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Sample records for clinical maternal-fetal medicine

  1. THE MATERNAL-FETAL MEDICINE: AN UPDATE

    Directory of Open Access Journals (Sweden)

    Vincenzo Berghella

    2013-12-01

    Full Text Available The development of Maternal-Fetal Medicine is contributing to an improvement of maternal well-being and of neonatal health, introducing a number of new and useful technologies. Advances in genomics in the field of prenatal screening and diagnosis allowed the discovery of fragments of cell-free fetal DNA in the maternal circulation and the use of chromosomal microarrays, which can test for microdeletions and microduplications in addition to aneuploidies. Color Doppler applications during pregnancy are expanding exponentially and Doppler flow velocity waveforms indices have provided important information from maternal, placental and fetal circulation with clinical implications. Ultrasound monitoring of fetal growth represents a fundamental tool to evaluate fetal wellbeing and several methods have been developed to improve fetal weight estimation accuracy. The combination of new biophysical and biochemical markers is enriching Maternal-Fetal Medicine and more research will allow to improve pregnancy outcome.

  2. Metabolomics Application in Maternal-Fetal Medicine

    Directory of Open Access Journals (Sweden)

    Vassilios Fanos

    2013-01-01

    Full Text Available Metabolomics in maternal-fetal medicine is still an “embryonic” science. However, there is already an increasing interest in metabolome of normal and complicated pregnancies, and neonatal outcomes. Tissues used for metabolomics interrogations of pregnant women, fetuses and newborns are amniotic fluid, blood, plasma, cord blood, placenta, urine, and vaginal secretions. All published papers highlight the strong correlation between biomarkers found in these tissues and fetal malformations, preterm delivery, premature rupture of membranes, gestational diabetes mellitus, preeclampsia, neonatal asphyxia, and hypoxic-ischemic encephalopathy. The aim of this review is to summarize and comment on original data available in relevant published works in order to emphasize the clinical potential of metabolomics in obstetrics in the immediate future.

  3. Metabolomics application in maternal-fetal medicine.

    Science.gov (United States)

    Fanos, Vassilios; Atzori, Luigi; Makarenko, Karina; Melis, Gian Benedetto; Ferrazzi, Enrico

    2013-01-01

    Metabolomics in maternal-fetal medicine is still an "embryonic" science. However, there is already an increasing interest in metabolome of normal and complicated pregnancies, and neonatal outcomes. Tissues used for metabolomics interrogations of pregnant women, fetuses and newborns are amniotic fluid, blood, plasma, cord blood, placenta, urine, and vaginal secretions. All published papers highlight the strong correlation between biomarkers found in these tissues and fetal malformations, preterm delivery, premature rupture of membranes, gestational diabetes mellitus, preeclampsia, neonatal asphyxia, and hypoxic-ischemic encephalopathy. The aim of this review is to summarize and comment on original data available in relevant published works in order to emphasize the clinical potential of metabolomics in obstetrics in the immediate future.

  4. Putting the "M" back in maternal-fetal medicine.

    Science.gov (United States)

    D'Alton, Mary E; Bonanno, Clarissa A; Berkowitz, Richard L; Brown, Haywood L; Copel, Joshua A; Cunningham, F Gary; Garite, Thomas J; Gilstrap, Larry C; Grobman, William A; Hankins, Gary D V; Hauth, John C; Iriye, Brian K; Macones, George A; Martin, James N; Martin, Stephanie R; Menard, M Kathryn; O'Keefe, Daniel F; Pacheco, Luis D; Riley, Laura E; Saade, George R; Spong, Catherine Y

    2013-06-01

    Although maternal death remains rare in the United States, the rate has not decreased for 3 decades. The rate of severe maternal morbidity, a more prevalent problem, is also rising. Rise in maternal age, in rates of obesity, and in cesarean deliveries as well as more pregnant women with chronic medical conditions all contribute to maternal mortality and morbidity in the United States. We believe it is the responsibility of maternal-fetal medicine (MFM) subspecialists to lead a national effort to decrease maternal mortality and morbidity. In doing so, we hope to reestablish the vital role of MFM subspecialists to take the lead in the performance and coordination of care in complicated obstetrical cases. This article will summarize our initial recommendations to enhance MFM education and training, to establish national standards to improve maternal care and management, and to address critical research gaps in maternal medicine.

  5. What is new in maternal-fetal medicine?: best articles from the past year.

    Science.gov (United States)

    Spong, Catherine Y

    2012-01-01

    This month, we focus on current research in maternal-fetal medicine. Dr. Spong discusses six recent publications, and each is concluded with a "bottom line" that is the take-home message. The complete reference for each can be found in Box 1 on this page, along with direct links to the abstracts.

  6. Simulation in maternal-fetal medicine: making a case for the need.

    Science.gov (United States)

    Goffman, Dena; Colleen, Lee; Bernstein, Peter S

    2013-06-01

    Medical error remains a cause for concern in obstetrics. Studies have shown that the most important contributing factors to adverse events in obstetrics often relate to poor teamwork and ineffective communication. A potential solution to these problems includes transforming institutions, obstetric departments, and maternal-fetal medicine divisions into high-reliability organizations. Simulation is a valuable tool which can be utilized, in obstetrics and maternal-fetal medicine, as an integral part of programs designed to advance knowledge and technical skills; improve communication and team function; and identify and correct systems issues. Simulation should be an integral part of our journey towards high reliability with the ultimate goal of improving patient safety and quality of care in obstetrics.

  7. Capacity planning for maternal-fetal medicine using discrete event simulation.

    Science.gov (United States)

    Ferraro, Nicole M; Reamer, Courtney B; Reynolds, Thomas A; Howell, Lori J; Moldenhauer, Julie S; Day, Theodore Eugene

    2015-07-01

    Maternal-fetal medicine is a rapidly growing field requiring collaboration from many subspecialties. We provide an evidence-based estimate of capacity needs for our clinic, as well as demonstrate how simulation can aid in capacity planning in similar environments. A Discrete Event Simulation of the Center for Fetal Diagnosis and Treatment and Special Delivery Unit at The Children's Hospital of Philadelphia was designed and validated. This model was then used to determine the time until demand overwhelms inpatient bed availability under increasing capacity. No significant deviation was found between historical inpatient censuses and simulated censuses for the validation phase (p = 0.889). Prospectively increasing capacity was found to delay time to balk (the inability of the center to provide bed space for a patient in need of admission). With current capacity, the model predicts mean time to balk of 276 days. Adding three beds delays mean time to first balk to 762 days; an additional six beds to 1,335 days. Providing sufficient access is a patient safety issue, and good planning is crucial for targeting infrastructure investments appropriately. Computer-simulated analysis can provide an evidence base for both medical and administrative decision making in a complex clinical environment. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  8. RANDOMIZED CONTROLLED TRIALS OF MATERNAL-FETAL SURGERY : A CHALLENGE TO CLINICAL EQUIPOISE

    NARCIS (Netherlands)

    Rodrigues, H. C. M. L.; van den Berg, P. P.

    2014-01-01

    This article focuses on maternal-fetal surgery (MFS) and on the concept of clinical equipoise that is a widely accepted requirement for conducting randomized controlled trials (RCT). There are at least three reasons why equipoise is unsuitable for MFS. First, the concept is based on a misconception

  9. Attitudes and Knowledge of Maternal-Fetal Medicine Fellows Regarding Noninvasive Prenatal Testing.

    Science.gov (United States)

    Swaney, Paul; Hardisty, Emily; Sayres, Lauren; Wiegand, Samantha; Vora, Neeta

    2016-02-01

    Using cell-free DNA in maternal serum to detect fetal aneuploidy has been shown to have high sensitivity and specificity. The purpose of this study was to assess attitudes and knowledge of Maternal-Fetal Medicine (MFM) fellows regarding noninvasive prenatal testing (NIPT). A 13 question survey was sent via listserv to US-based MFM fellows. One hundred sixteen fellows responded, a 42.3% response rate, with >75% reporting they are comfortable ordering NIPT. Most (82%) preferred that a patient discuss options with a provider or genetic counselor. Three common methods used to learn about NIPT were: formal educational activities (n = 78, 69%), self-review of the literature (n = 76, 67%), and discussions with peers (n = 73, 65%). On questions related to trisomy 21, accuracy was >70%. However, accuracy was lower regarding use in twin pregnancies (42%) and monosomy X screening (50%).

  10. Society for maternal-fetal medicine (SMFM) special report: the maternal-fetal medicine subspecialists' role within a health care system.

    Science.gov (United States)

    Sciscione, Anthony; Berghella, Vincenzo; Blackwell, Sean; Boggess, Kim; Helfgott, Andrew; Iriye, Brian; Keller, James; Menard, M Kathryn; O'Keeffe, Daniel; Riley, Laura; Stone, Joanne

    2014-12-01

    A maternal-fetal medicine (MFM) subspecialist has advanced knowledge of the medical, surgical, obstetrical, fetal, and genetic complications of pregnancy and their effects on both the mother and fetus. MFM subspecialists are complementary to obstetric care providers in providing consultations, co-management, or transfer of care for complicated patients before, during, and after pregnancy. The MFM subspecialist provides peer and patient education and performs research concerning the most recent approaches and treatments for obstetrical problems, thus promoting risk-appropriate care for these complicated pregnancies. The relationship between the obstetric care provider and the MFM subspecialist depends on the acuity of the maternal and/or fetal condition and the local resources. To achieve the goal of promoting early access and sustained adequate prenatal care for all pregnant women, we encourage collaboration with obstetricians, family physicians, certified midwives, and others, and we also encourage providing preconception, prenatal, and postpartum care counseling and coordination. Effective communication between all obstetric care team members is imperative. This special report was written with the intent that it would be broad in scope and appeal to a diverse readership, including administrators, allowing it to be applied to various systems of care both horizontally and vertically. We understand that these relationships are often complex and there are more models of care than could be addressed in this document. However, we aimed to promote the development of a highly effective team approach to the care of the high-risk pregnancy that will be useful in the most common models for obstetric care in the United States. The MFM subspecialist functions most effectively within a fully integrated and collaborative health care environment. This document defines the various roles that the MFM subspecialist can fulfill within different heath care systems through

  11. Randomized controlled trials of maternal-fetal surgery: a challenge to clinical equipoise.

    Science.gov (United States)

    Rodrigues, H C M L; van den Berg, P P

    2014-10-01

    This article focuses on maternal-fetal surgery (MFS) and on the concept of clinical equipoise that is a widely accepted requirement for conducting randomized controlled trials (RCT). There are at least three reasons why equipoise is unsuitable for MFS. First, the concept is based on a misconception about the nature of clinical research and the status of research subjects. Second, given that it is not clear who the research subject/s in MFS is/are, if clinical equipoise is to be used as a criterion to test the ethical appropriateness of RCT, its meaning should be unambiguous. Third, because of the multidisciplinary character of MFS, it is not clear who should be in equipoise. As a result, we lack an adequate criterion for the ethical review of MFS protocols. In our account, which is based on Chervenak and McCullough's seminal work in the field of obstetric ethics, equipoise is abandoned. and RCT involving MFS can be ethically initiated when a multidisciplinary ethics review board (ERB), having an evidence-based assessment of the risks involved, is convinced that the value of answering the research hypothesis, for the sake of the health interests of future pregnant women carrying fetuses with certain congenital birth defects, justifies the actual risks research participants might suffer within a set limit of low/manageable.

  12. Prenatal Detection of Cardiac Anomalies in Fetuses with Single Umbilical Artery: Diagnostic Accuracy Comparison of Maternal-Fetal-Medicine and Pediatric Cardiologist

    Directory of Open Access Journals (Sweden)

    Ilir Tasha

    2014-01-01

    Full Text Available Aim. To determine agreement of cardiac anomalies between maternal fetal medicine (MFM physicians and pediatric cardiologists (PC in fetuses with single umbilical artery (SUA. Methods. A retrospective review of all fetuses with SUA between 1999 and 2008. Subjects were studied by MFM and PC, delivered at our institution, and had confirmation of SUA and cardiac anomaly by antenatal and neonatal PC follow-up. Subjects were divided into four groups: isolated SUA, SUA and isolated cardiac anomaly, SUA and multiple anomalies without heart anomalies, and SUA and multiple malformations including cardiac anomaly. Results. 39,942 cases were studied between 1999 and 2008. In 376 of 39,942 cases (0.94%, SUA was diagnosed. Only 182 (48.4% met inclusion criteria. Cardiac anomalies were found in 21% (38/182. Agreement between MFM physicians and PC in all groups combined was 94% (171/182 (95% CI [89.2, 96.8]. MFM physicians overdiagnosed cardiac anomalies in 4.4% (8/182. MFM physicians and PC failed to antenatally diagnose cardiac anomaly in the same two cases. Conclusions. Good agreement was noted between MFM physicians and PC in our institution. Studies performed antenatally by MFM physicians and PC are less likely to uncover the entire spectrum of cardiac abnormalities and thus neonatal follow-up is suggested.

  13. Preventing the First Cesarean Delivery: Summary of a Joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, and American College of Obstetricians and Gynecologists Workshop

    Science.gov (United States)

    Spong, Catherine Y.; Berghella, Vincenzo; Wenstrom, Katharine D.; Mercer, Brian M.; Saade, George R.

    2012-01-01

    With over one-third of pregnancies in the United States being delivered by cesarean and the growing knowledge of morbidities associated with repeat cesarean deliveries, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the Society for Maternal-Fetal Medicine, and the American College of Obstetricians and Gynecologists convened a workshop to address the concept of preventing the first cesarean. The available information on maternal and fetal factors, labor management and induction, and non-medical factors leading to the first cesarean were reviewed as well as the implications of the first cesarean on future reproductive health. Key points were identified to assist with reduction in cesarean rates including that labor induction should be performed primarily for medical indication; if done for non-medical indications, the gestational age should be at least 39 weeks or more and the cervix should be favorable, especially in the nulliparous patient. Review of the current literature demonstrates the importance of adhering to appropriate definitions for failed induction and arrest of labor progress. The diagnosis of “failed induction” should only be made after an adequate attempt. Adequate time for normal latent and active phases of the first stage, and for the second stage, should be allowed, as long as the maternal and fetal conditions permit. The adequate time for each of these stages appears to be longer than traditionally estimated. Operative vaginal delivery is an acceptable birth method when indicated, and can safely prevent cesarean delivery. Given the progressively declining use, it is critical that training and experience in operative vaginal delivery is facilitated and encouraged. When discussing the first cesarean with a patient, counseling should include its effect on future reproductive health. PMID:23090537

  14. Preventing the first cesarean delivery: summary of a joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, and American College of Obstetricians and Gynecologists Workshop.

    Science.gov (United States)

    Spong, Catherine Y; Berghella, Vincenzo; Wenstrom, Katharine D; Mercer, Brian M; Saade, George R

    2012-11-01

    With more than one third of pregnancies in the United States being delivered by cesarean and the growing knowledge of morbidities associated with repeat cesarean deliveries, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the Society for Maternal-Fetal Medicine, and the American College of Obstetricians and Gynecologists convened a workshop to address the concept of preventing the first cesarean delivery. The available information on maternal and fetal factors, labor management and induction, and nonmedical factors leading to the first cesarean delivery was reviewed as well as the implications of the first cesarean delivery on future reproductive health. Key points were identified to assist with reduction in cesarean delivery rates including that labor induction should be performed primarily for medical indication; if done for nonmedical indications, the gestational age should be at least 39 weeks or more and the cervix should be favorable, especially in the nulliparous patient. Review of the current literature demonstrates the importance of adhering to appropriate definitions for failed induction and arrest of labor progress. The diagnosis of "failed induction" should only be made after an adequate attempt. Adequate time for normal latent and active phases of the first stage, and for the second stage, should be allowed as long as the maternal and fetal conditions permit. The adequate time for each of these stages appears to be longer than traditionally estimated. Operative vaginal delivery is an acceptable birth method when indicated and can safely prevent cesarean delivery. Given the progressively declining use, it is critical that training and experience in operative vaginal delivery are facilitated and encouraged. When discussing the first cesarean delivery with a patient, counseling should include its effect on future reproductive health.

  15. Expanded carrier screening in reproductive medicine-points to consider: a joint statement of the American College of Medical Genetics and Genomics, American College of Obstetricians and Gynecologists, National Society of Genetic Counselors, Perinatal Quality Foundation, and Society for Maternal-Fetal Medicine.

    Science.gov (United States)

    Edwards, Janice G; Feldman, Gerald; Goldberg, James; Gregg, Anthony R; Norton, Mary E; Rose, Nancy C; Schneider, Adele; Stoll, Katie; Wapner, Ronald; Watson, Michael S

    2015-03-01

    The Perinatal Quality Foundation and the American College of Medical Genetics and Genomics, in association with the American College of Obstetricians and Gynecologists, the Society for Maternal-Fetal Medicine, and the National Society of Genetic Counselors, have collaborated to provide education for clinicians and laboratories regarding the use of expanded genetic carrier screening in reproductive medicine. This statement does not replace current screening guidelines, which are published by individual organizations to direct the practice of their constituents. As organizations develop practice guidelines for expanded carrier screening, further direction is likely. The current statement demonstrates an approach for health care providers and laboratories who wish to or who are currently offering expanded carrier screening to their patients.

  16. Society for Maternal-Fetal Medicine

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    Navigate Home What is the Society Becoming a Member (US Membership) Becoming a Member (International Membership) International Task Force Mission and Vision Ethics & Endorsement Policy Message from ...

  17. 叶酸利用能力分子医学检测在母胎医学领域的应用%Application of molecularmedical examination of folic acid utilization ability in maternal-fetal medicine

    Institute of Scientific and Technical Information of China (English)

    李秀娟; 徐敏; 徐梅; 杨燕; 卢伟; 于雪梅; 姜晶

    2014-01-01

    目的:探讨分子医学检测叶酸利用能力在母胎医学领域的研究与应用。方法通过检测MTHFR基因C677T、A1298 C及MTRR基因A66 G相关多态性位点,分析其遗传特征及分布特点,从而对叶酸利用能力遗传风险进行分级。结果青岛地区围产期妇女发现高度叶酸利用能力遗传风险的比例为23.17%,显著高于全国参考数据的17.70%(χ2=7.136,P<0.05);中度和低度叶酸利用能力遗传风险的比例分别为33.07%和18.19%,全国参考数据为35.18%和12.08%,无显著性差异(χ2值分别为7.452、2.347,均P>0.05),未发现遗传风险的比例为25.57%,显著低于全国参考数据的33.04%(χ2=8.134,P<0.05)。实验组与对照组的叶酸利用能力总体构成不同,存在统计学差异(χ2=15.67,P<0.01),高度风险组与未发现风险组的相对危险度( RR)为2.61。结论青岛地区围产期妇女叶酸代谢和利用障碍与不良孕产妇有着重要的关系,基于Taqman-MGB探针检测的孕期叶酸补充指导和监测将是进一步降低新生儿出生缺陷的重要方法。%[ Abstact] Objective To explore the application of molecular medical examination of folic acid utilization ability in maternal-fetal medicine.Methods By detecting MTHFR gene C677T, A1298C and MTRR gene A66G related polymorphisms, their genetic characteristics and distribution were analyzed, and thus to classify the genetic risk of folic acid utilization ability.Results In Qingdao the high genetic risk of folic acid utilization ability in perinatal women was 23.17%, which was significantly higher than the national reference data (17.70%) (χ2 =7.136, P0.05).Genetic risk was not found in 25.57%perinatal women, which was obviously lower than the national reference data (33.04%) (χ2 =8.134,P<0.05).The overall composition of folic acid utilization ability in the experimental group and

  18. Maternal-fetal attachment in pregnant women who use illicit drugs.

    Science.gov (United States)

    Shieh, Carol; Kravitz, Melva

    2002-01-01

    To explore cognitive, affective, and altruistic dimensions of maternal-fetal attachment in pregnant women who use illicit drugs. Content analysis with deductive and inductive coding methods was used to uncover common themes in each dimension of attachment. A prenatal clinic of a tertiary medical center in the northeastern United States. Forty pregnant women. Inclusion criteria were the following: used illicit drugs after the last menstrual period, had felt fetal movement, and could read and speak English. Women in methadone treatment programs were excluded. Knowing the baby's characteristics and health through fetal movement, acknowledging the fetus as an individual with physical and emotional functions, and knowing the baby by relating the fetus to self and family members are the three major themes in cognitive attachment. Themes in affective attachment include mixing strong affection with guilt and viewing fetal movement as visual and tactile enjoyment but also discomfort. Common themes with conflicting feelings were salient in altruistic attachment, including feeling uncomfortable versus feeling worthwhile, viewing being pregnant as an incentive for lifestyle changes, battling with substance use and concern for fetal health, and alternating between uncertainty and hope in preparing for the baby's arrival. Maternal-fetal attachment is not a phenomenon that is present or absent, but a struggle manifested by guilt, concern, and uncertainty. Without proper treatment and counseling, many women struggle between illicit drug use and development of maternal-fetal attachment.

  19. Maternal-Fetal Immune Tolerance, Block by Block

    OpenAIRE

    Gobert, Michael; Lafaille, Juan J.

    2012-01-01

    How difficult is to go from egg to implanted embryo? The evolution of placentation in eutherian mammals created enormous challenges, in particular to the maternal immune system, as the fetus expresses paternal antigens that are capable of triggering immune rejection. Samstein et al. reveal a role for inducible regulatory T cells in the enforcement of maternal-fetal immune tolerance.

  20. Human cytomegalovirus induces a distinct innate immune response in the maternal-fetal interface.

    Science.gov (United States)

    Weisblum, Yiska; Panet, Amos; Zakay-Rones, Zichria; Vitenshtein, Alon; Haimov-Kochman, Ronit; Goldman-Wohl, Debra; Oiknine-Djian, Esther; Yamin, Rachel; Meir, Karen; Amsalem, Hagai; Imbar, Tal; Mandelboim, Ofer; Yagel, Simcha; Wolf, Dana G

    2015-11-01

    The initial interplay between human cytomegalovirus (HCMV) and innate tissue response in the human maternal-fetal interface, though crucial for determining the outcome of congenital HCMV infection, has remained unknown. We studied the innate response to HCMV within the milieu of the human decidua, the maternal aspect of the maternal-fetal interface, maintained ex vivo as an integral tissue. HCMV infection triggered a rapid and robust decidual-tissue innate immune response predominated by interferon (IFN)γ and IP-10 induction, dysregulating the decidual cytokine/chemokine environment in a distinctive fashion. The decidual-tissue response was already elicited during viral-tissue contact, and was not affected by neutralizing HCMV antibodies. Of note, IFNγ induction, reflecting immune-cell activation, was distinctive to the maternal decidua, and was not observed in concomitantly-infected placental (fetal) villi. Our studies in a clinically-relevant surrogate human model, provide a novel insight into the first-line decidual tissue response which could affect the outcome of congenital infection.

  1. Periviable birth: executive summary of a Joint Workshop by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, American Academy of Pediatrics, and American College of Obstetricians and Gynecologists.

    Science.gov (United States)

    Raju, T N K; Mercer, B M; Burchfield, D J; Joseph, G F

    2014-05-01

    This is an executive summary of a workshop on the management and counseling issues of women anticipated to deliver at a periviable gestation (broadly defined as 20 0/7 through 25 6/7 weeks of gestation), and the treatment options for the newborn. Upon review of the available literature, the workshop panel noted that the rates of neonatal survival and neurodevelopmental disabilities among the survivors vary greatly across the periviable gestations and are significantly influenced by the obstetric and neonatal management practices (for example, antenatal steroid, tocolytic agents and antibiotic administration; cesarean birth; and local protocols for perinatal care, neonatal resuscitation and intensive care support). These are, in turn, influenced by the variations in local and regional definitions of limits of viability. Because of the complexities in making difficult management decisions, obstetric and neonatal teams should confer prior to meeting with the family, when feasible. Family counseling should be coordinated with the goal of creating mutual trust, respect and understanding, and should incorporate evidence-based counseling methods. Since clinical circumstances can change rapidly with increasing gestational age, counseling should include discussion of the benefits and risks of various maternal and neonatal interventions at the time of counseling. There should be a plan for follow-up counseling as clinical circumstances evolve. The panel proposed a research agenda and recommended developing educational curricula on the care and counseling of families facing the birth of a periviable infant.

  2. 77 FR 42768 - Leadership Meeting on Maternal, Fetal, and Infant Opioid Exposure and Neonatal Abstinence Syndrome

    Science.gov (United States)

    2012-07-20

    ... CONTROL POLICY Leadership Meeting on Maternal, Fetal, and Infant Opioid Exposure and Neonatal Abstinence... Meeting on Maternal, Fetal and Infant Opioid Exposure and Neonatal Abstinence Syndrome (NAS) will bring together leaders in the field of policy, opioid exposed infants, pain treatment during pregnancy,...

  3. Ethical considerations for genetic testing, infertility, and balancing maternal-fetal needs.

    Science.gov (United States)

    Callister, Lynn Clark

    2011-01-01

    Among the ethical issues confronting maternal-child nurses are questions surrounding genetic testing, contraception and sterilization, infertility/assisted reproductive technology, and equality in balancing maternal-fetal needs. This article explores these issues, reviews the literature currently available, and discusses nursing clinical implications for each as well as representative case studies. The types of support needed by childbearing families who are facing ethical issues requires emotional and physical support, informational support, and advocacy support. The role of the nurse in educating women about the ethical implications of their choices cannot be overestimated. When women have been educated about the implications of their decisions and are therefore empowered to make informed decisions about their lives and their pregnancies, clinical nurses who practice ethically respect those decisions and support the women in their choices.

  4. Immune mechanisms at the maternal-fetal interface: perspectives and challenges

    Science.gov (United States)

    PrabhuDas, Mercy; Bonney, Elizabeth; Caron, Kathleen; Dey, Sudhansu; Erlebacher, Adrian; Fazleabas, Asgerally; Fisher, Susan; Golos, Thaddeus; Matzuk, Martin; McCune, Joseph M; Mor, Gil; Schulz, Laura; Soares, Michael; Spencer, Thomas; Strominger, Jack; Way, Sing Sing; Yoshinaga, Koji

    2016-01-01

    Leaders gathered at the US National Institutes of Health in November 2014 to discuss recent advances and emerging research areas in aspects of maternal-fetal immunity that may affect fetal development and pregnancy success. PMID:25789673

  5. Maternal-fetal fluid balance and aquaporins: from molecule to physiology

    Institute of Scientific and Technical Information of China (English)

    Xiao-yan SHA; Zheng-fang XIONG; Hui-shu LIU; Xiao-dan DI; Tong-hui MA

    2011-01-01

    Maternal-fetal fluid balance is critical during pregnancy, and amniotic fluid is essential for fetal growth and development. The placenta plays a key role in a successful pregnancy as the interface between the mother and her fetus. Aquaporins (AQPs) form specific water channels that allow the rapid transcellular movement of water in response to osmotic/hydrostatic pressure gradients. AQPs expression in the placenta and fetal membranes may play important roles in the maternal-fetal fluid balance.

  6. Spreadsheets in Clinical Medicine

    CERN Document Server

    Croll, Grenville J

    2006-01-01

    There is overwhelming evidence that the continued and widespread use of untested spreadsheets in business gives rise to regular, significant and unexpected financial losses. Whilst this is worrying, it is perhaps a relatively minor concern compared with the risks arising from the use of poorly constructed and/or untested spreadsheets in medicine, a practice that is already occurring. This article is intended as a warning that the use of poorly constructed and/or untested spreadsheets in clinical medicine cannot be tolerated. It supports this warning by reporting on potentially serious weaknesses found while testing a limited number of publicly available clinical spreadsheets.

  7. [Maternal-fetal transmission of Trypanosoma cruzi in Argentina].

    Science.gov (United States)

    de Rissio, Ana María; Scollo, Karenina; Cardoni, Rita L

    2009-01-01

    In the neonates born to T. cruzi infected mothers, the diagnosis of the congenital transmission relays on the detection of the parasites and/or the specific antibodies non-transferred by their mothers, in the absence of blood transfusion and vectorial transmission. In the early stage, approximately until the 7th month of life, when maternal immunoglobulins could be present, the diagnosis depends on the detection of the parasite. Then, in the late stage, from the 8th month, the detection of specific antibodies by at least 2 of 3 serological tests confirms the infection in the neonates. The diagnostic follow up of the children born to a group of sero-reactive pregnant women was carried out in the INP. The 11% of the mothers (29 out of 267) transmitted the infection to their children. The neonates of 20 of these mothers were diagnosed in the early stage, 14 and 6 in one or two controls, respectively. In the 9 remaining mothers the children were diagnosed in the late stage of the infection, mainly serologicaly. Our analisis of previously published reports stressed that the maternal-fetal transmission rate depends on the time of diagnostic follow up of the child. In this reports, mean values of mother to child transmission reported was 2% and 9% when the diagnosis of the neonates born to sero-reactive mothers was carried out only in the early stage or in the early and also the late stage, respectively.

  8. Maternal-fetal resource allocation: co-operation and conflict.

    Science.gov (United States)

    Fowden, A L; Moore, T

    2012-11-01

    Pregnancy is generally a co-operative interaction between mother and fetus in which the evolutionary genetic interests of both benefit from production of healthy offspring. While this view is largely supported by empirical data, Kinship Theory predicts that mother and fetus will disagree over the optimum level of maternal investment that maximises their respective fitnesses. This conflict will be more evident with polyandrous than monogamous mating systems, when resources are scarce and in late gestation when the fetus is growing maximally, particularly if conceptus mass is large relative to maternal mass. As the site of nutrient transfer, the placenta is pivotal in the tug-of-war between mother and fetus over resource allocation. It responds to both fetal signals of nutrient demand and maternal signals of nutrient availability and, by adapting its phenotype, regulates the distribution of available resources. These adaptations involve changes in placental size, morphology, transport characteristics, metabolism and hormone bioavailability. They are mediated by key growth regulatory, endocrine and nutrient supply genes responsive to mismatches between nutrient availability and the fetal genetic drive for growth. Indeed, evolution of genomic imprinting and placental secretion of hormones are believed to have been driven by maternal-fetal conflict over resource allocation. Although many of the specific mechanisms involved still have to be identified, the placenta confers optimal fitness on the offspring for its developmental environment by balancing conflict and cooperation in the allocation of resources through generation of nutrient transport phenotypes specific to the prevailing nutritional conditions and/or fetal genotype.

  9. Estimation of the incidence of bacterial vaginosis and other vaginal infections and its consequences on maternal/fetal outcome in pregnant women attending an antenatal clinic in a tertiary care hospital in North India

    Directory of Open Access Journals (Sweden)

    Lata Indu

    2010-01-01

    Full Text Available Aims: This study was undertaken to estimate the incidence of bacterial vaginosis (BV and other vaginal infections during pregnancy and its association with urinary tract infections (UTI and its consequences on pregnancy outcome, maternal and fetal morbidity and mortality. Settings and Design: Prospective cohort study. Materials and Methods: The present prospective cohort study was conducted on 200 women attending the antenatal clinic (ANC of a tertiary hospital. All pertinent obstetric and neonatal data covering antenatal events during the course of pregnancy, delivery, puerperium and condition of each newborn at the time of birth were collected. BV was detected by both Gram stain and gold standard clinical criteria (Amsel′s composite criteria. Statistical analysis used: Data were analyzed using SPSS version 9. Fischer′s exact test, chi square tests and Student′s′ test has been used for analysis. The probability of 5% was considered as significant for continuous variables such as age, period of gestation and birth weight. Odds ratio (OR and confidence interval (CI with 95% probability were determined. Results: The incidence of bacterial vaginosis was 41 in 200 patients. Adverse outcomes such as preterm labor, PROM and fetal complications were found more in pregnant women who had bacterial vaginosis (N=41, bacterial vaginosis with UTI (N=14 as compared to those without bacterial vaginosis (N=118. Conclusions: The incidence of poor pregnancy outcome was higher in bacterial vaginosis with UTI. Prevention of BV and UTI is cost effective to minimize the pregnancy-related complications and preterm labor to decrease in perinatal and maternal mortality and morbidity. We recommend all antenatal patients should be screened for the presence of bacterial vaginosis, other infections and UTI.

  10. Biomarkers in clinical medicine.

    Science.gov (United States)

    Chen, Xiao-He; Huang, Shuwen; Kerr, David

    2011-01-01

    Biomarkers have been used in clinical medicine for decades. With the rise of genomics and other advances in molecular biology, biomarker studies have entered a whole new era and hold promise for early diagnosis and effective treatment of many diseases. A biomarker is a characteristic that is objectively measured and evaluated as an indicator of normal biological processes, pathogenic processes or pharmacologic responses to a therapeutic intervention (1). They can be classified into five categories based on their application in different disease stages: 1) antecedent biomarkers to identify the risk of developing an illness, 2) screening biomarkers to screen for subclinical disease, 3) diagnostic biomarkers to recognize overt disease, 4) staging biomarkers to categorise disease severity, and 5) prognostic biomarkers to predict future disease course, including recurrence, response to therapy, and monitoring efficacy of therapy (1). Biomarkers can indicate a variety of health or disease characteristics, including the level or type of exposure to an environmental factor, genetic susceptibility, genetic responses to environmental exposures, markers of subclinical or clinical disease, or indicators of response to therapy. This chapter will focus on how these biomarkers have been used in preventive medicine, diagnostics, therapeutics and prognostics, as well as public health and their current status in clinical practice.

  11. Pharmacogenetics: transforming clinical medicine.

    Science.gov (United States)

    Newman, W G

    2012-01-01

    Pharmacogenetics, the study of genetic variation relevant to drug metabolism, is a rapidly evolving area of medicine. This brief review will consider some of the recent advances where inherited genetic variants have been associated with either drug efficacy or toxicity. Examples of where pharmacogenetic testing has been adopted into clinical practice will be provided as well as a look at its likely development over the next decade. Finally, the large increase in genetic testing of tumour tissue samples to predict response to molecularly targeted treatments in cancer will be considered.

  12. Analysis of maternal-fetal outcomes of valvular heart surgeries in

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    Alireza Yaghoubi

    2010-03-01

    Full Text Available Valvular heart surgery (VHS in pregnancy has its specific complexity and problems.Between years 1983-2007 11 women who underwent VHS during pregnancy were found and analyzed. Valvular heart surgery in pregnancy is associated with the least maternal-fetal side effects. Intensive evaluations before and during pregnancy with a specialized medical team is essential

  13. Determinants of maternal fetal attachment in women from a community-based sample

    NARCIS (Netherlands)

    Maas, A.J.B.M.; Vreeswijk, C.M.J.M.; Braeken, J.; Vingerhoets, A.J.J.M.; Bakel, van H.J.A.

    2014-01-01

    BackgroundMaternal fetal attachment (MFA) has been found to be an important predictor for the developing relationship between mother and child. During the last decades, research on determinants of MFA has yielded inconclusive and even contradictory results. Until now, a process model in which multip

  14. The HELLP-syndrome; maternal-fetal outcome and follow up of infants

    NARCIS (Netherlands)

    Roelofsen, AC; van Pampus, MG; Aarnoudse, JG

    2003-01-01

    Objective: To investigate maternal-fetal outcome of infants born after pregnancies complicated by (H)ELLP syndrome. Study design: A retrospective cohort study was performed on patients with the HELLP or ELLP syndrome. Maternal and perinatal complications were recorded. The follow-up period of the

  15. The role of mental health on maternal-fetal attachment in low-income women.

    Science.gov (United States)

    Alhusen, Jeanne L; Gross, Deborah; Hayat, Matthew J; Rose, Linda; Sharps, Phyllis

    2012-01-01

    To examine and describe the influence of maternal depressive symptoms on maternal-fetal attachment (MFA) in predominantly low-income women. Mixed method. Three urban obstetric/gynecologic (OB/GYN) clinics serving predominantly low-income women. A convenience sample of 166 women participated in the quantitative component and a purposeful subsample of 12 women participated in the qualitative component; all women were between 24 and 28 weeks gestation at the time of data collection. Linear regression models were used to examine the influence of depressive symptoms and social support on MFA. Individual in-depth interviews were conducted among a subsample of women to explore the influence of maternal depressive symptoms on MFA. Fifty-nine percent (n = 98) of participants had scores that were clinically significant for depressive symptoms. In the final model of social support and depressive symptoms regressed on MFA, social support (b = .23, 95% CI [0.09, .37], p = .002) and depressive symptoms (b = -1.02, 95% CI [-1.32, -.73], p Qualitative participants discussed the importance of social support in contributing to their mood state and MFA. Findings from this study highlight the importance of assessing for depressive symptoms during pregnancy given its influence on MFA. By understanding how important it was for these women to have a supportive person to experience their pregnancies with, nurses can improve the pregnancy experience for vulnerable populations. © 2012 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.

  16. Prediction of Maternal-Fetal Attachment Based on the Components of Gender Role in Pregnant women

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    Mojgan Zolfaghari

    2016-10-01

    Full Text Available Background and aim: Maternal concept is part of the feminine gender role. The important part of the maternal concept is the unique relationship experience between mother and child that begins with  maternal-fetal attachment(MFA during pregnancy. The aim of this study is predict the MFA according to Gender role in pregnant women in Shiraz city. Methods:This descriptive correlational study was conducted on 171 primiparous and multiparous women with Gestational age above 24 weeks of pregnancy reffering to the obstetric and midwifery department of Shiraz –Kowsar Hospital during 2 monthes period from May to June 2015,  which were selected using the Purposive sampling.Data were collected using a Demographic obstetric questionnaire   including  age and obstetric information,Cranly’s Maretnal Fetal Attachment  questionnaire(validity:0.85 and Bem Gender Role questionnaire(reliability:0.90 were used during this study.  For data analysis  Pearson correlation coefficient and multiple regression were performed,using spss version 16. Results:  Results showed a statistically significant correlation between components of femininity and masculinity of gender role with maternal-fetal attachment. Maximum correlation was between Masculinity and MFA ( R=0.33, P=0.001 and then between Femininity and MFA  (R=0.24,P=0.009.There was no correlation between neutral and MFA.(R=0.12,P=0.084  Almost 14% of the variance in maternal-fetal attachment was explained by gender role . According to the comparison of regression coefficients, the femininity indicator (β=0.159 ,P=0.015 and masculinity indicator (β=0.266, P=0.001 were positively predicted the maternal-fetal attachment, but neutral component (β=0.109, P=0.064 was not predicted the maternal-fetal attachment (Table 2. Conclusions: Gender role is part of mental health that predicts MFA during pregnancy. Mental health of mother and fetus can be improved by identifying mothers based Gender role. These

  17. Computer analysis of maternal-fetal heart rate recordings during labor in relation with maternal-fetal attachment and prediction of newborn acidemia.

    Science.gov (United States)

    Pinto, Paula; Costa-Santos, Cristina; Ayres-de-Campos, Diogo; Bernardes, João

    2016-01-01

    To assess combined maternal (MHR) and fetal heart rate (FHR) recordings during labor, in relation with maternal-fetal attachment and prediction of newborn acidemia. Fifty-nine simultaneous MHR and FHR recordings were acquired in the final minutes of labor. Computer analysis followed the FIGO guidelines with estimation of MHR and FHR baselines, accelerations, decelerations, short- (STV) and long-term variabilities. MHR and FHR characteristics, their differences and correlations were assessed in relation to labor progression and to newborn umbilical artery blood (UAB) pH lower than 7.15 and 7.20. To assess prediction of acidemia, areas under ROC curves (auROC) were calculated. Progression of labor was associated with a significant increase in MHR accelerations and FHR decelerations both in the non-acidemic and acidemic fetuses (p MHR-FHR correlations and differences in accelerations and decelerations in acidemic fetuses. The auROC ranged between 0.50 for FHR accelerations and 0.77 for MHR baseline plus FHR STV. MHR and FHR respond differently during labor with signs of increased maternal-fetal attachment during labor progression in acidemic fetuses. Combined MHR-FHR analysis may help to improve prediction of newborn acidemia compared with FHR analysis alone.

  18. Placentation, maternal-fetal interface, and conceptus loss in swine.

    Science.gov (United States)

    Kridli, Rami T; Khalaj, Kasra; Bidarimath, Mallikarjun; Tayade, Chandrakant

    2016-01-01

    Pregnancy is a delicate yet complex physiological process that requires fine-tuning of many factors (hormones, growth factors, cytokines, and receptors) between the mother and the conceptus to ensure the survival of the conceptus(es) to term. Any disturbance in the maternal-conceptus dialog can have detrimental effects on the affected conceptus or even the outcome of pregnancy as a whole. Being a litter-bearing species, such disruptions can lead to a loss of up to 45% of the totally healthy offspring during early (periattachment) and midgestation to late gestation in pigs. Although the exact mechanism is not entirely understood, several factors have been associated with the fetal loss including but not limited to uterine capacity, placental efficiency, genetics, nutrition, and deficits in vascularization at the maternal-fetal interface. Over the years, we investigated how immune cells are recruited to the porcine maternal-fetal interface and whether they contribute to vascularization. We also delineated how cytokines, chemokines, and cytokine destabilizing factors fine-tune inflammation and whether the cytokine shift from early to midpregnancy exists at the porcine maternal-fetal interface. Finally, we evaluated the role of microRNAs in regulating immune cell recruitment and their angiogenic functions during pregnancy. Collectively our research points out that the immune-angiogenesis axis at the porcine maternal interface is significantly involved in promoting new blood vessel development, regulating inflammatory responses and ultimately contributing to pregnancy success. In this review, we summarized current knowledge on spontaneous fetal loss in swine, with special attention to the mechanisms in immune reactivity and interplay at the maternal-fetal interface.

  19. The Role of Placental Nutrient Sensing in Maternal-Fetal Resource Allocation1

    OpenAIRE

    Díaz, Paula; Powell, Theresa L; Jansson, Thomas

    2014-01-01

    The placenta mediates maternal-fetal exchange and has historically been regarded as a passive conduit for nutrients. However, emerging evidence suggests that the placenta actively responds to nutritional and metabolic signals from the mother and the fetus. We propose that the placenta integrates a multitude of maternal and fetal nutritional cues with information from intrinsic nutrient-sensing signaling pathways to match fetal demand with maternal supply by regulating maternal physiology, pla...

  20. The effects of music listening on psychosocial stress and maternal-fetal attachment during pregnancy.

    Science.gov (United States)

    Chang, Hsing-Chi; Yu, Chen-Hsiang; Chen, Shu-Yueh; Chen, Chung-Hey

    2015-08-01

    While music listening has been studied as an intervention to help reduce anxiety in pregnant women, few studies have explored the effect of music listening on pregnancy-specific stress relief. This study examines the effects of music listening on psychosocial stress and maternal-fetal attachment during pregnancy. A randomized controlled trial was implemented. A valid sample of 296 pregnant women in their second or third trimester was randomly distributed into an experimental group (n=145) and a control group (n=151). The experimental group received routine prenatal care and music listening. The control group received routine prenatal care only. Data were collected using a demographic form, Pregnancy Stress Rating Scale (PSRS), Perceived Stress Scale (PSS), and Maternal-Fetal Attachment Scale (MFAS). The post-test results identified a significantly lower level of psychosocial stress in the experimental group than in the control group, particularly in terms of the stresses related to baby care and changing family relationships and to maternal role identification. However, no statistically significant differences in terms of perceived stress and maternal-fetal attachment were found between the post-test results of the two groups. This study provides evidence in support of using of music in interventions designed to relieve psychosocial stress in prenatal women. IRB approval number: ER98223. Copyright © 2015 Elsevier Ltd. All rights reserved.

  1. Placental adaptations to the maternal-fetal environment: implications for fetal growth and developmental programming.

    Science.gov (United States)

    Sandovici, Ionel; Hoelle, Katharina; Angiolini, Emily; Constância, Miguel

    2012-07-01

    The placenta is a transient organ found in eutherian mammals that evolved primarily to provide nutrients for the developing fetus. The placenta exchanges a wide array of nutrients, endocrine signals, cytokines and growth factors with the mother and the fetus, thereby regulating intrauterine development. Recent studies show that the placenta is not just a passive organ mediating maternal-fetal exchange. It can adapt its capacity to supply nutrients in response to intrinsic and extrinsic variations in the maternal-fetal environment. These dynamic adaptations are thought to occur to maximize fetal growth and viability at birth in the prevailing conditions in utero. However, some of these adaptations may also affect the development of individual fetal tissues, with patho-physiological consequences long after birth. Here, this review summarizes current knowledge on the causes, possible mechanisms and consequences of placental adaptive responses, with a focus on the regulation of transporter-mediated processes for nutrients. This review also highlights the emerging roles that imprinted genes and epigenetic mechanisms of gene regulation may play in placental adaptations to the maternal-fetal environment. Copyright © 2012 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

  2. Clinical Service of Chinese Medicine

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    @@ The clinical practice of traditional Chinese medicine (TCM) faces three major challenges:(1)How to enhance its contribution on overall medical service quality? (2) How to best address the unmet medical needs in the contemporary society? (3)How to guarantee that the traditional perspective for disease diagnosis and treatment not be neglected in clinical practice?

  3. [Scientific concepts in clinical medicine].

    Science.gov (United States)

    Rogler, G

    2003-11-28

    The understanding of the scientific basis and the theory of knowledge are surprisingly heterogeneous in practical and clinical medicine. It is frequently influenced or based on the philosophical theory of critical rationalism founded by Sir Karl Popper. Because the theory of knowledge and the understanding of scientific truth is the central basis for cautious and good clinical practise it is necessary to discuss both points to avoid unscientific auto-immunisation against critique in a type of medicine that regards herself as science-based. Evidence-based medicine would not be possible without interpretation and explanation of existing data into the individual treatment context. Besides an inductive or deductive logic the historical and situative side-conditions of the gathering of knowledge and of experiments are of central importance for their interpretation and their relevance in clinical practice. This historical and situative context warrants reflection but must also be paid attention to in the reflections on medical ethics.

  4. Onset of human preterm and term birth is related to unique inflammatory transcriptome profiles at the maternal fetal interface.

    Science.gov (United States)

    Bukowski, Radek; Sadovsky, Yoel; Goodarzi, Hani; Zhang, Heping; Biggio, Joseph R; Varner, Michael; Parry, Samuel; Xiao, Feifei; Esplin, Sean M; Andrews, William; Saade, George R; Ilekis, John V; Reddy, Uma M; Baldwin, Donald A

    2017-01-01

    Preterm birth is a main determinant of neonatal mortality and morbidity and a major contributor to the overall mortality and burden of disease. However, research of the preterm birth is hindered by the imprecise definition of the clinical phenotype and complexity of the molecular phenotype due to multiple pregnancy tissue types and molecular processes that may contribute to the preterm birth. Here we comprehensively evaluate the mRNA transcriptome that characterizes preterm and term labor in tissues comprising the pregnancy using precisely phenotyped samples. The four complementary phenotypes together provide comprehensive insight into preterm and term parturition. Samples of maternal blood, chorion, amnion, placenta, decidua, fetal blood, and myometrium from the uterine fundus and lower segment (n = 183) were obtained during cesarean delivery from women with four complementary phenotypes: delivering preterm with (PL) and without labor (PNL), term with (TL) and without labor (TNL). Enrolled were 35 pregnant women with four precisely and prospectively defined phenotypes: PL (n = 8), PNL (n = 10), TL (n = 7) and TNL (n = 10). Gene expression data were analyzed using shrunken centroid analysis to identify a minimal set of genes that uniquely characterizes each of the four phenotypes. Expression profiles of 73 genes and non-coding RNA sequences uniquely identified each of the four phenotypes. The shrunken centroid analysis and 10 times 10-fold cross-validation was also used to minimize false positive finings and overfitting. Identified were the pathways and molecular processes associated with and the cis-regulatory elements in gene's 5' promoter or 3'-UTR regions of the set of genes which expression uniquely characterized the four phenotypes. The largest differences in gene expression among the four groups occurred at maternal fetal interface in decidua, chorion and amnion. The gene expression profiles showed suppression of chemokines expression in TNL

  5. Onset of human preterm and term birth is related to unique inflammatory transcriptome profiles at the maternal fetal interface

    Directory of Open Access Journals (Sweden)

    Radek Bukowski

    2017-09-01

    Full Text Available Background Preterm birth is a main determinant of neonatal mortality and morbidity and a major contributor to the overall mortality and burden of disease. However, research of the preterm birth is hindered by the imprecise definition of the clinical phenotype and complexity of the molecular phenotype due to multiple pregnancy tissue types and molecular processes that may contribute to the preterm birth. Here we comprehensively evaluate the mRNA transcriptome that characterizes preterm and term labor in tissues comprising the pregnancy using precisely phenotyped samples. The four complementary phenotypes together provide comprehensive insight into preterm and term parturition. Methods Samples of maternal blood, chorion, amnion, placenta, decidua, fetal blood, and myometrium from the uterine fundus and lower segment (n = 183 were obtained during cesarean delivery from women with four complementary phenotypes: delivering preterm with (PL and without labor (PNL, term with (TL and without labor (TNL. Enrolled were 35 pregnant women with four precisely and prospectively defined phenotypes: PL (n = 8, PNL (n = 10, TL (n = 7 and TNL (n = 10. Gene expression data were analyzed using shrunken centroid analysis to identify a minimal set of genes that uniquely characterizes each of the four phenotypes. Expression profiles of 73 genes and non-coding RNA sequences uniquely identified each of the four phenotypes. The shrunken centroid analysis and 10 times 10-fold cross-validation was also used to minimize false positive finings and overfitting. Identified were the pathways and molecular processes associated with and the cis-regulatory elements in gene’s 5′ promoter or 3′-UTR regions of the set of genes which expression uniquely characterized the four phenotypes. Results The largest differences in gene expression among the four groups occurred at maternal fetal interface in decidua, chorion and amnion. The gene expression profiles showed

  6. Maternal-fetal transmission of Trypanosoma cruzi, a health problem slightly studied in Mexico: case Chiapas

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    Guillermina Campos-Valdez

    2016-05-01

    Full Text Available Objective. To determine the Trypanosoma cruzi infection prevalence in 1125 pregnant women and the transmission frequency to their children from Tapachula and Palenque, Chiapas. Materials and methods. We determined the prevalence by serology tests and the transmission frequency by polymerase chain reaction (PCR and T. cruzi reactivity capacity after 12 months. Results. Total maternal infection prevalence were 23/1 125 (2.04%, 9/600 (1.5% were from Tapachula and 14/525 (2.6% from Palenque. The seropositive women were between 20 and 35 years old, 31.8% have Premature Rapture of Membrane and 9.1% have history of perinatal death. The total percentage of positive newborns by PCR was 9/23 (39.13%, out of those 2/9 (22.2% are from Tapachula and 7/14 (50% from Palenque. The Maternal Fetal transmission frequency was. 2/9 (22.2% in Tapachula and 1/14 (7.14% in Palenque, all positive infants were asynthomatic. Conclusion. The maternal-fetal transmission rate in Chiapas State is variable; the reason could be the maternal immunological status and T. cruzi strain.

  7. [Maternal-fetal transmission of Trypanosoma cruzi, a health problem slightly studied in Mexico: case Chiapas].

    Science.gov (United States)

    Campos-Valdez, Guillermina; Canseco-Ávila, Luis Miguel; González-Noriega, Fernando; Alfaro-Zebadua, Oscar; Nava-Medecigo, Ismael Yadird; Jiménez-Cardoso, Enedina

    2016-06-01

    To determine the Trypanosoma cruzi infection prevalence in 1125 pregnant women and the transmission frequency to their children from Tapachula and Palenque, Chiapas. We determined the prevalence by serology tests and the transmission frequency by polymerase chain reaction (PCR) and T. cruzi reactivity capacity after 12 months. Total maternal infection prevalence were 23/1 125 (2.04%), 9/600 (1.5%) were from Tapachula and 14/525 (2.6%) from Palenque. The seropositive women were between 20 and 35 years old, 31.8% have Premature Rapture of Membrane and 9.1% have history of perinatal death. The total percentage of positive newborns by PCR was 9/23 (39.13%), out of those 2/9 (22.2%) are from Tapachula and 7/14 (50%) from Palenque. The Maternal Fetal transmission frequency was. 2/9 (22.2%) in Tapachula and 1/14 (7.14%) in Palenque, all positive infants were asynthomatic. The maternal-fetal transmission rate in Chiapas State is variable; the reason could be the maternal immunological status and T. cruzi strain.

  8. Improvements in fetal heart rate analysis by the removal of maternal-fetal heart rate ambiguities.

    Science.gov (United States)

    Pinto, Paula; Costa-Santos, Cristina; Gonçalves, Hernâni; Ayres-De-Campos, Diogo; Bernardes, João

    2015-11-19

    Misinterpretation of the maternal heart rate (MHR) as fetal may lead to significant errors in fetal heart rate (FHR) interpretation. In this study we hypothesized that the removal of these MHR-FHR ambiguities would improve FHR analysis during the final hour of labor. Sixty-one MHR and FHR recordings were simultaneously acquired in the final hour of labor. Removal of MHR-FHR ambiguities was performed by subtracting MHR signals from their FHR counterparts when the absolute difference between the two was less or equal to 5 beats per minute. Major MHR-FHR ambiguities were defined when they exceeded 1% of the tracing. Maternal, fetal and neonatal characteristics were evaluated in cases where major MHR-FHR ambiguities occurred and computer analysis of FHR recordings was compared, before and after removal of the ambiguities. Seventy-two percent of tracings (44/61) exhibited episodes of major MHR-FHR ambiguities, which were not significantly associated with any maternal, fetal or neonatal characteristics, but were associated with MHR accelerations, FHR signal loss and decelerations. Removal of MHR-FHR ambiguities resulted in a significant decrease in FHR decelerations, and improvement in FHR tracing classification. FHR interpretation during the final hour of labor can be significantly improved by the removal of MHR-FHR ambiguities.

  9. The role of placental nutrient sensing in maternal-fetal resource allocation.

    Science.gov (United States)

    Díaz, Paula; Powell, Theresa L; Jansson, Thomas

    2014-10-01

    The placenta mediates maternal-fetal exchange and has historically been regarded as a passive conduit for nutrients. However, emerging evidence suggests that the placenta actively responds to nutritional and metabolic signals from the mother and the fetus. We propose that the placenta integrates a multitude of maternal and fetal nutritional cues with information from intrinsic nutrient-sensing signaling pathways to match fetal demand with maternal supply by regulating maternal physiology, placental growth, and nutrient transport. This process, which we have called placental nutrient sensing, ensures optimal allocation of resources between the mother and the fetus to maximize the chances for propagation of parental genes without jeopardizing maternal health. We suggest that these mechanisms have evolved because of the evolutionary pressures of maternal undernutrition, which result in decreased placental growth and down-regulation of nutrient transporters, thereby limiting fetal growth to ensure maternal survival. These regulatory loops may also function in response to maternal overnutrition, leading to increased placental growth and nutrient transport in cases of maternal obesity or gestational diabetes. Thus, placental nutrient sensing modulates maternal-fetal resource allocation to increase the likelihood of reproductive success. This model implies that the placenta plays a critical role in mediating fetal programming and determining lifelong health.

  10. The Role of Placental Nutrient Sensing in Maternal-Fetal Resource Allocation1

    Science.gov (United States)

    Díaz, Paula; Powell, Theresa L.; Jansson, Thomas

    2014-01-01

    ABSTRACT The placenta mediates maternal-fetal exchange and has historically been regarded as a passive conduit for nutrients. However, emerging evidence suggests that the placenta actively responds to nutritional and metabolic signals from the mother and the fetus. We propose that the placenta integrates a multitude of maternal and fetal nutritional cues with information from intrinsic nutrient-sensing signaling pathways to match fetal demand with maternal supply by regulating maternal physiology, placental growth, and nutrient transport. This process, which we have called placental nutrient sensing, ensures optimal allocation of resources between the mother and the fetus to maximize the chances for propagation of parental genes without jeopardizing maternal health. We suggest that these mechanisms have evolved because of the evolutionary pressures of maternal undernutrition, which result in decreased placental growth and down-regulation of nutrient transporters, thereby limiting fetal growth to ensure maternal survival. These regulatory loops may also function in response to maternal overnutrition, leading to increased placental growth and nutrient transport in cases of maternal obesity or gestational diabetes. Thus, placental nutrient sensing modulates maternal-fetal resource allocation to increase the likelihood of reproductive success. This model implies that the placenta plays a critical role in mediating fetal programming and determining lifelong health. PMID:25122064

  11. [Contemporary clinical medicine--assurances and uncertainties].

    Science.gov (United States)

    Pacovský, V

    2009-01-01

    Selected topics in the contemporary clinical medicine are reflected. The main fields of interest and characteristic features unifying theory and praxis are outlined; specificities of clinical thinking and decision making, and conception of clinical medicine as a scientific discipline are presented. Author deals with assurances, various forms of irresolution in clinical medicine and with problems resulting from the scientific progress.

  12. Clinical trials and gender medicine

    Directory of Open Access Journals (Sweden)

    Mariarita Cassese

    2011-01-01

    Full Text Available Women use more medicines than men because they fall ill more often and suffer more from chronic diseases, but also because women pay more attention to their health and have more consciousness and care about themselves. Although medicines can have different effects on women and men, women still represent a small percentage in the first phases of trials (22% which are essential to verify drugs dosage, side effects, and safety. Even though women are more present in trials, studies results are not presented with a gender approach. This situation is due to educational, social, ethical and economical factors. The scientific research must increase feminine presence in clinical trials in order to be equal and correct, and all the key stakeholder should be involved in this process. We still have a long way to cover and it doesn't concern only women but also children and old people. The aim is to have a medicine not only illness-focused but patient-focused: a medicine able to take into consideration all the patient characteristics and so to produce a really personalized therapy. What above described is part of the reasons why in 2005 was founded the National Observatory for Women's Health (Osservatorio Nazionale sulla Salute della Donna, ONDa which promotes a gender health awareness and culture in Italy, at all the levels of the civil and scientific society.

  13. The Relationship of Maternal Age, Quickening, and Physical Symptoms of Pregnancy on the Development of Maternal-Fetal Attachment

    Science.gov (United States)

    1988-01-01

    submit to coitus from a sense of duty to the male. Zemlick and Watson (1974) studied 15 white, married, primiparous patients and found that mothers who...studied 100 primiparous women and used Cranley’s Maternal-Fetal Attachment Scale (MFA) to test three hypotheses: 1. There is a negative relationship

  14. Maternal fetal transmission of Trypanosoma cruzi: a problem of public health little studied in Mexico.

    Science.gov (United States)

    Cardoso, Enedina Jiménez; Valdéz, Guillermina Campos; Campos, Adrián Cortes; de la Luz Sanchez, Rene; Mendoza, Carlos Rivera; Hernández, Arturo Plascencia; Ramírez, María Hernández; Habana, Joel Ruiz; González, Edmundo Bonilla; Matzumura, Pablo Damian; Carlier, Yves

    2012-08-01

    The first case of neonatal Chagas was reported in Mexico in 1998, but there have been no studies since then. Therefore, we investigated the rates of congenital infection of Trypanosoma cruzi by examining the seroprevalence among 1448 pregnant women in Oaxaca, Jalisco and Mexico City. We performed ELISAs to screen for recombinant and total antigens in mothers, and examined the frequency of congenital T. cruzi transmission by PCR with cord blood and antibody testing in children when they reached two years old. Our results showed that the prevalence of infection in pregnant women was 7.32% (106/1448) overall, and 4.4% (35/794) in Oaxaca, 12.02% (67/557) in Jalisco and 4.12% (4/97) in the Mexico City. In Oaxaca, T. cruzi infection was detected by PCR in 20% (7/35) of infants born to seroreactive mothers and 11.9% (8/67) in Jalisco. No infections were identified in infants from the Mexico City. From these only eleven serological follow up their children are agree to take blood. Therefore, the maternal-fetal overall transmission rate was 4.08% (4/98) in Oaxaca and 9.1% (3/33) in Jalisco 1.5% (1/65) children with positive serology were given specific treatment Chagas. In conclusion, these are the first reports of the rates of congenital Chagas disease in Mexico. The seroprevalence was higher in mothers from Jalisco, and could be related to that there is not the periodic fumigation of the transmitting vector performed in that state. The high rates of maternal-fetal transmission found in Oaxaca could be related to the differences of pathogenicity of trypanosome. No association between both the rate of congenital transmission and the gynecologic anthropometric data was observed.

  15. A prospective study of maternal, fetal and neonatal deaths in low- and middle-income countries

    Science.gov (United States)

    Saleem, Sarah; Goudar, Shivaprasad S; Patel, Archana; Esamai, Fabian; Garces, Ana; Chomba, Elwyn; Althabe, Fernando; Moore, Janet; Kodkany, Bhalachandra; Pasha, Omrana; Belizan, Jose; Mayansyan, Albert; Derman, Richard J; Hibberd, Patricia L; Liechty, Edward A; Krebs, Nancy F; Hambidge, K Michael; Buekens, Pierre; Carlo, Waldemar A; Wright, Linda L; Koso-Thomas, Marion; Jobe, Alan H; Goldenberg, Robert L

    2014-01-01

    Abstract Objective To quantify maternal, fetal and neonatal mortality in low- and middle-income countries, to identify when deaths occur and to identify relationships between maternal deaths and stillbirths and neonatal deaths. Methods A prospective study of pregnancy outcomes was performed in 106 communities at seven sites in Argentina, Guatemala, India, Kenya, Pakistan and Zambia. Pregnant women were enrolled and followed until six weeks postpartum. Findings Between 2010 and 2012, 214 070 of 220 235 enrolled women (97.2%) completed follow-up. The maternal mortality ratio was 168 per 100 000 live births, ranging from 69 per 100 000 in Argentina to 316 per 100 000 in Pakistan. Overall, 29% (98/336) of maternal deaths occurred around the time of delivery: most were attributed to haemorrhage (86/336), pre-eclampsia or eclampsia (55/336) or sepsis (39/336). Around 70% (4349/6213) of stillbirths were probably intrapartum; 34% (1804/5230) of neonates died on the day of delivery and 14% (755/5230) died the day after. Stillbirths were more common in women who died than in those alive six weeks postpartum (risk ratio, RR: 9.48; 95% confidence interval, CI: 7.97–11.27), as were perinatal deaths (RR: 4.30; 95% CI: 3.26–5.67) and 7-day (RR: 3.94; 95% CI: 2.74–5.65) and 28-day neonatal deaths (RR: 7.36; 95% CI: 5.54–9.77). Conclusion Most maternal, fetal and neonatal deaths occurred at or around delivery and were attributed to preventable causes. Maternal death increased the risk of perinatal and neonatal death. Improving obstetric and neonatal care around the time of birth offers the greatest chance of reducing mortality. PMID:25177075

  16. Clinical Holistic Medicine: Holistic Adolescent Medicine

    Directory of Open Access Journals (Sweden)

    Søren Ventegodt

    2004-01-01

    Full Text Available The holistic medical approach seems to be efficient and can also be used in adolescent medicine. Supporting the teenager to grow and develop is extremely important in order to prevent many of the problems they can carry into adulthood. The simple consciousness-based, holistic medicine — giving love, winning trust, giving holding, and getting permission to help the patient feel, understand, and let go of negative beliefs — is easy for the physician interested in this kind of practice and it requires little previous training for the physician to be able to care for his/her patient. A deeper insight into the principles of holistic treatment and a thorough understanding of our fellow human beings are making it work even better. Holistic medicine is not a miracle cure, but rather a means by which the empathic physician can support the patient in improving his/her future life in respect to quality of life, health, and functional capacity — through coaching the patient to work on him/herself in a hard and disciplined manner. When the patient is young, this work is so much easier. During our lifetime, we have several emotional traumas arranged in the subconscious mind with the smallest at the top, and it is normal for the person to work on a large number of traumatic events that have been processed to varying degrees. Some traumas have been acknowledged, some are still being explored by the person, and yet others are still preconscious, which can be seen for example in the form of muscle tension. Sometimes the young dysfunctional patient carries severe traumas of a violent or sexual nature, but the physician skilled in the holistic medical toolbox can help the patient on his/her way to an excellent quality of life, full self-expression, a love and sex life, and a realization of his/her talents — all that a young patient is typically dreaming about. Biomedicine is not necessary or even recommended when the physical or mental symptoms are caused

  17. [Initial antibiotic therapy in maternal-fetal infections which include ampicillin even in countries where listeriosis is an incidental disease].

    Science.gov (United States)

    Boukadida, J; Taher, N Bel Hadj; Seket, B; Monastiri, K; Salem, N; Snoussi, N

    2002-06-01

    Neonatal listeriosis is an exceptional disease in Northern Africa. Hence, protocols for maternal-fetal infection treatment include only a third generation cephalosporin and an aminoside. This protocol does not take into account the possibility of Listeria monocytogenes infection. We report a fatal case of neonatal listeriosis in Tunisia. The use of first antibiotics in maternal-foetal infection must be reconsidered when lacking sufficient bacteriological data and include systematically ampicillin in presumptive antibiotic protocols.

  18. Graduate Program Organization in Clinical Veterinary Medicine.

    Science.gov (United States)

    Horne, R. D.

    1979-01-01

    Graduate training in clinical veterinary medicine is discussed. The options available to the student and problems that must be dealt with are presented, along with the requirements to accomplish a finely structured program that satisfies the needs of both the trainee and clinical veterinary medicine. (Author/MLW)

  19. Maternal-Fetal Cancer Risk Assessment of Ochratoxin A during Pregnancy

    Directory of Open Access Journals (Sweden)

    Chit Shing Jackson Woo

    2016-03-01

    Full Text Available Increasing evidence has demonstrated that in utero exposure to environmental chemicals may interfere with fetal development and increase the risk of disease and cancer development later in life. Ochratoxin A (OTA has been proven to induce diverse toxic effects including teratogenicity, carcinogenicity, immunotoxicity and potential endocrine disruption. Due to the continuous and widespread occurrence of OTA as a potential contaminant of staple foods, there is increasing concern of in utero exposure of fetus to this mycotoxin. In this study, maternal-fetal risk assessment of OTA during pregnancy was conducted using the benchmark dose approach for genotoxic carcinogens. The daily intake of OTA for Egyptian pregnant women was estimated based on their serum OTA level using the refined Klaassen equation for pregnancy. Fetal exposure level was also estimated based on the maternal data. Comparison between the estimated daily exposure and the negligible cancer risk intake (NCRI, and the calculation of margin of exposure (MOE implicated that OTA exposure from dietary intake would be of low health concern for this general subpopulation of Egyptian women. This subpopulation of pregnant women was generally estimated not to be in high-risk for toxicity induced by OTA.

