN). An advanced capability of these networks extended in this paper would be the ability to distribute, apply, report on and analyze the usage and effectiveness of targeted public health interventions in an anonymous way. In this paper we describe such a platform, its place in the HPSN and demonstrate its feasibility through an implementation. PMID:25570789

  3. Memory Interventions in the Criminal Justice System: Some Practical Ethical Considerations.

    Science.gov (United States)

    Cabrera, Laura Y; Elger, Bernice S

    2016-03-01

    In recent years, discussion around memory modification interventions has gained attention. However, discussion around the use of memory interventions in the criminal justice system has been mostly absent. In this paper we start by highlighting the importance memory has for human well-being and personal identity, as well as its role within the criminal forensic setting; in particular, for claiming and accepting legal responsibility, for moral learning, and for retribution. We provide examples of memory interventions that are currently available for medical purposes, but that in the future could be used in the forensic setting to modify criminal offenders' memories. In this section we contrast the cases of (1) dampening and (2) enhancing memories of criminal offenders. We then present from a pragmatic approach some pressing ethical issues associated with these types of memory interventions. The paper ends up highlighting how these pragmatic considerations can help establish ethically justified criteria regarding the possibility of interventions aimed at modifying criminal offenders' memories. PMID:26715046

  4. Management Information System for Clinics with Cloud Technology

    OpenAIRE

    Nguyen Quang Tan

    2013-01-01

    This paper discusses the problems associated with the development of information management systems clinics. Presentation model of the system, which is based on a platform of technology cloud computing IBM SmartCloud and mobile phones. Giving the composition and structure of the clinics information management system that successfully support for user in managing patient information, medical history of the patients, the images for the diagnosis, prescriptions.

  5. Experimental gingivitis induces systemic inflammatory markers in young healthy individuals: a single-subject interventional study.

    Directory of Open Access Journals (Sweden)

    Jörg Eberhard

    Full Text Available OBJECTIVES: We here investigated whether experimental gingivitis enhances systemic markers of inflammation which are also known as surrogate markers of atherosclerotic plaque development. BACKGROUND: Gingivitis is a low-level oral infection induced by bacterial deposits with a high prevalence within Western populations. A potential link between the more severe oral disease periodontitis and cardiovascular disease has already been shown. METHODS: 37 non-smoking young volunteers with no inflammatory disease or any cardiovascular risk factors participated in this single-subject interventional study with an intra-individual control. Intentionally experimental oral inflammation was induced by the interruption of oral hygiene for 21 days, followed by a 21-days resolving phase after reinitiation of oral hygiene. Primary outcome measures at baseline, day 21 and 42 were concentrations of hsCRP, IL-6, and MCP-1, as well as adhesion capacity and oxLDL uptake of isolated blood monocytes. RESULTS: The partial cessation of oral hygiene procedures was followed by the significant increase of gingival bleeding (34.0%, P<0.0001. This local inflammation was associated with a systemic increase in hsCRP (0.24 mg/L, P = 0.038, IL-6 (12.52 ng/L, P = 0.0002 and MCP-1 (9.10 ng/l, P = 0.124 in peripheral blood samples between baseline and day 21, which decreased at day 42. Monocytes showed an enhanced adherence to endothelial cells and increased foam cell formation after oxLDL uptake (P<0.050 at day 21 of gingivitis. CONCLUSIONS: Bacterial-induced gingival low-level inflammation induced a systemic increase in inflammatory markers. Dental hygiene almost completely reversed this experimental inflammatory process, suggesting that appropriate dental prophylaxis may also limit systemic markers of inflammation in subjects with natural gingivitis. International Clinical Trials Register Platform of the World Health Organization, registry number: DRKS00003366, URL

  6. One state's effort to improve recruitment, retention, and practice through multifaceted clinical supervision interventions.

    Science.gov (United States)

    Collins-Camargo, Crystal; Sullivan, Dana J; Washeck, Bonnie; Adams, Jeff; Sundet, Paul

    2009-01-01

    The professional literature has described the critical role child welfare supervisors play in the recruitment and retention (R&R) of a competent workforce and in practice enhancement to produce positive outcomes for children and families. Building on findings from a federally funded demonstration project related to implementation of clinical supervision in the child welfare setting, this article provides a description of a comprehensive approach to achievement of these outcomes: an integrated implementation of an employee selection protocol, 360-degree evaluation and employee development planning, and peer consultation and support groups for supervisors. An outline of the evaluation designed to assess relative effectiveness of each component on organizational culture, staff R&R, and practice is provided. PMID:20187564

  7. Experimental and clinical study on interventional therapy with scleroticcomplex agents for hepatic cysts

    Institute of Scientific and Technical Information of China (English)

    Shu Zhang An; Xi Xian Yao; Shu Lin Jiang; Dong iai Cui

    2000-01-01

    AIM To study the effect of sclerotic complex agents (SCA) on the gallbladder wall of hybrid rabbits, andits therapeutic effect in hepatic cysts.METHODS The SCA containing tetracycline and dexamethasone was injected into the gallbladder of rabbitsto compare its action with those of normal saline and absolute ethylalcohol on the gallbladder wall. Thetherapeutic effects of SCA and absolute ethylalcohol on hepatic cysts were observed.RESULTS Abnormal changes were not found in the tissue cells of gallbladder in normal saline group. Butin absolute ethylalcohol group, a large amount of oozing fluid and blood appeared, the absorption processwas slow, and the fibrous tissue proliferated scarcely. In SCA group, there was less oozing fluid, no blood inthe gallbladder, and the absorption was active and the fibrous tissues grow obviously. In clinical practice,SCA possesses much advantage in the treatment of hepatic cysts, by which the cysts closed promptly, theexudation reduced from early stimulation, and no relapse occurred. The cure rates at the third, sixth,twelfth and twenty-fourth month were 65.1%, 96.2%, 98.1%, and 99.1% respectively; while in thecontrol group were 10.8%, 36.0%, 67.6% and 88.3% respectively. The difference was significant(P<0.01, <0.01, <0.01, <0.05). After the observation for 24 months, no relapse occurred in the SCAgroup, but 7 (6.3%) cases relapsed in control group (P<0.05).CONCLUSION The sclerotic agents should be used in sequence, i. e., a high concentration wasadministered to reduce and destroy the epithelium of the cysts, and to promote fiber tissue adhesion and thenthe remaining drug was used to stimulate epithelium to absorb the exudation. This combined regimen wasproved to be an ideal and effective method for treating hepatic cysts clinically.

  8. Integrated Approach for Improving Small Scale Market Oriented Dairy Systems in Pakistan: Economic Impact of Interventions

    Directory of Open Access Journals (Sweden)

    A. Ghaffar

    2010-02-01

    Full Text Available The International Atomic Energy Agency (IAEA launched a Coordinated Research Program in 10 developing countries including Pakistan involving small scale market oriented dairy farmers to identify and prioritize the constraints and opportunities in the selected dairy farms, develop intervention strategies and assess the economic impact of the intervention. The interventions in animal health (control of mastitis at sub-clinical stage and reduction in calf mortality, nutrition (balanced feed reproduction (mineral supplementation, and general management (training of farmers were identified and implemented in a participatory approach at the selected dairy farms. The calf mortality was reduced from 35 to 13 percent up to the age of 3 months. Use of Alfa Deval post milking teat dips reduced the incidence of sub-clinical mastitis from 34 to 5% showing economical benefits of the interventions. Partial budget technique was used to analyze its impact in the registered herds. The farmers recorded monthly quantities of different feed ingredients and seasonal green fodder offered to the animals. From this data set total metabolizeable energy requirements and availability from feed were computed which revealed that animals were deficient in metabolizeable energy in all locations. This was also confirmed by seasonal variation in body condition scoring. At some selected farms the mineral mixture supplement was introduced which exhibited increased milk yield by 5 % in addition to shorten service period by 30 days. Three sessions of training were arranged to train the farmers to care new born calves, daily farm management and detect the animals in heat efficiently to enhance the over all income of the farmers. The overall income of the farm was increased by 40%.

  9. Antioxidant and Anticoagulant Status Were Improved by Personalized Dietary Intervention Based on Biochemical and Clinical Parameters in Cancer Patients.

    Science.gov (United States)

    Lee, Ga-Yi; Lee, Jong Jyun; Lee, Seung-Min

    2015-01-01

    We investigated whether personalized dietary intervention could improve clinical measurements such as immune cell-mediated cytotoxicity, serum albumin, derivatives of reactive oxygen metabolites (D-ROMS), D-dimer, and fibrinogen. Cancer patients received either a treatment support diet (TD, for those with chemotherapy), or a remission support diet (RD; for those in remission) for at least 3 wk (21-61 days). Both diets were low glycemic, low fat, and high plant protein diets; the diet for the TD group contained an additional 0.5 servings of protein. Based on clinical values, additional amounts of garlic, onion, tomato, shiitake, rice bran, kale, blueberry, pineapples, and/or turmeric powder were provided in regular meals. Estimated daily intake of protein, plant fat, garlic, onion, allicin, and quercetin was greater in the TD compared to the RD. An increased intake of vitamin A, vitamin C, vitamin E and selenium and a reduction in D-dimer were noted compared to baseline diets in both groups. A decrease in D-ROMS in the RD and an increase in albumin and an increased tendency in cytotoxicity in the TD were observed. In conclusion, personalized diets with supplemented functional ingredients improved antioxidant status and/or anticoagulant activity in cancer patients undergoing chemotherapy and in remission. PMID:26333154

  10. Clinical- and cost-effectiveness of a nurse led self-management intervention to reduce emergency visits by people with epilepsy.

    Directory of Open Access Journals (Sweden)

    Adam J Noble

    Full Text Available People with chronic epilepsy (PWE often make costly, and clinically unnecessary emergency department (ED visits. Some do it frequently. No studies have examined interventions to reduce them. An intervention delivered by an epilepsy nurse specialist (ENS might reduce visits. The rationale is it may optimize patients' self-management skills and knowledge of appropriate ED use. We examined such an intervention's clinical- and cost-effectiveness. Eighty-five adults with epilepsy were recruited from three London EDs with similar catchment populations. Forty-one PWE recruited from two EDs received treatment-as-usual (TAU and formed the comparison group. The remaining 44 PWE were recruited from the ED of a hospital that had implemented a new ENS service for PWE attending ED. These participants formed the intervention group. They were offered 2 one-to-one sessions with an ENS, plus TAU. Participants completed questionnaires on health service use and psychosocial well-being at baseline, 6- and 12-month follow-up. Covariates were identified and adjustments made. Sixty-nine (81% participants were retained at follow-up. No significant effect of the intervention on ED visits at 12 months or on other outcomes was found. However, due to less time as inpatients, the average service cost for intervention participants over follow-up was less than for TAU participants' (adjusted difference £558, 95% CI, -£2409, £648. Covariates most predictive of subsequent ED visits were patients' baseline feelings of stigmatization due to epilepsy and low confidence in managing epilepsy. The intervention did not lead to a reduction in ED use, but did not cost more, partly because those receiving the intervention had shorter hospital admissions. Our findings on long-term ED predictors clarifies what causes ED use, and suggests that future interventions might focus more on patients' perceptions of stigma and on their confidence in managing epilepsy. If addressed, ED visits

  11. Comparison of AIMS65 Score and Other Scoring Systems for Predicting Clinical Outcomes in Koreans with Nonvariceal Upper Gastrointestinal Bleeding

    Science.gov (United States)

    Park, Sung Min; Yeum, Seok Cheon; Kim, Byung-Wook; Kim, Joon Sung; Kim, Ji Hee; Sim, Eun Hui; Ji, Jeong-Seon; Choi, Hwang

    2016-01-01

    Background/Aims The AIMS65 score has not been sufficiently validated in Korea. The objective of this study was to compare the AIMS65 and other scoring systems for the prediction of various clinical outcomes in Korean patients with acute nonvariceal upper gastrointestinal bleeding (NVUGIB). Methods The AIMS65 score, clinical and full Rockall scores (cRS and fRS) and Glasgow-Blatchford (GBS) score were calculated in patients with NVUGIB in a single center retrospectively. The performance of these scores for predicting mortality, rebleeding, transfusion requirement, and endoscopic intervention was assessed by calculating the area under the receiver-operating characteristic curve. Results Of the 523 patients, 3.4% died within 30 days, 2.5% experienced rebleeding, 40.0% required endoscopic intervention, and 75.7% needed transfusion. The AIMS65 score was useful for predicting the 30-day mortality, the need for endoscopic intervention and for transfusion. The fRS was superior to the AIMS65, GBS, and cRS for predicting endoscopic intervention and the GBS was superior to the AIMS65, fRS, and cRS for predicting the transfusion requirement. Conclusions The AIMS65 score was useful for predicting the 30-day mortality, transfusion requirement, and endoscopic intervention in Korean patients with acute NVUGIB. However, it was inferior to the GBS and fRS for predicting the transfusion requirement and endoscopic intervention, respectively. PMID:27377742

  12. An Overview of Clinical Studies on Fiber Post Systems

    Directory of Open Access Journals (Sweden)

    Idil Dikbas

    2013-01-01

    Full Text Available Intraradicular posts are useful adjuncts in the restoration of endodontically treated teeth. These systems have undergone a significant evolution in recent years, and fiber-reinforced systems have started to be incorporated into routine clinical care more frequently. Despite the high number of laboratory studies pertaining to the characteristics of fiber posts, clinical studies evaluating their general success rates are rather limited. Since clinical investigations are reliable means to achieve information about the general behavior pattern of materials or techniques, assessment of this data will be beneficial to have a better understanding of fiber-reinforced intraradicular post systems. The purpose of this paper was to make a summary of clinical studies regarding various fiber posts. A PubMed search was conducted and articles dating back to 1990 were retrieved. The paper provides an overview of clinical studies on fiber posts specifically in the last decade as well as commentary analysis.

  13. Effects of an intervention aimed at improving nurse-patient communication in an oncology outpatient clinic

    DEFF Research Database (Denmark)

    Rask, Mette Trøllund; Jensen, Mette Lund; Andersen, Jørn;

    2009-01-01

    In an ever more burdened healthcare system, there is an urgent need to investigate whether patients benefit from the resources allocated to nurses' communication skills training in terms of improved patient outcomes. This study aimed to evaluate a standardized two 2-day (33 hours) communication s...

  14. Effects on Serum Fractalkine by Diet and Omega-3 Fatty Acid Intervention: Relation to Clinical Outcome

    Directory of Open Access Journals (Sweden)

    Kristian Laake

    2015-01-01

    Full Text Available Introduction. Fractalkine is a chemokine associated with atherosclerosis. Increased serum levels have been reported in unstable coronary artery disease (CAD and to predict mortality in heart failure. Mediterranean-like diet and omega-3 fatty acids (n3-PUFA have documented cardioprotective and anti-inflammatory effects. We have investigated the effect of Mediterranean-like dietary counseling and n-3 PUFA on serum fractalkine in an elderly population and its ability to predict cardiovascular disease (CVD. Materials and Methods. 563 men (age 64–75 yrs at high risk of CAD were randomized into a 2 × 2 factorial designed trial for 3-year dietary counseling and/or n-3 PUFA supplementation (2.4 g/d. Circulating levels of fractalkine were measured at baseline and at end of study. Clinical events were recorded after 3 years. Results. Fractalkine levels were significantly reduced in all groups from baseline to 3 years (P<0.001, all, but without between-group differences in changes. Fractalkine levels at baseline were not predictive for CVD events (n=68 or total mortality. Lower fractalkine levels were observed in smokers (P=0.019. Conclusions. Reduced levels of fractalkine from baseline to 3 years were observed, however, without any influence of Mediterranean-like diet or n-3 PUFA supplementation. Fractalkine levels at baseline were not predictive for later CVD events.

  15. Clinical intervention in aging: ethicolegal issues in assessing risk and benefit

    Directory of Open Access Journals (Sweden)

    Pierre Mallia

    2010-12-01

    Full Text Available Pierre MalliaMedical School, University of Malta, Mater Dei Hospital, MaltaAbstract: The ethical dimension of treating the elderly, including risk–benefit analysis, focuses mainly on quality of life and end-of-life issues. These include arguments on advance directives and the concept of extraordinary treatments. This paper looks more closely at the philosophical approach to aging in order to address questions on the direction of research and issues such as longevity and social construction of the aging process. It is the way society moves to understand the value-laden choices on aging that directs the goals of treatment and research. Whilst these vary culturally, one has to reckon with a postmodern view of aging which may, in turn, reflect on the course of action of future care and research in aging. The paper canvasses how, in reality, four principles act as guidelines for moral discourse, and discusses how changing values in society decide this course of action.Keywords: aging, principles, decision-making, conflict, treatment, clinical decision-making, social construction 

  16. Right sided single coronary artery origin: surgical interventions without clinical consequences.

    Science.gov (United States)

    Hamid, Tahir; Rose, Samman; Horner, Simon

    2011-11-01

    Congenital coronary anomalies are uncommon and are usually diagnosed incidentally during coronary angiogram or autopsy. Isolated coronary artery anomalies and the anomalous origin of left main stem (LMS) from the proximal portion of the right coronary artery or from the right sinus of valsalva are extremely rare. A 68 years old woman with atypical chest pains was referred for risk assessment for the general anaesthesia. A stress exercise treadmill test and myocardial perfusion scan revealed evidence of mild myocardial ischemia. Her coronary angiography revealed her left coronary artery to have a single origin with the right coronary artery. There were no flowlimiting lesions. A CT aortography confirmed a retro-aortic course of the left coronary artery. She successfully underwent multiple surgical procedures under general anaesthesia including total abdominal hysterectomy, Burch colposuspension (twice) for stress incontinence, intravesical botox injection for urge incontinence and haemorrhoidectomy for recurrent rectal mucosal prolapse. Various anaesthetic agents including halothane, thiopentone, suxamethonium, pancuronium, enflurane, fentanyl, propofol and isoflurane were used without any adverse clinical consequences. She remained well on 48 months follow-up. PMID:22078352

  17. Clinical value of the assistant interventional embolization in treatment of juvenile nasopharyngeal angiofibroma

    International Nuclear Information System (INIS)

    Objective: To study the application of the assistant digital subtraction angiography (DSA) with selective intra-arterial embolization in comprehensive treatment of juvenile nasopharyngeal angiofibroma. Methods: Among 17 patients with juvenile nasopharyngeal angiofibroma confirmed by surgery and biopsy from February 2000 to June 2005, 13 cases underwent DSA examination and selective intra-arterial embolization on 1-4 days before surgical operation, and 4 cases with uncontrollable epistaxis through conventional therapy were carried out urgent DSA and embolization as well as surgical operation on a scheduled day. Angiographic manifestations and hemostatic effects and impacts in surgical operation were observed. Results: The extent and blood supply of lesions and the features of feeding artery were clearly demonstrated by DSA. Supplying vessel was mainly maxillary artery originating from external caroted artery in 16 cases, and double supplying vessels from ramus of internal and external carotid arteries in 1 case. In general, the higher the nasopharyngeal angiofibroma grade was the more supplying branches would exist. As for epistaxis patients, the number of the presence of irregular distal vessels and the punctiform extravasation of contrast media were displayed in positive proportion. No severe complications occurred and active bleeding was stopped after embolization and furthermore with less blood loss during surgical operation statistically about 280-1600 ml (460±255.5). Conclusions: DSA examination and selective arterial embolization can not only present more accurate important clinical imaging features but also in favour of stop bleeding and enhance surgical outcomes for patients with nasopharyngeal angiogibroma. (authors)

  18. Acceptability of Mobile Phone Technology for Medication Adherence Interventions among HIV-Positive Patients at an Urban Clinic

    Directory of Open Access Journals (Sweden)

    Christopher W. T. Miller

    2013-01-01

    Full Text Available Mobile phone technology is increasingly used to overcome traditional barriers limiting access to care. The goal of this study was to evaluate access and willingness to use smart and mobile phone technology for promoting adherence among people attending an urban HIV clinic. One hundred consecutive HIV-positive patients attending an urban HIV outpatient clinic were surveyed. The questionnaire evaluated access to and utilization of mobile phones and willingness to use them to enhance adherence to HIV medication. The survey also included the CASE adherence index as a measure of adherence. The average age was 46.4 (. The majority of participants were males (63%, black (93%, and Hispanic (11.4% and reported earning less than $10,000 per year (67.3%. Most identified themselves as being current smokers (57%. The vast majority reported currently taking HAART (83.5%. Approximately half of the participants reported some difficulty with adherence (CASE < 10. Ninety-six percent reported owning a mobile phone. Among owners of mobile phones 47.4% reported currently owning more than one device. Over a quarter reported owning a smartphone. About 60% used their phones for texting and 1/3 used their phone to search the Internet. Nearly 70% reported that they would use a mobile device to help with HIV adherence. Those who reported being very likely or likely to use a mobile device to improve adherence were significantly more likely to use their phone daily ( and use their phone for text messages (. The vast majority of patients in an urban HIV clinic own mobile phones and would use them to enhance adherence interventions to HIV medication.