  20. Maternal-fetal unit interactions and eutherian neocortical development and evolution

    Directory of Open Access Journals (Sweden)

    Juan F Montiel

    2013-07-01

    Full Text Available The conserved brain design that primates inherited from early mammals differs from the variable adult brain size and species-specific brain dominances observed across mammals. This variability relies on the emergence of specialized cerebral cortical regions and sub-compartments, triggering an increase in brain size, areal interconnectivity and histological complexity that ultimately lies on the activation of developmental programs. Structural placental features are not well correlated with brain enlargement; however, several endocrine pathways could be tuned with the activation of neuronal progenitors in the proliferative neocortical compartments. In this article, we reviewed some mechanisms of eutherians maternal-fetal unit interactions associated with brain development and evolution. We propose a hypothesis of brain evolution where proliferative compartments in primates become activated by 'non-classical' endocrine placental signals participating in different steps of corticogenesis. Changes in the inner placental structure, along with placenta endocrine stimuli over the cortical proliferative activity would allow mammalian brain enlargement with a concomitant shorter gestation span, as an evolutionary strategy to escape from parent-offspring conflict.

  1. Maternal-Fetal Cancer Risk Assessment of Ochratoxin A during Pregnancy.

    Science.gov (United States)

    Woo, Chit Shing Jackson; El-Nezami, Hani

    2016-03-23

    Increasing evidence has demonstrated that in utero exposure to environmental chemicals may interfere with fetal development and increase the risk of disease and cancer development later in life. Ochratoxin A (OTA) has been proven to induce diverse toxic effects including teratogenicity, carcinogenicity, immunotoxicity and potential endocrine disruption. Due to the continuous and widespread occurrence of OTA as a potential contaminant of staple foods, there is increasing concern of in utero exposure of fetus to this mycotoxin. In this study, maternal-fetal risk assessment of OTA during pregnancy was conducted using the benchmark dose approach for genotoxic carcinogens. The daily intake of OTA for Egyptian pregnant women was estimated based on their serum OTA level using the refined Klaassen equation for pregnancy. Fetal exposure level was also estimated based on the maternal data. Comparison between the estimated daily exposure and the negligible cancer risk intake (NCRI), and the calculation of margin of exposure (MOE) implicated that OTA exposure from dietary intake would be of low health concern for this general subpopulation of Egyptian women. This subpopulation of pregnant women was generally estimated not to be in high-risk for toxicity induced by OTA.

  2. Maternal-Fetal Cancer Risk Assessment of Ochratoxin A during Pregnancy

    Science.gov (United States)

    Woo, Chit Shing Jackson; El-Nezami, Hani

    2016-01-01

    Increasing evidence has demonstrated that in utero exposure to environmental chemicals may interfere with fetal development and increase the risk of disease and cancer development later in life. Ochratoxin A (OTA) has been proven to induce diverse toxic effects including teratogenicity, carcinogenicity, immunotoxicity and potential endocrine disruption. Due to the continuous and widespread occurrence of OTA as a potential contaminant of staple foods, there is increasing concern of in utero exposure of fetus to this mycotoxin. In this study, maternal-fetal risk assessment of OTA during pregnancy was conducted using the benchmark dose approach for genotoxic carcinogens. The daily intake of OTA for Egyptian pregnant women was estimated based on their serum OTA level using the refined Klaassen equation for pregnancy. Fetal exposure level was also estimated based on the maternal data. Comparison between the estimated daily exposure and the negligible cancer risk intake (NCRI), and the calculation of margin of exposure (MOE) implicated that OTA exposure from dietary intake would be of low health concern for this general subpopulation of Egyptian women. This subpopulation of pregnant women was generally estimated not to be in high-risk for toxicity induced by OTA. PMID:27023600

  3. Maternal, fetal and renal outcomes of pregnancy-associated acute kidney injury requiring dialysis.

    Science.gov (United States)

    Krishna, A; Singh, R; Prasad, N; Gupta, A; Bhadauria, D; Kaul, A; Sharma, R K; Kapoor, D

    2015-01-01

    Pregnancy-associated acute kidney injury (PAKI) is encountered frequently in developing countries. We evaluated the maternal, fetal and renal outcomes in women with PAKI who needed at least one session of dialysis. Of the total of 98 cases (mean age 28.85 ± 5.13 years; mean parity 2.65 ± 1.28) of PAKI, the most common cause of PAKI was postabortal sepsis. Eighteen patients died; those with oligoanuria, sepsis and central nervous system (CNS) involvement were at greater risk of mortality. The relative risk (RR) of neonatal mortality was lower after with full-term delivery (RR: 0.17, 95% confidence interval (CI): 0.03-0.96, P = 0.02) compared to preterm delivery. Of the 80 surviving patients, 60 (75%) patients achieved complete recovery of renal function at the end of 3 months; and of the remaining 14 had presumed (n = 4) or, biopsy-proven (n = 10) acute patchy cortical necrosis. The RR of non-recovery of renal function was high (RR: 24.7, 95% CI: 3.4- 179.5) in patients who did not recover at 6 weeks. Of the 14 patients with cortical necrosis, 3 (21.42%) became independent of dialysis at 6 months. PAKI patients should be watched for dialysis independency for 6 months.

  4. Effect of Morus nigra aqueous extract treatment on the maternal-fetal outcome, oxidative stress status and lipid profile of streptozotocin-induced diabetic rats.

    Science.gov (United States)

    Volpato, G T; Calderon, I M P; Sinzato, S; Campos, K E; Rudge, M V C; Damasceno, D C

    2011-12-08

    Morus nigra, commonly known as black mulberry, is widely used in Brazilian folk medicine for the diabetes treatment. To evaluate the effect of Morus nigra aqueous extract treatment on maternal lipid and oxidative stress profile, reproductive outcomes, and also fetal anomaly incidence from diabetic and non-diabetic rats. Diabetes was induced by streptozotocin (40 mg/kg) in virgin female Wistar rats. Morus nigra leaf aqueous extract (400 mg/kg) was administered from day 0 to 20 of pregnancy. At day 21 of pregnancy, all rats were anesthetized and killed to obtain blood samples and maternal-fetal data. After treatment with Morus nigra extract, non-diabetic and diabetic rats presented no glycemic changes. Fetuses from diabetic dams, regardless of Morus nigra treatment, were small for pregnancy age. In diabetic dams, plant treatment caused reduced MDA, cholesterol, triglycerides and VLDL levels, and decreased placental index and weight as compared to diabetic group. The fetuses from diabetic rats treated with Morus nigra extract had lower frequency of skeletal and visceral anomalies as compared to diabetic group. Thus, Morus nigra leaf aqueous extract failed to control hyperglycemia in diabetic rats. However, Morus nigra treatment had antioxidant effect, contributing to reduce incidence of internal anomalies in offspring from diabetic dams. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  5. [Design of a Curriculum Clinical Social Medicine].

    Science.gov (United States)

    Gostomzyk, J G; Simoes, E; Mittelstaedt, G V

    2015-09-01

    The economic transformation of health care systems, which is supported by both the economic and the political sector, is in demand of constant humane correction. Legal regulations of social systems securing health corresponding to the code of social law are guard rails for a responsible use of limited resources and are subject to constant development. All doctors caring for patients should be in a position to reflect the real life context of their patients as both causal and modifying influence for health and disease from a social medical perspective, apart from their specific medical field of expertise.Accordingly 3 parts of sub-specialization training are suggested: clinical tasks of social medicine as detailed in the code of social law, clinical social medicine in health care according to the 5(th) book of the code of social law and social medicine in clinical social medicine/participation. Higher level-of-care hospitals, as well as rehabilitation clinics, should offer sub-specialization in social medicine without interruption of employment contracts. Corresponding criteria for the regulation on further education should be formulated by the German Society of Social Medicine and Prevention (DGSMP) as the competent scientific association and presented to the committee on further education of the Federal Medical Association. This aims at strengthening social medicine in clinical care.

  6. Nuclear medicine therapy principles and clinical applications

    CERN Document Server

    Aktolun, Cumali

    2012-01-01

    This book reviews nuclear medicine techniques and technology for therapy of malignant and benign diseases, covering scientific principles and clinical applications, and trials of experimental agents for treating tumors involving virtually every organ system.

  7. Evidence Based Studies in Clinical Transfusion Medicine

    NARCIS (Netherlands)

    A.J.G. Jansen (Gerard)

    2007-01-01

    textabstractAfter the introduction of blood component therapy in the 1960s, more and more attention is given to clinical transfusion medicine. Although blood transfusion is an important treatment in different clinical settings, there are still lack of much randomized clinical trials. Nowadays bloo

  8. Evidence Based Studies in Clinical Transfusion Medicine

    NARCIS (Netherlands)

    A.J.G. Jansen (Gerard)

    2007-01-01

    textabstractAfter the introduction of blood component therapy in the 1960s, more and more attention is given to clinical transfusion medicine. Although blood transfusion is an important treatment in different clinical settings, there are still lack of much randomized clinical trials. Nowadays

  9. Analysis of modern literature of maternal-fetal blood group incompatibility%母儿血型不合文献的用药情况分析

    Institute of Scientific and Technical Information of China (English)

    薛辉; 于爱敏; 宋芝华; 于滨

    2011-01-01

    Objective By selecting the prescriptions of treating blood group incompatibility in modern literature, and exploring their regularity, to establish the overall thought of traditional Chinese medicine in treatment.Methods 90 articles on maternal-fetal blood group incompatibility were found.Statistical methods were adopted to summarize high frequently used medicines and formula. Results High frequently used medicines were Virgate Wormwood Herb, Baical Skullcap Root, Rhubarb, Cape Jasmine Fruit, White peony Alba, Chinese Angelica,Largehead Atractylodes Rhizome,Motherwort Herb,and Milkvetch Root, which were mentioned for 238 times in the literatures, occupying 72.79% of the total frequency. Conclusion Based on this result,heat-clearing and dampness-removing, activating blood circulation to eliminate blood stasis was setup as the principle for treating this disease.%目的 选取现代文献中治疗血型不合的方剂,分析、探寻现代医者治疗母儿血型不合的用药规律,以便从整体上确立中医药治疗血型不合的基本思路.方法 检索到有关母儿血型不合的有效文献90篇,利用统计学方法,总结治疗该病的高频药物及基本方剂.结果 高频药物为茵陈、黄芩、大黄、栀子、白芍、当归、白术、益母草、川断、黄芪,出现频次为238味次,占所有药物总频次的72.79%.结论 根据出现高频次药物分析,清热利湿、活血化瘀为该病的治疗大法.

  10. Propofol Pharmacokinetics and Estimation of Fetal Propofol Exposure during Mid-Gestational Fetal Surgery: A Maternal-Fetal Sheep Model

    Science.gov (United States)

    Niu, Jing; Venkatasubramanian, Raja; Vinks, Alexander A.; Sadhasivam, Senthilkumar

    2016-01-01

    Background Measuring fetal drug concentrations is extremely difficult in humans. We conducted a study in pregnant sheep to simultaneously describe maternal and fetal concentrations of propofol, a common intravenous anesthetic agent used in humans. Compared to inhalational anesthesia, propofol supplemented anesthesia lowered the dose of desflurane required to provide adequate uterine relaxation during open fetal surgery. This resulted in better intraoperative fetal cardiac outcome. This study describes maternal and fetal propofol pharmacokinetics (PK) using a chronically instrumented maternal-fetal sheep model. Methods Fetal and maternal blood samples were simultaneously collected from eight mid-gestational pregnant ewes during general anesthesia with propofol, remifentanil and desflurane. Nonlinear mixed-effects modeling was performed by using NONMEM software. Total body weight, gestational age and hemodynamic parameters were tested in the covariate analysis. The final model was validated by bootstrapping and visual predictive check. Results A total of 160 propofol samples were collected. A 2-compartment maternal PK model with a third fetal compartment appropriately described the data. Mean population parameter estimates for maternal propofol clearance and central volume of distribution were 4.17 L/min and 37.7 L, respectively, in a typical ewe with a median heart rate of 135 beats/min. Increase in maternal heart rate significantly correlated with increase in propofol clearance. The estimated population maternal-fetal inter-compartment clearance was 0.0138 L/min and the volume of distribution of propofol in the fetus was 0.144 L. Fetal propofol clearance was found to be almost negligible compared to maternal clearance and could not be robustly estimated. Conclusions For the first time, a maternal-fetal PK model of propofol in pregnant ewes was successfully developed. This study narrows the gap in our knowledge in maternal-fetal PK model in human. Our study confirms

  11. Propofol Pharmacokinetics and Estimation of Fetal Propofol Exposure during Mid-Gestational Fetal Surgery: A Maternal-Fetal Sheep Model.

    Directory of Open Access Journals (Sweden)

    Pornswan Ngamprasertwong

    Full Text Available Measuring fetal drug concentrations is extremely difficult in humans. We conducted a study in pregnant sheep to simultaneously describe maternal and fetal concentrations of propofol, a common intravenous anesthetic agent used in humans. Compared to inhalational anesthesia, propofol supplemented anesthesia lowered the dose of desflurane required to provide adequate uterine relaxation during open fetal surgery. This resulted in better intraoperative fetal cardiac outcome. This study describes maternal and fetal propofol pharmacokinetics (PK using a chronically instrumented maternal-fetal sheep model.Fetal and maternal blood samples were simultaneously collected from eight mid-gestational pregnant ewes during general anesthesia with propofol, remifentanil and desflurane. Nonlinear mixed-effects modeling was performed by using NONMEM software. Total body weight, gestational age and hemodynamic parameters were tested in the covariate analysis. The final model was validated by bootstrapping and visual predictive check.A total of 160 propofol samples were collected. A 2-compartment maternal PK model with a third fetal compartment appropriately described the data. Mean population parameter estimates for maternal propofol clearance and central volume of distribution were 4.17 L/min and 37.7 L, respectively, in a typical ewe with a median heart rate of 135 beats/min. Increase in maternal heart rate significantly correlated with increase in propofol clearance. The estimated population maternal-fetal inter-compartment clearance was 0.0138 L/min and the volume of distribution of propofol in the fetus was 0.144 L. Fetal propofol clearance was found to be almost negligible compared to maternal clearance and could not be robustly estimated.For the first time, a maternal-fetal PK model of propofol in pregnant ewes was successfully developed. This study narrows the gap in our knowledge in maternal-fetal PK model in human. Our study confirms that maternal heart

  12. [Clinical trials with advanced therapy medicinal products].

    Science.gov (United States)

    Schüssler-Lenz, M; Schneider, C K

    2010-01-01

    For advanced therapies, the same basic principles for assessment apply as for any other biotechnological medicinal product. Nevertheless, the extent of data for quality, safety, and efficacy can be highly specific. Until recently, advanced therapies were not uniformly regulated across Europe, e.g., tissue engineered products were regulated either as medicinal products or medical devices. Thus, for some products no data from clinical studies are available, e.g., for autologous chondrocyte products. The draft guideline on Good Clinical Practice for clinical trials with advanced therapies describes specific additional requirements, e.g., ensuring traceability. Most clinical studies with advanced therapies in Germany are still in early phase I or II trials with highly divergent types of products and clinical indications. The Committee for Advanced Therapies (CAT) at the European Medicines Agency (EMEA) has been established to meet the scientific and regulatory challenges with advanced therapies.

  13. Oral administration of Chinese herbal medicine during gestation period for preventing hemolytic disease of the newborn due to ABO incompatibility: A systematic review of randomized controlled trials

    Science.gov (United States)

    Cao, Huijuan; Wu, Ruohan; Han, Mei; Caldwell, Patrina Ha Yuen

    2017-01-01

    Background About 85.3% of hemolytic disease of the newborn (HDN) is caused by maternal-fetal ABO blood group incompatibility. However, there is currently no recommended “best” therapy for ABO incompatibility during pregnancy. Objectives To systematically assess the safety and effectiveness of oral Chinese herbal medicine (CHM) for preventing HDN due to ABO incompatibility. Methods The protocol of this review was registered on the PROSPERO website (No. CRD42016038637).Six databases were searched from inception to April 2016. Randomized controlled trials (RCTs) of CHM for maternal-fetal ABO incompatibility were included. The primary outcome was incidence of HDN. The Cochrane risk of bias tool was used to assess the methodological quality of included trials. Risk ratios (RR) and mean differences with 95% confidence interval were used as effect measures. Meta-analyses using Revman 5.3 software were conducted if there were sufficient trials without obvious clinical or statistical heterogeneity available. Results Totally 28 RCTs involving3413 women were included in the review. The majority of the trials had unclear or high risk of bias. Our study found that the rate of HDN and the incidence of neonatal jaundice might be 70% lower in the herbal medicine group compared with the usual care group (RR from 0.25 to 0.30).After treatment with herbal medicine, women were twice as likely to have antibody titers lower than 1:64 compared with women who received usual care(RR from 2.15 to 3.14) and the umbilical cord blood bilirubin level in the herbal medicine group was 4umol/L lower than in those receiving usual care. There was no difference in Apgar scores or birthweights between the two groups. Conclusions This review found very low-quality evidence that CHM prevented HDN caused by maternal-fetal ABO incompatibility. No firm conclusions can be drawn regarding the effectiveness or safety of CHM for this condition. PMID:28719639

  14. 妊娠期阻塞性睡眠呼吸暂停低通气综合征诊治的初步研究%Clinical analysis of maternal-fetal outcome of obstructive sleep apnea hypopnea syndrome patients diagnosed during pregnancy

    Institute of Scientific and Technical Information of China (English)

    刘国莉; 韩芳; 王雁; 魏俊; 李静; 安培; 张晓红; 王建六

    2012-01-01

    Objective To explore the clinical characteristics of obstructive sleep apnea - hypopnea syndrome (OSAHS) diagnosed during pregnancy. Methods Data of 12 patients with OSAHS diagnosed by nocturnal blood oxygen saturation (SaO2) monitoring and polysomnography (PSG) during pregnancy from May 2008 to Oct 2011 at Peking University People's Hospital were analyzed retrospectively. Results All the 12 patients were snorers, one with OSAHS family history, one with hypothyroidism, the other 10 with hypertensive disorders complicating pregnancy (HDCP), 8 cases with BMI≥25 kg/m2 before pregnancy. Ten patients received continuous positive airway pressure (CPAP ) treatment with good compliance under informed consent The mean SaQ2 (MSa(02) and the lowest SaO2 (LSaO2) during sleep after treatment had significantly increased than that of before treatment (96. 29 ± 0.63) % vs(94.32±1.14 )% ( P<0.001), (89.5 ±5.28 )% vs ( 80.85±9.42 }% (P<0.05)i while the number of oxygen desaturation ≥4% per hour (DI4) significantly decreased (0.96±l.00 vs 11.16± 12. 06, P< 0.05). Two pregnency ended before 28 gestational weeks due to exacerbated HDCP. The case number of preterm labor, concurrent gestational diabetes and postpartum hemorrhage were 5, 6 and 2, respectively. The average weight of 10 live births were (3 231. 7±702.5) g (1 500~4 070) g, nine patients had taken CPAP therapy after the diagnosis of OSAHS, there were no fetal growth retardation nor neonatal asphyxia, 5 premature newborns and one term newborn with hypoglycemia were transferred to NICU. Conclusions Pregnant women who have OSAHS risk factors should be paid attention to during the perinatal care and nocturnal SaOz monitoring or PSG should be performed in the suspected OSAHS patients. The incidence of HDCP, gestational diabetes mellitus and preterm labor were relatively high in OSAHS patients. CPAP was a safe and effective treatment to OSAHS patients in pregnancy.%目的 探讨妊娠期阻塞性睡眠呼

  15. Clinical practice on the horizon: personalized medicine.

    Science.gov (United States)

    Chadwell, Katherine

    2013-01-01

    With the advent of the human genome project, we have never known so much about the uniqueness of individuals. Personalized medicine is poised to use this genetic and genomic information along with the impact of environment and clinical presentation to provide healthcare from an individual perspective. This offers the opportunity to improve our ability to diagnose and predict disease, provide earlier intervention, identify new treatment regimens, and address the safety and efficacy of drug use. The impact of personalized medicine to our current model of healthcare delivery is tremendous, and although strides have been made, there are still challenges and barriers to overcome before personalized medicine can be fully implemented. Advanced practice nurses may not be fully aware of the personalized medicine initiative or may not be well versed on genetic and genomic content, which is a key concept of personalized medicine. The role of advanced practice nurses is an integral part of the healthcare system, and as such, they are poised to be key providers and contributors to personalized medicine. The personalized medicine initiative is discussed along with examples of genetic and genomic information that lend to our understanding, diagnosis, and treatment of disease, as well as the role and responsibilities of advanced practice nurses. Resources for personalized medicine and genetic and genomic content are provided.

  16. Disruption of the hormonal network and the enantioselectivity of bifenthrin in trophoblast: maternal-fetal health risk of chiral pesticides.

    Science.gov (United States)

    Zhao, Meirong; Zhang, Ying; Zhuang, Shulin; Zhang, Quan; Lu, Chengsheng; Liu, Weiping

    2014-07-15

    Endocrine-disrupting chemicals (EDCs) can interfere with normal hormone signaling to increase health risks to the maternal-fetal system, yet few studies have been conducted on the currently used chiral EDCs. This work tested the hypothesis that pyrethroids could enantioselectively interfere with trophoblast cells. Cell viability, hormone secretion, and steroidogenesis gene expression of a widely used pyrethroid, bifenthrin (BF), were evaluated in vitro, and the interactions of BF enantiomers with estrogen receptor (ER) were predicted. At low or noncytotoxic concentrations, both progesterone and human chorionic gonadotropin secretion were induced. The expression levels of progesterone receptor and human leukocyte antigen G genes were significantly stimulated. The key regulators of the hormonal cascade, GnRH type-I and its receptor, were both upregulated. The expression levels of selected steroidogenic genes were also significantly altered. Moreover, a consistent enantioselective interference of hormone signaling was observed, and S-BF had greater effects than R-BF. Using molecular docking, the enantioselective endocrine disruption of BF was predicted to be partially due to enantiospecific ER binding affinity. Thus, BF could act through ER to enantioselectively disturb the hormonal network in trophoblast cells. These converging results suggest that the currently used chiral pesticides are of significant concern with respect to maternal-fetal health.

  17. Clinical holistic medicine: applied consciousness-based medicine.

    Science.gov (United States)

    Ventegodt, Søren; Merrick, Joav

    2004-03-03

    Consciousness-based medicine is our term for a form of medical treatment that works by direct appeal to the consciousness of the patient, in contrast to modern biomedical treatment where drugs are used to affect body chemistry. With this concept, maybe we are (in a sense) turning back to the "old medicine", where the family physician was the all-concerned "old country doctor" who knew the child, the siblings, the parents, the family, and the village. In a series of papers on clinical holistic medicine, we would like to present the classic art of healing, where the physician works mostly with his hands, then show how the modern biomedical physician performs with biochemistry, and finally introduce consciousness-based medicine. Some of our questions will be: If you improve your quality of life, will you also improve your health? Will learning more about yourself bring more purpose in your life? Will finding someone to live with in a loving and mutually respectful relationship improve your health? Scientists and thinkers like Antonovsky, Frankl, Maslow, and Jung have pointed to love as a unique way to coherence in life, and thus to biological order and a better health. Several scientific studies have also suggested that patients who focus on improving their quality of life usually will not follow the general statistics for survival, since somehow other factors are at play, which sometimes you will find referred to as "exceptional".

  18. Planning for a School of Clinical Medicine

    Science.gov (United States)

    Creditor, Morton C.

    1976-01-01

    Describes briefly the objectives, problem-oriented educational process, 4-phase curriculum, and resources of a new 3-year School of Clinical Medicine, part of a decentralized and regionalized scheme of medical education designed to improve geographic distribution of graduates, increase incentive to enter primary care specialties, and assure…

  19. Clinical Holistic Medicine: Applied Consciousness-Based Medicine

    OpenAIRE

    Søren Ventegodt; Joav Merrick

    2004-01-01

    Consciousness-based medicine is our term for a form of medical treatment that works by direct appeal to the consciousness of the patient, in contrast to modern biomedical treatment where drugs are used to affect body chemistry. With this concept, maybe we are (in a sense) turning back to the “old medicine”, where the family physician was the all-concerned “old country doctor” who knew the child, the siblings, the parents, the family, and the village. In a series of papers on clinical holistic...

  20. Clinical Holistic Medicine: Metastatic Cancer

    Directory of Open Access Journals (Sweden)

    Søren Ventegodt

    2004-01-01

    Full Text Available We believe that the consciousness-based/holistic medical toolbox has a serious additional offer to cancer patients and, as a consequence, designed a treatment for the patient with metastasized cancer. From a holistic perspective, cancer can be understood as a simple disturbance of the cells, arising from the tissue holding on to a trauma with strong emotional content. This is called “a blockage”, where the function of the cells is allocated from their original function in the tissue to a function of holding emotions. We hope to be able not only to improve the quality of life, but also to improve survival and in some cases even induce spontaneous remission of the metastasized cancer. This paper describes how work with a patient with metastasized cancer can be done in the holistic clinical practice in 14 days on an individual basis, helping the patient to recover her human character, purpose of life, coherence, and will to live, thus improving quality of life and possibly also survival time. The holistic therapeutic work includes (1 teaching existential theory, (2 working with life perspective and philosophy of life, (3 helping the patient to acknowledge the state of the disease and the feelings connected to it, and finally (4 getting the patient into the holistic state of healing: (a feeling old repressed emotions, (b understanding why she got sick from a holistic point of view, and finally (c letting go of the negative beliefs and decisions that made her sick according to the holistic theory of nongenetic diseases. The theory of the human character, the quality of life theories, the holistic theory of cancer, the holistic process theory of healing, the theory of (Antonovsky coherence, and the life mission theory are the most important theories for the patient to find hope and mobilize the will to fight the cancer and survive. The patient went through the following phases: (1 finding the purpose of life and hidden resources; (2 confronting

  1. Clinical Holistic Medicine: Applied Consciousness-Based Medicine

    Directory of Open Access Journals (Sweden)

    Søren Ventegodt

    2004-01-01

    Full Text Available Consciousness-based medicine is our term for a form of medical treatment that works by direct appeal to the consciousness of the patient, in contrast to modern biomedical treatment where drugs are used to affect body chemistry. With this concept, maybe we are (in a sense turning back to the “old medicine”, where the family physician was the all-concerned “old country doctor” who knew the child, the siblings, the parents, the family, and the village. In a series of papers on clinical holistic medicine, we would like to present the classic art of healing, where the physician works mostly with his hands, then show how the modern biomedical physician performs with biochemistry, and finally introduce consciousness-based medicine. Some of our questions will be: If you improve your quality of life, will you also improve your health? Will learning more about yourself bring more purpose in your life? Will finding someone to live with in a loving and mutually respectful relationship improve your health? Scientists and thinkers like Antonovsky, Frankl, Maslow, and Jung have pointed to love as a unique way to coherence in life, and thus to biological order and a better health. Several scientific studies have also suggested that patients who focus on improving their quality of life usually will not follow the general statistics for survival, since somehow other factors are at play, which sometimes you will find referred to as “exceptional”.

  2. [Brief psychotherapy in clinical medicine patients].

    Science.gov (United States)

    Knobel, M

    1992-01-01

    The criteria that "illness is biographical crisis od the individual" and that the only medicine is "personal medicine" is stressed. Clinical medicine, which covers medicine in its entirety, demands conceptual and doctrinal reaffirmations so that gradually the patient can come to be dealt with as a human being fron a holistic point of view, which commences with his complaint and consultation, continues with the interview and semiology, to finish with the diagnosis and therapy which, although in some cases it may be surgical, is still medical and integral. All the steps mentioned are bio-socio-cultural thus, whether in the practice of general clinical medicine or in the most specialized and technologically sophisticated clinical medicine, the animist component is not lacking and demands a minimum degree of "psychosomatic" Knowledge. The use of a psychotherapeutic technique is proposed which, while based on the psychoanalysis theory, is distanced technically from it as a "psychotherapy on limited time and goals", which abbreviates the disease, and is projected not as the "focus" of therapeutic work, but as a re-evaluation of the "life style" of each individual, and tends to help to develop a "project for life" suited to the possible personal, familiar and social well-being of the "patient". Technically speaking, this modality of brief psychotherapy is based on the nonuse of transferential interpretations, on impeding the regression od the patient, on facilitating a cognitice-affective development of his conflicts and thus obtain an internal object mutation which allows the transformation of the "past" into true history, and the "present" into vital perspectives. This technique is within reach of every health professional.

  3. ACCELERATIVE AND RADIONUCLIDE TECHNOLOGIES IN CLINICAL MEDICINE

    Directory of Open Access Journals (Sweden)

    A. P. Chernyaev

    2016-01-01

    Full Text Available Methods based on accelerative and radionuclide technologies are more and more invading clinical practice of modern medicine. The aim of this review is to demonstrate the role of nuclear physics techniques for treatment and diagnostics of various disorders. We analyzed data published in the last 50 years in research papers, reports and other open sources considering particulars of electron accelerators and heavy charged particles in radiation and nuclear medicine and presenting the information on prevalence of accelerators and other high-tech medical equipment in Russia and worldwide.

  4. Sex and gender differences in clinical medicine.

    Science.gov (United States)

    Regitz-Zagrosek, Vera; Seeland, Ute

    2012-01-01

    Sex and gender differences in frequent diseases are more widespread than one may assume. In addition, they have significant yet frequently underestimated consequences on the daily practice of medicine, on outcomes and effects of therapies. Gender medicine is a novel medical discipline that takes into account the effects of sex and gender on the health of women and men. The major goal is to improve health and health care for both, for women as well as for men. We give in this chapter an overview on sex and gender differences in a number of clinical areas, in cardiovascular diseases, pulmonary diseases, gastroenterology and hepatology, in nephrology, autoimmune diseases, endocrinology, hematology, neurology. We discuss the preferential use of male animals in drug development, the underrepresentation of women in early and cardiovascular clinical trials, sex and gender differences in pharmacology, in pharmacokinetics and pharmacodynamics, in management and drug use. Most guidelines do not include even well-known sex and gender differences. European guidelines for the management of cardiovascular diseases in pregnancy have only recently been published. Personalized medicine cannot replace gender-based medicine. Large databases reveal that gender remains an independent risk factor after ethnicity, age, comorbidities, and scored risk factors have been taken into account. Some genetic variants carry a different risk in women and men. The sociocultural dimension of gender integrating lifestyle, environment, stress, and other variables cannot be replaced by a sum of biological parameters. Because of this prominent role of gender, clinical care algorithms must include gender-based assessment.

  5. Association of Combined Maternal-Fetal TNF-α Gene G308A Genotypes with Preterm Delivery: A Gene-Gene Interaction Study

    Directory of Open Access Journals (Sweden)

    Mingbin Liang

    2010-01-01

    Full Text Available Preterm delivery (PTD is a complicated perinatal adverse event. We were interested in association of G308A polymorphism in tumor necrosis factor-α (TNF-α gene with PTD; so we conducted a genetic epidemiology study in Anqing City, Anhui Province, China. Case families and control families were all collected between July 1999 and June 2002. To control potential population stratification as we could, all eligible subjects were ethnic Han Chinese. 250 case families and 247 control families were included in data analysis. A hybrid design which combines case-parent triads and control parents was employed, to test maternal-fetal genotype (MFG incompatibility. The method is based on a log-linear modeling approach. In summary, we found that when the mother's or child's genotype was G/A, there was a reduced risk of PTD; however when the mother's or child's genotype was genotype A/A, there was a relatively higher risk of PTD. Combined maternal-fetal genotype GA/GA showed the most reduced risk of PTD. Comparison of the LRTs showed that the model with maternal-fetal genotype effects fits significantly better than the model with only maternal and fetal genotype main effects (log-likelihood = −719.4, P=.023, significant at 0.05 level. That means that the combined maternal-fetal genotype incompatibility was significantly associated with PTD. The model with maternal-fetal genotype effects can be considered a gene-gene interaction model. We claim that both maternal effects and fetal effects should be considered together while investigating genetic factors of certain perinatal diseases.

  6. Cryogenic Thermophysical Studies for Clinical Medicine

    Institute of Scientific and Technical Information of China (English)

    华泽钊

    2002-01-01

    Cryogenic technology has been widely used in clinical medicine and in pharmaceutics, so thermophysical studies are extremely important to solve problems during freezing and thawing. This paper reports some recent research in clinical medicine, including cryo-injury, cryosurgery, and cryopreservation of some important cells and tissues. Microscopic images of the freezing process with a cryomicroscope system show that the dendritic ice growth is affected by the solution concentration, the cooling rate, and the number of embryos. An enthalpy method is used for the freeze-thaw analysis of the cryosurgery with a program developed to predict the temperature profile and the interface motion, which compares well with experimental results. A very rapid cooling technique is developed by quenching the samples into subcooled liquid nitrogen for vitrification of cells and tissues. An analytical method developed to prevent the fracture of arteries during freezing has been verified by the electronic microscopic investigation.

  7. [Undergraduate teaching project on clinical laboratory medicine].

    Science.gov (United States)

    Kayaba, Hiroyuki

    2003-11-01

    Undergraduate teaching in clinical laboratory medicine is at the center of contemporary medical education. Students are expected to learn advanced laboratory medicine and basic diagnostic skills such as blood sampling, peripheral blood cell counting, blood typing, cross match test, urinalysis, electrocardiography, and bacteriological examinations through their training program. In our department, we have compulsory lectures, a basic practical training course and an advanced training course for the medical students. The compulsory lectures are programmed for the students in the fourth grade to obtain basic knowledge of clinical laboratory medicine and the patho-physiology of diseases. The teaching staff makes every effort to make their lectures exciting and interesting. As we experienced as medical students in the past, boring lectures give students nothing but a nap. For every senior teaching staff in our school, it is obligatory to be evaluated on their lectures by the students and other teaching staff every year to improve their teaching skills and materials. Teaching materials utilizing personal computers and the Internet are becoming more and more important. The basic practical training course is for the students in the fifth grade. The laboratory technicians help us teach students basic diagnostic skills in this program. The students in the advanced training course have to attend morning conferences in the department, including reverse clinico-pathological conferences and laboratory investigations. The reversed clinico-pathological conferences are popular among the students. Through our training programs, we hope that the students raise many questions that they solve themselves in the future, as well as learning established clinical laboratory medicine.

  8. [Clinical medicine of the western medicine in the 18th century].

    Science.gov (United States)

    Zhen, C

    2001-07-01

    The 18th century is an important turning point not only in human history, but also in medical history. G. B. Morgagni was an Italian who founded the organic pathology in the 18th century, which was a bridge between basic medicine and clinical medicine of western medicine. H. Boerhaave called for "paying attention to the development of clinical medicine", and under this situation, western clinical medicine was attached importance and developed again in the 18th century. However, at the same time, the mechanical materialism was also infiltrated into western clinical medicine.

  9. Analogies and metaphors in clinical medicine.

    Science.gov (United States)

    Masukume, Gwinyai; Zumla, Alimuddin

    2012-02-01

    Medicine is traditionally known as an 'art', and not an exact 'science'. Medical images of clinical signs and pathology were communicated through 'metaphors' in the 19th and early 20th centuries to make recognition easier in anticipation of the clinical counterpart when encountered in medical practice. They have served as teaching aids, enhancing memory retention for medical students, nurses and doctors and have withstood the test of time. Standard medical textbooks contain metaphors that have become entrenched in teaching, learning and examining in medical schools and hospitals worldwide. The continued use of metaphors has given rise to an ongoing debate, particularly in Africa, due to the usage of inappropriate or unfamiliar metaphors which are not locally or culturally relevant. Despite this, medical analogies will no doubt continue to be useful for medical education, clinical practice and 'aide memoirs' for examinations, and bring light humour, for a long time to come.

  10. Recruitment and Retention of Patients into Emergency Medicine Clinical Trials

    OpenAIRE

    Cofield,Stacey; Conwit, Robin; Barsan, William; Quinn, James

    2010-01-01

    The emergency medicine and pre-hospital environments are unlike any other clinical environments and require special consideration to allow the successful implementation of clinical trials. This article reviews the specific issues involved in Emergency Medicine Clinical Trials (EMCT), and provides strategies from emergency medicine and non-emergency medicine trials to maximize recruitment and retention. While the evidence supporting some of these strategies is deficient, addressing recruitment...

  11. Recruitment and Retention of Patients into Emergency Medicine Clinical Trials

    Science.gov (United States)

    Cofield, Stacey; Conwit, Robin; Barsan, William; Quinn, James

    2010-01-01

    The emergency medicine and pre-hospital environments are unlike any other clinical environments and require special consideration to allow the successful implementation of clinical trials. This article reviews the specific issues involved in Emergency Medicine Clinical Trials (EMCT), and provides strategies from emergency medicine and non-emergency medicine trials to maximize recruitment and retention. While the evidence supporting some of these strategies is deficient, addressing recruitment and retention issues with specific strategies will help researchers deal with these issues in their funding applications and in turn develop the necessary infrastructure to participate in emergency medicine clinical trials. PMID:21040112

  12. 77 FR 44695 - Revised Meeting Notice: Leadership Meeting on Maternal, Fetal, and Infant Opioid Exposure and...

    Science.gov (United States)

    2012-07-30

    ... treatment during pregnancy, and addiction treatment during and after pregnancy. The meeting will be held on... and the need for women with drug use disorders to access treatment through family medicine and gynecological practitioners, and specialty treatment providers; (4) to discuss legal and policy issues...

  13. MATERNAL MIND-MINDEDNESS: RELATIONS WITH MATERNAL-FETAL ATTACHMENT AND STABILITY IN THE FIRST TWO YEARS OF LIFE: FINDINGS FROM AN AUSTRALIAN PROSPECTIVE STUDY.

    Science.gov (United States)

    McMahon, Catherine; Camberis, Anna-Lisa; Berry, Sinead; Gibson, Frances

    2016-01-01

    Mind-mindedness captures a caregiver's attunement to his or her infant's mental states, and the tendency to interpret behavior as resulting from these mental states. The construct is assessed through analysis of maternal language during interaction or from mothers' use of mental state words when invited to describe their child. This study examined whether maternal-fetal attachment predicted maternal mind-mindedness, whether there was continuity in mind-mindedness over the first 2 postnatal years, and concordance for the two approaches to measurement. One hundred fifty women completed a questionnaire measure of maternal-fetal attachment in the third trimester of pregnancy and participated in home visits to assess maternal mind-mindedness when their infants were 7 months and 19 months of age. Path analysis showed that maternal-fetal attachment predicted indices of maternal mind-mindedness at 7 and 19 months; mothers who made more mind-related comments during play at 7 months also did so at 19 months, and mothers who made more mind-related comments during play at 19 months also used more mental state words when describing their child. Results suggest that a proclivity to mind-mindedness may be a caregiver characteristic that is present prior to birth and stable over time. © 2015 Michigan Association for Infant Mental Health.

  14. Chikungunya and dengue virus infections during pregnancy: seroprevalence, seroincidence and maternal-fetal transmission, southern Thailand, 2009-2010.

    Science.gov (United States)

    Laoprasopwattana, K; Suntharasaj, T; Petmanee, P; Suddeaugrai, O; Geater, A

    2016-01-01

    Limited information is available on the seroprevalence of chikungunya virus (CHIKV) infection and maternal-fetal transmission incidence of CHIKV and dengue virus (DENV) infections during the 2008-2009 CHIKV outbreak in southern Thailand. A community-based post-epidemic seroprevalence study was conducted in parturient women admitted to the Thepa District Hospital in Songkhla Province, Thailand, for delivery from November 2009 to May 2010. The women were tested for chikungunya (CHIK) IgM/IgG and dengue (DEN) IgM/IgG. Cord blood samples were also tested for CHIK IgM or DEN IgM in women who tested positive for CHIK IgM or DEN IgM, respectively. The seroprevalence of CHIKV infection (CHIK IgM or IgG positive) was 227/319 (71·2%) with pre-outbreak seroprevalence (IgM-/IgG+) of 43·6% and the seroprevalence of DENV infection was 288/319 (90·3%). Complications during pregnancy, newborn outcomes and congenital anomalies were not different in those who had recent, remote or no CHIKV infections. None of the newborns whose mothers were CHIK or DEN IgM positive had cord blood positive for both CHIK and DEN IgM. In conclusion, both CHIKV and DENV are endemic in southern Thailand; during the recent CHIKV outbreak CHIK seroprevalence increased from 43·6% to 71·2%.

  15. War trauma and maternal-fetal attachment predicting maternal mental health, infant development, and dyadic interaction in Palestinian families.

    Science.gov (United States)

    Punamäki, Raija-Leena; Isosävi, Sanna; Qouta, Samir R; Kuittinen, Saija; Diab, Safwat Y

    2017-10-01

    Optimal maternal-fetal attachment (MFA) is believed to be beneficial for infant well-being and dyadic interaction, but research is scarce in general and among risk populations. Our study involved dyads living in war conditions and examined how traumatic war trauma associates with MFA and which factors mediate that association. It also modeled the role of MFA in predicting newborn health, infant development, mother-infant interaction, and maternal postpartum mental health. Palestinian women from the Gaza Strip (N = 511) participated during their second trimester (T1), and when their infants were 4 (T2) and 12 (T3) months. Mothers reported MFA (interaction with, attributions to, and fantasies about the fetus), social support, and prenatal mental health (post-traumatic stress disorder, depression, and anxiety) at T1, newborn health at T2, and the postpartum mental health, infant's sensorimotor and language development, and mother-infant interaction (emotional availability) at T3. Results revealed, first, that war trauma was not directly associated with MFA but that it was mediated through a low level of social support and high level of maternal prenatal mental health problems. Second, intensive MFA predicted optimal mother-reported infant's sensorimotor and language development and mother-infant emotional availability but not newborn health or maternal postpartum mental health.

  16. Johnson Space Center Flight Medicine Clinic Experience

    Science.gov (United States)

    Landry, Trela

    2006-01-01

    Being a member of the Flight Medicine Clinic (FMC) Staff is a great experience. I joined the FMC staff 2 years ago when I became part of the Kelsey-Seybold team. The FMC staff consists of Flight Surgeons, Family Clinic Physician, Nursing staff, Wellness Coordinator and Support staff. We serve as the Primary Care Physicians for the astronauts and their families and provide annual physicals for the retired astronauts. We have approximately 800 patients in the FMC. As the Family Clinic Physician, I care for the astronaut spouses and children and provide annual physicals for the retired astronauts. Since we have a small patient population, we have the opportunity to spend increased personal time with our patients, which I enjoy. We have a pretty healthy patient population, who are very interested in their overall health and preventive care. In preparation for a shuttle launch, our nursing staff assists the flight surgeons with the astronaut physical exams, which occur 10 days prior to launch and again 3 days after their return. We also provide Primary Contact physicals for the families and guests, who will be in close contact with shuttle crew members. During these physicals, we provide education, emphasizing the importance of preventing the spread of communicable diseases to shuttle crew members. Being a part of the Space Medicine Program is an honor. To know that you contribute in some way to our nation s Space Program is very special. (This article was prepared by Dr. Trela Landry, M.D. for inclusion in a Kelsey-Seybold newsletter on 25 OCT 2006.)

  17. Review of clinical medicine and religious practice.

    Science.gov (United States)

    Stewart, William C; Adams, Michelle P; Stewart, Jeanette A; Nelson, Lindsay A

    2013-03-01

    The purpose was to evaluate faith-based studies within the medical literature to determine whether there are ways to help physicians understand how religion affects patients’ lives and diseases. We reviewed articles that assessed the influence of religious practices on medicine as a primary or secondary variable in clinical practice. This review evaluated 49 articles and found that religious faith is important to many patients, particularly those with serious disease, and patients depend on it as a positive coping mechanism. The findings of this review can suggest that patients frequently practice religion and interact with God about their disease state. This spiritual interaction may benefit the patient by providing comfort, increasing knowledge about their disease, greater treatment adherence, and quality of life. The results of prayer on specific disease states appear inconsistent with cardiovascular disease but stronger in other disease states.

  18. Society for Maternal-Fetal Medicine (SMFM) Special Report: Current approaches to measuring quality of care in obstetrics.

    Science.gov (United States)

    Bailit, Jennifer L; Gregory, Kimberly D; Srinivas, Sindhu; Westover, Thomas; Grobman, William A; Saade, George R

    2016-09-01

    Heath care measurement and evaluation is an integral piece of the health care system. The creation and assessment of care performance metrics are important and relevant for the obstetric community including both clinicians and patients. Careful deliberation is required to create a measurement system that results in optimal care for women and families. This article reviews the current approaches to measuring quality in obstetrics. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. A/H1N1 pandemic influenza vaccination: A retrospective evaluation of adverse maternal, fetal and neonatal outcomes in a cohort of pregnant women in Italy.

    Science.gov (United States)

    Fabiani, Massimo; Bella, Antonino; Rota, Maria C; Clagnan, Elena; Gallo, Tolinda; D'Amato, Maurizio; Pezzotti, Patrizio; Ferrara, Lorenza; Demicheli, Vittorio; Martinelli, Domenico; Prato, Rosa; Rizzo, Caterina

    2015-05-05

    Although concerns about safety of influenza vaccination during pregnancy have been raised in the past, vaccination of pregnant women was recommended in many countries during the 2009 A/H1N1 pandemic influenza. A retrospective cohort study was conducted to evaluate the risk of adverse maternal, fetal and neonatal outcomes among pregnant women vaccinated with a MF59-adjuvanted A/H1N1 pandemic influenza vaccine. The study was carried out in four Italian regions (Piemonte, Friuli-Venezia-Giulia, Lazio, and Puglia) among 102,077 pregnant women potentially exposed during the second or third trimester of gestation to the vaccination campaign implemented in 2009/2010. Based on data retrieved from the regional administrative databases, the statistical analysis was performed using the Cox proportional-hazards model, adjusting for the propensity score to account for the potential confounding effect due to the socio-demographic characteristics and the clinical and reproductive history of women. A total of 100,332 pregnant women were eligible for the analysis. Of these, 2003 (2.0%) received the A/H1N1 pandemic influenza vaccination during the second or third trimester of gestation. We did not observe any statistically significant association between the A/H1N1 pandemic influenza vaccination and different maternal outcomes (hospital admissions for influenza, pneumonia, hypertension, eclampsia, diabetes, thyroid disease, and anaemia), fetal outcomes (fetal death after the 22nd gestational week) and neonatal outcomes (pre-term birth, low birth weight, low 5-min Apgar score, and congenital malformations). Pre-existing health-risk conditions (hospital admissions and drug prescriptions for specific diseases before the onset of pregnancy) were observed more frequently among vaccinated women, thus suggesting that concomitant chronic conditions increased vaccination uptake. The results of this study add some evidence on the safety of A/H1N1 pandemic influenza vaccination during

  20. Tasks of research in forensic medicine - different study types in clinical research and forensic medicine.

    Science.gov (United States)

    Madea, Burkhard; Saukko, Pekka; Musshoff, Frank

    2007-01-17

    In the last years the research output of forensic medicine has sometimes been regarded as insufficient and as of poor quality, especially when parameters as impact factors and external funding were taken into account. However, forensic medicine has different tasks compared to clinical medicine. The main difference between basic subjects, clinical and forensic medicine is not a lack of scientific efficiency in forensic medicine but is a result of the questions asked, the available methods and specific aims. In contrast to natural-scientific research, forensic science has furthermore important intersections with arts and socio-scientific disciplines. Etiologic and pathogenetic research is of only limited relevance in forensic medicine. Thus, forensic medicine is excluded from these research fields, which are mainly supported by external funding. In forensic medicine research mainly means applied research regarding findings, the probative value and reconstruction as well as examination at different points of intersection between medicine and law. Clinical types of research such as controlled randomised, prospective cross-sectional, cohort or case-control studies can only rarely be applied in forensic medicine due to the area specific research fields (e.g. thantatology, violent death, vitality, traffic medicine, analytical toxicology, hemogenetics and stain analysis). The types of studies which are successfully established in forensic medicine are comparison of methods, sensitivity studies, validation of methods, kinetic examinations etc. Tasks of research in forensic medicine and study types, which may be applied will be addressed.

  1. A short note on probability in clinical medicine.

    Science.gov (United States)

    Upshur, Ross E G

    2013-06-01

    Probability claims are ubiquitous in clinical medicine, yet exactly how clinical events relate to interpretations of probability has been not been well explored. This brief essay examines the major interpretations of probability and how these interpretations may account for the probabilistic nature of clinical events. It is argued that there are significant problems with the unquestioned application of interpretation of probability to clinical events. The essay concludes by suggesting other avenues to understand uncertainty in clinical medicine.

  2. Evidence-based integrative medicine in clinical veterinary oncology.

    Science.gov (United States)

    Raditic, Donna M; Bartges, Joseph W

    2014-09-01

    Integrative medicine is the combined use of complementary and alternative medicine with conventional or traditional Western medicine systems. The demand for integrative veterinary medicine is growing, but evidence-based research on its efficacy is limited. In veterinary clinical oncology, such research could be translated to human medicine, because veterinary patients with spontaneous tumors are valuable translational models for human cancers. An overview of specific herbs, botanics, dietary supplements, and acupuncture evaluated in dogs, in vitro canine cells, and other relevant species both in vivo and in vitro is presented for their potential use as integrative therapies in veterinary clinical oncology. Published by Elsevier Inc.

  3. Integrative medicine: a tale of two clinics

    Directory of Open Access Journals (Sweden)

    Kachan Natasha

    2008-06-01

    Full Text Available Abstract Background Integrative medicine (blending the best of complementary and alternative medicine (CAM with conventional medicine is becoming increasingly popular. Objectives The objectives of this paper are to compare and contrast the development of two teams that set out to establish integrative medical clinics, highlighting key issues found to be common to both settings, and to identify factors that appear to be necessary for integration to occur. Methods At St Michael's Hospital (an inner-city teaching hospital in Toronto, Canada, a total of 42 interviews were conducted between February 2004 and August 2006 wi18 key participants (4 administrators, 2 chiropractors, 2 physiotherapists and 10 family physicians. At the CARE (Complementary and Alternative Research and Education Program at Stollery Children's Hospital, Edmonton, Canada, 44 interviews were conducted with 24 people on four occasions: June 2004, March 2005, November 2006, and June 2007. Basic content analysis was used to identify the key themes from the transcribed interviews. Results Despite the contextual differences between the two programs, a striking number of similar themes emerged from the data. The five most important shared themes were: 1 the necessity of "champions" and institutional facilitators to conceive of, advocate for, and bring the programs to fruition; 2 the credibility of these champions and facilitators (and the credibility of the program being established was key to the acceptance and growth of the program in each setting; 3 the ability to find the "right" practitioners and staff to establish the integrative team was crucial to each program's ultimate success; 4 the importance of trust (both the trustworthiness of the developing program as well as the trust that developed between the practitioners in the integrative team; and 5 the challenge of finding physical space to house the programs. Conclusion The programs were ultimately successful because of the

  4. High and low protein∶ carbohydrate dietary ratios during gestation alter maternal-fetal cortisol regulation in pigs.

    Directory of Open Access Journals (Sweden)

    Ellen Kanitz

    Full Text Available Imbalanced maternal nutrition during gestation can cause alterations of the hypothalamic-pituitary-adrenal (HPA system in offspring. The present study investigated the effects of maternal low- and high-protein diets during gestation in pigs on the maternal-fetal HPA regulation and expression of the glucocorticoid receptor (GR, mineralocorticoid receptor (MR, 11β-hydroxysteroid dehydrogenase 1 and 2 (11β-HSD1 and 11β-HSD2 and c-fos mRNAs in the placenta and fetal brain. Twenty-seven German Landrace sows were fed diets with high (HP, 30%, low (LP, 6.5% or adequate (AP, 12.1% protein levels made isoenergetic by varying the carbohydrate levels. On gestational day 94, fetuses were recovered under general anesthesia for the collection of blood, brain and placenta samples. The LP diet in sows increased salivary cortisol levels during gestation compared to the HP and AP sows and caused an increase of placental GR and c-fos mRNA expression. However, the diurnal rhythm of plasma cortisol was disturbed in both LP and HP sows. Total plasma cortisol concentrations in the umbilical cord vessels were elevated in fetuses from HP sows, whereas corticosteroid-binding globulin levels were decreased in LP fetuses. In the hypothalamus, LP fetuses displayed an enhanced mRNA expression of 11β-HSD1 and a reduced expression of c-fos. Additionally, the 11β-HSD2 mRNA expression was decreased in both LP and HP fetuses. The present results suggest that both low and high protein∶carbohydrate dietary ratios during gestation may alter the expression of genes encoding key determinants of glucocorticoid hormone action in the fetus with potential long-lasting consequences for stress adaptation and health.

  5. Laboratory research at the clinical trials of Veterinary medicinal Products

    OpenAIRE

    ZHYLA M.I.

    2011-01-01

    The article analyses the importance of laboratory test methods, namely pathomorfological at conduct of clinical trials. The article focuses on complex laboratory diagnostics at determination of clinical condition of animals, safety and efficacy of tested medicinal product.

  6. Introduciton to Clinical Medicine: Description of a Course.

    Science.gov (United States)

    Tuteur, Peter G.

    1979-01-01

    The Introduction to Clinical Medicine course developed at Washington University School of Medicine (St. Louis) early in 1973 is described, which, in part, was the product of a revision of two previous courses: clinical diagnosis and physical diagnosis. The new course stresses techniques of bedside data collection, communication of data, and data…

  7. Goal-setting in clinical medicine.

    Science.gov (United States)

    Bradley, E H; Bogardus, S T; Tinetti, M E; Inouye, S K

    1999-07-01

    The process of setting goals for medical care in the context of chronic disease has received little attention in the medical literature, despite the importance of goal-setting in the achievement of desired outcomes. Using qualitative research methods, this paper develops a theory of goal-setting in the care of patients with dementia. The theory posits several propositions. First, goals are generated from embedded values but are distinct from values. Goals vary based on specific circumstances and alternatives whereas values are person-specific and relatively stable in the face of changing circumstances. Second, goals are hierarchical in nature, with complex mappings between general and specific goals. Third, there are a number of factors that modify the goal-setting process, by affecting the generation of goals from values or the translation of general goals to specific goals. Modifying factors related to individuals include their degree of risk-taking, perceived self-efficacy, and acceptance of the disease. Disease factors that modify the goal-setting process include the urgency and irreversibility of the medical condition. Pertinent characteristics of the patient-family-clinician interaction include the level of participation, control, and trust among patients, family members, and clinicians. The research suggests that the goal-setting process in clinical medicine is complex, and the potential for disagreements regarding goals substantial. The nature of the goal-setting process suggests that explicit discussion of goals for care may be necessary to promote effective patient-family-clinician communication and adequate care planning.

  8. Herbal Medicine Today: Clinical and Research Issues

    Directory of Open Access Journals (Sweden)

    Fabio Firenzuoli

    2007-01-01

    Full Text Available Herbal medicine is the use of medicinal plants for prevention and treatment of diseases: it ranges from traditional and popular medicines of every country to the use of standardized and tritated herbal extracts. Generally cultural rootedness enduring and widespread use in a Traditional Medical System may indicate safety, but not efficacy of treatments, especially in herbal medicine where tradition is almost completely based on remedies containing active principles at very low and ultra low concentrations, or relying on magical-energetic principles.

  9. Patient Safety Implications of Electronic Alerts and Alarms of Maternal - Fetal Status During Labor.

    Science.gov (United States)

    Simpson, Kathleen Rice; Lyndon, Audrey; Davidson, Leigh Ann

    2016-01-01

    When nurses care for women during labor, they encounter numerous alerts and alarms from electronic fetal monitors and their surveillance systems. Notifications of values of physiologic parameters for a woman and fetus that may be outside preset limits are generated via visual and audible cues. There is no standardization of these alert and alarm parameters among electronic fetal monitoring vendors in the United States, and there are no data supporting their sensitivity and specificity. Agreement among professional organizations about physiologic parameters for alerts and alarms commonly used during labor is lacking. It is unknown if labor nurses view the alerts and alarms as helpful or a nuisance. There is no evidence that they promote or hinder patient safety. This clinical issue warrants our attention as labor nurses. © 2016 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses.

  10. Maternal-fetal HLA sharing and preeclampsia: variation in effects by seminal fluid exposure in a case-control study of nulliparous women in Iowa.

    Science.gov (United States)

    Triche, Elizabeth W; Harland, Karisa K; Field, Elizabeth H; Rubenstein, Linda M; Saftlas, Audrey F

    2014-03-01

    Whereas histocompatibility is critical for transplantation, HLA histoincompatibility is associated with successful pregnancy. Literature on HLA sharing and preeclampsia has been inconsistent; most studies focused on maternal-paternal rather than maternal-fetal sharing. This study examines whether maternal-fetal histocompatibility is associated with preeclampsia, and whether effects vary by semen exposure history. This case-control study of nulliparous women was designed to examine associations among HLA sharing, semen exposure, and preeclampsia. 258 preeclampsia cases and 182 normotensive controls met the eligibility criteria. HLA typing for mother and baby was performed for HLA-A, -B, -C, -DRB1, and -DQB1. We further restricted our study sample to 224 mother-baby pairs who had complete HLA typing for all five genes. Seminal fluid exposure indexes incorporated information on type of practice, frequency, contraceptive use (for vaginal exposure) and ingestion practices (for oral exposure). Multivariate models were adjusted for BMI and education. HLA-A matching, Class I matching, and combined Class I and II matching were associated with increased odds of preeclampsia. Among women with low semen exposure, effects of Class I matching were amplified (HLA-A matching, OR=6.27, 95%CI=1.04, 37.97; Class I matching, OR=4.49 per one-match increase, 95%CI=1.89, 14.50). With moderate to high semen exposure, Class II matching effects predominated (HLA-DQB1, OR=3.22, 95%CI=1.04, 9.99; Class II, OR=1.76 per one-match increase, 95%CI=1.05, 2.98; and total matches, OR=1.45 per one-match increase, 95%CI=1.02, 2.06). We found consistent evidence that maternal-fetal HLA sharing was associated with preeclampsia in a pattern influenced by prior vaginal exposure to paternal seminal fluid.

  11. The frequency of ABO blood group maternal-fetal incompatibility, maternal iso-agglutinins, and immune agglutinins quantitation in Osogbo, Osun State, South-West of Nigeria.

    Science.gov (United States)

    Oseni, Bashiru S; Akomolafe, Oluseun F

    2011-01-01

    ABO incompatibility in maternal-fetal relationship has been shown to cause hemolytic disease of the newborn (HDNB); a survey which is not yet done in this locality. Frequency of ABO blood group maternal-fetal incompatibility, maternal iso-agglutinins, and immune agglutinins quantitation was carried out in Osogbo, Osun State, South-West of Nigeria. A total of 260 subjects comprising 130 postpartum mothers within the age range of 22-35 years having good obstetrics history and normal delivery, with their 130 neonate babies were used for the study. ABO cell and serum groupings were carried out on the subjects using standard antisera and cells with appropriate controls. Direct Coomb's Test was carried out on neonate red cells. Antibody quantitation by double dilution on the maternal serum using red cells containing corresponding antigen to the antibody was determined. A titer, which is the reciprocal of the highest dilution showing agglutination by Indirect Coombs Test, was determined. Another batch of sera was pretreated with 2-mecarptoethanol before determining the titer. The distribution study results obtained were compared in percentages, whereas the antibodies quantitation was expressed as titers using the mode of the titers for compariso-agglutininsn. Thirty-eight percent (50) mothers were ABO incompatible with their babies, whereas 62% (80) mothers were compatible. The distribution of blood groups in the compatible population showed blood group O (45%); A (30%); B (20%); and AB (5%). Mothers O, A, and B carrying incompatible babies had a frequency of 24% each, whereas mothers AB had 28%. Serologist differences occur in maternal ABO antibodies of corresponding incompatible baby ABO antigens. A high incidence of ABO maternal-fetal incompatibility observed without detection of immune agglutinins is indicative of a rare incidence of HDNB due to ABO incompatibility in the population studied.

  12. Determination of maternal-fetal biomarkers of prenatal exposure to ethanol: a review.

    Science.gov (United States)

    Joya, X; Friguls, B; Ortigosa, S; Papaseit, E; Martínez, S E; Manich, A; Garcia-Algar, O; Pacifici, R; Vall, O; Pichini, S

    2012-10-01

    The deleterious effects exerted by prenatal ethanol exposure include physical, mental, behavioural and/or learning disabilities that are included in the term fetal alcohol spectrum disorder (FASD). Objective assessment of exposure to ethanol at both prenatal and postnatal stages is essential for early prevention and intervention. Since pregnant women tend to underreport alcohol drinking by questionnaires, a number of biological markers have been proposed and evaluated for their capability to highlight gestational drinking behaviour. These biomarkers include classical biomarkers (albeit indirect) of alcohol-induced pathology (mean corpuscular volume (MCV), gamma glutamyltransferase (GGT), aspartate aminotransferase (AST) and alanine aminotransferase (ALT)) acetaldehyde-derived conjugates, and finally derivatives of non-oxidative ethanol metabolism (fatty acid ethyl esters (FAEEs), ethyl glucuronide (EtG), ethyl sulphate (EtS) and phosphaditylethanol (PEth)). Since ethanol itself and acetaldehyde are only measured few hours after ethanol intake in conventional matrices such as blood, urine and sweat, they are only useful to detect recent ethanol exposure. In the past few years, the non-oxidative ethanol metabolites have received increasing attention because of their specificity and in some case wide time-window of detection in non-conventional matrices from the pregnant mother (oral fluid and hair) and fetus-newborn (neonatal hair, meconium, placenta and umbilical cord). This article reviews bioanalytical procedures for the determination of these markers of ethanol consumption during pregnancy and related prenatal exposure. In addition, clinical toxicological applications of these procedures are presented and discussed.

  13. Hipertireoidismo na gravidez: repercussões materno-fetais Hyperthyroidism during pregnancy: maternal-fetal outcomes

    Directory of Open Access Journals (Sweden)

    Amanda Tavares Pinheiro

    2008-09-01

    Full Text Available OBJETIVO: avaliar a experiência do Hospital das Clínicas da Faculdade de Medicina de Botucatu da Universidade Estadual Paulista "Júlio de Mesquita Filho", no acompanhamento de gestantes com hipertireoidismo. MÉTODOS: foram estudadas, retrospectivamente, 60 pacientes, divididas em grupos com hipertireoidismo compensado (GHC=24 e com hipertireoidismo descompensado (GHD=36 e comparadas quanto a características clínico-laboratoriais e intercorrências. Para análise dos resultados, foram utilizados o teste t de Student, as tabelas de contingência, regressão linear múltipla e regressão logística múltipla, com nível de significância de 5,0%. RESULTADOS: propiltiouracil (PTU foi usado por 94,0% do GHD e 42,0% do GHC (pPURPOSE: to evaluate the experience of Hospital das Clínicas da Faculdade de Medicina de Botucatu da Universidade Estadual Paulista "Júlio de Mesquita Filho", in the follow-up of pregnant women with hyperthyroidism. METHODS: Sixty patients, divided in groups with compensated hyperthyroidism (CHG=24 and with uncompensated hyperthyroidism (UHG=36 were retrospectively studied and compared concerning clinical-laboratorial characteristics and intercurrences. The t-Student test, contingency tables, multiple linear regression and multiple logistic regression with significance level at 5.0% were used. RESULTS: propylthiouracil (PTU was used by 94.0% of UHG and by 42.0% of CHG (p<0.0001; maternal complications close to delivery have occurred in 20.6% of UHG and in 11.8% of CHG, and UHG presented three fetal deaths, influenced by the mother age, higher level of T4L (lT4L and of PTU dose (PTUd in the third trimester (p=0.007; restriction of intra-uterine growth, influenced by lT4L and PTUd in the third trimester has occurred in nine UHG and in three CHG cases, and oligoamnios has occurred in 12 patients (83.3% of UGH and 16.7% of CGH, influenced by age and lT4L in the third trimester (p=0.04; the gestational age at delivery was 34.4

  14. Effects of calcium supplementation during pregnancy on maternal, fetal and birth outcomes.

    Science.gov (United States)

    Imdad, Aamer; Bhutta, Zulfiqar A

    2012-07-01

    Gestational hypertensive disorders are the second leading cause of maternal death worldwide. Epidemiological and clinical studies have shown that an inverse relationship exists between calcium intake and development of hypertension in pregnancy. The purpose of this review was to evaluate preventive effect of calcium supplementation during pregnancy on gestational hypertensive disorders and related maternal and neonatal morbidity and mortality. A literature search was carried out on PubMed, WHOLIS, PAHO and Cochrane Library. Only randomised trials were included in the review. Data were extracted into a standardised Excel sheet. Primary outcomes were pre-eclampsia, preterm birth and birthweight. Other neonatal outcomes such as neonatal mortality, small-for-gestational age and low birthweight were also evaluated. A total of 15 randomised controlled trials were included in this review. Pooled analysis showed that calcium supplementation during pregnancy reduced risk of pre-eclampsia by 52% [relative risk (RR) 0.48; 95% confidence interval (CI) 0.34, 0.67] and that of severe pre-eclampsia by 25% (RR 0.75 [95% CI 0.57, 0.98]). There was no effect on incidence of eclampsia (RR 0.73 [95% CI 0.41, 1.27]). There was a significant reduction for risk of maternal mortality/severe morbidity (RR 0.80 [95% CI 0.65, 0.97]). Calcium supplementation during pregnancy was also associated with a significant reduction in risk of pre-term birth (RR 0.76 [95% CI 0.60, 0.97]). There was an extra gain of 85 g in the intervention group compared with control (mean difference 85 g [95% CI 37, 133]). There was no effect of calcium supplementation on perinatal mortality (RR 0.90 [95% CI 0.74, 1.09]). There was a statistically non-significant increased risk of urolithiasis in the intervention group compared with control (RR 1.52 [95% CI 0.06, 40.67]). In conclusion, calcium supplementation during pregnancy is associated with a reduction in risk of gestational hypertensive disorders and pre

  15. [Eluding clinical medicine: a phenomenon that can be stopped].