  19. Recommendations for Responsible Monitoring and Regulation of Clinical Software Systems

    OpenAIRE

    Miller, Randolph A; Gardner, Reed M.

    1997-01-01

    In mid-1996, the FDA called for discussions on regulation of clinical software programs as medical devices. In response, a consortium of organizations dedicated to improving health care through information technology has developed recommendations for the responsible regulation and monitoring of clinical software systems by users, vendors, and regulatory agencies. Organizations assisting in development of recommendations, or endorsing the consortium position include the...

  20. The Stochastic Dynamics for Ecological Tourism System with Visitor Educational Intervention

    Directory of Open Access Journals (Sweden)

    Dongping Wei

    2013-01-01

    Full Text Available The ever-increasing visitation in parks and protected areas continues to present a considerable challenge for worldwide land managers with allowing recreational use while preserving natural conditions. In China, the fast expanding visitation in protected areas is quickly damaging the natural resources and precious culture without effective visitor education, while regulation and site management are also gaining very limited efficacy. We propose a differential equation to describe the ecological tourism system. Shown by the theoretical proof and numerical simulation, the ecological tourism system is unstable without any perturbed factors, especially visitor educational intervention, because the solution of the dynamic system explodes in a finite time given any initial value. Supposing that the intrinsic increasing rate of stakeholders in the systems stochastically perturbed by the visitor educational intervention, we discover that the stochastic dynamic model can effectively suppress the explosion of the solution. As such, we demonstrate that the tourism system can develop steadily and safely even under a large amount of visitors in public vacation, when employing continuous visitor education intervention programmes.

  1. Effect of the “Spiritual Support” Intervention on Spirituality and the Clinical Parameters of Women Who Have Undergone Mastectomy: A Pilot Study

    Directory of Open Access Journals (Sweden)

    Caroline Guilherme

    2016-03-01

    Full Text Available This study aimed to evaluate the effect of the spiritual support intervention on spirituality and the clinical parameters of women who have undergone mastectomy. This is a pilot study of a randomized clinical trial. The spiritual support intervention was composed of meditation, guided imagery, music, and respiratory relaxation. The outcomes were: spirituality, blood pressure, heart rate, and oxygen saturation. A total of 27 patients were recruited for the study (intervention group, n = 13; control group, n = 14 (Clinical Trials: NCT 01866670/CAE: 00896312.0.0000.5393. The intervention helped patients with breast cancer to increase expression of their spirituality (p = 0.040 and it also decreased heart rate on the first (p = 0.038 and third day (p = 0.017. There was a difference in oxygen saturation on the second day in the control group (p = 0.039. Patients reported that their participation in the research was positive. This intervention had an effect on the sample of women who had undergone mastectomy.

  2. Changes in actual and perceived physical abilities in clinically obese children: a 9-month multi-component intervention study.

    Directory of Open Access Journals (Sweden)

    Milena Morano

    Full Text Available OBJECTIVES: (1 To examine relationships among changes in physical activity, physical fitness and some psychosocial determinants of activity behavior in a clinical sample of obese children involved in a multi-component program; (2 to investigate the causal relationship over time between physical activity and one of its strongest correlates (i.e. perceived physical ability. METHODS: Self-reported physical activity and health-related fitness tests were administered before and after a 9-month intervention in 24 boys and 20 girls aged 8 to 11 years. Individuals' perceptions of strength, speed and agility were assessed using the Perceived Physical Ability Scale, while body image was measured using Collins' Child Figure Drawings. RESULTS: Findings showed that body mass index, physical activity, performances on throwing and weight-bearing tasks, perceived physical ability and body image significantly improved after treatment among obese children. Gender differences were found in the correlational analyses, showing a link between actual and perceived physical abilities in boys, but not in girls. For the specific measurement interval of this study, perception of physical ability was an antecedent and not a potential consequence of physical activity. CONCLUSIONS: Results indicate that a multi-component activity program not based merely on a dose-effect approach enhances adherence of the participants and has the potential to increase the lifelong exercise skills of obese children. Rather than focusing entirely on diet and weight loss, findings support the inclusion of interventions directed toward improving perceived physical ability that is predictive of subsequent physical activity.

  3. Drugs and Polymers for Delivery Systems in OA Joints: Clinical Needs and Opportunities

    Directory of Open Access Journals (Sweden)

    Maarten Janssen

    2014-03-01

    Full Text Available Osteoarthritis (OA is a big burden of disease worldwide and one of the most common causes of disability in the adult population. Currently applied therapies consist of physical therapy, oral medication, intra-articular injections, and surgical interventions, with the main goal being to reduce pain and improve function and quality of life. Intra-articular (IA administration of drugs has potential benefits in OA treatment because it minimizes systemic bioavailability and side effects associated with oral administration of drugs without compromising the therapeutic effect in the joint. However, IA drug residence time is short and there is a clinical need for a vehicle that is able to provide a sustained release long enough for IA therapy to fulfill its promise. This review summarizes the use of different polymeric systems and the incorporated drugs for IA drug delivery in the osteoarthritic joint with a primary focus on clinical needs and opportunities.

  4. Mammography calibration qualities establishment in a Mo- Mo clinical system

    Science.gov (United States)

    Corrêa, E. L.; dos Santos, L. R.; Vivolo, V.; Potiens, M. P. A.

    2016-07-01

    In this study the mammography calibration qualities were established in a clinical mammography system. The objective is to provide the IPEN instruments calibration laboratory with both mammography calibration methods (using a clinical and an industrial system). The results showed a good behavior of mammography equipment, in terms of kVp, PPV and exposure time. The additional filtration of molybdenum is adequate, air-kerma rates were determined and spectra were obtained.

  5. Overdenture with accesspost system: A clinical report

    OpenAIRE

    Deepti C Jain; Veena Hegde; I. N. Aparna; Dhanasekar, B.

    2011-01-01

    A patient presented with an unfavorable distribution of teeth in the arch which precluded treatment with a removable partial denture. The unique pattern of partial edentulism was treated with an overdenture restoration using accesspost system. The final restoration was stable, well retained and esthetic, serving as a conservative approach to root preservation.

  6. Clinical approach of patients with systemic amyloidosis

    NARCIS (Netherlands)

    Hazenberg, Bouke

    2011-01-01

    Amyloidosis is the name of diseases characterised by deposition of protein fibrils with a beta-sheet structure. This beta-sheet structure generates affinity of amyloid for Congo red dye and is resistant to proteolysis. The main three types of systemic amyloidosis are AA (related to underlying chroni

  7. Overdenture with accesspost system: A clinical report

    Directory of Open Access Journals (Sweden)

    Deepti C Jain

    2011-01-01

    Full Text Available A patient presented with an unfavorable distribution of teeth in the arch which precluded treatment with a removable partial denture. The unique pattern of partial edentulism was treated with an overdenture restoration using accesspost system. The final restoration was stable, well retained and esthetic, serving as a conservative approach to root preservation.

  8. A Manual-Based Intervention to Address Clinical Crises and Retain Patients in the Treatment of Adolescents with Depression Study (TADS)

    Science.gov (United States)

    May, Diane E.; Kratochvil, Christopher J.; Puumala, Susan E.; Silva, Susan G.; Rezac, Amy J.; Hallin, Mary J.; Reinecke, Mark A.; Vitiello, Benedetto; Weller, Elizabeth B.; Pathak, Sanjeev; Simons, Anne D.; March, John S.

    2007-01-01

    Objective: To describe a manual-based intervention to address clinical crises and retain participants in the Treatment for Adolescents with Depression Study (TADS). Method: The use of adjunct services for attrition prevention (ASAP) is described for adolescents (ages 12-17 years) during the 12-week acute treatment in TADS, from 2000 to 2003.…

  9. Representing clinical communication knowledge through database management system integration.

    Science.gov (United States)

    Khairat, Saif; Craven, Catherine; Gong, Yang

    2012-01-01

    Clinical communication failures are considered the leading cause of medical errors [1]. The complexity of the clinical culture and the significant variance in training and education levels form a challenge to enhancing communication within the clinical team. In order to improve communication, a comprehensive understanding of the overall communication process in health care is required. In an attempt to further understand clinical communication, we conducted a thorough methodology literature review to identify strengths and limitations of previous approaches [2]. Our research proposes a new data collection method to study the clinical communication activities among Intensive Care Unit (ICU) clinical teams with a primary focus on the attending physician. In this paper, we present the first ICU communication instrument, and, we introduce the use of database management system to aid in discovering patterns and associations within our ICU communications data repository. PMID:22874366

  10. Representing clinical communication knowledge through database management system integration.

    Science.gov (United States)

    Khairat, Saif; Craven, Catherine; Gong, Yang

    2012-01-01

    Clinical communication failures are considered the leading cause of medical errors [1]. The complexity of the clinical culture and the significant variance in training and education levels form a challenge to enhancing communication within the clinical team. In order to improve communication, a comprehensive understanding of the overall communication process in health care is required. In an attempt to further understand clinical communication, we conducted a thorough methodology literature review to identify strengths and limitations of previous approaches [2]. Our research proposes a new data collection method to study the clinical communication activities among Intensive Care Unit (ICU) clinical teams with a primary focus on the attending physician. In this paper, we present the first ICU communication instrument, and, we introduce the use of database management system to aid in discovering patterns and associations within our ICU communications data repository.

  11. Early renin-angiotensin system intervention is more beneficial than late intervention in delaying end-stage renal disease in patients with type 2 diabetes

    DEFF Research Database (Denmark)

    Schievink, B; Kröpelin, T; Mulder, S;

    2016-01-01

    AIMS: To develop and validate a model to simulate progression of diabetic kidney disease (DKD) from early onset until end-stage renal disease (ESRD), and to assess the effect of renin-angiotensin system (RAS) intervention in early, intermediate and advanced stages of DKD. METHODS: We used data from...

  12. Clinical Study of Xiongshao Capsule (芎芍胶囊) in Preventing Restenosis after Coronary Interventional Treatment

    Institute of Scientific and Technical Information of China (English)

    徐浩; 陈可冀; 史大卓; 马晓昌; 吕树铮; 毛节明

    2002-01-01

    Objective: To evaluate the effect of Xiongshao Capsule (XS, 芎芍胶囊) in preventing clinical and angiographic restenosis after coronary angioplasty or/and stenting. Methods: The total of 108 coronary heart disease patients with successful coronary angioplasty or/and stenting were randomly divided into the control group (55 cases, routine treatment) and the XS group (53 cases, routine treatment combined with XS). The recurrence of angina, clinical end-point events, changing of blood-stasis syndrome score (BSSS) and coronary angiography within 6 month after coronary angioplasty or/and stenting were observed. Results: Follow-up angiography was performed in 42 patients including 18 cases in the XS group (restenosis was observed in 7 patients) and 24 cases in the control group (restenosis was observed in 17 patients), there was significant difference between the occurrence of restenosis in XS and that in control group (P<0.05). The occurrence of clinical end-point events (death, nonfatal target lesion myocardial infarction, coronary artery bypass graft surgery, or repeat target-vessel angioplasty) in the XS group (18.8%) was significantly lower than that in the control group (40%)(P<0.05). The recurrent angina was observed in 13 cases in the XS group, there was significant difference as compared with 27 cases in the control group (P<0.05). There was also remarkable significance for the difference of base-line and follow-up BSSS between groups (P<0.01). Logistic multivariate stepwise regress analysis and multivariate regress analysis of the related factors with restenosis confirmed by coronary angiography showed that, the base-line BSSS and the difference of base-line and follow-up BSSS were important influencing factors on the occurrence of restenosis after interventional treatment (P<0.05). Conclusion: XS could markedly reduce the occurrence of angiographic restenosis, clinical end-point events and recurrent angina, improve condition of blood-stasis after coronary

  13. Development of a clinical data warehouse from an intensive care clinical information system.

    Science.gov (United States)

    de Mul, Marleen; Alons, Peter; van der Velde, Peter; Konings, Ilse; Bakker, Jan; Hazelzet, Jan

    2012-01-01

    There are relatively few institutions that have developed clinical data warehouses, containing patient data from the point of care. Because of the various care practices, data types and definitions, and the perceived incompleteness of clinical information systems, the development of a clinical data warehouse is a challenge. In order to deal with managerial and clinical information needs, as well as educational and research aims that are important in the setting of a university hospital, Erasmus Medical Center Rotterdam, The Netherlands, developed a data warehouse incrementally. In this paper we report on the in-house development of an integral part of the data warehouse specifically for the intensive care units (ICU-DWH). It was modeled using Atos Origin Metadata Frame method. The paper describes the methodology, the development process and the content of the ICU-DWH, and discusses the need for (clinical) data warehouses in intensive care.

  14. Ethical and diversity challenges in ecologically sensitive systems-oriented interventions.

    Science.gov (United States)

    Jason, Leonard A

    2015-11-01

    This article discusses ethical and diversity challenges involved in implementing ecologically sensitive, systems-oriented research. These issues are considered with reference to a series of community-based interventions dealing with stigma and chronic illness, recovery from substance-use disorders, and prevention of tobacco use. Each of these ecological interventions incorporates a systems approach, which allows an understanding of how individuals affect and are influenced by their social environments. In addition, issues of diversity with respect to underrepresented and marginalized groups are considered, including overcoming obstacles to gaining access to resources and promoting increased opportunities and empowerment. Throughout, the central importance of developing relationships with key gatekeepers and stakeholders, as well as timely and effective communications with various coalition members, is highlighted. By bringing into the research and policy process diverse citizen/participant suggestions and input regarding the need for, or design and implementation of ecologically and systems-based interventions, researchers can build collaborative relationships that fuel trust and partnerships, leading to more ethically responsible research. (PsycINFO Database Record

  15. Modelling household responses to energy efficiency interventions via system dynamics and survey data

    Directory of Open Access Journals (Sweden)

    S Davis

    2010-12-01

    Full Text Available An application of building a system dynamics model of the way households might respond to interventions aimed at reducing energy consumption (specifically the use of electricity is described in this paper. A literature review of past research is used to build an initial integrated model of household consumption, and this model is used to generate a small number of research hypotheses about how households possessing different characteristics might react to various types of interventions. These hypotheses are tested using data gathered from an efficiency intervention conducted in a town in the South African Western Cape in which households were able to exchange regular light bulbs for more efficient compact fluorescent lamp light bulbs. Our experiences are (a that a system dynamics approach proved useful in advancing a non-traditional point of view for which, for historical and economic reasons, data were not abundantly available; (b that, in areas where traditional models are heavily quantitative, some scepticism to a system dynamics model may be expected; and (c that a statistical comparison of model results by means of empirical data may be an effective tool in reducing such scepticism.

  16. Semantically based clinical TCM telemedicine systems

    CERN Document Server

    Wong, Allan K Y; Lin, Wilfred W K; Dillon, Tharam S; Chang, Elizabeth J

    2015-01-01

    Recent years have seen the development of two significant trends namely: the adoption of some Traditional Chinese Medicine Practices into mainstream Allopathic Western Medicine and the advent of the internet and broad band networks leading to an increased interest in the use of Telemedicine to deliver medical services. In this book, we see the convergence of these two trends leading to a semantically-based TCM Telemedicine system that utilizes an ontology to provide sharable knowledge in the TCM realm to achieve this. The underpinning research required the development of a three-layer architecture and an Ontology of the TCM knowledge. As TCM knowledge like all medical knowledge is not frozen in time it was important to develop an approach that would allow evolution of the Ontology when new evidence became available. In order for the system to be practically grounded it was important to work with an industry partner PuraPharm Group/HerbMiners Informatics Limited. This partnership was initiated through Professo...

  17. Access to reliable information about long-term prognosis influences clinical opinion on use of lifesaving intervention.

    Directory of Open Access Journals (Sweden)

    Stephen Honeybul

    Full Text Available BACKGROUND: Decompressive craniectomy has been traditionally used as a lifesaving rescue treatment in severe traumatic brain injury (TBI. This study assessed whether objective information on long-term prognosis would influence healthcare workers' opinion about using decompressive craniectomy as a lifesaving procedure for patients with severe TBI. METHOD: A two-part structured interview was used to assess the participants' opinion to perform decompressive craniectomy for three patients who had very severe TBI. Their opinion was assessed before and after knowing the predicted and observed risks of an unfavourable long-term neurological outcome in various scenarios. RESULTS: Five hundred healthcare workers with a wide variety of clinical backgrounds participated. The participants were significantly more likely to recommend decompressive craniectomy for their patients than for themselves (mean difference in visual analogue scale [VAS] -1.5, 95% confidence interval -1.3 to -1.6, especially when the next of kin of the patients requested intervention. Patients' preferences were more similar to patients who had advance directives. The participants' preferences to perform the procedure for themselves and their patients both significantly reduced after knowing the predicted risks of unfavourable outcomes, and the changes in attitude were consistent across different specialties, amount of experience in caring for similar patients, religious backgrounds, and positions in the specialty of the participants. CONCLUSIONS: Access to objective information on risk of an unfavourable long-term outcome influenced healthcare workers' decision to recommend decompressive craniectomy, considered as a lifesaving procedure, for patients with very severe TBI.

  18. Compliance of an elderly hip fracture population with secondary preventative measures. Efficacy of a simple clinical practice intervention.

    LENUS (Irish Health Repository)

    Street, John

    2012-02-03

    Secondary pharmaceutical measures are effective in all age groups for the prevention of osteoporotic fractures. This prospective study determines the demographics of 566 consecutive osteoporotic hip fractures presenting to a Level 1 Trauma Center. We examine the efficacy of simple treatment recommendations for pharmaceutical treatment of osteoporosis and the factors determining general practitioner and patient compliance with these recommendations in a community setting. One out of four patients (24.5%) had sustained a previous fragility fracture. Mean age was 80 years. Twenty five percent were resident in a nursing home and only 10% were taking anti-resorptive therapy preoperatively. In hospital mortality was 6%, and 39% of recruited patients were dead at 12 months. By this time more than half the survivors were resident in a nursing home. The compliance with anti-resorptive therapy had increased to over 70% consequent to our simple recommendations. Significant differences in GP and patient compliance were observed between nursing home and own residence dwellers. This study demonstrates the efficacy of a simple clinical practice intervention in increasing patient and GP compliance with secondary fracture prevention measures. We also discuss many of the confounding issues determining this compliance.

  19. What is the right time for supportive versus expressive interventions in supervision? An illustration based on a clinical mistake.

    Science.gov (United States)

    Leibovich, Liat; Zilcha-Mano, Sigal

    2016-09-01

    Although supportive-expressive (SE) psychotherapy is one of the most studied psychodynamic therapies today, little is known empirically about effective strategies in SE supervision, or in psychodynamic supervision in general (Diener & Mesrie, 2015; Watkins, 2011). One of the important questions in SE psychotherapy is how to decide when to use supportive and when to use expressive interventions. As a parallel process, this type of decision is relevant also to SE supervision. The present case study focuses on the decision-making process in an SE supervision session: when should supervisors use supportive as opposed to expressive strategies with their supervisees? Our aim is to develop decision rules that reliably support supervisors' decisions. We analyze a clinical error made by supervisors in this type of decision making, and show how mistakes of this type can either be avoided or, when they occur, how to turn them into opportunities for learning and for the formation of new understanding and growth. Similarly to the finding that therapists with better skills in managing their countertransference feelings were shown to have better outcomes with their patients (Gelso, Latts, Gomez, & Fassinger, 2002; Hayes, Gelso, & Hummel, 2011), we suggest that the management of the supervisors' feelings, and working through their mistakes with the therapists, can contribute to the supervisory relationship and to the development of the psychodynamic therapists' skills. (PsycINFO Database Record PMID:27631858

  20. Clinical importance of hyperemic coronary blood flow (thrombolysis in myocardial infarction-intravenous flow) after primary percutaneous coronary intervention.

    Science.gov (United States)

    Karakoyun, Süleyman; Tanboga, Ibrahim Halil; Kurt, Mustafa; Aksakal, Enbiya; Kaya, Ahmet; Isik, Turgay; Ekinci, Mehmet; Sevimli, Serdar; Acikel, Mahmut

    2014-10-01

    We aimed to investigate clinical, demographic and angiographic factors associated with hyperemic coronary blood flow (HCBF) and the relation of HCBF with mortality at 30 days. Our study included 809 consecutive patients with acute ST-segment elevation myocardial infarction who underwent primary percutaneous coronary intervention (PCI). We divided corrected thrombolysis in myocardial infarction (TIMI) frame count (TFC) values into three tertiles: less than 14, 14-28 and more than 28. Corrected TFC less than 14 was defined as HCBF or TIMI intravenous flow. The primary end-point of the present study was all-cause mortality within 30 days. Among the HCBF group (n = 58), the patients with poor myocardial perfusion demonstrated the highest mortality rate within the 30-day follow-up period (33%). Low TIMI myocardial perfusion grade, history of no smoking, left ventricular ejection fraction (LVEF), and high Killip status and low LVEF were found to be independently associated with 1-month all-cause mortality. The present study showed that HCBF after primary PCI has a high 30-day mortality when associated with impaired reperfusion. PMID:24842315

  1. Early intervention in Moscow preschool education system: shift from rapid growth to quality improvement in preschool early intervention programs in Moscow

    Directory of Open Access Journals (Sweden)

    A. M. Kazmin

    2013-04-01

    Full Text Available Early intervention services and lekoteks in Moscow preschool education system are aimed to help children from several months to 7 years of age with developmental disorders and their parents. The number of such programs reached 200 in 2012 and was growing faster than the number of professionals skilled to work at them. This obvious mismatch situation emerged the need for quality assessment and structured educational programs for specialist initial education and recertification. In this article we discuss the most commonly used protocols in early intervention programs, and current trends in their improvement. We also propose a model for quality standard development in early intervention services and lekoteks, based on worldwide experience and ISO (ISO 9001:2000 quality management principles.

  2. The Development of a Multi-Level Model for Crisis Preparedness and Intervention in the Greek Educational System

    Science.gov (United States)

    Hatzichristiou, Chryse; Issari, Philia; Lykitsakou, Konstantina; Lampropoulou, Aikaterini; Dimitropoulou, Panayiota

    2011-01-01

    This article proposes a multi-level model for crisis preparedness and intervention in the Greek educational system. It presents: a) a brief overview of leading models of school crisis preparedness and intervention as well as cultural considerations for contextually relevant crisis response; b) a description of existing crisis intervention…

  3. A Bullying Intervention System in High School: A Two-Year School-Wide Follow-Up

    Science.gov (United States)

    Allen, Kathleen P.

    2010-01-01

    This study is an evaluation of a systemic, two-year, whole-school bullying intervention initiative that was implemented in a US public high school. Students and staff members were anonymously surveyed before and after the intervention. The goals of the initiative were to reduce bullying and victimization, increase disclosure, increase intervention…

  4. Psychophysiological effects of a web-based stress management system: A prospective, randomized controlled intervention study of IT and media workers [ISRCTN54254861

    Directory of Open Access Journals (Sweden)

    Theorell Töres

    2005-07-01

    Full Text Available Abstract Background The aim of the present study was to assess possible effects on mental and physical well-being and stress-related biological markers of a web-based health promotion tool. Methods A randomized, prospectively controlled study was conducted with before and after measurements, involving 303 employees (187 men and 116 women, age 23–64 from four information technology and two media companies. Half of the participants were offered web-based health promotion and stress management training (intervention lasting for six months. All other participants constituted the reference group. Different biological markers were measured to detect possible physiological changes. Results After six months the intervention group had improved statistically significantly compared to the reference group on ratings of ability to manage stress, sleep quality, mental energy, concentration ability and social support. The anabolic hormone dehydroepiandosterone sulphate (DHEA-S decreased significantly in the reference group as compared to unchanged levels in the intervention group. Neuropeptide Y (NPY increased significantly in the intervention group compared to the reference group. Chromogranin A (CgA decreased significantly in the intervention group as compared to the reference group. Tumour necrosis factor α (TNFα decreased significantly in the reference group compared to the intervention group. Logistic regression analysis revealed that group (intervention vs. reference remained a significant factor in five out of nine predictive models. Conclusion The results indicate that an automatic web-based system might have short-term beneficial physiological and psychological effects and thus might be an opportunity in counteracting some clinically relevant and common stress and health issues of today.

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

    OpenAIRE

    Levinton, Paula H.; Dunning, Tessa F.E.

    1980-01-01

    Information requirements of mental health providers are sufficiently different from those of other health care managers to warrant a different approach to the development of management information systems (MIS). Advances in computer technology and increased demands for fiscal accountability have led to developing integrated mental health information systems (MHIS) that support clinical and management requirements.

  6. Specialized Gas Chromatography--Mass Spectrometry Systems for Clinical Chemistry.

    Science.gov (United States)

    Gochman, Nathan; And Others

    1979-01-01

    A discussion of the basic design and characteristics of gas chromatography-mass spectrometry systems used in clinical chemistry. A comparison of three specific systems: the Vitek Olfax IIA, Hewlett-Packard HP5992, and Du Pont DP-102 are included. (BB)

  7. Effectiveness of personalized face-to-face and telephone nursing counseling interventions for cardiovascular risk factors: a controlled clinical trial 1

    Science.gov (United States)

    Vílchez Barboza, Vivian; Klijn, Tatiana Paravic; Salazar Molina, Alide; Sáez Carrillo, Katia Lorena

    2016-01-01

    Abstract Objective: to evaluate the effect and gender differences of an innovative intervention involving in-person and telephone nursing counseling to control cardiovascular risk factors (arterial hypertension, dyslipidemia, and overweight), improve health-related quality of life and strengthen self-efficacy and social support in persons using the municipal health centers' cardiovascular health program. Method: a randomized controlled clinical trial involving participants randomized into the intervention group who received traditional consultation plus personalized and telephone nursing counseling for 7 months (n = 53) and the control group (n = 56). The study followed the Consolidated Standards of Reporting Trials Statement. Results: women in the intervention group presented a significant increase in the physical and mental health components compared to the control group, with decreases in weight, abdominal circumference, total cholesterol, low-density lipoprotein cholesterol, and the atherogenic index. The effects attributable to the intervention in the men in the intervention group were increased physical and emotional roles and decreased systolic and diastolic pressure, waist circumference, total cholesterol, low-density lipoprotein cholesterol, atherogenic index, cardiovascular risk factor, and 10-year coronary risk. Conclusion: this intervention is an effective strategy for the control of three cardiovascular risk factors and the improvement of health-related quality of life. PMID:27508917

  8. Prevention of depression and anxiety in later life: design of a randomized controlled trial for the clinical and economic evaluation of a life-review intervention

    Directory of Open Access Journals (Sweden)

    Smit Filip

    2009-07-01

    Full Text Available Abstract Background Depressive and anxiety symptoms in older adults could develop into significant health problems with detrimental effects on quality of life and a possibly poor prognosis. Therefore, there is a need for preventive interventions which are at once effective, acceptable and economic affordable. Methods and design This paper describes the design of a study evaluating "The stories we live by", a preventive life-review group intervention, which was recently developed for adults of 55 years and over with depressive and anxiety symptoms. Both clinical and economic effectiveness will be evaluated in a pragmatic randomized controlled trial. The participants in the intervention condition will receive the 8-session preventive intervention. The participants in the control condition will have access to usual care. Clinical end-terms are depressive and anxiety symptoms, current major depressive episode, quality of life and positive mental health post-treatment (3 months after baseline and at follow-ups (6 and 12 months after baseline. Additional goals of this study are to identify groups for whom the intervention is particularly effective and to identify the therapeutic pathways that are vital in inducing clinical change. This will be done by analyzing if treatment response is moderated by demographics, personality, past major depressive episodes, important life events and chronically disease, and mediated by reminiscence functions, perceived control, automatic positive thoughts and meaning in life. Finally the cost-effectiveness of the intervention relative to care as usual will be assessed by computing incremental costs per case of depression and anxiety avoided (cost-effectiveness and per quality adjusted life year (QALY (cost utility. Discussion It is expected that both the life-review intervention and its evaluation will contribute to the existing body of knowledge in several ways. First, the intervention is unique in linking life

  9. Spontaneous improvement in randomised clinical trials: meta-analysis of three-armed trials comparing no treatment, placebo and active intervention

    DEFF Research Database (Denmark)

    Krogsbøll, Lasse Theis; Hróbjartsson, Asbjørn; Gøtzsche, Peter C

    2009-01-01

    were psychological in 17 trials, physical in 15 trials, and pharmacological in 5 trials. Overall, across all conditions and interventions, there was a statistically significant change from baseline in all three arms. The standardized mean difference (SMD) for change from baseline was -0.24 (95...... from baseline, and we aimed at quantifying these contributions. METHODS: Systematic review and meta-analysis, based on a Cochrane review of the effect of placebo interventions for all clinical conditions. We selected all trials that had randomised the patients to three arms: no treatment, placebo...

  10. Nurses' Clinical Decision Making on Adopting a Wound Clinical Decision Support System.

    Science.gov (United States)

    Khong, Peck Chui Betty; Hoi, Shu Yin; Holroyd, Eleanor; Wang, Wenru

    2015-07-01

    Healthcare information technology systems are considered the ideal tool to inculcate evidence-based nursing practices. The wound clinical decision support system was built locally to support nurses to manage pressure ulcer wounds in their daily practice. However, its adoption rate is not optimal. The study's objective was to discover the concepts that informed the RNs' decisions to adopt the wound clinical decision support system as an evidence-based technology in their nursing practice. This was an exploratory, descriptive, and qualitative design using face-to-face interviews, individual interviews, and active participatory observation. A purposive, theoretical sample of 14 RNs was recruited from one of the largest public tertiary hospitals in Singapore after obtaining ethics approval. After consenting, the nurses were interviewed and observed separately. Recruitment stopped when data saturation was reached. All transcribed interview data underwent a concurrent thematic analysis, whereas observational data were content analyzed independently and subsequently triangulated with the interview data. Eight emerging themes were identified, namely, use of the wound clinical decision support system, beliefs in the wound clinical decision support system, influences of the workplace culture, extent of the benefits, professional control over nursing practices, use of knowledge, gut feelings, and emotions (fear, doubt, and frustration). These themes represented the nurses' mental outlook as they made decisions on adopting the wound clinical decision support system in light of the complexities of their roles and workloads. This research has provided insight on the nurses' thoughts regarding their decision to interact with the computer environment in a Singapore context. It captured the nurses' complex thoughts when deciding whether to adopt or reject information technology as they practice in a clinical setting. PMID:26066306

  11. Almanac 2012: interventional cardiology. The national society journals present selected research that has driven recent advances in clinical cardiology

    Directory of Open Access Journals (Sweden)

    Meier Pascal

    2013-02-01

    Full Text Available The field of interventional cardiology continues to progress quickly. The efficacy of percutaneous interventions with newer generation drug-eluting stents has advanced a lot over the last decade. This improvement in stent performance has broadened the level of indication towards more complex interventions such as left main and multivessel PCI. Major improvements continue in the field of medical co-therapy such as antiplatelet therapies (bivalirudin, prasugrel, ticagrelor and this will further improve outcomes of PCI. The same is true for intravascular imaging such as ultrasound IVUS and optical coherence tomography OCT. However, interventional cardiology has become a rather broad field, also including alcohol septal ablation for hypertrophic obstructive cardiomyopathy, etc. At the moment, the fastest growing area is the structural interventions, especially for aortic valve stenosis (transcatheter aortic valve implantation TAVI and for mitral regurgitation (mitral clipping.This review covers recent advances in all these different fields of interventional cardiology.

  12. Introduction of Education Systems for Clinical Engineers in Japan

    Institute of Scientific and Technical Information of China (English)

    Jun Yoshioka; Keiko Fukuta; Hiroki Igeta; Takeshi Ifuku; Tadayuki Kawasaki

    2016-01-01

    Japanese clinical engineer (CE) is a significant and unique profession compared with other nations with its dual clinical and technology focus and national licensing. The CE system of licensing was established in May 1987 under the Clinical Engineers Act. CEs are required to complete 3 to 4 years in designated schools and pass a national examination. It is a professional medical position responsible for the operation and maintenance of life-support and non-life-support medical device systems under the direction of physicians. Currently approximately 70 educational institutes - including technical colleges and universities - provide diverse and wide-ranging curricula from engineering to various clinical disciplines to produce CEs. Since clinical practice training is mandatory as a part of institute work, an important approach for CEs is gained by working in hospitals. The comprehensive curricula and the licensing system in Japan together serve to keep the appropriate quantity and quality of CEs. The Japan Association for Clinical Engineers (JACE) was established in February 1990; one of its aims is to support improvement of CEs throughout their careers through various lectures, seminars, on-the-job trainings, workshops, and an annual member meeting. New CEs can now take advantage of video e-learning. For junior CEs, there are seminars for hyperbaric oxygen therapy, blood purification, heart-lung bypass, respiratory therapy, operating room, intensive care unit, arrhythmia and aphaeresis related devices, as well as healthcare technology management (HTM). Also, the institutes provide a leadership seminar alongside this clinical practice training. Besides the licensing process, a proper certification system for CEs is a critical element in the clinical field. This enhances the ability of CEs to engage in more extensive duties and develop specialties, as well as to provide better healthcare. Associated societies provide certification with technology qualifications in

  13. Pressure and pain In Systemic sclerosis/Scleroderma - an evaluation of a simple intervention (PISCES: randomised controlled trial protocol

    Directory of Open Access Journals (Sweden)

    Alcacer-Pitarch Begonya

    2012-02-01

    Full Text Available Abstract Background Foot problems associated with Systemic Sclerosis (SSc/Scleroderma have been reported to be both common and disabling. There are only limited data describing specifically, the mechanical changes occurring in the foot in SSc. A pilot project conducted in preparation for this trial confirmed the previous reports of foot related impairment and reduced foot function in people with SSc and demonstrated a link to mechanical etiologies. To-date there have been no formal studies of interventions directed at the foot problems experienced by people with Systemic Sclerosis. The primary aim of this trial is to evaluate whether foot pain and foot-related health status in people with Systemic Sclerosis can be improved through the provision of a simple pressure-relieving insole. Methods The proposed trial is a pragmatic, multicenter, randomised controlled clinical trial following a completed pilot study. In four participating centres, 140 consenting patients with SSc and plantar foot pain will be randomised to receive either a commercially available pressure relieving and thermally insulating insole, or a sham insole with no cushioning or thermal properties. The primary end point is a reduction in pain measured using the Foot Function Index Pain subscale, 12 weeks after the start of intervention. Participants will complete the primary outcome measure (Foot Function Index pain sub-scale prior to randomisation and at 12 weeks post randomisation. Secondary outcomes include participant reported pain and disability as derived from the Manchester Foot Pain and Disability Questionnaire and plantar pressures with and without the insoles in situ. Discussion This trial protocol proposes a rigorous and potentially significant evaluation of a simple and readily provided therapeutic approach which, if effective, could be of a great benefit for this group of patients. Trial registration number ISRCTN: ISRCTN02824122

  14. Development of an auxiliary system for the execution of vascular catheter interventions with a reduced radiological risk; system description and first experimental results.

    Science.gov (United States)

    Placidi, Giuseppe; Franchi, Danilo; Marsili, Luca; Gallo, Pasquale

    2007-11-01

    Vascular catheterization is a common procedure in clinical medicine. It is normally performed by a specialist using an X-ray fluoroscopic guide and contrast-media. In the present paper, an image-guided navigation system which indicates a path providing guidance to the desired target inside the vascular tree is described with the aim of reducing the exposure of personnel and patients to X-rays during the catheterization procedure. A 3D model of the patient vascular tree, reconstructed with data collected by an angiography before starting the intervention, is used as a guide map instead of fluoroscopic scans. An accurate spatial correspondence between the body of the patient and the 3D reconstructed vascular model is established and, by means of a position indicator installed over the catheter tip, the real-time position/orientation of the tip is indicated correctly. This paper describes the system and the operational procedures necessary to use the proposed method efficiently during a catheter intervention. Preliminary experimental results on a phantom are also reported.

  15. Therapeutic intervention at cellular quality control systems in Alzheimer's and Parkinson's diseases.

    Science.gov (United States)

    Arduino, Daniela M; Esteves, A Raquel; Silva, Diana F F; Martins-Branco, Diogo; Santos, Daniel; Pimentel, Diana F Gomes; Cardoso, Sandra M

    2011-01-01

    Cellular homeostasis relies on quality control systems so that damaged biologic structures are either repaired or degraded and entirely replaced by newly formed proteins or even organelles. The clearance of dysfunctional cellular structures in long-lived postmitotic cells, like neurons, is essential to eliminate, per example, defective mitochondria, lipofuscin-loaded lysosomes and oxidized proteins. Short-lived proteins are degraded mainly by proteases and proteasomes whether most long-lived proteins and all organelles are digested by autophagy in the lysosomes. Recently, it an interplay was established between the ubiquitin-proteasome system and macroautophagy, so that both degradative mechanisms compensate for each other. In this article we describe each of these clearance systems and their contribution to neuronal quality control. We will highlight some of the findings that provide evidence for the dysfunction of these systems in Alzheimer's and Parkinson's diseases. Ultimately, we provide an outline on potential therapeutic interventions based on the modulation of cellular degradative systems.

  16. The Effect of Educational-Spiritual Intervention on The Burnout of The Parents of School Age Children with Cancer: A Randomized Controlled Clinical Trial

    Science.gov (United States)

    Beheshtipour, Nooshin; Nasirpour, Parisa; Yektatalab, Shahrzad; Karimi, Mehran; Zare, Najaf

    2016-01-01

    Background: Parents of children with cancer experience high levels of stress and discomfort. Religious beliefs are important sources of comfort and support for many cancer patients and their families. The present study aimed to assess the effect of educational-spiritual intervention on burnout of the parents of the children with cancer. Methods: In this randomized clinical trial, 135 parents of children with cancer were randomly assigned into intervention and control groups. Data were collected through SMBQ (Shirom and Melamed Burnout Questionnaire) from both groups, before, immediately after and one month after the intervention. Educational-spiritual programs were held for six weeks, one session every week. The data were analyzed by SPSS using independent t-test, and repeated measure ANOVA. Results: The results showed that the mean burnout score before the intervention in the intervention group was 4.28±0.61 and in the control group it was 4.23±0.50; most of the parents reported moderate to high burnout. But, there was a significant difference between the intervention and control groups immediately after and one month after the intervention (t=10.16, Pburnout score in the intervention group was less than the control group. Results also showed that there was a significant difference between the two groups in terms of parental burnout in three times of measurements (F=58.62, Pburnout of the parents of the children with cancer. Due to high burnout of most of the parents, offering such a program could be beneficial for them. More studies in this regard are recommended. Trial Registration Number: IRCT2014061818144N1 PMID:26793734

  17. Screening and brief interventions for hazardous and harmful alcohol use among patients with active tuberculosis attending primary care clinics in South Africa: a cluster randomized controlled trial protocol

    Directory of Open Access Journals (Sweden)

    Naidoo Pamela P

    2011-05-01

    Full Text Available Abstract Background In 2008 the World Health Organization (WHO reported that South Africa had the highest tuberculosis (TB incidence in the world. This high incidence rate is linked to a number of factors, including HIV co-infection and alcohol use disorders. The diagnosis and treatment package for TB and HIV co-infection is relatively well established in South Africa. However, because alcohol use disorders may present more insidiously, making it difficult to diagnose, those patients with active TB and misusing alcohol are not easily cured from TB. With this in mind, the primary purpose of this cluster randomized controlled trial is to provide screening for alcohol misuse and to test the efficacy of brief interventions in reducing alcohol intake in those patients with active TB found to be misusing alcohol in primary health care clinics in three provinces in South Africa. Methods/Design Within each of the three selected health districts with the highest TB burden in South Africa, 14 primary health care clinics with the highest TB caseloads will be selected. Those agreeing to participate will be stratified according to TB treatment caseload and the type of facility (clinic or community health centre. Within strata from 14 primary care facilities, 7 will be randomly selected into intervention and 7 to control study clinics (42 clinics, 21 intervention clinics and 21 control clinics. At the clinic level systematic sampling will be used to recruit newly diagnosed TB patients. Those consenting will be screened for alcohol misuse using the AUDIT. Patients who screen positive for alcohol misuse over a 6-month period will be given either a brief intervention based on the Information-Motivation-Behavioural Skills (IMB Model or an alcohol use health education leaflet. A total sample size of 520 is expected. Discussion The trial will evaluate the impact of alcohol screening and brief interventions for patients with active TB in primary care settings in

  18. Evaluating statistical and clinical significance of intervention effects in single-case experimental designs: an SPSS method to analyze univariate data.