    Science.gov (United States)

    Benor, Dan E

    2010-04-01

    A study published in this issue (Lotan et at.) reveals distressing data on the percentage of 4th year students, after their first clerkship, that regret their choice of medicine as a career and contemplate a non-clinical vocational path. This phenomenon, entitled "eluding clinical medicine", is analyzed in terms of early professional socialization of the students toward sciences and their difficulty to tolerate ambiguity and uncertainty, so typical to clinical medicine. Also discussed is the student's incapability to integrate acquired knowledge across disciplines and to interweave it into clinical reality. Rectification of this escape from clinical medicine" may require modification of the pattern of the students' professional socialization during their first years of studies by such measures as early clinical exposure, interdisciplinary integration and practice in decision-making and problem-solving throughout the so-called "preclinical phase". The alarming findings presented in the above-mentioned study call for immediate response.

  16. Cytokine medicines in clinical practice: current issues.

    Science.gov (United States)

    Barnes, Theresa; Moots, Robert J; Goodacre, John

    2005-10-21

    Cytokine medicines have been licensed for the treatment of rheumatoid arthritis since 2000. The rheumatology community has accrued a large amount of experience in the use of these medications. This experience has led to the development of guidelines for their use that include ongoing vigilance for long term adverse events and efficacy using the Biologics Register. Delivery of these expensive therapies has prompted extensive system developments within rheumatology. The cytokine medicines have provided important tools to probe the pathogenesis of rheumatoid and other inflammatory diseases. Further cytokine medicines, in various stages of development, are on the horizon and continue to stimulate excitement within this fast expanding field.

  17. An analysis of variations of indications and maternal-fetal prognosis for caesarean section in a tertiary hospital of Beijing

    Science.gov (United States)

    Liu, Yajun; Wang, Xin; Zou, Liying; Ruan, Yan; Zhang, Weiyuan

    2017-01-01

    decreased in 2014. Caesarean delivery on maternal request (CDMR) cannot improve the maternal-fetal prognosis compared with the spontaneous vaginal delivery. With the releasing of China's 2 children policy, more CS will be implemented due to previous CS. There is a need for further research that evaluates interventions for increasing VBAC rates that target clinicians. PMID:28207498

  18. Clinical practice in community medicine: Challenges and opportunities

    Directory of Open Access Journals (Sweden)

    Rajesh Kumar

    2017-01-01

    Full Text Available Clinical practice with community health perspective makes community medicine a unique specialty. In their health centers, community physicians not only implement disease prevention programs, assess community health needs, manage healthcare teams and advocate for health promoting policies but also diagnose and treat diseases. However, participation of community medicine faculty in the delivery of clinical care varies from place to place due to administrative constraints. Health centers attached with medical college are not dependent on community medicine faculty for clinical service as these centers have their own medical and paramedical staff; whereas, other clinical departments in medical colleges depend on their faculty for delivery of clinical care in the hospital. Consequently, a perception is gaining ground that community medicine is a para-clinical specialty. Strategies for a fixed tenured rotation of faculty in the health centers should be evolved. All faculty members of community medicine must also provide clinical care in the health centers and the quantum of clinical services provided by each one of them should be reported widely to all stakeholders. Community medicine residency programs must ensure that trainee community physicians acquire competency to deliver comprehensive primary health care (promotive, preventive, curative, and rehabilitative in a health center.

  19. Literature and medicine: contributions to clinical practice.

    Science.gov (United States)

    Charon, R; Banks, J T; Connelly, J E; Hawkins, A H; Hunter, K M; Jones, A H; Montello, M; Poirer, S

    1995-04-15

    Introduced to U.S. medical schools in 1972, the field of literature and medicine contributes methods and texts that help physicians develop skills in the human dimensions of medical practice. Five broad goals are met by including the study of literature in medical education: 1) Literary accounts of illness can teach physicians concrete and powerful lessons about the lives of sick people; 2) great works of fiction about medicine enable physicians to recognize the power and implications of what they do; 3) through the study of narrative, the physician can better understand patients' stories of sickness and his or her own personal stake in medical practice; 4) literary study contributes to physicians' expertise in narrative ethics; and 5) literary theory offers new perspectives on the work and the genres of medicine. Particular texts and methods have been found to be well suited to the fulfillment of each of these goals. Chosen from the traditional literary canon and from among the works of contemporary and culturally diverse writers, novels, short stories, poetry, and drama can convey both the concrete particularity and the metaphorical richness of the predicaments of sick people and the challenges and rewards offered to their physicians. In more than 20 years of teaching literature to medical students and physicians, practitioners of literature and medicine have clarified its conceptual frameworks and have identified the means by which its studies strengthen the human competencies of doctoring, which are a central feature of the art of medicine.

  20. [Placebo control and clinical trial of Chinese medicine].

    Science.gov (United States)

    Wu, Jing

    2010-10-01

    World Health Organization aims to develop safe, effective and practical traditional medicine. Traditional Chinese medicine (TCM) and other complementary and alternative medicine are being recognized in the whole world nowadays. However, the definite effect of Chinese medicine is still in need of scientific research proof. Placebo control is of equal importance to active control and blank control in clinical trial of TCM. This article briefly reviewed the importance of placebo control and commented on its present situation in clinical trial of TCM. This article also brought up the preliminary proposals of placebo application in TCM clinical trial. We should emphasize scientific placebo preparation and good design of placebo-controlled trial, which are directed by International Conference on Harmonization of Technical Requirements for Registration of Pharmaceuticals for Human Use. A good clinical trial project will avoid unnecessary wastes and provide safe and effective treatment for people.

  1. Toxicological considerations of herbal medicines in clinical use

    Institute of Scientific and Technical Information of China (English)

    IkegF; FujiY

    2002-01-01

    Based on herbal crude drugs listed in WHO monographs,the clinical uses and toxicity such as acute,chronic and mutagenic of 16 herbal medicines among 210 medicinal prescriptions used in present-day Japan are summarized.These herbal medicines are claddified into two categories:8 kinds of prescription containing Bupleurum root such as Sho-saiko-to and Saiko-keishi-to,or 8 kinds of prescription not containing Bupleurum root such as Juzen-taiho-to and Ninjin-yoei-to.Some potential interactions between herbal medicine and the Western drugs are also described.

  2. Significance of Evidence-based Medicine in the Assessment of Chinese Medicine Clinical Efficacy

    Institute of Scientific and Technical Information of China (English)

    WANG Ji-yao

    2010-01-01

    @@ Evidence-based medicine (EBM) requires the integration of the best research evidence with our clinical expertise and our patient's unique values and circumstances.The best evidence is valid and clinically relevant,especially from patient-centered clinical research.The clinical expertise means the ability to use our clinical skills and past experiences to rapidly identify each patient's unique health state and diagnosis,their individual risks,and the benefits of interventions (1)..

  3. A Deliberation for Evaluating Clinical Effects in Chinese Medicine

    Institute of Scientific and Technical Information of China (English)

    WANG Jia-liang

    2010-01-01

    @@ Chinese medicine (CM) has several thousands of years of history and has made a great contribution to human health and disease prevention in the world.Since there are so many differences between CM and Western medicine (WM) on their theory and methods in disease diagnosis and treatment,how to evaluate the clinical effects exactly and correctly in clinical practice becomes one bottleneck problem in CM.This is also the primary theme of the 369th Xiangshan Seminar,2010,Beijing.

  4. Motivation of clinical teachers at Schools of Sports Medicine:

    OpenAIRE

    Rosety-Rodríguez, Manuel; Ordoñez, Francisco; Alvero-Cruz, José; Rosety,Ignacio; Fornieles,Gabriel; Díaz, Antonio; Rosety, Miguel; CAMACHO, ALEJANDRA; García-Domingo, Jerónimo; Vaz, Carmen

    2013-01-01

    Introduction This was the first study to focus on what factors may motivate clinical teachers in Sports Medicine Schools. These findings would be of particular interest at a time of decreasing resources for Schools of Sports Medicine to reward teaching. Material and methods A total of 32 clinical teachers (13 females [40%]; 19 males [60%]) volunteered for this observational, cross-sectional study. Conventional Q-methodology so that participants rank-ordered 69 numbered stateme...

  5. [Akita University Graduate School of Medicine: status of clinical laboratory medicine education].

    Science.gov (United States)

    Ito, Wataru; Chihara, Junichi

    2010-03-01

    Education in laboratory medicine is important. However, many medical students and doctors cannot understand this importance. This problem may be caused by the unclear character of laboratory medicine in research as well as hospital work, resulting in a lack of staff in the Department of Laboratory Medicine. One of the characters of laboratory medicine is its all-inclusive actions unrestrained by medical specialty. Thus, we tell medical students that the staff of laboratory medicine are suitable members of the infection control team (ICT) and nutrition support team (NST) in lectures. Moreover, we also teach allergy, immunology, infection, and sex-specific medicine, which are some subjects the topics of research. Many students in Akita University recognize that the staff of the Department of Laboratory Medicine are specialists of infection and allergy. On the other hand, young doctors can also receive postgraduate clinical training and conduct research not restricted to allergy and infection. We have a policy whereby the Department of Laboratory Medicine always opens its door widely to everyone including students and doctors. Nine staff joined the Department of Laboratory Medicine of Akita University about ten years, and now, can fully provide students with medical education. To solve some problems regarding education in laboratory medicine, we should promote our roles in medical education as well as in hospitals, and increase the number of staff.

  6. Clinical Holistic Medicine: When Biomedicine is Inadequate

    Directory of Open Access Journals (Sweden)

    Søren Ventegodt

    2004-01-01

    Full Text Available The modern physician is using pharmaceuticals as his prime tool. Unfortunately, this tool is much less efficient than you might expect from the biochemical theory. The belief in drugs as the solution to the health problems of mankind, overlooking important existing knowledge on quality of life, personal development, and holistic healing seems to be one good reason why approximately every second citizen of our modern society is chronically ill. The biomedical paradigm and the drugs are certainly useful, because in many situations we could not do without the drugs (like antibiotics, but curing infections or diseases in young age is not without consequences, as the way we perceive health and medicine is influenced by such experiences. When we get a more severe disease in midlife, we also believe drugs will make us healthy again. But at this age, the drugs do not work efficiently anymore, because we have turned older and lost much of the biological coherence that made us heal easily when we were younger. Now we need to assume responsibility, take learning, and improve our quality of life. We need a more holistic medicine that can help us back to life by allowing us to access our hidden resources. The modern physician cannot rely solely on drugs, but must also have holistic tools in his medical toolbox. This is the only way we can improve the general health of our populations. Whenever NNT (Number Needed to Treat is 2 or higher, the likelihood of the drug to cure the patient is less than 50%, which is not satisfying to any physician. In this case, he must ethically try something more in order to cure his patients, which is the crossroads where both traditional manual medicine and the tools of a scientific holistic medicine are helpful.

  7. Clinical applications of Personalized Medicine: a new paradigm and challenge.

    Science.gov (United States)

    Di Sanzo, Mariantonia; Fineschi, Vittorio; Borro, Marina; La Russa, Raffaele; Santurro, Alessandro; Scopetti, Matteo; Simmaco, Maurizio; Frati, Paola

    2017-02-23

    The personalized medicine is an emergent and rapidly developing method of clinical practice that uses new technologies to provide decisions in regard to the prediction, prevention, diagnosis and treatment of disease. The continue evolution of technology and the developments in molecular diagnostics and genomic analysis increased the possibility of an even more understanding and interpretation of the human genome and exome, allowing a "personalized" approach to clinical care, so that the concepts of "Systems Medicine" and "System Biology" are increasingly actual. The purpose of this study is to evaluate the personalized medicine about its indications and benefits, actual clinical applications and future perspectives as well as its issues and health care implications. It was made a careful review of the scientific literature on this field that highlighted the applicability and usefulness of this new medical approach as well as the fact that personalized medicine strategy is even more increasing in numerous fields of applications.

  8. Zika Virus Infects Early- and Midgestation Human Maternal Decidual Tissues, Inducing Distinct Innate Tissue Responses in the Maternal-Fetal Interface.

    Science.gov (United States)

    Weisblum, Yiska; Oiknine-Djian, Esther; Vorontsov, Olesya M; Haimov-Kochman, Ronit; Zakay-Rones, Zichria; Meir, Karen; Shveiky, David; Elgavish, Sharona; Nevo, Yuval; Roseman, Moshe; Bronstein, Michal; Stockheim, David; From, Ido; Eisenberg, Iris; Lewkowicz, Aya A; Yagel, Simcha; Panet, Amos; Wolf, Dana G

    2017-02-15

    Zika virus (ZIKV) has emerged as a cause of congenital brain anomalies and a range of placenta-related abnormalities, highlighting the need to unveil the modes of maternal-fetal transmission. The most likely route of vertical ZIKV transmission is via the placenta. The earliest events of ZIKV transmission in the maternal decidua, representing the maternal uterine aspect of the chimeric placenta, have remained unexplored. Here, we show that ZIKV replicates in first-trimester human maternal-decidual tissues grown ex vivo as three-dimensional (3D) organ cultures. An efficient viral spread in the decidual tissues was demonstrated by the rapid upsurge and continued increase of tissue-associated ZIKV load and titers of infectious cell-free virus progeny, released from the infected tissues. Notably, maternal decidual tissues obtained at midgestation remained similarly susceptible to ZIKV, whereas fetus-derived chorionic villi demonstrated reduced ZIKV replication with increasing gestational age. A genome-wide transcriptome analysis revealed that ZIKV substantially upregulated the decidual tissue innate immune responses. Further comparison of the innate tissue response patterns following parallel infections with ZIKV and human cytomegalovirus (HCMV) revealed that unlike HCMV, ZIKV did not induce immune cell activation or trafficking responses in the maternal-fetal interface but rather upregulated placental apoptosis and cell death molecular functions. The data identify the maternal uterine aspect of the human placenta as a likely site of ZIKV transmission to the fetus and further reveal distinct patterns of innate tissue responses to ZIKV. Our unique experimental model and findings could further serve to study the initial stages of congenital ZIKV transmission and pathogenesis and evaluate the effect of new therapeutic interventions. In view of the rapid spread of the current ZIKV epidemic and the severe manifestations of congenital ZIKV infection, it is crucial to learn

  9. Placebos used in clinical trials for Chinese herbal medicine.

    Science.gov (United States)

    Qi, Guan D; We, Ding A; Chung, Leung P; Fai, Cheng K

    2008-06-01

    One of the important components in randomized Controlled Trial (RCT) is blinding. The gold standard of clinical trials is to achieve a double blind design. However, only a small number of randomized controlled trials in traditional Chinese medicine have been reported, most of them are of poor quality in methodology including placebo preparation and verification. The purpose of the article is to review the validity of placebo used in blinded clinical trials for Chinese herbal medicine (CHM) in recent years and related patents. We searched the Wanfang Database (total of 827 Chinese journals of medicine and/or pharmacy, from 1999 to 2005) and 598 full-length articles related to placebo clinical trials were found. 77 placebo blinded clinical trials for Chinese medicine were extracted by manual search from the 598 articles. After reviewing the 77 full-length articles, we found that nearly half of the clinical trials did not pay attention to the physical quality of the testing drug and placebo and whether they were of comparable physical quality. The rest provided very limited placebo information so that blinding assurance could not be assumed. Only 2 articles (2.6%) specifically validated the comparability between the testing drug and the placebo. Researchers in Chinese medicine commonly ignored the quality of the placebo in comparison to the test drug. This may be causing bias in the clinical trials. Quality specifications and evaluation of the placebo should deserve special attention to reduce bias in randomized controlled trials in TCM study.

  10. Radioactive isotopes in clinical medicine and research. Abstracts

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2007-07-01

    The review on the International Symposium on radioactive isotopes in clinical medicine and research in Bad Hofgastein, Austria, 9-12 January 2008, contains 42 papers and 29 poster contributions on the following topics: radiopharmaceutical sciences; radiopharmaceutical sciences in oncology and cardiology; therapy; endocrinology; molecular imaging; clinical PET; physics: image processing; instrumentation, neurology, psychiatry.

  11. Application and Exploration of Big Data Mining in Clinical Medicine

    Institute of Scientific and Technical Information of China (English)

    Yue Zhang; Shu-Li Guo; Li-Na Han; Tie-Ling Li

    2016-01-01

    Objective:To review theories and technologies of big data mining and their application in clinical medicine.Data Sources:Literatures published in English or Chinese regarding theories and technologies of big data mining and the concrete applications of data mining technology in clinical medicine were obtained from PubMed and Chinese Hospital Knowledge Database from 1975 to 2015.Study Selection:Original articles regarding big data mining theory/technology and big data mining's application in the medical field were selected.Results:This review characterized the basic theories and technologies of big data mining including fuzzy theory,rough set theory,cloud theory,Dempster-Shafer theory,artificial neural network,genetic algorithm,inductive learning theory,Bayesian network,decision tree,pattern recognition,high-performance computing,and statistical analysis.The application of big data mining in clinical medicine was analyzed in the fields of disease risk assessment,clinical decision support,prediction of disease development,guidance of rational use of drugs,medical management,and evidence-based medicine.Conclusion:Big data mining has the potential to play an important role in clinical medicine.

  12. Clinical update on nursing home medicine: 2013.

    Science.gov (United States)

    Messinger-Rapport, Barbara J; Gammack, Julie K; Thomas, David R; Morley, John E

    2013-12-01

    This is the seventh article in the series of Clinical Updates on Nursing Home Care. The topics covered are antiresorptive drugs, hip fracture, hypertension, orthostatic hypotension, depression, undernutrition, anorexia, cachexia, sarcopenia, exercise, pain, and behavioral and psychological symptoms of dementia.

  13. NMR clinical imaging and spectroscopy: Its impact on nuclear medicine

    Energy Technology Data Exchange (ETDEWEB)

    1990-02-02

    This is a collection of four papers describing aspects of past and future use of nuclear magnetic resonance as a clinical diagnostic tool. The four papers are entitled (1) What Does NMR Offer that Nuclear Medicine Does Not by Jerry W. Froelich, (2) Oncological Imaging: Now, Future and Impact Jerry W. Froelich, (3) Magnetic Resonance Spectroscopy/Spectroscopic Imaging and Nuclear Medicine: Past, Present and Future by H. Cecil Charles, and (4) MR Cardiology: Now, Future and Impact by Robert J. Herfkens.

  14. NMR clinical imaging and spectroscopy: Its impact on nuclear medicine

    Energy Technology Data Exchange (ETDEWEB)

    1990-02-02

    This is a collection of four papers describing aspects of past and future use of nuclear magnetic resonance as a clinical diagnostic tool. The four papers are entitled (1) What Does NMR Offer that Nuclear Medicine Does Not? by Jerry W. Froelich, (2) Oncological Imaging: Now, Future and Impact Jerry W. Froelich, (3) Magnetic Resonance Spectroscopy/Spectroscopic Imaging and Nuclear Medicine: Past, Present and Future by H. Cecil Charles, and (4) MR Cardiology: Now, Future and Impact by Robert J. Herfkens.

  15. Chinese medical researches of maternal-fetal ABO blood type incompatibility%母儿ABO血型不合的中医药研究进展

    Institute of Scientific and Technical Information of China (English)

    胡凤英; 赵蕾; 吕玲

    2010-01-01

    母罂ABO血型不合可导致多种新生儿疾病甚至死亡,部分核黄疸幸存儿的智力发育多受到影响.本文综述了母婴ABO血型不合的病因病机、孕前期和妊娠期中医药治疗的方法及其疗效.%Maternal-fetal ABO blood type incompatibility is an autoimmune disease.This disease can lead to miscarriage,stillbirth,children edema,early-onset neonatal jaundice,hemolytic anemia,kemicterus and neonatal death,etc.The author overviewed the etiology and pathogenesis of Matemal-fetal ABO blood type incompatibility,as well as the TCM therapeutic methods and effects in treating this disease at pre-pregnancy period and pregnancy.

  16. [Contemplation on the application of big data in clinical medicine].

    Science.gov (United States)

    Lian, Lei

    2015-01-01

    Medicine is another area where big data is being used. The link between clinical treatment and outcome is the key step when applying big data in medicine. In the era of big data, it is critical to collect complete outcome data. Patient follow-up, comprehensive integration of data resources, quality control and standardized data management are the predominant approaches to avoid missing data and data island. Therefore, establishment of systemic patients follow-up protocol and prospective data management strategy are the important aspects of big data in medicine.

  17. Porcine reproductive and respiratory syndrome virus infection is associated with an increased number of Sn-positive and CD8-positive cells in the maternal-fetal interface.

    Science.gov (United States)

    Karniychuk, U U; De Spiegelaere, W; Nauwynck, H J

    2013-09-01

    It is already known that porcine reproductive and respiratory syndrome virus (PRRSV) infection in lungs changes a local cell pattern and cytokine profile. However, there is no information about cellular and immunological events upon PRRSV infection in the maternal-fetal interface yet. The altered number and/or function of macrophages and NK cells in the maternal-fetal interface during infection may have a functional importance for virus replication. In addition, local cellular and immunological disbalance may also disrupt fragile homeostasis and contribute to the PRRSV-related reproductive disorders. Sialoadhesin (Sn)-positive macrophages are target cells for PRRSV and Sn overexpression has been observed upon chronic inflammatory and infectious diseases. It is also known that mouse Sn-positive macrophages in lymph nodes are able to closely interact with and activate NK cells in response to viral particles. Therefore, the main purpose of the present study was to examine if PRRSV infection is associated with altered Sn expression on endometrial and placental macrophages. In addition, CD8-positive cells (porcine endometrial NK cells were previously described as CD8(+)CD3(-) cells) were localized and quantified in the PRRSV-positive and control tissues. Tissue samples were obtained from three PRRSV-inoculated and three non-inoculated control sows at 100 days of gestation. Real-time RT-PCR showed a clear upregulation of Sn mRNA expression in the PRRSV-positive endometrium/placenta (pPRRSV-inoculated sows had a significantly higher number of Sn-positive macrophages in the endometrium and placenta due to de novo Sn expression on local CD163-positive macrophages. Along with the increased number of Sn-positive macrophages an increased number of CD8-positive cells, which were mostly CD3-negative, was observed in the PRRSV-positive endometrium. The effects of the observed cellular changes on virus replication and potential contribution to placental damage and reproductive

  18. Early Life Exposure to Fructose Alters Maternal, Fetal and Neonatal Hepatic Gene Expression and Leads to Sex-Dependent Changes in Lipid Metabolism in Rat Offspring.

    Science.gov (United States)

    Clayton, Zoe E; Vickers, Mark H; Bernal, Angelica; Yap, Cassandra; Sloboda, Deborah M

    2015-01-01

    Fructose consumption is associated with altered hepatic function and metabolic compromise and not surprisingly has become a focus for perinatal studies. We have previously shown that maternal fructose intake results in sex specific changes in fetal, placental and neonatal outcomes. In this follow-up study we investigated effects on maternal, fetal and neonatal hepatic fatty acid metabolism and immune modulation. Pregnant rats were randomised to either control (CON) or high-fructose (FR) diets. Fructose was given in solution and comprised 20% of total caloric intake. Blood and liver samples were collected at embryonic day 21 (E21) and postnatal day (P)10. Maternal liver samples were also collected at E21 and P10. Liver triglyceride and glycogen content was measured with standard assays. Hepatic gene expression was measured with qPCR. Maternal fructose intake during pregnancy resulted in maternal hepatic ER stress, hepatocellular injury and increased levels of genes that favour lipogenesis. These changes were associated with a reduction in the NLRP3 inflammasome. Fetuses of mothers fed a high fructose diet displayed increased hepatic fructose transporter and reduced fructokinase mRNA levels and by 10 days of postnatal age, also have hepatic ER stress, and elevated IL1β mRNA levels. At P10, FR neonates demonstrated increased hepatic triglyceride content and particularly in males, associated changes in the expression of genes regulating beta oxidation and the NLRP3 inflammasome. Further, prenatal fructose results in sex-dependant changes in levels of key clock genes. Maternal fructose intake results in age and sex-specific alterations in maternal fetal and neonatal free fatty acid metabolism, which may be associated in disruptions in core clock gene machinery. How these changes are associated with hepatic inflammatory processes is still unclear, although suppression of the hepatic inflammasome, as least in mothers and male neonates may point to impaired immune sensing.

  19. Differential expression of angiotensin II type 1 and type 2 receptors at the maternal-fetal interface: potential roles in early placental development.

    Science.gov (United States)

    Tower, C L; Lui, S; Charlesworth, N R; Smith, S D; Aplin, J D; Jones, R L

    2010-12-01

    Angiotensin II (Ang II) is locally generated in the placenta and regulates syncytial transport, vascular contractility and trophoblast invasion. It acts through two receptor subtypes, AGTR1 and AGTR2 (AT1 and AT2), which typically mediate antagonising actions. The objectives of this study are to characterise the cellular distribution of AGTR1 and AGTR2 at the maternal-fetal interface and explore the effects on cytotrophoblast turnover. Low levels of AGTR2 mRNA were detected in first trimester placental homogenates using real-time PCR. Immunohistochemistry using polyclonal antibodies against AGTR1 and AGTR2 detected the receptors in first trimester placenta, decidua basalis and villous tip outgrowths in culture. Serial staining with cytokeratin-7 was used to identify extravillous trophoblasts (EVTs). AGTR1 was found in the syncytiotrophoblast microvillous membrane, in a subpopulation of villous cytotrophoblasts, and in Hofbauer cells. AGTR1 was strongly upregulated in cytotrophoblasts in cell columns and villous tip outgrowths, but was absent in interstitial and endovascular EVTs within the decidua. AGTR2 immunostaining was present in Hofbauer cells and villous cytotrophoblasts, but was absent from syncytiotrophoblast. Faint staining was detected in cell column cytotrophoblasts and villous outgrowths, but not in EVTs within the decidua. Both receptors were detected in placental homogenates by western blotting. Ang II significantly increased proliferation of cytotrophoblasts in both villous explants and villous tip outgrowths, but did not affect apoptosis. Blockade of AGTR1 and AGTR2 together abrogated this effect. This study shows specific expression patterns for AGTR1 and AGTR2 in distinct trophoblast populations at the maternal-fetal interface and suggests that Ang II plays a role in placental development and generation of EVTs.

  20. Key considerations for conducting Chinese medicine clinical trials in hospitals

    OpenAIRE

    Shergis Johannah L; Parker Shefton; Coyle Meaghan E; Zhang Anthony L; Xue Charlie C

    2013-01-01

    Abstract Conducting clinical trials of Chinese medicines (CM) in hospitals presents challenges for researchers. The success of hospital-based CM clinical trials may be influenced by the protocol design, including the maintenance of CM theory in compliance with scientific rigour and hospital guidelines and justified treatment approaches with results that can translate into clinical practice. Other influences include personnel and resources such as a dedicated team open to CM with an establishe...

  1. Clinical update on nursing home medicine: 2012.

    Science.gov (United States)

    Messinger-Rapport, Barbara J; Cruz-Oliver, Dulce M; Thomas, David R; Morley, John E

    2012-09-01

    This article is the sixth in the series of clinical updates on nursing home care. The topics covered are management of hypertension, antidepressant medications in people with dementia, peripheral arterial disease, probiotics in prevention, and treatment of Clostridium difficile-associated diarrhea, frailty, and falls.

  2. Clinical Holistic Medicine: Holistic Treatment of Children

    Directory of Open Access Journals (Sweden)

    Søren Ventegodt

    2004-01-01

    Full Text Available We believe a holistic approach to problems in childhood and adolescence will benefit the child, adolescent, and the whole family. As a rule, children have far less to say in the family than their parents. Therefore, it is the parents who set the agenda and decide how things are done at home and in relation to the child. Most often, it is also the parents who have a problem when the child is not thriving. The child thus acts as the thermometer of the family. When children are not feeling well or are sick, the parents are not doing well either. Most problems arising from dysfunctional patterns are almost impossible for the parents to solve on their own, but with help and support from the holistically oriented physician, we believe that many problems can be discovered and solved. Not only can health problems be addressed, but also problems of poor thriving in the family in general. With the physician in the role of a coach, the family can be provided with relevant exercises that will change the patterns of dysfunction. Consciousness-based medicine also seems to be efficient with children and adolescents, who are much more sensitive to the psychosocial dimensions than adults. Five needs seem to be essential for the thriving and health of the child: attention, respect, love, acceptance (touch, and acknowledgment. The physician should be able to see if the child lacks fulfillment in one or more of these needs, and he can then demonstrate to the parents how these needs should be handled. This should be followed by simple instructions and exercises for the parents in the spirit of coaching. This approach is especially relevant when the child is chronically ill.

  3. Can emergency medicine research benefit from adaptive design clinical trials?

    Science.gov (United States)

    Flight, Laura; Julious, Steven A; Goodacre, Steve

    2017-04-01

    Adaptive design clinical trials use preplanned interim analyses to determine whether studies should be stopped or modified before recruitment is complete. Emergency medicine trials are well suited to these designs as many have a short time to primary outcome relative to the length of recruitment. We hypothesised that the majority of published emergency medicine trials have the potential to use a simple adaptive trial design. We reviewed clinical trials published in three emergency medicine journals between January 2003 and December 2013. We determined the proportion that used an adaptive design as well as the proportion that could have used a simple adaptive design based on the time to primary outcome and length of recruitment. Only 19 of 188 trials included in the review were considered to have used an adaptive trial design. A total of 154/165 trials that were fixed in design had the potential to use an adaptive design. Currently, there seems to be limited uptake in the use of adaptive trial designs in emergency medicine despite their potential benefits to save time and resources. Failing to take advantage of adaptive designs could be costly to patients and research. It is recommended that where practical and logistical considerations allow, adaptive designs should be used for all emergency medicine clinical trials. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  4. Complementary and alternative medicine use in a pediatric neurology clinic.

    Science.gov (United States)

    Aburahma, Samah K; Khader, Yousef S; Alzoubi, Karem; Sawalha, Noor

    2010-08-01

    To evaluate the frequency and determinants of complementary and alternative medicine (CAM) use in children attending a pediatric neurology clinic in North Jordan, a parent completed questionnaire survey of children attending the pediatric neurology clinic at King Abdullah University Hospital from March to July 2008 was conducted. A review of 176 completed questionnaires showed that 99 parents (56%) had used CAM for their child's specific neurological illness. The most common modalities were prayer/reciting the Quran (77%), religious healers (30%), massage with olive oil (32%), and consumption of honey products (29%). The most common reason was religious beliefs in 68%. None reported lack of trust in conventional medicine as the reason behind seeking CAM. Factors significantly associated with CAM use were speech delay, belief in its usefulness, father's age more than 30 years, and mothers with education less than high school. CAM had a supplementary role in relation to traditional western medicine use.

  5. Toward clinical genomics in everyday medicine: perspectives and recommendations.

    Science.gov (United States)

    Delaney, Susan K; Hultner, Michael L; Jacob, Howard J; Ledbetter, David H; McCarthy, Jeanette J; Ball, Michael; Beckman, Kenneth B; Belmont, John W; Bloss, Cinnamon S; Christman, Michael F; Cosgrove, Andy; Damiani, Stephen A; Danis, Timothy; Delledonne, Massimo; Dougherty, Michael J; Dudley, Joel T; Faucett, W Andrew; Friedman, Jennifer R; Haase, David H; Hays, Tom S; Heilsberg, Stu; Huber, Jeff; Kaminsky, Leah; Ledbetter, Nikki; Lee, Warren H; Levin, Elissa; Libiger, Ondrej; Linderman, Michael; Love, Richard L; Magnus, David C; Martland, AnneMarie; McClure, Susan L; Megill, Scott E; Messier, Helen; Nussbaum, Robert L; Palaniappan, Latha; Patay, Bradley A; Popovich, Bradley W; Quackenbush, John; Savant, Mark J; Su, Michael M; Terry, Sharon F; Tucker, Steven; Wong, William T; Green, Robert C

    2016-01-01

    Precision or personalized medicine through clinical genome and exome sequencing has been described by some as a revolution that could transform healthcare delivery, yet it is currently used in only a small fraction of patients, principally for the diagnosis of suspected Mendelian conditions and for targeting cancer treatments. Given the burden of illness in our society, it is of interest to ask how clinical genome and exome sequencing can be constructively integrated more broadly into the routine practice of medicine for the betterment of public health. In November 2014, 46 experts from academia, industry, policy and patient advocacy gathered in a conference sponsored by Illumina, Inc. to discuss this question, share viewpoints and propose recommendations. This perspective summarizes that work and identifies some of the obstacles and opportunities that must be considered in translating advances in genomics more widely into the practice of medicine.

  6. Methodology guideline for clinical studies investigating traditional Chinese medicine and integrative medicine: executive summary.

    Science.gov (United States)

    Liu, Jian-Ping; Chen, Ke-Ji

    2015-10-01

    This guideline aims to provide a methodological guidance for clinical studies in TCM and integrative medicine in terms of study design, execution, and reporting. The commonly used methods including experimental and observational methods were introduced in this guideline such as randomized clinical trials, cohort study, case-control study, case series, and qualitative method which can be incorporated into above quantitative methods. The guideline can be used for the evaluation of therapeutic effect of TCM therapies or their combination with conventional therapy. TCM therapy refers to one of the followings or their combination: herbal medicine, acupuncture, moxibustion, cupping, Taichi/Qigong, and Guasha,Tuina (therapeutic massage). It is also suitable for research and development of ethnopharmaceuticals or folk medicine.

  7. Key considerations for conducting Chinese medicine clinical trials in hospitals

    Directory of Open Access Journals (Sweden)

    Shergis Johannah L

    2013-02-01

    Full Text Available Abstract Conducting clinical trials of Chinese medicines (CM in hospitals presents challenges for researchers. The success of hospital-based CM clinical trials may be influenced by the protocol design, including the maintenance of CM theory in compliance with scientific rigour and hospital guidelines and justified treatment approaches with results that can translate into clinical practice. Other influences include personnel and resources such as a dedicated team open to CM with an established research culture and the ability to maximise participant recruitment. This article identifies the key challenges and limitations of conducting CM clinical trials in Australian hospitals.

  8. Echocardiography as a Research and Clinical Tool in Veterinary Medicine

    OpenAIRE

    Allen, D G

    1982-01-01

    Echocardiography is the accepted term for the study of cardiac ultrasound. Although a relatively new tool for the study of the heart in man it has already found wide acceptance in the area of cardiac research and in the study of clinical cardiac disease. Animals had often been used in the early experiments with cardiac ultrasound, but only recently has echocardiography been used as a research and clinical tool in veterinary medicine. In this report echocardiography is used in the research of ...

  9. Clinical Next Generation Sequencing for Precision Medicine in Cancer

    OpenAIRE

    Dong, Ling; Wang, Wanheng; Li, Alvin; Kansal, Rina; Chen, Yuhan; Hong CHEN; Li, Xinmin

    2015-01-01

    Rapid adoption of next generation sequencing (NGS) in genomic medicine has been driven by low cost, high throughput sequencing and rapid advances in our understanding of the genetic bases of human diseases. Today, the NGS method has dominated sequencing space in genomic research, and quickly entered clinical practice. Because unique features of NGS perfectly meet the clinical reality (need to do more with less), the NGS technology is becoming a driving force to realize the dream of precision ...

  10. Integrative Medicine in Clinical Practice:From Pattern Differentiation in Traditional Chinese Medicine to Disease Treatment

    Institute of Scientific and Technical Information of China (English)

    吕爱平; 陈可冀

    2009-01-01

    Pattern(syndrome) differentiation is the key theory in traditional Chinese medicine(TCM) and the important diagnostic principle for TCM therapy.More and more medical researchers recognize that the combination of disease diagnosis in biomedicine and pattern differentiation in TCM is essential for the clinical practice, and it has been a common practice model in China since it will produce better clinical effects.

  11. Review of splanchnic oximetry in clinical medicine

    Science.gov (United States)

    Bailey, Sean M.; Mally, Pradeep V.

    2016-09-01

    Global tissue perfusion and oxygenation are important indicators of physiologic function in humans. The monitoring of splanchnic oximetry through the use of near-infrared spectroscopy (NIRS) is an emerging method used to assess tissue oxygenation status. Splanchnic tissue oxygenation (SrS) is thought to be potentially of high value in critically ill patients because gastrointestinal organs can often be the first to suffer ischemic injury. During conditions of hypovolemia, cardiac dysfunction, or decreased oxygen-carrying capacity, blood flow is diverted toward vital organs, such as the brain and the heart at the expense of the splanchnic circulation. While monitoring SrS has great potential benefit, there are limitations to the technology and techniques. SrS has been found to have a relatively high degree of variability that can potentially make it difficult to interpret. In addition, because splanchnic organs only lie near the skin surface in children and infants, and energy from currently available sensors only penetrates a few centimeters deep, it can be difficult to use clinically in a noninvasive manner in adults. Research thus far is showing that splanchnic oximetry holds great promise in the ability to monitor patient oxygenation status and detect disease states in humans, especially in pediatric populations.

  12. Notes on "Clinical and Internal Medicine. Past, Present and Future”

    Directory of Open Access Journals (Sweden)

    Ricardo Hodelín Tablada

    2014-06-01

    Full Text Available "Clinical and Internal Medicine. Past, Present and Future" is a book written by Professor Alfredo Darío Espinosa Brito and published by Medical Sciences in 2011. It was awarded the prize of the Cuban Academy of Sciences. This article aims to encourage reading this book, a veritable compendium of the past, present and future of internal medicine. It outlines the issues addressed, from the structure designed for them to a fairly comprehensive assessment of the elements that define the scientific and literary value of this work.

  13. Technical Developments and Clinical Use of Telemedicine in Sleep Medicine

    Directory of Open Access Journals (Sweden)

    Marie Bruyneel

    2016-12-01

    Full Text Available The use of assistive technology and telemedicine is likely to continue to shape our medical practice in the future, notably in the field of sleep medicine, especially within developed countries. Currently, the number of people suffering from obstructive sleep apnea syndrome (OSAS is increasing. Telemedicine (TM can be used in a variety of ways in sleep medicine: telediagnostics, teleconsultation, teletherapy and telemonitoring of patients being treated with positive pressure devices. In this review, we aim to summarize the recent scientific progresses of these techniques and their potential clinical applications and give consideration to the remaining problems related to TM application.

  14. Reproductive medicine involving genome editing: clinical uncertainties and embryological needs.

    Science.gov (United States)

    Ishii, Tetsuya

    2017-01-01

    Genome editing based on site-directed nucleases facilitated efficient and versatile genetic modifications in human cells. However, recent reports, demonstrating CRISPR/Cas9-mediated genome editing in human embryos have raised profound concerns worldwide. This commentary explores the clinical justification and feasibility of reproductive medicine using germline genome editing. Despite the perceived utility of reproductive medicine for treating intractable infertility, it is difficult to justify germline genome editing from the perspective of the prospective child. As suggested by the UK legalization regarding mitochondrial donation, the prevention of genetic disease in offspring by genome editing might be acceptable in limited cases of serious or life-threatening conditions, where no alternative medicine is available. Nonetheless, the mosaicism underlying human embryos as well as the off-target effect by artificial nucleases will likely hamper preimplantation genetic diagnosis prior to embryo transfer. Such considerations suggest that this type of reproductive medicine should not be developed toward a clinical application. However, the clinical uncertainties underscore the need for embryology that can address fundamental questions regarding germline aneuploidy and mosaicism using genome editing. Copyright © 2016 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

  15. An eMERGE Clinical Center at Partners Personalized Medicine

    Directory of Open Access Journals (Sweden)

    Jordan W. Smoller

    2016-01-01

    Full Text Available The integration of electronic medical records (EMRs and genomic research has become a major component of efforts to advance personalized and precision medicine. The Electronic Medical Records and Genomics (eMERGE network, initiated in 2007, is an NIH-funded consortium devoted to genomic discovery and implementation research by leveraging biorepositories linked to EMRs. In its most recent phase, eMERGE III, the network is focused on facilitating implementation of genomic medicine by detecting and disclosing rare pathogenic variants in clinically relevant genes. Partners Personalized Medicine (PPM is a center dedicated to translating personalized medicine into clinical practice within Partners HealthCare. One component of the PPM is the Partners Healthcare Biobank, a biorepository comprising broadly consented DNA samples linked to the Partners longitudinal EMR. In 2015, PPM joined the eMERGE Phase III network. Here we describe the elements of the eMERGE clinical center at PPM, including plans for genomic discovery using EMR phenotypes, evaluation of rare variant penetrance and pleiotropy, and a novel randomized trial of the impact of returning genetic results to patients and clinicians.

  16. Challenges of Identifying Clinically Actionable Genetic Variants for Precision Medicine

    Directory of Open Access Journals (Sweden)

    Tonia C. Carter

    2016-01-01

    Full Text Available Advances in genomic medicine have the potential to change the way we treat human disease, but translating these advances into reality for improving healthcare outcomes depends essentially on our ability to discover disease- and/or drug-associated clinically actionable genetic mutations. Integration and manipulation of diverse genomic data and comprehensive electronic health records (EHRs on a big data infrastructure can provide an efficient and effective way to identify clinically actionable genetic variants for personalized treatments and reduce healthcare costs. We review bioinformatics processing of next-generation sequencing (NGS data, bioinformatics infrastructures for implementing precision medicine, and bioinformatics approaches for identifying clinically actionable genetic variants using high-throughput NGS data and EHRs.

  17. [Application of Delphi method in traditional Chinese medicine clinical research].

    Science.gov (United States)

    Bi, Ying-fei; Mao, Jing-yuan

    2012-03-01

    In recent years, Delphi method has been widely applied in traditional Chinese medicine (TCM) clinical research. This article analyzed the present application situation of Delphi method in TCM clinical research, and discussed some problems presented in the choice of evaluation method, classification of observation indexes and selection of survey items. On the basis of present application of Delphi method, the author analyzed the method on questionnaire making, selection of experts, evaluation of observation indexes and selection of survey items. Furthermore, the author summarized the steps of application of Delphi method in TCM clinical research.

  18. Contemporary art in medicine: the Cleveland Clinic art collection

    Science.gov (United States)

    2011-01-01

    Fine art is good medicine. It comforts, elevates the spirit, and affirms life and hope. Art in the healthcare setting, combined with outstanding care and service, creates an environment that encourages healing and supports the work of medical professionals. As one of the world’s great medical centers, Cleveland Clinic has always included the arts in its healing environment. The four founders and subsequent leadership encouraged artistic and musical expression by employees. Distinguished artworks have long hung on the walls. In 1983, an Aesthetics Committee was officially formed at Cleveland Clinic to address issues of art and design in Cleveland Clinic facilities. PMID:24282686

  19. Contemporary art in medicine: the Cleveland Clinic art collection.

    Science.gov (United States)

    Finkel, Jennifer

    2011-12-01

    Fine art is good medicine. It comforts, elevates the spirit, and affirms life and hope. Art in the healthcare setting, combined with outstanding care and service, creates an environment that encourages healing and supports the work of medical professionals. As one of the world's great medical centers, Cleveland Clinic has always included the arts in its healing environment. The four founders and subsequent leadership encouraged artistic and musical expression by employees. Distinguished artworks have long hung on the walls. In 1983, an Aesthetics Committee was officially formed at Cleveland Clinic to address issues of art and design in Cleveland Clinic facilities.

  20. Traditional Chinese medicine: potential for clinical treatment of rheumatoid arthritis.

    Science.gov (United States)

    Moudgil, Kamal D; Berman, Brian M

    2014-07-01

    Rheumatoid arthritis (RA) is a chronic debilitating autoimmune disease affecting people worldwide. Increasing numbers of RA patients in the west are resorting to various complementary and alternative medicine modalities for relief of symptoms and well-being. Herbal products and acupuncture representing traditional Chinese medicine (TCM) are two of the most commonly used forms of complementary and alternative medicine. Frequently, their efficacy against RA and safety have been inferred from anecdotal experience or pilot testing on a relatively small number of patients following inadequate study designs. Accordingly, significant efforts need to be invested in objectively testing TCM in clinical trials that are sufficiently powered, randomized, blinded, possess appropriate controls and follow standard criteria for assessment of the outcomes. In addition, the mechanisms underlying the immunomodulatory and other antiarthritic activities of TCM modalities need to be better defined. These efforts would help validate the scientific rationale for the use of TCM for the management of RA.

  1. The Top 100 Cited Articles in Clinical Orthopedic Sports Medicine.

    Science.gov (United States)

    Nayar, Suresh K; Dein, Eric J; Spiker, Andrea M; Bernard, Johnathan A; Zikria, Bashir A

    2015-08-01

    Orthopedic sports medicine continues to evolve, owing much of its clinical management and practice to rigorous academic research. In this review, we identify and describe the top 100 cited articles in clinical sports medicine and recognize the authors and institutions driving the research. We collected articles (excluding basic science, animal, and cadaveric studies) from the 25 highest-impact sports medicine journals and analyzed them by number of citations, journal, publication date, institution, country, topic, and author. Mean number of citations was 408 (range, 229-1629). The articles were published in 7 journals, most in the 1980s to 2000s, and represented 15 countries. Thirty topics were addressed, with a heavy emphasis on anterior cruciate ligament injury and reconstruction, knee rating systems, rotator cuff reconstruction, and chondrocyte transplantation. The 3 most cited articles, by Insall and colleagues, Constant and Murley, and Tegner and Lysholm, addressed a knee, a shoulder, and another knee rating system, respectively. Several authors contributed multiple articles. The Hospital for Special Surgery and the University of Bern contributed the most articles (5 each). This study provides a comprehensive list of the past century's major academic contributions to sports medicine. Residents and fellows may use this list to guide their scholarly investigations.

  2. Formal errors in non-pharmaceutical medicine (CAM): clinical medicine, mind-body medicine, body-psychotherapy, holistic medicine, clinical holistic medicine and sexology.

    Science.gov (United States)

    Ventegodt, Søren; Andersen, Niels Jørgen; Kandel, Isack; Merrick, Joav

    2009-01-01

    This paper identifies five formal errors in non-drug medicine including most types of complementary and alternative medicine (CAM). These are based on five central principles of healing from the curriculum of the EU master in complementary, psychosocial and integrated health sciences (EU-MSc-CAM) from the Interuniversity College in Graz, Austria. An error is defined, as a therapeutic intervention that judged from established scientific knowledge should have been done differently. We found formal errors regarding: 1) The principle of salutogenesis, 2) The principle of similarity, 3) The principle that healing happens in surplus of resources, 4) The principle of using as little force as possible (primum non nocere), 5) The Hering's law of cure (you will get well in the opposite order of the way you got ill). From the primary errors secondary errors can be identified: A) Focusing on the patient's consciousness instead of the patient's unconscious, B) Wasting time on taking anamnesis and giving diagnoses, C) To ignore that the therapy does not help, D) Not to refer a patient that you know cannot be helped by you, E) Not to observe that a close relationship does not develop between therapist and patient, F) To work on a patient that you are not competent to help, G) Not to support the development of the patient into an independent person, H) Not letting go of the patient. None of the errors caused harm to the patient but slowed down healing. The presented list of errors is ideal for training and supervision.

  3. Effects of epidural ropivacaine labor analgesia on duration of labor and maternal-fetal%罗哌卡因用于分娩镇痛对产程和母婴的影响

    Institute of Scientific and Technical Information of China (English)

    贾亚楠; 白华; 李明静; 李帆; 孟凡杰

    2014-01-01

    目的:探讨罗哌卡因用于分娩镇痛时对产程和母婴的影响。方法采用回顾性研究的方法,将本院198例产妇分为镇痛组和对照组,观察两组产妇产程、产后2小时出血量及两组新生儿的Apgar评分情况。结果较对照组而言,镇痛组第一产程有所缩短(t=2.343,P<0.05),第二产程有所延长(t=2.391,P<0.05)。两组在产后2小时出血量及两组新生儿的Apgar评分情况上差异无显著性(t=2.343,P>0.05)。结论罗哌卡因用于产妇的镇痛分娩是安全有效的,但实际使用时仍需要结合产妇实际情况,进行合理用药。%Objective To study the effects of epidural ropivacaine labor analgesia on duration of labor and maternal-fetal. Methods 198 maternals from one of third-grade class-A hospital were divided into analgesia group and the control group to observe two groups of maternal labor, postpartum 2 hours blood loss and two groups of neonatal Apgar score by using retrospective study method. Results Compare matched control but speech, the town was painful the set produce a distance to have to shorten in the ifrst (t=2.343, P<0.05) and produce in the second distance up had extension (t = 2.391, P < 0.05). Show differences on nonentity of two sets of the circumstances of Apgar grade points that bleed quantity and two sets of new borns in the postnatal period 2 hours. Conclusion The ropivacaine is a safety because of useding for the pregnant woman's town pain childbearing effective of, but still need to combine a pregnant woman actual circumstance while physically using, carry on reasonable to use a medicine.

  4. Clinical uses of the medicinal leech: A practical review

    Directory of Open Access Journals (Sweden)

    B S Porshinsky

    2011-01-01

    Full Text Available The medicinal leech, Hirudo medicinalis, is an excellent example of the use of invertebrates in the treatment of human disease. Utilized for various medical indications since the ancient times, the medicinal leech is currently being used in a narrow range of well-defined and scientifically-grounded clinical applications. Hirudotherapy is most commonly used in the setting of venous congestion associated with soft tissue replantations and free flap-based reconstructive surgery. This is a comprehensive review of current clinical applications of hirudotherapy, featuring a comprehensive search of all major medical search engines (i.e. PubMed, Google Scholar, ScientificCommons and other cross-referenced sources. The authors focus on indications, contraindications, practical application/handling of the leech, and therapy-related complications.

  5. Properties and clinical application of zirconia bioceramics in medicine

    Directory of Open Access Journals (Sweden)

    Čedomir Oblak

    2014-01-01

    Full Text Available Background: A group of inorganic non-metal biomaterials, that are commonly used in clinical medicine to replace or repair tissues, can be classified as a bioceramics. This group includes bioactive glasses, glass-ceramics, hydroxy-apatite and some other calcium phosphates. In addition, some bio-inert engineering ceramics materials have become increasingly utilised, aluminum oxide, zirconium oxide and their composites being the most popular. With the developement of yttria stabilized tetragonal zirconium oxide ceramics (Y-TZP medical community received a high strength biomaterial that is currently a material of choice for the manufacturing of medical devices. Y-TZP ceramics is becoming also increasingly used in dental medicine, where frameworks are manufactured by the use of computer-assisted technology.Conclusions: The article describes the basic properties of zirconia oxide ceramics important for the use in clinical medicine; high strength and fracture toughness, biocompatibility and negligible radiation. The ageing issue of this particular material, which is attributable to the thermo-dynamical instability of tetragonal zirconium oxide in hydrothermal conditions, is also discussed. When exposed to an aqueous environment over long periods of time, the surface of the Y-TZP ceramic will start transforming spontaneously into the monoclinic structure. The mechanism leading to the t-m transformation is temperature-dependent and is accompanied by extensive micro-cracking, which ultimately leads to strength degradation. The degradation might influence the clinical success rate of medical devices and therefore Y-TZP femoral heads are no longer made of pure zirconium oxide. Composites of zirconium and aluminium oxides are used instead, that are currently the strongest ceramic materials used in clinical medicine. In this work the clinical application of zirconia oxide ceramics in dental medicine is also presented. Conventional porcelain fused to metal

  6. A systematic review of clinical audit in companion animal veterinary medicine

    National Research Council Canada - National Science Library

    Rose, Nicole; Toews, Lorraine; Pang, Daniel S J

    2016-01-01

    .... In contrast, in veterinary medicine there appear to have been a limited number of clinical audits published, indicating that while clinical audit is recognised, its adoption in veterinary medicine...

  7. Genotype and fetal size affect maternal-fetal amino acid status and fetal endocrinology in Large White × Landrace and Meishan pigs.

    Science.gov (United States)

    Ashworth, Cheryl J; Nwagwu, Margaret O; McArdle, Harry J

    2013-01-01

    This study compared maternal plasma amino acid concentrations, placental protein secretion in vitro and fetal body composition and plasma amino acid and hormone concentrations in feto-placental units from the smallest and a normally-sized fetus carried by Large White × Landrace or Meishan gilts on Day 100 of pregnancy. Compared with Large White × Landrace, Meishan placental tissue secreted more protein and Meishan fetuses contained relatively more fat and protein, but less moisture. Fetal plasma concentrations of insulin, triiodothryonine, thyroxine and insulin-like growth factor (IGF)-II were higher in Meishan than Large White × Landrace fetuses. In both breeds, fetal cortisol concentrations were inversely related to fetal size, whereas concentrations of IGF-I were higher in average-sized fetuses. Concentrations of 10 amino acids were higher in Large White × Landrace than Meishan gilts, while glutamine concentrations were higher in Meishan gilts. Concentrations of alanine, aspartic acid, glutamic acid and threonine were higher in Meishan than Large White × Landrace fetuses. Average-sized fetuses had higher concentrations of asparagine, leucine, lysine, phenylalanine, threonine, tyrosine and valine than the smallest fetus. This study revealed novel genotype and fetal size differences in porcine maternal-fetal amino acid status and fetal hormone and metabolite concentrations.

  8. The Fetal Allograft Revisited: Does the Study of an Ancient Invertebrate Species Shed Light on the Role of Natural Killer Cells at the Maternal-Fetal Interface?

    Directory of Open Access Journals (Sweden)

    Breton F. Barrier

    2008-07-01

    Full Text Available Human pregnancy poses a fundamental immunological problem because the placenta and fetus are genetically different from the host mother. Classical transplantation theory has not provided a plausible solution to this problem. Study of naturally occurring allogeneic chimeras in the colonial marine invertebrate, Botryllus schlosseri, has yielded fresh insight into the primitive development of allorecognition, especially regarding the role of natural killer (NK cells. Uterine NK cells have a unique phenotype that appears to parallel aspects of the NK-like cells in the allorecognition system of B. schlosseri. Most notably, both cell types recognize and reject “missing self” and both are involved in the generation of a common vascular system between two individuals. Chimeric combination in B. schlosseri results in vascular fusion between two individual colonies; uterine NK cells appear essential to the establishment of adequate maternal-fetal circulation. Since human uterine NK cells appear to de-emphasize primary immunological function, it is proposed that they may share the same evolutionary roots as the B. schlosseri allorecognition system rather than a primary origin in immunity.

  9. Maternal Fetal Attachment, Locus of Control and Adherence to STI/HIV Prevention and Prenatal Care Promotion Behaviors in Urban Women.

    Science.gov (United States)

    Kornfield, Sara L; Geller, Pamela A; Epperson, C Neill

    Young women of childbearing age are disproportionately affected by sexually transmitted infections (STIs) including HIV. In particular, young women have more frequent and more serious health problems from STI or HIV infection than men, and among women, African American women have especially high rates of infection. Pregnancy is an important time for beginning or continued STI and HIV prevention behaviors as discontinuing condom use when the contraceptive motivation is gone puts women and their fetuses at risk for contraction of STIs and HIV if they remain sexually active. There are many personal attributes that predict adherence to STI risk reduction behaviors including health related locus of control. The current study surveyed a group of 100 low-income, urban dwelling minority women during their pregnancies to determine whether maternal-fetal attachment, a characteristic specific to pregnancy, favorably influences pregnant women's health related locus of control such that women might be more inclined to engage in preventative STI/HIV risk reduction behaviors. Our findings revealed that while our sample has very high levels of MFA despite the high rate of unplanned pregnancy, condom use is not the method used to reduce the risk of contracting STIs/HIV. Rather, women are more likely to limit their number of sexual partners during pregnancy. While this is beneficial, pregnant women in non-monogamous relationships may discount the importance of condom use during pregnancy. Prenatal care providers can provide education about condom use as a beneficial prenatal care behavior similar to taking prenatal vitamins.

  10. [Examples of the use of music in clinical medicine].

    Science.gov (United States)

    Myskja, A; Lindbaek, M

    2000-04-10

    Music has been an element in medical practice throughout history. There is growing interest in music as a therapeutic tool. Since there is no generally accepted standard for how, when and where music should be applied within a medical framework, this literature study endeavours to present an overview of central areas of application of music in medicine. It further attempts to find tentative conclusions that may be drawn from existing clinical research on the efficacy of music as a medical tool. Traditionally, music has been linked to the treatment of mental illness, and has been used successfully to treat anxiety and depression and improve function in schizophrenia and autism. In clinical medicine several studies have shown analgetic and anxiolytic properties that have been used in intensive care units, both in diagnostic procedures like gastroscopy and in larger operations, in preoperative as well as postoperative phases, reducing the need for medication in several studies. The combination of music with guided imagery and deep relaxation has shown reduction of symptoms and increased well-being in chronic pain syndromes, whether from cancer or rheumatic origin. Music has been used as support in pregnancy and gestation, in internal medicine, oncology, paediatrics and other related fields. The use of music with geriatric patients could prove to be especially fruitful, both in its receptive and its active aspect. Studies have shown that music can improve function and alleviate symptoms in stroke rehabilitation, Parkinson's disease, Alzheimer's disease and other forms of dementia. The role of music in medicine is primarily supportive and palliative. The supportive role of music has a natural field of application in palliative medicine and terminal care. Music is well tolerated, inexpensive, with good compliance and few side effects.

  11. Andragogy in clinical medicine: implications for medical educators

    Directory of Open Access Journals (Sweden)

    Dr. Geetha Mani

    2014-03-01

    Full Text Available In Medical education, the final desired outcome is to prepare the students to meet the challenges in delivering health care to individuals and the community in the most competent and professional manner. Application of Andragogy in medical education especially clinical medicine will enrich the learning experience of students with respect to diagnosing their needs, acquiring knowledge, skills and appropriate attitudes. Various strategies such as problem based learning, clinically associated teaching, critical reflection, role modeling and constructive feedback can be used to enhance the students’ competence and inculcate professionalism among the students.

  12. Application of virtual reality technology in clinical medicine

    Science.gov (United States)

    Li, Lan; Yu, Fei; Shi, Dongquan; Shi, Jianping; Tian, Zongjun; Yang, Jiquan; Wang, Xingsong; Jiang, Qing

    2017-01-01

    The present review discusses the application of virtual reality (VR) technology in clinical medicine, especially in surgical training, pain management and therapeutic treatment of mental illness. We introduce the common types of VR simulators and their operational principles in aforementioned fields. The clinical effects are also discussed. In almost every study that dealt with VR simulators, researchers have arrived at the same conclusion that both doctors and patients could benefit from this novel technology. Moreover, advantages and disadvantages of the utilization of VR technology in each field were discussed, and the future research directions were proposed. PMID:28979666

  13. [The practical medicine and its reformation in XVII-XIX centuries, report 2: the becoming of clinical medicine].

    Science.gov (United States)

    2012-01-01

    The article deals with the becoming of clinical medicine in chronologic scope from 1800 to middle 1870s. The major scientific achievements related to the application of practical medicine such methods as clinical anatomical comparison, laboratory experiment, chemical analysis, physical, instrumental, functional, laboratory diagnostics are discussed.

  14. Chinese medicine pattern differentiation and its implications for clinical practice.

    Science.gov (United States)

    Ferreira, Arthur Sá; Lopes, Agnaldo José

    2011-11-01

    Chinese medicine practitioners apply the differentiation reasoning for decision-making. The wide scope of Chinese medicine intervention provides coverage of methods and techniques with applications to primary, secondary and tertiary levels of prevention. The rapid evolution of mathematical and computational techniques allowed the implementation of several models for pattern differentiation that were tested for several physiologic systems. Concurrently, it is argued that pattern differentiation might improve the efficacy of either traditional or conventional medical interventions. This article reviewed the influence of pattern differentiation into clinical practice organized by medical field: general pattern differentiation; genitourinary (recurrent cystitis); cardiovascular (coronary heart disease; arterial hypertension; angina pectoris); neurology (stroke); surgery; metabolic (diabetes mellitus); hepatic (cirrhosis); gastrointestinal (chronic superficial gastritis); orthopedic (low back pain; rheumatoid arthritis; cervical spondylosis; elbow arthritis); oncology (gastric mucosal dysplasia; lung cancer); gynecologic and obstetric manifestations (nausea and vomiting). The reviewed studies presented achievements that have contributed to the integration of Chinese medicine and evidence-based medicine in the treatment of many mild and severe diseases. Target diseases considered as major public health problems were also investigated and the results are promising regarding the possibility to treat guided by pattern differentiation.

  15. Clinical research of traditional Chinese medicine in big data era.

    Science.gov (United States)

    Zhang, Junhua; Zhang, Boli

    2014-09-01

    With the advent of big data era, our thinking, technology and methodology are being transformed. Data-intensive scientific discovery based on big data, named "The Fourth Paradigm," has become a new paradigm of scientific research. Along with the development and application of the Internet information technology in the field of healthcare, individual health records, clinical data of diagnosis and treatment, and genomic data have been accumulated dramatically, which generates big data in medical field for clinical research and assessment. With the support of big data, the defects and weakness may be overcome in the methodology of the conventional clinical evaluation based on sampling. Our research target shifts from the "causality inference" to "correlativity analysis." This not only facilitates the evaluation of individualized treatment, disease prediction, prevention and prognosis, but also is suitable for the practice of preventive healthcare and symptom pattern differentiation for treatment in terms of traditional Chinese medicine (TCM), and for the post-marketing evaluation of Chinese patent medicines. To conduct clinical studies involved in big data in TCM domain, top level design is needed and should be performed orderly. The fundamental construction and innovation studies should be strengthened in the sections of data platform creation, data analysis technology and big-data professionals fostering and training.

  16. [Gender medicine. Sex- and gender-specific aspects of clinical medicine].

    Science.gov (United States)

    Kautzky-Willer, A

    2014-09-01

    Gender medicine studies sex- and gender-based differences in the development and prevention of diseases, the awareness and presentation of symptoms, and the effectiveness of therapy. Gender medicine is part of personalized medicine, considering differences in biological and psychosocial factors individually. There are differences in genes, chromosomes, hormones, and metabolism as well as differences in culture, environment, and society. Lifelong interactions between physical and psychosocial factors will influence the health and ill-health of men and women in different ways. Epigenetic modifications provide evidence of the impact of environment and lifestyle during vulnerable phases on biological processes, effecting future generations. Maternal lifestyle and environmental factors during pregnancy can impact the health of offspring in later life already in utero in a sex-specific way. Pain, stress, and coping styles differ between men and women. Women experience more dramatic physical changes during their lifetime, which are associated with specific burdens and psychosocial alterations. Women with multiple roles and responsibilities suffering from stress develop depression more frequently. However, men are often not diagnosed and treated appropriately in cases of depression or osteoporosis, diseases that are typically considered "female." There are prominent differences between men and women in medicine regarding the immune system, inflammation, and noncommunicable diseases such as obesity, type 2 diabetes, hypertension, and cardiovascular disease. Women experience more often autoimmune diseases and suffer more frequently from (chronic) pain, neurodegenerative changes, and functional disabilities. Men have shorter life expectancy but relatively more healthy years of life, which is in greater part ascribed to psychosocial determinants. State-of-the-art clinical medicine comprises individual risk factors based on sex- and gender-sensitive health programs in order to

  17. Clinical Mass Spectrometry: Achieving Prominence in Laboratory Medicine

    Energy Technology Data Exchange (ETDEWEB)

    Annesley, Thomas M.; Cooks, Robert G.; Herold, David A.; Hoofnagle, Andrew N.

    2016-01-04

    Each year the journal Clinical Chemistry publishes a January special issue on a topic that is relevant to the laboratory medicine community. In January 2016 the topic is mass spectrometry, and the issue is entitled “Clinical Mass Spectrometry: Achieving Prominence in Laboratory Medicine”. One popular feature in our issues is a Q&A on a topic, clearly in this case mass spectrometry. The journal is assembling a panel of 5-6 experts from various areas of mass spectrometry ranging from instrument manufacturing to practicing clinical chemists. Dick Smith is one of the scientist requested to participate in this special issue Q&A on Mass Spectrometry. The Q&A Transcript is attached

  18. The clinical practice of emergency medicine in Mahajanga, Madagascar

    Directory of Open Access Journals (Sweden)

    Vijay C. Kannan

    2016-03-01

    Conclusion: This is the first descriptive study of the clinical practice of emergency medicine in Mahajanga, Madagascar. It provides both the Malagasy and international medical communities with an objective analysis of the practice of emergency care in Madagascar from both diagnostic and therapeutic standpoints. Emergency care here focuses on the management of traumatic injury and infectious disease. The diagnostic imaging, pharmacologic and procedural therapeutic interventions reflect the burdens placed upon this institution by these diseases. We hope this study will provide guidance for the further development of Malagasy-specific emergency care systems.

  19. The human genome project: Prospects and implications for clinical medicine

    Energy Technology Data Exchange (ETDEWEB)

    Green, E.D.; Waterston, R.H. (Washington Univ., St. Louis, MO (United States))

    1991-10-09

    The recently initiated human genome project is a large international effort to elucidate the genetic architecture of the genomes of man and several model organisms. The initial phases of this endeavor involve the establishment of rough blueprints (maps) of the genetic landscape of these genomes, with the long-term goal of determining their precise nucleotide sequences and identifying the genes. The knowledge gained by these studies will provide a vital tool for the study of many biologic processes and will have a profound impact on clinical medicine.