    Science.gov (United States)

    Maric, Marija; de Haan, Else; Hogendoorn, Sanne M; Wolters, Lidewij H; Huizenga, Hilde M

    2015-03-01

    Single-case experimental designs are useful methods in clinical research practice to investigate individual client progress. Their proliferation might have been hampered by methodological challenges such as the difficulty applying existing statistical procedures. In this article, we describe a data-analytic method to analyze univariate (i.e., one symptom) single-case data using the common package SPSS. This method can help the clinical researcher to investigate whether an intervention works as compared with a baseline period or another intervention type, and to determine whether symptom improvement is clinically significant. First, we describe the statistical method in a conceptual way and show how it can be implemented in SPSS. Simulation studies were performed to determine the number of observation points required per intervention phase. Second, to illustrate this method and its implications, we present a case study of an adolescent with anxiety disorders treated with cognitive-behavioral therapy techniques in an outpatient psychotherapy clinic, whose symptoms were regularly assessed before each session. We provide a description of the data analyses and results of this case study. Finally, we discuss the advantages and shortcomings of the proposed method.

  19. Implementation of a school-based social and emotional learning intervention: understanding diffusion processes within complex systems.

    Science.gov (United States)

    Evans, Rhiannon; Murphy, Simon; Scourfield, Jonathan

    2015-07-01

    Sporadic and inconsistent implementation remains a significant challenge for social and emotional learning (SEL) interventions. This may be partly explained by the dearth of flexible, causative models that capture the multifarious determinants of implementation practices within complex systems. This paper draws upon Rogers (2003) Diffusion of Innovations Theory to explain the adoption, implementation and discontinuance of a SEL intervention. A pragmatic, formative process evaluation was conducted in alignment with phase 1 of the UK Medical Research Council's framework for Developing and Evaluating Complex Interventions. Employing case-study methodology, qualitative data were generated with four socio-economically and academically contrasting secondary schools in Wales implementing the Student Assistance Programme. Semi-structured interviews were conducted with 15 programme stakeholders. Data suggested that variation in implementation activity could be largely attributed to four key intervention reinvention points, which contributed to the transformation of the programme as it interacted with contextual features and individual needs. These reinvention points comprise the following: intervention training, which captures the process through which adopters acquire knowledge about a programme and delivery expertise; intervention assessment, which reflects adopters' evaluation of an intervention in relation to contextual needs; intervention clarification, which comprises the cascading of knowledge through an organisation in order to secure support in delivery; and intervention responsibility, which refers to the process of assigning accountability for sustainable delivery. Taken together, these points identify opportunities to predict and intervene with potential implementation problems. Further research would benefit from exploring additional reinvention activity. PMID:25726153

  20. Methodology of integration of a clinical data warehouse with a clinical information system: the HEGP case.

    Science.gov (United States)

    Zapletal, Eric; Rodon, Nicolas; Grabar, Natalia; Degoulet, Patrice

    2010-01-01

    Clinical Data Warehouses (CDW) can complement current Clinical Information Systems (CIS) with functions that are not easily implemented by traditional operational database systems. Here, we describe the design and deployment strategy used at the Pompidou University Hospital in southwest Paris. Four realms are described: technological realm, data realm, restitution realm, and administration realm. The corresponding UML use cases and the mapping rules from the shared integrated electronic health records to the five axes of the i2b2 CDW star model are presented. Priority is given to the anonymization and security principles used for the 1.2 million patient records currently stored in the CDW. Exploitation of a CDW by clinicians and investigators can facilitate clinical research, quality evaluations and outcome studies. These indirect benefits are among the reasons for the continuous use of an integrated CIS.

  1. Evidence-based interventional pain medicine according to clinical diagnoses. 17. Herpes zoster and post-herpetic neuralgia.

    Science.gov (United States)

    van Wijck, Albert J M; Wallace, Mark; Mekhail, Nagy; van Kleef, Maarten

    2011-01-01

    Herpes zoster infection is caused by a reactivation of the latent varicella zoster virus that causes chicken pox. It appears predominantly in older adults whose immunity for the virus has waned. The natural course of the disease is usually favorable, and the symptoms disappear spontaneously within a few weeks. Some patients, however, have prolonged pain: post-herpetic neuralgia. The diagnosis of acute zoster infection is made on the clinical signs including the appearance of rash. Post-herpetic neuralgia is described as sharp, burning, aching, or shooting constantly present in the dermatome that corresponds with the earlier rash. The objectives of treating herpes zoster are: (1) acute pain reduction; (2) promotion of recovery of epidermal defects and prevention of secondary infections; and (3) reduction or prevention of post-herpetic neuralgia. The objective of the treatment of post-herpetic neuralgia is primarily pain alleviation and improvement of the quality of life. Early treatment of the infection and the pain is believed to reduce the risk for post-herpetic neuralgia. This persistent pain syndrome is difficult to treat. Antiepileptic drugs and tricyclic antidepressants are the first choice. Interventional treatments, such as epidural injections of corticosteroids and local anesthetic drugs, have an effect on the acute pain but are of limited use in preventing post-herpetic neuralgia. When conservative treatment fails in providing satisfactory relief of post-herpetic neuralgia, a sympathetic block may be considered (2 C+); if this treatment provides unsatisfactory results, spinal cord stimulation may be considered, in a study context (2 C+). PMID:21114617

  2. Clinical effect of selective thrombus aspiration during primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction

    Directory of Open Access Journals (Sweden)

    Hai-wei LIU

    2015-06-01

    Full Text Available Objective To assess impact of selective thrombus aspiration (TA during primary percutaneous coronary intervention (pPCI on long-term prognosis in patients with ST-segment elevation myocardial infarction (STEMI. Methods  Between Jan. 2008 and Jan. 2014, a total of 2357 STEMI patients [429 in thrombus aspiration (TA group and 1928 in routine percutaneous coronsry intorventim (PCI group (control group] were eligible for the study criteria and candidates for pPCI were enrolled in this study. The reflow of the involved vessel in pPCI procedure, stent thrombosis and major adverse cardiac events (MACE were comparatively analyzed in the two groups during hospital stay and 12-month follow-up period. Results Although the success rate of TA procedure was significantly lower in TA group compared with that in control group (P<0.001, both the TIMI flow grade ≥2 after TA procedure and stent implantation occurred more frequently in TA group than in control group (P<0.05. The rates of MACE and stent thrombosis showed no difference between two groups during in-hospital and 12-month follow-up period (P>0.05. But the rates of total MACE and target vessel revascularization were significantly higher in control group than in TA group (P=0.04. Conclusion Selective TA procedure before primary PCI could improve final myocardial reperfusion, reduce the incidence of MACE and improve the 1-year clinical result for STEMI patients. DOI: 10.11855/j.issn.0577-7402.2015.04.04

  3. Reimbursement of radiologically guided vascular interventions within the DRG-System: What wil change?

    International Nuclear Information System (INIS)

    Purpose: To evaluate reimbursement within the DRG-system ('diagnosis-related groups') compared with traditional reimbursement for interventional therapy of hospitalized patients. Materials and Methods: Reimbursement calculation was prospectively analyzed in two respects for 30 consecutive patients who underwent percutaneous transluminal angioplasty (PTA) of the lower extremity arteries: (1) based on the DRG-system; (2) based on the traditional system. Additional evaluation was performed for five further, typical vascular procedures on the basis of real documentation and calculation data (stenting of the carotid artery, fibrinolytic therapy of basilar artery occlusion, stenting of renal artery stenosis, angioplasty of hemodialysis-shunt stenosis and aspiration thrombectomy of an infrapopliteal arterial occlusion). Results: In our hospital, the introduction of the DRG system would reduce reimbursement by approximately 1100 Euro per PTA patient. However, the other vascular radiological procedures can be expected to increase the payments by up to 4500 Euro. Conclusion: To minimize imminent reduction of reimbursement for patients with peripheral PTA, complete documentation and economical patient management is mandatory. Payment may increase significantly for patients with the other reported vascular interventional procedures. (orig.)

  4. Impact of Body Mass Index on the Clinical Outcomes after Percutaneous Coronary Intervention in Patients ≥75 Years Old

    Institute of Scientific and Technical Information of China (English)

    Pei-Yuan He; Yue-Jin Yang; Shu-Bin Qiao; Bo Xu; Min Yao; Yong-Jian Wu; Yuan Wu

    2015-01-01

    Background:The impact of body mass index (BMI) on the clinical outcomes after percutaneous coronary intervention (PCI) in patients ≥75 years old remained unclear.Methods:A total of 1098 elderly patients undergoing PCI with stent implantation were recruited.Patients were divided into four groups by the value of BMI:Underweight (<20.0 kg/m2),normal weight (20.0-24.9 kg/m2),overweight (25.0-29.9 kg/m2) and obese (≥30.0 kg/m2).Major clinical outcomes after PCI were compared between the groups.The primary endpoint was defined as in-hospital major adverse cardiovascular events (MACEs),which included death,myocardial infarction (MI) and target vessel revascularization.The secondary endpoint was defined as 1 year death.Logistic regression analysis was performed to adjust for the potential confounders.Results:Totally,1077 elderly patients with available BMIs were included in the analysis.Patients of underweight,normal weight,overweight and obese accounted for 5.6%,45.4%,41.5% and 7.5% of the population,respectively.Underweight patients were more likely to attract ST-segment elevation MI,and get accompanied with anemia or renal dysfunction.Meanwhile,they were less likely to achieve thrombolysis in MI 3 grade flow after PCI,and receive beta-blocker,angiotensin converting enzyme inhibitor or angiotensin receptor blocker after discharge.In underweight,normal weight,overweight and obese patients,in-hospital MACE were 1.7%,2.7%,3.8%,and 3.7% respectively (P =0.68),and 1 year mortality rates were 5.0%,3.9%,5.1% and 3.7% (P =0.80),without significant difference between the groups.Multivariate regression analysis showed that the value of BMI was not associated with in-hospital MACE in patients at 75 years old.Conclusions:The BMI "obese paradox" was not found in patients ≥75 years old.It was suggested that BMI may not be a sensitive predictor of adverse cardiovascular events in elderly patients.

  5. Clinical outcomes of patients with major bleeding after primary coronary intervention for acute ST-segment elevation myocardial infarction

    International Nuclear Information System (INIS)

    Objective: To evaluate the clinical outcomes of patients complicated with major bleeding after primary coronary intervention (PCI) for acute ST-segment elevation myocardial infarction (STEMI). Methods: During the period of January 2004-January 2008, primary PCI was performed in 412 consecutive patients with acute STEMI at Shanghai Ruijin Hospital. The clinical data were retrospectively analyzed. Major adverse cardiac events (MACE), including death, reoccurrence of myocardial infarction and target vessel revascularization, in patients with major bleeding were compared with that in patients without major bleeding. Results: Compared to patients without bleeding, the patients with bleeding were older (70.0 ± 8.9 years vs 64.9 ± 12.7 years, P=0.04), mainly the females (51.9% vs 23.1%, P=0.001) and treated more often with glycoprotein (GP) IIb / IIIa receptor inhibitor (88.9% vs 69.4%, P=0.03) or intra-aortic balloon pump (7.4% vs 1.3%, P=0.02). In-hospital and one-year MACE rate in the patients with bleeding was 18.5% and 37.0% respectively,which were significantly higher than that in the patients without bleeding (5.7% and 14.3%, with P=0.008 and P=0.002, respectively). Multivariate analysis indicated that patient aged over 70 years, feminine gender and use of GP IIb/IIIa receptor inhibitor were independent predictors for the occurrence of major bleeding. The occurrence of major bleeding after primary PCI was significantly correlated with MACE occurred within one year after the procedure (OR 2.79, 95% CI: 2.21-5.90, P<0.001). Conclusion: In patients with acute STEMI, the occurrence of major bleeding after primary PCI is closely linked to the increased MACE rate within one year after the treatment.Feminine gender, aged patient and use of GPIIb/IIIa receptor inhibitor are independent predictors to increase the danger of major bleeding. (authors)

  6. Salmonella internalization in mung bean sprouts and pre- and postharvest intervention methods in a hydroponic system.

    Science.gov (United States)

    Ge, Chongtao; Rymut, Susan; Lee, Cheonghoon; Lee, Jiyoung

    2014-05-01

    Mung bean sprouts, typically consumed raw or minimally cooked, are often contaminated with pathogens. Internalized pathogens pose a high risk because conventional sanitization methods are ineffective for their inactivation. The studies were performed (i) to understand the potential of internalization of Salmonella in mung bean sprouts under conditions where the irrigation water was contaminated and (ii) to determine if pre- and postharvest intervention methods are effective in inactivating the internalized pathogen. Mung bean sprouts were grown hydroponically and exposed to green fluorescence protein-tagged Salmonella Typhimurium through maturity. One experimental set received contaminated water daily, while other sets received contaminated water on a single day at different times. For preharvest intervention, irrigation water was exposed to UV, and for postharvest intervention-contaminated sprouts were subjected to a chlorine wash and UV light. Harvested samples were disinfected with ethanol and AgNO3 to differentiate surface-associate pathogens from the internalized ones. The internalized Salmonella Typhimurium in each set was quantified using the plate count method. Internalized Salmonella Typhimurium was detected at levels of 2.0 to 5.1 log CFU/g under all conditions. Continuous exposure to contaminated water during the entire period generated significantly higher levels of Salmonella Typhimurium internalization than sets receiving contaminated water for only a single day (P < 0.05). Preintervention methods lowered the level of internalized Salmonella by 1.84 log CFU/g (P < 0.05), whereas postintervention methods were ineffective in eliminating internalized pathogens. Preintervention did not completely inactivate bacteria in sprouts and demonstrated that the remaining Salmonella Typhimurium in water became more resistant to UV. Because postharvest intervention methods are ineffective, proper procedures for maintaining clean irrigation water must be followed

  7. CliniProteus: A flexible clinical trials information management system

    Science.gov (United States)

    Mathura, Venkatarajan S; Rangareddy, Mahendiranath; Gupta, Pankaj; Mullan, Michael

    2007-01-01

    Clinical trials involve multi-site heterogeneous data generation with complex data input-formats and forms. The data should be captured and queried in an integrated fashion to facilitate further analysis. Electronic case-report forms (eCRF) are gaining popularity since it allows capture of clinical information in a rapid manner. We have designed and developed an XML based flexible clinical trials data management framework in .NET environment that can be used for efficient design and deployment of eCRFs to efficiently collate data and analyze information from multi-site clinical trials. The main components of our system include an XML form designer, a Patient registration eForm, reusable eForms, multiple-visit data capture and consolidated reports. A unique id is used for tracking the trial, site of occurrence, the patient and the year of recruitment. Availability http://www.rfdn.org/bioinfo/CTMS/ctms.html. PMID:21670796

  8. Signal distortion from microelectrodes in clinical EEG acquisition systems

    Science.gov (United States)

    Stacey, William C.; Kellis, Spencer; Patel, Paras R.; Greger, Bradley; Butson, Christopher R.

    2012-10-01

    Many centers are now using high-density microelectrodes during traditional intracranial electroencephalography (iEEG) both for research and clinical purposes. These microelectrodes are FDA-approved and integrate into clinical EEG acquisition systems. However, the electrical characteristics of these electrodes are poorly described and clinical systems were not designed to use them; thus, it is possible that this shift into clinical practice could have unintended consequences. In this study, we characterized the impedance of over 100 commercial macro- and microelectrodes using electrochemical impedance spectroscopy (EIS) to determine how electrode properties could affect signal acquisition and interpretation. The EIS data were combined with the published specifications of several commercial EEG systems to design digital filters that mimic the behavior of the electrodes and amplifiers. These filters were used to analyze simulated brain signals that contain a mixture of characteristic features commonly observed in iEEG. Each output was then processed with several common quantitative EEG measurements. Our results show that traditional macroelectrodes had low impedances and produced negligible distortion of the original signal. Brain tissue and electrical wiring also had negligible filtering effects. However, microelectrode impedances were much higher and more variable than the macroelectrodes. When connected to clinical amplifiers, higher impedance electrodes produced considerable distortion of the signal at low frequencies (60 Hz), which caused significant changes in amplitude, phase, variance and spectral band power. In contrast, there were only minimal changes to the signal content for frequencies above 100 Hz. In order to minimize distortion with microelectrodes, we determined that an acquisition system should have an input impedance of at least 1 GΩ, which is much higher than most clinical systems. These results show that it is critical to account for variations

  9. Effect of psychological intervention on health-related quality of life in people with systemic lupus erythematosus: A systematic review

    Directory of Open Access Journals (Sweden)

    Hui Liang

    2014-09-01

    Conclusions: The results show that psychological interventions can effectively improve the health-related quality of life in patients with SLE. The full benefit and clinical performance of psychological care requires further investigation by a series of multicenter, large-sample size randomized controlled trails.

  10. Assessing Patient Exposure to a Video-Based Intervention in STD Clinic Waiting Rooms: Findings From the Safe in the City Trial.

    Science.gov (United States)

    Besera, Ghenet T; Cox, Shanna; Malotte, C Kevin; Rietmeijer, Cornelis A; Klausner, Jeffrey D; O'Donnell, Lydia; Margolis, Andrew D; Warner, Lee

    2016-09-01

    Safe in the City, a video intervention for clinic waiting rooms, was previously shown to reduce sexually transmitted disease (STD) incidence. However, little is known about patients' recall of exposure to the intervention. Using data from a nested study of patients attending clinics during the trial, we assessed whether participants recalled Safe in the City, and, if so, how the intervention affected subsequent attitudes and behaviors. Analyses were restricted to responses to a 3-month follow-up questionnaire among participants who were exposed to the video (n = 708). Impact was measured as participants' reports of the video's effect on behaviors and attitudes. Associations were evaluated using multivariable logistic regression. Of participants who were exposed, 685 (97%) recalled viewing the video, and 68% recalled all three vignettes. After watching the video, participants felt more positive about condoms (69%) and comfortable acquiring condoms (56%), were reminded of important information about STDs and condoms (90%), and tried to apply what they learned to their lives (59%). Compared with those who recalled viewing one or two vignettes, participants who recalled viewing all three vignettes reported more positive attitudes toward condoms and peer/provider communication. These findings demonstrate that a low-resource video intervention for waiting rooms can provide sufficient exposure to positively influence STD-related attitudes/behaviors. PMID:27091608

  11. Exercise and Motor Training in People with Parkinson's Disease: A Systematic Review of Participant Characteristics, Intervention Delivery, Retention Rates, Adherence, and Adverse Events in Clinical Trials

    Directory of Open Access Journals (Sweden)

    Natalie E. Allen

    2012-01-01

    Full Text Available There is research evidence that exercise and motor training are beneficial for people with Parkinson's disease (PD, and clinicians seek to implement optimal programs. This paper summarizes important factors about the nature and reporting of randomized controlled trials of exercise and/or motor training for people with PD which are likely to influence the translation of research into clinical practice. Searches identified 53 relevant trials with 90 interventions conducted for an average duration of 8.3 (SD 4.2 weeks. Most interventions were fully supervised (74% and conducted at a facility (79%. Retention rates were high with 69% of interventions retaining ≥85% of their participants; however adherence was infrequently reported, and 72% of trials did not report adverse events. Overall, the labor-intensive nature of most interventions tested in these trials and the sparse reporting of adherence and adverse events are likely to pose difficulties for therapists attempting to balance benefits and costs when selecting protocols that translate to sustainable clinical practice for people with PD.

  12. Outcomes of Health System Structures, Highly Pertinent Clinical Information, Idea Stimulators, Clinical Reviews, and Prediction Tools: JABFM Exemplified.

    Science.gov (United States)

    Bowman, Marjorie A; Neale, Anne Victoria; Seehusen, Dean A

    2016-01-01

    This issue exemplifies the types of articles that JABFM publishes to advance family medicine. We have articles on the implications of health system organizational structures. Three of these are international articles at the level of the national health system (1 from China) and systematic local health interventions (1 from Canada and 1 from Netherlands). Inside the United States, where there are more family physicians, there is less obesity, and designation as a Patient Centered Medical Home is related to increased rates of colorectal cancer screening. Review articles on common clinical topics discuss treatments that are changing (acne in pregnancy) or lack consensus (distal radial fractures). We have articles on making life easier in the office, such as for predicting Vitamin D levels, osteoporosis, and pre-diabetes in normal weight adults. There are articles to raise awareness of the "newest" testing or treatments, that is, auditory brainstem implants. "Reminder" articles highlight known entities that need to be reinforced to prevent over-/underdiagnosis or treatment, for example, "cotton fever." Another article discusses the increased risk for postoperative complications with sleep apnea. We also provide "thought" pieces, in this case about the terminology we are using to extend our concept of patient-centered medical homes.

  13. Outcomes of Health System Structures, Highly Pertinent Clinical Information, Idea Stimulators, Clinical Reviews, and Prediction Tools: JABFM Exemplified.

    Science.gov (United States)

    Bowman, Marjorie A; Neale, Anne Victoria; Seehusen, Dean A

    2016-01-01

    This issue exemplifies the types of articles that JABFM publishes to advance family medicine. We have articles on the implications of health system organizational structures. Three of these are international articles at the level of the national health system (1 from China) and systematic local health interventions (1 from Canada and 1 from Netherlands). Inside the United States, where there are more family physicians, there is less obesity, and designation as a Patient Centered Medical Home is related to increased rates of colorectal cancer screening. Review articles on common clinical topics discuss treatments that are changing (acne in pregnancy) or lack consensus (distal radial fractures). We have articles on making life easier in the office, such as for predicting Vitamin D levels, osteoporosis, and pre-diabetes in normal weight adults. There are articles to raise awareness of the "newest" testing or treatments, that is, auditory brainstem implants. "Reminder" articles highlight known entities that need to be reinforced to prevent over-/underdiagnosis or treatment, for example, "cotton fever." Another article discusses the increased risk for postoperative complications with sleep apnea. We also provide "thought" pieces, in this case about the terminology we are using to extend our concept of patient-centered medical homes. PMID:26957371

  14. Laboratory automation in clinical bacteriology: what system to choose?

    Science.gov (United States)

    Croxatto, A; Prod'hom, G; Faverjon, F; Rochais, Y; Greub, G

    2016-03-01

    Automation was introduced many years ago in several diagnostic disciplines such as chemistry, haematology and molecular biology. The first laboratory automation system for clinical bacteriology was released in 2006, and it rapidly proved its value by increasing productivity, allowing a continuous increase in sample volumes despite limited budgets and personnel shortages. Today, two major manufacturers, BD Kiestra and Copan, are commercializing partial or complete laboratory automation systems for bacteriology. The laboratory automation systems are rapidly evolving to provide improved hardware and software solutions to optimize laboratory efficiency. However, the complex parameters of the laboratory and automation systems must be considered to determine the best system for each given laboratory. We address several topics on laboratory automation that may help clinical bacteriologists to understand the particularities and operative modalities of the different systems. We present (a) a comparison of the engineering and technical features of the various elements composing the two different automated systems currently available, (b) the system workflows of partial and complete laboratory automation, which define the basis for laboratory reorganization required to optimize system efficiency, (c) the concept of digital imaging and telebacteriology, (d) the connectivity of laboratory automation to the laboratory information system, (e) the general advantages and disadvantages as well as the expected impacts provided by laboratory automation and (f) the laboratory data required to conduct a workflow assessment to determine the best configuration of an automated system for the laboratory activities and specificities. PMID:26806135

  15. Social work in the Veterans Health Administration (VA) System: rewards, challenges, roles and interventions.

    Science.gov (United States)

    Beder, Joan; Postiglione, Paul

    2013-01-01

    For the social worker in the Veterans Health Administration (VA) System, numerous challenges are faced and met while serving the nation's Veterans. As part of the multidisciplinary team, social workers perform a variety of tasks and function in diverse roles. The qualitative survey research reported in this article sought to detail what social workers identified about the impact and rewards of their work and what they saw as the challenges and frustrations. In addition the social workers were asked to clarify their role with the patient and the family. Intervention strategies used in the course of the social workers interaction with the Veterans was also ascertained.

  16. The "close-in" or ultra high-risk model: a safe and effective strategy for research and clinical intervention in prepsychotic mental disorder.

    Science.gov (United States)

    McGorry, Patrick D; Yung, Alison R; Phillips, Lisa J

    2003-01-01

    The development of a new frontier for research and early intervention in psychotic disorders is highly dependent on the construction of synergistic clinical infrastructures. This has catalyzed great progress in the recognition, enhanced treatment, and study of first episode psychosis, and the task is even more challenging when the boundaries are extended to include the earliest clinical phase of illness, the prodromal or prepsychotic phase. This article describes the conceptual and practical building blocks for the construction of service models for intervention in the postonset clinical phase prior to the attainment of current diagnostic thresholds. This is best regarded as indicated prevention, a form of very early secondary prevention, which involves a blend of immediate clinical care combined with research-oriented preventive intervention. The experience of the Personal Assessment and Crisis Evaluation (PACE) Clinic in Melbourne across several stages of growth is described and contrasted with that of several emerging centers in Europe and North America. The progress to date, the lessons learned, and the unresolved challenges and opportunities are detailed. It is concluded that service models can be developed that are acceptable and helpful to young people and their families, and that create a unique environment for the study of the transition to frank psychotic disorder. The ultimate clinical utility and general safety of this approach and the range of effective treatments remain unclear, and will be determined by more extensive research. Such research must be conducted in a logical and rigorous manner with the best designs possible, sensitive to input from consumers and caregivers and to ethical considerations.

  17. Clinical decision support for perioperative information management systems.

    Science.gov (United States)

    Wanderer, Jonathan P; Ehrenfeld, Jesse M

    2013-12-01

    Clinical decision support (CDS) systems are being used to optimize the increasingly complex care that our health care system delivers. These systems have become increasingly important in the delivery of perioperative care for patients undergoing cardiac, thoracic, and vascular procedures. The adoption of perioperative information management systems (PIMS) has allowed these technologies to enter the operating room and support the clinical work flow of anesthesiologists and operational processes. Constructing effective CDS systems necessitates an understanding of operative work flow and technical considerations as well as achieving integration with existing information systems. In this review, we describe published examples of CDS for PIMS, including support for cardiopulmonary bypass separation physiological alarms, β-blocker guideline adherence, enhanced revenue capture for arterial line placement, and detection of hemodynamic monitoring gaps. Although these and other areas are amenable to CDS systems, the challenges of latency and data reliability represent fundamental limitations on the potential application of these tools to specific types of clinical issues. Ultimately, we expect that CDS will remain an important tool in our efforts to optimize the quality of care delivered.

  18. The effect of system intervention on the cognitive control of preschool children.

    Science.gov (United States)

    Modarressi, T

    1975-06-01

    In response to the high rate of learning problems among socially deprived children, the Baltimore Early School Admission Project set up a system intervention model engaging three points of entry: parents, educators, and mental health workers. The emphasis was on: a) the redefinition of the roles of all participants; b) the school as a self-reliant system, discouraging referrals to outside agencies; c) the development of the children's functioning and adaptive potentials, based on their individual cognitive styles. The program included five public schools. Ninety-one children between the ages of 4 and 5 years were involved. All of these were selected from a hard core socioeconomically deprived population. Eighty-three percent were black and 17 per cent white. Fifteen children were identified as "vulnerable" according to specific criteria provided to the teachers and the parents. Of the vulnerable group, nine children's learning problems were related primarily to emotional and environmental factors, five had perceptual, sensory-motor dysfunction mixed with emotional factors, and one suffered primarily from brain damage. Results indicated that only one of the vulnerable children required referral outside of that provided in the above design. Eleven vulnerable children performed as well as the nonvulnerable group, and three showed a moderate improvement. Furthermore, five children with serious learning problems responded to the systemic intervention as well as they might have with specialized professional help.

  19. Avertable dose intervention applied in emergency response dose evaluation system for nuclear emergency preparedness in Taiwan

    International Nuclear Information System (INIS)

    In Taiwan the new guides for the nuclear emergency public protective action were laid down by the Atomic Energy Council (AEC) of Executive Yuan, Taiwan, ROC on July 15th, 2005. The main modifications of the guides are that the avertable dose is applied as the intervention levels and suggests the public protective actions. The emergency response dose evaluation system named RPDOSE, which was developed in 2005, was employed in this work to enhance the capability of the avertable dose evaluation for the villages in the emergency planning zone (EPZ). The period of the long-term weather forecasting data was extended from 4 to 8 days to satisfy the requirement of avertable dose computing. According to the intervention levels, the RPDOSE system is used to calculate the avertable dose and suggest appropriate public protective actions such as sheltering, evacuation or iodine prophylaxis as well as the proposed acting times for each village in the EPZ. This system was employed and examined in the annual nuclear emergency exercise of 2008 in the Maanshan nuclear power plant.

  20. Interventions to Support System-level Implementation of Health Promoting Schools: A Scoping Review.

    Science.gov (United States)

    McIsaac, Jessie-Lee D; Hernandez, Kimberley J; Kirk, Sara F L; Curran, Janet A

    2016-02-01

    Health promoting schools (HPS) is recognized globally as a multifaceted approach that can support health behaviours. There is increasing clarity around factors that influence HPS at a school level but limited synthesized knowledge on the broader system-level elements that may impact local implementation barriers and support uptake of a HPS approach. This study comprised a scoping review to identify, summarise and disseminate the range of research to support the uptake of a HPS approach across school systems. Two reviewers screened and extracted data according to inclusion/exclusion criteria. Relevant studies were identified using a multi-phased approach including searching electronic bibliographic databases of peer reviewed literature, hand-searching reference lists and article recommendations from experts. In total, 41 articles met the inclusion criteria for the review, representing studies across nine international school systems. Overall, studies described policies that provided high-level direction and resources within school jurisdictions to support implementation of a HPS approach. Various multifaceted organizational and professional interventions were identified, including strategies to enable and restructure school environments through education, training, modelling and incentives. A systematic realist review of the literature may be warranted to identify the types of intervention that work best for whom, in what circumstance to create healthier schools and students. PMID:26861376

  1. A Clinical Decision Support System for Breast Cancer Patients

    Science.gov (United States)

    Fernandes, Ana S.; Alves, Pedro; Jarman, Ian H.; Etchells, Terence A.; Fonseca, José M.; Lisboa, Paulo J. G.

    This paper proposes a Web clinical decision support system for clinical oncologists and for breast cancer patients making prognostic assessments, using the particular characteristics of the individual patient. This system comprises three different prognostic modelling methodologies: the clinically widely used Nottingham prognostic index (NPI); the Cox regression modelling and a partial logistic artificial neural network with automatic relevance determination (PLANN-ARD). All three models yield a different prognostic index that can be analysed together in order to obtain a more accurate prognostic assessment of the patient. Missing data is incorporated in the mentioned models, a common issue in medical data that was overcome using multiple imputation techniques. Risk group assignments are also provided through a methodology based on regression trees, where Boolean rules can be obtained expressed with patient characteristics.

  2. Clinical Application of Stem Cells in the Cardiovascular System

    Science.gov (United States)

    Stamm, Christof; Klose, Kristin; Choi, Yeong-Hoon

    Regenerative medicine encompasses "tissue engineering" - the in vitro fabrication of tissues and/or organs using scaffold material and viable cells - and "cell therapy" - the transplantation or manipulation of cells in diseased tissue in vivo. In the cardiovascular system, tissue engineering strategies are being pursued for the development of viable replacement blood vessels, heart valves, patch material, cardiac pacemakers and contractile myocardium. Anecdotal clinical applications of such vessels, valves and patches have been described, but information on systematic studies of the performance of such implants is not available, yet. Cell therapy for cardiovascular regeneration, however, has been performed in large series of patients, and numerous clinical studies have produced sometimes conflicting results. The purpose of this chapter is to summarize the clinical experience with cell therapy for diseases of the cardiovascular system, and to analyse possible factors that may influence its outcome.

  3. Effect of a pro-breastfeeding intervention on the maintenance of breastfeeding for 2 years or more: randomized clinical trial with adolescent mothers and grandmothers

    OpenAIRE

    Silva, Cristiano Francisco da; Nunes, Leandro Meirelles; Schwartz, Renata; Giugliani, Elsa Regina Justo

    2016-01-01

    Background Being an adolescent mother and cohabiting with the maternal grandmother have been shown to be risk factors for a shorter breastfeeding duration. The objective of this study was to assess whether the positive effects of a pro-breastfeeding intervention aimed at adolescent mothers and maternal grandmothers on the prevalence of breastfeeding observed in the first year of life were maintained at 2 years of age. Methods This study is the continuation of a randomized clinical trial initi...

  4. [Knowledge management system for laboratory work and clinical decision support].

    Science.gov (United States)

    Inada, Masanori; Sato, Mayumi; Yoneyama, Akiko

    2011-05-01

    This paper discusses a knowledge management system for clinical laboratories. In the clinical laboratory of Toranomon Hospital, we receive about 20 questions relevant to laboratory tests per day from medical doctors or co-medical staff. These questions mostly involve the essence to appropriately accomplish laboratory tests. We have to answer them carefully and suitably because an incorrect answer may cause a medical accident. Up to now, no method has been in place to achieve a rapid response and standardized answers. For this reason, the laboratory staff have responded to various questions based on their individual knowledge. We began to develop a knowledge management system to promote the knowledge of staff working for the laboratory. This system is a type of knowledge base for assisting the work, such as inquiry management, laboratory consultation, process management, and clinical support. It consists of several functions: guiding laboratory test information, managing inquiries from medical staff, reporting results of patient consultation, distributing laboratory staffs notes, and recording guidelines for laboratory medicine. The laboratory test information guide has 2,000 records of medical test information registered in the database with flexible retrieval. The inquiry management tool provides a methos to record all questions, answer easily, and retrieve cases. It helps staff to respond appropriately in a short period of time. The consulting report system treats patients' claims regarding medical tests. The laboratory staffs notes enter a file management system so they can be accessed to aid in clinical support. Knowledge sharing using this function can achieve the transition from individual to organizational learning. Storing guidelines for laboratory medicine will support EBM. Finally, it is expected that this system will support intellectual activity concerning laboratory work and contribute to the practice of knowledge management for clinical work support

  5. [Knowledge management system for laboratory work and clinical decision support].

    Science.gov (United States)

    Inada, Masanori; Sato, Mayumi; Yoneyama, Akiko

    2011-05-01

    This paper discusses a knowledge management system for clinical laboratories. In the clinical laboratory of Toranomon Hospital, we receive about 20 questions relevant to laboratory tests per day from medical doctors or co-medical staff. These questions mostly involve the essence to appropriately accomplish laboratory tests. We have to answer them carefully and suitably because an incorrect answer may cause a medical accident. Up to now, no method has been in place to achieve a rapid response and standardized answers. For this reason, the laboratory staff have responded to various questions based on their individual knowledge. We began to develop a knowledge management system to promote the knowledge of staff working for the laboratory. This system is a type of knowledge base for assisting the work, such as inquiry management, laboratory consultation, process management, and clinical support. It consists of several functions: guiding laboratory test information, managing inquiries from medical staff, reporting results of patient consultation, distributing laboratory staffs notes, and recording guidelines for laboratory medicine. The laboratory test information guide has 2,000 records of medical test information registered in the database with flexible retrieval. The inquiry management tool provides a methos to record all questions, answer easily, and retrieve cases. It helps staff to respond appropriately in a short period of time. The consulting report system treats patients' claims regarding medical tests. The laboratory staffs notes enter a file management system so they can be accessed to aid in clinical support. Knowledge sharing using this function can achieve the transition from individual to organizational learning. Storing guidelines for laboratory medicine will support EBM. Finally, it is expected that this system will support intellectual activity concerning laboratory work and contribute to the practice of knowledge management for clinical work support.

  6. Construction of HMI Network System for Individualized Maternity Intervention Service against Birth Defects in Community

    Institute of Scientific and Technical Information of China (English)

    Xu-huai HU

    2007-01-01

    The paper expounds the community maternity service system against birth defects,from the viewpoint of individualized service in family planning. We have utilized modern information technology to develop health management information (HMI) network with individualized maternity, and to establish the community service system for intervention of birth defects. The service system applied the concept of modern health management information to implementing informational management for screening,treatment, following up, outcome monitoring, so as to provide a base for promotion of health, diagnosis, treatment as well as scientific research, with the prenatal screening of Down's syndrome as a model. The introduction to informational network during the processes of service has been carried out with regards to its composition, function and application, while introducing the effects of computerized case record individualized in prevention, management and research of Down's syndrome.

  7. Multifunction laser systems in clinical and resort practice

    OpenAIRE

    ZABULONOV, Yuriy; Vladimirov, Alexander; Chukhraiev, Nikolay; Elmehsenawi, Yousry; Zukow, Walery

    2016-01-01

    SHUPYKNATIONALMEDICALACADEMY OF POSTGRADUATE EDUCATION UKRAINIANSOCIETY OFPHYSICAL AND REHABILITATION MEDICINE RADOM UNIVERSITY       Yuriy Zabulonov, Alexander Vladimirov, Nikolay Chukhraiev, Yousry Elmehsenawi, Walery Zukow       MULTIFUNCTION LASER SYSTEMS IN CLINICAL AND RESORT PRACTICE   Edited by Yuriy Zabulonov, Alexander Vladimirov, Nikolay Chukhraiev, Yousry Elmehsenawi, Walery Zukow  ...

  8. ROV: improving remotely operated vehicle (ROV) intervention capabilities for blowout preventer override systems

    Energy Technology Data Exchange (ETDEWEB)

    Lazar, Stephen [Christopher S. Mancini, Tomball, TX (United States)

    2012-07-01

    Events during 2010 have focused attention on increased ROV/BOP Intervention capabilities and standardization of BOP/ROV interfaces in the oil and gas offshore industry. Currently no enforced set standards for ROV intervention panels or manifold types for use on BOP Override systems are specified. The industry offers multiple configurations at present. This abstract will discuss the advantages and disadvantages of the various configurations in existence, trending toward suggested industry standards taking shape as requirements in the near term. Standards for the offshore industry or a set specification must be made to increase safety and functionality of BOP control systems. To date, ROV override capabilities have been added to existing engineered BOP systems. BOP designed closing times were not a critical consideration, only that the access was there to allow for ROV override. Increased ROV flow and pressure capabilities: no current minimum flow requirements for Emergency BOP Override pumps are established. Based on stack valving and configuration, a minimum, 7 gpm may be required to shift valving fully to allow BOP operator function. IADC/API minimum requirements may be proposed at 10 gpm at 3000psi. Based on shear pressures exceeding 3000psi, pressures of 5000psi should be considered. Current intervention skids/pump capabilities will be required if ROVs must achieve API 16D BOP minimum closing times. Remote or isolated accumulation for increased intervention capabilities offers possibilities when ANY ROV of opportunity can trigger a function (such as small inspection type ROVs). Increased volumes will be required. This is critical in functioning stack rams with an ROV of opportunity to achieve API 16D closing times. We now understand that higher flows and pressures are required along with standardization of stab types. Current recommendations: API 17H Hi-Flow manifolds should be added to essential ROV overrides. ROV skids will have a minimum requirement of 10gpm

  9. Development of an accelerometer-linked online intervention system to promote physical activity in adolescents.

    Directory of Open Access Journals (Sweden)

    Nicole Guthrie

    Full Text Available Most adolescents do not achieve the recommended levels of moderate-to-vigorous physical activity (MVPA, placing them at increased risk for a diverse array of chronic diseases in adulthood. There is a great need for scalable and effective interventions that can increase MVPA in adolescents. Here we report the results of a measurement validation study and a preliminary proof-of-concept experiment testing the impact of Zamzee, an accelerometer-linked online intervention system that combines proximal performance feedback and incentive motivation features to promote MVPA. In a calibration study that parametrically varied levels of physical activity in 31 12-14 year-old children, the Zamzee activity meter was shown to provide a valid measure of MVPA (sensitivity in detecting MVPA = 85.9%, specificity = 97.5%, and r = .94 correspondence with the benchmark RT3 accelerometer system; all p < .0001. In a subsequent randomized controlled multi-site experiment involving 182 middle school-aged children assessed for MVPA over 6 wks, intent-to-treat analyses found that those who received access to the Zamzee intervention had average MVPA levels 54% greater than those of a passive control group (p < 0.0001 and 68% greater than those of an active control group that received access to a commercially available active videogame (p < .0001. Zamzee's effects on MVPA did not diminish significantly over the course of the 6-wk study period, and were statistically significant in both females and males, and in normal- vs. high-BMI subgroups. These results provide promising initial indications that combining the Zamzee activity meter with online proximal performance feedback and incentive motivation features can positively impact MVPA levels in adolescents.