  20. Careers in clinical academic medicine: new opportunities or old threats?

    Science.gov (United States)

    Buckley, Christopher D

    2007-01-01

    Academic medicine may have been in crisis but it is now starting to flourish again. In the words of Eric Thomas: "Clinical academia has a rosy future if you really celebrate and respect it as an activity, if you ensure a supply of graduates committed to research, if you get the relationship right with the key partners, if you get the best facilities for prosecuting research". It looks as though many of these 'ifs' will now be fulfilled within the reforming agenda of MMC.

  1. Emergency medicine and internal medicine trainees’ smartphone use in clinical settings in the United States

    Directory of Open Access Journals (Sweden)

    Sonja E. Raaum

    2015-10-01

    Full Text Available Purpose: Smartphone technology offers a multitude of applications (apps that provide a wide range of functions for healthcare professionals. Medical trainees are early adopters of this technology, but how they use smartphones in clinical care remains unclear. Our objective was to further characterize smartphone use by medical trainees at two United States academic institutions, as well as their prior training in the clinical use of smartphones. Methods: In 2014, we surveyed 347 internal medicine and emergency medicine resident physicians at the University of Utah and Brigham and Women’s Hospital about their smartphone use and prior training experiences. Scores (0%–100% were calculated to assess the frequency of their use of general features (email, text and patient-specific apps, and the results were compared according to resident level and program using the Mann-Whitney U-test. Results: A total of 184 residents responded (response rate, 53.0%. The average score for using general features, 14.4/20 (72.2% was significantly higher than the average score for using patient-specific features and apps, 14.1/44 (33.0%, P<0.001. The average scores for the use of general features, were significantly higher for year 3–4 residents, 15.0/20 (75.1% than year 1–2 residents, 14.1/20 (70.5%, P=0.035, and for internal medicine residents, 14.9/20 (74.6% in comparison to emergency medicine residents, 12.9/20 (64.3%, P= 0.001. The average score reflecting the use of patient-specific apps was significantly higher for year 3–4 residents, 16.1/44 (36.5% than for year 1–2 residents, 13.7/44 (31.1%; P=0.044. Only 21.7% of respondents had received prior training in clinical smartphone use. Conclusion: Residents used smartphones for general features more frequently than for patient-specific features, but patient-specific use increased with training. Few residents have received prior training in the clinical use of smartphones.

  2. Comparison of Patient Health History Questionnaires Used in General Internal and Family Medicine, Integrative Medicine, and Complementary and Alternative Medicine Clinics.

    Science.gov (United States)

    Laube, Justin G R; Shapiro, Martin F

    2017-05-01

    Health history questionnaires (HHQs) are a set of self-administered questions completed by patients prior to a clinical encounter. Despite widespread use, minimal research has evaluated the content of HHQs used in general internal medicine and family medicine (GIM/FM), integrative medicine, and complementary and alternative medicine (CAM; chiropractic, naturopathic, and Traditional Chinese Medicine [TCM]) clinics. Integrative medicine and CAM claim greater emphasis on well-being than does GIM/FM. This study investigated whether integrative medicine and CAM clinics' HHQs include more well-being content and otherwise differ from GIM/FM HHQs. HHQs were obtained from GIM/FM (n = 9), integrative medicine (n = 11), naturopathic medicine (n = 5), chiropractic (n = 4), and TCM (n = 7) clinics in California. HHQs were coded for presence of medical history (chief complaint, past medical history, social history, family history, surgeries, hospitalizations, medications, allergies, review of systems), health maintenance procedures (immunization, screenings), and well-being components (nutrition, exercise, stress, sleep, spirituality). In HHQs of GIM/FM clinics, the average number of well-being components was 1.4 (standard deviation [SD], 1.4) compared with 4.0 (SD, 1.1) for integrative medicine (p medicine (p = 0.04), 2.0 (SD, 1.4) for chiropractic (p = 0.54), and 2.0 (SD, 1.5) for TCM (p = 0.47). In HHQs of GIM/FM clinics, the average number of medical history components was 6.4 (SD, 1.9) compared with 8.3 (SD, 1.2) for integrative medicine (p = 0.01), 9.0 (SD, 0) for naturopathic medicine (p = 0.01), 7.1 (SD, 2.8) for chiropractic (p = 0.58), and 7.1 (SD, 1.7) for TCM (p = 0.41). Integrative and naturopathic medicine HHQs included significantly more well-being and medical history components than did GIM/FM HHQs. Further investigation is warranted to determine the optimal HHQ content to support the clinical and preventive

  3. Critical thinking in clinical medicine: what is it?

    Science.gov (United States)

    Gupta, Mona; Upshur, Ross

    2012-10-01

    In this paper, we explore the recent emphasis, in various medical contexts, of the term 'critical' or the notion of 'being critical'. We identify various definitions of being critical and note that they differ strikingly. What are these different uses of the term trying to capture that is important in clinical medicine and medical education? We have analysed these qualities as responsibilist, epistemic virtues. We believe that a virtues approach is best able to make sense of the non-cognitive elements of 'being critical', such as the honesty and courage to question claims in the face of persuasion, authority or social pressure. Medical educators and professional bodies seem to agree that being critical is important and desirable. Yet, it is unclear how this quality can be optimally fostered and balanced with the constraints that act upon individual practitioners in the context of institutional medicine including professional standards and the demands of the doctor-patient relationship. Other constraints such as authoritarianism, intimidation and financial pressures may act against the expression of being critical or even the cultivation of critical thinking. The issue of the constraints on critical thinking and the potential hazards it entails will require further consideration by those who encourage being critical in medicine.

  4. Clinical Holistic Medicine: Classic Art of Healingor the Therapeutic Touch

    Directory of Open Access Journals (Sweden)

    Søren Ventegodt

    2004-01-01

    Full Text Available Touching is often a forgotten part of medicine. The manual medicine or therapeutic touch (TT is much more powerful than many modern, biomedically oriented physicians think. Pain and discomfort can be alleviated just by touching the sick area and in this way help the patient to be in better contact with the tissue and organs of their body. Lack of presence in the body seems to be connected with many symptoms that can be readily reversed simply by sensitive touch. When touch is combined with therapeutic work on mind and feelings, holistic healing seems to be facilitated and many problems can be solved in a direct and easy way in the clinic without drugs. This paper gives examples of the strength of manual medicine or therapeutic touch in its most simple form, and points to the power of physical contact between physician and his patient in the context of the theory and practice of holistic healing. Intimacy seems highly beneficial for the process of healing and it is very important to distinguish clearly between intimacy and sexuality for the physician and his patent to be able to give and receive touch without fear and without holding back emotionally.

  5. Quality of natural product clinical trials: a comparison of those published in alternative medicine versus conventional medicine journals.

    Science.gov (United States)

    Cochrane, Zara Risoldi; Gregory, Philip; Wilson, Amy

    2011-06-01

    To compare the quality of natural product clinical trials published in alternative medicine journals versus those published in conventional medicine journals. Systematic search and review of the literature. Randomized controlled trials of natural products were included if they were published in English between 2003 and 2008. Articles were categorized by their journal of publication (alternative medicine versus conventional medicine). Two independent reviewers evaluated study quality using guidelines from the Cochrane Collaboration. The results with respect to the primary outcome (positive or negative) were also assessed. Thirty articles were evaluated, 15 published in alternative medicine journals and 15 in conventional medicine journals. Of articles published in alternative medicine journals, 33.33% (n = 5) were considered low quality, and none were considered high quality. Of articles published in conventional medicine journals, 26.67% (n = 4) were considered low quality and 6.67% (n = 1) were considered high quality. Two thirds of all trials reviewed were of unclear quality, due to inadequate reporting of information relating to the study's methodology. Similar proportions of positive and negative primary outcomes were found in alternative and conventional medicine journals, and low-quality articles were not more likely to report a positive primary outcome (Fisher's exact test, two-tailed p = .287). The quality of natural product randomized controlled trials was similar among alternative and conventional medicine journals. Efforts should be made to improve the reporting of natural product clinical trials for accurate determinations of study quality to be possible.

  6. The future of functional MRI in clinical medicine.

    Science.gov (United States)

    Bullmore, Ed

    2012-08-15

    In the last 20 years or so, functional MRI has matured very rapidly from being an experimental imaging method in the hands of a few labs to being a very widely available and widely used workhorse of cognitive neuroscience and clinical neuroscience research internationally. FMRI studies have had a considerable impact on our understanding of brain system phenotypes of neurological and psychiatric disorders; and some impact already on development of new therapeutics. However, the direct benefit of fMRI to individual patients with brain disorders has so far been minimal. Here I provide a personal perspective on what has already been achieved, and imagine how the further development of fMRI over the medium term might lead to even greater engagement with clinical medicine.

  7. [Quality inspection of clinical research in traditional Chinese medicine].

    Science.gov (United States)

    Li, Rui; Weng, Wei-liang; Tian, Yuan-xiang; Li, Qiu-yan; Lu, Fang

    2010-05-01

    Beginning with 4-level quality control measures of clinical research in traditional Chinese medicine (TCM), we elaborated the implementation process and demands of quality control measures of each level, including quality control, monitoring, auditing, and inspection. On the basis of joint inspection experience of 41 projects of the "Prevention and Treatment of Difficult and Complicated Diseases of TCM" plan of the "11th Five-year National Key Technology R&D Program", we analyzed the ensuring effect of 4-level quality control system and joint inspection model, and then pointed out the existing problems in the executing process of quality control system at different levels and joint inspection model. Finally we investigated what should be revised in the quality control system and joint inspection model, thus providing the theoretical support for quality inspection improvement of TCM clinical research.

  8. Ethical Diversity and the Role of Conscience in Clinical Medicine

    Directory of Open Access Journals (Sweden)

    Stephen J. Genuis

    2013-01-01

    Full Text Available In a climate of plurality about the concept of what is “good,” one of the most daunting challenges facing contemporary medicine is the provision of medical care within the mosaic of ethical diversity. Juxtaposed with escalating scientific knowledge and clinical prowess has been the concomitant erosion of unity of thought in medical ethics. With innumerable technologies now available in the armamentarium of healthcare, combined with escalating realities of financial constraints, cultural differences, moral divergence, and ideological divides among stakeholders, medical professionals and their patients are increasingly faced with ethical quandaries when making medical decisions. Amidst the plurality of values, ethical collision arises when the values of individual health professionals are dissonant with the expressed requests of patients, the common practice amongst colleagues, or the directives from regulatory and political authorities. In addition, concern is increasing among some medical practitioners due to mounting attempts by certain groups to curtail freedom of independent conscience—by preventing medical professionals from doing what to them is apparently good, or by compelling practitioners to do what they, in conscience, deem to be evil. This paper and the case study presented will explore issues related to freedom of conscience and consider practical approaches to ethical collision in clinical medicine.

  9. Acupuncture in clinical and experimental reproductive medicine: a review.

    Science.gov (United States)

    Franconi, G; Manni, L; Aloe, L; Mazzilli, F; Giambalvo Dal Ben, G; Lenzi, A; Fabbri, A

    2011-04-01

    Acupuncture has been used as treatment for infertility for hundreds of years, and recently it has been studied in male and female infertility and in assisted reproductive technologies, although its role in reproductive medicine is still debated. To review studies on acupuncture in reproductive medicine, in experimental and clinical settings. Papers were retrieved on PubMed and Google Scholar and were included in the review if at least the abstract was in English. There is evidence of benefit mainly when acupuncture is performed on the day of embryo transfer (ET) in the live birth rate. Benefit is also evident when acupuncture is performed for female infertility due to polycystic ovary syndrome (PCOS). There is some evidence of sperm quality improvement when acupuncture is performed on males affected by idiopathic infertility. Experimental studies suggest that acupuncture effects are mediated by changes in activity of the autonomic nervous system and stimulation of neuropeptides/neurotransmitters which may be involved in the pathogenesis of infertility. Acupuncture seems to have beneficial effects on live birth rate when performed on the day of ET, and to be useful also in PCOS as well as in male idiopathic infertility, with very low incidence of side effects. However, further studies are necessary to confirm the clinical results and to expand our knowledge of the mechanisms involved.

  10. Mobile in situ obstetric emergency simulation and teamwork training to improve maternal-fetal safety in hospitals.

    Science.gov (United States)

    Guise, Jeanne-Marie; Lowe, Nancy K; Deering, Shad; Lewis, Patricia O; O'Haire, Christen; Irwin, Lori K; Blaser, Molly; Wood, Laurie S; Kanki, Barbara G

    2010-10-01

    Evidence from other high-risk industries has demonstrated that teamwork skills can be taught and effective teamwork may improve safety. Increasingly, health care providers, hospital administrators, and quality and safety professionals are considering simulation as a strategy to improve quality and patient safety. A mobile obstetric emergency simulation and team training program was created to bring simulation technology and teamwork training used routinely in other high reliability fields directly to health care institutions. A mobile unit constituted a practical approach, given the expense of simulation equipment, the time required for staff to develop educational materials and simulation scenarios, and the need to have a standardized program to promote consistent evaluation across sites. Between 2007 and 2009, in situ simulation of obstetric emergencies and teamwork training was tested with more than 150 health care professionals in labor and delivery units across four rural and two community hospitals in Oregon. HOW DO ORGANIZATIONS DETERMINE WHICH TYPE OF SIMULATION IS BEST FOR THEM? Because simulation technologies are relatively costly to start and maintain, it can be challenging for hospitals and health care professionals to determine which format (send staff to a simulation center, develop in-house simulation program, develop a consortium of hospitals that run a simulation program, or use a mobile simulation program) is best for them. In situ simulation is an effective way to develop new skills, to maintain infrequently used clinical skills even among experienced clinical teams, and to uncover and address latent safety threats in the clinical setting.

  11. [From classification medicine to clinical medicine (the end of the XVIII century--1870s). Communication 2. The first stage of clinical medicine development: introduction of the method of clinico-anatomic correlations].

    Science.gov (United States)

    2011-01-01

    The first stage of clinical medicine development is analysed which covers the period from early 1800s to middle 1870s. Considered are basic research achievements associated with introduction of the method of clinico-anatomic correlations into practical medicine.

  12. Investigate the maternal-fetal outcomes of eclampsia complicated with different degree of ;liver damage%子痫并发不同程度肝损害对母胎结局的影响

    Institute of Scientific and Technical Information of China (English)

    谢玉珍; 陈海霞; 何青; 卢澄钰; 李兆生; 李映桃

    2016-01-01

    目的:探讨子痫并发轻、中、重度肝功能损害的临床特点及对母胎结局的影响。方法:回顾分析2009年1月1日至2014年12月30日广州医科大学附属第三医院收治的79例子痫且合并肝功能损害患者的临床资料,按肝功能损害程度分为轻、中、重度3组,比较各组的临床特征及对母胎结局的影响。结果:子痫并发肝损害的发病率为0.24%(79/33084)。轻、中、重度肝功能损害患者的最高收缩压及舒张压比较,差异均有统计学意义(P0.05);3组的抽搐次数比较,差异无统计学意义( P>0.05)。重度并发HELLP综合征与轻度与中度组比较,差异有统计学意义( P0.05)。3组的入住ICU时间比较,差异有统计学意义(P0.05)。3组的新生儿窒息、胎儿生长受限、早产、转新生儿重症监护室率、围产儿死亡差异比较,差异均无统计学意义(P>0.05)。结论:血压控制不良加重肝脏损害;随着肝损害程度加重,HELLP综合征发生率及转重症监护室风险明显增加,但与围产儿结局无明显相关性。%Objective:To investigate the maternal-fetal outcomes of eclampsia compli-cated with different degree of liver damage and explore clinical disposal strategies. Methods:A retrospective chart review of all admissions between Jan. 1,2009 and Dec. 30,2014 included 79 cases with eclampsia who had been hospitalized with abnormal liver function divided into the light,moderate and severe liver damage in the Third Affiliated Hospital of Guangzhou Medical University. To compare the correlations between clinical features and maternal-fetal outcomes a-mong three groups. Results:The incidence of eclampsia with hepatic dysfunction was 0. 24%(79/33084 ) . There was statistically significant about systolic blood pressure/diastolic blood pressure among three groups(P0 . 05 ) . There was no statistically significant difference in the num-ber of tic among three groups. There was no statistically significant

  13. The use of traditional Chinese herb medicine in the treatment of maternal-fetal blood group incompatibility: attached a case report

    Institute of Scientific and Technical Information of China (English)

    徐蕴华; 盖铭英; 刘俊涛; 杨剑秋; 刘善英; 边旭明; 崔子琴; 葛秦生

    2003-01-01

    @@ Patient,Hosp No.C-690021,female,age 34,G3/P2 .LMP:Jan.4,2000.EDC:Oct.11,2000,Menses 7/30-32 days.She wasreferred to our hospital from Xiamen because of her third pregnancy with fetal ascites at 25 weeks.

  14. Relações entre a saúde mental da gestante e o apego materno-fetal Relations between pregnant women's mental health and maternal-fetal attachment

    Directory of Open Access Journals (Sweden)

    Patrícia Alvarenga

    2012-12-01

    Full Text Available O estudo investigou as relações entre variáveis sociodemográficas, saúde mental da gestante e o apego materno-fetal no terceiro trimestre de gestação. Participaram do estudo 261 gestantes selecionadas através de amostragem por acessibilidade em quatro maternidades públicas. As gestantes responderam individualmente uma ficha de dados sociodemográficos, a Escala de Apego Materno-Fetal e o SRQ-20. A análise de regressão revelou que o número de filhos (4% e a saúde mental materna (4,2% explicaram parte da variância no apego materno-fetal. A escolaridade da mãe e do pai não esteve associada a essa variável. O modelo de regressão múltipla considerando os quatro fatores analisados, explicou 8,2% da variância nos escores de apego materno-fetal. Discutem-se as implicações dessas variáveis na formação do vínculo da mãe com o bebê durante a gestação.This study investigated the relations among sociodemographic variables, pregnant women mental health, and maternal-fetal attachment in the third trimester of pregnancy. Participants were 261 pregnant women recruited from public maternity wards using a convenience sampling technique. Each pregnant woman completed a sociodemographic data form, the Maternal-Fetal Attachment Scale, and the SRQ-20. Regression analysis revealed that the number of children (4% and mothers' mental health (4.2% accounted for part of the variance in maternal-fetal attachment scores. Father's and mother's schooling was not associated with this variable. Taking the four analyzed factors into account, a multiple regression model accounted for 8.2% of the variance in the maternal-fetal attachment scores. The implications of these variables for mother-infant bonding during pregnancy are discussed.

  15. Clinical Holistic Medicine: Holistic Treatment of Mental Disorders

    Directory of Open Access Journals (Sweden)

    Søren Ventegodt

    2005-01-01

    Full Text Available We believe that holistic medicine can be used for patient's with mental health disorders. With holistic psychiatry, it is possible to help the mentally ill patient to heal existentially. As in holistic medicine, the methods are love or intense care, winning the trust of the patient, getting permission to give support and holding, and daring to be fully at the patient's service. Our clinical experiences have led us to believe that mental health patient's can heal if only you can make him or her feel the existential pain at its full depth, understand what the message of the suffering is, and let go of all the negative attitudes and beliefs connected with the disease. Many mentally ill young people would benefit from a few hours of existential holistic processing in order to confront the core existential pains. To help the mentally ill patient, you must understand the level of responsibility and help process the old traumas that made the patient escape responsibility for his or her own life and destiny. To guide the work, we have developed a responsibility scale going from (1 free perception over (2 emotional pain to (3 psychic death (denial of life purpose further down to (4 escape and (5 denial to (6 destruction of own perception and (7 hallucination further down to (8 coma, suicide, and unconsciousness. This scale seems to be a valuable tool to understand the state of consciousness and the nature of the process of healing that the patient must go through.

  16. The clinical application of mobile technology to disaster medicine.

    Science.gov (United States)

    Case, Timothy; Morrison, Cecily; Vuylsteke, Alain

    2012-10-01

    Mobile health care technology (mHealth) has the potential to improve communication and clinical information management in disasters. This study reviews the literature on health care and computing published in the past five years to determine the types and efficacy of mobile applications available to disaster medicine, along with lessons learned. Five types of applications are identified: (1) disaster scene management; (2) remote monitoring of casualties; (3) medical image transmission (teleradiology); (4) decision support applications; and (5) field hospital information technology (IT) systems. Most projects have not yet reached the deployment stage, but evaluation exercises show that mHealth should allow faster processing and transport of patients, improved accuracy of triage and better monitoring of unattended patients at a disaster scene. Deployments of teleradiology and field hospital IT systems to disaster zones suggest that mHealth can improve resource allocation and patient care. The key problems include suitability of equipment for use in disaster zones and providing sufficient training to ensure staff familiarity with complex equipment. Future research should focus on providing unbiased observations of the use of mHealth in disaster medicine.

  17. A novel LabVIEW-based multi-channel non-invasive abdominal maternal-fetal electrocardiogram signal generator.

    Science.gov (United States)

    Martinek, Radek; Kelnar, Michal; Koudelka, Petr; Vanus, Jan; Bilik, Petr; Janku, Petr; Nazeran, Homer; Zidek, Jan

    2016-02-01

    This paper describes the design, construction, and testing of a multi-channel fetal electrocardiogram (fECG) signal generator based on LabVIEW. Special attention is paid to the fetal heart development in relation to the fetus' anatomy, physiology, and pathology. The non-invasive signal generator enables many parameters to be set, including fetal heart rate (FHR), maternal heart rate (MHR), gestational age (GA), fECG interferences (biological and technical artifacts), as well as other fECG signal characteristics. Furthermore, based on the change in the FHR and in the T wave-to-QRS complex ratio (T/QRS), the generator enables manifestations of hypoxic states (hypoxemia, hypoxia, and asphyxia) to be monitored while complying with clinical recommendations for classifications in cardiotocography (CTG) and fECG ST segment analysis (STAN). The generator can also produce synthetic signals with defined properties for 6 input leads (4 abdominal and 2 thoracic). Such signals are well suited to the testing of new and existing methods of fECG processing and are effective in suppressing maternal ECG while non-invasively monitoring abdominal fECG. They may also contribute to the development of a new diagnostic method, which may be referred to as non-invasive trans-abdominal CTG +  STAN. The functional prototype is based on virtual instrumentation using the LabVIEW developmental environment and its associated data acquisition measurement cards (DAQmx). The generator also makes it possible to create synthetic signals and measure actual fetal and maternal ECGs by means of bioelectrodes.

  18. Epigenetic therapies - a new direction in clinical medicine.

    Science.gov (United States)

    Stein, R A

    2014-07-01

    A major biomedical advance from recent years was the finding that gene expression and phenotypic traits may be shaped by potentially reversible and heritable modifications that occur without altering the sequence of the nucleotides, and became known as epigenetic changes. The term 'epigenetics' dates back to the 1940s, when it was first used in context of cellular differentiation decisions that are made during development. Since then, our understanding of epigenetic modifications that govern development and disease expanded considerably. The contribution of epigenetic changes to shaping phenotypes brings at least two major clinically relevant benefits. One of these, stemming from the reversibility of epigenetic changes, involves the possibility to therapeutically revert epigenetic marks to re-establish prior gene expression patterns. The strength and the potential of this strategy are illustrated by the first four epigenetic drugs that were approved in recent years and by the additional candidates that are at various stages in preclinical studies and clinical trials. The second particularity is the finding that epigenetic changes precede the appearance of histopathological modifications. This has the potential to facilitate the emergence of epigenetic biomarkers, some of which already entered the clinical arena, catalysing a major shift in prophylactic and therapeutic strategies, and promising to fill a decades-old gap in preventive medicine.

  19. Monitoring medicines use: the role of the clinical pharmacologist.

    Science.gov (United States)

    Williams, David

    2012-10-01

    Appreciation of the potential of newly marketed medicines to produce both benefit and harm has increased the role of the clinical pharmacologist. Pharmacoepidemiology applies epidemiological reasoning, methods and knowledge to the study of the uses and effects of drugs in human populations. Pharmacovigilence identifies and then responds to safety issues about marketed drugs. Whilst adverse drug reaction (ADR) reporting systems can identify potential problems with drugs, determination of causation requires population-based studies of adverse events (including information from large clinical trials), which attempt to link unequivocally the adverse outcome to the drug in question. Pharmacovigilance is closely linked to postmarketing surveillance and is important for determining issues such as the long-term effects of drugs, identification of low-frequency ADRs, the effectiveness of drugs for their licensed indications or in new indications and other factors which may modify the efficacy and effectiveness of the drug in question. The related field of drug utilization developed in parallel with the study of adverse drug reactions, in recognition of the dramatic increase in the marketing of new drugs, the wide variations in the patterns and extent of drug prescribing, the growing concern about ADRs and the increasing costs of drugs. With the ever increasing number of recognized adverse effects of drugs, prescribing errors, patients' expectations concerning drug safety and the need for appropriate new drug appraisal, the clinical pharmacologist will play an important role both in the introduction of new drugs and in improving the safe and effective use of established drugs.

  20. Monitoring medicines use: the role of the clinical pharmacologist.

    LENUS (Irish Health Repository)

    Williams, David

    2012-10-01

    Appreciation of the potential of newly marketed medicines to produce both benefit and harm has increased the role of the clinical pharmacologist. Pharmacoepidemiology applies epidemiological reasoning, methods and knowledge to the study of the uses and effects of drugs in human populations. Pharmacovigilence identifies and then responds to safety issues about marketed drugs. Whilst adverse drug reaction (ADR) reporting systems can identify potential problems with drugs, determination of causation requires population-based studies of adverse events (including information from large clinical trials), which attempt to link unequivocally the adverse outcome to the drug in question. Pharmacovigilance is closely linked to postmarketing surveillance and is important for determining issues such as the long-term effects of drugs, identification of low-frequency ADRs, the effectiveness of drugs for their licensed indications or in new indications and other factors which may modify the efficacy and effectiveness of the drug in question. The related field of drug utilization developed in parallel with the study of adverse drug reactions, in recognition of the dramatic increase in the marketing of new drugs, the wide variations in the patterns and extent of drug prescribing, the growing concern about ADRs and the increasing costs of drugs. With the ever increasing number of recognized adverse effects of drugs, prescribing errors, patients\\' expectations concerning drug safety and the need for appropriate new drug appraisal, the clinical pharmacologist will play an important role both in the introduction of new drugs and in improving the safe and effective use of established drugs.

  1. [Artificial intelligence to assist clinical diagnosis in medicine].

    Science.gov (United States)

    Lugo-Reyes, Saúl Oswaldo; Maldonado-Colín, Guadalupe; Murata, Chiharu

    2014-01-01

    Medicine is one of the fields of knowledge that would most benefit from a closer interaction with Computer studies and Mathematics by optimizing complex, imperfect processes such as differential diagnosis; this is the domain of Machine Learning, a branch of Artificial Intelligence that builds and studies systems capable of learning from a set of training data, in order to optimize classification and prediction processes. In Mexico during the last few years, progress has been made on the implementation of electronic clinical records, so that the National Institutes of Health already have accumulated a wealth of stored data. For those data to become knowledge, they need to be processed and analyzed through complex statistical methods, as it is already being done in other countries, employing: case-based reasoning, artificial neural networks, Bayesian classifiers, multivariate logistic regression, or support vector machines, among other methodologies; to assist the clinical diagnosis of acute appendicitis, breast cancer and chronic liver disease, among a wide array of maladies. In this review we shift through concepts, antecedents, current examples and methodologies of machine learning-assisted clinical diagnosis.

  2. Clinical Study on Treatment of Depression with Combined Acupuncture & Medicine

    Institute of Scientific and Technical Information of China (English)

    XU Hong; WANG Qiao-chu; HAN Chou-ping

    2003-01-01

    Purpose To observe and compare the curative effects of combined acupuncture and medicine with simple herbal medicine on treatment of depression. Method Altogether 63 cases were enrolled according to the determination of internationally accepted self-evaluation depression scales (SDS), among them 33 cases were treated with combination of acupuncture and herbal medicine (acupuncture-medicine group) and the other 30 cases were in treated with herbal medicine alone (herbal medicine group) Results The total effective rate of acupuncture-medicine group was 90.9% and that of herbal group was 80.0%. And there was significant statistics difference between the curative effects of two groups (P <0.05) without obvious adverse reaction. Conclusion Combination of acupuncture and medicine has better effect in treating depression than herbal medicine group.

  3. Glycemic Status During Pregnancy in Gestational Diabetic & Non-Gestational Diabetic Women & its Effect on Maternal & Fetal Outcome

    Directory of Open Access Journals (Sweden)

    A P Sawant

    2012-01-01

    Full Text Available Aims & Objectives: 1.To study the time course of plasma glucose, in gestational diabetic and normal pregnant women. 2.To compare maternal outcome and fetal outcome in gestational diabetic and normal pregnant women. Materials and Methods: Five hundred pregnant individuals visiting the Antenatal Clinic of Rural Medical College, Loni in either half of the gestation were screened and gestational diabetes mellitus was diagnosed according to the WHO criteria. Results: The scope of diabetes and pregnancy encompasses not only diabetics marching through pregnancy but also, any form of abnormal glucose tolerance developing during gestation, termed as gestational diabetes, abnormal glucose tolerance of any etiology recognized or unrecognized starting before pregnancy or revealed during pregnancy, is associated with a high risk of a poor maternal and fetal outcomes. In our study we found a significantly higher incidence of caesarean section in-patients with GDM when compared with the normal group (67% versus 25%, P <0.001. In GDM cases, we observed fetal macrosomia, high birth weight etc. Naturally these are the factors, which add to the pre-existing unfavourable maternal factors affecting the process of labour adversely. We observed a significant difference in the incidence of preterm labour in between the GDM and non-GDM groups (22% Vs 13%, p<0.05. These individuals underwent a process of preterm labour at a gestational age of 32+3 weeks. Hyperglycemia and polyhydramnios are held responsible for preterm labour. The incidence rate of PIH was more in subjects with GDM as compared to the other group. However this difference failed to prove statistically significant at 5% level of significance. Though we did not get a significant difference in occurrence of PIH in between the GDM and non-GDM groups, we do agree with the comment that hyperglycemia earlier in the pregnancy is associated with greater incidence of PIH as three of the four cases who were diagnosed

  4. HTRA3 expression in non-pregnant rhesus monkey ovary and endometrium, and at the maternal-fetal interface during early pregnancy

    Directory of Open Access Journals (Sweden)

    Findlay Jock K

    2008-06-01

    Full Text Available Abstract Background HTRA3 is a recently identified member of the mammalian serine protease family HTRA (high temperature requirement factor A. In both the rodent and the human HTRA3 is transcribed into two mRNA species (long and short through alternative splicing. We have previously shown that HTRA3 is expressed in the mature rat ovary and may be involved in folliculogenesis and luteinisation. HTRA3 is also upregulated during mouse and human placental development. The current study investigated whether HTRA3 is also localised in the primate ovary (rhesus monkey n = 7. In addition, we examined the non-pregnant rhesus monkey endometrium (n = 4 and maternal-fetal interface during early pregnancy (n = 5 to further investigate expression of HTRA3 in primate endometrium and placentation. Methods HTRA3 mRNA levels in several rhesus monkey tissues was determined by semiquantitative RT-PCR. Protein expression and localisation of HTRA3 was determined by immunohistochemistry. Results Long and short forms of HTRA3 mRNA were detected in the ovary, aorta, bladder, small intestine, skeletal muscle, heart and uterus but not the liver nor the kidney. HTRA3 protein was immunolocalised to the oocyte of all follicular stages in the rhesus monkey ovary. Protein expression in mural and cumulus granulosa cells of late secondary follicles increased significantly compared to granulosa cells of primordial, primary and secondary follicles. Mural and cumulus granulosa cells of antral follicles also showed a significant increase in expression. Staining intensity was higher in the granulosa-lutein cells compared to the theca-lutein cells of corpora lutea (n = 3. In the non-pregnant monkey endometrium, HTRA3 was detected in the glandular epithelium. The basalis endometrial glands showed higher staining intensity than functionalis endometrial glands. During early pregnancy, strong staining for HTRA3 protein was seen in both maternal decidual cells and glands. Conclusion We

  5. Appropriate Use of Drug Testing in Clinical Addiction Medicine.

    Science.gov (United States)

    Jarvis, Margaret; Williams, Jessica; Hurford, Matthew; Lindsay, Dawn; Lincoln, Piper; Giles, Leila; Luongo, Peter; Safarian, Taleen

    : Biological drug testing is a tool that provides information about an individual's recent substance use. Like any tool, its value depends on using it correctly; that is, on selecting the right test for the right person at the right time. This document is intended to clarify appropriate clinical use of drug testing in addiction medicine and aid providers in their decisions about drug testing for the identification, diagnosis, treatment, and recovery of patients with, or at risk for, addiction. The RAND Corporation (RAND)/University of California, Los Angeles (UCLA) Appropriateness Method (RAM) process for combining scientific evidence with the collective judgment of experts was used to identify appropriate clinical practices and highlight areas where research is needed. Although consensus panels and expert groups have offered guidance on the use of drug testing for patients with addiction, very few addressed considerations for patients across settings and in different levels of care. This document will focus primarily on patients in addiction treatment and recovery, where drug testing is used to assess patients for a substance use disorder, monitor the effectiveness of a treatment plan, and support recovery. Inasmuch as the scope includes the recognition of addiction, which often occurs in general healthcare settings, selected special populations at risk for addiction visiting these settings are briefly included.

  6. New trends for clinical research of traditional Chinese medicine in China

    Institute of Scientific and Technical Information of China (English)

    SHANG Hong-cai; LI You-ping; CHEN Jing; ZHANG Jun-hua; ZHANG Bo-li

    2008-01-01

    @@ To the Editor: In former times, traditional Chinese medicine (TCM) individualized its treatment protocol or clinical practice without considering the principles of modern medicine.The standard methodology of random selection, blinding and placebo control, followed by statistical analysis was generally overlooked. This had a negative effect on the development of TCM.Recently, the volume of applied research in Chinese medicine is growing rapidly and the quality is improving.1 There is good evidence supporting the use of some Chinese patent medicine treatments.2-4 Further, there is a more open attitude to Chinese medicine among conventional health professionals, partly explained by the rise of evidence-based medicine (EBM).

  7. Do differences in the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists positions on the ethics of maternal-fetal interventions reflect subtly divergent professional sensitivities to pregnant women and fetuses?

    Science.gov (United States)

    Brown, Stephen D; Truog, Robert D; Johnson, Judith A; Ecker, Jeffrey L

    2006-04-01

    As therapeutic interventions that are designed for the direct benefit of the fetus have evolved, pediatric specialists along with obstetricians have become increasingly engaged in the management of pregnancies that are complicated by fetal disorders. Do the 2 groups of medical specialists hold differing "world views" on the nature of the maternal-fetal relationship that could have an impact on decision-making? A direct comparison of the positions of the ethics committees of the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists concerning maternal-fetal conflicts and fetal therapy reveals subtle but telling differences. Compared with the American College of Obstetricians and Gynecologists policy, the American Academy of Pediatrics statement accords somewhat less weight to maternal decision-making and is more tolerant of overriding maternal refusal of interventions that are recommended for fetal benefit. In doing so, it may oblige pregnant patients to assume greater risk and tolerate diminished autonomy. We urge leaders from both disciplines to meet and seek consensus so that a common approach and language can guide treatment of the patients whom we share.

  8. Risk of discontinuation of Advanced Therapy Medicinal Products clinical trials.

    Science.gov (United States)

    Hanna, Eve; Rémuzat, Cecile; Auquier, Pascal; Toumi, Mondher

    2016-01-01

    Advanced therapy medicinal products (ATMPs) constitute a class of innovative products that encompasses gene therapy, somatic cell therapy, and tissue-engineered products (TEP). There is an increased investment of commercial and non-commercial sponsors in this field and a growing number of ATMPs randomized clinical trials (RCT) and patients enrolled in such trials. RCT generate data to prove the efficacy of a new therapy, but the discontinuation of RCTs wastes scarce resources. Our objective is to identify the number and characteristics of discontinued ATMPs trials in order to evaluate the rate of discontinuation. We searched for ATMPs trials conducted between 1999 to June 2015 using three databases, which are Clinicaltrials.gov, the International Clinical Trials Registry Platform (ICTRP), and the EU Drug Regulating Authorities Clinical Trials (EudraCT). We selected the ATMPs trials after elimination of the duplicates. We identified the disease areas and the sponsors as commercial or non-commercial organizations. We classified ATMPs by type and trial status, that is, ongoing, completed, terminated, discontinued, and prematurely ended. Then, we calculated the rate of discontinuation. Between 1999 and June 2015, 143 withdrawn, terminated, or prematurely ended ATMPs clinical trials were identified. Between 1999 and June 2013, 474 ongoing and completed clinical trials were identified. Therefore, the rate of discontinuation of ATMPs trials is 23.18%, similar to that for non-ATMPs drugs in development. The probability of discontinuation is, respectively, 27.35, 16.28, and 16.34% for cell therapies, gene therapies, and TEP. The highest discontinuation rate is for oncology (43%), followed by cardiology (19.2%). It is almost the same for commercial and non-commercial sponsors; therefore, the discontinuation reason may not be financially driven. No failure risk rate per development phase is available for ATMPs. The discontinuation rate may prove helpful when assessing the

  9. A clinically meaningful theory of outcome measures in rehabilitation medicine.

    Science.gov (United States)

    Massof, Robert W

    2010-01-01

    Comparative effectiveness research in rehabilitation medicine requires the development and validation of clinically meaningful and scientifically rigorous measurements of patient states and theories that explain and predict outcomes of intervention. Patient traits are latent (unobservable) variables that can be measured only by inference from observations of surrogate manifest (observable) variables. In the behavioral sciences, latent variables are analogous to intensive physical variables such as temperature and manifest variables are analogous to extensive physical variables such as distance. Although only one variable at a time can be measured, the variable can have a multidimensional structure that must be understood in order to explain disagreements among different measures of the same variable. The use of Rasch theory to measure latent trait variables can be illustrated with a balance scale metaphor that has randomly added variability in the weights of the objects being measured. Knowledge of the distribution of the randomly added variability provides the theoretical structure for estimating measures from ordinal observation scores (e.g., performance measures or rating scales) using statistical inference. In rehabilitation medicine, the latent variable of primary interest is the patient's functional ability. Functional ability can be estimated from observations of surrogate performance measures (e.g., speed and accuracy) or self-report of the difficulty the patient experiences performing specific activities. A theoretical framework borrowed from project management, called the Activity Breakdown Structure (ABS), guides the choice of activities for assessment, based on the patient's value judgments, to make the observations clinically meaningful. In the case of low vision, the functional ability measure estimated from Rasch analysis of activity difficulty ratings was discovered to be a two-dimensional variable. The two visual function dimensions are independent

  10. Evolution of the Model of the Clinical Practice of Emergency Medicine: 1979 to Present.

    Science.gov (United States)

    Counselman, Francis L; Beeson, Michael S; Marco, Catherine A; Adsit, Susan K; Harvey, Anne L; Keehbauch, Julia N

    2017-02-01

    The Model of the Clinical Practice of Emergency Medicine (the EM Model) is a three-dimensional representation of the clinical practice of emergency medicine. It is a product of successful collaboration involving the American Board of Emergency Medicine (ABEM), the American College of Emergency Physicians (ACEP), the Society for Academic Emergency Medicine (SAEM), the Emergency Medicine Residents' Association (EMRA), the Council of Emergency Medicine Residency Directors (CORD), the Residency Review Committee for Emergency Medicine (RRC-EM), and the American Academy of Emergency Medicine (AAEM). In 2017, the most recent update and revision of the EM Model will be published. This document will represent the culmination of nearly 40 years of evolution, from a simple listing of presenting patient complaints, clinical symptoms, and disease states into a three-dimensional representation of the clinical practice of emergency medicine. These dimensions include conditions and components, physician tasks, and patient acuity. In addition, over the years, two other documents have been developed, the Knowledge, Skills, and Abilities (KSAs) and the Emergency Medicine Milestones. Both serve as related and complementary educational and assessment tools. This article will review the development of the EM Model from its inception in 1979 to today. © 2016 by the Society for Academic Emergency Medicine.

  11. [Process and key points of clinical literature evaluation of post-marketing traditional Chinese medicine].

    Science.gov (United States)

    Liu, Huan; Xie, Yanming

    2011-10-01

    The clinical literature evaluation of the post-marketing traditional Chinese medicine is a comprehensive evaluation by the comprehensive gain, analysis of the drug, literature of drug efficacy, safety, economy, based on the literature evidence and is part of the evaluation of evidence-based medicine. The literature evaluation in the post-marketing Chinese medicine clinical evaluation is in the foundation and the key position. Through the literature evaluation, it can fully grasp the information, grasp listed drug variety of traditional Chinese medicines second development orientation, make clear further clinical indications, perfect the medicines, etc. This paper discusses the main steps and emphasis of the clinical literature evaluation. Emphasizing security literature evaluation should attach importance to the security of a comprehensive collection drug information. Safety assessment should notice traditional Chinese medicine validity evaluation in improving syndrome, improveing the living quality of patients with special advantage. The economics literature evaluation should pay attention to reliability, sensitivity and practicability of the conclusion.

  12. Usage report of pharmacopuncture in musculoskeletal patients visiting Korean medicine hospitals and clinics in Korea

    OpenAIRE

    Lee, Yoon Jae; Shin, Joon-Shik; Lee, Jinho; Kim, Me-Riong; Park, Ki Byung; Lee, Hwa Dong; Lee, Yoonmi; Hong, Jungwan; Ha, In-Hyuk

    2016-01-01

    Background Pharmacopuncture is a relatively new acupuncture therapy combining acupuncture with herbal medicine. While pharmacopuncture is applied extensively in Korean medicine treatment, there are no clinical reports regarding what types of pharmacopuncture are used for which diseases. Methods Data was extracted retrospectively from the electronic medical records of all inpatients and outpatients at 12 Korean medicine hospitals and clinics during the period of December 17, 2010 to October 2,...

  13. Personalized medicine. Closing the gap between knowledge and clinical practice.

    Science.gov (United States)

    Anaya, Juan-Manuel; Duarte-Rey, Carolina; Sarmiento-Monroy, Juan C; Bardey, David; Castiblanco, John; Rojas-Villarraga, Adriana

    2016-08-01

    Personalized medicine encompasses a broad and evolving field informed by a patient distinctive information and biomarker profile. Although terminology is evolving and some semantic interpretations exist (e.g., personalized, individualized, precision), in a broad sense personalized medicine can be coined as: "To practice medicine as it once used to be in the past using the current biotechnological tools." A humanized approach to personalized medicine would offer the possibility of exploiting systems biology and its concept of P5 medicine, where predictive factors for developing a disease should be examined within populations in order to establish preventive measures on at-risk individuals, for whom healthcare should be personalized and participatory. Herein, the process of personalized medicine is presented together with the options that can be offered in health care systems with limited resources for diseases like rheumatoid arthritis and type 1 diabetes.

  14. Evidence-based medicine: the design and interpretation of noninferiority clinical trials in veterinary medicine.

    Science.gov (United States)

    Freise, K J; Lin, T-L; Fan, T M; Recta, V; Clark, T P

    2013-01-01

    Noninferiority trials are clinical studies designed to demonstrate that an investigational drug is at least as effective as an established treatment within a predetermined margin. They are conducted, in part, because of ethical concerns of administering a placebo to veterinary patients when an established effective treatment exists. The use of noninferiority trial designs has become more common in veterinary medicine with the increasing number of established veterinary therapeutics and the desire to eliminate potential pain or distress in a placebo-controlled study. Selecting the appropriate active control and an a priori noninferiority margin between the investigational and active control drug are unique and critical design factors for noninferiority studies. Without reliable historical knowledge of the disease response in the absence of treatment and of the response to the selected active control drug, proper design and interpretation of a noninferiority trial is not possible. Despite the appeal of conducting noninferiority trials to eliminate ethical concerns of placebo-controlled studies, there are real limitations and possible ethical conundrums associated with noninferiority trials. The consequences of incorrect study conclusions because of poor noninferiority trial design need careful attention. Alternative trial designs to typical noninferiority studies exist, but these too have limitations and must also be carefully considered.

  15. [Traditional Chinese medicine injection clinical use management model for evaluation].

    Science.gov (United States)

    Liu, Fang; Ma, Rong; Liao, Xing; Chai, Shi-Wei

    2012-09-01

    Discussion on assessment and intervention models to promote the rational use of medicines of Chinese medicine injection effect. Using systematic prescription assessment and intervention work mode, formed expert group guide established assessment standard, developed the prescription audit specification, and extracted all Chinese medicine injection prescription of outpatient 2010 first quarter (in front of intervention) and 2011 first quarter (behind intervention), respectively for 2 543 and 3 122. The percent of the non-indication of medication in front of intervention outpatient fell from 3.44% to behind intervention of 2.66% (PChinese medicine injections.

  16. Historic images in nuclear medicine: 1976: the first issue of clinical nuclear medicine and the first human FDG study.

    Science.gov (United States)

    Hess, Søren; Høilund-Carlsen, Poul Flemming; Alavi, Abass

    2014-08-01

    In 1976, 2 major molecular imaging events coincidentally took place: Clinical Nuclear Medicine was first published in June, and in August researchers at the Hospital of the University of Pennsylvania created the first images in humans with F-FDG. FDG was initially developed as part of an evolution set in motion by fundamental research studies with positron-emitting tracers in the 1950s by Michel Ter-Pegossian and coworkers at the Washington University. Today, Clinical Nuclear Medicine is a valued scientific contributor to the molecular imaging community, and FDG PET is considered the backbone of this evolving and exciting discipline.

  17. Vulnerabilidade programática na prevenção da transmissão materno-fetal da AIDS Program deficiencies in the prevention of maternal-fetal transmission of AIDS

    Directory of Open Access Journals (Sweden)

    Katia V. de O. Feliciano

    2002-08-01

    Full Text Available OBJETIVOS: avaliar a operacionalidade das ações de prevenção da transmissão materno-fetal do HIV na assistência pré-natal. MÉTODOS: estudo descritivo realizado na cidade do Recife, Pernambuco, de maio a julho de 1998, em 27 unidades dos seis Distritos Sanitários: 19 Centros de Saúde, duas Maternidades e seis do Programas de Saúde da Família (PSF. A organização foi caracterizada por meio de observações e entrevistas com gerentes e equipes técnicas. Acompanhou-se o processo de trabalho durante, no mínimo, dois turnos, em dias da semana aleatoriamente selecionados, totalizando 214 horas. As 355 gestantes presentes responderam um questionário: idade, antecedentes obstétricos, número de consultas, acessibilidade e orientações recebidas. RESULTADOS: em 63,0% das unidades houve demanda reprimida. Somente 41,6% das gestantes em seguimento tiveram a consulta atual agendada pelo serviço após a anterior. Em relação às doenças sexualmente transmissíveis: todos solicitaram o teste luético e 67,0% convocaram os parceiros quando o exame é positivo; não houve oferta universal do teste anti-HIV, nenhum realizou aconselhamento, apenas 26,7% dos médicos que identificaram gestantes de risco para AIDS solicitaram o teste e 19,8% das gestantes receberam orientações sobre essas doenças. CONCLUSÕES: a vulnerabilidade institucional na execução das ações programáticas e o amplo conjunto de necessidades de saúde da mulher em idade reprodutiva reiteram a importância de organizar o pré-natal.OBJECTIVES: to assess the effectiveness of maternal-fetal HIV transmission prevention programs at the pre-natal care stage. METHODS:a descriptive study was held in the city of Recife, Pernambuco, from May to July 1998, in 27 locations of six Sanitary Districts: 19 Health Centers, two Maternity Clinics and six Family Health Programs (PSF. The study focused on observation and interviews of managers and technical teams. Their work was followed

  18. La transmisión madre-hijo del Trypanosoma cruzi en la Argentina Maternal fetal-transmission of Trypanosoma cruzi in Argentina

    Directory of Open Access Journals (Sweden)

    Ana María de Rissio

    2009-10-01

    could be present, the diagnosis depends on the detection of the parasite. Then, in the late stage, from the 8th month, the detection of specific antibodies by at least 2 of 3 serological tests confirms the infection in the neonates. The diagnostic follow up of the children born to a group of sero-reactive pregnant women was carried out in the INP. The 11% of the mothers (29 out of 267 transmitted the infection to their children. The neonates of 20 of these mothers were diagnosed in the early stage, 14 and 6 in one or two controls, respectively. In the 9 remaining mothers the children were diagnosed in the late stage of the infection, mainly serologicaly. Our analisis of previously published reports stressed that the maternal-fetal transmission rate depends on the time of diagnostic follow up of the child. In this reports, mean values of mother to child transmission reported was 2% and 9% when the diagnosis of the neonates born to sero-reactive mothers was carried out only in the early stage or in the early and also the late stage, respectively.

  19. [Why Strive after Clinical Social Medicine? From Epidemiological Association to Personalized Social Medicine: a Case of Breast Cancer Care].

    Science.gov (United States)

    Simoes, E; Sokolov, A N; Graf, J; Pavlova, M A; Brucker, S Y; Wallwiener, D; Schmahl, F W; Bamberg, M

    2016-02-01

    Advances in biomedicine, especially molecular biology and genetics, gave rise to the concept of personalized medicine targeting the patient's individual characteristics and needs to ensure the best possible therapy and healthcare. This concept, however, can be successfully implemented only if due consideration is given to (psycho-)social factors, as is shown for instance by considerably reduced post-therapy survival rates among cancer patients in regions with lower socioeconomic status, How breast cancer patients, for instance, find their way back to daily life and work after initial treatment at a breast center is substantially determined by multiple factors going beyond pure medical care. These factors critically affect health status and therapy outcomes, but are missing in current research agenda. A profound expertise in social medicine is required to respond in ways tailored to the individual's healthcare needs that go beyond just medical therapy. This expertise comprises, in particular, knowledge of inequality of access to healthcare due to varying health competence that in turn, results in inequality of health outcome and care. Competence in social medicine both in the clinic and outpatient care can help to individually target negative factors that originate from the social environment as well as from deficits in communication and coordination in the healthcare system and have an effect on the health status of patients..This, however, requires institutionalization of (clinical) social medicine and in particular, better opportunities for advanced training in social medicine in clinical departments and outpatient units.

  20. Evidence-based medicine and values-based medicine: partners in clinical education as well as in clinical practice.

    Science.gov (United States)

    Peile, Ed

    2013-02-15

    The best clinical decisions are based on both evidence and values in what is known as the 'two-feet principle'. Anecdotally, educationalists find teaching clinicians to become more evidence based is relatively simple in comparison to encouraging them to become more values based. One reason is likely to be the importance of values awareness. As values-based practice is premised on a mutual respect for the diversity of values, clinicians need to develop the skills to ascertain patient values and to get in touch with their own beliefs and preferences in order to understand those at play in any consultation. Only then can shared decision-making processes take place within a shared framework of values. In a research article published in BMC Medicine, Altamirano-Bustamante and colleagues highlight difficulties that clinicians face in getting in touch with their own values. Despite finding that healthcare personnel's core values were honesty and respect, autonomy was initially low ranked by participants. One significant aspect of this work is that this group has demonstrated that the extent to which clinicians value 'autonomy' and 'openness to change' can both be positively influenced by well designed education.

  1. [Construction and thinking of data element standard directory of traditional Chinese medicine clinical pharmacy information].

    Science.gov (United States)

    Wang, Xiao-Xia; Jin, Zhong-Zheng; Guo, Gui-Ming; Zhai, Hua-Qiang; Jin, Shi-Yuan

    2014-05-01

    The aim of this study was to develop the data element standard directory of traditional Chinese medicine (TCM) clinical pharmacy information, to provide application standards and models of TCM clinical pharmacy for the electronic medical record (EMR). The developed line of work is as follows: initially establish research through four forms: literature analysis, questionnaires, discussion groups, expert advice. The research range from the Chinese herbal medicine research, herbal origin, harvesting, processing, identification of traits, physical and chemical identification, modern research, character, taste, Indications, clinical application, processing, dispensing medicine, Chinese medicine specifications, usage, dosage, caution, efficacy indications to small packaging applications, drug research, management and other related issues, including traditional Chinese medicine theory, application and hospital management information; according to the general and part 16 content of the national "Health Information Data Element Standards", and the basic method of extracting data element to study and develop the data element of TCM clinical pharmacy information from the defining content. Correspondingly propose the ideas and methods of construction of the "Data Element Standard Directory of TCM Clinical Pharmacy Information", sort out medicine clinical information data element standard catalog, divided into basic categories, clinical application class, management class three parts, and set norms and standards of identifying data elements, definitions, allowable value of traditional Chinese medicine clinical information, and discuss the sources and standards of information collection, leaving the interface, standardized and scientific terminology, docking with the existing standards, maintenance and management program and oter issues.

  2. Practice of clinical forensic medicine in Sri Lanka: does it need a new era?

    Science.gov (United States)

    Kodikara, Sarathchandra

    2012-07-01

    Clinical forensic medicine is a sub-specialty of forensic medicine and is intimately associated with the justice system of a country. Practice of clinical forensic medicine is evolving, but deviates from one jurisdiction to another. Most English-speaking countries practice clinical forensic medicine and forensic pathology separately while most non-English-speaking countries practice forensic medicine which includes clinical forensic medicine and forensic pathology. Unlike the practice of forensic pathology, several countries have informal arrangements to deal with forensic patients and there are no international standards of practice or training in this discipline. Besides, this is rarely a topic of discussion. In the adversarial justice system in Sri Lanka, the designated Government Medical Officers practice both clinical forensic medicine and forensic pathology. Practice of clinical forensic medicine, and its teaching and training in Sri Lanka depicts unique features. However, this system has not undergone a significant revision for many decades. In this communication, the existing legal framework, current procedure of practice, examination for drunkenness, investigations, structure of referrals, reports, subsequent legal procedures, undergraduate, in-service, and postgraduate training are discussed with suggestions for reforms.

  3. [From classification medicine to clinical medicine (the end of the XVIII century--70-ies of the XIX century). Communication 1. Beginning of the new style of medical thinking (clinical thinking)].

    Science.gov (United States)

    Stochik, A M; Zatravkin, S N

    2011-01-01

    This communication is devoted to appearance of a qualitatively different methodological approach to problems of practical medicine in 1890s. This approach gave rise to formation of a new style of medical thinking (clinical thinking) and development of clinical medicine.

  4. Regulatory and clinical aspects of psychotropic medicinal products bioequivalence.

    Science.gov (United States)

    Bałkowiec-Iskra, Ewa; Cessak, Grzegorz; Kuzawińska, Olga; Sejbuk-Rozbicka, Katarzyna; Rokita, Konrad; Mirowska-Guzel, Dagmara

    2015-07-01

    Introduction of generic medicinal products to the market has increased access to modern therapies but also enabled significant reduction in their cost, leading to containment of public expenditures on medicinal products reimbursement. The critical assessment of bioequivalence of any reference medicinal product and its counterpart is based on comparison of their rate and extent of absorption. It is assumed that two medicinal products are bioequivalent when their rate and extent of absorption do not show significant differences when administered at the same dose under similar experimental conditions. Bioequivalent medicinal products are declared to be also therapeutically equivalent and can be used interchangeably. However, despite regulatory declaration, switching from reference to generic drugs is often associated with concerns of healthcare providers about decreased treatment effectiveness or occurrence of adverse drug reactions. The aim of this article is to provide a description of rules that guide registration of generic medicinal products in the European Union and to analyze specific examples from the scientific literature concerning therapeutic equivalence of reference and generic antidepressant and antipsychotic medicinal products.

  5. Clinical Holistic Medicine: The Patient with Multiple Diseases

    Directory of Open Access Journals (Sweden)

    Søren Ventegodt

    2005-01-01

    Full Text Available In clinical practice, patients can present with many different diseases, often both somatic and mental. Holistic medicine will try to see the diseases as a whole, as symptoms of a more fundamental imbalance in the state of being. The holistic physician must help the patient to recover existence and a good relationship with self. According to the life mission theory, theory of character, and holistic process theory of healing, recovering the purpose of life (the life mission is essential for the patient to regain life, love, and trust in order to find happiness and realize the true purpose of life. We illustrate the power of the holistic medical approach with a case study of an invalidated female artist, aged 42 years, who suffered from multiple severe health problems, many of which had been chronic for years. She had a combination of neurological disturbances (tinnitus, migraine, minor hallucinations, immunological disturbances (recurrent herpes simplex, phlegm in the throat, fungal infection in the crotch, hormonal disturbances (14 days of menstruation in each cycle, muscle disturbances (neck tensions, mental disturbances (tendency to cry, inferiority feeling, mild depression, desolation, anxiety, abdominal complaints, hemorrhoids, and more. The treatment was a combined strategy of improving the general quality of life, recovering her human character and purpose of life (“renewing the patients life energy”, “balancing her global information system”, and processing the local blockages, thus healing most of her many different diseases in a treatment using 30 h of intense holistic therapy over a period of 18 months.

  6. Regulatory acceptance of animal models of disease to support clinical trials of medicines and advanced therapy medicinal products.

    Science.gov (United States)

    Cavagnaro, Joy; Silva Lima, Beatriz

    2015-07-15

    The utility of animal models of disease for assessing the safety of novel therapeutic modalities has become an increasingly important topic of discussion as research and development efforts focus on improving the predictive value of animal studies to support accelerated clinical development. Medicines are approved for marketing based upon a determination that their benefits outweigh foreseeable risks in specific indications, specific populations, and at specific dosages and regimens. No medicine is 100% safe. A medicine is less safe if the actual risks are greater than the predicted risks. The purpose of preclinical safety assessment is to understand the potential risks to aid clinical decision-making. Ideally preclinical studies should identify potential adverse effects and design clinical studies that will minimize their occurrence. Most regulatory documents delineate the utilization of conventional "normal" animal species to evaluate the safety risk of new medicines (i.e., new chemical entities and new biological entities). Animal models of human disease are commonly utilized to gain insight into the pathogenesis of disease and to evaluate efficacy but less frequently utilized in preclinical safety assessment. An understanding of the limitations of the animal disease models together with a better understanding of the disease and how toxicity may be impacted by the disease condition should allow for a better prediction of risk in the intended patient population. Importantly, regulatory authorities are becoming more willing to accept and even recommend data from experimental animal disease models that combine efficacy and safety to support clinical development.

  7. Hearings Before the Select Committee on Nutrition and Human Needs of the United States Senate, Ninety-Third Congress, First Session. Maternal, Fetal, and Infant Nutrition--1973. Part 1--Consequences of Malnutrition; Part 2--Government Responses. Hearings Held Washington, D.C., June 5, 6, and 7, 1973.

    Science.gov (United States)

    Congress of the U.S., Washington, DC. Senate Select Committee on Nutrition and Human Needs.

    Part One of these hearings before the Select Committee on Nutrition and Human Needs of the United States Senate includes the testimony of scientists and doctors engaged in research regarding the relationship between maternal, fetal, and infant nutrition and optimum mental and physical development of the child. In testimony it was shown that the…

  8. National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines for use of tumor markers in clinical practice

    DEFF Research Database (Denmark)

    Sturgeon, Catharine M; Hoffman, Barry R; Chan, Daniel W

    2008-01-01

    BACKGROUND: This report presents updated National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines summarizing quality requirements for the use of tumor markers. METHODS: One subcommittee developed guidelines for analytical quality relevant to serum and tissue-based tumor...

  9. Reducing weight in an internal medicine outpatient clinic using a lifestyle medicine approach: A proof of concept.

    Science.gov (United States)

    Lucini, Daniela; Cesana, Giovanna; Vigo, Chiara; Malacarne, Mara; Pagani, Massimo

    2015-11-01

    Chronic non-communicable diseases represent the major drivers of disease burden, being responsible for the majority of health care cost and deaths. Almost half of premature deaths is due to behaviors amenable to change. Accordingly, addressing behavior might represent a strategic change in the health delivery system. Improving lifestyle requires a specific strategy embedding the active collaboration of individuals with a multilevel team-oriented medical practice. With the present study we sought to assess whether the implementation of cognitive-behavioral strategies, following the principles of lifestyle medicine in an outpatient clinic provides better results in weight reduction as compared to simpler strategies as presently executed in General Practitioners' offices. This is an observational study on 173 subjects (age 53.1 ± 11.5), comparing three different groups of preventive practice: a personalized lifestyle medicine, combining cognitive behavioral strategies with patient tailored prescription of exercise and nutrition (Group A); a semi-structured approach with generic counseling (Group B); and an unstructured advice (Group C). At the end of the intervention period (17-20 months), group A showed an average weight loss of 5.4 ± 5.1 kg, which was significantly (pinternal medicine clinics. This methodology appears more efficacious in inducing weight reduction after more than a year as compared to usual family medicine approaches. Copyright © 2015 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

  10. The Role of Medicinal Cannabis in Clinical Therapy: Pharmacists' Perspectives

    OpenAIRE

    Sami Isaac; Bandana Saini; Chaar, Betty B

    2016-01-01

    Background Medicinal cannabis has recently attracted much media attention in Australia and across the world. With the exception of a few countries, cannabinoids remain illegal–known for their adverse effects rather than their medicinal application and therapeutic benefit. However, there is mounting evidence demonstrating the therapeutic benefits of cannabis in alleviating neuropathic pain, improving multiple sclerosis spasticity, reducing chemotherapy induced nausea and vomiting, and many oth...

  11. The Role of Medicinal Cannabis in Clinical Therapy: Pharmacists' Perspectives.

    Directory of Open Access Journals (Sweden)

    Sami Isaac

    Full Text Available Medicinal cannabis has recently attracted much media attention in Australia and across the world. With the exception of a few countries, cannabinoids remain illegal-known for their adverse effects rather than their medicinal application and therapeutic benefit. However, there is mounting evidence demonstrating the therapeutic benefits of cannabis in alleviating neuropathic pain, improving multiple sclerosis spasticity, reducing chemotherapy induced nausea and vomiting, and many other chronic conditions. Many are calling for the legalisation of medicinal cannabis including consumers, physicians and politicians. Pharmacists are the gatekeepers of medicines and future administrators/dispensers of cannabis to the public, however very little has been heard about pharmacists' perspectives. Therefore the aim of this study was to explore pharmacists' views about medicinal cannabis; its legalisation and supply in pharmacy.Semi-structured interviews with 34 registered pharmacists in Australia were conducted. All interviews were audio-recorded, transcribed ad verbatim and thematically analysed using the NVivo software.Emergent themes included stigma, legislation, safety and collaboration. Overall the majority of pharmacists felt national legalisation of a standardised form of cannabis would be suitable, and indicated various factors and strategies to manage its supply. The majority of participants felt that the most suitable setting would be via a community pharmacy setting due to the importance of accessibility for patients.This study explored views of practicing pharmacists, revealing a number of previously undocumented views and barriers about medicinal cannabis from a supply perspective. There were several ethical and professional issues raised for consideration. These findings highlight the important role that pharmacists hold in the supply of medicinal cannabis. Additionally, this study identified important factors, which will help shape future

  12. Clinical Holistic Medicine: Tools for a Medical Science Based on Consciousness

    Directory of Open Access Journals (Sweden)

    Søren Ventegodt

    2004-01-01

    Full Text Available Biomedicine focuses on the biochemistry of the body, while consciousness-based medicine — holistic medicine — focuses on the individual's experiences and conscious whole (Greek: holos, whole. Biomedicine perceives diseases as mechanical errors at the micro level, while consciousness-based medicine perceives diseases as disturbances in attitudes, perceptions, and experiences at the macro level — in the organism as a whole. Thus, consciousness-based medicine is based on the whole individual, while biomedicine is based on its smallest parts, the molecules. These two completely different points of departure make the two forms of medicine very different; they represent two different mind sets and two different frames of reference or medical paradigms. This paper explains the basic tools of clinical holistic medicine based on the life mission theory and holistic process theory, with examples of holistic healing from the holistic medical clinic.

  13. A Lifestyle Medicine Clinic in a Community Pharmacy Setting

    Directory of Open Access Journals (Sweden)

    Thomas L. Lenz, PharmD, MA, PAPHS

    2010-01-01

    Full Text Available Chronic diseases continue to be a significant burden to the health care system. Pharmacists have been able to show that drugtherapy for patients with chronic diseases can be improved through medication therapy management (MTM services but have yet to become significantly involved in implementing lifestyle modification programs to further control and prevent chronic conditions. A novel and innovative lifestyle medicine program was started by pharmacists in a community pharmacy in 2008 to more comprehensively prevent and manage chronic conditions. The lifestyle medicine program consists of designing seven personalized programs for patients to address physical activity, nutrition, alcohol consumption, weight control, stress management, sleep success, and tobacco cessation (if needed. The lifestyle medicine program complements existing MTM services for patients with hypertension, dyslipidemia, and/or diabetes. This program is innovative because pharmacists have developed and implemented amethod to combine lifestyle medicine with MTM services to not only manage chronic conditions, but prevent the progression of those conditions and others. Several innovative tools have also been developed to enhance the effectiveness of a lifestyle medicine program. This manuscript describes the program’s pharmacy setting, pharmacy personnel, participants and program details as well as the tools used to integrate a lifestyle medicine program with MTM services.

  14. Patient Use of Complementary and Alternative Medicines in an Outpatient Pediatric Neurology Clinic.

    Science.gov (United States)

    Kenney, Daniel; Jenkins, Sarah; Youssef, Paul; Kotagal, Suresh

    2016-05-01

    This article describes the use of complementary and alternative medicines in an outpatient pediatric neurology clinic, and assesses family attitudes toward the efficacy of complementary and alternative medicines versus prescription medications. Complementary and alternative medicine is an important element of the modern health care landscape. There is limited information about whether, and to what extent, families perceive its utility in childhood neurological disorders. Surveys were distributed to 500 consecutive patients at a child neurology clinic in Rochester, Minnesota. Questions pertained to the child's diagnoses, use of complementary and alternative medicines, and the specific complementary and alternative medicine modalities that were used. Opinions were also gathered on the perceived efficacy of complementary and alternative medicines and prescription medications. Data were compared using χ(2) or Fisher exact tests as indicated. A total of 484 surveys were returned, of which 327 were usable. Only 17.4% admitted to use of complementary and alternative medicine to treat neurological problems. However, in follow-up questioning, actually 41.6% of patients recognized that they were using one or more types of complementary and alternative medicines. Disorders associated with a statistically significant increased prevalence of complementary and alternative medicine use were headache (50.8% with headache used complementary and alternative medicine versus 35.7% without headache; P = 0.008, Fisher exact test), chronic fatigue (63.2% vs 38.8%; P = 0.005, Fisher exact test), and sleep disorders (77.1% vs 37.3%; P pediatric neurology patients in our clinic are also using complementary and alternative medicine. Only 38.5% of these recognize themselves as using complementary and alternative medicine, underlining the need to inquire in-depth about its use. Patients who are less satisfied with their prescription medications are more likely to use complementary and

  15. Clinical chemistry: challenges for analytical chemistry and the nanosciences from medicine.

    Science.gov (United States)

    Durner, Jürgen

    2010-02-01

    Clinical chemistry and laboratory medicine can look back over more than 150 years of eventful history. The subject encompasses all the medicinal disciplines as well as the remaining natural sciences. Clinical chemistry demonstrates how new insights from basic research in biochemical, biological, analytical chemical, engineering, and information technology can be transferred into the daily routine of medicine to improve diagnosis, therapeutic monitoring, and prevention. This Review begins with a presentation of the development of clinical chemistry. Individual steps between the drawing of blood and interpretation of laboratory data are then illustrated; here not only are pitfalls described, but so are quality control systems. The introduction of new methods and trends into medicinal analysis is explored, along with opportunities and problems associated with personalized medicine.

  16. [From classificational medicine to clinical medicine (the end of the XVIII century to 1870s). Communication 3. The second stage of clinical medicine development: introduction of methods of laboratory experiment and chemical analysis].

    Science.gov (United States)

    Stochik, A M; Zatravkin, S N

    2011-01-01

    The article concerns the end stage of clinical medicine establishment covering the period from early 1840s to the middle 1870s of the XIX century. Basic scientific achievements related to introduction into practical medicine of the methods of laboratory experiment and chemical analysis are reviewed.

  17. Complementary and Alternative Medicine Use in Modern Obstetrics: A Survey of the Central Association of Obstetricians & Gynecologists Members.

    Science.gov (United States)

    Babbar, Shilpa; Williams, Karen B; Maulik, Dev

    2016-10-05

    The use of complementary and alternative medicine during pregnancy is currently on the rise. A validated survey was conducted at the Central Association of Obstetrician and Gynecologists annual meeting to evaluate the knowledge, attitude, and practice of general obstetricians and gynecologists and maternal-fetal medicine specialists in America. We obtained 128 responses: 73 electronically (57%) and 55 via the paper survey (43%). Forty-five percent reported personally using complementary and alternative medicine and 9% of women respondents used complementary and alternative medicine during pregnancy. Overall, 62% had advised their patients to utilize some form of complementary and alternative medicine in pregnancy. Biofeedback, massage therapy, meditation, and yoga were considered the most effective modalities in pregnancy (median [semi-interquartile range] = 2 [0.5]). Maternal-fetal medicine specialists were significantly more likely to disagree on the use of complementary and alternative medicine for risk reduction of preterm birth compared to obstetricians and gynecologists (P = .03). As the use of complementary and alternative medicine continues to rise in reproductive-age women, obstetricians will play an integral role in incorporating complementary and alternative medicine use with conventional medicine. © The Author(s) 2016.

  18. Hippocrates of Kos, the father of clinical medicine, and Asclepiades of Bithynia, the father of molecular medicine. Review.

    Science.gov (United States)

    Yapijakis, Christos

    2009-01-01

    Hippocrates of Kos (460-377 Before Common Era, BCE) is universally recognized as the father of modern medicine, which is based on observation of clinical signs and rational conclusions, and does not rely on religious or magical beliefs. Hippocratic medicine was influenced by the Pythagorean theory that Nature was made of four elements (water, earth, wind and fire), and therefore, in an analogous way, the body consisted of four fluids or 'humors' (black bile, yellow bile, phlegm and blood). The physician had to reinstate the healthy balance of these humors by facilitating the healing work of 'benevolent Nature'. The Hippocratic Oath contains the Pythagorean duties of justice, secrecy, respect for teachers and solidarity with peers. The clinical and ethical basics of medical practice as well as most clinical terms used even today have their origins in Hippocrates. His contribution in clinical medicine is immense. Asclepiades of Bithynia (124-40 BCE) was the first physician who established Greek medicine in Rome. Influenced by the Epicurean philosophy, he adhered to atomic theory, chance and evolution, and did not accept the theory of a 'benevolent Nature'. He suggested that the human body is composed of molecules and void spaces, and that diseases are caused by alteration of form or position of a patient's molecules. Asclepiades favored naturalistic therapeutic methods such as a healthy diet, massage and physical exercise. Above all, he introduced the friendly, sympathetic, pleasing and painless treatment of patients into medical practice, influenced by the teachings of Epicurus on pleasure and friendship. He was the first who made the highly important division of diseases into acute and chronic ones and to perform an elective non-emergency tracheotomy. As the founder of the Methodic School, Asclepiades was the first known physician who spoke about what is known today as molecular medicine.

  19. Stem cells: progressions and applications in clinical medicine

    Directory of Open Access Journals (Sweden)

    Ali Hosseini Bereshneh

    2016-05-01

    Full Text Available Stem cells are undifferentiated and multi pluripotent cells which can differentiate into a variety of mature cells and tissues such as nervous tissue, muscle tissue, epithelial tissue, skeletal tissue and etc. Stem cells from all different source have three unique features: 1 Proliferative capability: Stem cells are capable of self dividing and self renewing for long periods or more than six months at least that called immortalization. 2 Undifferentiated nature: It’s considered as one of the essential characteristics of stem cell, so it doesn't have any tissue-specific construction. 3 Differentiation to the different cells from all organs: This ability can Induced by tissue specific transcription factors. Because of that, they are so important in prevention and treatment of human disease. Depending on the sources from which they derive, they have different types which can be used to produce special cells and tissues. The most significant types of stem cells are; embryonic stem cells (ESCs which are derived from embryos, adult stem cells (ASCs which are derived from differentiated cells in a specific tissue, induced pluripotent stem cells (iPSs which are produced from adult differentiated cells that have been genetically reprogrammed to act resemble to an embryonic stem cell and cord blood stem cells which contains haematopoietic stem cells and derived from the umbilical cord after gestation. By providing a medium containing of special growth factor, it is possible to orientated stem cell differentiation pathway and gained certain cells from them. The important uses of stem cells includes damaged heart tissue cells improvements and bone tissue repairing, cancer treatment, damaged neurological and spinal tissue repairing, improving burns and injuries and the treatment of diabetes, infertility and spermatogenesis dysfunction. Furthermore, the application of them in gene therapy is an important issue in the modern medicine science due to the role

  20. [N.D. Strazhesko and his role in the development of modern clinical medicine].

    Science.gov (United States)

    Pavlovskiĭ, L N

    2008-01-01

    The article presents information on academician N.D.Strazheshko- the founder of one of key native therapeutic schools with its new, original features. In the article was shown an important contribution of the scientist to the study of significant questions related to internal medicine and his role in the development of current clinical medicine.

  1. Clinical governance and clinical competence to support new scenarios and role of internal medicine

    Directory of Open Access Journals (Sweden)

    Antonino Mazzone

    2015-11-01

    Full Text Available The complex patient, who has often multiple, chronic and progressive disorders, who has undergone polytherapy, should be evaluated totally with respect not only to medical side, but also to psychological and clinical side. The shortage of specialists in disciplines that require technical skills, obtained by training and performing a sufficient number of annual procedures, contributes to the need for reorganizing health care; in this background the Internist devolves less time to charitable activities in favor of competences related to the processes. The knowledge of the clinical governance (CG should be the common heritage of all the actors of the health system, that need to be made up of professionals able to coordinate and make easy the implementation and the spread the CG culture. At least initially we propose to focus the testing strictly on the medical department. As already mentioned above, the natural Internist predisposition, cultural and training, leads him to a multidisciplinary vision of medicine that allows acquiring more easily the tools that make up the structure of CG, being able to facilitate the application. The acquisitions of professional competence and clinical governance play a key role in the Internist culture. The purpose of an Internist with professional skills and managerial capacity, is to act within the department to facilitate and simplify the horizontal interaction among other similar corporate structures and to help the Management to improve structural and clinical appropriateness in Hospital and to better the relations between hospital and territory, identifying the critical issues and the possible solutions.

  2. Moral maps and medical imaginaries: clinical tourism at Malawi's College of Medicine.

    Science.gov (United States)

    Wendland, Claire L

    2012-01-01

    At an understaffed and underresourced urban African training hospital, Malawian medical students learn to be doctors while foreign medical students, visiting Malawi as clinical tourists on short-term electives, learn about “global health.” Scientific ideas circulate fast there; clinical tourists circulate readily from outside to Malawi but not the reverse; medical technologies circulate slowly, erratically, and sometimes not at all. Medicine's uneven globalization is on full display. I extend scholarship on moral imaginations and medical imaginaries to propose that students map these wards variously as places in which—or from which—they seek a better medicine. Clinical tourists, enacting their own moral maps, also become representatives of medicine “out there”: points on the maps of others. Ethnographic data show that for Malawians, clinical tourists are colleagues, foils against whom they construct ideas about a superior and distinctly Malawian medicine and visions of possible alternative futures for themselves.

  3. Intervalos de referência longitudinais de parâmetros doplervelocimétricos materno-fetais Longitudinal reference intervals of maternal-fetal Doppler parameters

    Directory of Open Access Journals (Sweden)

    Nelsilene Mota Carvalho Tavares

    2013-01-01

    scanned fortnightly from 18 to 40 weeks for the measurements of PI of the UA, MCA, DV and UtA. Linear mixed models were used for the elaboration of longitudinal reference intervals (5th, 50th and 95th percentiles of these measurements. PI obtained for the placental and abdominal portions of the umbilical artery were compared by the t-test for independent samples. Two-sided p values of less than 0.05 were considered statistically significant. RESULTS: A total of 164 patients underwent 1,242 scans. There was significant decrease in PI values of all vessels studied with gestational age (GA. From the 18th to the 40th week of pregnancy, the median PI values of UA (abdominal and placental ends of the cord, MCA, DV and the mean PI of the UtA ranged from 1.19 to 0.74, 1.33 to 0.78, 1.56 to 1.39, 0.58 to 0.41, and 0.98 to 0.66, respectively. The following equations were obtained for the prediction of the medians: PI-UA=1.5602786 - (0.020623 x GA; Logarithm of the PI-MCA=0.8149111 - (0.004168 x GA - [0.02543 x (GA - 28.7756²]; Logarithm of the PI-DV=-0.26691- (0.015414 x GA; PI-UtA = 1.2362403 - (0.014392 x GA. There was a significant difference between the PI-UA obtained at the abdominal and placental ends of the umbilical cord (p<0.001. CONCLUSIONS: Longitudinal reference intervals for the main gestational Doppler parameters were obtained in a Brazilian cohort. These intervals could be more adequate for the follow-up of maternal-fetal hemodynamic modifications in normal and abnormal pregnancies, a fact that still requires further validation.

  4. Handbook of nuclear medicine and molecular imaging principles and clinical applications

    CERN Document Server

    Kim, Edmund E; Tateishi, Ukihide; Baum, Richard P

    2012-01-01

    This handbook will provide updated information on nuclear medicine and molecular imaging techniques as well as its clinical applications, including radionuclide therapy, to trainees and practitioners of nuclear medicine, radiology and general medicine. Updated information on nuclear medicine and molecular imaging are vitally important and useful to both trainees and existing practitioners. Imaging techniques and agents are advancing and changing so rapidly that concise and pertinent information are absolutely necessary and helpful. It is hoped that this handbook will help readers be better equipped for the utilization of new imaging methods and treatments using radiopharmaceuticals.

  5. Promoting integrative medicine by computerization of traditional Chinese medicine for scientific research and clinical practice: The SuiteTCM Project

    Institute of Scientific and Technical Information of China (English)

    Arthur de Sá Ferreira

    2013-01-01

    BACKGROUND:Chinese and contemporary Western medical practices evolved on different cultures and historical contexts and,therefore,their medical knowledge represents this cultural divergence.Computerization of traditional Chinese medicine (TCM) is being used to promote the integrative medicine to manage,process and integrate the knowledge related to TCM anatomy,physiology,semiology,pathophysiology,and therapy.METHODS:We proposed the development of the SuiteTCM software,a collection of integrated computational models mainly derived from epidemiology and statistical sciences for computerization of Chinese medicine scientific research and clinical practice in all levels of prevention.The software includes components for data management (DataTCM),simulation of cases (SimTCM),analyses and validation of datasets (SciTCM),clinical examination and pattern differentiation (DiagTCM,Tongue TCM,and Pulse TCM),intervention selection (AcuTCM,HerbsTCM,and DietTCM),management of medical records (ProntTCM),epidemiologic investigation of sampled data (ResearchTCM),and medical education,training,and assessment (StudentTCM).DISCUSSION:The SuiteTCM project is expected to contribute to the ongoing development of integrative medicine and the applicability of TCM in worldwide scientific research and health care.The SuiteTCM 1.0 runs on Windows XP or later and is freely available for download as an executable application.

  6. [Literature survey on botanical origin and clinical application of traditional Tibetan medicine "Shengdeng"].

    Science.gov (United States)

    Chen, De-Dao; Meng, Xian-Hua; Zhang, Ying-Shan; Chen, Gen-Ping; Huang, Yu-Lan

    2012-10-01

    "Shengdeng" is its Tibetan transliteration referring to many medicines. Tibetan doctors and pharmacists in different areas use different drugs in formulation and clinical application, which are easily confused. In order to grasp the formula and clinical application accurately, we conduct a literature survey on history and current state of botanical origin and clinical application of "Shengdeng", making clear the application of various herbs named "Shengdeng" and providing reference to all Tibetan researchers and clinical workers in formulation and clinical application.

  7. Another Fine MeSH: Clinical Medicine Meets Information Science.

    Science.gov (United States)

    O'Rourke, Alan; Booth, Andrew; Ford, Nigel

    1999-01-01

    Discusses evidence-based medicine (EBM) and the need for systematic use of databases like MEDLINE with more sophisticated search strategies to optimize the retrieval of relevant papers. Describes an empirical study of hospital libraries that examined requests for information and search strategies using both structured and unstructured forms.…

  8. The business of palliative medicine--part 6: clinical operations in a comprehensive integrated program.

    Science.gov (United States)

    Lagman, Ruth L; Walsh, Declan; LeGrand, Susan B; Davis, Mellar P

    2011-03-01

    The medical care of individuals with advanced disease is complex and has historically been fragmented and suboptimal. Palliative medicine attempts to address these needs. The Harry R. Horvitz Center for Palliative Medicine at the Cleveland Clinic is an established comprehensive integrated program. Structured and seamless clinical operations are important to ensure the best delivery of high-quality medical care and continuity for those affected by life-limiting illness.

  9. Changing the Face of Veterinary Medicine: Research and Clinical Developments at AAVMC Institutions.

    Science.gov (United States)

    Smith, Donald F; Hagstrom, Melena R

    2015-01-01

    This paper provides a 50-year overview of research and clinical advances in AAVMC member colleges in four representative fields of veterinary medicine: oncology, vaccine development, production medicine, and public health. Though emphasis is on the progress since the mid-1960s, the salient background and associated personnel in each field are also identified to the extent that their description informs more recent events. Advances in board certification and post-graduate clinical and research educational opportunities are also described.

  10. Behavioral medicine and clinical health psychology: introduction to the special issue.

    Science.gov (United States)

    Christensen, Alan J; Nezu, Arthur M

    2013-04-01

    This issue represents the 4th Journal of Consulting and Clinical Psychology special issue on behavioral medicine and clinical health psychology over the past 4 decades. Recent developments in health care policy, as well as in the maturation of the science, make a special issue in this area particularly timely. This collection includes state of the clinical science reviews, reports of clinical trials, and articles addressing theory and methods in behavioral medicine and clinical health psychology. A multilevel, ecological perspective that considers multiple levels of influences (e.g., cultural influences on behavior-health linkages, individual differences) is salient throughout many of the articles. Our hope is that this sampling of this broad field, and coverage of some key issues and areas, will play a role in stimulating the next 10 years of research, practice, and policy implementation in behavioral medicine and clinical health psychology.

  11. [Consumption of medicinal herbs in patients attending a gastroenterology outpatient clinic].

    Science.gov (United States)

    Devesa Jordà, F; Pellicer Bataller, J; Ferrando Ginestar, J; Borghol Hariri, A; Bustamante Balén, M; Ortuño Cortés, J; Ferrando Marrades, I; Llobera Bertran, C; Sala Lajo, A; Miñana Morell, M; Nolasco Bonmatí, A; Fresquet Febrer, J L

    2004-04-01

    The consumption of medicinal herbs is one of the most important topics in alternative and complementary medicine. The widespread use of these substances among the general population gives rise to the possibility of therapeutic or toxic effects in patients seeking conventional medical assistance. To determine the frequency of medicinal herb use, the species consumed and the profile of medicinal herb consumers among patients with gastrointestinal disorders, patients attending the gastroenterology outpatient clinic of the Francesc de Borja district hospital (Gandía, Spain) over a 5-month period were interviewed and 539 valid questionnaires were obtained. A total of 34.7% of the interviewees had taken medicinal herbs at some time and 26.9% had used them in the last year. Self-prescription was reported by 67.1%. Medicinal herbs were mainly obtained in the pharmacy or herbalist's (74.7%). The results of medicinal herb therapy were considered good or excellent by 80.3% of the interviewees, average by 18.6% and poor by 1.1%. In the univariate analysis, medicinal herb consumption was positively associated with female sex (p Mentha pulegium (4.4%) and Valeriana officinalis (4.4%). The results show that consumption of medicinal herbs is frequent among patients attending the gastroenterology outpatient clinic of a district hospital. The probable profile of those showing maximum consumption is: female sex, university education, lower gastrointestinal disorder, functional gastrointestinal disorder, psychotropic drug consumption and use of TE.

  12. The medical ethos and social responsibility in clinical medicine.

    Science.gov (United States)

    Francis, C. K.

    2001-01-01

    The medical profession will face many challenges in the new millennium. As medicine looks forward to advances in molecular genetics and the prospect of unprecedented understanding of the causes and cures of human disease, clinicians, scientists and bioethicists may benefit from reflection upon the origins of the medical ethos and its relevance to postmodern medicine. Past distortions of the medical ethos, such as Nazism and the Tuskegee Syphilis Study, as well as more recent experience with the ethical challenges of employer-based market driven managed care, provide important lessons as medicine contemplates the future. Racial and ethnic disparities in health status and access to care serve as a reminders that the racial doctrines that fostered the horrors of the Holocaust and the Tuskegee Syphilis Study have not been completely removed from contemporary thinking. Inequalities in health status based on race and ethnicity, as well as socioeconomic status, attest to the inescapable reality of racism in America. When viewed against a background of historical distortions and disregard for the traditional tenets of the medical ethos, persistent racial and ethnic disparities and health and the prospect of genetic engineering raise the specter of discrimination because of genotype, a postmodern version of "racist medicine" or of a "new eugenics." There is a need to balance medicine's devotion to the wellbeing of the patient and the primacy of the patient-physician relationship against with the need to meet the health care needs of society. The challenge facing the medical profession in the new millennium is to establish an equilibrium between the responsibility to assure quality health care for the individual patient while affecting societal changes to achieve "health for all." PMID:11405593

  13. The European Register of Specialists in Clinical Chemistry and Laboratory Medicine: guide to the Register, version 3-2010

    DEFF Research Database (Denmark)

    McMurray, Janet; Zérah, Simone; Hallworth, Michael;

    2010-01-01

    In 1997, the European Communities Confederation of Clinical Chemistry and Laboratory Medicine (EC4) set up a Register for European Specialists in Clinical Chemistry and Laboratory Medicine. The operation of the Register is undertaken by a Register Commission (EC4RC). During the last 12 years, more...... than 2200 specialists in Clinical Chemistry and Laboratory Medicine have joined the Register. In 2007, EC4 merged with the Forum of European Societies of Clinical Chemistry and Laboratory Medicine (FESCC) to form the European Federation of Clinical Chemistry and Laboratory Medicine (EFCC). Two previous...

  14. [Plea for a strengthening of clinical social medicine].

    Science.gov (United States)

    Simoes, E; Gostomzyk, J G; Schmahl, F W; Bamberg, M; Brucker, S Y; Wallwiener, D

    2014-09-01

    Social medicine is concerned--in the midst of a constantly changing society--with the social and economic conditions that influence health, disease and medical care. A comprehensive medical care therefore requires medical doctors who, beyond the biomedical issues, realize diseases in the context of the social needs of the individual person and systematically include these in their prevention, treatment and rehabilitation concepts.The system of social security, particularly the health care system, depends on medical doctors' expertise in helping patients for the appropriate use of services from the system of social security. According to the German professional education regulations for doctors the additional specialization in "social medicine" also includes the competence for "assessment of the nature and extent of health disorders and their classification in the framework of social security systems". This judgment is one part of the tasks of the Medical Services belonging to the various branches of the social security system. It is also provided in practice by medical doctors with competence in social medicine working in acute care facilities.

  15. Navigating legal constraints in clinical data warehousing: a case study in personalized medicine.

    Science.gov (United States)

    Jefferys, Benjamin R; Nwankwo, Iheanyi; Neri, Elias; Chang, David C W; Shamardin, Lev; Hänold, Stefanie; Graf, Norbert; Forgó, Nikolaus; Coveney, Peter

    2013-04-01

    Personalized medicine relies in part upon comprehensive data on patient treatment and outcomes, both for analysis leading to improved models that provide the basis for enhanced treatment, and for direct use in clinical decision-making. A data warehouse is an information technology for combining and standardizing multiple databases. Data warehousing of clinical data is constrained by many legal and ethical considerations, owing to the sensitive nature of the data being stored. We describe an unconstrained clinical data warehousing architecture, some of the legal constraints that have led us to reconsider this architecture, and the legal and technical solutions to these constraints developed for the clinical data warehouse in the personalized medicine project p-medicine. We also propose some changes to the legal constraints that will further enable clinical research.

  16. Navigating legal constraints in clinical data warehousing: a case study in personalized medicine

    Science.gov (United States)

    Jefferys, Benjamin R.; Nwankwo, Iheanyi; Neri, Elias; Chang, David C. W.; Shamardin, Lev; Hänold, Stefanie; Graf, Norbert; Forgó, Nikolaus; Coveney, Peter

    2013-01-01

    Personalized medicine relies in part upon comprehensive data on patient treatment and outcomes, both for analysis leading to improved models that provide the basis for enhanced treatment, and for direct use in clinical decision-making. A data warehouse is an information technology for combining and standardizing multiple databases. Data warehousing of clinical data is constrained by many legal and ethical considerations, owing to the sensitive nature of the data being stored. We describe an unconstrained clinical data warehousing architecture, some of the legal constraints that have led us to reconsider this architecture, and the legal and technical solutions to these constraints developed for the clinical data warehouse in the personalized medicine project p-medicine. We also propose some changes to the legal constraints that will further enable clinical research. PMID:24427531

  17. Regulation of Clinical Trials with Advanced Therapy Medicinal Products in Germany.

    Science.gov (United States)

    Renner, Matthias; Anliker, Brigitte; Sanzenbacher, Ralf; Schuele, Silke

    2015-01-01

    In the European Union, clinical trials for Advanced Therapy Medicinal Products are regulated at the national level, in contrast to the situation for a Marketing Authorisation Application, in which a centralised procedure is foreseen for these medicinal products. Although based on a common understanding regarding the regulatory requirement to be fulfilled before conduct of a clinical trial with an Advanced Therapy Investigational Medicinal Product, the procedures and partly the scientific requirements for approval of a clinical trial application differ between the European Union Member States. This chapter will thus give an overview about the path to be followed for a clinical trial application and the subsequent approval process for an Advanced Therapy Investigational Medicinal Product in Germany and will describe the role of the stakeholders that are involved. In addition, important aspects of manufacturing, quality control and non-clinical testing of Advanced Therapy Medicinal Products in the clinical development phase are discussed. Finally, current and future approaches for harmonisation of clinical trial authorisation between European Union Member States are summarised.

  18. Polanyi's tacit knowing and the relevance of epistemology to clinical medicine.

    Science.gov (United States)

    Henry, Stephen G

    2010-04-01

    Most clinicians take for granted a simple, reductionist understanding of medical knowledge that is at odds with how they actually practice medicine; routine medical decisions incorporate more complicated kinds of information than most standard accounts of medical reasoning suggest. A better understanding of the structure and function of knowledge in medicine can lead to practical improvements in clinical medicine. This understanding requires some familiarity with epistemology, the study of knowledge and its structure, in medicine. Michael Polanyi's theory of tacit knowing is advanced as the basis for developing a more accurate understanding of medical knowledge. Tacit knowing, which explores the taken-for-granted background knowledge that underlies all human knowing, is explained in detail with a focus on its relevance for clinical medicine. The implications of recognizing tacit knowing in medicine and medical decisions are discussed. These include the ability to explain the importance of the clinical encounter in medical practice, mechanisms for analysing patient and doctor as persons, and the need for humility given the uncertainty that the tacit dimension injects into all medical decisions. This more robust medical epistemology allows clinicians to better articulate the nature and importance of patient-centred care, to avoid pitfalls inherent in reductionist approaches to medical knowledge, and to think more clearly about the relationships between medicine and health care at the individual and population levels.

  19. Significance of Kampo, Japanese Traditional Medicine, in the Treatment of Obesity: Basic and Clinical Evidence

    Directory of Open Access Journals (Sweden)

    Jun-ichi Yamakawa

    2013-01-01

    Full Text Available The cause of obesity includes genetic and environmental factors, including cytokines derived from adipocytes (adipo-cytokines. Although drug therapy is available for obesity, it is highly risky. Our main focus in this review is on the traditional form of Japanese medicine, Kampo, in the treated of obesity. Two Kampo formulas, that is, bofutsushosan (防風通聖散 and boiogito (防己黄耆湯, are covered by the national health insurance in Japan for the treatment of obesity. Various issues related to their action mechanisms remain unsolved. Considering these, we described the results of basic experiments and presented clinical evidence and case reports on osteoarthritis as examples of clinical application of their two Kampo medicine. Traditional medicine is used not only for treatment but also for prevention. In clinical practice, it is of great importance to prove the efficacy of combinations of traditional medicine and Western medicine and the utility of traditional medicine in the attenuation of adverse effects of Western medicine.

  20. [Education Program of Kampo-medicine for Undergraduates in Preparation for Clinical Setting].

    Science.gov (United States)

    Homma, Masato

    2016-01-01

    Kampo-medicine has become popular in Japanese medical practice combined with western medicine. For example, Daikenchu-To for intestinal obstruction after surgical operation, Shakuyakukanzo-To and Goshajinki-Gan for anti-cancer agents-induced neuropathy, and Yokkan-San for behavioral psychological symptoms of dementia are alternatively used in addition to conventional treatments in Japan. However, combined use of Kampo-medicine and western medicine may cause unexpected adverse events including undesirable drug-drug interactions because Kampo-medicine was not originally developed to be used with western medicine. Although adverse effects of Kampo-medicine are rare compared with those of western medicine, severe events such as liver dysfunction and interstitial pneumonia have been reported in increasing trends. Medical staff including pharmacists, therefore, should be aware of the onset of adverse events before the patients' symptoms become severe. Several adverse effects are caused by chemical constituents such as glycyrrhizin in licorice for pseudoaldosteronism and geniposide in Gardeniae fructus for mesenteric phlebosclerosis. To understand the adverse effects of Kampo-medicine, pharmacists should learn trends in current medication as well as pharmacology and toxicology of the chemical constituents in pharmacognosy. These issues should also be addressed in educational materials for students of clinical pharmacy and pharmacy practice.

  1. Systematic review of emergency medicine clinical practice guidelines: Implications for research and policy.

    Science.gov (United States)

    Venkatesh, Arjun K; Savage, Dan; Sandefur, Benjamin; Bernard, Kenneth R; Rothenberg, Craig; Schuur, Jeremiah D

    2017-01-01

    Over 25 years, emergency medicine in the United States has amassed a large evidence base that has been systematically assessed and interpreted through ACEP Clinical Policies. While not previously studied in emergency medicine, prior work has shown that nearly half of all recommendations in medical specialty practice guidelines may be based on limited or inconclusive evidence. We sought to describe the proportion of clinical practice guideline recommendations in Emergency Medicine that are based upon expert opinion and low level evidence. Systematic review of clinical practice guidelines (Clinical Policies) published by the American College of Emergency Physicians from January 1990 to January 2016. Standardized data were abstracted from each Clinical Policy including the number and level of recommendations as well as the reported class of evidence. Primary outcomes were the proportion of Level C equivalent recommendations and Class III equivalent evidence. The primary analysis was limited to current Clinical Policies, while secondary analysis included all Clinical Policies. A total of 54 Clinical Policies including 421 recommendations and 2801 cited references, with an average of 7.8 recommendations and 52 references per guideline were included. Of 19 current Clinical Policies, 13 of 141 (9.2%) recommendations were Level A, 57 (40.4%) Level B, and 71 (50.4%) Level C. Of 845 references in current Clinical Policies, 67 (7.9%) were Class I, 272 (32.3%) Class II, and 506 (59.9%) Class III equivalent. Among all Clinical Policies, 200 (47.5%) recommendations were Level C equivalent, and 1371 (48.9%) of references were Class III equivalent. Emergency medicine clinical practice guidelines are largely based on lower classes of evidence and a majority of recommendations are expert opinion based. Emergency medicine appears to suffer from an evidence gap that should be prioritized in the national research agenda and considered by policymakers prior to developing future quality

  2. Precision manufacturing for clinical-quality regenerative medicines.

    Science.gov (United States)

    Williams, David J; Thomas, Robert J; Hourd, Paul C; Chandra, Amit; Ratcliffe, Elizabeth; Liu, Yang; Rayment, Erin A; Archer, J Richard

    2012-08-28

    Innovations in engineering applied to healthcare make a significant difference to people's lives. Market growth is guaranteed by demographics. Regulation and requirements for good manufacturing practice-extreme levels of repeatability and reliability-demand high-precision process and measurement solutions. Emerging technologies using living biological materials add complexity. This paper presents some results of work demonstrating the precision automated manufacture of living materials, particularly the expansion of populations of human stem cells for therapeutic use as regenerative medicines. The paper also describes quality engineering techniques for precision process design and improvement, and identifies the requirements for manufacturing technology and measurement systems evolution for such therapies.

  3. Clinical Holistic Medicine: Whiplash, Fibromyalgia, and Chronic Fatigue

    Directory of Open Access Journals (Sweden)

    Søren Ventegodt

    2005-01-01

    Full Text Available Holistic treatment of the highly complex, “new diseases” are often possible with the tools of consciousness-based medicine. The treatment is more complicated and the cure usually takes longer than for less-complex diseases. The problem with these patients is that they have less easily accessible resources than most patients, as they suffer from a combined socio-psycho-physical problem with depression, poor social standing, low confidence, and low self-esteem. Often, they have also already tried most of the specialist and alternative treatments on the market. To cure them, the most important thing is to coach them to improve their social life by changing their behavior to be of more value to others. Holding and processing must be especially careful and the contract with the patients must be extremely explicit in order to work on their personal development for 6—12 months. The new diseases can be cured with consciousness-based medicine if the patients are motivated and keep their appointments and agreements. Low responsibility, low personal energy, little joy of life, and limited insight into self and existence are some of the features of the new diseases that make them difficult to cure. The important thing is to keep a pace the patient can follow and give the patient a row of small successes and as few failures as possible. The new diseases are a challenge, a unique chance to improve communication, holding, and processing skills.

  4. [Construction of Research-Oriented State Key Clinical Department by Highlighting the Characteris- tics and Advantages of Chinese Medicine].

    Science.gov (United States)

    Ma, Shi-yu; Guo, Li-heng; Han, Yun; Li, Jian; Zhang, Min-zhou

    2016-04-01

    As the largest research-oriented specialty department in national traditional Chinese medicine hospitals, the Department of Critical Care Medicine in Guangdong Provincial Hospital of Chinese Medicine insists on the development mode combined with clinical medicine and scientific research. By taking clinical and basic researches for integrative medicine preventing and treating acute myocardial in-farction and sepsis as a breakthrough, authors explored key problems of Chinese medicine in improving the prognosis related diseases and patients' quality of life. In recent 3 years our department has successively become the principal unit of the national key specialties cooperative group of critical care medicine (awarded by State Administration of Traditional Chinese Medicine), the key clinical specialties (awarded by National Health and Family Planning Commission), and Guangzhou key laboratory construction unit, and achieved overall lap in clinical medical treatment, personnel training, scientific research, and social service.

  5. Clinical oncology and palliative medicine as a combined specialty--a unique model in Hong Kong.

    Science.gov (United States)

    Yeung, Rebecca; Wong, Kam-Hung; Yuen, Kwok-Keung; Wong, Ka-Yan; Yau, Yvonne; Lo, Sing-Hung; Liu, Rico

    2015-07-01

    The importance of early integration of palliative care (PC) into oncology treatment is increasingly being recognized. However, there is no consensus on what is the optimal way of integration. This article describes a unique model in Hong Kong where clinical oncology and palliative medicine (PM) is integrated through the development of PM as a subspecialty under clinical oncology.

  6. Geriatric Medicine Fellows' Experiences and Attitudes toward an Objective Structured Clinical Examination (OSCE)

    Science.gov (United States)

    Bagri, Anita S.; Zaw, Khin M.; Milanez, Marcos N.; Palacios, Juan J.; Qadri, Syeda S.; Bliss, Linda A.; Roos, Bernard A.; Ruiz, Jorge G.

    2009-01-01

    A total of 8 geriatric medicine fellows participated in an objective structured clinical examination (OSCE) assessing communication skills and clinical reasoning in common geriatric syndromes. To determine their perceptions about the experience, we conducted surveys and semistructured interviews. We analyzed the survey data using descriptive…

  7. Geriatric Medicine Fellows' Experiences and Attitudes toward an Objective Structured Clinical Examination (OSCE)

    Science.gov (United States)

    Bagri, Anita S.; Zaw, Khin M.; Milanez, Marcos N.; Palacios, Juan J.; Qadri, Syeda S.; Bliss, Linda A.; Roos, Bernard A.; Ruiz, Jorge G.

    2009-01-01

    A total of 8 geriatric medicine fellows participated in an objective structured clinical examination (OSCE) assessing communication skills and clinical reasoning in common geriatric syndromes. To determine their perceptions about the experience, we conducted surveys and semistructured interviews. We analyzed the survey data using descriptive…

  8. Monetary Value of a Prescription Assistance Program Service in a Rural Family Medicine Clinic

    Science.gov (United States)

    Whitley, Heather P.

    2011-01-01

    Purpose: To quantify the monetary value of medications provided to rural Alabamians through provision of pharmaceutical manufacturer-sponsored prescription assistance programs (PAPs) provided by a clinical pharmacist in a private Black Belt family medicine clinic during 2007 and 2008. Methods: Patients struggling to afford prescription medications…

  9. Practice and considerations of teaching reform of integrated nervous system course for the clinical medicine program

    Institute of Scientific and Technical Information of China (English)

    Juan LI; Liang ZHU; Feng LI; Wen-long DING

    2015-01-01

    Basic Medicine Faculty of Shanghai Jiao Tong University organically integrates basic medicine courses relevant to the central nervous system(including anatomy,physiology,pathology,and pharmacology)and clinical medicine courses(including imaging and diagnostics)into the nervous system module according to course arrangement of domestic and abroad medical schools and has offered to students of eight-year clinical medicine program since 2009.This paper summarizes experiences of the teaching team of nervous system course in nearly six years,explores the development and optimization of the integrated nervous system course from perspectives of arrangement of teaching contents,development of the teaching team,reform of teaching models,and optimization of teaching resources,and considers existing problems and countermeasures during the course development,so as to provide strategic guidance for further optimization and perfection of the integrated nervous system course.

  10. Beyond the myth of expensive clinical study: assessment of traditional medicines.

    Science.gov (United States)

    Graz, Bertrand; Elisabetsky, Elaine; Falquet, Jacques

    2007-09-25

    Clinical studies with human subjects represent the only assessment of effectiveness and safety that can translate into medical practice, and national or local health policy. There are several reasons why traditional medicines (in fact medicinal plants and other alternative or complementary medicines) should be subjected to more clinical research with patient observation and follow-up: firstly, this would help to select products of interest for further investigations in ethnopharmacology; secondly, it could translate into immediate recommendations for the population using the assessed local treatments. Contrary to a commonly held myth, clinical studies can be conducted at relatively low cost, if one works with local/regional research institutes and with doctoral students, focusing on meaningful clinical measures rather than sophisticated laboratory analyses. This paper describes special designs of clinical studies, appropriate for traditional medicines and tested in the field, including: the retrospective treatment-outcome population survey, the prognosis- outcome method (with modern physicians observing progress of patients treated by a traditional healer), the dose-escalating prospective study (detecting a dose-response phenomenon in humans). It is suggested that this approach offers the best cost-effective course of action for obtaining maximal benefits from traditional medicines, especially those used for treating endemic diseases.

  11. Interpretation of biomonitoring data in clinical medicine and the exposure sciences.

    Science.gov (United States)

    Williams, Bryan L; Barr, Dana B; Wright, J Michael; Buckley, Brian; Magsumbol, Melina S

    2008-11-15

    Biomonitoring has become a fundamental tool in both exposure science and clinical medicine. Despite significant analytical advances, the clinical use of environmental biomarkers remains in its infancy. Clinical use of environmental biomarkers poses some complex scientific and ethical challenges. The purpose of this paper is compare how the clinical and exposure sciences differ with respect to their interpretation and use of biological data. Additionally, the clinical use of environmental biomonitoring data is discussed. A case study is used to illustrate the complexities of conducting biomonitoring research on highly vulnerable populations in a clinical setting.

  12. MEDICINAL HERBS USED BY CLIENTS ATTENDING CLINICAL UNITS OF SANTA MARCELINA, PORTO VELHO RO BRAZIL

    OpenAIRE

    Caetano, Rosemeiry Soares; FACULDADE SÃO LUCAS; de Souza, Ana Cristina Ramos; FACULDADE SÃO LUCAS; Feitoza, Leiliane Ferreira; FACULDADE SÃO LUCAS

    2014-01-01

    Many people are currently using medicinal herbs as a therapeutic alternative. Current paper tries to recover and analyze popular lore on the use of medicinal plants to cure diseases. Methodology consists of data collection by interviews with clients of clinical units of the Santa Marcelina Community in Porto Velho RO Brazil. Seventy-nine species and 46 botanic families were identified with special reference to Asteraceae and Lamiaceae with 10 and 8 species each. The most mentioned species wer...

  13. Clinical medicine for Intensive Care especialists. Questions to an expert.

    Directory of Open Access Journals (Sweden)

    Alfredo Darío Espinosa Brito

    2010-12-01

    Full Text Available Conception, organization, and development of Intensive Care Medicine is one of the greatest contribution that medical care services brought to the professional practice of doctors and paramedic personnel in the second part of the 20th centrury. In our country, since the 70’s years, this field was incorporated in our National Health System to the daily work of our professionals as to the patients expectations, in an almost an imperceptible way. Twenty polemical questions were asked to an expert, about several current dilemmas in this field. The questions and the answes are only a motivation for new debates in medical services, in medical education activities and in research.

  14. Clinical Research Informatics for Big Data and Precision Medicine.

    Science.gov (United States)

    Weng, C; Kahn, M G

    2016-11-10

    To reflect on the notable events and significant developments in Clinical Research Informatics (CRI) in the year of 2015 and discuss near-term trends impacting CRI. We selected key publications that highlight not only important recent advances in CRI but also notable events likely to have significant impact on CRI activities over the next few years or longer, and consulted the discussions in relevant scientific communities and an online living textbook for modern clinical trials. We also related the new concepts with old problems to improve the continuity of CRI research. The highlights in CRI in 2015 include the growing adoption of electronic health records (EHR), the rapid development of regional, national, and global clinical data research networks for using EHR data to integrate scalable clinical research with clinical care and generate robust medical evidence. Data quality, integration, and fusion, data access by researchers, study transparency, results reproducibility, and infrastructure sustainability are persistent challenges. The advances in Big Data Analytics and Internet technologies together with the engagement of citizens in sciences are shaping the global clinical research enterprise, which is getting more open and increasingly stakeholder-centered, where stakeholders include patients, clinicians, researchers, and sponsors.

  15. Integration of evidence based medicine into the clinical years of a medical curriculum

    Directory of Open Access Journals (Sweden)

    Mazen Ferwana

    2012-01-01

    Full Text Available Teaching Evidence Based Medicine (EBM helps medical students to develop their decision making skills based on current best evidence, especially when it is taught in a clinical context. Few medical schools integrate Evidence Based Medicine into undergraduate curriculum, and those who do so, do it at the academic years only as a standalone (classroom teaching but not at the clinical years. The College of Medicine at King Saud bin Abdulaziz University for Health Sciences was established in January 2004. The college adopted a four-year Problem Based Learning web-based curriculum. The objective of this paper is to present our experience in the integration of the EBM in the clinical phase of the medical curriculum. We teach EBM in 3 steps: first step is teaching EBM concepts and principles, second is teaching the appraisal and search skills, and the last step is teaching it in clinical rotations. Teaching EBM at clinical years consists of 4 student-centered tutorials. In conclusion, EBM may be taught in a systematic, patient centered approach at clinical rounds. This paper could serve as a model of Evidence Based Medicine integration into the clinical phase of a medical curriculum.

  16. Clinical implications for substandard, nonproprietary medicines in multiple sclerosis: focus on fingolimod

    Science.gov (United States)

    Correale, Jorge; Chiquete, Erwin; Boyko, Alexey; Beran, Roy G; Strauch, Jorge Barahona; Milojevic, Snezana; Frider, Nadina

    2016-01-01

    Both proprietary and nonproprietary medicines are expected to undergo rigorous preapproval testing and both should meet stringent health authority regulatory requirements related to quality to obtain approval. Nonproprietary (also known as copy, or generic) medicines, which base their authorization and use on the proprietary documentation and label, are often viewed as a means to help lower the cost and, thus, increase patient access. If these medicines fail to meet quality standards, such as good manufacturing practice and bioequivalence (in humans), they are then defined as substandard copies and can pose serious risks to patients in terms of safety and efficacy. Potentially noncontrolled or different manufacturing process and excipients in nonproprietary medicines may result in poor batch-to-batch reproducibility (accurate and consistent quantity of each ingredient in each capsule/tablet) and lower quality. Substandard, nonproprietary copies of medicines that are immunomodulatory or immunosuppressive are of concern to patients due to their possible untoward safety and lack of efficacy events. This article reviews the potential risks associated with nonproprietary medicines that do not meet the regulatory requirements of the United States Food and Drug Administration, the European Medicines Agency, or the World Health Organization. The clinical implications for patients are described. This article focuses on nonproprietary medicines for multiple sclerosis, particularly fingolimod, that are not identical to proprietary versions and could thus fail to meet efficacy expectations or have different impact on the safety of patients with multiple sclerosis. PMID:27418809

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

    Science.gov (United States)

    Wardle, Jonathan Lee; Sarris, Jerome

    2014-06-01

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

  18. Maternal-fetal iron status and the relationship between it and the expression of placental iron transporters%母-胎铁状态及与胎盘铁转运因子表达的关系

    Institute of Scientific and Technical Information of China (English)

    李燕琴; 贾志; 白斌; 颜虹; 张耀辉

    2012-01-01

    目的 对母-胎铁营养之间的关系及其与胎盘铁转运因子表达的关系进行分析,为进一步理解母-胎铁营养关系及其调节机制提供线索.方法 以健康足月的40名不同铁营养状态孕妇为研究对象,采集分娩时母亲静脉血及脐血、胎盘,进行血液学检测及Western Blot和实时定量PCR检测.结果 胎儿的各项血液学参数均高于母亲.母亲血红蛋白浓度与胎儿的红细胞计数有显著相关性(r=0.504,P<0.05);母亲血红蛋白浓度和胎盘组织铁蛋白的蛋白表达呈显著相关性(r=0.436,P<0.05).其余各指标之间均无明显的相关性.结论 母-胎铁状态之间及其与胎盘铁转运因子的表达之间仅部分具有一定的相关性.%Objective To analyze the correlation between-maternal and fetal iron status and the relationship between maternd-fetal iron status and the expression of placental iron transporters, so as to provide clue for further understanding of maternal-fetal iron nutrition and its regulatory mechanism. Methods Forty healthy full-term pregnant women with different iron nutrition status were chosen for the research. Maternal vein blood, umbilical cord blood and placental tissues were collected at the delivery. Routine blood test, Western Blot and realtime PCR test were conducted in this study. Results All hematological parameters of umbilical cord blood were higher than those of maternal blood. The maternal hemoglobin level was significantly correlated with fetal red blood count( r = 0. 504, P <0. 05 ). There were also significant correlations between maternal hemoglobin level and the protein expression of placental ferritin( r = 0. 436, P < 0. 05 ). The other indexes showed no significant correlation. Conclusion Only some of parameters of maternal-fetal iron status and placental iron transporters are correlated.

  19. Trend and impact of international collaboration in clinical medicine papers published in Malaysia.

    Science.gov (United States)

    Low, Wah Yun; Ng, Kwan Hoong; Kabir, M A; Koh, Ai Peng; Sinnasamy, Janaki

    2014-01-01

    Research collaboration is the way forward in order to improve quality and impact of its research findings. International research collaboration has resulted in international co-authorship in scientific communications and publications. This study highlights the collaborating research and authorship trend in clinical medicine in Malaysia from 2001 to 2010. Malaysian-based author affiliation in the Web of Science (Science Citation Index Expanded) and clinical medicine journals (n = 999) and articles (n = 3951) as of 30th Oct 2011 were downloaded. Types of document analyzed were articles and reviews, and impact factors (IF) in the 2010 Journal Citation Report Science Edition were taken to access the quality of the articles. The number of publications in clinical medicine increased from 4.5 % (n = 178) in 2001 to 23.9 % (n = 944) in 2010. The top three contributors in the subject categories are Pharmacology and Pharmacy (13.9 %), General and Internal Medicine (13.6 %) and Tropical Medicine (7.3 %). By journal tier system: Tier 1 (18.7 %, n = 738), Tier 2 (22.5 %, n = 888), Tier 3 (29.6 %, n = 1170), Tier 4 (27.2 %, n = 1074), and journals without IF (2.1 %, n = 81). University of Malaya was the most productive. Local collaborators accounted for 60.3 % and international collaborations 39.7 %. Articles with international collaborations appeared in journals with higher journal IFs than those without international collaboration. They were also cited more significantly than articles without international collaborations. Citations, impact factor and journal tiers were significantly associated with international collaboration in Malaysia's clinical medicine publications. Malaysia has achieved a significant number of ISI publications in clinical medicine participation in international collaboration.

  20. Three-dimensional neurosonography - a novel field in fetal medicine.

    Science.gov (United States)

    Lipa, Michał; Pooh, Ritsuko Kimata; Wielgoś, Mirosław

    2017-01-01

    Neurosonography is a promising technique for prenatal diagnosis, combining features of ultrasound imaging with fetal neurology. The brain is a three-dimensional structure, therefore observing brain structure in the three basic planes (sagittal, coronal and axial) is mandatory. The anterior fontanelle and sagittal suture may serve as acoustic ultrasound windows in the transvaginal brain scan, allowing to obtain high-resolution neuroimages of the intracranial structures. Furthermore, three-dimensional (3D) ultrasound combined with the transvaginal brain approach provides detailed and sophisticated neuroimages. Three orthogonal planes of the brain, tomographic ultrasound imaging (TUI) and other off-line approaches (e.g. volume contrast imaging (VCI) or HDlive silhouette imaging) may be obtained from a single 3D dataset. 3D Doppler ultrasound enables visualization of the intracerebral vascularity, allowing to obtain more precise information on cerebral perfusion. Various abnormal brain conditions, including ventriculomegaly, agenesis of the corpus callosum, posterior fossa abnormalities and others, can be well-demonstrated. Due to high rates of the associated anomalies and uncertain prognosis, any suspicion of CNS abnormalities shall imply detailed ultrasonographic evaluation of the fetal anatomy to exclude the associated anomalies. Despite a growing number of neuroimaging modalities, prenatal counselling remains a challenge as prediction of brain functionality and the neurological prognosis often remain uncertain. New investigations on the relations between various migration disorders and gene mutations, as well as recent clinical research on the relations between neuroimaging detection of local migration disorders using sophisticated imaging technologies and the postnatal neurological prognosis will contribute to the development of maternal-fetal medicine as well as pediatric neurology.

  1. Complementary and alternative medicine use by visitors to rural Japanese family medicine clinics: results from the international complementary and alternative medicine survey.

    Science.gov (United States)

    Shumer, Gregory; Warber, Sara; Motohara, Satoko; Yajima, Ayaka; Plegue, Melissa; Bialko, Matthew; Iida, Tomoko; Sano, Kiyoshi; Amenomori, Masaki; Tsuda, Tsukasa; Fetters, Michael D

    2014-09-25

    There is growing interest in the use of complementary and alternative medicine (CAM) throughout the world, however previous research done in Japan has focused primarily on CAM use in major cities. The purpose of this study was to develop and distribute a Japanese version of the International Complementary and Alternative Medicine Questionnaire (I-CAM-Q) to assess the use of CAM among people who visit rural Japanese family medicine clinics. Using a Japanese version of the International Complementary and Alternative Medicine Questionnaire (I-CAM-Q), a cross-sectional survey was conducted in three rural family medicine clinics. All patients and those accompanying patients who met inclusion criteria were eligible to participate. Data were entered into SPSS Statistics and analyzed for use by age, gender, and location. Of the 519 respondents who participated in the project, 415 participants reported CAM use in the past 12 months (80.0%). When prayer is excluded, the prevalence of CAM use drops to 77.3% in the past year, or 403 respondents. The most common forms of CAM used by respondents were pain relief pads (n = 170, 32.8%), herbal medicines/supplements (n = 167, 32.2%), and massage by self or family (n = 166, 32.0%). Female respondents, individuals with higher levels of education, and those with poorer overall health status were more likely to use CAM than respondents without these characteristics. Only 22.8% of CAM therapies used were reported to physicians by survey participants. These data indicate that CAM use in rural Japan is common. The results are consistent with previous studies that show that Japanese individuals are more interested in forms of CAM such as pain relief pads and massage, than in mind-body forms of CAM like relaxation and meditation. Due to the high utilization of certain CAM practices, and given that most CAM users do not disclose their CAM use to their doctors, we conclude that physicians in rural Japan would benefit by asking about CAM use

  2. Family Medicine needs assessment: Studying the clinical work of ...

    African Journals Online (AJOL)

    admin

    change of activity by clicking a start and stop button on an electronic tablet. ... demographic questions. At the end of each day, .... as a satisfying, long-term career choice. The reflections of the ... perhaps reflecting the specialized nature of some clinics in the latter. ... care, the burden of care delivery has been shifted largely.

  3. The emergence of trust in clinics of alternative medicine

    DEFF Research Database (Denmark)

    Pedersen, Inge Kryger; Hansen, Vibeke Holm; Grünenberg, Kristina

    2016-01-01

    qualitative studies and informing the empirical findings with a sociological concept of trust, this article provides new empirical insights on how trust emerges in Danish clinics of acupuncture, reflexology and homeopathy. The analysis demonstrates how trust is situational and emerges through both clients...

  4. Designing clinically useful systems: examples from medicine and dentistry.

    Science.gov (United States)

    Koch, S

    2003-12-01

    Despite promising results in medical informatics research and the development of a large number of different systems, few systems get beyond a prototype state and are really used in practice. Among other factors, the lack of explicit user focus is one main reason. The research projects presented in this paper follow a user-centered system development approach based on extensive work analyses in interdisciplinary working groups, taking into account human cognitive performance. Different medical and health-care specialists, together with researchers in human-computer interaction and medical informatics, specify future clinical work scenarios. Special focus is put on analysis and design of the information and communication flow and on exploration of intuitive visualization and interaction techniques for clinical information. Adequate choice of the technical access device is made depending on the user's work situation. It is the purpose of this paper to apply this method in two different research projects and thereby to show its potential for designing clinically useful systems that do support and not hamper clinical work. These research projects cover IT support for chairside work in dentistry (http://www.dis.uu.se/mdi/research/projects/orquest) and ICT support for home health care of elderly citizens (http://www.medsci.uu.se/mie/project/closecare).

  5. Clinical Holistic Medicine: Holistic Treatment of Rape and Incest Trauma

    Directory of Open Access Journals (Sweden)

    Søren Ventegodt

    2005-01-01

    Full Text Available Studies indicate that at least 15% of the female population in western countries has experienced sexual abuse and severe sexual traumas. This paper explains how even serious sexual abuse and trauma can be healed when care and resources encourage the patient to return to the painful life events. When the physician cares and receives the trust of the patient, emotional holding and processing will follow quite naturally. Spontaneous regression seems to be an almost pain-free way of integrating the severe traumas from earlier experiences of rape and incest. This technique is a recommended alternative to classical timeline therapy using therapeutic commands. When traumatized patients distance themselves from their soul (feelings, sexuality, and existential depth, they often lose their energy and enjoyment of life. However, this does not mean that they are lost to life. Although it may seem paradoxical, a severe trauma may be a unique opportunity to regain enjoyment of life. The patient will often be richly rewarded for the extensive work of clearing and sorting out in order to experience a new depth in his or her existence and emotional life, with a new ability to understand life in general and other people in particular. So what may look like a tragedy can be transformed into a unique gift; if the patient gets sufficient support, there is the possibility of healing and learning. Consciousness-based medicine seems to provide severely traumatized patients with the quality of support and care needed for their soul to heal.

  6. The clinical effects of music therapy in palliative medicine.

    Science.gov (United States)

    Gallagher, Lisa M; Lagman, Ruth; Walsh, Declan; Davis, Mellar P; Legrand, Susan B

    2006-08-01

    This study was to objectively assess the effect of music therapy on patients with advanced disease. Two hundred patients with chronic and/or advanced illnesses were prospectively evaluated. The effects of music therapy on these patients are reported. Visual analog scales, the Happy/Sad Faces Assessment Tool, and a behavior scale recorded pre- and post-music therapy scores on standardized data collection forms. A computerized database was used to collect and analyze the data. Utilizing the Wilcoxon signed rank test and a paired t test, music therapy improved anxiety, body movement, facial expression, mood, pain, shortness of breath, and verbalizations. Sessions with family members were also evaluated, and music therapy improved families' facial expressions, mood, and verbalizations. All improvements were statistically significant (Presponse to music therapy. Objective data were obtained for a large number of patients with advanced disease. This is a significant addition to the quantitative literature on music therapy in this unique patient population. Our results suggest that music therapy is invaluable in palliative medicine.

  7. Integrating clinical medicine into biomedical graduate education to promote translational research: strategies from two new PhD programs.

    Science.gov (United States)

    Smith, Carolyn L; Jarrett, Marcia; Bierer, S Beth

    2013-01-01

    For several decades, a barrier has existed between research and clinical medicine, making it difficult for aspiring scientists to gain exposure to human pathophysiology and access to clinical/translational research mentors during their graduate training. In 2005, the Howard Hughes Medical Institute announced the Med Into Grad initiative to support graduate programs that integrate clinical knowledge into PhD biomedical training, with the goal of preparing a new cadre of translational researchers to work at the interface of the basic sciences and clinical medicine. Two institutions, Baylor College of Medicine and the Cleveland Clinic/Case Western Reserve University, developed new PhD programs in translational biology and/or molecular medicine. These programs teach the topics and skills that today's translational researchers must learn and expose students to clinical medicine. In this article, the authors compare and contrast the history, implementation, and evaluation of the Translational Biology and Molecular Medicine program at Baylor College of Medicine and the Molecular Medicine program at the Cleveland Clinic/Case Western Reserve University. The authors also demonstrate the feasibility of creating a multidisciplinary graduate program in molecular medicine that integrates pathophysiology and clinical medicine without extending training time. They conclude with a discussion of the similarities in training approaches that exist despite the fact that each program was independently developed and offer observations that emerged during their collaboration that may benefit others who are considering developing similar programs.

  8. Chinese herbal medicine for idiopathic sudden sensorineural hearing loss: a systematic review of randomised clinical trials.

    Science.gov (United States)

    Su, C-X; Yan, L-J; Lewith, G; Liu, J-P

    2013-12-01

    Idiopathic sudden sensorineural hearing loss has great impact on quality of life. Many clinical trials using Chinese herbal medicine for idiopathic sudden sensorineural hearing loss have been conducted and reported beneficial results. However, there is no critical appraised evidence on efficacy and safety of Chinese herbal medicine for idiopathic sudden sensorineural hearing loss to inform clinical use. To assess the beneficial effect and safety of Chinese herbal medicine for idiopathic sudden sensorineural hearing loss. Systematic review of randomised clinical trials. Seven electronic databases and two trial registries were searched for all eligible trials from inception to January 2013. Two authors independently selected trials and extracted data. The Cochrane risk of bias tool was utilised to assess the methodological quality of the included trials. revman 5.2 software was applied for data analysis with effect estimate presented as risk ratio and mean difference with its 95% confidence interval. Forty-one randomised clinical trials involving 3560 participants were identified. Five kinds of Chinese herbal medicine were trialed. All trials compared conventional therapies of steroids, vasodilators, anticoagulants, nutritional supplements or hyperbaric oxygen with or without herbal medicine. No trial was identified that compared herbal medicine alone with placebo. No trial was identified that blinded the participants or the observers to their herbal medication. Only one trial adequately reported its method of randomisation. No trial reported the sample size calculated to show an effect. All trials had material other defects giving a high likelihood of bias. Because of the overall poor quality of all 41 trials, it was concluded that there was no level-one evidence to support the use of Chinese herbal medicine, alone or in addition to conventional therapies, to improve the hearing in adults with idiopathic sudden sensorineural hearing loss. Two trials reported adverse

  9. [Research on establishment of clinical safety intensive hospital monitoring net of traditional Chinese medicine injection].

    Science.gov (United States)

    Wang, Lian-Xin; Xie, Yan-Ming; Wang, Zhi-Fei

    2012-09-01

    The establishment of clinical safety monitoring net of traditional Chinese medicine (TCM) injection is the one of the key issues of the monitoring work. The monitoring net is including varieties of types of net, such as clinical monitoring net, multimedia network platform, the net of experts or talents. The paper will introduce the establishing method of clinical safety monitoring net, the establishing of clinical safety monitoring net, and the establishing of network based on the internet, the knowledge network construction of experts, the net construction of talents are all included, to assure the development for clinical safety monitoring work.

  10. A systematic review of clinical audit in companion animal veterinary medicine.

    Science.gov (United States)

    Rose, Nicole; Toews, Lorraine; Pang, Daniel S J

    2016-02-26

    Clinical audit is a quality improvement process with the goal of continuously improving quality of patient care as assessed by explicit criteria. In human medicine clinical audit has become an integral and required component of the standard of care. In contrast, in veterinary medicine there appear to have been a limited number of clinical audits published, indicating that while clinical audit is recognised, its adoption in veterinary medicine is still in its infancy. A systematic review was designed to report and evaluate the veterinary literature on clinical audit in companion animal species (dog, cat, horse). A systematic search of English and French articles using Proquest Dissertations and Theses database (February 6, 2014), CAB Abstracts (March 21, 2014 and April 4, 2014), Scopus (March 21, 2014), Web of Science Citation index (March 21, 2014) and OVID Medline (March 21, 2014) was performed. Included articles were those either discussing clinical audit (such as review articles and editorials) or reporting parts of, or complete, audit cycles. The majority of articles describing clinical audit were reviews. From 89 articles identified, twenty-one articles were included and available for review. Twelve articles were reviews of clinical audit in veterinary medicine, five articles included at least one veterinary clinical audit, one thesis was identified, one report was of a veterinary clinical audit website and two articles reported incomplete clinical audits. There was no indication of an increase in the number of published clinical audits since the first report in 1998. However, there was evidence of article misclassification, with studies fulfilling the criteria of clinical audit not appropriately recognised. Quality of study design and reporting of findings varied considerably, with information missing on key components, including duration of study, changes in practice implemented between audits, development of explicit criteria and appropriate statistical

  11. A call to the use of the clinical method in the practice of perinatal medicine

    Directory of Open Access Journals (Sweden)

    Carlos Esteban Zerquera Álvarez

    2010-12-01

    Full Text Available A reflection on the appropriateness and current application of the clinical method, defined as the diagnostic process inherent to the practice of human medicine is presented. Considerations about the scientific nature of the clinical method and its application in perinatal medicine along with its specific characteristics in this field are stated. Several considerations about the impact of high technology and the risk of its use when the appropriate balance is not achieved, which could lead to dehumanization and medical malpractice are proposed.

  12. Clinical challenges and opportunities of mesenchymal stem cells in musculoskeletal medicine.

    Science.gov (United States)

    Centeno, Christopher J

    2014-01-01

    The use of stem cells in orthopedics has been researched for many years, with robust animal data that show efficacy in cartilage healing, tendon repair, and intervertebral disk treatment. Early clinical data are also just starting to be published, and these results are encouraging. Safety data in large case series, some that lasted for many years, have also been published. The field of tissue engineering with stem cells in musculoskeletal impairments has the potential to reduce morbidity and improve clinical outcomes. The regulatory environment for this area of medicine is still developing. Copyright © 2014 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

  13. The clinical role of nuclear medicine in rheumatoid arthritis patients

    Energy Technology Data Exchange (ETDEWEB)

    Vos, K. (Leiden Univ. Medical Center (Netherlands). Dept. of Rheumatology); Van der Linden, E. (Leiden Univ. Medical Center (Netherlands). Dept. of Radiology); Pauwels, E.K.J. (Leiden Univ. Medical Center (Netherlands). Dept. of Radiology Leiden Univ. Medical Center (Netherlands). Division of Nuclear Medicine)

    1999-03-01

    In patients with rheumatoid arthritis (RA) synovitis activity is the dominant clinical variable that determines the therapeutic approach. At present, the amount of painful and swollen joint assessed by physical examination, is generally used to measure the degree of synovitis activity is not available. The availability of an objective and reproducible method to evaluate synovitis activity in RA would be of great value in patient management and in examination of therapeutic effects. An advantage of the use of radiopharmaceuticals in detection of arthritis activity, compared with other imaging techniques, is the possibility to depict all joints in a single image. Furthermore the technique may image joints which are difficult to assess clinically or radiographically and may also detect joint inflammation in an early phase. In this overview different scintigraphic techniques are compared with each other and with other diagnostic imaging modalities.

  14. Superman meets Don Quixote: stereotypes in clinical medicine.

    Science.gov (United States)

    Pinkus, Rosa Lynn

    1986-01-01

    Drawing in part on her experiences as a "humanist-in-residence" on a neurological surgery service, the author discusses how stereotypic views held by and toward physicians and humanists interfere with the teaching of ethics to physicians and, indirectly, to the general public. She traces the development of these stereotypes over the past hundred years and suggests ways that they can be overcome to permit more effective working relationships between physicians and clinical ethicists.

  15. Clinical Holistic Medicine: Mental Disorders in a Holistic Perspective

    Directory of Open Access Journals (Sweden)

    Søren Ventegodt

    2005-01-01

    Full Text Available From a holistic perspective, psychiatric diseases are caused by the patient’s unwillingness to assume responsibility for his life, existence, and personal relations. The loss of responsibility arises from the repression of the fundamental existential dimensions of the patients. Repression of love and purpose causes depersonalization (i.e., a lack of responsibility for being yourself and for the contact with others, loss of direction and purpose in life. Repression of strength in mind and emotions leads to derealization (the breakdown of the reality testing, often with mental delusions and hallucinations. The repression of joy and gender leads to devitalization (emotional emptiness, loss of joy, personal energy, sexuality, and pleasure in life.The losses of existential dimensions are invariably connected to traumas with life-denying decisions. Healing the wounds of the soul by holding and processing will lead to the recovery of the person's character, purpose of life, and existential responsibility. It can be very difficult to help a psychotic patient. The physician must first love his patient unconditionally and then fully understand the patient in order to meet and support the patient to initiate the holistic process of healing. It takes motivation and willingness to suffer on behalf of the patients in order to heal, as the existential and emotional pain of the traumas resulting in insanity is often overwhelming. We believe that most psychiatric diseases can be alleviated or cured by the loving and caring physician who masters the holistic toolbox. Further research is needed to document the effect of holistic medicine in psychiatry.

  16. Clinical and scientific results in perinatal care of pregnancy complicated by insulin dependent diabetes mellitus in Croatia.