  10. Cross-system evaluation of clinical trial search engines.

    Science.gov (United States)

    Jiang, Silis Y; Weng, Chunhua

    2014-01-01

    Clinical trials are fundamental to the advancement of medicine but constantly face recruitment difficulties. Various clinical trial search engines have been designed to help health consumers identify trials for which they may be eligible. Unfortunately, knowledge of the usefulness and usability of their designs remains scarce. In this study, we used mixed methods, including time-motion analysis, think-aloud protocol, and survey, to evaluate five popular clinical trial search engines with 11 users. Differences in user preferences and time spent on each system were observed and correlated with user characteristics. In general, searching for applicable trials using these systems is a cognitively demanding task. Our results show that user perceptions of these systems are multifactorial. The survey indicated eTACTS being the generally preferred system, but this finding did not persist among all mixed methods. This study confirms the value of mixed-methods for a comprehensive system evaluation. Future system designers must be aware that different users groups expect different functionalities.

  11. [Clinical trial data management and quality metrics system].

    Science.gov (United States)

    Chen, Zhao-hua; Huang, Qin; Deng, Ya-zhong; Zhang, Yue; Xu, Yu; Yu, Hao; Liu, Zong-fan

    2015-11-01

    Data quality management system is essential to ensure accurate, complete, consistent, and reliable data collection in clinical research. This paper is devoted to various choices of data quality metrics. They are categorized by study status, e.g. study start up, conduct, and close-out. In each category, metrics for different purposes are listed according to ALCOA+ principles such us completeness, accuracy, timeliness, traceability, etc. Some general quality metrics frequently used are also introduced. This paper contains detail information as much as possible to each metric by providing definition, purpose, evaluation, referenced benchmark, and recommended targets in favor of real practice. It is important that sponsors and data management service providers establish a robust integrated clinical trial data quality management system to ensure sustainable high quality of clinical trial deliverables. It will also support enterprise level of data evaluation and bench marking the quality of data across projects, sponsors, data management service providers by using objective metrics from the real clinical trials. We hope this will be a significant input to accelerate the improvement of clinical trial data quality in the industry.

  12. The Smart Drug Delivery System and Its Clinical Potential

    Science.gov (United States)

    Liu, Dong; Yang, Fang; Xiong, Fei; Gu, Ning

    2016-01-01

    With the unprecedented progresses of biomedical nanotechnology during the past few decades, conventional drug delivery systems (DDSs) have been involved into smart DDSs with stimuli-responsive characteristics. Benefiting from the response to specific internal or external triggers, those well-defined nanoplatforms can increase the drug targeting efficacy, in the meantime, reduce side effects/toxicities of payloads, which are key factors for improving patient compliance. In academic field, variety of smart DDSs have been abundantly demonstrated for various intriguing systems, such as stimuli-responsive polymeric nanoparticles, liposomes, metals/metal oxides, and exosomes. However, these nanoplatforms are lack of standardized manufacturing method, toxicity assessment experience, and clear relevance between the pre-clinical and clinical studies, resulting in the huge difficulties to obtain regulatory and ethics approval. Therefore, such relatively complex stimulus-sensitive nano-DDSs are not currently approved for clinical use. In this review, we highlight the recent advances of smart nanoplatforms for targeting drug delivery. Furthermore, the clinical translation obstacles faced by these smart nanoplatforms have been reviewed and discussed. We also present the future directions and perspectives of stimuli-sensitive DDS in clinical applications. PMID:27375781

  13. Toll-like Receptors in Systemic Lupus Erythematosus Prospects for Therapeutic Intervention

    Science.gov (United States)

    Kim, Wan-Uk; Sreih, Antoine; Bucala, Richard

    2009-01-01

    Recent experimental and clinical studies have placed new emphasis on the role of the innate immune system in SLE. Nucleic acid-containing immune complexes activate the innate response by engaging specific Toll-like receptors (TLRs) and promote the generation of autoantibodies. Pharmacologic modulation of TLR-directed pathways may offer new therapeutic approaches for the treatment of SLE. PMID:18722558

  14. A fuzzy logic decision support system for assessing clinical nutritional risk

    Directory of Open Access Journals (Sweden)

    Ali Mohammad Hadianfard

    2015-04-01

    Full Text Available Introduction: Studies have indicated a global high prevalence of hospital malnutrition on admission and during hospitalization. Clinical Nutritional Risk Screen (CNRS is a way to identify malnutrition and manage nutritional interventions. Several traditional and non-computer based tools have been suggested for screening nutritional risk levels. The present study was an attempt to employ a computer based fuzzy model decision support system as a nutrition-screening tool for inpatients. Method: This is an applied modeling study. The system architecture was designed based on the fuzzy logic model including input data, inference engine, and output. A clinical nutritionist entered nineteen input variables using a windows-based graphical user interface. The inference engine was involved with knowledge obtained from literature and the construction of ‘IF-THEN’ rules. The output of the system was stratification of patients into four risk levels from ‘No’ to ‘High’ where a number was also allocated to them as a nutritional risk grade. All patients (121 people admitted during implementing the system participated in testing the model. The classification tests were used to measure the CNRS fuzzy model performance. IBM SPSS version 21 was utilized as a tool for data analysis with α = 0.05 as a significance level. Results: Results showed that sensitivity, specificity, accuracy, and precision of the fuzzy model performance were 91.67% (±4.92, 76% (±7.6, 88.43% (±5.7, and 93.62% (±4.32, respectively. Instant performance on admission and very low probability of mistake in predicting malnutrition risk level may justify using the model in hospitals. Conclusion: To conclude, the fuzzy model-screening tool is based on multiple nutritional risk factors, having the capability of classifying inpatients into several nutritional risk levels and identifying the level of required nutritional intervention.

  15. [Stent implantation as initial coronary interventional therapy? A theoretical model on clinical and economical consequences of in-stent restenosis].

    Science.gov (United States)

    Pfund, A; Wendland, G; Baer, F; Lauterbach, K; Höpp, H W

    2000-08-01

    The reduction of acute complications and late restenosis compared to conventional PTCA has led to a rapid increase in stent implantation as initial treatment for coronary stenosis. As a result, in-stent restenosis has become an important clinical and economical problem, especially the diffuse form, which is much more likely to reappear. In order to compare the consequences of initial stenting and initial angioplasty, we developed an analytic model, considering the differences between diffuse and focal in-stent restenosis. The simulation based on the optimized therapeutic proceeding following an elective 1-vessel revascularization of a 60-year-old patient, dealing with probabilities for acute complications and late restenosis taken from the literature and in-hospital costs obtained from 200 elective interventions. In the stent group 71.0% of patients were free of any target lesion-related event, compared to 60.2% in the PTCA group. Catheter reintervention was necessary for 32.1% of the patients initially treated with angioplasty and for 17.6% of the initially stented patients, whereas 7.7% of the stent patients had to undergo elective bypass surgery as final treatment compared to 2.8% in the PTCA arm. Long-term medical costs for initial stenting (6,237 Euros) were 14% higher than for conventional PTCA (5,345 Euros). Taking also into consideration the indirect costs (loss of productivity) for a collective with an employment rate of 50%, the difference between stent implantation (9,067 Euros) and angioplasty (8,581 Euros) is smaller. Initial treatment of coronary stenosis by stent implantation decreases the rate of repeat revascularization compared to initial PTCA, but there is a greater likelihood that elective bypass surgery will become necessary. This difference in following treatment is related to the occurrence of diffuse in-stent restenosis. When calculating the long-term costs stenting still appeared to be more expensive than PTCAA because the savings in

  16. An Information System to Support and Monitor Clinical Trial Process

    Directory of Open Access Journals (Sweden)

    Daniela Luzi

    2013-01-01

    Full Text Available The demand of transparency of clinical research results, the need of accelerating the process oftransferring innovation in the daily medical practice as well as assuring patient safety and product efficacymake it necessary to extend the functionality of traditional trial registries. These new systems shouldcombine different functionalities to track the information exchange, support collaborative work, manageregulatory documents and monitor the entire clinical investigation (CIV lifecycle. This is the approachused to develop MEDIS, a Medical Device Information System, described in this paper under theperspective of the business process, and the underlining architecture. Moreover, MEDIS was designed onthe basis of Health Level 7 (HL7 v.3 standards and methodology to make it interoperable with similarregistries, but also to facilitate information exchange between different health information systems.

  17. Nerve growth factor-mediated regulation of pain signalling and proposed new intervention strategies in clinical pain management.

    Science.gov (United States)

    McKelvey, Laura; Shorten, George D; O'Keeffe, Gerard W

    2013-02-01

    Nerve growth factor (NGF) is the founding member of the neurotrophins family of proteins. It was discovered more than half a century ago through its ability to promote sensory and sympathetic neuronal survival and axonal growth during the development of the peripheral nervous system, and is the paradigmatic target-derived neurotrophic factor on which the neurotrophic hypothesis is based. Since that time, NGF has also been shown to play a key role in the generation of acute and chronic pain and in hyperalgesia in diverse pain states. NGF is expressed at high levels in damaged or inflamed tissues and facilitates pain transmission by nociceptive neurons through a variety of mechanisms. Genetic mutations in NGF or its tyrosine kinase receptor TrkA, lead to a congenital insensitivity or a decreased ability of humans to perceive pain. The hereditary sensory autonomic neuropathies (HSANs) encompass a spectrum of neuropathies that affect one's ability to perceive sensation. HSAN type IV and HSAN type V are caused by mutations in TrkA and NGF respectively. This review will focus firstly on the biology of NGF and its role in pain modulation. We will review neuropathies and clinical presentations that result from the disruption of NGF signalling in HSAN type IV and HSAN type V and review current advances in developing anti-NGF therapy for the clinical management of pain.

  18. Compassionate use of interventions: results of a European Clinical Research Infrastructures Network (ECRIN) survey of ten European countries

    LENUS (Irish Health Repository)

    Whitfield, Kate

    2010-11-12

    Abstract Background \\'Compassionate use\\' programmes allow medicinal products that are not authorised, but are in the development process, to be made available to patients with a severe disease who have no other satisfactory treatment available to them. We sought to understand how such programmes are regulated in ten European Union countries. Methods The European Clinical Research Infrastructures Network (ECRIN) conducted a comprehensive survey on clinical research regulatory requirements, including questions on regulations of \\'compassionate use\\' programmes. Ten European countries, covering approximately 70% of the EU population, were included in the survey (Austria, Denmark, France, Germany, Hungary, Ireland, Italy, Spain, Sweden, and the UK). Results European Regulation 726\\/2004\\/EC is clear on the intentions of \\'compassionate use\\' programmes and aimed to harmonise them in the European Union. The survey reveals that different countries have adopted different requirements and that \\'compassionate use\\' is not interpreted in the same way across Europe. Four of the ten countries surveyed have no formal regulatory system for the programmes. We discuss the need for \\'compassionate use\\' programmes and their regulation where protection of patients is paramount. Conclusions \\'Compassionate use\\' is a misleading term and should be replaced with \\'expanded access\\'. There is a need for expanded access programmes in order to serve the interests of seriously ill patients who have no other treatment options. To protect these patients, European legislation needs to be more explicit and informative with regard to the regulatory requirements, restrictions, and responsibilities in expanded access programmes.

  19. Physicians’ use of computerized clinical decision supports to improve medication management in the elderly – the Seniors Medication Alert and Review Technology intervention

    Directory of Open Access Journals (Sweden)

    Alagiakrishnan K

    2016-01-01

    Full Text Available Kannayiram Alagiakrishnan,1 Patricia Wilson,2 Cheryl A Sadowski,3 Darryl Rolfson,1 Mark Ballermann,4,5 Allen Ausford,6,7 Karla Vermeer,7 Kunal Mohindra,8 Jacques Romney,9 Robert S Hayward10 1Department of Medicine, Division of Geriatric Medicine, 2Department of Medicine, 3Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, 4Chief Medical Information Office, Alberta Health Services, 5Division of Critical Care, Department of Medicine, University of Alberta, 6Department of Family Medicine, University of Alberta, 7Lynwood Family Physician, 8eClinician EMR, Alberta Health Services-Information Systems, 9Department of Medicine, Division of Endocrinology, 10Division of General Internal Medicine, University of Alberta, Edmonton, AB, Canada Background: Elderly people (aged 65 years or more are at increased risk of polypharmacy (five or more medications, inappropriate medication use, and associated increased health care costs. The use of clinical decision support (CDS within an electronic medical record (EMR could improve medication safety.Methods: Participatory action research methods were applied to preproduction design and development and postproduction optimization of an EMR-embedded CDS implementation of the Beers’ Criteria for medication management and the Cockcroft–Gault formula for estimating glomerular filtration rates (GFR. The “Seniors Medication Alert and Review Technologies” (SMART intervention was used in primary care and geriatrics specialty clinics. Passive (chart messages and active (order-entry alerts prompts exposed potentially inappropriate medications, decreased GFR, and the possible need for medication adjustments. Physician reactions were assessed using surveys, EMR simulations, focus groups, and semi-structured interviews. EMR audit data were used to identify eligible patient encounters, the frequency of CDS events, how alerts were managed, and when evidence links were followed.Results: Analysis of

  20. Features and variations of a radial artery approach in southern Chinese populations and their clinical significance in percutaneous coronary intervention

    Institute of Scientific and Technical Information of China (English)

    LI Lang; ZENG Zhi-yu; ZHONG Ji-ming; WU Xiang-hong; ZENG Shu-yi; TANG Er-wen; CHEN Wei

    2013-01-01

    Background More and more percutaneous coronary intervention were done from radial artery approach.But the great limitation of radial artery approach and main failure cause of transradial coronary intervention is smaller size and more variations of a radial artery approach.The aim of the study is to explore the features and variations of a radial artery approach in southern Chinese populations and their clinical significance in percutaneous coronary intervention.Methods A total of 1400 patients who underwent scheduled first time transradial coronary angiography between July 2007 and September 2010 were enrolled.Radial arteriography was performed in all patients to detect the anatomical variations of this vessel.All patients' radial and ulnar artery inner diameters were measured using a computer assisted quantification method.A detailed patient history was recorded.Multivariate Logistic regression analysis was performed to evaluate the predictive value of variables (including age,gender,ethnicity,height,weight,body mass index,smoking,diabetes,hypertension and dyslipidemia) in arterial tortuosities and variations of this vessel.Results In southern Chinese populations,there were no significant differences in the diameters of the forearm arteries:the mean radial artery inner diameter was (3.04±0.43) mm in ethnic Han Chinese and (3.05±0.42) mm in ethnic Zhuang Chinese,P >0.05),the mean ulnar artery inner diameter was (3.03±0.38) mm in Han Chinese and (3.05±0.36) mm in Zhuang Chinese,P >0.05).It was estimated that the inner diameter of the radial artery was not smaller than a 6F Cordis sheath in 86.1% of male patients and in 57.0% of female patients,and not smaller than a 7F Cordis sheath in 59.3% of male patients and 24.9% of female patients.The factors found to positively affect the size of the radial artery were sex (bj=0.309,P <0.01),weight (bj=0.103,P <0.01),and diabetes mellitus (bj=-0.088,P <0.01) was found to negatively affect radial artery

  1. All-ceramic systems: laboratory and clinical performance.

    Science.gov (United States)

    Guess, Petra C; Schultheis, Stefan; Bonfante, Estevam A; Coelho, Paulo G; Ferencz, Jonathan L; Silva, Nelson R F A

    2011-04-01

    Several all-ceramic systems have been developed in dentistry to meet the increased expectations of patients and dentists for highly aesthetic, biocompatible, and long-lasting restorations. However, early bulk fractures or chippings have led the research community to investigate the mechanical performance of the all-ceramic systems. This overview explores the current knowledge of monolithic and bilayer dental all-ceramic systems, addressing composition and processing mechanisms, laboratory and clinical performance, and possible future trends for all-ceramic materials. PMID:21473997

  2. Design and methods for a randomized clinical trial of a diabetes self-management intervention for low-Income Latinos: Latinos en Control

    Directory of Open Access Journals (Sweden)

    Lemon Stephenie C

    2009-12-01

    Full Text Available Abstract Background US Latinos have greater prevalence of type 2 diabetes (diabetes, uncontrolled diabetes and diabetes co-morbidities compared to non-Latino Whites. They also have lower literacy levels and are more likely to live in poverty. Interventions are needed to improve diabetes control among low-income Latinos. Methods and design This randomized clinical trial tested the efficacy of a culturally- and literacy-tailored diabetes self-management intervention (Latinos en Control on glycemic control among low-income Latinos with diabetes, compared to usual care (control. Participants were recruited from five community health centers (CHCs in Massachusetts. The theory-based intervention included an intensive phase of 12 weekly sessions and a follow-up maintenance phase of 8 monthly sessions. Assessments occurred at baseline, and at 4 and 12 months. The primary outcome was glycosylated hemoglobin (HbA1c. Secondary outcomes were self-management behaviors, weight, lipids and blood pressure. Additional outcomes included diabetes knowledge, self-efficacy, depression and quality of life. The study was designed for recruitment of 250 participants (estimated 20% dropout rate to provide 90% power for detecting a 7% or greater change in HbA1c between the intervention and control groups. This is a difference in change of HbA1c of 0.5 to 0.6%. Discussion Low-income Latinos bear a great burden of uncontrolled diabetes and are an understudied population. Theory-based interventions that are tailored to the needs of this high-risk population have potential for improving diabetes self-management and reduce health disparities. This article describes the design and methods of a theory driven intervention aimed at addressing this need. Trial registration http://www.clinicaltrials.gov # NCT00848315

  3. Details of a Successful Clinical Decision Support System

    Science.gov (United States)

    Friedlin, Jeff; Dexter, Paul R.; Overhage, J. Marc

    2007-01-01

    Computerized physician order entry (CPOE) with clinical decision support (CDS) is regarded as one of the most effective ways to improve the quality of health care and increase patient safety. As electronic medical records become more available, such systems will increasingly become the method of choice to achieve these goals. Creating a CPOE/CDS system is a complex task, and some fail despite time consuming and expensive development. The CPOE system at the Regenstrief Institute incorporates sophisticated CDS and is one of the oldest and most successful in the U.S. Many years in development, it is currently used by hundreds of providers. Our well established, successful system can serve as a template or model for the future development of similar systems. We recently completed a full analysis of our CPOE/CDS system and present details of its structure, functionality and contents. PMID:18693837

  4. NOTE: MRI-guided robotic system for transperineal prostate interventions: proof of principle

    Science.gov (United States)

    van den Bosch, Michiel R.; Moman, Maaike R.; van Vulpen, Marco; Battermann, Jan J.; Duiveman, Ed; van Schelven, Leonard J.; de Leeuw, Hendrik; Lagendijk, Jan J. W.; Moerland, Marinus A.

    2010-03-01

    In this study, we demonstrate the proof of principle of the University Medical Center Utrecht (UMCU) robot dedicated to magnetic resonance imaging (MRI)-guided interventions in patients. The UMCU robot consists of polymers and non-ferromagnetic materials. For transperineal prostate interventions, it can be placed between the patient's legs inside a closed bore 1.5T MR scanner. The robot can manually be translated and rotated resulting in five degrees of freedom. It contains a pneumatically driven tapping device to automatically insert a needle stepwise into the prostate using a controller unit outside the scanning room. To define the target positions and to verify the needle insertion point and the needle trajectory, a high-resolution 3D balanced steady state free precession (bSSFP) scan that provides a T2/T1-weighted contrast is acquired. During the needle insertion fast 2D bSSFP images are generated to track the needle on-line. When the target position is reached, the radiation oncologist manually places a fiducial gold marker (small seed) at this location. In total two needle trajectories are used to place all markers. Afterwards, a high-resolution 3D bSSFP scan is acquired to visualize the fiducial gold markers. Four fiducial gold markers were placed transperineally into the prostate of a patient with a clinical stage T3 prostate cancer. In the generated scans, it was possible to discriminate the patient's anatomy, the needle and the markers. All markers were delivered inside the prostate. The procedure time was 1.5 h. This study proves that MRI-guided needle placement and seed delivery in the prostate with the UMCU robot are feasible.

  5. A networked modular hardware and software system for MRI-guided robotic prostate interventions

    Science.gov (United States)

    Su, Hao; Shang, Weijian; Harrington, Kevin; Camilo, Alex; Cole, Gregory; Tokuda, Junichi; Hata, Nobuhiko; Tempany, Clare; Fischer, Gregory S.

    2012-02-01

    Magnetic resonance imaging (MRI) provides high resolution multi-parametric imaging, large soft tissue contrast, and interactive image updates making it an ideal modality for diagnosing prostate cancer and guiding surgical tools. Despite a substantial armamentarium of apparatuses and systems has been developed to assist surgical diagnosis and therapy for MRI-guided procedures over last decade, the unified method to develop high fidelity robotic systems in terms of accuracy, dynamic performance, size, robustness and modularity, to work inside close-bore MRI scanner still remains a challenge. In this work, we develop and evaluate an integrated modular hardware and software system to support the surgical workflow of intra-operative MRI, with percutaneous prostate intervention as an illustrative case. Specifically, the distinct apparatuses and methods include: 1) a robot controller system for precision closed loop control of piezoelectric motors, 2) a robot control interface software that connects the 3D Slicer navigation software and the robot controller to exchange robot commands and coordinates using the OpenIGTLink open network communication protocol, and 3) MRI scan plane alignment to the planned path and imaging of the needle as it is inserted into the target location. A preliminary experiment with ex-vivo phantom validates the system workflow, MRI-compatibility and shows that the robotic system has a better than 0.01mm positioning accuracy.

  6. Child Disaster Mental Health Services: a Review of the System of Care, Assessment Approaches, and Evidence Base for Intervention.

    Science.gov (United States)

    Pfefferbaum, Betty; North, Carol S

    2016-01-01

    Several decades of research have informed our knowledge of children's reactions to disasters and the factors that influence their reactions. This article describes the system of care for child disaster mental health services using population risk to determine needed services and a stepped care approach built on assessment and monitoring to advance children to appropriate services. To assess the evidence base for disaster interventions, recent reviews of numerous child disaster mental health interventions are summarized.

  7. Implementation of a School-Based Social and Emotional Learning Intervention: Understanding Diffusion Processes Within Complex Systems

    OpenAIRE

    Evans, Rhiannon; Murphy, Simon; Scourfield, Jonathan

    2015-01-01

    Sporadic and inconsistent implementation remains a significant challenge for social and emotional learning (SEL) interventions. This may be partly explained by the dearth of flexible, causative models that capture the multifarious determinants of implementation practices within complex systems. This paper draws upon Rogers (2003) Diffusion of Innovations Theory to explain the adoption, implementation and discontinuance of a SEL intervention. A pragmatic, formative process evaluation was condu...

  8. Comparative efficacy of two primary care interventions to assist withdrawal from long term benzodiazepine use: A protocol for a clustered, randomized clinical trial

    Directory of Open Access Journals (Sweden)

    Roca Miguel

    2011-04-01

    Full Text Available Abstract Background Although benzodiazepines are effective, long-term use is not recommended because of potential adverse effects; the risks of tolerance and dependence; and an increased risk of hip fractures, motor vehicle accidents, and memory impairment. The estimated prevalence of long-term benzodiazepine use in the general population is about 2,2 to 2,6%, is higher in women and increases steadily with age. Interventions performed by General Practitioners may help patients to discontinue long-term benzodiazepine use. We have designed a trial to evaluate the effectiveness and safety of two brief general practitioner-provided interventions, based on gradual dose reduction, and will compare the effectiveness of these interventions with that of routine clinical practice. Methods/Design In a three-arm cluster randomized controlled trial, general practitioners will be randomly allocated to: a a group in which the first patient visit will feature a structured interview, followed by visits every 2-3 weeks to the end of dose reduction; b a group in which the first patient visit will feature a structured interview plus delivery of written instructions to self-reduce benzodiazepine dose, or c routine care. Using a computerized pharmaceutical prescription database, 495 patients, aged 18-80 years, taking benzodiazepine for at least 6 months, will be recruited in primary care health districts of three regions of Spain (the Balearic Islands, Catalonia, and Valencia. The primary outcome will be benzodiazepine use at 12 months. The secondary outcomes will include measurements of anxiety and depression symptoms, benzodiazepine dependence, quality of sleep, and alcohol consumption. Discussion Although some interventions have been shown to be effective in reducing benzodiazepine consumption by long-term users, the clinical relevance of such interventions is limited by their complexity. This randomized trial will compare the effectiveness and safety of two

  9. A systematic review of interventions conducted in clinical or community settings to improve dual-task postural control in older adults

    Directory of Open Access Journals (Sweden)

    Agmon M

    2014-03-01

    Full Text Available Maayan Agmon,1 Basia Belza,2 Huong Q Nguyen,2,3 Rebecca G Logsdon,2 Valerie E Kelly41The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Studies, University of Haifa, Israel; 2School of Nursing, University of Washington, Seattle, WA, USA; 3Department of Research and Evaluation, Kaiser Permanente, CA, USA; 4School of Medicine, University of Washington, Seattle, WA, USABackground: Injury due to falls is a major problem among older adults. Decrements in dual-task postural control performance (simultaneously performing two tasks, at least one of which requires postural control have been associated with an increased risk of falling. Evidence-based interventions that can be used in clinical or community settings to improve dual-task postural control may help to reduce this risk.Purpose: The aims of this systematic review are: 1 to identify clinical or community-based interventions that improved dual-task postural control among older adults; and 2 to identify the key elements of those interventions.Data sources: Studies were obtained from a search conducted through October 2013 of the following electronic databases: PubMed, CINAHL, PsycINFO, and Web of Science.Study selection: Randomized and nonrandomized controlled studies examining the effects of interventions aimed at improving dual-task postural control among community-dwelling older adults were selected.Data extraction: All studies were evaluated based on methodological quality. Intervention characteristics including study purpose, study design, and sample size were identified, and effects of dual-task interventions on various postural control and cognitive outcomes were noted.Data synthesis: Twenty-two studies fulfilled the selection criteria and were summarized in this review to identify characteristics of successful interventions.Limitations: The ability to synthesize data was limited by the heterogeneity in participant characteristics, study designs, and outcome

  10. A comparison of three interventions for homeless youth evidencing substance use disorders: results of a randomized clinical trial.

    Science.gov (United States)

    Slesnick, Natasha; Guo, Xiamei; Brakenhoff, Brittany; Bantchevska, Denitza

    2015-07-01

    While research on homeless adolescents and young adults evidencing substance use disorder is increasing, there is a dearth of information regarding effective interventions, and more research is needed to guide those who serve this population. The current study builds upon prior research showing promising findings of the community reinforcement approach (CRA) (Slesnick, Prestopnik, Meyers, & Glassman, 2007). Homeless adolescents and young adults between the ages of 14 to 20 years were randomized to one of three theoretically distinct interventions: (1) CRA (n = 93), (2) motivational enhancement therapy (MET, n = 86), or (3) case management (CM, n = 91). The relative effectiveness of these interventions was evaluated at 3, 6, and 12 months post-baseline. Findings indicated that substance use and associated problems were significantly reduced in all three interventions across time. Several moderating effects were found, especially for sex and history of childhood abuse. Findings show little evidence of superiority or inferiority of the three interventions and suggest that drop-in centers have choices for addressing the range of problems that these adolescents and young adults face. PMID:25736623

  11. High frame rate photoacoustic imaging using clinical ultrasound system

    Science.gov (United States)

    Sivasubramanian, Kathyayini; Pramanik, Manojit

    2016-03-01

    Photoacoustic tomography (PAT) is a potential hybrid imaging modality which is gaining attention in the field of medical imaging. Typically a Q-switched Nd:YAG laser is used to excite the tissue and generate photoacoustic signals. But, they are not suitable for clinical applications owing to their high cost, large size. Also, their low pulse repetition rate (PRR) of few tens of hertz prevents them from being used in real-time PAT. So, there is a growing need for an imaging system capable of real-time imaging for various clinical applications. In this work, we are using a nanosecond pulsed laser diode as an excitation source and a clinical ultrasound imaging system to obtain the photoacoustic imaging. The excitation laser is ~803 nm in wavelength with energy of ~1.4 mJ per pulse. So far, the reported frame rate for photoacoustic imaging is only a few hundred Hertz. We have demonstrated up to 7000 frames per second framerate in photoacoustic imaging (B-mode) and measured the flow rate of fast moving obje ct. Phantom experiments were performed to test the fast imaging capability and measure the flow rate of ink solution inside a tube. This fast photoacoustic imaging can be used for various clinical applications including cardiac related problems, where the blood flow rate is quite high, or other dynamic studies.

  12. Implementing Response to Intervention: Challenges of Diversity and System Change in a High Stakes Environment

    Science.gov (United States)

    Cavendish, Wendy; Harry, Beth; Menda, Anne Maria; Espinosa, Anabel; Mahotiere, Margarette

    2016-01-01

    Background: The Response to Intervention (RTI) approach involves the use of a dynamic model built around the systematic documentation of students' response to research-based instructional interventions. Although there has been widespread implementation of RTI models for early intervention and in some cases, as a means to identify students with…

  13. An issue tracking system to facilitate the enhancement of clinical data quality in the clinical breast care project.

    Science.gov (United States)

    Zhang, Yonghong; Sun, Weihong; Gutchell, Emily M; Hu, Hai; Liebman, Michael N; Shriver, Craig D; Mural, Richard J

    2007-10-11

    An online issue tracking (QAIT) system was developed to support the QA of questionnaire-based clinical data and tissue banking in the Clinical Breast Care Project (CBCP). The web-based system provides a centralized storage and management of QA issues and role-based access to related information and functions via internet. The QAIT system greatly improved the QA process for the CBCP clinical data and tissue banking and can be easily adapted to other applications.

  14. Effectiveness of a nursing intervention in decreasing the anxiety levels of family members of patients undergoing cardiac surgery: a randomized clinical trial

    Science.gov (United States)

    Hamester, Letícia; de Souza, Emiliane Nogueira; Cielo, Cibele; Moraes, Maria Antonieta; Pellanda, Lúcia Campos

    2016-01-01

    ABSTRACT Objective: to verify the effectiveness of nursing orientation provided to families of patients in the immediate post-operative following cardiac surgery before the first visit to the post-anesthesia care unit, in decreasing anxiety levels, compared to the unit's routine orientation. Method: open randomized clinical trial addressing family members in the waiting room before the first visit in the immediate post-operative period. The family members assigned to the intervention group received audiovisual orientation concerning the patients' conditions at the time and the control group received the unit's routine orientation. Outcome anxiety was assessed using the STAI-State. Results: 210 individuals were included, 105 in each group, aged 46.4 years old on average (±14.5); 69% were female and 41% were the patients' children. The mean score obtained on the anxiety assessment in the intervention group was 41.3±8.6, while the control group scored 50.6±9.4 (p<0.001). Conclusion: a nursing intervention focused on providing guidance to families before their first visit to patients in the immediate post-operative period of cardiac surgery helps to decrease the levels of anxiety of companions, making them feel better prepared for the moment. ReBEC (Brazilian Clinical Trials Registry) and The Universal Trial Number (UTN), No. U1111-1145-6172. PMID:27533263

  15. Clinical Characteristics and Psychological Intervention of Children with Attention Deficit Hyperactivity Disorder%多动症儿童的临床特点及心理干预

    Institute of Scientific and Technical Information of China (English)

    杨惠青

    2016-01-01

    Objective:To analyze the clinical features and effect of psychological intervention on children with attention deficit hyperactivity disorder. Methods:90 cases of children with attention deficit hyperactivity disorder, clinical characteristics of whom were investigated with questionnaire sur-vey, were and randomly divided into group A and group B, both treated with drugs, group B added psychological intervention, effect of the two groups were compared. Results:The clinical features of children with attention deficit hyperactivity disorder included attention defect, weak impul-sion control, hyperactivity, learning disability, abnormal relationships;PSQ scores of the two groups after intervention were lower than those before intervention, and group B lower than group A (P<0.05). Conclusion:Attention deficit, hyperactivity, learning disability and the like are the clinical characteristics of children with attention deficit hyperactivity disorder, who accepted psychological intervention is effective, being worthy of promo-tion.%目的:分析多动症儿童的临床特点及心理干预对多动症儿童的效果。方法:90例多动症儿童问卷调查其临床特点,随机平分为甲组与乙组,两组均用药物治疗,乙组另予心理干预,比较两组效果。结果:多动症儿童的临床特点为注意缺陷、冲动控制性弱、活动过度、学习困难、人际关系异常;干预后两组患者各项PSQ评分均低于干预前,且乙组低于甲组(P<0.05)。结论:注意缺陷、活动过度、学习困难等是多动症儿童的临床特点,多动症儿童予以心理干预效果确切,值得临床推广。

  16. Improving the Quality and Safety of Drug Use in Hospitalized Elderly : Assessing the Effects of Clinical Pharmacist Interventions and Identifying Patients at Risk of Drug-related Morbidity and Mortality

    OpenAIRE

    Alassaad, Anna

    2014-01-01

    Older people admitted to hospital are at high risk of rehospitalization and medication errors. We have demonstrated, in a randomized controlled trial, that a clinical pharmacist intervention reduces the incidence of revisits to hospital for patients aged 80 years or older admitted to an acute internal medicine ward. The aims of this thesis were to further study the effects of the intervention and to investigate possibilities of targeting the intervention by identifying predictors of treatment...

  17. Clinical audit and quality systems - practical implementation in Finland

    International Nuclear Information System (INIS)

    Clinical audit is a new concept of significant importance for the quality of radiological practices, introduced by the EC Medical Exposure Directive (MED, 97/43/EURATOM). By definition, clinical audit means 'a systematic examination or review of medical radiological procedures which seeks to improve the quality and the outcome of patient care, through structured review whereby radiological practices, procedures, and results are examined against agreed standards for good medical radiological procedures, with modifications of the practices where indicated and the application of new standards if necessary'. In its most profound meaning, being introduced in the medical exposure directive, clinical audit can be seen as a review of the success in implementing the justification and optimization principles, and therefore, it is to a large extent an issue of radiation safety for the patient. According to the directive, clinical audits shall be 'carried out in accordance with national procedures'. For the last few years, parallel to the development of the MED in Europe, there has been a worldwide tendency to implement appropriate quality systems (QS) in the health care organizations, in accordance with the international quality standards (ISO 9000 series etc). Such quality systems have been applied for a long time and very widely by the industry. It is a strong belief that the development of quality systems for health care would result in equal benefits as trusted in industry, in terms of efficiency and safety of health care services. For radiological practices, the quality systems are expected to become a framework for improving the optimization of practices and for maintaining good radiation safety, as well as providing a mechanism to prevent mistakes and accidents. In some countries, like the UK and The Netherlands, there are legal requirements to establish and maintain quality systems at certain type of radiological units. In some countries and some radiological units

  18. Interventional MRI

    Energy Technology Data Exchange (ETDEWEB)

    Fukatsu, Hiroshi [Nagoya Univ. (Japan). School of Medicine

    2002-01-01

    MR guided interventional procedures have become useful clinical tools recently. In this article the authors discuss the usefulness and problems of MR-guided needle biopsy and MR-guided laser induced thermotherapy (LITT) for clinical cases. MR enabled optimal plane monitoring with desired image contrast during the procedure without X-ray irradiation for puncture and tissue sampling. Also only MR could non-invasively provide interstitial temperature information during laser ablation. Bone and soft tissue lesions are likely to be candidates for MR interventions because they are free from any physiological motions, and radiologists should compare MR-guidance with CT- or US guidance for individual cases in order to achieve a less invasive diagnosis or treatment. (author)

  19. The understanding of the special administration of nursing care in the intervention ward

    International Nuclear Information System (INIS)

    Because of the particularity of the interventional therapy,that is,the interventional management covers a large scope in clinical application and involves the diagnosis and treatment of various diseases of multiple systems and organs,the clinical interventional practice has really brought an unprecedented challenge for the administration of the nursing care in the intervention ward. In our hospital, independent nursing group for the intervention ward was established two years ago. For the past two years, we have constantly groped and summarized the reasonable and effect administration of interventional nursing care. Pertinent administrative measures, such as nurse training, strengthening of communication with physicians and focusing on key links in nursing care and promptly finding out the weak points in clinical work, have effectively improved the quality of clinical nursing, in this way the clinical nursing practice has been integrated into the interventional therapy and the safe and high-quality nursing service has been provided to the patients. (authors)

  20. Caregiver involvement in a large clinical systems project.

    OpenAIRE

    Sales, S.; Mathews, P.; Gamblin, D.; Gee, S.

    1994-01-01

    The Kaiser Permanente Northern California Region (KPNCR) CareGiver Workstation (CGW) Project's mission is to develop and implement a clinical workstation system that will enhance each caregiver-member interaction and aid in the decision-making processes of direct patient care in the inpatient and outpatient settings. The requirements analysis approach for CareGiver Workstation (CGW) is based on the belief that extensive caregiver involvement will provide a better understanding of the diverse ...

  1. Clinical and biochemical landmarks in systemic autoinflammatory diseases.

    Science.gov (United States)

    Cantarini, Luca; Rigante, Donato; Brizi, Maria Giuseppina; Lucherini, Orso Maria; Sebastiani, Gian Domenico; Vitale, Antonio; Gianneramo, Valentina; Galeazzi, Mauro

    2012-11-01

    Systemic autoinflammatory diseases are a group of inherited disorders of the innate immune system characterized by seemingly unprovoked inflammation recurring at variable intervals and involving skin, serosal membranes, joints, and gastrointestinal apparatus, with reactive amyloidosis as a possible severe long-term complication. Recent advances in genetics and molecular biology have improved our understanding of the pathogenesis of these diseases, including familial Mediterranean fever, mevalonate kinase deficiency syndrome, tumor necrosis factor receptor-associated periodic syndrome, cryopyrin-associated periodic syndromes, and hereditary pyogenic and granulomatous disorders: the vast majority of these conditions are related to the activation of the interleukin-1 pathway, which results in (or from?) a common unifying pathogenetic mechanism. Their diagnostic identification derives from the combination of clinical data, evaluation of acute phase reactants, clinical efficacy in response to specific drugs, and recognition of specific mutations in the relevant genes, although genetic tests may be unconstructive in some cases. This review will discuss clinical and laboratory clues useful for a diagnostic approach to systemic autoinflammatory diseases.

  2. [Psychosocial interventions and caregiver support].

    Science.gov (United States)

    Hüll, M; Wernher, I

    2010-07-01

    Despite an increasing number of trials on the effects of psychosocial interventions in dementia, recommendations concerning these interventions are still based on limited evidence. The S3 dementia guidelines, initiated by the German associations of psychiatry and neurology (DGPPN and DGN), suggest the use of procedures including reality orientation, reminiscence, and cognitive stimulation at recommendation level C. Occupational therapy (including caregiver education), physical activation and music therapy are also suggested at recommendation level C. On a higher level of recommendation (level B), structured support of the caregiver is recommended. Based on the German healthcare system and depending on local structures, this may be offered at the medical office of a general practitioner, a specialist for neurology or psychiatry or at a memory clinic or an outpatient clinic. Furthermore, caregiver support is provided by local branches of the German Alzheimer Association. An increase in recent high level trials suggests an upcoming improvement of the evidence base for psychosocial interventions. PMID:20567961

  3. HIV Prevention Counseling Intervention Delivered During Routine Clinical Care Reduces HIV Risk Behavior in HIV-Infected South Africans Receiving Antiretroviral Therapy: The Izindlela Zokuphila/Options for Health Randomized Trial

    Science.gov (United States)

    Fisher, Jeffrey D.; Cornman, Deborah H.; Shuper, Paul A.; Christie, Sarah; Pillay, Sandy; Macdonald, Susan; Ngcobo, Ntombenhle; Amico, K. Rivet; Lalloo, Umesh; Friedland, Gerald; Fisher, William A.

    2014-01-01

    Context Sustainable interventions are needed to minimize HIV risk behavior among people living with HIV (PLWH) in South Africa on antiretroviral therapy (ART), a significant proportion of whom do not achieve viral suppression. Objective To determine whether a brief lay counselor delivered intervention implemented during routine care can reduce risky sex among PLWH on ART. Design Cluster randomized 16 HIV clinical care sites in KwaZulu Natal, South Africa, to intervention or standard-of-care. Setting Publicly funded HIV clinical care sites. Patients 1891 PLWH on ART received the HIV prevention counseling intervention (n = 967) or standard-of-care counseling (n = 924). Intervention Lay counselors delivered a brief intervention using motivational interviewing strategies based on the Information—Motivation—Behavioral Skills (IMB) model during routine clinical care. Main Outcome Measures Number of sexual events without a condom in the past four weeks with partners of any HIV status, and with partners perceived to be HIV-negative or HIV-status unknown, assessed at baseline, 6, 12, and 18 months. Results Intervention participants reported significantly greater reductions in HIV risk behavior on both primary outcomes, compared to standard-of-care participants. Differences in STI incidence between arms were not observed. Conclusion Effective behavioral interventions, delivered by lay counselors within the clinical care setting, are consistent with the strategy of linking HIV care and HIV prevention and integrating biomedical and behavioral approaches to stemming the HIV epidemic. PMID:25230288

  4. Using the Social Enterprise Intervention (SEI) and Individual Placement and Support (IPS) models to improve employment and clinical outcomes of homeless youth with mental illness1

    Science.gov (United States)

    Ferguson, Kristin M.