    Science.gov (United States)

    Djelmis, J

    1998-01-01

    At the Department of Obstetrics and Gynecology, Perinatal Unit for Diabetes and Fetal Growth, School of Medicine, Zagreb, perinatal care of pregnancies complicated with insulin dependent diabetes melitus (IDDM), has been performed for more than 36 years. The intention of this review is to show our own results in the management of IDDM pregnancies and the latest clinical advances in perinatal care of such pregnancies. Pregnancy complicated with IDDM is at risk because of numerous maternal, fetal and neonatal complications. Recent advances in medicine, especially in diabetology and perinatology, helps clinician avoid or lessen antenatal or perinatal complications in IDDM pregnancies. The main result of improved perinatal care is that today fetal and neonatal mortality in IDDM pregnancy is almost equal to that of healthy pregnant population. Intensive preconceptual care and optimal regulation of IDDM have resulted not only in decreased perinatal mortality but also in a decreased rate of congenital malformation. Tight glycemia control during pregnancy has a beneficial effect on fetal growth. Intensive control of fetal growth, verification of lung maturation at term by amniocenthesis, and control of fetal oxygenation will result in delivery of a mature eutrophic newborn with the lowest rate of neonatal complications possible. Perinatal mortality of less than 2% in IDDM pregnancy can be obtained by planned delivery between 38 and 39 weeks of gestation by either vaginal route or cesarean section, depending on indications. After delivery, intensive care of the newborn is necessary.

  17. What does «integrative medicine» provide to daily scientific clinical care?

    Science.gov (United States)

    Bataller-Sifre, R; Bataller-Alberola, A

    2015-11-01

    Integrative medicine is an ambitious and noble-minded attempt to address the shortcomings of the current public health systems in our Western societies, which is restricted by the limited time available, especially in outpatient clinics. Integrative medicine also does not limit the possibilities of useful therapies that have been tested over the centuries (from China, India, etc.) or of certain resources that do not achieve the level of desired scientific credibility but that present certain therapeutic support in specific cases (homeopathy, acupuncture, etc.) but still require a scientific approach. Finally, the resource of botanical products (phytotherapy) constitutes a wide range of possibilities that universities can (and do) make progress on by providing drug brands for these products through the use of the scientific method and evidence-based medical criteria. This approach will help avoid the irrationality of the daily struggle between conventional scientific medicine (which we apply to the immense majority of patients) and the other diagnostic-therapeutic «guidelines» (natural medicine, alternative medicine, complementary medicine, patient-focused medicine and others). Copyright © 2015. Published by Elsevier España, S.L.U.

  18. Year-End Clinic Handoffs: A National Survey of Academic Internal Medicine Programs.

    Science.gov (United States)

    Phillips, Erica; Harris, Christina; Lee, Wei Wei; Pincavage, Amber T; Ouchida, Karin; Miller, Rachel K; Chaudhry, Saima; Arora, Vineet M

    2017-06-01

    While there has been increasing emphasis and innovation nationwide in training residents in inpatient handoffs, very little is known about the practice and preparation for year-end clinic handoffs of residency outpatient continuity practices. Thus, the latter remains an identified, yet nationally unaddressed, patient safety concern. The 2014 annual Association of Program Directors in Internal Medicine (APDIM) survey included seven items for assessing the current year-end clinic handoff practices of internal medicine residency programs throughout the country. Nationwide survey. All internal medicine program directors registered with APDIM. Descriptive statistics of programs and tools used to formulate a year-end handoff in the ambulatory setting, methods for evaluating the process, patient safety and quality measures incorporated within the process, and barriers to conducting year-end handoffs. Of the 361 APDIM member programs, 214 (59%) completed the Transitions of Care Year-End Clinic Handoffs section of the survey. Only 34% of respondent programs reported having a year-end ambulatory handoff system, and 4% reported assessing residents for competency in this area. The top three barriers to developing a year-end handoff system were insufficient overlap between graduating and incoming residents, inability to schedule patients with new residents in advance, and time constraints for residents, attendings, and support staff. Most internal medicine programs do not have a year-end clinic handoff system in place. Greater attention to clinic handoffs and resident assessment of this care transition is needed.

  19. Clinical application of somatosensory amplification in psychosomatic medicine

    Directory of Open Access Journals (Sweden)

    Nakao Mutsuhiro

    2007-10-01

    Full Text Available Abstract Many patients with somatoform disorders are frequently encountered in psychosomatic clinics as well as in primary care clinics. To assess such patients objectively, the concept of somatosensory amplification may be useful. Somatosensory amplification refers to the tendency to experience a somatic sensation as intense, noxious, and disturbing. It may have a role in a variety of medical conditions characterized by somatic symptoms that are disproportionate to demonstrable organ pathology. It may also explain some of the variability in somatic symptomatology found among different patients with the same serious medical disorder. It has been assessed with a self-report questionnaire, the Somatosensory Amplification Scale. This instrument was developed in a clinical setting in the U.S., and the reliability and validity of the Japanese and Turkish versions have been confirmed as well. Many studies have attempted to clarify the specific role of somatosensory amplification as a pathogenic mechanism in somatization. It has been reported that somatosensory amplification does not correlate with heightened sensitivity to bodily sensations and that emotional reactivity exerts its influence on somatization via a negatively biased reporting style. According to our recent electroencephalographic study, somatosensory amplification appears to reflect some aspects of long-latency cognitive processing rather than short-latency interoceptive sensitivity. The concept of somatosensory amplification can be useful as an indicator of somatization in the therapy of a broad range of disorders, from impaired self-awareness to various psychiatric disorders. It also provides useful information for choosing appropriate pharmacological or psychological therapy. While somatosensory amplification has a role in the presentation of somatic symptoms, it is closely associated with other factors, namely, anxiety, depression, and alexithymia that may also influence the same

  20. Objective Structured Clinical Examinations Provide Valid Clinical Skills Assessment in Emergency Medicine Education

    Directory of Open Access Journals (Sweden)

    Wallenstein, Joshua

    2014-12-01

    Full Text Available Introduction: Evaluation of emergency medicine (EM learners based on observed performance in the emergency department (ED is limited by factors such as reproducibility and patient safety. EM educators depend on standardized and reproducible assessments such as the objective structured clinical examination (OSCE. The validity of the OSCE as an evaluation tool in EM education has not been previously studied. The objective was to assess the validity of a novel management-focused OSCE as an evaluation instrument in EM education through demonstration of performance correlation with established assessment methods and case item analysis. Methods: We conducted a prospective cohort study of fourth-year medical students enrolled in a required EM clerkship. Students enrolled in the clerkship completed a five-station EM OSCE. We used Pearson’s coefficient to correlate OSCE performance with performance in the ED based on completed faculty evaluations. Indices of difficulty and discrimination were computed for each scoring item. Results: We found a moderate and statistically-significant correlation between OSCE score and ED performance score [r(239 =0.40, p<0.001]. Of the 34 OSCE testing items the mean index of difficulty was 63.0 (SD =23.0 and the mean index of discrimination was 0.52 (SD =0.21. Conclusion: Student performance on the OSCE correlated with their observed performance in the ED, and indices of difficulty and differentiation demonstrated alignment with published best-practice testing standards. This evidence, along with other attributes of the OSCE, attest to its validity. Our OSCE can be further improved by modifying testing items that performed poorly and by examining and maximizing the inter-rater reliability of our evaluation instrument. [West J Emerg Med. 2015;16(1:121–126.

  1. The Addiction Recovery Clinic: A Novel, Primary-Care-Based Approach to Teaching Addiction Medicine.

    Science.gov (United States)

    Holt, Stephen R; Segar, Nora; Cavallo, Dana A; Tetrault, Jeanette M

    2017-05-01

    Substance use is highly prevalent in the United States, but little time in the curriculum is devoted to training internal medicine residents in addiction medicine. In 2014, the authors developed and launched the Addiction Recovery Clinic (ARC) to address this educational gap while also providing outpatient clinical services to patients with substance use disorders. The ARC is embedded within the residency primary care practice and is staffed by three to four internal medicine residents, two board-certified addiction medicine specialists, one chief resident, and one psychologist. Residents spend one half-day per week for four consecutive weeks at the ARC seeing new and returning patients. Services provided include pharmacological and behavioral treatments for opioid, alcohol, and other substance use disorders, with direct referral to local addiction treatment facilities as needed. Visit numbers, a patient satisfaction survey, and an end-of-rotation resident evaluation were used to assess the ARC. From 2014 to 2015, 611 patient encounters occurred, representing 97 new patients. Sixty-one (63%) patients were seen for opioid use disorder. According to patient satisfaction surveys, 29 (of 31; 94%) patients reported that the ARC probably or definitely helped them to cope with their substance use. Twenty-eight residents completed the end-of-rotation evaluation; all rated the rotation highly. The ARC offers a unique primary-care-based approach to exposing internal medicine residents to the knowledge and skills necessary to diagnose, treat, and prevent unhealthy substance use. Future research will examine other clinical and educational outcomes.

  2. [The purpose of clinical laboratory accreditation in transplantation medicine].

    Science.gov (United States)

    Flegar-Mestrić, Zlata; Nazor, Aida; Perkov, Sonja; Surina, Branka; Siftar, Zoran; Ozvald, Ivan; Vidas, Zeljko

    2011-09-01

    Although transplantation of solid organs has become a more standardized method of treatment, liver transplantation represents an exceptional multidisciplinary clinical procedure requiring understanding of specific pathophysiological changes that occur in the end stage of liver disease. Liver transplantation has been performed at Merkur University Hospital since 1998, with 360 transplantations performed to date. The most common indications are alcohol liver disease, cirrhosis caused by hepatitis B and C virus, hepatocellular carcinoma and cryptogenetic liver cirrhosis. Laboratory tests required for liver transplantation are performed at Department of Clinical Chemistry, Merkur University Hospital, accredited according to ISO 15189 in 2007 for the areas of clinical chemistry, laboratory hematology and coagulation, laboratory immunology-cell immunophenotyping, and molecular diagnosis. The complexity of liver transplant patients requires constant interaction between the anesthesiologist team and clinical laboratory, which has to ensure fast and efficient intraoperative monitoring of biochemical and liver profile: electrolytes and acid-base status, complete blood count, coagulation profile and monitoring of graft function according to the individual patient's health status. Dynamics of intraoperative changes is measured in whole arterial blood samples on a Nova Biomedical Stat Profile Critical Care Xpress mobile acid-base analyzer. Frequent monitoring of ionized calcium and magnesium levels is very important because of citrated blood transfusion and for appropriate therapeutic procedure. During anhepatic stage, there is a progressive increase in lactate level concentration. After reperfusion, a rapid increase in lactate clearance is an excellent indicator of stable graft initial function and its adequate size. During the transplantation procedure, there is usually a biphasic acid-base disturbance characterized by metabolic acidosis and then by metabolic alkalosis. The

  3. Clinical and forensic medicine issues in osteoporosis fractures.

    Science.gov (United States)

    Molfetta, Luigi; Caldo, Davide

    2011-04-01

    Severe osteoporosis is characterized by a densitometry T-score lower than 2.5 associated with one or more fragility fractures. Fragility fractures represent a serious social and economic problem; the diagnosis of osteoporosis is an unachieved target by orthopaedic surgeons, despite the chance to detect it in many clinical assets and the availability of effective treatment tools. It is necessary to stick to scientific society guidelines, thus avoiding legal consequences related to the diagnosis, the therapy, the prescription coherence and the correct information due to patients.

  4. Therapeutic complement inhibition – from experimental to clinical medicine.

    Science.gov (United States)

    Lappegård, Knut Tore; Bjerre, Anna; Tjønnfjord, Geir Erland; Mollnes, Tom Eirik

    2015-10-20

    Internationally, the use of the C5-inhibiting monoclonal antibody eculizumab has in the course of just a few years become the first choice of treatment of atypical haemolytic uraemic syndrome and the most severe phenotypes of paroxysmal nocturnal haemoglobinuria. At present eculizumab is the only complement inhibitor in ordinary clinical use. This despite the fact that there only exists one randomised, placebo-controlled trial of eculizumab for paroxysmal nocturnal haemoglobinuria and none for atypical haemolytic uraemic syndrome, and that the therapy is very costly. There is reason to believe that complement inhibition as therapy will increase in the future, and that other drugs will also prove to be effective.

  5. Clinical Holistic Health: Advanced Tools for Holistic Medicine

    Directory of Open Access Journals (Sweden)

    Søren Ventegodt

    2006-01-01

    Full Text Available According to holistic medical theory, the patient will heal when old painful moments, the traumatic events of life that are often called “gestalts”, are integrated in the present “now”. The advanced holistic physician’s expanded toolbox has many different tools to induce this healing, some that are more dangerous and potentially traumatic than others. The more intense the therapeutic technique, the more emotional energy will be released and contained in the session, but the higher also is the risk for the therapist to lose control of the session and lose the patient to his or her own dark side. To avoid harming the patient must be the highest priority in holistic existential therapy, making sufficient education and training an issue of highest importance. The concept of “stepping up” the therapy by using more and more “dramatic” methods to get access to repressed emotions and events has led us to a “therapeutic staircase” with ten steps: (1 establishing the relationship; (2 establishing intimacy, trust, and confidentiality; (3 giving support and holding; (4 taking the patient into the process of physical, emotional, and mental healing; (5 social healing of being in the family; (6 spiritual healing — returning to the abstract wholeness of the soul; (7 healing the informational layer of the body; (8 healing the three fundamental dimensions of existence: love, power, and sexuality in a direct way using, among other techniques, “controlled violence” and “acupressure through the vagina”; (9 mind-expanding and consciousness-transformative techniques like psychotropic drugs; and (10 techniques transgressing the patient's borders and, therefore, often traumatizing (for instance, the use of force against the will of the patient.We believe that the systematic use of the staircase will greatly improve the power and efficiency of holistic medicine for the patient and we invite a broad cooperation in scientifically testing the

  6. Repeating tests: different roles in research studies and clinical medicine.

    Science.gov (United States)

    Monach, Paul A

    2012-10-01

    Researchers often decide whether to average multiple results in order to produce more precise data, and clinicians often decide whether to repeat a laboratory test in order to confirm its validity or to follow a trend. Some of the major sources of variation in laboratory tests (analytical imprecision, within-subject biological variation and between-subject variation) and the effects of averaging multiple results from the same sample or from the same person over time are discussed quantitatively in this article. This analysis leads to the surprising conclusion that the strategy of averaging multiple results is only necessary and effective in a limited range of research studies. In clinical practice, it may be important to repeat a test in order to eliminate the possibility of a rare type of error that has nothing to do analytical imprecision or within-subject variation, and for this reason, paradoxically, it may be most important to repeat tests with the highest sensitivity and/or specificity (i.e., ones that are critical for clinical decision-making).

  7. The increasing impact of laboratory medicine on clinical cardiology.

    Science.gov (United States)

    Clerico, Aldo

    2003-07-01

    The practice of cardiology continues to evolve along with a better understanding of the pathophysiology of cardiovascular disease and the development of new therapeutic procedures. Consequently, new demands are being made on the in vitro diagnostics industry to improve the performance of existing cardiac markers and to develop novel markers for new cardiac disease indications. Indeed, in the last 20 years there has been a progressive increase in new laboratory tests for markers of cardiac diseases. Several highly sensitive and/or specific assays for the detection of myocardial ischemic damage as well as some immunoassays for cardiac natriuretic hormones, now considered a reliable marker of myocardial function, have become commercially available. In parallel, a growing number of some novel risk factors, which can be assessed and monitored by laboratory methods, have been added to the classical risk factors for cardiovascular disease. Finally, the recent explosion of genetic analysis may soon place at the clinical cardiologist's disposal many laboratory tests for defining the diagnosis at the molecular level, assessing new risk factors, and better targeting the pharmaceutical approaches in patients with cardiovascular disease. In the present article, after a brief description of the analytical tests included in these four groups, each group's impact on clinical cardiology is discussed in detail.

  8. Effect of Morus nigra aqueous extract treatment on the maternal-fetal outcome, oxidative stress status and lipid profile of streptozotocin-induced diabetic rats

    OpenAIRE

    Volpato, Gustavo Tadeu; Calderon, Iracema Mattos Paranhos; Sinzato, S. [UNESP; de Campos, Kleber Eduardo; Rudge, Marilza Vieira Cunha [UNESP; Damasceno,Débora Cristina

    2011-01-01

    Ethnopharmacological relevance: Morus nigra, commonly known as black mulberry, is widely used in Brazilian folk medicine for the diabetes treatment.Aim of this study: To evaluate the effect of Morus nigra aqueous extract treatment on maternal lipid and oxidative stress profile, reproductive outcomes, and also fetal anomaly incidence from diabetic and non-diabetic rats.Materials and methods: Diabetes was induced by streptozotocin (40 mg/kg) in virgin female Wistar rats. Morus nigra leaf aqueou...

  9. Rehabilitation Medicine in a Small Clinic: Effort of a private clinic with small inpatient facility in a province of Japan.

    Science.gov (United States)

    Kondo, Ken

    2012-05-01

    Dyna Rehabilitation Clinic is a small clinic located in Tochigi (Japan) with a capacity of 19 patients, serving as the core facility in providing borderless and seamless care in medicine, rehabilitation medicine, and long-term care; from inpatient rehabilitation for recovering patients to home-visit medical services and long-term care, including terminal care. In Japan, the managing physician of an authorized clinic with small inpatient facilities lives within the clinic's property or in the land adjacent to it and attends the inpatients while responding to local medical needs on a 24-hour basis, reflecting local climate, communities, and culture. Unlike a large-scale hospital, a clinic with a small-scale inpatient facilities specialized in rehabilitation with close links to local communities can still survive as a business and contribute to local society - Dyna Rehabilitation Clinic is a good example. Patients vary in their diseases, complications, age, family structure, living environment, financial status, sense of values, and the lives they lead. It is impossible to meet all such needs with one standard rehabilitation scheme - but, clinics with small inpatient facilities, such as Dyna Rehabilitation Clinic, can provide more treatment more flexibly, and fill in the gap.

  10. Targeting cancer epigenetics: Linking basic biology to clinical medicine.

    Science.gov (United States)

    Shinjo, Keiko; Kondo, Yutaka

    2015-12-01

    Recent studies provide compelling evidence that epigenetic dysregulation is involved in almost every step of tumor development and progression. Differences in tumor behavior, which ultimately reflects clinical outcome, can be explained by variations in gene expression patterns generated by epigenetic mechanisms, such as DNA methylation. Therefore, epigenetic abnormalities are considered potential biomarkers and therapeutic targets. DNA methylation is stable at certain specific loci in cancer cells and predominantly reflects the characteristic clinicopathological features. Thus, it is an ideal biomarker for cancer screening, classification and prognostic purposes. Epigenetic treatment for cancers is based on the pharmacologic targeting of various core transcriptional programs that sustains cancer cell identity. Therefore, targeting aberrant epigenetic modifiers may be effective for multiple processes compared with using a selective inhibitor of aberrant single signaling pathway. This review provides an overview of the epigenetic alterations in human cancers and discusses about novel therapeutic strategies targeting epigenetic alterations.

  11. Curcumin: from ancient medicine to current clinical trials.

    Science.gov (United States)

    Hatcher, H; Planalp, R; Cho, J; Torti, F M; Torti, S V

    2008-06-01

    Curcumin is the active ingredient in the traditional herbal remedy and dietary spice turmeric (Curcuma longa). Curcumin has a surprisingly wide range of beneficial properties, including anti-inflammatory, antioxidant, chemopreventive and chemotherapeutic activity. The pleiotropic activities of curcumin derive from its complex chemistry as well as its ability to influence multiple signaling pathways, including survival pathways such as those regulated by NF-kappaB, Akt, and growth factors; cytoprotective pathways dependent on Nrf2; and metastatic and angiogenic pathways. Curcumin is a free radical scavenger and hydrogen donor, and exhibits both pro- and antioxidant activity. It also binds metals, particularly iron and copper, and can function as an iron chelator. Curcumin is remarkably non-toxic and exhibits limited bioavailability. Curcumin exhibits great promise as a therapeutic agent, and is currently in human clinical trials for a variety of conditions, including multiple myeloma, pancreatic cancer, myelodysplastic syndromes, colon cancer, psoriasis and Alzheimer's disease.

  12. Nocebo phenomena in medicine: their relevance in everyday clinical practice.

    Science.gov (United States)

    Häuser, Winfried; Hansen, Ernil; Enck, Paul

    2012-06-01

    Nocebo phenomena are common in clinical practice and have recently become a popular topic of research and discussion among basic scientists, clinicians, and ethicists. We selectively searched the PubMed database for articles published up to December 2011 that contained the key words "nocebo" or "nocebo effect." By definition, a nocebo effect is the induction of a symptom perceived as negative by sham treatment and/or by the suggestion of negative expectations. A nocebo response is a negative symptom induced by the patient's own negative expectations and/or by negative suggestions from clinical staff in the absence of any treatment. The underlying mechanisms include learning by Pavlovian conditioning and reaction to expectations induced by verbal information or suggestion. Nocebo responses may come about through unintentional negative suggestion on the part of physicians and nurses. Information about possible complications and negative expectations on the patient's part increases the likelihood of adverse effects. Adverse events under treatment with medications sometimes come about by a nocebo effect. Physicians face an ethical dilemma, as they are required not just to inform patients of the potential complications of treatment, but also to minimize the likelihood of these complications, i.e., to avoid inducing them through the potential nocebo effect of thorough patient information. Possible ways out of the dilemma include emphasizing the fact that the proposed treatment is usually well tolerated, or else getting the patient's permission to inform less than fully about its possible side effects. Communication training in medical school, residency training, and continuing medical education would be desirable so that physicians can better exploit the power of words to patients' benefit, rather than their detriment.

  13. The aquaporin family of water channel proteins in clinical medicine.

    Science.gov (United States)

    Lee, M D; King, L S; Agre, P

    1997-05-01

    The aquaporins are a family of membrane channel proteins that serve as selective pores through which water crosses the plasma membranes of many human tissues and cell types. The sites where aquaporins are expressed implicate these proteins in renal water reabsorption, cerebrospinal fluid secretion and reabsorption, generation of pulmonary secretions, aqueous humor secretion and reabsorption, lacrimation, and multiple other physiologic processes. Determination of the aquaporin gene sequences and their chromosomal locations has provided insight into the structure and pathophysiologic roles of these proteins, and primary and secondary involvement of aquaporins is becoming apparent in diverse clinical disorders. Aquaporin-1 (AQP1) is expressed in multiple tissues including red blood cells, and the Colton blood group antigens represent a polymorphism on the AQP1 protein. AQP2 is restricted to renal collecting ducts and has been linked to congenital nephrogenic diabetes insipidus in humans and to lithium-induced nephrogenic diabetes insipidus and fluid retention from congestive heart failure in rat models. Congenital cataracts result from mutations in the mouse gene encoding the lens homolog Aqp0 (Mip). The present understanding of aquaporin physiology is still incomplete; identification of additional members of the aquaporin family will affect future studies of multiple disorders of water distribution throughout the body. In some tissues, the aquaporins may participate in the transepithelial movement of fluid without being rate limiting, so aquaporins may be involved in clinical disorders without being causative. As outlined in this review, our challenge is to identify disease states in which aquaporins are involved, to define the aquaporins' roles mechanistically, and to search for ways to exploit this information therapeutically.

  14. ATTITUDE AND PERCEPTION OF FACULTIES TOWARDS TEACHING EVIDENCE BASED MEDICINE TO PRE - CLINICAL & PARA - CLINICAL MEDICAL STUDENTS

    Directory of Open Access Journals (Sweden)

    Bhavita Patel

    2015-02-01

    Full Text Available NTRODUCTION: Evidence - based medicine (EBM is defined as the „conscientious, explicit, and judicious use of current best evidence‟. It i s an important tool for lifelong learning in medicine, and medical students can develop the skills necessary to understand and use EBM. The teaching of EBM in Sumandeep Vidyapeeth is as part of Evidence Based Education System (EBES. The university has imp lemented the 16 hours of teaching with project work on Evidence Based Medicine in 1st MBBS and 2nd MBBS curriculum in addition to MBBS syllabus. AIMS & OBJECTIVES: This study was planned to take feedback from all the faculties those who are involved in Evi dence based Medicine teaching to evaluate their attitude and perception towards this innovative teaching method and to recommend improvements. MATERIAL & METHODS: A Descriptive, self - structured , pilot pretested questionnaire based cross sectional study was conducted in the year 2013 - 2014 among 40 faculties from 7 Departments like Anatomy, Physiology, Biochemistry, Microbiology, Pharmacology, Pathology and Forensic Medicine teaching Evidence Base d Medicine to students at S.B.K.S MI & RC, Sumandeep Vidyapeeth. Data was expressed as percentage. RESULTS: The response rate for the study was 75%. Almost 87% of faculties agreed that teaching EBM is a welcoming development during pre and para clinical ye ars. About 80% faculties agreed that it will help them in future clinical learning. 87% faculties agreed that literature and research searching improves their day to day teaching. About 77% of faculties have attended workshop and training held in Universit y and 83% of faculties agreed that they are interested in more learning and improving skills necessary to incorporate Evidence based medicine into their discipline. Barriers included shortage of time and need for training in teaching EBM. CONCLUSION: Facul ties of this University teaching Pre - clinical and Para - clinical medical students recognized

  15. Roadmap to a Comprehensive Clinical Data Warehouse for Precision Medicine Applications in Oncology.

    Science.gov (United States)

    Foran, David J; Chen, Wenjin; Chu, Huiqi; Sadimin, Evita; Loh, Doreen; Riedlinger, Gregory; Goodell, Lauri A; Ganesan, Shridar; Hirshfield, Kim; Rodriguez, Lorna; DiPaola, Robert S

    2017-01-01

    Leading institutions throughout the country have established Precision Medicine programs to support personalized treatment of patients. A cornerstone for these programs is the establishment of enterprise-wide Clinical Data Warehouses. Working shoulder-to-shoulder, a team of physicians, systems biologists, engineers, and scientists at Rutgers Cancer Institute of New Jersey have designed, developed, and implemented the Warehouse with information originating from data sources, including Electronic Medical Records, Clinical Trial Management Systems, Tumor Registries, Biospecimen Repositories, Radiology and Pathology archives, and Next Generation Sequencing services. Innovative solutions were implemented to detect and extract unstructured clinical information that was embedded in paper/text documents, including synoptic pathology reports. Supporting important precision medicine use cases, the growing Warehouse enables physicians to systematically mine and review the molecular, genomic, image-based, and correlated clinical information of patient tumors individually or as part of large cohorts to identify changes and patterns that may influence treatment decisions and potential outcomes.

  16. Clinical implications for substandard, nonproprietary medicines in multiple sclerosis: focus on fingolimod

    Directory of Open Access Journals (Sweden)

    Correale J

    2016-06-01

    Full Text Available Jorge Correale,1 Erwin Chiquete,2 Alexey Boyko,3 Roy G Beran,4–6 Jorge Barahona Strauch,7,8 Snezana Milojevic,9 Nadina Frider101Department of Neurology, Raúl Carrea Institute for Neurological Research, Foundation for the Fight against Infant Neurological Illnesses (FLENI, Buenos Aires, Argentina; 2Department of Neurology and Psychiatry, Salvador Zubirán National Institute of Medical Sciences and Nutrition, Mexico City, Mexico; 3Clinical and Research Center “MS and Other Demyelinating Diseases” at the Neuroclinical Hospital, Department of Neurology, Neurosurgery and Medical Genetics of the Pirogov Russian National Research Medical University, Moscow, Russia; 4South Western Clinical School, University of New South Wales, Liverpool, 5Department of Neurology, Liverpool Hospital, Sydney, NSW, 6School of Medicine, Griffith University, Southport, QLD, Australia; 7Department of Neurology, Clínica Alemana de Santiago, 8School of Medicine, Universidad del Desarrollo, Santiago, Chile; 9Novartis Pharma AG, Basel, Switzerland; 10Novartis Latin America and Canada Region, Buenos Aires, ArgentinaAbstract: Both proprietary and nonproprietary medicines are expected to undergo rigorous preapproval testing and both should meet stringent health authority regulatory requirements related to quality to obtain approval. Nonproprietary (also known as copy, or generic medicines, which base their authorization and use on the proprietary documentation and label, are often viewed as a means to help lower the cost and, thus, increase patient access. If these medicines fail to meet quality standards, such as good manufacturing practice and bioequivalence (in humans, they are then defined as substandard copies and can pose serious risks to patients in terms of safety and efficacy. Potentially noncontrolled or different manufacturing process and excipients in nonproprietary medicines may result in poor batch-to-batch reproducibility (accurate and consistent quantity of

  17. Evidence-Based Medicine in Otolaryngology, Part 6: Patient-Reported Outcomes in Clinical Practice.

    Science.gov (United States)

    Carroll, Thomas L; Lee, Stella E; Lindsay, Robin; Locandro, Drew; Randolph, Gregory W; Shin, Jennifer J

    2017-09-01

    The assessment of patient-reported outcome measures (PROMs) in the outpatient setting is gaining momentum in clinical and research venues. Implementing this data capture into one's practice, however, is not a one-size-fits-all venture, and it is critical to determine when, how, and where to include these patient-centered assessments. This installment of the "Evidence-Based Medicine in Otolaryngology" series provides insight into the implementation process and experiences with successful incorporation of PROMs into clinical practice. Specifically, 4 differing clinical scenarios and collection techniques are described, including data acquisition protocols, formats for clinician data usage, and applications of PROM results in clinical and research scenarios.

  18. Characteristics of Ascending, Descending, Floating and Sinking Theor y based on the Concept of Translational Medicine and its Clinical Application

    Institute of Scientific and Technical Information of China (English)

    Wang Xiaohui; Zhai Huaqiang; Wang Wei; Wang Xiaoxia; Zhang Xiaojuan; Zhang Tian

    2013-01-01

    Ascending, descending, lfoating and sinking theory is the summarization for the effects of drugs on the body. Translational medicine establishes a bi-directional conversion channels between clinics and laboratories. This article mainly introduces the relationship between traditional Chinese medicine (TCM) ascending, descending, lfoating and sinking theory and the concept of translational medicine, and how to study this theory based on the concept of translational medicine.

  19. Combining Clinical Information and Patient Reported Outcome Measures in Orthopaedic Surgery and Sports Medicine

    NARCIS (Netherlands)

    Kampen, D.A. van

    2013-01-01

    In this thesis we investigated the use of clinical information and Patient Reported Outcome Measures (PROMs) for patient evaluation in orthopaedic surgery and sports medicine. In the first part, we showed that the Dutch version of the Simple Shoulder Test (SST) is a valid and reliable

  20. Combining Clinical Information and Patient Reported Outcome Measures in Orthopaedic Surgery and Sports Medicine

    NARCIS (Netherlands)

    Kampen, D.A. van

    2013-01-01

    In this thesis we investigated the use of clinical information and Patient Reported Outcome Measures (PROMs) for patient evaluation in orthopaedic surgery and sports medicine. In the first part, we showed that the Dutch version of the Simple Shoulder Test (SST) is a valid and reliable instrumen

  1. Implementing genomics and pharmacogenomics in the clinic: The National Human Genome Research Institute's genomic medicine portfolio.

    Science.gov (United States)

    Manolio, Teri A

    2016-10-01

    Increasing knowledge about the influence of genetic variation on human health and growing availability of reliable, cost-effective genetic testing have spurred the implementation of genomic medicine in the clinic. As defined by the National Human Genome Research Institute (NHGRI), genomic medicine uses an individual's genetic information in his or her clinical care, and has begun to be applied effectively in areas such as cancer genomics, pharmacogenomics, and rare and undiagnosed diseases. In 2011 NHGRI published its strategic vision for the future of genomic research, including an ambitious research agenda to facilitate and promote the implementation of genomic medicine. To realize this agenda, NHGRI is consulting and facilitating collaborations with the external research community through a series of "Genomic Medicine Meetings," under the guidance and leadership of the National Advisory Council on Human Genome Research. These meetings have identified and begun to address significant obstacles to implementation, such as lack of evidence of efficacy, limited availability of genomics expertise and testing, lack of standards, and difficulties in integrating genomic results into electronic medical records. The six research and dissemination initiatives comprising NHGRI's genomic research portfolio are designed to speed the evaluation and incorporation, where appropriate, of genomic technologies and findings into routine clinical care. Actual adoption of successful approaches in clinical care will depend upon the willingness, interest, and energy of professional societies, practitioners, patients, and payers to promote their responsible use and share their experiences in doing so.

  2. Quality of registration for clinical trials published in emergency medicine journals.

    Science.gov (United States)

    Jones, Christopher W; Platts-Mills, Timothy F

    2012-10-01

    In 2005, the International Committee of Medical Journal Editors established clinical trial registration as a requirement for articles submitted to member journals, with the goal of improving the transparency of clinical research. The objective of this study is to characterize the registration of clinical trials published in emergency medicine journals. Randomized trials involving human subjects and published between June 1, 2008, and May 31, 2011 in the 5 emergency medicine journals with the highest impact factors were included. We assessed the clarity of registered primary outcomes, timing of registration relative to patient enrollment, and consistency between registered and published outcomes. Of the 123 trials included, registry entries were identified for 57 (46%). Of the 57 registered studies, 45 (79%) were registered after the initiation of subject enrollment, 9 (16%) had registered outcomes that were unclear, and 26 (46%) had discrepancies between registered and published outcomes. Only 5 studies were registered before patient enrollment with a clear primary outcome that was consistent with the published primary outcome. Annals of Emergency Medicine was the only journal in which the majority of trials were registered. Current compliance with clinical trial registration guidelines is poor among trials published in emergency medicine journals. Copyright © 2012. Published by Mosby, Inc.

  3. Exploring integrative medicine for back and neck pain - a pragmatic randomised clinical pilot trial

    OpenAIRE

    2009-01-01

    Abstract Background A model for integrative medicine (IM) adapted to Swedish primary care was previously developed. The aim of this study was to explore the feasibility of a pragmatic randomised clinical trial to investigate the effectiveness of the IM model versus conventional primary care in the management of patients with non-specific back/neck pain. Specific objectives included the exploration of recruitment and retention rates, patient and care characteristics, clinical differences and e...

  4. New Toronto clinic for men may be sign of growing entrepreneurship within medicine.

    Science.gov (United States)

    Lowry, F

    1995-07-15

    A Toronto physician has opened a new clinic for male patients, particularly highly stressed executives, who pay to have their physical, mental and nutritional health assessed. The Health Institute for Men, which opened in January, is located close to the Toronto Stock Exchange. It charges $450 for the initial visit, which includes a complete history, mental-assessment exam and thorough physical. The chair of the CMA Board of Directors considers the clinic a sign of growing entrepreneurship within Canadian medicine.

  5. LMNA cardiomyopathy: cell biology and genetics meet clinical medicine.

    Science.gov (United States)

    Lu, Jonathan T; Muchir, Antoine; Nagy, Peter L; Worman, Howard J

    2011-09-01

    Mutations in the LMNA gene, which encodes A-type nuclear lamins (intermediate filament proteins expressed in most differentiated somatic cells), cause a diverse range of diseases, called laminopathies, that selectively affect different tissues and organ systems. The most prevalent laminopathy is cardiomyopathy with or without different types of skeletal muscular dystrophy. LMNA cardiomyopathy has an aggressive clinical course with higher rates of deadly arrhythmias and heart failure than most other heart diseases. As awareness among physicians increases, and advances in DNA sequencing methods make the genetic diagnosis of LMNA cardiomyopathy more common, cardiologists are being faced with difficult questions regarding patient management. These questions concern the optimal use of intracardiac cardioverter defibrillators to prevent sudden death from arrhythmias, and medical interventions to prevent heart damage and ameliorate heart failure symptoms. Data from a mouse model of LMNA cardiomyopathy suggest that inhibitors of mitogen-activated protein kinase (MAPK) signaling pathways are beneficial in preventing and treating cardiac dysfunction; this basic research discovery needs to be translated to human patients.

  6. LMNA cardiomyopathy: cell biology and genetics meet clinical medicine

    Directory of Open Access Journals (Sweden)

    Jonathan T. Lu

    2011-09-01

    Full Text Available Mutations in the LMNA gene, which encodes A-type nuclear lamins (intermediate filament proteins expressed in most differentiated somatic cells, cause a diverse range of diseases, called laminopathies, that selectively affect different tissues and organ systems. The most prevalent laminopathy is cardiomyopathy with or without different types of skeletal muscular dystrophy. LMNA cardiomyopathy has an aggressive clinical course with higher rates of deadly arrhythmias and heart failure than most other heart diseases. As awareness among physicians increases, and advances in DNA sequencing methods make the genetic diagnosis of LMNA cardiomyopathy more common, cardiologists are being faced with difficult questions regarding patient management. These questions concern the optimal use of intracardiac cardioverter defibrillators to prevent sudden death from arrhythmias, and medical interventions to prevent heart damage and ameliorate heart failure symptoms. Data from a mouse model of LMNA cardiomyopathy suggest that inhibitors of mitogen-activated protein kinase (MAPK signaling pathways are beneficial in preventing and treating cardiac dysfunction; this basic research discovery needs to be translated to human patients.

  7. Clinical Holistic Medicine: Social Problems Disguised as Illness

    Directory of Open Access Journals (Sweden)

    Søren Ventegodt

    2004-01-01

    Full Text Available Many of the diseases seen in the clinic are actually symptoms of social problems. It is often easier for the physician to treat the symptoms than to be a coach and help the patient to assume responsibility in order to improve quality of life, social situation, and relations. If the physician ignores the signs of the disease as a symptom of social problems, and treats the patient with pharmaceuticals, he can give the patient the best justification in the world not to do anything about the situation. It is very important that the physician is not tricked by the games the socially troubled patient, more or less unconsciously, is playing. A firm and wise attitude that confronts the patient with his or her lack of responsibility for solving social problems seems to be a constructive way out. The physician can give holding and support, but the responsibility must remain with the patient. Often it is better for the patient that the physician abstains from giving drugs that can remedy the symptoms and takes the role of a coach instead. Suffering is not necessarily bad, suffering is actually highly motivating and often the most efficient source of learning. Coaching can help the patient canalize his motivation into highly constructive considerations and behavior. A holistic approach thus gives the patient learning and helps him rehabilitate his social reality. Concerning children with recurrent or chronic pain, we have observed an overuse of painkillers, where we believe part is of a psychosomatic nature due to poor thriving in the family. Here the physician has an important job helping the parents to develop as persons, teaching them the basic holding of awareness, respect, care, acknowledgment and acceptance of their child. Most of the chronic pain and discomfort with children can be improved if the physician understands how to use the holistic medical toolbox.

  8. The European Register of Specialists in Clinical Chemistry and Laboratory Medicine: guide to the Register, version 3-2010

    DEFF Research Database (Denmark)

    McMurray, Janet; Zérah, Simone; Hallworth, Michael

    2010-01-01

    In 1997, the European Communities Confederation of Clinical Chemistry and Laboratory Medicine (EC4) set up a Register for European Specialists in Clinical Chemistry and Laboratory Medicine. The operation of the Register is undertaken by a Register Commission (EC4RC). During the last 12 years, mor...

  9. Harnessing the potential clinical use of medicinal plants as anti-diabetic agents

    Directory of Open Access Journals (Sweden)

    Campbell-Tofte JI

    2012-08-01

    Full Text Available Joan IA Campbell-Tofte,1 Per Mølgaard,2 Kaj Winther11Department of Clinical Biochemistry, Frederiksberg University Hospital, Frederiksberg, Denmark; 2Department of Medicinal Chemistry, Faculty of Pharmaceutical Sciences, University of Copenhagen, Copenhagen, DenmarkAbstract: Diabetes is a metabolic disorder arising from complex interactions between multiple genetic and/or environmental factors. The characteristic high blood sugar levels result from either lack of the hormone insulin (type 1 diabetes, T1D, or because body tissues do not respond to the hormone (type 2 diabetes, T2D. T1D patients currently need exogenous insulin for life, while for T2D patients who do not respond to diet and exercise regimes, oral anti-diabetic drugs (OADs and sometimes insulin are administered to help keep their blood glucose as normal as possible. As neither the administration of insulin nor OADs is curative, many patients develop tissue degenerative processes that result in life-threatening diabetes comorbidities. Several surveys of medicinal plants used as anti-diabetic agents amongst different peoples have been published. Some of this interest is driven by the ongoing diabetes pandemic coupled with the inadequacies associated with the current state of-the-art care and management of the syndrome. However, there is a huge cleft between traditional medicine and modern (Western medicine, with the latter understandably demanding meaningful and scientific validation of anecdotal evidence for acceptance of the former. The main problems for clinical evaluation of medicinal plants with promising anti-diabetic properties reside both with the complexity of components of the plant materials and with the lack of full understanding of the diabetes disease etiology. This review is therefore focused on why research activities involving an integration of Systems Biology-based technologies of pharmacogenomics, metabolomics, and bioinformatics with standard clinical data

  10. [Development and Quality Evaluation of Evidence-based Clinical Practice Guidelines of Chinese Medicine].

    Science.gov (United States)

    Jiang, Yue-rong; Chen, Ke-ji

    2016-01-01

    More attentions have been paid to the development of evidence-based clinical practice guidelines (ECPGs) of Chinese medicine (CM). International guideline evaluation instruments such as Appraisal of Guidelines for Research and Evaluation (AGREE I) has been gradually applied in ECPGs quality evaluation of CM. Nowadays, there are some certain methodological defects in partial ECPGs of Chinese medicine, with relatively low applicability and slowly update. It is suggested to establish technical specifications of CM-ECPGs in accordance with the characteristics of CM and international general specification, strengthen the quality evaluation of CM-ECPGs, attach great importance to the regularly update as well as popularization and application of CM-ECPGs.

  11. Ethical considerations in clinical research on herbal medicine for prevention of cardiovascular disease in the ageing.

    Science.gov (United States)

    Koonrungsesomboon, Nut; Karbwang, Juntra

    2016-10-15

    Cardiovascular disease (CVD) in the ageing is a major public health problem worldwide. The nature of most CVD is subclinical with pathological processes that can span over years. Use of preventive measures could be an appropriate approach to prevailing over CVD in the ageing, and herbal medicine is one of the promising preventive approaches and is currently of interest among medical societies. In the evidence-based era, herbal medicine is, however, often underestimated and approached with skepticism, mainly due to the paucity of scientific evidence. Properly designed clinical trials on herbal medicine for prevention of CVD in a geriatric population are thus of importance and of clinical value. To review ethical issues and discuss considerations when such research is proposed. Four ethical issues, including the scientific validity of research, risk-benefit assessments, subject selection and vulnerability, and informed consent, are structured and extensively discussed in this article. Ethical core considerations of prevention research of CVD on herbal medicine involve particular attention on the scientific validity of research, risk-benefit assessments, subject selection and vulnerability, and informed consent. These issues and considerations are keys, although they must be adapted to an individual research setting in which a clinical study is proposed. Copyright © 2015 Elsevier GmbH. All rights reserved.

  12. Regulatory considerations in production of a cell therapy medicinal product in Europe to clinical research.

    Science.gov (United States)

    Martín, Patricia Gálvez; Martinez, Adolfina Ruiz; Lara, Visitación Gallardo; Naveros, Beatriz Clares

    2014-02-01

    The development of new drugs using stem cells has become a clinic alternative for the treatment of different diseases such as Alzheimer's, diabetes and myocardial infarction. Similar to conventional medicines, stem cells as new medicinal products for cell therapy are subjected to current legislation concerning their manufacture process. Besides, their legality is determined by the Regulatory Agencies belonging to the Member State of the European Union in which they are being registered. With the evolution of therapy that uses cells as medicines, there is a need to develop the appropriate legislative and regulatory framework capable of ensuring their safety and effectiveness. However, few works have been published regarding the regulations that these products must comply through production and commercialization processes. The present work is focused on the description of key events during clinical development and cell production of stem cells as drugs. Such as the regulations, requirements and directives involved in the production of cell therapy medicinal products, from the clinical design stage to its commercialization in Europe.

  13. Vertical integration of biochemistry and clinical medicine using a near-peer learning model.

    Science.gov (United States)

    Gallan, Alexander J; Offner, Gwynneth D; Symes, Karen

    2016-11-12

    Vertical integration has been extensively implemented across medical school curricula but has not been widely attempted in the field of biochemistry. We describe a novel curricular innovation in which a near-peer learning model was used to implement vertical integration in our medical school biochemistry course. Senior medical students developed and facilitated a case-based small group session for first year biochemistry students. Students were surveyed before and after the session on their attitudes about biochemistry, as well as the effectiveness of the session. Prior to the session, the students believed biochemistry was more important to understanding the basic science of medicine than it was to understanding clinical medicine or becoming a good physician. The session improved students' attitudes about the importance of biochemistry in clinical medicine, and after the session they now believe that understanding biochemistry is equally important to the basic sciences as clinical medicine. Students would like more sessions and believe the senior student facilitators were knowledgeable and effective teachers. The facilitators believe they improved their teaching skills. This novel combination of near-peer learning and vertical integration in biochemistry provided great benefit to both first year and senior medical students, and can serve as a model for other institutions. © 2016 by The International Union of Biochemistry and Molecular Biology, 44(6):507-516, 2016.

  14. Development of emergency medicine as academic and distinct clinical discipline in Bosnia & Herzegovina.

    Science.gov (United States)

    Salihefendic, Nizama; Zildzic, Muharem; Masic, Izet; Hadziahmetovic, Zoran; Vasic, Dusko

    2011-01-01

    Emergency medicine is a new academic discipline, as well as a recent independent clinical specialization with the specific principles of practice, education and research. It is also a very important segment of the overall health care and health system. Emergency medicine as a distinct specialty was introduced in the U.S. in 1970. Ten years later and relatively quickly emergency medicine was introduced in the health system in Bosnia and Herzegovina as a specialty with a special education program for specialist and a final exam. Compare the development of emergency medicine in Bosnia and Herzegovina with the trends of development of this discipline in the world as a specialization and an academic discipline. Identify specific problems and possible solutions and learn lessons from other countries. Reviewed are the literature data on the development of emergency medicine in the world, programs of undergraduate and postgraduate teaching, the organizational scheme of emergency centers and residency. This is then compared with data of the current status of emergency medicine as an academic discipline and a recognized specialization, in Bosnia and Herzegovina. There are substantial differences in the development of emergency medicine in the United States, European Union and Bosnia and Herzegovina. Although Bosnia and Herzegovina relatively early recognized specialty of emergency medicine in academia, it failed to mach the academic progress with the practical implementation. A&E departments in the Community Health Centers failed to meet the desired objectives even though they were led by specialists in emergency medicine. The main reason being the lack of space and equipment as well as staff needed to meet set standards of good clinical practice, education and research. Furthermore the Curriculum of undergraduate education and specialization does not match modern concept of educational programs that meet the principles set out in emergency medicine and learning through

  15. [Exercise is medicine: development and evidence-based practice in clinical exercise physiology].

    Science.gov (United States)

    Zhou, Shi

    2014-08-01

    It has been well established that appropriate physical activity and exercise play an important role in promotion of health and fitness, prevention of disease and treatment and rehabilitation of health conditions. However, practice based on scientific evidence, in respect of the role and effectiveness of exercise interventions in prevention and treatment of diseases, has only been promoted and implemented in the fields of clinical exercise physiology, public health and medicine in recent years. This brief review provides an introduction of the concept of "Exercise is Medicine", the development and evidence-based practice in Clinical Exercise Physiology, and the role and training of Clinical Exercise Physiologist in the health care system of some other countries.

  16. Bioinformatics Workflow for Clinical Whole Genome Sequencing at Partners HealthCare Personalized Medicine

    Directory of Open Access Journals (Sweden)

    Ellen A. Tsai

    2016-02-01

    Full Text Available Effective implementation of precision medicine will be enhanced by a thorough understanding of each patient’s genetic composition to better treat his or her presenting symptoms or mitigate the onset of disease. This ideally includes the sequence information of a complete genome for each individual. At Partners HealthCare Personalized Medicine, we have developed a clinical process for whole genome sequencing (WGS with application in both healthy individuals and those with disease. In this manuscript, we will describe our bioinformatics strategy to efficiently process and deliver genomic data to geneticists for clinical interpretation. We describe the handling of data from FASTQ to the final variant list for clinical review for the final report. We will also discuss our methodology for validating this workflow and the cost implications of running WGS.

  17. The Necessity of Data Mining in Clinical Emergency Medicine; A Narrative Review of the Current Literatrue

    Science.gov (United States)

    Parva, Elahe; Boostani, Reza; Ghahramani, Zahra; Paydar, Shahram

    2017-01-01

    Clinical databases can be categorized as big data, include large quantities of information about patients and their medical conditions. Analyzing the quantitative and qualitative clinical data in addition with discovering relationships among huge number of samples using data mining techniques could unveil hidden medical knowledge in terms of correlation and association of apparently independent variables. The aim of this research is using predictive algorithm for prediction of trauma patients on admission to hospital to be able to predict the necessary treatment for patients and provided the necessary measures for the trauma patients who are before entering the critical situation. This study provides a review on data mining in clinical medicine. The relevant, recently-published studies of data mining on medical data with a focus on emergency medicine were investigated to tackle pros and cons of such approaches. The results of this study can be used in prediction of trauma patient’s status at six hours after admission to hospital. PMID:28507995

  18. Advancing Medication Reconciliation in an Outpatient Internal Medicine Clinic through a Pharmacist-Led Educational Initiative

    Directory of Open Access Journals (Sweden)

    Sarah M. Westberg, Pharm.D.

    2010-01-01

    Full Text Available Objectives: To develop and deliver an effective pharmacist-led educational initiative to clinic staff to advance medication reconciliation in the electronic medical record of an outpatient internal medicine clinic.Methods: An educational initiative designed to improve the ability of nursing staff in medication reconciliation was launched in the outpatient internal medicine clinic of a regional healthcare system. The education was provided by the pharmacist to clinic nursing staff, including registered nurses, licensed practical nurses, and certified medical assistants. The impact of this training was measured through pre-initiation and post-implementation surveys, competency assessments and an audit. Results: The educational initiative was successfully designed and delivered to clinic nursing staff. Assessment of the initiative found that all nursing staff completing competency assessments successfully passed. Pre-initiation- and post-implementation- survey responses on the self-assessed ability to gather and document accurate medication lists did not show significant changes. Informal observations in the clinic indicated that this initiative changed the culture of the clinic, creating increased awareness of the importance of accurate medications and increased emphasis on medication reconciliation.Conclusions: The expertise of pharmacists can be utilized to educate nursing staff on the skills and abilities necessary to gather and document accurate medication lists. This study did not find measurable changes in the accuracy of medication lists in this clinic. Future research is needed to determine the best methods to train health professionals in medication reconciliation to ensure accurate medication lists in the outpatient setting.

  19. The European Register of Specialists in Clinical Chemistry and Laboratory Medicine: Code of Conduct, Version 2--2008.

    LENUS (Irish Health Repository)

    McMurray, Janet

    2009-01-01

    In 1997, the European Communities Confederation of Clinical Chemistry and Laboratory Medicine (EC4) set up a Register for European Specialists in Clinical Chemistry and Laboratory Medicine. The operation of the Register is undertaken by a Register Commission (EC4RC). During the last 10 years, more than 2000 specialists in Clinical Chemistry and Laboratory Medicine have joined the Register. In 2007, EC4 merged with the Federation of European Societies of Clinical Chemistry and Laboratory Medicine (FESCC) to form the European Federation of Clinical Chemistry and Laboratory Medicine (EFCC). A Code of Conduct was adopted in 2003 and a revised and updated version, taking account particularly of the guidelines of the Conseil Européen des Professions Libérales (CEPLIS) of which EFCC is a member, is presented in this article. The revised version was approved by the EC4 Register Commission and by the EFCC Executive Board in Paris on 6 November, 2008.

  20. The European Register of Specialists in Clinical Chemistry and Laboratory Medicine: guide to the Register, version 3-2010.

    LENUS (Irish Health Repository)

    McMurray, Janet

    2010-07-01

    In 1997, the European Communities Confederation of Clinical Chemistry and Laboratory Medicine (EC4) set up a Register for European Specialists in Clinical Chemistry and Laboratory Medicine. The operation of the Register is undertaken by a Register Commission (EC4RC). During the last 12 years, more than 2200 specialists in Clinical Chemistry and Laboratory Medicine have joined the Register. In 2007, EC4 merged with the Forum of European Societies of Clinical Chemistry and Laboratory Medicine (FESCC) to form the European Federation of Clinical Chemistry and Laboratory Medicine (EFCC). Two previous Guides to the Register have been published, one in 1997 and another in 2003. The third version of the Guide is presented in this article and is based on the experience gained and development of the profession since the last revision. Registration is valid for 5 years and the procedure and criteria for re-registration are presented as an Appendix at the end of the article.

  1. 3D Reconstruction from X-ray Fluoroscopy for Clinical Veterinary Medicine using Differential Volume Rendering

    Science.gov (United States)

    Khongsomboon, Khamphong; Hamamoto, Kazuhiko; Kondo, Shozo

    3D reconstruction from ordinary X-ray equipment which is not CT or MRI is required in clinical veterinary medicine. Authors have already proposed a 3D reconstruction technique from X-ray photograph to present bone structure. Although the reconstruction is useful for veterinary medicine, the thechnique has two problems. One is about exposure of X-ray and the other is about data acquisition process. An x-ray equipment which is not special one but can solve the problems is X-ray fluoroscopy. Therefore, in this paper, we propose a method for 3D-reconstruction from X-ray fluoroscopy for clinical veterinary medicine. Fluoroscopy is usually used to observe a movement of organ or to identify a position of organ for surgery by weak X-ray intensity. Since fluoroscopy can output a observed result as movie, the previous two problems which are caused by use of X-ray photograph can be solved. However, a new problem arises due to weak X-ray intensity. Although fluoroscopy can present information of not only bone structure but soft tissues, the contrast is very low and it is very difficult to recognize some soft tissues. It is very useful to be able to observe not only bone structure but soft tissues clearly by ordinary X-ray equipment in the field of clinical veterinary medicine. To solve this problem, this paper proposes a new method to determine opacity in volume rendering process. The opacity is determined according to 3D differential coefficient of 3D reconstruction. This differential volume rendering can present a 3D structure image of multiple organs volumetrically and clearly for clinical veterinary medicine. This paper shows results of simulation and experimental investigation of small dog and evaluation by veterinarians.

  2. Patients visiting the complementary medicine clinic for pain: a cross sectional study

    Directory of Open Access Journals (Sweden)

    Press Yan

    2011-05-01

    Full Text Available Abstract Background Pain is one of the most common reasons for seeking medical care. The purpose of this study was to characterize patients visiting the complementary medicine clinic for a pain complaint. Methods This is a cross-sectional study. The study took place at Clalit Health Services (CHS complementary clinic in Beer-Sheva, Israel. Patients visiting the complementary clinic, aged 18 years old and older, Hebrew speakers, with a main complaint of pain were included. Patients were recruited consecutively on random days of the month during a period of six months. Main outcome measures were: pain levels, location of pain, and interference with daily activities. Once informed consent was signed patients were interviewed using a structured questionnaire by a qualified nurse. The questionnaire included socio-demographic data, and the Brief Pain Inventory (BPI. Results Three-hundred and ninety-five patients were seen at the complementary medicine clinic during the study period, 201 (50.8% of them met the inclusion criteria. Of them, 163 (81.1% agreed to participate in the study and were interviewed. Pain complaints included: 69 patients (46.6% with back pain, 65 (43.9% knee pain, and 28 (32.4% other limbs pain. Eighty-two patients (50.3% treated their pain with complementary medicine as a supplement for their conventional treatment, and 55 (33.7% felt disappointed from the conventional medicine experience. Eighty-three patients (50.9% claimed that complementary medicine can result in better physical strength, or better mental state 51 (31.3%. Thirty-seven patients (22.7% were hoping that complementary medicine will prevent invasive procedures. Conclusion Given the high proportion of patients with unsatisfactory pain relief using complementary and alternative medicine (CAM, general practitioners should gain knowledge about CAM and CAM providers should gain training in pain topics to improve communication and counsel patients. More clinical

  3. Helen Flanders Dunbar, John Dewey, and clinical pragmatism: reflections on method in psychosomatic medicine and bioethics.

    Science.gov (United States)

    Hart, Curtis W

    2002-01-01

    This article outlines the method utilized by physicians and major figures in the founding of Clinical Pastoral Education, Helen Flanders Dunbar, in her work of 1943, Psychosomatic Diagnosis, and relates it to the currently evolving approach in bioethics known as clinical pragmatism. It assesses Dewey's influence on both Dunbar in psychosomatic medicine and clinical pragmatism in bioethics, and illustrates the breadth of influence of the school of philosophical thought known as pragmatism with which Dewey's name and those of William James and Charles Sanders Pierce are most often identified.

  4. The Center for Clinical Epidemiology and Biostatistics of the Perelman School of Medicine at the University of Pennsylvania: an organizational model for clinical research in a school of medicine.

    Science.gov (United States)

    Strom, Brian L; Kelly, Thomas O; Landis, J Richard; Feldman, Harold I

    2012-01-01

    A new model for the conduct of clinical research was established at the University of Pennsylvania (Penn) School of Medicine, now the Perelman School of Medicine, through the development of the interdepartmental Center for Clinical Epidemiology and Biostatistics in 1993 and the basic science Department of Biostatistics and Epidemiology in 1994. The authors describe the development and evolution of these novel structures.Five key objectives were achieved with these structures' creation: (1) Clinical faculty have the opportunity to be identified as both clinicians and epidemiologists, (2) nonclinical faculty have an academic "home," (3) clinical trainees are now educated in population medicine, which promotes its incorporation into their clinical practice, (4) population medicine and clinical medicine have become fully integrated, and (5) better epidemiologic research is conducted, informed by clinical insights.Today's center is the primary home for epidemiology and biostatistics at Penn, linking epidemiology, biostatistics, clinical medicine, and the health sciences. The center's core faculty manage their own research programs, conduct primary research in epidemiology and biostatistics, serve as members of collaborative research teams, manage cores and service centers that support research projects, and lead graduate training programs in epidemiology and biostatistics. The department provides an academic home and structure for faculty, provides primary research in epidemiology and biostatistics, supports the center's mission, and provides training in biostatistics. This organizational approach has wide applicability across schools of medicine in the United States and abroad and has been a model for many.

  5. Why we should understand the patient experience: clinical empathy and medicines optimisation.

    Science.gov (United States)

    Jubraj, Barry; Barnett, Nina L; Grimes, Lesley; Varia, Sneha; Chater, Angel; Auyeung, Vivian

    2016-10-01

    To critically discuss the need for pharmacists to underpin their consultations with appropriate 'clinical empathy' as part of effective medicines optimisation. Use of literature around empathy, consultation and pharmacy practice to develop a case for greater clinical empathy in pharmacy consultations. Clinical empathy is defined from the literature and applied to pharmacy consultations, with a comparison to empathy in other clinical professions. Historical barriers to the embedding of clinical empathy into pharmacy consultations are also explored. We challenge the pharmacy profession to consider how clinical empathy should underpin consultations with a series of introspective questions and provide some sample questions to support pharmacy consultations. We also make the case for appropriate education and professional development of consultation skills at undergraduate and postgraduate level. We contend that patients' relationships with practitioners are critical, and a lack of empathy can impact the effectiveness of care. © 2016 Royal Pharmaceutical Society.

  6. A novel misoprostol delivery system for induction of labor: clinical utility and patient considerations

    Directory of Open Access Journals (Sweden)

    Stephenson ML

    2015-04-01

    Full Text Available Megan L Stephenson, Deborah A WingDivision of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Irvine Medical Center, Orange, CA, USAAbstract: Induction of labor is one of the most commonly performed obstetric procedures and will likely become more common as the reproductive population in developed nations changes. As the proportion of women undergoing induction grows, there is a constant search for more efficacious ways to induce labor while maintaining fetal and maternal safety as well as patient satisfaction. With almost half of induced labors requiring cervical ripening, methods for achieving active labor and vaginal delivery are constantly being investigated. Prostaglandins have been shown to be effective induction agents, and specifically vaginal misoprostol, used off-label, have been widely utilized to initiate cervical ripening and active labor. The challenge is to administer this medication accurately while maintaining the ability to discontinue the medication when needed. The misoprostol vaginal insert initiates cervical ripening utilizing a delivery system that controls medication release and can be rapidly removed. This paper reviews the design, development, and clinical utility of the misoprostol vaginal insert for induction of labor as well as patient considerations related to the delivery system.Keywords: misoprostol, induction, cervical ripening, vaginal insert

  7. The enduring legacy of Alfred Gilman senior (1908-1984) to pharmacology and clinical medicine.

    Science.gov (United States)

    Rubin, Ronald P

    2016-09-28

    Alfred Gilman was best known for his co-authorship with Louis Goodman of the seminal textbook on pharmacology The Pharmacological Basis of Therapeutics in 1941. The book made the discipline of pharmacology relevant to clinical medicine by providing a link between the basic medical sciences and the practice of medicine. Gilman was also instrumental in establishing the use of chemotherapy in the treatment of cancer and made important contributions in areas related to renal function, acid-base balance, and diuretics. During the 1960s, he created a first rate department at the newly formed Albert Einstein College of Medicine. A superb lecturer, he commented incisively on issues related to pharmacology, therapeutics, and pathophysiology. Dr Gilman also provided a key link between academia and the pharmaceutical industry by serving as a consultant to several drug firms. The legacy of Alfred Gilman senior was continued by his son, Alfred Goodman Gilman, who became a Nobel Laureate. © The Author(s) 2016.

  8. Anticandidal activity of medicinal plants and Pseudomonas aeruginosa strains of clinical specimens.

    Science.gov (United States)

    Bora, Limpon

    2016-04-01

    This study was designed to investigate the in vitro anticandidal activity of some medicinal plants and Pseudomonas aeruginosa strains against Candida species. The antifungal activity of methanolic extracts of five medicinal plants, namely, Cinnamomum porrectum, Lippia nudiflora, Cestrum nocturnum, Trachyspermum ammi, and Sida carpinifolia were studied. The medicinal characteristics of these plants were compared with commercially used antibiotics. The antimicrobial assay was done by agar well diffusion and the broth dilution method. Among the plants used, T. ammi and C. nocturnum were found to be more potent than the others. Twenty P. aeruginosa strains were isolated from various clinical specimens. The total inhibitions obtained were found to be 47%, 38%, and 36% in blood agar, whereas in Sabouraud dextrose agar (SDA) the inhibitions were 57%, 48%, and 37%, respectively.

  9. Characteristics of adult smokers presenting to a mind-body medicine clinic.

    Science.gov (United States)

    Luberto, Christina M; Chad-Friedman, Emma; Dossett, Michelle L; Perez, Giselle K; Park, Elyse R

    2016-09-29

    Mind-body interventions can improve vulnerabilities that underlie smoking behavior. The characteristics of smokers who use mind-body medicine have not been explored, preventing the development of targeted interventions. Patients (N = 593) presenting to a mind-body medicine clinic completed self-report measures. Patients were 67 percent never smokers, 27 percent former smokers, and 6 percent current smokers. Current smokers were younger; more likely to be single, unemployed, or on disability; and report greater depression symptoms, greater pain, and lower social support (ps mind-body medicine have unique psychosocial needs that should be targeted in mind-body smoking cessation interventions.

  10. Clinical Poems and Clinical Conversations: Some Thoughts on Working with Family Medicine Residents

    Science.gov (United States)

    Stein, Howard F.

    2006-01-01

    This paper describes an experiment in which Family Medicine residents composed, read, and discussed their poems as a way of bringing to life their often complex relationships with patients. It argues that this approach mobilizes the physicians' own creativity in the service of reflective practice and improved doctor-patient relationships. This…

  11. Science, humanism, judgement, ethics: person-centered medicine as an emergent model of modern clinical practice.

    Science.gov (United States)

    Miles, Andrew

    2013-01-01

    The Medical University of Plovdiv (MUP) has as its motto 'Committed to humanity". But what does humanity in modern medicine mean? Is it possible to practise a form of medicine that is without humanity? In the current article, it is argued that modern medicine is increasingly being practised in a de-personalised fashion, where the patient is understood not as a unique human individual, a person, but rather as a subject or an object and more in the manner of a complex biological machine. Medicine has, it is contended, become distracted from its duty to care, comfort and console as well as to ameliorate, attenuate and cure and that the rapid development of medicine's scientific knowledge is, paradoxically, principally causative. Signal occurrences in the 'patient as a person' movement are reviewed, together with the emergence of the evidence-based medicine (EBM) and patient-centered care (PCC) movements. The characteristics of a model of medicine evolving in response to medicine's current deficiencies--person-centered healthcare (PCH)--are noted and described. In seeking to apply science with humanism, via clinical judgement, within an ethical framework, it is contended that PCH will prove to be far more responsive to the needs of the individual patient and his/her personal circumstances than current models of practice, so that neither a reductive anatomico-pathological, disease-centric model of illness (EBM), nor an aggressive patient-directed, consumerist form of care (PCC) is allowed continued dominance within modern healthcare systems. In conclusion, it is argued that PCH will enable affordable advances in biomedicine and technology to be delivered to patients within a humanistic framework of clinical practice that recognises the patient as a person and which takes full account of his/her stories, values, preferences, goals, aspirations, fears, worries, hopes, cultural context and which responds to his/her psychological, emotional, spiritual and social necessities

  12. Information management to enable personalized medicine: stakeholder roles in building clinical decision support

    Directory of Open Access Journals (Sweden)

    Brinner Kristin M

    2009-10-01

    Full Text Available Abstract Background Advances in technology and the scientific understanding of disease processes are presenting new opportunities to improve health through individualized approaches to patient management referred to as personalized medicine. Future health care strategies that deploy genomic technologies and molecular therapies will bring opportunities to prevent, predict, and pre-empt disease processes but will be dependent on knowledge management capabilities for health care providers that are not currently available. A key cornerstone to the potential application of this knowledge will be effective use of electronic health records. In particular, appropriate clinical use of genomic test results and molecularly-targeted therapies present important challenges in patient management that can be effectively addressed using electronic clinical decision support technologies. Discussion Approaches to shaping future health information needs for personalized medicine were undertaken by a work group of the American Health Information Community. A needs assessment for clinical decision support in electronic health record systems to support personalized medical practices was conducted to guide health future development activities. Further, a suggested action plan was developed for government, researchers and research institutions, developers of electronic information tools (including clinical guidelines, and quality measures, and standards development organizations to meet the needs for personalized approaches to medical practice. In this article, we focus these activities on stakeholder organizations as an operational framework to help identify and coordinate needs and opportunities for clinical decision support tools to enable personalized medicine. Summary This perspective addresses conceptual approaches that can be undertaken to develop and apply clinical decision support in electronic health record systems to achieve personalized medical care. In

  13. Levels of Evidence in the Clinical Sports Medicine Literature: Are We Getting Better Over Time?

    Science.gov (United States)

    Grant, Heather M; Tjoumakaris, Fotios P; Maltenfort, Mitchell G; Freedman, Kevin B

    2014-07-01

    There has been an increased emphasis on improving the level of evidence used as the basis for clinical treatment decisions. Several journals now require a statement of the level of evidence as a basic gauge of the study's strength. To review the levels of evidence in published articles in the clinical sports medicine literature and to determine if there has been an improvement in the levels of evidence published over the past 15 years. Systematic review. All articles from the years 1995, 2000, 2005, and 2010 in The American Journal of Sports Medicine (AJSM), Arthroscopy, and sports medicine-related articles from The Journal of Bone and Joint Surgery-American (JBJS-A) were analyzed. Articles were categorized by type and ranked for level of evidence according to guidelines from the Centre for Evidence-Based Medicine. Excluded were animal, cadaveric, and basic science articles; editorials; surveys; special topics; letters to the editor; and correspondence. Statistical analysis was performed with chi-square. A total of 1580 articles over the 4 periods met the inclusion criteria. The percentage of level 1 and 2 studies increased from 6.8% to 12.6%, 22.9%, and 23.5%, respectively (P sports medicine literature over the past 15 years, particularly in JBJS-A and AJSM. The largest increase was seen in diagnostic studies, while therapeutic and prognostic studies demonstrated modest improvement. The emphasis on increasing levels of evidence to guide treatment decisions for sports medicine patients may be taking effect. © 2014 The Author(s).