    2013-01-01

    Prior research reveals high unemployment rates among homeless youth. The literature offers many examples of using evidence-informed and evidence-based supported employment models with vulnerable populations to assist them in obtaining and maintaining employment and concurrently addressing mental health challenges. However, there are few examples to date of these models with homeless youth with mental illness. The purpose of this article was thus to describe a methodology for establishing a university-agency research partnership to design, implement, evaluate, and replicate evidence-informed and evidence-based interventions with homeless youth with mental illness to enhance their employment, mental health, and functional outcomes. Data from two studies are used to illustrate the relationship between vocational skill-building/employment and mental health among homeless youth. The article concludes with a discussion of the implications of conducting community-based participatory employment and clinical intervention research. The author highlights the opportunities and tensions associated with this approach. PMID:24294127

  5. A Cost-Benefit Analysis of a Family Systems Intervention for Managing Pediatric Chronic Illness.

    Science.gov (United States)

    Distelberg, Brian J; Emerson, Natacha D; Gavaza, Paul; Tapanes, Daniel; Brown, Whitney N; Shah, Huma; Williams-Reade, Jacqueline; Montgomery, Susanne

    2016-07-01

    Despite recent increases of psychosocial programs for pediatric chronic illness, few studies have explored their economic benefits. This study investigated the costs-benefits of a family systems-based, psychosocial intervention for pediatric chronic illness (MEND: Mastering Each New Direction). A quasi-prospective study compared the 12-month pre-post direct and indirect costs of 20 families. The total cost for program was estimated to $5,320. Families incurred $15,249 less in direct and $15,627 less in indirect costs after MEND. On average, medical expenses reduced by 86% in direct and indirect costs, for a cost-benefit ratio of 0.17. Therefore, for every dollar spent on the program, families and their third payers saved approximately $5.74. Implications for healthcare policy and reimbursements are discussed. PMID:27282311

  6. An examination of cross-cultural systems implementing evidence-based assessment and intervention approaches

    Directory of Open Access Journals (Sweden)

    Murray Laura K

    2006-01-01

    Full Text Available Implementation of evidence-based assessment and intervention approaches for youth with behavioral and/or emotional problems is rising to recognition worldwide. Feasibility research is critical to examine what characteristics of systems allow for success or barriers to the implementation of evidence-based practices into real-world settings, especially when working cross-culturally. This paper briefly reviews the experience of 4 international sites to understand how the overall structure and specific site variables directed the implementation of the World Health Organization and the World Psychiatry Association project. Discussion includes a thematic summary of the successes and challenges experienced by the sites, and future directions of feasibility studies.

  7. Balancing Broad Ideas with Context: An Evaluation of Student Accuracy in Describing Ecosystem Processes after a System-Level Intervention

    Science.gov (United States)

    Jordan, Rebecca C.; Brooks, Wesley R.; Hmelo-Silver, Cindy; Eberbach, Catherine; Sinha, Suparna

    2014-01-01

    Promoting student understanding of ecosystem processes is critical to biological education. Yet, teaching complex life systems can be difficult because systems are dynamic and often behave in a non-linear manner. In this paper, we discuss assessment results from a middle school classroom intervention in which a conceptual representation framework…

  8. Fundamental study of a real-time occupational dosimetry system for interventional radiology staff

    International Nuclear Information System (INIS)

    Real-time monitoring of the radiation doses received by interventional radiology (IR) staff has become highly desirable. However, occupational doses are rarely measured in real time, due to the lack of a feasible method for use in IR. Recently, the i2 system by RaySafe™ has been introduced to measure occupational exposure in IR in real time. The i2 system consists of several personal dosimeters (PDs) and a base station with a display and computer interfacing. We evaluated the fundamental performance (dose linearity, dose-rate dependence, angular dependence, batch uniformity and reproducibility) of the i2 system. The dose linearity of the i2 was excellent (R2 = 1.00) The i2 exhibited slight dose-rate dependence (∼20%) at very high dose rates (250 mGy h−1). Little angular dependence (within 20%) was observed between 0° and ±45°, in either the vertical or horizontal direction. We also found that the PD was highly sensitive (about 200%) at angles behind it, e.g. 180°. However, this backscattered radiation is not a problem, in general, due to the placement of the i2 sensor (PD) on the lead apron. We conclude that the i2 system facilitates accurate real-time monitoring and management of occupational doses during IR. (note)

  9. Clinical impact of targeted amplicon sequencing for meningioma as a practical clinical-sequencing system.

    Science.gov (United States)

    Yuzawa, Sayaka; Nishihara, Hiroshi; Yamaguchi, Shigeru; Mohri, Hiromi; Wang, Lei; Kimura, Taichi; Tsuda, Masumi; Tanino, Mishie; Kobayashi, Hiroyuki; Terasaka, Shunsuke; Houkin, Kiyohiro; Sato, Norihiro; Tanaka, Shinya

    2016-07-01

    Recent genetic analyses using next-generation sequencers have revealed numerous genetic alterations in various tumors including meningioma, which is the most common primary brain tumor. However, their use as routine laboratory examinations in clinical applications for tumor genotyping is not cost effective. To establish a clinical sequencing system for meningioma and investigate the clinical significance of genotype, we retrospectively performed targeted amplicon sequencing on 103 meningiomas and evaluated the association with clinicopathological features. We designed amplicon-sequencing panels targeting eight genes including NF2 (neurofibromin 2), TRAF7, KLF4, AKT1, and SMO. Libraries prepared with genomic DNA extracted from PAXgene-fixed paraffin-embedded tissues of 103 meningioma specimens were sequenced using the Illumina MiSeq. NF2 loss in some cases was also confirmed by interphase-fluorescent in situ hybridization. We identified NF2 loss and/or at least one mutation in NF2, TRAF7, KLF4, AKT1, and SMO in 81 out of 103 cases (79%) by targeted amplicon sequencing. On the basis of genetic status, we categorized meningiomas into three genotype groups: NF2 type, TRAKLS type harboring mutation in TRAF7, AKT1, KLF4, and/or SMO, and 'not otherwise classified' type. Genotype significantly correlated with tumor volume, tumor location, and magnetic resonance imaging findings such as adjacent bone change and heterogeneous gadolinium enhancement, as well as histopathological subtypes. In addition, multivariate analysis revealed that genotype was independently associated with risk of recurrence. In conclusion, we established a rapid clinical sequencing system that enables final confirmation of meningioma genotype within 7 days turnaround time. Our method will bring multiple benefits to neuropathologists and neurosurgeons for accurate diagnosis and appropriate postoperative management. PMID:27102344

  10. Clinical efficacy evaluation of Shuangshen Tongguan capsule on acute myocardial infarction patients after direct percutaneous coronary intervention

    Institute of Scientific and Technical Information of China (English)

    王永刚

    2013-01-01

    Objective To evaluate the therapeutic efficacy of Shuangshen Tongguan Capsule(STC) on acute myocardial infarction(AMI) patients after direct percutaneous coronary intervention(PCI). Methods Using a randomized controlled method,AMI patients with elevated ST segment after successful direct PCI were randomly assigned

  11. Clinical observation on scores of anxiety, depression and quality of life for advanced gastrointestinal carcinoma patients with palliation intervention therapy

    International Nuclear Information System (INIS)

    Objective: To evaluate the influence of palliative intervention therapy on advanced gastrointestinal carcinoma patients with depression and anxiety before and after the treatment. Methods: 56 advanced gastrointestinal carcinoma patients were selected and treated with intra-arterial perfusion chemotherapy or intra-arterial perfusion chemotherapy with embolization. Curative effects were assessed with the SDS, SAS and FACT-G before and after the treatment. In addition, all patients took self-assessment with SCL-90, comparing with the Chinese norms. Results: SCL-90 scores including the somatization agent, depression agent, and anxiety agent scores of the advanced gastrointestinal carcinoma were higher than those of Chinese norms, with significant difference (P<0.05). After palliative intervention therapy, the scores of SDS and SAS were lower than those before the palliative intervention therapy with significant difference (P< 0.05); and furthermore with an obvious improvement in the scores of FACT-G (P<0.05). Conclusion: Palliative intervention therapy for advanced gastrointestinal carcinoma patients can improve the complaints of depression anxiety and quality of life. (authors)

  12. Impact of transfer for primary percutaneous coronary intervention on survival and clinical outcomes (from the HORIZONS-AMI Trial).

    NARCIS (Netherlands)

    Wohrle, J.; Desaga, M.; Metzger, C.; Huber, K.; Suryapranata, H.; Guetta, V.; Guagliumi, G.; Witzenbichler, B.; Parise, H.; Mehran, R.; Stone, G.W.

    2010-01-01

    Primary percutaneous coronary intervention (PCI) is the preferred reperfusion strategy in patients with ST-segment elevation myocardial infarction (STEMI). We evaluated whether presentation of patients with STEMI to a noninterventional facility requiring transfer for primary PCI compared to direct a

  13. Study of Clinical Practical Model of Urinary System Injury

    Directory of Open Access Journals (Sweden)

    Gang Li

    2015-01-01

    Full Text Available Background: In order to improve the clinical treatment level of urinary system injury, it is necessary to build up an animal model of urinary system wound, which is not only analogous to real clinical practice, but also simple and practical. Methods: We have developed the third generation of firearm fragment wound generator based on the first and the second producer. The best explosive charge of the blank cartridge was selected by gradient powder loading experiments. The firearm fragment injuries were made to the bulbous urethra of 10 New Zealand male rabbits. One week preoperatively and 2, 4 and 8 weeks postoperatively, all the animals underwent urethroscopy and urethrography. At 2, 4 and 8 weeks postoperatively, two animals were randomly selected and killed, and the urethra was cut off for pathological examination. Results: The shooting distance of the third generation of firearm fragment wound generator is 2 cm. The best explosive charge of the blank cartridge is 1 g of nitrocotton. All rabbits survived the procedures and stayed alive until they were killed. Injuries were limited to bulbous urethra and distal urethra. Round damaged areas, 1-1.5 cm in length, on the ventral wall were observed. Ureteroscopy results showed that canal diameter gradually shrank by over 50% in 9 rabbits. The rate of success was 90%. Urethrography result noted that a 1-1.3 cm stricture was formed at the bulbous urethra. Histology results of injured stricture urethra showed that fibrous connective tissue hyperplasia and hyaline degeneration caused further stricture in the canal. Conclusions: The third generation of firearm fragment wound generator imitates the bullet firing process and is more accurate and repeatable. The corresponding rabbit model of traumatic complex urethral stricture simulates the real complex clinical conditions. This animal model provides a standardized platform for clinical researches on treating traumatic injuries to the urinary system.

  14. Thorombolytic therapy with rescue percutaneous coronary intervention versus primary percutaneous coronary intervention in patients with acute myocardial infarction: a multicenter randomized clinical trial

    Institute of Scientific and Technical Information of China (English)

    GAO Run-lin; L(U) Shu-zheng; WEI Meng; ZENG Ding-yin; CHEN Ji-lin; QIN Xue-wen; XU Bo; DU Chang-hui; HAN Ya-ling; YANG Xin-chun; MAO Jie-ming; FANG Wei-yi; WANG Lei; SHEN Wei-feng; LI Zhan-quan; JIA Guo-liang

    2010-01-01

    Background Although thrombolytic therapy with rescue percutaneous coronary intervention (PCI) is a common treatment strategy for ST-segment elevation acute myocardial infarction (STEMI), scant data are available on its efficacy relative to primary PCI, and comparison was therefore the aim of this study.Methods This multicenter, open-label, randomized, parallel trial was conducted in 12 hospitals on patients (age ≤70 years) with STEMI who presented within 12 hours of symptom onset (mean interval >3 hours). Patients were randomized to three groups: primary PCI group (n=101); recombinant staphylokinase (r-Sak) group (n=104); and recombinant tissue-type plasminogen activator (rt-PA) group (n=106). For all patients allocated to the thrombolytic therapy arm, coronary angiography was performed at 90 minutes after drug therapy to confirm infarct-related artery (IRA) patency; rescue PCI was performed in cases with TIMI flow grade ≤2. Bare-metal stent implantation was planned for all patients. Results After randomization it required an average of 113.4 minutes to start thrombolytic therapy (door-to-needle time)and 141.2 minutes to perform first balloon inflation in the IRA (door to balloon time).Rates of IRA patency (TIMI flow grade 2 or 3) and TIMI flow grade 3 were significantly lower in the thrombolysis group at 90 minutes after drug therapy than in the primary PCI group at the end of the procedure (70.5% vs. 98.0%, P <0.0001, and 53.0% vs. 85.9%, P <0.0001, respectively). Rescue PCI with stenting was performed in 117 patients (55.7%) in the thrombolytic therapy arm. Rates of patency and TIMI flow grade 3 were still significantly lower in the rescue PCI than in the primary PCI group (88.9% vs. 97.9%, P=0.0222, and 68.4% vs. 85.0%, P=0.0190, respectively). At 30 days post-therapy, mortality rate was significantly higher in the thrombolysis combined with rescue PCI group than in primary PCI group (7.1% vs. 0, P=0.0034). Rates of death/Ml and bleeding complications were

  15. Driver's behavioural changes with new intelligent transport system interventions at railway level crossings--A driving simulator study.

    Science.gov (United States)

    Larue, Grégoire S; Kim, Inhi; Rakotonirainy, Andry; Haworth, Narelle L; Ferreira, Luis

    2015-08-01

    Improving safety at railway level crossings is an important issue for the Australian transport system. Governments, the rail industry and road organisations have tried a variety of countermeasures for many years to improve railway level crossing safety. New types of intelligent transport system (ITS) interventions are now emerging due to the availability and the affordability of technology. These interventions target both actively and passively protected railway level crossings and attempt to address drivers' errors at railway crossings, which are mainly a failure to detect the crossing or the train and misjudgement of the train approach speed and distance. This study aims to assess the effectiveness of three emerging ITS that the rail industry considers implementing in Australia: a visual in-vehicle ITS, an audio in-vehicle ITS, as well as an on-road flashing beacons intervention. The evaluation was conducted on an advanced driving simulator with 20 participants per trialled technology, each participant driving once without any technology and once with one of the ITS interventions. Every participant drove through a range of active and passive crossings with and without trains approaching. Their speed approach of the crossing, head movements and stopping compliance were measured. Results showed that driver behaviour was changed with the three ITS interventions at passive crossings, while limited effects were found at active crossings, even with reduced visibility. The on-road intervention trialled was unsuccessful in improving driver behaviour; the audio and visual ITS improved driver behaviour when a train was approaching. A trend toward worsening driver behaviour with the visual ITS was observed when no trains were approaching. This trend was not observed for the audio ITS intervention, which appears to be the ITS intervention with the highest potential for improving safety at passive crossings.

  16. Spiritual Assessment within Clinical Interventions Focused on Quality of Life Assessment in Palliative Care: A Secondary Analysis of a Systematic Review

    Directory of Open Access Journals (Sweden)

    Gianluca Catania

    2016-03-01

    Full Text Available One of the most crucial palliative care challenges is in determining how patients’ needs are defined and assessed. Although physical and psychological needs are commonly documented in patient’s charts, spiritual needs are less frequently reported. The aim of this review was to determine which explicit, longitudinal documentation of spiritual concerns would sufficiently affect clinical care to alleviate spiritual distress or promote spiritual wellbeing. A secondary analysis of a systematic review originally aimed at appraising the effectiveness of complex interventions focused on quality of life in palliative care was conducted. Five databases were searched for articles reporting interventions focused on QoL including at least two or more QoL dimensions. A narrative synthesis was performed to synthesize findings. In total, 10 studies were included. Only three studies included spiritual wellbeing assessment. Spirituality tools used to assess spiritual wellbeing were different between studies: Hospital QoL Index 14; Spiritual Needs Inventory; Missoula-Vitas QoL Index; and the Needs Assessment Tool: Progressive Disease-Cancer. Only one study reported a healthcare professional’s session training in the use of the QoL tool. Two out of three studies showed in participants an improvement in spiritual wellbeing, but changes in spiritual wellbeing scores were not significant. Overall patients receiving interventions focused on QoL assessment experienced both improvements in their QoL and in their spiritual needs. Although spiritual changes were not significant, the results provide evidence that a spiritual need exists and that spiritual care should be appropriately planned and delivered. Spiritual needs assessment precedes spiritual caring. It is essential that interventions focused on QoL assessment in palliative care include training on how to conduct a spiritual assessment and appropriate interventions to be offered to patients to address their

  17. 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

  18. NeuroControl: system identification approach for clinical benefit.

    Directory of Open Access Journals (Sweden)

    Carel G.M. Meskers

    2015-09-01

    Full Text Available Progress in diagnosis and treatment of movement disorders after neurological diseases like stroke, cerebral palsy, dystonia and at old age requires understanding of the altered capacity to adequately respond to physical obstacles in the environment. With posture and movement disorders, the control of muscles is hampered, resulting in aberrant force generation and improper impedance regulation. Understanding of this improper regulation not only requires the understanding of the role of the neural controller, but also attention for the 1 the interaction between the neural controller and the plant, comprising the biomechanical properties of the skeleton including the viscoelastic properties of the contractile (muscle and non-contractile (connective tissues: neuromechanics and 2 the closed loop nature of neural controller and biomechanical system in which cause and effect interact and are hence difficult to separate. Properties of the neural controller and the biomechanical system need to be addressed synchronously by the combination of haptic robotics, (closed loop system identification, and neuro-mechanical modelling. In this paper, we argue that assessment of neuromechanics in response to well defined environmental conditions and tasks may provide for key parameters to understand posture and movement disorders in neurological diseases and as biomarkers to increase accuracy of prediction models for functional outcome and effects of intervention.

  19. Incorporation of Therapeutic Interventions in Physiologically Based Pharmacokinetic Modeling of Human Clinical Case Reports of Accidental or Intentional Overdosing with Ethylene Glycol

    Energy Technology Data Exchange (ETDEWEB)

    Corley, Rick A.; McMartin, K. E.

    2005-05-16

    Ethylene glycol is a high production volume chemical used in the manufacture of resins and fibers, antifreeze, deicing fluids, heat transfer and hydraulic fluids. Although occupational uses of ethylene glycol have not been associated with adverse effects, there are case reports where humans have either intentionally or accidentally ingested large quantities of ethylene glycol, primarily from antifreeze. The acute toxicity of ethylene glycol in humans and animals and can proceed through three stages, each associated with a different metabolite: central nervous system depression (ethylene glycol), cardiopulmonary effects associated with metabolic acidosis (glycolic acid) and ultimately renal toxicity (oxalic acid), depending upon the total amounts consumed and effectiveness of therapeutic interventions. A physiologically based pharmacokinetic (PBPK) model developed in a companion paper (Corley et al., 2004) was refined in this study to include clinically relevant treatment regimens for ethylene glycol poisoning such as hemodialysis or metabolic inhibition with either ethanol or fomepizole. Such modifications enabled the model to describe several human case reports which included analysis of ethylene glycol and/or glycolic acid. Such data and model simulations provide important confirmation that the PBPK model developed previously can adequately describe the pharmacokinetics of ethylene glycol in humans following low, occupational or environmentally relevant inhalation exposures, as well as massive oral doses even under conditions where treatments have been employed that markedly affect the disposition of ethylene glycol and glycolic acid. By integrating the case report data sets with controlled studies in this PBPK model, it was demonstrated that fomepizole, if administered early enough in a clinical situation, can be more effective than ethanol or hemodialysis in preventing the metabolism of ethylene glycol to more toxic metabolites. Hemodialysis remains an

  20. Clinical information systems: cornerstone for an efficient hospital management.

    Science.gov (United States)

    Lovis, Christian

    2011-01-01

    The university hospitals of Geneva are the largest consortium of public hospitals in Switzerland. This organization is born in 1995, after a political decision to merge the seven public and teaching hospitals of the Canton of Geneva. From an information technologies perspective, it took several years to reach a true unified vision of the complete organization. The clinical information system is deployed in all sites covering in- and outpatient cares. It is seen as the cornerstone of information management and flow in the organization, for direct patient care and decision support, but also for the management to drive, improve and leverage the activities, for better efficiency, quality and safety of care, but also to drive processes. As the system has become more important for the organization, it has required progressive changes in its governance. The high importance of interoperability and use of formal representation has become a major challenge in order to be able to reuse clinical information for real-time care and management activities, and for secondary usage such as billing, resource management, strategic planning and clinical research. This paper proposes a short overview of the tools allowing to leverage the management for physicians, nurses, human resources and hospital governance.