  14. The expanding role of the clinical haematologist in the new world of advanced therapy medicinal products.

    Science.gov (United States)

    Lowdell, Mark W; Thomas, Amy

    2017-01-01

    Advanced therapy medicinal products (ATMPs) represent the current pinnacle of 'patient-specific medicines' and will change the nature of medicine in the near future. They fall into three categories; somatic cell-therapy products, gene therapy products and cells or tissues for regenerative medicine, which are termed 'tissue engineered' products. The term also incorporates 'combination products' where a human cell or tissue is combined with a medical device. Plainly, many of these new medicines share similarities with conventional haematological stem cell transplant products and donor lymphocyte infusions as well as solid organ grafts and yet ATMPs are regulated as medicines and their development has remained predominantly in academic settings and within specialist centres. However, with the advent of commercialisation of dendritic cell vaccines, chimeric antigen receptor (CAR)-T cells and genetically modified autologous haematopoietic stem cells to cure single gene-defects in β-thalassaemia and haemophilia, the widespread availability of these therapies needs to be accommodated. Uniquely to ATMPs, the patient or an allogeneic donor is regularly part of the manufacturing process. All of the examples given above require procurement of blood, bone marrow or an apheresate from a patient as a starting material for manufacture. This can only occur in a clinical facility licensed for the procurement of human cells for therapeutic use and this is likely to fall to haematology departments, either as stem cell transplant programmes or as blood transfusion departments, to provide under a contract with the company that will manufacture and supply the final medicine. The resource implications associated with this can impact on all haematology departments, not just stem cell transplant units, and should not be under-estimated.

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

    Science.gov (United States)

    Cartabellotta, A

    1998-03-01

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

  16. Clinical Utility of a Precision Medicine Test Evaluating Outpatients with Suspected Obstructive Coronary Artery Disease.

    Science.gov (United States)

    Ladapo, Joseph A; Budoff, Matt; Sharp, David; Zapien, Michael; Huang, Lin; Maniet, Bruce; Herman, Lee; Monane, Mark

    2017-04-01

    Identifying patients with obstructive coronary artery disease can be challenging for primary care physicians. Advances in precision medicine may help augment clinical tools and redefine the paradigm for evaluating coronary artery disease in the outpatient setting. A blood-based age/sex/gene expression score (ASGES) incorporating key features of precision medicine has shown clinical validity with a 96% negative predictive value and 89% sensitivity in estimating a symptomatic patient's current likelihood of obstructive coronary artery disease. To better characterize the clinical utility of the ASGES and measure its impact on clinician decision-making, a community-based registry was established. The prospective PRESET Registry (NCT01677156) enrolled stable, nonacute adult patients presenting with typical or atypical symptoms suggestive of obstructive coronary artery disease from 21 US primary care practices from August 2012 to August 2014. Demographics, clinical characteristics, and ASGES results (predefined as low [ASGES ≤15] or elevated [ASGES >15]) were collected, as were referrals to Cardiology or further functional/anatomic cardiac testing after ASGES testing. Patients were followed for 1 year post ASGES testing. Among the 566-patient cohort (median age 56 years), clinicians referred 26/252 (10%) of patients with low scores vs 137/314 (44%) of patients with elevated scores to Cardiology or advanced cardiac testing for further evaluation (unadjusted odds ratio 0.15, P medicine in the delivery of cardiovascular care. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

  17. Education and training for medicines development, regulation and clinical research in emerging countries.

    Directory of Open Access Journals (Sweden)

    Sandor - Kerpel-Fronius

    2015-04-01

    Full Text Available The aim of this satellite workshop held at the 17th World Congress of Basic and Clinical Pharmacology (WCP2014 was to discuss the needs, optimal methods and practical approaches for extending education teaching of medicines development, regulation and clinical research to Low and Middle Income Countries (LMIC’s. It was generally agreed that, for efficiently treating the rapidly growing number of patients suffering from non-communicable diseases, modern drug therapy has to become available more widely and with a shorter time lag in these countries. To achieve this goal many additional experts working in medicines development, regulation and clinical research have to be trained in parallel. The competence-oriented educational programs designed within the framework of the European Innovative Medicine Initiative-PharmaTrain (IMI-PhT project were developed with the purpose to cover these interconnected fields. In addition, the programs can be easily adapted to the various local needs, primarily due to their modular architecture and well defined learning outcomes. Furthermore, the program is accompanied by stringent quality assurance standards which are essential for providing internationally accepted certificates. Effective cooperation between international and local experts and organizations, the involvement of the industry, health care centers and governments is essential for successful education. The initiative should also support the development of professional networks able to manage complex health care strategies. In addition it should help establish cooperation between neighboring countries for jointly managing clinical trials, as well as complex regulatory and ethical issues.

  18. Education and training for medicines development, regulation, and clinical research in emerging countries.

    Science.gov (United States)

    Kerpel-Fronius, Sandor; Rosenkranz, Bernd; Allen, Elizabeth; Bass, Rolf; Mainard, Jacques D; Dodoo, Alex; Dubois, Dominique J; Hela, Mandisa; Kern, Steven; Massud, Joao; Silva, Honorio; Whitty, Jeremy

    2015-01-01

    The aim of this satellite workshop held at the 17th World Congress of Basic and Clinical Pharmacology (WCP2014) was to discuss the needs, optimal methods and practical approaches for extending education and teaching of medicines development, regulation, and clinical research to Low and Middle Income Countries (LMICs). It was generally agreed that, for efficiently treating the rapidly growing number of patients suffering from non-communicable diseases, modern drug therapy has to become available more widely and with a shorter time lag in these countries. To achieve this goal many additional experts working in medicines development, regulation, and clinical research have to be trained in parallel. The competence-oriented educational programs designed within the framework of the European Innovative Medicine Initiative-PharmaTrain (IMI-PhT) project were developed with the purpose to cover these interconnected fields. In addition, the programs can be easily adapted to the various local needs, primarily due to their modular architecture and well defined learning outcomes. Furthermore, the program is accompanied by stringent quality assurance standards which are essential for providing internationally accepted certificates. Effective cooperation between international and local experts and organizations, the involvement of the industry, health care centers and governments is essential for successful education. The initiative should also support the development of professional networks able to manage complex health care strategies. In addition it should help establish cooperation between neighboring countries for jointly managing clinical trials, as well as complex regulatory and ethical issues.

  19. HIV in (and out of) the clinic: biomedicine, traditional medicine and spiritual healing in Harare.

    Science.gov (United States)

    O'Brien, Stephen; Broom, Alex

    2014-01-01

    Contemporary lived experiences of the human immunodeficiency virus (HIV) are shaped by clinical and cultural encounters with illness. In sub-Saharan countries such as Zimbabwe, HIV is treated in very different ways in various therapeutic contexts including by biomedical experts, traditional medicine and faith healers. The co-existence of such expertise raises important questions around the potencies and limits of medicalisation and alternative healing practices in promoting HIV recovery. First, in this study, drawing on in-depth qualitative interviews with 60 people from poor urban areas in Harare, we explore the experiences of people living with and affected by HIV. Specifically, we sought to document, interrogate and reflect on their perceptions and experiences of biomedicine in relation to traditional medicine and spiritual healing. Their accounts indicate that traditional medicine and spiritual beliefs continue to significantly influence the way in which HIV is understood, and the forms of help and care people seek. Second, we observe the dramatic and overwhelmingly beneficial impact of Antiretroviral Therapy and conclude through Zimbabwean's own stories that limitations around delivery and wider structural inequalities impede its potential. Lastly, we explore some practical implications of the biomedical clinic (and alternative healing practices) being understood as sites of ideological and expert contestation. This paper aimed to add to our knowledge of the relationships between traditional medicine and spiritual healing in connection with biomedicine and how this may influence HIV treatment and prevention.

  20. Strategies to overcome clinical, regulatory, and financial challenges in the implementation of personalized medicine.

    Science.gov (United States)

    Tsimberidou, Apostolia M; Ringborg, Ulrik; Schilsky, Richard L

    2013-01-01

    This article highlights major developments over the last decade in personalized medicine in cancer. Emerging data from clinical studies demonstrate that the use of targeted agents in patients with targetable molecular aberrations improves clinical outcomes. Despite a surge of studies, however, significant gaps in knowledge remain, especially in identifying driver molecular aberrations in patients with multiple aberrations, understanding molecular networks that control carcinogenesis and metastasis, and most importantly, discovering effective targeted agents. Implementation of personalized medicine requires continued scientific and technological breakthroughs; standardization of tumor tissue acquisition and molecular testing; changes in oncology practice and regulatory standards for drug and device access and approval; modification of reimbursement policies by health care payers; and innovative ways to collect and analyze electronic patient information that are linked to prospective clinical registries and rapid learning systems. Informatics systems that integrate clinical, laboratory, radiologic, molecular, and economic data will improve clinical care and will provide infrastructure to enable clinical research. The initiative of the EurocanPlatform aims to overcome the challenges of implementing personalized medicine in Europe by sharing patients, biologic materials, and technological resources across borders. The EurocanPlatform establishes a complete translational cancer research program covering the drug development process and strengthening collaborations among academic centers, pharmaceutical companies, regulatory authorities, health technology assessment organizations, and health care systems. The CancerLinQ rapid learning system being developed by ASCO has the potential to revolutionize how all stakeholders in the cancer community assemble and use information obtained from patients treated in real-world settings to guide clinical practice, regulatory

  1. The proposed EU-regulation on clinical trials on medicinal products: an unethical proposal?

    Science.gov (United States)

    Heringa, Jilles; Dute, Joseph

    2013-09-01

    The Commission has proposed a regulation 'on clinical trials on medicinal products for human use' to introduce one regulatory framework for clinical trials in the European Union. This regulation should replace the current clinical trials directive (2001/20/EC). In this article we describe and critically review the main provisions of the proposed regulation. We assess the consequences for a sound authorisation procedure of clinical trials and the level of protection for human subjects. We note that the proposed regulation is inconsistent with applicable international legal documents, such as the Biomedicine Convention and the Declaration of Helsinki. We conclude that the proposed regulation does not ensure a "high level of human health protection"--required by its legal basis in the TFEU--because it may force Member States concerned to accept a reporting Member States' approval of--in their estimation--an unethical clinical trial.

  2. [Combination analysis of new drug discovery with "Xiaohe Silian" method and traditional Chinese medicine clinical pharmacy].

    Science.gov (United States)

    Liu, Yang; Zhai, Hua-Qiang; Xiang, Jia-Mei; Wang, Jing-Juan; Zhao, Bao-Sheng; Wang, Gang; Dong, Hong-Huan; Ouyang, Guo-Qing

    2014-07-01

    With the kernel of efficacy, "Xiaohe Silian" was a pattern and method for new drug discovery which was constituted with "metabolism-efficacy, toxicity-efficacy, quality-efficacy and structure-efficacy". Its connotation was in keeping with traditional Chinese medicine (TCM) clinical pharmacy. This paper systematically summarized the research method of new drug discovery practice process for TCM. To avoid western drug like in TCM new drug discovery, we carried out combination analysis with TCM clinical pharmacy. The correlation analysis between basic elements of "Xiaohe Silian(n) and TCM clinical pharmacy was studied to guarantee this method could integrate closely with TCM clinic from all angles. Hence, this method aimed to provide a new method for TCM new drug discovery on the basis of TCM clinical pharmacy with insisting on holistic view of multicomponent study, kinetic view of metabolic process when the curative effect occurred and molecular material view of quality control and structure-activity exposition.

  3. An Innovative Clinical Skills “Boot Camp” for Dental Medicine Residents

    Directory of Open Access Journals (Sweden)

    Jenny Castillo

    2017-05-01

    Full Text Available During a 1-year hospital-based residency, dental residents are required to rotate through many departments including surgery, medicine, and emergency medicine. It became apparent that there was a gap between clinical skills knowledge taught in dental school curriculum and skills required for hospital-based patient care. In response, a simulation-based intensive clinical skill “boot camp” was created. The boot camp provided an intensive, interactive 3-day session for the dental residents. During the 3 days, residents were introduced to medical knowledge and skills that were necessary for their inpatient hospital rotations but were lacking in traditional dental school curriculum. Effectiveness of the boot camp was assessed in terms of knowledge base and comfort through presession and postsession surveys. According to resident feedback, this intensive introduction for the dental residents improved their readiness for their inpatient hospital-based residency.

  4. Translating molecular medicine into clinical tools: doomed to fail by neglecting basic preanalytical principles

    Directory of Open Access Journals (Sweden)

    Mannello Ferdinando

    2009-10-01

    Full Text Available Abstract This commentary discusses a study on measurements of matrix metalloproteinase 9 (MMP-9 in serum of pseudoxanthoma elasticum patients recently published in Journal of Molecular Medicine. This study can be considered the typical "obstacle" to effective translational medicine as previously documented in JTM journal. Although serum has been frequently proven as inappropriate sample for determining numerous circulating MMPs, among them MMP-9, there are over and over again studies, as in this case, that measure MMP-9 in serum. Comparative measurements in serum and plasma samples demonstrated higher concentrations for MMP-9 in serum due to the additional release from leukocytes and platelets following the coagulation/fibrinolysis process. From this example it can be concluded that translating basic research discoveries into clinical tools needs a more intensive exchange between basic biomedical research and clinical scientists already in an early stage. Otherwise a lost of translation, as discussed in JTM journal, seems to be inevitable.

  5. Health Anxiety Levels in Patients Admitted to Internal Medicine Outpatient Clinic for Several Times

    Directory of Open Access Journals (Sweden)

    Ali Gul

    2014-12-01

    Full Text Available Aim: Health anxiety (HA in patients consist of incorrect reference to normal bodily sensations as a signs of a serious disease. The aim of this study is to investigate the HA in patients admitted to internal medicine outpatient clinic for several times within one year. Material and Method: 60 patients who admitted more than one time to internal medicine outpatient clinic within one year and the control group consisted of 60 people were enrolled in this study. Short-form of health anxiety inventory (SAE-KF was given to these groups, The results were compared statistically. Results: SAE-KF scores were significantly higher in the patient group (11.17 ± 6.07 than the control group (10.71±4.44 (Z=-5.96, P

  6. EVIDENCE-BASED MEDICINE AND THE CLINICAL STUDY ON ACUPUNCTURE AND MOXIBUSTION

    Institute of Scientific and Technical Information of China (English)

    吴滨; 李宁

    2001-01-01

    In this article, the authors hold that the evidence-based medicine(EBM) is a new medical action produced at the historic moment in clinical practice, which is promoting development of the medicine and even the whole life science in a fully new train of thought end method. Further the briefly introduced contents are the effect of EBM, the difficulty of utilizing in the acupuncture clinical practice and how to resolve them. It is highly recommended that the doctors of the acupuncture science field should study EBM and its effect and difficulties in practice as earlier as possible, insistently assimilate new knowledge and keep abreast of the times' progress to facilitate the further development of acupunctology.

  7. Scientific Principles and Rigorous Processes Should Be Followed in Developing Clinical Guidelines for Therapeutic Interventions of Integrative Medicine

    Institute of Scientific and Technical Information of China (English)

    LAI Shi-long; WU Da-rong; LAO Ying-rong

    2008-01-01

    @@ A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care(1-4).

  8. HIV in (and out of) the clinic: Biomedicine, traditional medicine and spiritual healing in Harare

    OpenAIRE

    O'Brien, Stephen; Broom, Alex

    2014-01-01

    Abstract Contemporary lived experiences of the human immunodeficiency virus (HIV) are shaped by clinical and cultural encounters with illness. In sub-Saharan countries such as Zimbabwe, HIV is treated in very different ways in various therapeutic contexts including by biomedical experts, traditional medicine and faith healers. The co-existence of such expertise raises important questions around the potencies and limits of medicalisation and alternative healing practices in promoting HIV recov...

  9. Implementing Genomic Clinical Decision Support for Drug‐Based Precision Medicine

    Science.gov (United States)

    Formea, CM; Hoffman, JM; Matey, E; Peterson, JF; Boyce, RD

    2017-01-01

    The explosive growth of patient‐specific genomic information relevant to drug therapy will continue to be a defining characteristic of biomedical research. To implement drug‐based personalized medicine (PM) for patients, clinicians need actionable information incorporated into electronic health records (EHRs). New clinical decision support (CDS) methods and informatics infrastructure are required in order to comprehensively integrate, interpret, deliver, and apply the full range of genomic data for each patient.1 PMID:28109071

  10. Training in clinical forensic medicine in the UK--perceptions of current regulatory standards.

    Science.gov (United States)

    Stark, Margaret M; Norfolk, Guy A

    2011-08-01

    As clinical forensic medicine (CFM) is not currently recognised as a speciality in the UK there are no nationally agreed mandatory standards for training forensic physicians in either general forensic (GFM) or sexual offence medicine (SOM). The General Medical Council (GMC), the medical regulator in the UK, has issued clear standards for training in all specialities recommending that "trainees must be supported to acquire the necessary skills and experience through induction, effective educational supervision, an appropriate workload and time to learn". In order to evaluate the current situation in the field of clinical forensic medicine, doctors who have recently (within the last two years) started working in the field "trainees" (n = 38), and trainers (n = 61) with responsibility for clinical and educational supervision of new trainees, were surveyed by questionnaire to gather their perceptions of how the relevant GMC standards are being met in initial on-the-job training. Telephone interviews were performed with eleven doctors working as clinical or medical directors to determine their views. It is clear that currently the quality of training in CFM is sub-standard and inconsistent and that the published standards, as to the minimum requirement for training that must be met by post-graduate medical and training providers at all levels, are not being met. The Faculty of Forensic and Legal Medicine (FFLM) needs to set explicit minimum standards which will comply with the regulator and work to pilot credentialing for forensic physicians. A number of recommendations are made for urgent FFLM development.

  11. Statistical issues and limitations in personalized medicine research with clinical trials.

    Science.gov (United States)

    Rubin, Daniel B; van der Laan, Mark J

    2012-07-20

    We discuss using clinical trial data to construct and evaluate rules that use baseline covariates to assign different treatments to different patients. Given such a candidate personalization rule, we first note that its performance can often be evaluated without actually applying the rule to subjects, and a class of estimators is characterized from a statistical efficiency standpoint. We also point out a recently noted reduction of the rule construction problem to a classification task and extend results in this direction. Together these facts suggest a natural form of cross-validation in which a personalized medicine rule can be constructed from clinical trial data using standard classification tools and then evaluated in a replicated trial. Because replication is often required by the FDA to provide evidence of safety and efficacy before pharmaceutical drugs can be marketed, there are abundant data with which to explore the potential benefits of more tailored therapy. We constructed and evaluated personalized medicine rules using simulations based on two active-controlled randomized clinical trials of antibacterial drugs for the treatment of skin and skin structure infections. Unfortunately we present negative results that did not suggest benefit from personalization. We discuss the implications of this finding and why statistical approaches to personalized medicine problems will often face difficult challenges.

  12. Regulatory requirements for clinical trial and marketing authorisation application for cell-based medicinal products.

    Science.gov (United States)

    Salmikangas, P; Flory, E; Reinhardt, J; Hinz, T; Maciulaitis, R

    2010-01-01

    The new era of regenerative medicine has led to rapid development of new innovative therapies especially for diseases and tissue/organ defects for which traditional therapies and medicinal products have not provided satisfactory outcome. Although the clinical use and developments of cell-based medicinal products (CBMPs) could be witnessed already for a decade, robust scientific and regulatory provisions for these products have only recently been enacted. The new Regulation for Advanced Therapies (EC) 1394/2007 together with the revised Annex I, Part IV of Directive 2001/83/EC provides the new legal framework for CBMPs. The wide variety of cell-based products and the foreseen limitations (small sample sizes, short shelf life) vs. particular risks (microbiological purity, variability, immunogenicity, tumourigenicity) associated with CBMPs have called for a flexible, case-by-case regulatory approach for these products. Consequently, a risk-based approach has been developed to allow definition of the amount of scientific data needed for a Marketing Authorisation Application (MAA) of each CBMP. The article provides further insight into the initial risk evaluation, as well as to the quality, non-clinical, and clinical requirements of CBMPs. Special somatic cell therapies designed for active immunotherapy are also addressed.

  13. History of foreign clinical forensic medicine%国外法医临床学发展史

    Institute of Scientific and Technical Information of China (English)

    杨天潼; 姜竹青

    2016-01-01

    法医临床学是法医学的重要分支学科,正处于蓬勃发展阶段。研究法医临床学的发展史,对明确其定义和实践范畴,维护司法公正,具有重要意义。本文将从“简介、历史溯源、18世纪之后的法医临床学发展、现代法医临床学、世界法医临床学司法实践现状和结语”六个部分介绍法医临床学在国外,尤其是英国的发展历史,促进我国法医临床学的学科建设和发展。%Clinical forensic medicine is a branch of forensic medical practice. Clinical forensic medicine has evolved into a rapidly growing era. Launching a research on the history of clinical forensic medicine is signiifcant to define the discipline boundary of clinical forensic medicine. To demonstrate the historical development of the foreign clinical forensic medicine, this article mainly contains six parts, including“Introduction, Historical References, Clinical Forensic Medicine in Post-Eighteenth Century, Contemporary Clinical Forensic Medicine, Global Clinical Forensic Medicine, and Conclusion”. The history outlined in this article will assist the construction and development of clinical forensic medicine in China.

  14. Resident satisfaction with continuity clinic and career choice in general internal medicine.

    Science.gov (United States)

    Peccoralo, Lauren A; Tackett, Sean; Ward, Lawrence; Federman, Alex; Helenius, Ira; Christmas, Colleen; Thomas, David C

    2013-08-01

    The quality of the continuity clinic experience for internal medicine (IM) residents may influence their choice to enter general internal medicine (GIM), yet few data exist to support this hypothesis. To assess the relationship between IM residents' satisfaction with continuity clinic and interest in GIM careers. Cross-sectional survey assessing satisfaction with elements of continuity clinic and residents' likelihood of career choice in GIM. IM residents at three urban medical centers. Bivariate and multivariate associations between satisfaction with 32 elements of outpatient clinic in 6 domains (clinical preceptors, educational environment, ancillary staff, time management, administrative, personal experience) and likelihood of considering a GIM career. Of the 225 (90 %) residents who completed surveys, 48 % planned to enter GIM before beginning their continuity clinic, whereas only 38 % did as a result of continuity clinic. Comparing residents' likelihood to enter GIM as a result of clinic to likelihood to enter a career in GIM before clinic showed that 59 % of residents had no difference in likelihood, 28 % reported a lower likelihood as a result of clinic, and 11 % reported higher likelihood as a result of clinic. Most residents were very satisfied or satisfied with all clinic elements. Significantly more residents (p ≤ 0.002) were likely vs. unlikely to enter GIM if they were very satisfied with faculty mentorship (76 % vs. 53 %), time for appointments (28 % vs. 11 %), number of patients seen (33 % vs. 15 %), personal reward from work (51 % vs. 23 %), relationship with patients (64 % vs. 42 %), and continuity with patients (57 % vs. 33 %). In the multivariate analysis, being likely to enter GIM before clinic (OR 29.0, 95 % CI 24.0-34.8) and being very satisfied with the continuity of relationships with patients (OR 4.08, 95 % CI 2.50-6.64) were the strongest independent predictors of likelihood to enter GIM as a result of clinic. Resident satisfaction

  15. [Pharmaceutical analysis and clinical efficacy of Kampo medicine, maoto, extract suppository against pediatric febrile symptoms].

    Science.gov (United States)

    Nishimura, Nobuhiro; Doi, Norio; Uemura, Tomochika; Taketani, Takeshi; Hayashi, George; Kasai, Takeshi; Kanai, Rie; Yamaguchi, Seiji; Iwamoto, Kikuo; Naora, Kohji

    2009-06-01

    A traditional Chinese herbal medicine, Kampo medicine, maoto, has been widely used in the treatment of febrile symptoms caused by viral infection. This herbal extract granule for oral use, however, is not well accepted by infants or young children due to its unpleasant taste and odor. Therefore, we prepared Kampo medicine, maoto, suppository and investigated the pharmaceutical and clinical efficacy of the suppository. Kampo medicine, maoto, granules were micro-pulverized and homogeneously dispersed into Hosco-H15 to prepare suppositories containing 0.25 to 1.0 g herbal extract by the conventional fusion method. Content of l-ephedrine, an index compound of Kampo medicine, maoto, in the extract granules and suppositories was determined by using a high performance liquid chromatographic method. Physicochemical experiments revealed that the suppository containing 0.5 g herbal extract had the most suitable melting point of 34 degrees C. Contents of l-ephedrine in the suppository were constant, 93-96% of those in the same amount of the extract granules in different three lots. Upper and lower portions of the suppository had the same content of l-ephedrine. The suppository maintained more than 95% of l-ephedrine content through 6 months at 4 degrees C, room temperature and 40 degrees C, although maldistribution of the extract constituent was observed after storage at 40 degrees C. The suppository was administered to 21 pediatric febrile patients at a dose of 1/3 to 2 full pieces depending on their body weight and physical status. Significant reduction (psuppository was found to satisfy the physicochemical quality and quantity standards as well as to be clinically applicable to neonates, infants and children with viral febrile symptoms without any adverse effects.

  16. Nuclear medicine in the acute clinical setting: indications, imaging findings, and potential pitfalls.

    Science.gov (United States)

    Uliel, Livnat; Mellnick, Vincent M; Menias, Christine O; Holz, Andrew L; McConathy, Jonathan

    2013-01-01

    Nuclear medicine imaging provides valuable functional information that complements information obtained with anatomic imaging techniques in the evaluation of patients with specific acute clinical manifestations. Nuclear medicine studies are most often used in conjunction with other imaging modalities and as a problem-solving tool. Under certain circumstances a nuclear medicine study may be indicated as the first-line imaging modality, as in the case of renal scintigraphy for transplant dysfunction in the early postoperative period. Nuclear imaging may be preferred when a conventional first-line study is contraindicated or when it is important to minimize radiation exposure. The portability of nuclear imaging offers particular advantages for the evaluation of critically ill patients whose clinical condition is unstable and who cannot be safely transported out of the intensive care unit. The ability to visualize physiologic and pathophysiologic processes over relatively long time periods without adding to the patient's radiation exposure contributes to the high diagnostic sensitivity of several types of nuclear medicine studies. Viewing the acquired images in the cine mode adds to the value of these studies for diagnosing and characterizing dynamic abnormalities such as intermittent internal bleeding and bile or urine leakage. In this pictorial review, the spectrum of nuclear medicine studies commonly performed in the acute care setting is reviewed according to body systems and organs, with detailed descriptions of the indications, technical considerations, findings, and potential pitfalls of each type of study. Supplemental material available at http://radiographics.rsna.org/lookup/suppl/doi:10.1148/rg.332125098/-/DC1.

  17. Emotional Intelligence in Internal Medicine Residents: Educational Implications for Clinical Performance and Burnout.

    Science.gov (United States)

    Satterfield, Jason; Swenson, Sara; Rabow, Michael

    2009-01-01

    We measured emotional intelligence (EQ; the ability to perceive, understand, and manage emotions in the self and others) in a sample of 28 internal medicine residents at the beginning and end of an academic year. EQ scores increased significantly over the course of the year. Higher EQ scores at the end of the year were significantly related to higher ratings for overall clinical performance and medical interviewing. Higher EQ scores also correlated with lower levels of burnout. Results suggest that clinically significant changes in EQ can occur over the course of medical training. Further study should determine if and how educational interventions can affect EQ, EQ-related performance, and burnout.

  18. Clinical practice guidelines for the management of hypothyroidism.

    Science.gov (United States)

    Brenta, Gabriela; Vaisman, Mario; Sgarbi, José Augusto; Bergoglio, Liliana Maria; Andrada, Nathalia Carvalho de; Bravo, Pedro Pineda; Orlandi, Ana Maria; Graf, Hans

    2013-06-01

    Hypothyroidism has long been known for its effects on different organ systems, leading to hypometabolism. However, subclinical hypothyroidism, its most prevalent form, has been recently related to cardiovascular risk and also to maternal-fetal complications in pregnant women. In these clinical practice guidelines, several aspects of this field have been discussed with the clear objectives of helping physicians treat patients with hypothyroidism, and of sharing some of our Latin American-based clinical experience. The Latin American Thyroid Society commissioned a Task Force on Hypothyroidism to develop evidence-based clinical guidelines on hypothyroidism. A systematic review of the available literature, focused on the primary databases of MedLine/PubMed and Lilacs/SciELO was performed. Filters to assess methodological quality were applied to select the best quality studies. The strength of recommendation on a scale from A-D was based on the Oxford Centre for Evidence--based Medicine, Levels of Evidence 2009, allowing an unbiased opinion devoid of subjective viewpoints. The areas of interest for the studies comprised diagnosis, screening, treatment and a special section for hypothyroidism in pregnancy. Several questions based on diagnosis, screening, treatment of hypothyroidism in adult population and specifically in pregnant women were posed. Twenty six recommendations were created based on the answers to these questions. Despite the fact that evidence in some areas of hypothyroidism, such as therapy, is lacking, out of 279 references, 73% were Grade A and B, 8% Grade C and 19% Grade D. These evidence-based clinical guidelines on hypothyroidism will provide unified criteria for management of hypothyroidism throughout Latin America. Although most of the studies referred to are from all over the world, the point of view of thyroidologists from Latin America is also given.

  19. Challenges in the clinical development requirements for the marketing authorization of new medicines in southeast Asia.

    Science.gov (United States)

    Kudrin, Alex

    2009-03-01

    A rapid growth of investment into clinical research and new drug development has manifested itself by an exponential increase of new products coming onto the worldwide market. The emerging pharmaceutical and biotech markets in Southeast Asia are believed to be extremely promising from a commercial point of view in the next decade. The unique position of the Asian market and the diversity in clinical research initiatives are linked with diverse regulatory requirements for clinical development and registration of new medicines. Some of these differences have an impact on timelines for marketing authorizations in South Korea, China, Thailand, Japan, Singapore, and other countries. One of the approaches to streamlining regulatory strategy in different countries is the initiation of multicountry international clinical trials trying to address requirements and allowing registration in several regional countries simultaneously. Increasing cooperation between South Asian countries in relation to regulatory requirements and clinical development will facilitate the registration of innovative medicines in this rapidly developing region of the world and enable improved cohesiveness between countries in a drug safety framework.

  20. Emerging Utility of Virtual Reality as a Multidisciplinary Tool in Clinical Medicine.

    Science.gov (United States)

    Pourmand, Ali; Davis, Steven; Lee, Danny; Barber, Scott; Sikka, Neal

    2017-07-31

    Among the more recent products borne of the evolution of digital technology, virtual reality (VR) is gaining a foothold in clinical medicine as an adjunct to traditional therapies. Early studies suggest a growing role for VR applications in pain management, clinical skills training, cognitive assessment and cognitive therapy, and physical rehabilitation. To complete a review of the literature, we searched PubMed and MEDLINE databases with the following search terms: "virtual reality," "procedural medicine," "oncology," "physical therapy," and "burn." We further limited our search to publications in the English language. Boolean operators were used to combine search terms. The included search terms yielded 97 potential articles, of which 45 were identified as meeting study criteria, and are included in this review. These articles provide data, which strongly support the hypothesis that VR simulations can enhance pain management (by reducing patient perception of pain and anxiety), can augment clinical training curricula and physical rehabilitation protocols (through immersive audiovisual environments), and can improve clinical assessment of cognitive function (through improved ecological validity). Through computer-generated, life-like digital landscapes, VR stands to change the current approach to pain management, medical training, neurocognitive diagnosis, and physical rehabilitation. Additional studies are needed to help define best practices in VR utilization, and to explore new therapeutic uses for VR in clinical practice.

  1. Teaching family medicine residents how to answer clinical questions using QUIPs

    Directory of Open Access Journals (Sweden)

    Lisa Bishop

    2013-09-01

    Full Text Available Background: “Questions in Practice” (QUIP rounds are used to encourage residents to quickly find, evaluate, and incorporate information into clinical practice. It is an opportunity for residents to identify a clinical question, research the answer, present the evidence, and discuss how to apply it to practice. The value of using this method to teach residents has not been evaluated. Methods: A sampling of all first and second-year family medicine residents enrolled in the Memorial University Family Medicine program were invited to participate in the survey. The survey gathered information about the residents’ current experiences with answering clinical questions, their experience during QUIP rounds, and the value of an interdisciplinary approach. Results: The response rate was 91% (42/46. Medical websites (45% and journal article indexes (34% were most often used. Through QUIPs, 50% of the students identified new methods to retrieve answers, 80% considered it a useful learning experience, 75% had improved confidence, and clinical knowledge improved in 97%. Conclusions: Residents are familiar with many general sources of medical information, and QUIPs helped improve confidence in their knowledge and ability to answer questions. QUIPs appear to be a useful tool for teaching information resources and how to interpret and apply evidence to clinical situations.

  2. Developing knowledge resources to support precision medicine: principles from the Clinical Pharmacogenetics Implementation Consortium (CPIC).

    Science.gov (United States)

    Hoffman, James M; Dunnenberger, Henry M; Kevin Hicks, J; Caudle, Kelly E; Whirl Carrillo, Michelle; Freimuth, Robert R; Williams, Marc S; Klein, Teri E; Peterson, Josh F

    2016-07-01

    To move beyond a select few genes/drugs, the successful adoption of pharmacogenomics into routine clinical care requires a curated and machine-readable database of pharmacogenomic knowledge suitable for use in an electronic health record (EHR) with clinical decision support (CDS). Recognizing that EHR vendors do not yet provide a standard set of CDS functions for pharmacogenetics, the Clinical Pharmacogenetics Implementation Consortium (CPIC) Informatics Working Group is developing and systematically incorporating a set of EHR-agnostic implementation resources into all CPIC guidelines. These resources illustrate how to integrate pharmacogenomic test results in clinical information systems with CDS to facilitate the use of patient genomic data at the point of care. Based on our collective experience creating existing CPIC resources and implementing pharmacogenomics at our practice sites, we outline principles to define the key features of future knowledge bases and discuss the importance of these knowledge resources for pharmacogenomics and ultimately precision medicine.

  3. Clinical Distribution and Molecular Basis of Traditional Chinese Medicine ZHENG in Cancer

    Directory of Open Access Journals (Sweden)

    Zhen Chen

    2012-01-01

    Full Text Available In traditional Chinese medicine (TCM clinical practice, ZHENG (also known as syndrome helps to guide design of individualized treatment strategies. In this study, we investigated the clinical use of ZHENG in TCM-treated cancer patients by systematically analyzing data from all relevant reports in the Chinese-language scientific literature. We aimed to determine the clinical ZHENG distributions in six common cancers (lung, liver, gastric, breast, colorectal, and pancreatic with the expectation of uncovering a theoretical basis for TCM ZHENG as a clinical cancer treatment. In addition, we also reviewed the molecular basis underlying Xue-Yu (blood stasis, Shi-Re (dampness-heat, Yin-Xu (Yin deficiency, and Pi-Xu (spleen deficiency ZHENG that are commonly found in cancer patients. The results from our summary study provide insights into the potential utility of TCM ZHENG and may contribute to a better understanding of the molecular basis of TCM ZHENG in cancer.

  4. A clinical study of integrating acupuncture and Western medicine in treating patients with Parkinson's disease.

    Science.gov (United States)

    Chen, Fang-Pey; Chang, Ching-Mao; Shiu, Jing-Huei; Chiu, Jen-Hwey; Wu, Ta-Peng; Yang, Jen-Lin; Kung, Yen-Ying; Chen, Fun-Jou; Chern, Chang-Ming; Hwang, Shinn-Jang

    2015-01-01

    Complementary therapy with acupuncture for Parkinson's disease (PD) has been studied for quite a long time, but the effectiveness of the treatment still remains unclear. The aim of this study is to evaluate the integrated effects of acupuncture treatment in PD patients who received western medicine. In the short-term acupuncture treatment study, 20 patients received acupuncture therapy twice a week in acupoints DU 20, GB 20, LI 11, LI 10, LI 4, GB 31, ST 32, GB 34 and GB 38 along with western medicine for 18 weeks, and 20 controlled patients received western medicine only. In the long-term acupuncture treatment, 13 patients received acupuncture treatment twice a week for 36 weeks. The outcome parameters include Unified Parkinson's disease rating scale (UPDRS), Beck Anxiety Inventory (BAI), Beck Depression Inventory-Version 2 (BDI-II), and WHO quality of life (WHOQOL). In the short-term clinical trial, a higher percentage of patients in the acupuncture group had score improvement in UPDRS total scores (55% vs. 15%, p = 0.019), sub-score of mind, behavior and mood (85% vs. 25%, p acupuncture treatment, the mean UPDRS total scores and sub-score of mentation, behavior and mood, sub-score of complications of therapy and BDI-II score decreased significantly when compared to the pretreatment baseline. In conclusion, acupuncture treatment had integrated effects in reducing symptoms and signs of mind, behavior, mood, complications of therapy and depression in PD patients who received Western medicine.

  5. Use of complementary and alternative medicine among patients with chronic diseases at outpatient clinics.

    Science.gov (United States)

    Hasan, Syed Shahzad; Ahmed, Syed Imran; Bukhari, Nadeem Irfan; Loon, William Cheah Wei

    2009-08-01

    The primary objective of this study was to evaluate the use of complementary and alternative medicine among patients with chronic diseases at outpatient clinics. Another aim was to identify demographic and socio-economic factors that are associated with CAM use. Face-to-face interviews of conveniently selected patients with chronic diseases were conducted in outpatient clinics of a general hospital. A validated data collection form was used to gather the information regarding pattern, perception, reasons, and perceived effect of CAM on the disease state. The other relevant information including demographics, diagnosis, indication, and treatment were collected from the patients' medical records. Out of 321 patients interviewed in this study, 205 patients were using some form of CAM, and thus the utilisation rate was 63.9%. A significant number of patients (35.5%) were using CAM for diabetes mellitus. Thirteen types of CAM were identified in the study with the most common being vitamins supplements (48.2%), herbal medicines (26.4%), ginseng (4.7%) and traditional Chinese medicine (4.0%). The patients with higher education level, higher income, and aged more than 50 years were independently associated with CAM use. Majority of the patients (77.6%) reported that their condition had improved by using CAM. The present study confirms the high frequency of CAM use among patients with chronic diseases in a Malaysian public hospital. The popularity of CAM indicated the patients' preference towards holistic approach to health care.

  6. Clinical Experiences of Korean Medicine Treatment against Urinary Bladder Cancer in General Practice

    Directory of Open Access Journals (Sweden)

    Taeyeol Park

    2016-01-01

    Full Text Available Urinary bladder cancer (UBC is one of the most common cancers, with 1 out of every 26 men and 1 out of every 80 women worldwide developing the disease during their lifetime. Moreover, it is a disease that predominantly affects the elderly and is becoming a major health problem as the elderly population continues to rapidly increase. In spite of the rapid development of medical science, the 5-year survival rate has remained around 75% since the 1990s, and the FDA has approved no new drugs for UBC over the last 10 years. In addition, most patients experience frequent recurrence and poor quality of life after diagnosis. Therefore, in order to solve unmet needs by alternative methods, we present our clinical cases of UBC where we observed outstanding results including regression and recurrence prevention exclusively through Traditional Korean Medicine such as (1 herbal therapy, (2 acupuncture, (3 pharmacopuncture and needle-embedding therapy, (4 moxibustion, and (5 cupping therapy. From our experience, it appears that multimodal strategies for synergistic efficiency are more effective than single Korean Medicine treatment. We hope this will encourage investigation of the efficacy of Korean Medicine treatment in clinical trials for UBC patients.

  7. Bryophyllum pinnatum and Related Species Used in Anthroposophic Medicine: Constituents, Pharmacological Activities, and Clinical Efficacy.

    Science.gov (United States)

    Fürer, Karin; Simões-Wüst, Ana Paula; von Mandach, Ursula; Hamburger, Matthias; Potterat, Olivier

    2016-07-01

    Bryophyllum pinnatum (syn. Kalanchoe pinnata) is a succulent perennial plant native to Madagascar that was introduced in anthroposophic medicine in the early 20th century. In recent years, we conducted a large collaborative project to provide reliable data on the chemical composition, pharmacological properties, and clinical efficacy of Bryophyllum. Here, we comprehensively review the phytochemistry, as well as the pharmacological and clinical data. As to the pharmacology, special emphasis is given to properties related to the use in anthroposophic medicine as a treatment for "hyperactivity diseases", such as preterm labor, restlessness, and sleep disorders. Studies suggesting that B. pinnatum may become a new treatment option for overactive bladder syndrome are also reviewed. Tolerability is addressed, and toxicological data are discussed in conjunction with the presence of potentially toxic bufadienolides in Bryophyllum species. The few data available on two related species with medicinal uses, Bryophyllum daigremontianum and Bryophyllum delagoense, have also been included. Taken together, current data support the use of B. pinnatum for the mentioned indications, but further studies are needed to fully understand the modes of action, and to identify the pharmacologically active constituents.

  8. [Acupuncture clinical studies and evidence-based medicine--an update].

    Science.gov (United States)

    Lao, Li-xing

    2008-02-01

    Acupuncture has been widely used in the West in recent years and demand has been growing for scientific evaluation of its clinical efficacy. The practice of evidence-based medicine has brought new challenges in the design of acupuncture research, and publication of randomized clinical trials on acupuncture has significantly increased. While systematic reviews of these trials have advanced our current knowledge, they have exposed deficiencies in research design and revealed that one design can not answer all research questions. Few clinical studies conducted in China have been published in the West, and most published in Chinese suffer from methodological design flaws that render the results unreliable and unconvincing. Such flaws include inadequate or no randomization, inadequate control, unsatisfactory outcome measurements, lack of proper concealment, insufficient follow-up, and improper statistical analysis. To foster high quality acupuncture clinical research in China, we must cultivate innovation and creativity in research design. It is unwise to simply follow or copy the research methodology of Western pharmaceutical studies. Acupuncture and traditional Chinese medicine (TCM) must be evaluated using rigorous scientific methods that preserve the essence of TCM concepts, so that acupuncture and TCM, these ancient healing arts, can continue to play an important role in the health care systems of modern societies.

  9. Clinical Sequencing Exploratory Research Consortium: Accelerating Evidence-Based Practice of Genomic Medicine.

    Science.gov (United States)

    Green, Robert C; Goddard, Katrina A B; Jarvik, Gail P; Amendola, Laura M; Appelbaum, Paul S; Berg, Jonathan S; Bernhardt, Barbara A; Biesecker, Leslie G; Biswas, Sawona; Blout, Carrie L; Bowling, Kevin M; Brothers, Kyle B; Burke, Wylie; Caga-Anan, Charlisse F; Chinnaiyan, Arul M; Chung, Wendy K; Clayton, Ellen W; Cooper, Gregory M; East, Kelly; Evans, James P; Fullerton, Stephanie M; Garraway, Levi A; Garrett, Jeremy R; Gray, Stacy W; Henderson, Gail E; Hindorff, Lucia A; Holm, Ingrid A; Lewis, Michelle Huckaby; Hutter, Carolyn M; Janne, Pasi A; Joffe, Steven; Kaufman, David; Knoppers, Bartha M; Koenig, Barbara A; Krantz, Ian D; Manolio, Teri A; McCullough, Laurence; McEwen, Jean; McGuire, Amy; Muzny, Donna; Myers, Richard M; Nickerson, Deborah A; Ou, Jeffrey; Parsons, Donald W; Petersen, Gloria M; Plon, Sharon E; Rehm, Heidi L; Roberts, J Scott; Robinson, Dan; Salama, Joseph S; Scollon, Sarah; Sharp, Richard R; Shirts, Brian; Spinner, Nancy B; Tabor, Holly K; Tarczy-Hornoch, Peter; Veenstra, David L; Wagle, Nikhil; Weck, Karen; Wilfond, Benjamin S; Wilhelmsen, Kirk; Wolf, Susan M; Wynn, Julia; Yu, Joon-Ho

    2016-06-02

    Despite rapid technical progress and demonstrable effectiveness for some types of diagnosis and therapy, much remains to be learned about clinical genome and exome sequencing (CGES) and its role within the practice of medicine. The Clinical Sequencing Exploratory Research (CSER) consortium includes 18 extramural research projects, one National Human Genome Research Institute (NHGRI) intramural project, and a coordinating center funded by the NHGRI and National Cancer Institute. The consortium is exploring analytic and clinical validity and utility, as well as the ethical, legal, and social implications of sequencing via multidisciplinary approaches; it has thus far recruited 5,577 participants across a spectrum of symptomatic and healthy children and adults by utilizing both germline and cancer sequencing. The CSER consortium is analyzing data and creating publically available procedures and tools related to participant preferences and consent, variant classification, disclosure and management of primary and secondary findings, health outcomes, and integration with electronic health records. Future research directions will refine measures of clinical utility of CGES in both germline and somatic testing, evaluate the use of CGES for screening in healthy individuals, explore the penetrance of pathogenic variants through extensive phenotyping, reduce discordances in public databases of genes and variants, examine social and ethnic disparities in the provision of genomics services, explore regulatory issues, and estimate the value and downstream costs of sequencing. The CSER consortium has established a shared community of research sites by using diverse approaches to pursue the evidence-based development of best practices in genomic medicine.

  10. 50th anniversary of Clinical Chemistry and Laboratory Medicine--a historical overview.

    Science.gov (United States)

    Körber, Friedrich; Plebani, Mario

    2013-01-01

    In the early 1960s, Joachim Brugsch, one of the founders of Clinical Chemistry and Laboratory Medicine (CCLM) (then Zeitschrift für Klinische Chemie), had the idea to found a journal in the upcoming field of clinical chemistry. He approached Ernst Schütte, who was associated with the De Gruyter publishing house through another journal, to participate, and Schütte thus became the second founder of this Journal. The aim was to create a vehicle allowing the experts to express their opinions and raise their voices more clearly than they could in a journal that publishes only original experimental papers, a laborious and difficult, but important endeavor, as the profession of clinical chemistry was still in the early stages of development at this time. The first issue of this Journal was published in early 1963, and today, we are proud to celebrate the 50th anniversary of CCLM. This review describes the development of this Journal in light of the political situation of the time when it was founded, the situation of the publisher Walter De Gruyter after the erection of the Berlin Wall, and the development of clinical chemistry, and later on, laboratory medicine as a well-acknowledged discipline and profession.

  11. Evolution of Clinical Proteomics and its Role in Medicine | Office of Cancer Clinical Proteomics Research

    Science.gov (United States)

    NCI's Office of Cancer Clinical Proteomics Research authored a review of the current state of clinical proteomics in the peer-reviewed Journal of Proteome Research. The review highlights outcomes from the CPTC program and also provides a thorough overview of the different technologies that have pushed the field forward. Additionally, the review provides a vision for moving the field forward through linking advances in genomic and proteomic analysis to develop new, molecularly targeted interventions.

  12. Clinical complexity in medicine: A measurement model of task and patient complexity

    Science.gov (United States)

    Islam, R.; Weir, C.; Fiol, G. Del

    2016-01-01

    Summary Background Complexity in medicine needs to be reduced to simple components in a way that is comprehensible to researchers and clinicians. Few studies in the current literature propose a measurement model that addresses both task and patient complexity in medicine. Objective The objective of this paper is to develop an integrated approach to understand and measure clinical complexity by incorporating both task and patient complexity components focusing on infectious disease domain. The measurement model was adapted and modified to healthcare domain. Methods Three clinical Infectious Disease teams were observed, audio-recorded and transcribed. Each team included an Infectious Diseases expert, one Infectious Diseases fellow, one physician assistant and one pharmacy resident fellow. The transcripts were parsed and the authors independently coded complexity attributes. This baseline measurement model of clinical complexity was modified in an initial set of coding process and further validated in a consensus-based iterative process that included several meetings and email discussions by three clinical experts from diverse backgrounds from the Department of Biomedical Informatics at the University of Utah. Inter-rater reliability was calculated using Cohen’s kappa. Results The proposed clinical complexity model consists of two separate components. The first is a clinical task complexity model with 13 clinical complexity-contributing factors and 7 dimensions. The second is the patient complexity model with 11 complexity-contributing factors and 5 dimensions. Conclusion The measurement model for complexity encompassing both task and patient complexity will be a valuable resource for future researchers and industry to measure and understand complexity in healthcare. PMID:26404626

  13. Microquimerismo fetal-materno nas doenças reumáticas auto-imunes Maternal-fetal microchimerism in autoimmune rheumatic diseases

    Directory of Open Access Journals (Sweden)

    Karin Spat Albino Barcellos

    2004-02-01

    Full Text Available Estudos recentes indicam a existência de um tráfego bidirecional de células durante a gestação humana normal. Células fetais persistem no sangue periférico materno por muitos anos após a gestação. Muitas doenças auto-imunes são mais prevalentes em mulheres, algumas das quais apresentam pico de incidência em fases tardias dos anos férteis femininos. A doença enxerto-versushospedeiro é uma condição conhecida de quimerismo e possui similaridades clínicas com algumas doenças auto-imunes reumáticas, notavelmente com esclerose sistêmica e síndrome de Sjögren e, algumas vezes, com lúpus eritematoso sistêmico. Este artigo explora a hipótese de que o microquimerismo fetal contribua para a patogênese de algumas doenças auto-imunes, baseado em revisões de estudos anteriores que trabalharam com esta hipótese. São apresentadas ressalvas de ordem conceitual e técnica a serem consideradas na interpretação dos dados da literatura.Recent studies indicate that there is bi-directional traffic of cells during normal human pregnancy. Fetal cells have been found to persist in the maternal peripheral blood for many years after pregnancy. Many autoimmune diseases are more prevalent in women, and some of them have peak incidence at late stages of childbearing years. Chronic graft versus host disease (cGVHD is a known condition of chimerism and has clinical similarities to some rheumatic autoimmune diseases, notably systemic sclerosis, Sjögren's syndrome and systemic lupus erythematosus. This article explores the hypothesis that fetal microchimerism contributes to the pathogenesis of some autoimmune diseases, based on reviews of previous studies that have worked with this hypothesis. Technical and conceptual considerations are presented for a critical appraisal of the available literature.

  14. [Clinical trials and licensing of monoclonal antibodies and biological medicines for cancer treatment in Brazil].

    Science.gov (United States)

    Silva, Cecilia Ferreira da; Silva, Miriam Ventura da; Osorio-de-Castro, Claudia Garcia Serpa

    2016-03-01

    Objective To analyze the pathway of clinical trials of monoclonal antibodies and biological medicines for cancer treatment involving Brazilian institutions from 2003 to 2012. Method This retrospective, descriptive study was based on review of two clinical trial registries, ClinicalTrials.gov and the Brazilian registry ReBEC. Phase II or III studies with participation from Brazilian institutions listed in at least one of the registries were included. Following selection of the trials, the pathway of monoclonal antibodies and biological medicines was investigated from the research stage until licensing by the Brazilian Agency for Sanitary Surveillance (Anvisa), Food and Drug Administration (FDA), and European Medicines Agency (EMA). Results Nine trials (eight phase III and one phase II) were selected. All had a randomized, controlled design. Two trials were double-blind and seven were open-label, and all recruited adults (≥ 18 years of age) of both sexes. The mean number of patients recruited per trial was 985.2. Seven trials had been completed and two had been terminated early. All trials were sponsored by non-Brazilian pharmaceutical companies and focused on renal, colorectal, gastric, and lung (non-small cell) cancer, non-Hodgkin lymphoma, and melanoma, and involved the use of cetuximab, figitumumab, ipilimumab, rituximab, bevacizumab and interferon alfa-2a. The FDA was the first agency to license the drugs, followed by EMA, except in the case of interferon alfa-2a, which was not approved by EMA. We were unable to determine the year of drug licensing by Anvisa in Brazil. Conclusions The participation of Brazil in clinical trials of monoclonal antibodies and biological medications for cancer treatment is insufficient. The quality of the available information on trials, history of licensing, and other relevant elements is a major weakness of the sources reviewed.

  15. The EC4 European syllabus for post-graduate training in clinical chemistry and laboratory medicine

    DEFF Research Database (Denmark)

    Wieringa, Gijsbert; Zerah, Simone; Jansen, Rob

    2012-01-01

    Laboratory medicine's practitioners across the European community include medical, scientific and pharmacy trained specialists whose contributions to health and healthcare is in the application of diagnostic tests for screening and early detection of disease, differential diagnosis, monitoring......, management and treatment of patients, and their prognostic assessment. In submitting a revised common syllabus for post-graduate education and training across the 27 member states an expectation is set for harmonised, high quality, safe practice. In this regard an extended 'Core knowledge, skills...... and competencies' division embracing all laboratory medicine disciplines is described. For the first time the syllabus identifies the competencies required to meet clinical leadership demands for defining, directing and assuring the efficiency and effectiveness of laboratory services as well as expectations...

  16. Design, clinical translation and immunological response of biomaterials in regenerative medicine

    Science.gov (United States)

    Sadtler, Kaitlyn; Singh, Anirudha; Wolf, Matthew T.; Wang, Xiaokun; Pardoll, Drew M.; Elisseeff, Jennifer H.

    2016-07-01

    The field of regenerative medicine aims to replace tissues lost as a consequence of disease, trauma or congenital abnormalities. Biomaterials serve as scaffolds for regenerative medicine to deliver cells, provide biological signals and physical support, and mobilize endogenous cells to repair tissues. Sophisticated chemistries are used to synthesize materials that mimic and modulate native tissue microenvironments, to replace form and to elucidate structure-function relationships of cell-material interactions. The therapeutic relevance of these biomaterial properties can only be studied after clinical translation, whereby key parameters for efficacy can be defined and then used for future design. In this Review, we present the development and translation of biomaterials for two tissue engineering targets, cartilage and cornea, both of which lack the ability to self-repair. Finally, looking to the future, we discuss the role of the immune system in regeneration and the potential for biomaterial scaffolds to modulate immune signalling to create a pro-regenerative environment.

  17. Clinical Observation of Acupuncture plus Patent Chinese Medicine for Post-stroke Constipation

    Institute of Scientific and Technical Information of China (English)

    Song Xue-feng; Wu Ying; Zhang Zheng-xu; Zheng De-song

    2014-01-01

    Objective: To observe the clinical efficacy of acupuncture plus patent Chinese medicine in treating post-stroke constipation. Methods: Sixty eligible patients with post-stroke constipation were randomized into a treatment group and a control group, 30 in each group. The treatment group was intervened by acupuncture plusMa Zi Ren pill, while the control group was byMa Zi Ren pill alone. The symptoms of constipation were observed before and after intervention. Results: After 2-week treatment, the constipation condition was improved in both groups, and the improvement in the treatment group was statistically more significant than that in the control group (P Conclusion: Acupuncture at specific acupoints plus patent Chinese medicine can produce a content therapeutic efficacy.

  18. [Histological view of ethics in medicine and handling of residual samples in clinical laboratories].

    Science.gov (United States)

    Yoshida, Hiroshi

    2004-03-01

    One of the important ethical issues in clinical laboratory medicine is whether organs and/or specimens should belong to the examinees. Tracing back to ancient Greece, an episode of the death of Asklepios, killed by Zeus to revive the dead, and the great contribution of Hippocrates to medicine including the vow and ethics of medicine, have been described. In the relationship between doctors and patients, the former had been superior to the latter for more than 2400 years, however, the situation has been changing from that to the same position since 1960th, along with the development of bioethics from medical ethics. For the promotion of bioethics, world medical associations have contributed declarations and continuous discussion. The declarations are based on the avoidance of actions detrimental to the life, health, privacy or dignity of examinees. On the medical use of human organs and specimens in relation to human rights, the mind and the body, discussion has continued, however, a consensus on the details has not been reached. A view on the use of residual samples for methodological study, teaching and research in the clinical laboratory was proposed by the Japanese Society of Laboratory Medicine in 2002. Briefly, it included confidentiality of the laboratory staff, responsibility of the laboratory director, the absence of a necessity to obtain consent for the use of residual samples for methodological study when they are made anonymous or pooled, and the recommendation to obtain a judgement by an ethics committee for research use. The background and discussion for the proposal and the current situation on how to obtain consent from patients in Japan are mentioned.

  19. Prospective registration, bias risk and outcome-reporting bias in randomised clinical trials of traditional Chinese medicine

    DEFF Research Database (Denmark)

    Liu, Jian-Ping; Han, Mei; Li, Xin-Xue;

    2013-01-01

    Clinical trials on Traditional Chinese Medicine (TCM) should be registered in a publicly accessible international trial register and report on all outcomes. We systematically assessed and evaluated TCM trials in registries with their subsequent publications.......Clinical trials on Traditional Chinese Medicine (TCM) should be registered in a publicly accessible international trial register and report on all outcomes. We systematically assessed and evaluated TCM trials in registries with their subsequent publications....

  20. Typical investigational medicinal products follow relatively uniform regulations in 10 European Clinical Research Infrastructures Network (ECRIN) countries

    DEFF Research Database (Denmark)

    Gluud, Christian; Kubiak, Christine; Whitfield, Kate

    2012-01-01

    In order to facilitate multinational clinical research, regulatory requirements need to become international and harmonised. The EU introduced the Directive 2001/20/EC in 2004, regulating investigational medicinal products in Europe.......In order to facilitate multinational clinical research, regulatory requirements need to become international and harmonised. The EU introduced the Directive 2001/20/EC in 2004, regulating investigational medicinal products in Europe....

  1. MD-CTS: An integrated terminology reference of clinical and translational medicine.

    Science.gov (United States)

    Ray, Will; Finamore, Joe; Rastegar-Mojarad, Majid; Kadolph, Chris; Ye, Zhan; Bohne, Jacquie; Xu, Yin; Burish, Dan; Sondelski, Joshua; Easker, Melissa; Finnegan, Brian; Bartkowiak, Barbara; Smith, Catherine Arnott; Tachinardi, Umberto; Mendonca, Eneida A; Weichelt, Bryan; Lin, Simon M

    2016-01-01

    New vocabularies are rapidly evolving in the literature relative to the practice of clinical medicine and translational research. To provide integrated access to new terms, we developed a mobile and desktop online reference-Marshfield Dictionary of Clinical and Translational Science (MD-CTS). It is the first public resource that comprehensively integrates Wiktionary (word definition), BioPortal (ontology), Wiki (image reference), and Medline abstract (word usage) information. MD-CTS is accessible at http://spellchecker.mfldclin.edu/. The website provides a broadened capacity for the wider clinical and translational science community to keep pace with newly emerging scientific vocabulary. An initial evaluation using 63 randomly selected biomedical words suggests that online references generally provided better coverage (73%-95%) than paper-based dictionaries (57-71%).

  2. MD-CTS: An integrated terminology reference of clinical and translational medicine

    Directory of Open Access Journals (Sweden)

    Will Ray

    2016-01-01

    Full Text Available New vocabularies are rapidly evolving in the literature relative to the practice of clinical medicine and translational research. To provide integrated access to new terms, we developed a mobile and desktop online reference—Marshfield Dictionary of Clinical and Translational Science (MD-CTS. It is the first public resource that comprehensively integrates Wiktionary (word definition, BioPortal (ontology, Wiki (image reference, and Medline abstract (word usage information. MD-CTS is accessible at http://spellchecker.mfldclin.edu/. The website provides a broadened capacity for the wider clinical and translational science community to keep pace with newly emerging scientific vocabulary. An initial evaluation using 63 randomly selected biomedical words suggests that online references generally provided better coverage (73%-95% than paper-based dictionaries (57–71%.

  3. On art and science: an epistemic framework for integrating social science and clinical medicine.

    Science.gov (United States)

    Wasserman, Jason Adam

    2014-06-01

    Calls for incorporating social science into patient care typically have accounted for neither the logistic constraints of medical training nor the methodological fallacies of utilizing aggregate "social facts" in clinical practice. By elucidating the different epistemic approaches of artistic and scientific practices, this paper illustrates an integrative artistic pedagogy that allows clinical practitioners to generate social scientific insights from actual patient encounters. Although there is no shortage of calls to bring social science into medicine, the more fundamental processes of thinking by which art and science proceed have not been addressed to this end. As such, the art of medical practice is conceptualized as an innate gift, and thus little is done to cultivate it. Yet doing so is more important than ever because uncertainty in diagnosing and treating chronic illnesses, the most significant contemporary mortality risks, suggests a re-expanding role for clinical judgment.

  4. Can Emergency Medicine Residents Reliably Use the Internet to Answer Clinical Questions?

    Directory of Open Access Journals (Sweden)

    June Abbas

    2011-05-01

    Full Text Available Introduction: The study objective was to determine the accuracy of answers to clinical questions by emergency medicine (EM residents conducting Internet searches by using Google. Emergency physicians commonly turn to outside resources to answer clinical questions that arise in the emergency department (ED. Internet access in the ED has supplanted textbooks for references because it is perceived as being more up to date. Although Google is the most widely used general Internet search engine, it is not medically oriented and merely provides links to other sources. Users must judge the reliability of the information obtained on the links. We frequently observed EM faculty and residents using Google rather than medicine-specific databases to seek answers to clinical questions. Methods: Two EM faculties developed a clinically oriented test for residents to take without the use of any outside aid. They were instructed to answer each question only if they were confident enough of their answer to implement it in a patient-care situation. Questions marked as unsure or answered incorrectly were used to construct a second test for each subject. On the second test, they were instructed to use Google as a resource to find links that contained answers. Results: Thirty-three residents participated. The means for the initial test were 32% correct, 28% incorrect, and 40% unsure. On the Google test, the mean for correct answers was 59%; 33% of answers were incorrect and 8% were unsure. Conclusion: EM residents’ ability to answer clinical questions correctly by using Web sites from Google searches was poor. More concerning was that unsure answers decreased, whereas incorrect answers increased. The Internet appears to have given the residents a false sense of security in their answers. Innovations, such as Internet access in the ED, should be studied carefully before being accepted as reliable tools for teaching clinical decision making. [West J Emerg Med. 2011

  5. 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.

  6. Assessing research impact in academic clinical medicine: a study using Research Excellence Framework pilot impact indicators

    Directory of Open Access Journals (Sweden)

    Ovseiko Pavel V

    2012-12-01

    Full Text Available Abstract Background Funders of medical research the world over are increasingly seeking, in research assessment, to complement traditional output measures of scientific publications with more outcome-based indicators of societal and economic impact. In the United Kingdom, the Higher Education Funding Council for England (HEFCE developed proposals for the Research Excellence Framework (REF to allocate public research funding to higher education institutions, inter alia, on the basis of the social and economic impact of their research. In 2010, it conducted a pilot exercise to test these proposals and refine impact indicators and criteria. Methods The impact indicators proposed in the 2010 REF impact pilot exercise are critically reviewed and appraised using insights from the relevant literature and empirical data collected for the University of Oxford’s REF pilot submission in clinical medicine. The empirical data were gathered from existing administrative sources and an online administrative survey carried out by the university’s Medical Sciences Division among 289 clinical medicine faculty members (48.1% response rate. Results The feasibility and scope of measuring research impact in clinical medicine in a given university are assessed. Twenty impact indicators from seven categories proposed by HEFCE are presented; their strengths and limitations are discussed using insights from the relevant biomedical and research policy literature. Conclusions While the 2010 pilot exercise has confirmed that the majority of the proposed indicators have some validity, there are significant challenges in operationalising and measuring these indicators reliably, as well as in comparing evidence of research impact across different cases in a standardised manner. It is suggested that the public funding agencies, medical research charities, universities, and the wider medical research community work together to develop more robust methodologies for capturing

  7. Clinical trials in nuclear medicine: Present and future; Les essais cliniques en medecine nucleaire: etat et perspectives

    Energy Technology Data Exchange (ETDEWEB)

    Chaumet-Riffaud, P. [Medecine nucleaire, centre hospitalier de Kremlin-Bicetre, Kremlin-Bicetre, (France); Cachin, F. [EA 4231, medecine nucleaire, CRLCC Jean-Perrin, faculte de medecine, Clermont-Ferrand, (France); Couturier, O. [Inserm U646, departement de medecine nucleaire, CHU d Angers, Angers, (France); Desruet, M.D. [Pole d imagerie clinique de biophysique et medecine nucleaire, Paris, (France); Radiopharmacie, unite Inserm 877, hopital Michallon, CHU de Grenoble, BP217, 38043 Grenoble cedex 9, (France); Kraeber-Bodere, F. [Inserm UMR 601, CHU/CLCC Rene-Gauducheau, Nantes, (France); Talbot, J.N. [Medecine nucleaire, hopital Tenon, Paris, (France); Vuillez, J.P. [Radiopharmacie, unite Inserm 877, hopital Michallon, CHU de Grenoble, BP217, 38043 Grenoble cedex 9, (France)

    2009-05-15

    The particular status of radiopharmaceuticals, together with the positioning of nuclear medicine in multidisciplinary approach of oncology, lead to real difficulties for conception, validation and granting of clinical trials which are necessary for demonstrating clinical interest of new compounds, for diagnosis as well as for therapeutic use. This article is a presentation of some recent clinical trials conducted in nuclear medicine in France, showing its dynamism but also pointing out some encountered difficulties. These experiences could lead to reflexion in order to improve the clinical research performances, taking into account a scientific and regulatory context more and more constraining. (authors)

  8. Clinical decision support systems for improving diagnostic accuracy and achieving precision medicine.

    Science.gov (United States)

    Castaneda, Christian; Nalley, Kip; Mannion, Ciaran; Bhattacharyya, Pritish; Blake, Patrick; Pecora, Andrew; Goy, Andre; Suh, K Stephen

    2015-01-01

    As research laboratories and clinics collaborate to achieve precision medicine, both communities are required to understand mandated electronic health/medical record (EHR/EMR) initiatives that will be fully implemented in all clinics in the United States by 2015. Stakeholders will need to evaluate current record keeping practices and optimize and standardize methodologies to capture nearly all information in digital format. Collaborative efforts from academic and industry sectors are crucial to achieving higher efficacy in patient care while minimizing costs. Currently existing digitized data and information are present in multiple formats and are largely unstructured. In the absence of a universally accepted management system, departments and institutions continue to generate silos of information. As a result, invaluable and newly discovered knowledge is difficult to access. To accelerate biomedical research and reduce healthcare costs, clinical and bioinformatics systems must employ common data elements to create structured annotation forms enabling laboratories and clinics to capture sharable data in real time. Conversion of these datasets to knowable information should be a routine institutionalized process. New scientific knowledge and clinical discoveries can be shared via integrated knowledge environments defined by flexible data models and extensive use of standards, ontologies, vocabularies, and thesauri. In the clinical setting, aggregated knowledge must be displayed in user-friendly formats so that physicians, non-technical laboratory personnel, nurses, data/research coordinators, and end-users can enter data, access information, and understand the output. The effort to connect astronomical numbers of data points, including '-omics'-based molecular data, individual genome sequences, experimental data, patient clinical phenotypes, and follow-up data is a monumental task. Roadblocks to this vision of integration and interoperability include ethical, legal

  9. Clinical research advances in traditional Chinese medicine in treatment of icteric hepatitis

    Directory of Open Access Journals (Sweden)

    GUO Qiyu

    2017-05-01

    Full Text Available The pathogenesis of icteric hepatitis is that pathogenic dampness blocks the middle energizer or blood stasis blocks the bile duct, so that the bile is not excreted normally and moves to the skin surface, which makes the skin yellow. Traditional Chinese medicine (TCM has unique advantages in the prevention and treatment of icteric hepatitis. This article systematically introduces the etiology and pathogenesis of icteric hepatitis and the TCM syndrome differentiation therapy for icteric hepatitis, in order to provide a reference for the clinical treatment of icteric hepatitis and the improvement in its prognosis.

  10. [World level of competitiveness of national researches in the field of clinical medicine].

    Science.gov (United States)

    Starodubov, V I; Kuznetsov, S L; Kurakova, N G; Tsvetkova, L A; Aref'ev, P G

    2012-01-01

    There is proposed formalization of concepts ,world research levelb and "leading scientific technological directions" of global science used in program documents which define main trends of reformation of Russian science. Use of bibliographic index as an example of "normalized citation in related area" for analyzing various subject areas for Russian clinic medicine it was shown that there is a different correlation of some areas of some national subject areas to their world levels. It was noted that it's necessary to develop national methodology of Russian science audit considering its national aspect which is a real problem while application world-acclaimed methods.

  11. The Role of Clinical Records in Narrative Medicine: A Discourse of Message.

    Science.gov (United States)

    Murphy, John W; Choi, Jung Min; Cadeiras, Martin

    2016-01-01

    This article is designed to unite theory and practice. The focus of attention is the impact of narrative medicine on clinical records. Specifically important is that records are created through dialogue, whereby patients are able to grow the record through their ability to offer critiques and alternative explanations. Merely allowing patients to peruse their records, through advances in technology, is not sufficient to facilitate this aim. Various theoretical and practical considerations are discussed that may facilitate patient involvement and the creation of more accurate and relevant patient records.

  12. Reflective writing in the competency-based curriculum at the cleveland clinic lerner college of medicine.

    Science.gov (United States)

    Isaacson, J Harry; Salas, Renee; Koch, Carl; McKenzie, Margaret

    2008-01-01

    The Cleveland Clinic Lerner College of Medicine of Case Western Reserve University is a five-year medical school where the major emphasis is to train physician investigators. In this article we describe our experience with reflective writing in our competency-based medical school, which has reflective practice as one of the nine core competencies. We outline how we use reflective writing as a way to help students develop their reflective practice skills. Reflective writing opportunities, excerpts of student pieces, and faculty and student perspectives are included. We have experienced the value of reflective writing in medical school education and believe elements of our program can be adapted to other training environments.

  13. The Practice of Korean Medicine: An Overview of Clinical Trials in Acupuncture

    Directory of Open Access Journals (Sweden)

    Yong-Suk Kim

    2005-01-01

    Full Text Available Acupuncture, one of the Oriental medical therapeutic techniques that can be traced back at least 2500 years, is growing in popularity all over the world. Korea has continued to develop its own unique tradition of medicine throughout its long history, and has formed different types of acupuncture methods. The purpose of this review is to summarize clinical case studies in acupuncture and related therapies, such as acupressure, electric acupuncture, auricular acupuncture and moxibustion in Korea. A survey of Korean journals revealed that a total of 124 studies were published from 1983 to 2001. Results obtained from the survey showed that most clinical studies using acupuncture, electric acupuncture, moxibustion and other traditional therapies could alleviate a relatively broad range of medical problems. However, it should be emphasized that almost all clinical case studies published in various local journals did not follow the ‘good clinical practice’ with respect to regulatory aspects. Since they were not conducted using the randomized double-blinded controls with a large sample size, all the results should be considered as therapeutic indications. This review is an attempt to show the scope of acupuncture in our country and the kind of diseases, after many years of clinical experience, that were deemed valid targets for clinical trials.

  14. [Study of clinical character and medicinal therapy of viral hepatitis in hospital based on real world].

    Science.gov (United States)

    Li, Yun-ru; Wang, Lian-xin; Xie, Yan-ming; Yang, Wei; Wang, Zhuo-yue; Yi, Dan-hui; Wang, Yong-yan

    2014-09-01

    Viral hepatitis was the most common infectious disease in china. But the diagnosis and treatment were varied because the viral hepatitis patients were hospitalized in different kinds of hospital such as infectious disease hospital, general hospital and Chinese medical hospital. It was necessary to know clinical characters and information of viral hepatitis patients in different hospitals. The general information, subtype distribution, prognosis, complication, medication and relations of onset with solar term from 41 180 viral hepatitis patients based on HIS data were analyzed. It was found that the age of patients between 18 to 59 years old was most; most patients were males. The national basic medical insurance was the most type of payment. The outcome of viral hepatitis in the youth and female were better than that in the old and male. Acute hepatitis was easer to restore than chronic hepatitis. Liver cirrhosis and hepatocellular carcinoma were the two most complications. The peak of onset was during summer solstice, slight heat and great heat. The most common Chinese medicine was Diammonium glycyrrhizinate and the most common western medicine was reduced glutathione. The combination of D. glycyrrhizinate with reduced glutathione, polyene phosphatidylcholine and thymosin was the main pattern. But It was not knew if the combination of western and Chinese medicine was the most effective therapy to protect liver function. It was necessary to take deeply research of the relationship between the combination therapy and their effectiveness.

  15. Saudi Internal Medicine Residents׳ Perceptions of the Objective Structured Clinical Examination as a Formative Assessment Tool

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    Salwa Alaidarous

    2016-12-01

    Full Text Available The Saudi Commission for Health Specialties first implemented the Objective Structured Clinical Examinations (OSCE as part of the final year Internal Medicine clerkship exam during the 2007–2008 academic year. This study evaluated Internal Medicine residents׳ overall perceptions of the OSCE as a formative assessment tool. It focused on residents׳ perceptions of the OSCE stations׳ attributes, determined the acceptability of the process, and provided feedback to enhance further development of the assessment tool. The main objective was to assess Internal Medicine resident test-takers׳ perceptions and acceptance of the OSCE, and to identify its strengths and weaknesses through their feedback. Sixty six residents were involved in the studied administered on November 8th 2012 at King Abdulaziz University Hospital in Jeddah, Kingdom of Saudi Arabia. Overall, resident׳s evaluation of the OSCE was favorable and encouraging. To this end, we recommend that formative assessment opportunities using the OSCE for providing feedback to students should be included in the curriculum, and continuing refinement and localized adaptation of OSCEs in use should be pursued by course directors and assessment personnel.

  16. Clinical holistic medicine: classic art of healing or the therapeutic touch.

    Science.gov (United States)

    Ventegodt, Søren; Morad, Mohammed; Merrick, Joav

    2004-03-04

    Touching is often a forgotten part of medicine. The manual medicine or therapeutic touch (TT) is much more powerful than many modern, biomedically oriented physicians think. Pain and discomfort can be alleviated just by touching the sick area and in this way help the patient to be in better contact with the tissue and organs of their body. Lack of presence in the body seems to be connected with many symptoms that can be readily reversed simply by sensitive touch. When touch is combined with therapeutic work on mind and feelings, holistic healing seems to be facilitated and many problems can be solved in a direct and easy way in the clinic without drugs. This paper gives examples of the strength of manual medicine or therapeutic touch in its most simple form, and points to the power of physical contact between physician and his patient in the context of the theory and practice of holistic healing. Intimacy seems highly beneficial for the process of healing and it is very important to distinguish clearly between intimacy and sexuality for the physician and his patent to be able to give and receive touch without fear and without holding back emotionally.

  17. An educational game for teaching clinical practice guidelines to Internal Medicine residents: development, feasibility and acceptability.

    Science.gov (United States)

    Akl, Elie A; Mustafa, Reem; Slomka, Thomas; Alawneh, Alia; Vedavalli, Abhishek; Schünemann, Holger J

    2008-11-18

    Adherence to Clinical Practice Guidelines (CPGs) remains suboptimal among internal medicine trainees. Educational games are of growing interest and have the potential to improve adherence to CPGs. The objectives of this study were to develop an educational game to teach CPGs in Internal Medicine residency programs and to evaluate its feasibility and acceptability. We developed the Guide-O-Game(c) in the format of a TV game show with questions based on recommendations of CPGs. The development of the Guide-O-Game(c) consisted of the creation of a multimedia interactive tool, the development of recommendation-based questions, and the definition of the game's rules. We evaluated its feasibility through pilot testing and its acceptability through a qualitative process. The multimedia interactive tool uses a Macromedia Flash web application and consists of a manager interface and a user interface. The user interface allows the choice of two game styles. We created so far 16 sets of questions relating to 9 CPGs. The pilot testing proved that the game was feasible. The qualitative evaluation showed that residents considered the game to be acceptable. We developed an educational game to teach CPGs to Internal Medicine residents that is both feasible and acceptable. Future work should evaluate its impact on educational outcomes.

  18. Comparative study on the impact of laparoscopy and abdominal laparotomy to maternal-fetal at gestation period%妊娠期腹腔镜与开腹手术对母胎影响的对比研究

    Institute of Scientific and Technical Information of China (English)

    黄晓晖; 范保维; 罗喜平; 金文艳; 曾俐琴; 陈丹

    2014-01-01

    Objective To compare and analyze the impact on maternal-fetal of laparoscopy and abdominal laparotomy and evaluate the safety of laparoscopy during pregnancy.Methods In this prospective controlled study,20 pregnant patients underwent a laparoscopy,and the other 20 pregnant patients underwent an exploratory laparotomy during the same period of time.The parameters including anesthesia time,operative time,blood loss,arterial blood gas analysis in the fifteen minute after surgery,uterine artery blood flow,postoperative pain,postoperative recovery and pregnancy outcomes were collected.Results The anesthesia time and the operative time in laparoscopic group were significantly shorter than those in laparotomy group [(18.91 ± 8.76) min vs (35.28 ± 14.67) min,t=4.28,P < 0.05,(17.85 ± 6.32) min vs (30.27 ± 10.41) min,t=4.56,P < 0.05].The blood loss was significantly different during laparoscopic group and laparotomy group [(15.48 ± 10.24) ml vs (25.48 ± 15.56) ml,t=2.40,P < 0.05].The stubbs catheter time,postoperative ambulation time,postoperative discharge time in the laparoscopic group were (6.58 ± 0.92) h,(6.98 ± 1.69) h and (18.52 ± 3.45) h respectively,while those were (24.63 ± 3.85) h,(25.37 ± 5.34) h,(23.67 ± 7.81) h in the laparotomy group (t=2.70,14.68,20.39; all P < 0.05).The postoperative pain by laparoscopy was significantly lighter than that by laparotomy (P < 0.05).There was no statistical significant difference between arterial blood gas analysis and uterine artery blood flow in two groups (P > 0.05),and we didn't see any difference from abortion rate,premature birth rate,term delivery rate,the rate of birth defects,neonatal Apgar score and full-term birth weight.Conclusion Compared with laparotomy,laparoscopy has relatively less impact on maternal-fetal,and it won't increase the risk of adverse pregnancy outcomes.%目的 对比分析妊娠期腹腔镜与开腹手术对母胎影响的情况,评估妊娠期腹腔镜的安全性.方法

  19. [Maternal-fetal transmission of HIV].

    Science.gov (United States)

    Gillet, J Y; Bongain, A; Monpoux, F; Mariani, R

    1995-02-01

    HIV infection in children is mainly the result of a mother-to-child transmission. The contamination during pregnancy is well known but intrapartum vertical transmission may also occur through ascending infection, blood exchange between mother and child, or direct contact with vaginal or cervical secretions. In addition HIV can be transmitted via breast milk. The reported rates of vertical transmission are highly variable: 14.4% in a European study, 18.3% in a French survey, 20 to 25% in the USA, 35 to 50% in Africa. It is unclear whether such a large variation of the rate of transmission is due to methodological differences or to different distributions of risk factors in the populations. There are some known predictive factors of HIV transmission such as low CD4 cells count, positive p24 antigenaemia and elevated concentrations of virus. The role of other factors is still debated: prematurity, virus (CMV, HTLV-1, HVB, HVC), C section prior labour, rupture of membranes. The prevention of HIV infection in infants is mainly based on contra-indication of pregnancy in infected women, desinfection of the vagina at the beginning of labour, early protection of the newborn by avoiding skin lesions and immediate washing, preventive treatment by zidovudin during pregnancy.

  20. In vitro antimicrobial activity of ten medicinal plants against clinical isolates of oral cancer cases

    Directory of Open Access Journals (Sweden)

    Kaushal Vivek

    2011-05-01

    Full Text Available Abstract Background Suppression of immune system in treated cancer patients may lead to secondary infections that obviate the need of antibiotics. In the present study, an attempt was made to understand the occurrence of secondary infections in immuno-suppressed patients along with herbal control of these infections with the following objectives to: (a isolate the microbial species from the treated oral cancer patients along with the estimation of absolute neutrophile counts of patients (b assess the in vitro antimicrobial activity medicinal plants against the above clinical isolates. Methods Blood and oral swab cultures were taken from 40 oral cancer patients undergoing treatment in the radiotherapy unit of Regional Cancer Institute, Pt. B.D.S. Health University, Rohtak, Haryana. Clinical isolates were identified by following general microbiological, staining and biochemical methods. The absolute neutrophile counts were done by following the standard methods. The medicinal plants selected for antimicrobial activity analysis were Asphodelus tenuifolius Cav., Asparagus racemosus Willd., Balanites aegyptiaca L., Cestrum diurnum L., Cordia dichotoma G. Forst, Eclipta alba L., Murraya koenigii (L. Spreng. , Pedalium murex L., Ricinus communis L. and Trigonella foenum graecum L. The antimicrobial efficacy of medicinal plants was evaluated by modified Kirby-Bauer disc diffusion method. MIC and MFC were investigated by serial two fold microbroth dilution method. Results Prevalent bacterial pathogens isolated were Staphylococcus aureus (23.2%, Escherichia coli (15.62%, Staphylococcus epidermidis (12.5%, Pseudomonas aeruginosa (9.37%, Klebsiella pneumonia (7.81%, Proteus mirabilis (3.6%, Proteus vulgaris (4.2% and the fungal pathogens were Candida albicans (14.6%, Aspergillus fumigatus (9.37%. Out of 40 cases, 35 (87.5% were observed as neutropenic. Eight medicinal plants (A. tenuifolius, A. racemosus, B. aegyptiaca, E. alba, M. koenigii, P. murex R

  1. Clinical preventive services in Guatemala: a cross-sectional survey of internal medicine physicians.

    Directory of Open Access Journals (Sweden)

    Juan E Corral

    Full Text Available BACKGROUND: Guatemala is currently undergoing an epidemiologic transition. Preventive services are key to reducing the burden of non-communicable diseases, and smoking counseling and cessation are among the most cost-effective and wide-reaching strategies. Internal medicine physicians are fundamental to providing such services, and their knowledge is a cornerstone of non-communicable disease control. METHODS: A national cross-sectional survey was conducted in 2011 to evaluate knowledge of clinical preventive services for non-communicable diseases. Interns, residents, and attending physicians of the internal medicine departments of all teaching hospitals in Guatemala completed a self-administered questionnaire. Participants' responses were contrasted with the Guatemalan Ministry of Health (MoH prevention guidelines and the US Preventive Services Task Force (USPSTF recommendations. Analysis compared knowledge of recommendations within and between hospitals. RESULTS: In response to simulated patient scenarios, all services were recommended by more than half of physicians regardless of MoH or USPSTF recommendations. Prioritization was adequate according to the MoH guidelines but not including other potentially effective services (e.g. colorectal cancer and lipid disorder screenings. With the exception of colorectal and prostate cancer screening, less frequently recommended by interns, there was no difference in recommendation rates by level. CONCLUSION: Guatemalan internal medicine physicians' knowledge on preventive services recommendations for non-communicable diseases is limited, and prioritization did not reflect cost-effectiveness. Based on these data we recommend that preventive medicine training be strengthened and development of evidence-based guidelines for low-middle income countries be a priority.

  2. Pregnancy with heart disease of different cardiac function in the choice of the ways of childbirth and the relationship of maternal-fetal prognosis%妊娠合并心脏病不同心功能状态分娩方式的选择及其与母儿预后的关系

    Institute of Scientific and Technical Information of China (English)

    陆丽; 陈洁; 朱启英

    2013-01-01

    目的 探讨妊娠合并心脏病不同心功能状态分娩方式的选择及其与母儿预后的关系.方法 对2002年2月至2011年2月在新疆医科大学第一临床医学院住院分娩的102例妊娠合并心脏病患者临床资料进行回顾性分析.结果 ①实际分娩的102例妊娠合并心脏病患者中,先天性心脏病所占比例最高,其次是心律失常.②孕前心脏手术后妊娠能够明显改善妊娠妇女的心功能状况,使其安全渡过妊娠分娩期.③心功能Ⅲ-Ⅳ级组剖宫产率高于心功能Ⅰ-Ⅱ级组(P<0.05).④心功能Ⅲ-Ⅳ级组早产、足月低体重儿、新生儿窒息、围生儿死亡发生率均高于心功能Ⅰ-Ⅱ级组(P<0.05);心功能Ⅲ-Ⅳ级平均分娩孕周、新生儿平均体重均低于心功能Ⅰ-Ⅱ级(P<0.05).结论 妊娠合并心脏病患者心脏病类型的构成情况与国内外报道基本一致.心脏手术后妊娠明显改善孕产妇围产期心功能,使妊娠结局良好.心功能Ⅲ-Ⅳ级者均应行剖宫产终止妊娠.母亲心功能状态直接影响妊娠结局.%Objective: To investigate pregnancy with heart disease of different cardiac function in the choice of the ways of childbirth and the relationship of maternal -fetal prognosis. Methods; Clinical data of 102cases of pregnant women with heart diseases in the Obstetrics in First Clinical Medical School of Xinjiang Medical University from February 2002 to February 2011 were analyzed retrospectively. Results; (1) In 102 patients, congenital heart disease is the highest proportion, the second is arrhythmia. (2) The cardiac surgery before pregnancy can obviously improve the cardiac function of pregnant women , make its security through the pregnancy during delivery. (3 ) Cardiac function level III - IV group cesarean section rate was higher than the cardiac function level I - II group (P<0. 05). (4) The incidence of premature delivery, low weight of newborns , suffocation and perinatal mortality of

  3. Ethical Considerations for Acupuncture and Chinese Herbal Medicine Clinical Trials: A Cross-Cultural Perspective

    Directory of Open Access Journals (Sweden)

    Christopher Zaslawski

    2010-01-01

    Full Text Available Many ethical concerns revolve around the four basic principles of research: merit and integrity, respect for human beings, weighting of risk–benefit and justice. These principles form the basis for any discussion concerning human research ethics and are applicable to all areas of research including acupuncture and Chinese herbal medicine. World Health Organisation document, Guidelines for Clinical Research on Acupuncture, states that ‘consideration should be given to the different value systems that are involved in human rights such as social, cultural and historical issues’ and that ‘further studies should be conducted in relation to ethical issues involved in clinical research on acupuncture’. In addition to outlining the four basic principles, this paper will also examine the effect of Asian culture on Western human research ethics and how this may impact upon issues such as informed consent and weighting of risk–benefit.

  4. [Professor HE Tianyou's clinical experience of acupuncture and medicine on intractable facial paralysis].

    Science.gov (United States)

    Yan, Fenghua; Yao, Xuhong; Yan, Xingke; Zhang, Yongkui; Jing, Xiaohui; He, Tianyou

    2015-02-01

    Professor HE Tianyou's unique understanding and treatment characteristics for intractahle facial paralysis are introduced. In clinical practice professor HE highly values acupoint selection and manipulation application, and integrates Chinese and western medicine to flexibly choose acupoints and formulate prescriptions according to syndrome differentiation and location differentiation, besides, he creates several specialized manipulation methods including "tug-of war opposite acupuncture method" and "tractive flash cupping". Based on strengthening body and dredging collaterals. more attention is given on stimulation to local paralyzed facial nerves; meanwhile acupuncture and medication are combined to improve clinical efficacy. During the treatment, the important role of psychological counseling on patient's anxiety is emphasized, and comprehensive treatment is given physically and psychologically in order to achieve the purpose of total rehabilitation.

  5. Stereoroentgenographic System With Portable Calibration Cage For Use In Clinical Medicine

    Science.gov (United States)

    Moffitt, Francis; Baumrind, Sheldon; Chafetz, Neil; Curry, Sean

    1983-07-01

    For the past five years, we have been accumulating information on the performance of a stereoroentgenographic system developed for use in clinical medicine and first reported at the NATO Symposium on the Application of Human Biostereometrics. This system represents an adaptation of normal case coplanar stereometry and involves the use of a single emitter which is displaced in a controlled fashion between exposures. The system has been used primarily for the detection of applicance loosening and settling following the placement of total hip protheses and also for the detection of pseudorthosis following lumbo-sacral fusion. One major goal has been the development of a data acquisition and analysis system suitable for general hospital use which can be operated by technicians without specialized photogrammetric training. This report will focus on system design and on the delineation of technical problems encountered during routine clinical use of the system.

  6. Using the script concordance test to assess clinical reasoning skills in undergraduate and postgraduate medicine.

    Science.gov (United States)

    Wan, S H

    2015-10-01

    The script concordance test is a relatively new format of written assessment that is used to assess higher-order clinical reasoning and data interpretation skills in medicine. Candidates are presented with a clinical scenario, followed by the reveal of a new piece of information. The candidates are then asked to assess whether this additional information increases or decreases the probability or likelihood of a particular diagnostic, investigative, or management decision. To score these questions, the candidate's decision in each question is compared with that of a reference panel of expert clinicians. This review focuses on the development of quality script concordance questions, using expert panellists to score the items and set the passing score standard, and the challenges in the practical implementation (including pitfalls to avoid) of the written assessment.

  7. [Exploration into the preparation of placebos used in Chinese medicinal clinical trial].

    Science.gov (United States)

    Tang, Xu-Dong; Bian, Li-Qun; Gao, Rui

    2009-07-01

    Placebo-controlled clinical trials have been more and more emphasized in traditional Chinese medicine (TCM) researches, while the preparation of TCM placebos is still to be improved. For this work, some elements should be taken into consideration comprehensively, including the design of clinical trial, the characteristics of researched disease, the nature of testing drugs, and the way of medication, etc. And the technological process for placebo manufacturing should be selected properly depending upon the basis of the above elements. Un-biased foodstuff is good as excipient for TCM placebos preparation. The placebo should be made in dosage-form similar to that of the testing drug as possible, if there are difficulties for simulating them in appearance and smell completely. However, its potential pharmacological activity meeting to the acceptance of researchers should be ensured.

  8. A history of HbA1c through Clinical Chemistry and Laboratory Medicine.

    Science.gov (United States)

    Gillery, Philippe

    2013-01-01

    HbA(1c) was discovered in the late 1960s and its use as marker of glycemic control has gradually increased over the course of the last four decades. Recognized as the gold standard of diabetic survey, this parameter was successfully implemented in clinical practice in the 1970s and 1980s and internationally standardized in the 1990s and 2000s. The use of standardized and well-controlled methods, with well-defined performance criteria, has recently opened new directions for HbA(1c) use in patient care, e.g., for diabetes diagnosis. Many reports devoted to HbA1c have been published in Clinical Chemistry and Laboratory Medicine (CCLM) journal. This review reminds the major steps of HbA(1c) history, with a special emphasis on the contribution of CCLM in this field.

  9. Typical investigational medicinal products follow relatively uniform regulations in 10 European Clinical Research Infrastructures Network (ECRIN countries

    Directory of Open Access Journals (Sweden)

    Gluud Christian

    2012-03-01

    Full Text Available Abstract Background In order to facilitate multinational clinical research, regulatory requirements need to become international and harmonised. The EU introduced the Directive 2001/20/EC in 2004, regulating investigational medicinal products in Europe. Methods We conducted a survey in order to identify the national regulatory requirements for major categories of clinical research in ten European Clinical Research Infrastructures Network (ECRIN countries-Austria, Denmark, France, Germany, Hungary, Ireland, Italy, Spain, Sweden, and United Kingdom-covering approximately 70% of the EU population. Here we describe the results for regulatory requirements for typical investigational medicinal products, in the ten countries. Results Our results show that the ten countries have fairly harmonised definitions of typical investigational medicinal products. Clinical trials assessing typical investigational medicinal products require authorisation from a national competent authority in each of the countries surveyed. The opinion of the competent authorities is communicated to the trial sponsor within the same timelines, i.e., no more than 60 days, in all ten countries. The authority to which the application has to be sent to in the different countries is not fully harmonised. Conclusion The Directive 2001/20/EC defined the term 'investigational medicinal product' and all regulatory requirements described therein are applicable to investigational medicinal products. Our survey showed, however, that those requirements had been adopted in ten European countries, not for investigational medicinal products overall, but rather a narrower category which we term 'typical' investigational medicinal products. The result is partial EU harmonisation of requirements and a relatively navigable landscape for the sponsor regarding typical investigational medicinal products.

  10. Person-centered approaches in medicine: clinical tasks, psychological paradigms, and postnonclassic perspective

    Directory of Open Access Journals (Sweden)

    Mezzich J.E.

    2013-01-01

    Full Text Available The article aims to demonstrate advances in methodological means suggested by Vygotsky’s cultural-historical concept in association with a theoretical model of a Person-centered diagnosis and practical use of the construct for clinical psychology and medicine. This, to a greater extent, arises from the fact that the cultural-historical concept (due to its humanistic nature and epistemological content is closely related to the person-centered integrative approach. But for all that the concept corresponds to the ideals of postnonclassical model of scientific rationality with a number of ‘key’ features. Above all it manifests its “methodological maturity” to cope with open self-developing systems, which is most essential at the modern stage of scientific knowledge.The work gives consideration to ‘defining pillars’ of Person-centered approach in modern medicine, to humanistic traditions of the Russian clinical school, and high prospects in diagnostics of such mental constructs as “subjective pattern of disease” and “social situation of personal development in disease” - within the context of person-centered integrative diagnosis.This article discusses the need for implementation a cross-cultural study of subjective pattern of disease and its correlation with a particular “social situation of personality development under disease conditions”. It aims at development and substantiation of the model of person-centered integrative approach, enhancement of its diagnostic scope and, consequently, improvement of the model of person-centered care in modern psychiatry and medicine.

  11. Diabetic Osteoporosis: A Review of Its Traditional Chinese Medicinal Use and Clinical and Preclinical Research

    Directory of Open Access Journals (Sweden)

    Rufeng Ma

    2016-01-01

    Full Text Available Aim. The incidence of diabetic osteoporosis (DOP is increasing due to lack of effective management over the past few decades. This review aims to summarize traditional Chinese medicine (TCM suitability in the pathogenesis and clinical and preclinical management of DOP. Methods. Literature sources used were from Medline (Pubmed, CNKI (China Knowledge Resource Integrated Database, and CSTJ (China Science and Technology Journal Database online databases. For the consultation, keywords such as diabetic osteoporosis (DOP, TCM, clinical study, animal experiment, toxicity, and research progress were used in various combinations. Around 100 research papers and reviews were visited. Results. Liver-spleen-kidney insufficiency may result in development of DOP. 18 clinical trials are identified to use TCM compound prescriptions for management of patients with DOP. TCM herbs and their active ingredients are effective in preventing the development of DOP in streptozotocin (STZ and alloxan as well as STZ combined with ovariectomy insulted rats. Among them, most frequently used TCM herbs in clinical trials are Radix Astragali, Radix et Rhizoma Salviae Miltiorrhizae, Radix Rehmanniae Preparata, and Herba Epimedii. Some of TCM herbs also exhibit toxicities in clinical and preclinical research. Conclusions. TCM herbs may act as the novel sources of anti-DOP drugs by improving bone and glucolipid metabolisms. However, the pathogenesis of DOP and the material base of TCM herbs still merit further study.

  12. Diabetic Osteoporosis: A Review of Its Traditional Chinese Medicinal Use and Clinical and Preclinical Research.

    Science.gov (United States)

    Ma, Rufeng; Zhu, Ruyuan; Wang, Lili; Guo, Yubo; Liu, Chenyue; Liu, Haixia; Liu, Fengwei; Li, Hongjun; Li, Yu; Fu, Min; Zhang, Dongwei

    2016-01-01

    Aim. The incidence of diabetic osteoporosis (DOP) is increasing due to lack of effective management over the past few decades. This review aims to summarize traditional Chinese medicine (TCM) suitability in the pathogenesis and clinical and preclinical management of DOP. Methods. Literature sources used were from Medline (Pubmed), CNKI (China Knowledge Resource Integrated Database), and CSTJ (China Science and Technology Journal Database) online databases. For the consultation, keywords such as diabetic osteoporosis (DOP), TCM, clinical study, animal experiment, toxicity, and research progress were used in various combinations. Around 100 research papers and reviews were visited. Results. Liver-spleen-kidney insufficiency may result in development of DOP. 18 clinical trials are identified to use TCM compound prescriptions for management of patients with DOP. TCM herbs and their active ingredients are effective in preventing the development of DOP in streptozotocin (STZ) and alloxan as well as STZ combined with ovariectomy insulted rats. Among them, most frequently used TCM herbs in clinical trials are Radix Astragali, Radix et Rhizoma Salviae Miltiorrhizae, Radix Rehmanniae Preparata, and Herba Epimedii. Some of TCM herbs also exhibit toxicities in clinical and preclinical research. Conclusions. TCM herbs may act as the novel sources of anti-DOP drugs by improving bone and glucolipid metabolisms. However, the pathogenesis of DOP and the material base of TCM herbs still merit further study.

  13. Clinical Trials of Precision Medicine through Molecular Profiling: Focus on Breast Cancer.

    Science.gov (United States)

    Zardavas, Dimitrios; Piccart-Gebhart, Martine

    2015-01-01

    High-throughput technologies of molecular profiling in cancer, such as gene-expression profiling and next-generation sequencing, are expanding our knowledge of the molecular landscapes of several cancer types. This increasing knowledge coupled with the development of several molecularly targeted agents hold the promise for personalized cancer medicine to be fully realized. Moreover, an expanding armamentarium of targeted agents has been approved for the treatment of specific molecular cancer subgroups in different diagnoses. According to this paradigm, treatment selection should be dictated by the specific molecular aberrations found in each patient's tumor. The classical clinical trials paradigm of patients' eligibility being based on clinicopathologic parameters is being abandoned, with current clinical trials enrolling patients on the basis of specific molecular aberrations. New, innovative trial designs have been generated to better tackle the multiple challenges induced by the increasing molecular fragmentation of cancer, namely: (1) longitudinal cohort studies with or without downstream trials, (2) studies assessing the clinical utility of molecular profiling, (3) master or umbrella trials, (4) basket trials, (5) N-of-1 trials, and (6) adaptive design trials. This article provides an overview of the challenges for clinical trials in the era of molecular profiling of cancer. Subsequently, innovative trial designs with respective examples and their potential to expedite efficient clinical development of targeted anticancer agents is discussed.

  14. Comparsion analysis of data mining models applied to clinical research in traditional Chinese medicine.

    Science.gov (United States)

    Zhao, Yufeng; Xie, Qi; He, Liyun; Liu, Baoyan; Li, Kun; Zhang, Xiang; Bai, Wenjing; Luo, Lin; Jing, Xianghong; Huo, Ruili

    2014-10-01

    To help researchers selecting appropriate data mining models to provide better evidence for the clinical practice of Traditional Chinese Medicine (TCM) diagnosis and therapy. Clinical issues based on data mining models were comprehensively summarized from four significant elements of the clinical studies: symptoms, symptom patterns, herbs, and efficacy. Existing problems were further generalized to determine the relevant factors of the performance of data mining models, e.g. data type, samples, parameters, variable labels. Combining these relevant factors, the TCM clinical data features were compared with regards to statistical characters and informatics properties. Data models were compared simultaneously from the view of applied conditions and suitable scopes. The main application problems were the inconsistent data type and the small samples for the used data mining models, which caused the inappropriate results, even the mistake results. These features, i.e. advantages, disadvantages, satisfied data types, tasks of data mining, and the TCM issues, were summarized and compared. By aiming at the special features of different data mining models, the clinical doctors could select the suitable data mining models to resolve the TCM problem.

  15. Drug Dose Adjustment in Dialysis Patients Admitted in Clinics Other Than Internal Medicine.

    Science.gov (United States)

    Solak, Yalcin; Biyik, Zeynep; Gaipov, Abduzhappar; Kayrak, Mehmet; Ciray, Hilal; Cizmecioglu, Ahmet; Tonbul, Halil Zeki; Turk, Suleyman

    2016-01-01

    Many drugs that are administered during hospitalization are metabolized or excreted through kidneys, consequently require dosage adjustment. We aimed to investigate inappropriate prescription of drugs requiring renal dose adjustment (RDA) in various surgical and medical inpatient clinics. We retrospectively determined dialysis patients hospitalized between January 2007 and December 2010. Inpatient clinics, including cardiology, pulmonary medicine, neurology, infectious diseases (medical clinics) and cardiovascular surgery, orthopedics, general surgery, obstetrics and gynecology, and neurosurgery (surgical clinics), were screened via electronic database. Total and RDA medications were determined. RDA drugs correctly adjusted to creatinine clearance were labeled as RDA-A (appropriate), otherwise as RDA-I (inappropriate). Renal doses of RDA medications were based on the "American College of Physicians Drug Prescribing in Renal Failure, fifth Edition." Two hundred seventeen hospitalization records of 172 dialysis patients (92 men and 80 women) were included in the analysis. Mean age of patients was 59.4 ± 14.6 years, and the mean hospitalization duration was 8.5 ± 7.8 days. In total, 247 (84.3%, percentage in drugs requiring dose adjustment) and 175 (46.2%) drugs have been inadequately dosed in surgical and medical clinics, respectively. The percentage of patients to whom at least 1 RDA-I drug was ordered was 92% and 91.4% for surgical and medical clinics, respectively (P > 0.05). Nephrology consultation numbers were 8 (7.1%) in surgical and 32 (30.4%) in medical clinics. The most common RDA-I drugs were aspirin and famotidine. A significant portion of RDA drugs was ordered inappropriately both in surgical and medical clinics. Nephrology consultation rate was very low. Measures to increase physician awareness are required to improve results.

  16. Cold Atmospheric Plasma for Medicine: State of Research and Clinical Application

    Science.gov (United States)

    von Woedtke, Thomas

    2015-09-01

    Basic research in plasma medicine has made excellent progress and resulted in the fundamental insights that biological effects of cold atmospheric plasmas (CAP) are significantly caused by changes of the liquid environment of cells, and are dominated by redox-active species. First CAP sources are CE-certified as medical devices. Main focus of plasma application is on wound healing and treatment of infective skin diseases. Clinical applications in this field confirm the supportive effect of cold plasma treatment in acceleration of healing of chronic wounds above all in cases where conventional treatment fails. Cancer treatment is another actual and emerging field of CAP application. The ability of CAP to kill cancer cells by induction of apoptosis has been proved in vitro. First clinical applications of CAP in palliative care of cancer are realized. In collaboration with Hans-Robert Metelmann, University Medicine Greifswald; Helmut Uhlemann, Klinikum Altenburger Land GmbH Altenburg; Anke Schmidt and Kai Masur, Leibniz Institute for Plasma Science and Technology (INP Greifswald); Renate Schönebeck, Neoplas Tools GmbH Greifswald; and Klaus-Dieter Weltmann, Leibniz Institute for Plasma Science and Technology (INP Greifswald).

  17. Clinical Study on Treatment of Incipient Diabetic Nephropathy by Integrated Traditional Chinese and Western Medicine

    Institute of Scientific and Technical Information of China (English)

    bian; fang

    2001-01-01

    [1]Mogensen CE. Early diabetic renal involvement and nephropathy. In: Alberti KGMM. Krall Lp (eds). The Diabetes Annual(1/3). Amsterdan: Elsevier, 1987∶306-311.[2]WANG XB, SANG Y, KONG XM, et al. Clinical observation on treatment of non-insulin dependent type of diabetes mellitus accompanied with microalbuminuria by Tangshen capsule combining western medicine. CJIM(Chin) 1997;17(10)∶622-623.[3]LU RH. Diagnosis and treatment of diabetes mellitus and its complications by traditional Chinese and western medicine. Beijing: People's Health Publishing House, 1998∶527-531.[4]Febre J, Balant LP, Dayerpa, et al. The kidney in maturity on set diabetes mellitus: a clinical study on 510 patients. Kidney Int 1982;21∶730-738.[5]David M, Neumann L, Lishher M. Plasma lipids and the progression of nephropathy in diabetes mellitus type 2: effect of ACE inhibitors. Kidney Int 1995;47∶907.[6]CAO SF, FANG FZ, AN XY, et al. Significance of microalbuminuria, blood and urine β2-MG and THP in diagnosis of early stage diabetic nephropathy. Chinese J Nephrology 1992;8(3)∶164-165.

  18. [Painting realism and medicine: the two surgical clinics of Thomas Eakins].

    Science.gov (United States)

    Cabello, Felipe

    2015-06-01

    Realism is a painting style that began with Millet and Courbet in politically convulsed France in the middle of the nineteenth century. In the second half of that century, the pragmatic and democratic tradition of the United States fostered the careers of many realist painters, including that of Thomas Eakins. Eakins, trained in France, developed his career completely associated with Philadelphia at a time when this city was in the vanguard of American emerging industry, culture and medicine. Eakins "The clinic of Dr. Gross" and the "The clinic of Dr. Agnew" are icons of these developments and symbolize a perfect union of art and medicine. Both paintings permit the viewer to appreciate the artist's mastery, originality and Americanism while simultaneously tracking the progress of surgery as evidenced by the introduction of asepsis, anesthesia and nursing. Eakins mastery is revealed by its use of some European Old Masters approaches to portray medical professionals undertaking their daily duties in their work environments with critical and unadorned vision. This combination of vision and skills led Eakins to create a highly original yet analytical art. Unfortunately, his representations were far ahead of his time and resulted in under appreciation of his paintings and a censorious reaction to their content. His contemporaries rejection of Eakins work negatively affected his career as a painter, as a teacher and even his private life. This judgment was overturned in subsequent years and by the twentieth century Eakins was recognized as an American master without parallel.

  19. Transferring Aviation Practices into Clinical Medicine for the Promotion of High Reliability.

    Science.gov (United States)

    Powell-Dunford, Nicole; McPherson, Mark K; Pina, Joseph S; Gaydos, Steven J

    2017-05-01

    Aviation is a classic example of a high reliability organization (HRO)-an organization in which catastrophic events are expected to occur without control measures. As health care systems transition toward high reliability, aviation practices are increasingly transferred for clinical implementation. A PubMed search using the terms aviation, crew resource management, and patient safety was undertaken. Manuscripts authored by physician pilots and accident investigation regulations were analyzed. Subject matter experts involved in adoption of aviation practices into the medical field were interviewed. A PubMed search yielded 621 results with 22 relevant for inclusion. Improved clinical outcomes were noted in five research trials in which aviation practices were adopted, particularly with regard to checklist usage and crew resource-management training. Effectiveness of interventions was influenced by intensity of application, leadership involvement, and provision of staff training. The usefulness of incorporating mishap investigation techniques has not been established. Whereas aviation accident investigation is highly standardized, the investigation of medical error is characterized by variation. The adoption of aviation practices into clinical medicine facilitates an evolution toward high reliability. Evidence for the efficacy of the checklist and crew resource-management training is robust. Transference of aviation accident investigation practices is preliminary. A standardized, independent investigation process could facilitate the development of a safety culture commensurate with that achieved in the aviation industry.Powell-Dunford N, McPherson MK, Pina JS, Gaydos SJ. Transferring aviation practices into clinical medicine for the promotion of high reliability. Aerosp Med Hum Perform. 2017; 88(5):487-491.

  20. Evidence-based medicine in pre-clinical years: a study of early introduction and usefulness

    Science.gov (United States)

    ACHARYA, YOGESH; RAGHAVENDRA RAO, M.V.; ARJA, SATEESH

    2017-01-01

    Introduction: Evidence Based Medicine (EBM) has established itself as a strong predictor of future medical practice by medical students. The purpose of this study was to determine the effectiveness of EBM in pre-clinical years and reflect on self-assessment skill of 4th semester medical students regarding the understanding of EBM and its various determinants. Methods: All of the 4th semester (MD4) medical students at the Avalon University of Medical School, Curacao who had completed their EBM curriculum were asked to voluntarily participate in a cross sectional student survey containing qualitative and quantitative questionnaires in a 10-point scale. The students’ responses were analyzed statistically and the results reported. Results: Twenty-three students participated in the survey. 91% of them reported that EBM had helped them to better understand research process and 95% believed that EBM was necessary to develop clinical skills in the future. 78% of the students agreed that they were provided with enough resources for effective implementation of EBM in the university. All participants (100%) self reported that they could appraise the research articles effectively (mean score 8.26, S.D-1.45). Conclusions: EBM is an integrative and comprehensive way to successfully adopt concepts of acquired medical knowledge for effective medical practice. Early introduction of EBM in preclinical years proved favorable in students and better equipped them with the ability to critically apprehend and appraise new research and innovations in medicine for optimal learning experience. There is a definitive need for scientific and systematic design of the curriculum for early introduction of EBM in pre-clinical years, best suited for the students. The principles should be directed towards further research for the effective implementation of EBM to enhance clinical skills. PMID:28761882

  1. New medicinal products for chronic heart failure: advances in clinical trial design and efficacy assessment.

    Science.gov (United States)

    Cowie, Martin R; Filippatos, Gerasimos S; Alonso Garcia, Maria de Los Angeles; Anker, Stefan D; Baczynska, Anna; Bloomfield, Daniel M; Borentain, Maria; Bruins Slot, Karsten; Cronin, Maureen; Doevendans, Pieter A; El-Gazayerly, Amany; Gimpelewicz, Claudio; Honarpour, Narimon; Janmohamed, Salim; Janssen, Heidi; Kim, Albert M; Lautsch, Dominik; Laws, Ian; Lefkowitz, Martin; Lopez-Sendon, Jose; Lyon, Alexander R; Malik, Fady I; McMurray, John J V; Metra, Marco; Figueroa Perez, Santiago; Pfeffer, Marc A; Pocock, Stuart J; Ponikowski, Piotr; Prasad, Krishna; Richard-Lordereau, Isabelle; Roessig, Lothar; Rosano, Giuseppe M C; Sherman, Warren; Stough, Wendy Gattis; Swedberg, Karl; Tyl, Benoit; Zannad, Faiez; Boulton, Caroline; De Graeff, Pieter

    2017-06-01

    Despite the availability of a number of different classes of therapeutic agents with proven efficacy in heart failure, the clinical course of heart failure patients is characterized by a reduction in life expectancy, a progressive decline in health-related quality of life and functional status, as well as a high risk of hospitalization. New approaches are needed to address the unmet medical needs of this patient population. The European Medicines Agency (EMA) is undertaking a revision of its Guideline on Clinical Investigation of Medicinal Products for the Treatment of Chronic Heart Failure. The draft version of the Guideline was released for public consultation in January 2016. The Cardiovascular Round Table of the European Society of Cardiology (ESC), in partnership with the Heart Failure Association of the ESC, convened a dedicated two-day workshop to discuss three main topic areas of major interest in the field and addressed in this draft EMA guideline: (i) assessment of efficacy (i.e. endpoint selection and statistical analysis); (ii) clinical trial design (i.e. issues pertaining to patient population, optimal medical therapy, run-in period); and (iii) research approaches for testing novel therapeutic principles (i.e. cell therapy). This paper summarizes the key outputs from the workshop, reviews areas of expert consensus, and identifies gaps that require further research or discussion. Collaboration between regulators, industry, clinical trialists, cardiologists, health technology assessment bodies, payers, and patient organizations is critical to address the ongoing challenge of heart failure and to ensure the development and market access of new therapeutics in a scientifically robust, practical and safe way. © 2017 The Authors. European Journal of Heart Failure © 2017 European Society of Cardiology.

  2. The Theory of Clinical Medicine of Huangdi's Classic of Internal Medicine%《黄帝内经》的临床医学理论

    Institute of Scientific and Technical Information of China (English)

    周安方

    2011-01-01

    The rich theory of clinical medicine of Huangdi 's Classic of Internal Medicine includes the clinical guiding ideology, theory of pathogenic factor and pathogenesis, theory of clinical diagnosis and examination, theory of clinical differentiation of syndrome, theory of clinical treatment. And the clinical guiding ideology includes the ideology of people o-riented, prevention foremost and harmony premium. And the theory of clinical treatment includes theory of root treatment, theory of yin - yang balance, theory of harmony of Qi and blood, theory of harmony of healthy Qi and pathogenic factor, theory of naturopathy, theory of five elements restraint, theory of opposition treatment, theory of correspondence between flavors and viscera. The theories and methods of Huangdis Classic of Internal Medicine have significant guiding effects on TCM clinic.%的临床医学理论非常丰富,它包括临床指导思想、病因病机理论、临床诊察理论、临床辩证理论、临床论治理论等,其临床指导思想包括以人为本思想、以防为主思想、以和为贵思想;其临床论治理论包括治病求本理论、阴阳求衡理论、气血求和理论、正邪求谐理论、时势求顺理论、五行制胜理论、以此治彼理论、各有所宜理论等.的这些理论及其方法,对中医临床具有重要的指导作用.

  3. Management of the woman with threatened birth of an infant of extremely low gestational age. Fetus and Newborn Committee, Canadian Paediatric Society, Maternal-Fetal Medicine Committee, Society of Obstetricians and Gynaecologists of Canada.

    OpenAIRE

    1994-01-01

    OBJECTIVE: To offer guidelines for parents, physicians and other members of the health-care team for management of the probable birth of an infant with a gestational age of 26 completed weeks or less. OPTIONS: Vaginal birth or birth by cesarean section for fetal indications and active treatment or palliative care of the infant at birth. OUTCOMES: Increased risk of complications for the mother from cesarean section at this stage of pregnancy and the difficulty in making a prognosis before or a...

  4. Acute inpatient palliative medicine in a cancer center: clinical problems and medical interventions--a prospective study.

    Science.gov (United States)

    Lagman, Ruth; Rivera, Nilo; Walsh, Declan; LeGrand, Susan; Davis, Mellar P

    2007-01-01

    The clinical characteristics and medical interventions of the 100 consecutive cancer admissions to the acute care inpatient palliative medicine unit at the Cleveland Clinic for 2 months are described. Median age was 62 years (range, 31 to 92 years). The male-female ratio was 1:1. Most admissions were referred by hematology-oncology and had prior antineoplastic therapy. Reasons for admission were symptom control and cancer-related complications. Patients underwent invasive diagnostic and therapeutic procedures, hydration, transfusions, radiation, or chemotherapy, or a combination, during their admission. Most were discharged home with hospice care or had outpatient clinic follow-up. The mortality rate was 20%. Aggressive multidisciplinary management of symptoms, disease complications, comorbid conditions, and psychosocial problems were provided. Palliative medicine physicians provided continuity of care in the outpatient clinic and at home. An acute inpatient palliative medicine unit within a tertiary level medical center has a definable and important role in comprehensive cancer care.

  5. Curricula for teaching the content of clinical practice guidelines to family medicine and internal medicine residents in the US: a survey study

    Directory of Open Access Journals (Sweden)

    Moheet Amir

    2009-09-01

    Full Text Available Abstract Background Teaching the content of clinical practice guidelines (CPGs is important to both clinical care and graduate medical education. The objective of this study was to determine the characteristics of curricula for teaching the content of CPGs in family medicine and internal medicine residency programs in the United States. Methods We surveyed the directors of family medicine and internal medicine residency programs in the United States. The questionnaire included questions about the characteristics of the teaching of CPGs: goals and objectives, educational activities, evaluation, aspects of CPGs that the program teaches, the methods of making texts of CPGs available to residents, and the major barriers to teaching CPGs. Results Of 434 programs responding (out of 839, 52%, 14% percent reported having written goals and objectives related to teaching CPGs. The most frequently taught aspect was the content of specific CPGs (76%. The top two educational strategies used were didactic sessions (76% and journal clubs (64%. Auditing for adherence by residents was the primary evaluation strategy (44%, although 36% of program directors conducted no evaluation. Programs made texts of CPGs available to residents most commonly in the form of paper copies (54% while the most important barrier was time constraints on faculty (56%. Conclusion Residency programs teach different aspects of CPGs to varying degrees, and the majority uses educational strategies not supported by research evidence.

  6. Latest status of the clinical and industrial applications of cell sheet engineering and regenerative medicine.

    Science.gov (United States)

    Egami, Mime; Haraguchi, Yuji; Shimizu, Tatsuya; Yamato, Masayuki; Okano, Teruo

    2014-01-01

    Cell sheet engineering, which allows tissue engineering to be realized without the use of biodegradable scaffolds as an original approach, using a temperature-responsive intelligent surface, has been applied in regenerative medicine for various tissues, and a number of clinical studies have been already performed for life-threatening diseases. By using the results and findings obtained from the initial clinical studies, additional investigative clinical studies in several tissues with cell sheet engineering are currently in preparation stage. For treating many patients effectively by cell sheet engineering, an automated system integrating cell culture, cell-sheet fabrication, and layering is essential, and the system should include an advanced three-dimensional suspension cell culture system and an in vitro bioreactor system to scale up the production of cultured cells and fabricate thicker vascularized tissues. In this paper, cell sheet engineering, its clinical application, and further the authors' challenge to develop innovative cell culture systems under newly legislated regulatory platform in Japan are summarized and discussed.

  7. A prospective study of the clinical content of palliative medicine interdisciplinary team meetings.

    Science.gov (United States)

    Powazki, Ruth D; Walsh, Declan; Shrotriya, Shiva

    2015-12-01

    Structured interprofessional communication should improve the structure and clarity of the plan of care. The interdisciplinary team meeting (IDTM) is an opportunity for shared information on patients' and family care needs. We report a prospective observations study of palliative medicine IDTM, which recorded the clinical issues discussed. One hundred and forty-five disparate clinical items were identified for 59 patients and were discussed by the IDTM in about 240 minutes. By content analysis and research meeting consensus, they were grouped into 9 agreed interdisciplinary themes. The 9 themes were then subjected to biostatistical analysis and 3 communication clusters identified. Themes consisted of 3 major communication clusters: (1) clinical services, (2) psychosocial, and (3) care plan. Two themes (information exchange and clinical transitions) did not cluster. The IDTM identified patient care need, reported concerns, and supported collaboration in proactive patient care plans. Future research projects with more patients and a large number of meetings can confirm our findings. This should also examine specific contributions by professional discipline.

  8. Evaluation of complementary-alternative medicine (CAM) questionnaire development for Indonesian clinical psychologists: A pilot study.

    Science.gov (United States)

    Liem, Andrian; Newcombe, Peter A; Pohlman, Annie

    2017-08-01

    This study aimed to evaluate questionnaire development to measure the knowledge of Complementary-Alternative Medicine (CAM), attitudes towards CAM, CAM experiences, and CAM educational needs of clinical psychologists in Indonesia. A 26-item questionnaire was developed through an extensive literature search. Data was obtained from provisional psychologists from the Master of Professional Clinical Psychology programs at two established public universities in urban areas of Indonesia. To validate the questionnaire, panel reviews by executive members of the Indonesian Clinical Psychology Association (ICPA), experts in health psychology, and experts in public health and CAM provided their professional judgements. The self-reporting questionnaire consisted of four scales including: knowledge of CAM (6 items), attitudes towards CAM (10 items), CAM experiences (4 items), and CAM educational needs (6 items). All scales, except CAM Experiences, were assessed on a 7-point Likert scale. Sixty provisional psychologists were eligible to complete the questionnaire with a response rate of 73% (N=44). The results showed that the CAM questionnaire was reliable (Cronbach's coefficient alpha range=0.62-0.96; item-total correlation range=0.14-0.92) and demonstrated content validity. Following further psychometric evaluation, the CAM questionnaire may provide the evidence-based information to inform the education and practice of Indonesian clinical psychologists. Copyright © 2017 Elsevier Ltd. All rights reserved.

  9. Athlete presentations and sports injury frequencies by sport branches at a university sports medicine clinic.

    Science.gov (United States)

    Tahirbegolli, Bernard; Dinçer, Şensu; Gözübüyük, Ömer B; Değirmenci, Ufuk; Yildiz, Safinaz; Vehid, Suphi

    2017-02-22

    We aimed to investigate the profile of athletes by determining the branch of sports, type, and area of sustained sports injury, and the frequencies through athletes' presentations to the largest university clinic in one of the most crowded and athletepopulated cities of Turkey, Istanbul. THE study population comprised 1302 athletes who presented to the sports medicine clinic between the dates of July 1st, 2014, and June 30th, 2015. This record-based study examined all athlete presentations using the physical examination cards. Eight hundred sixty-five of the athletes were male. The median age of applicants was 21 years (interquartile range 16-30 years), the median body mass index was 22.23 kg/m2 (range, 20.01-24.67 kg/m2), and the median years of sports activity was 5 years (range, 0-10 years). Presentations to the clinic were significantly higher in April (p=0.003). The most commonly injured body part was the knee and soccer was the leading sport among the patients; anterior cruciate ligament injury was the most common pathology among soccer players. Athletes who presented to our clinic most commonly sustained a lower extremity injury. It was notable that ligament injuries were seen as commonly as muscle injuries.

  10. Heart rate control with adrenergic blockade: Clinical outcomes in cardiovascular medicine

    Directory of Open Access Journals (Sweden)

    David Feldman

    2010-05-01

    Full Text Available David Feldman1, Terry S Elton2, Doron M Menachemi3, Randy K Wexler41Heart Failure/Transplant and VAD Programs, Minneapolis Heart Institute, Minneapolis, Minnesota, USA; 2Division of Pharmacology, College of Pharmacology, The Ohio State University, Columbus, Ohio, USA; 3Heart Failure Services, Edith Wolfson Medical Center, The Heart Institute, Sakler School of Medicine, Tel-Aviv University, Holon, Israel; 4Department of Clinical Family Medicine, The Ohio State University, Columbus, Ohio, USAAbstract: The sympathetic nervous system is involved in regulating various cardiovascular parameters including heart rate (HR and HR variability. Aberrant sympathetic nervous system expression may result in elevated HR or decreased HR variability, and both are independent risk factors for development of cardiovascular disease, including heart failure, myocardial infarction, and hypertension. Epidemiologic studies have established that impaired HR control is linked to increased cardiovascular morbidity and mortality. One successful way of decreasing HR and cardiovascular mortality has been by utilizing β-blockers, because their ability to alter cell signaling at the receptor level has been shown to mitigate the pathogenic effects of sympathetic nervous system hyperactivation. Numerous clinical studies have demonstrated that β-blocker-mediated HR control improvements are associated with decreased mortality in postinfarct and heart failure patients. Although improved HR control benefits have yet to be established in hypertension, both traditional and vasodilating β-blockers exert positive HR control effects in this patient population. However, differences exist between traditional and vasodilating β-blockers; the latter reduce peripheral vascular resistance and exert neutral or positive effects on important metabolic parameters. Clinical evidence suggests that attainment of HR control is an important treatment objective for patients with cardiovascular

  11. Quantitative Analysis of Contributing Factors Affecting Patient Satisfaction in Family Medicine Service Clinics at Brooke Army Medical Center

    Science.gov (United States)

    2008-06-06

    physicians, Doctors of Medicine (M.D.) or Doctors of Osteopathy (D.O.); physician assistants; or clinical nurse practitioners. Physicians, physician...treatment methods including spinal manipulation and the whole body concept and confer the Doctor of Osteopathy (D.O.) degree. After completion of...medical school, both Doctors of Medicine and Doctors of Osteopathy are licensed by their state boards and may become board certified in any medical

  12. Liquid dynamic medicine and N-of-1 clinical trials: a change of perspective in oncology research.

    Science.gov (United States)

    Silvestris, Nicola; Ciliberto, Gennaro; De Paoli, Paolo; Apolone, Giovanni; Lavitrano, Maria Luisa; Pierotti, Marco A; Stanta, Giorgio

    2017-09-13

    The increasing use of genomics to define the pattern of actionable mutations and to test and validate new therapies for individual cancer patients, and the growing application of liquid biopsy to dynamically track tumor evolution and to adapt molecularly targeted therapy according to the emergence of tumor clonal variants is shaping modern medical oncology., In order to better describe this new therapeutic paradigm we propose the term "Liquid dynamic medicine" in the place of "Personalized or Precision medicine". Clinical validation of the "Liquid dynamic medicine" approach is best captured by N-of-1 trials where each patient acts as tester and control of truly personalized therapies.

  13. International Conference on Harmonisation; guidance on E11 clinical investigation of medicinal products in the pediatric population; availability. Notice.

    Science.gov (United States)

    2000-12-15

    The Food and Drug Administration (FDA) is announcing the availability of a guidance entitled "E11 Clinical Investigation of Medicinal Products in the Pediatric Population." The guidance was prepared under the auspices of the International Conference on Harmonisation of Technical Requirements for Registration of Pharmaceuticals for Human Use (ICH). The guidance sets forth critical issues in pediatric drug development and approaches to the safe, efficient, and ethical study of medicinal products in the pediatric population. The guidance is intended to encourage and facilitate the timely development of pediatric medicinal products internationally.

  14. Clinical Observation on Treatment of Anxiety with Combined Acupuncture and Medicine

    Institute of Scientific and Technical Information of China (English)

    ZHOU Zhi-hua; YU Wei-ying; WU Zhou-hong; WU Bo-xiang; DAI Xiao-ying; HAN Chou-ping

    2003-01-01

    Purpose To observe the curative effect of combined acupuncture and medicine on anxiety. Method An acupuncture plus medicine group and a medicine group were established for a comparison of their curative effects on anxiety. Results The total effective rate was 96% in the acupuncture plus medicine group and 64% in the medicine group, and there was a significant difference between the two groups (P<0.001). Conclusion The curative effect of combined acupuncture and medicine on anxiety is better than that of simple medicine.

  15. Application of diet-derived taste active components for clinical nutrition: perspectives from ancient Ayurvedic medical science, space medicine, and modern clinical nutrition.

    Science.gov (United States)

    Kulkarni, Anil D; Sundaresan, Alamelu; Rashid, Muhammad J; Yamamoto, Shigeru; Karkow, Francisco

    2014-01-01

    The principal objective of this paper is to demonstrate the role of taste and flavor in health from the ancient science of Ayurveda to modern medicine; specifically their mechanisms and roles in space medicine and their clinical relevance in modern heath care. It also describes the brief history of the use of the monosodium glutamate or flavor enhancers ("Umami substance") that improve the quality of food intake by stimulating chemosensory perception. In addition, the dietary nucleotides are known to be the components of "Umami substance" and the benefit of their use has been proposed in various types of patients with cancer, radiation therapy, organ transplantation, and for application in space medicine.

  16. 孕足月胎膜早破残余羊水量与母儿预后的关系%Residue amniotic fluid volume after premature rupture of membranes and maternal-fetal outcome

    Institute of Scientific and Technical Information of China (English)

    桑琳; 吴艳

    2013-01-01

    Objective To determine the relationship between the residue amniotic fluid volume after premature rupture of membranes (PROM) and maternal-fetal prognosis. Methods 162 pregnant women with PROM were studied , hospitalized in department of Obstetrics and Gynecology ,the Affiliated Hefei Hospital of Anhui Medical University from Jun . 2011 to Dec. 2011. According to Amniotic fluid index (AFl)by ultrasound,patients were assigned into three groups :(1)Group of normal amniotic fluid;90 pregnant women(80 mm≤ AFI 0. 05 ). The rupture distance delivery time of three groups had no significant difference (P >0. 05). The puerperal morbidity of three groups had no significant difference (P >0. 05). The Neonatal asphyxia of oligohydramnios group was significantly higher than that of normal amniotic fluid group ( P 0. 05 ). There was no significant difference between borderline oligohydramnios group and oligohydramnios group (P >0. 05). Conclusion Oligohydramnios after prom increase neonatal asphyxia and cesarean section rate . The amniotie fluid volume might be an important prognostic indicator to assess the maternal and neonatal outcomes when PROM happened .%目的 探讨足月胎膜早破残余羊水量与母儿预后关系.方法 采用回顾性研究方法选择该院2011年6-12月162例孕足月胎膜早破病例,根据破膜后残余羊水的羊水指数(AFI)将162例孕妇分成三组,其中羊水指数正常组90例(80 mm≤AFI<180 mm),可疑羊水过少组40例(50 mm≤AFI<80 mm),羊水过少组32例(AFI<50 mm).比较其分娩方式及母儿结局.结果 羊水过少组剖宫产率明显高于羊水指数正常组,差异有统计学意义(P<0.05).可疑羊水过少组与羊水指数正常组相比剖宫产率差异无统计学意义(P>0.05),三组破膜距分娩时间相比差异均无统计学意义(P>0.05),三组产后产褥病率发生率差异均无统计学意义(P>0.05),羊水过少组新生儿窒息率明显高于羊水指数正常

  17. 妊娠梅毒母婴阻断治疗效果及护理%Effect of blocking of maternal-fetal transmission of syphilis on pregnancy and nursing

    Institute of Scientific and Technical Information of China (English)

    汪雪玲; 李春梅; 刘雪净; 刘建云

    2012-01-01

    目的 探讨母婴阻断治疗及护理对妊娠梅毒患者的影响.方法 采用回顾性方法对住院分娩的108例妊娠梅毒患者及婴儿资料进行随访分析,比较治疗与非治疗患者妊娠结局及新生儿预后情况.结果 108例妊娠梅毒孕妇分娩孕周平均(38.22±1.795)周,早产5例占4.63%,治疗组足月产率98.51%高于未治疗组的90.24%,但差异无统计学意义(x2=2.29,P>0.05);治疗组孕妇分娩的先天梅毒患儿为4.48%少于未治疗组的29.27%,差异有统计学意义(x2=13.07,P<0.01);孕妇在孕期未行正规治疗或未治疗者,及新生儿诊为先天梅毒者,立即进行驱梅治疗,79.63%血浆反应素环状卡片试验(RPR)在1岁内全部转阴,79.41%梅毒螺旋体颗粒凝集试验(TPPA)在18个月内转阴,其余均为2-3年内转阴.结论 加强妊娠梅毒孕妇的孕期保健和管理工作,做好宣传教育和婴儿的随访监测工作,对预防先天性梅毒及保证婴儿的健康成长有重要意义.%Objective To explore blocking of maternal-fetal transmission of syphilis in pregnancy and nursing care.Methods By retrospectively analyzing 108 cases,collected from January 2005 to October 2007,of blocking matemal-fetal transmission data among pregnant women infected with syphilis.Pregnancy outcome and prognosis status were compared between those under therapy and those were not. Results Average gestational week was( 38.22 ± 1.795 ) weeks,5 patients had premature delivery,accounting for 4.63% ; Fullterm rate in treatment group was 98.51% and 90.24% in untreatment group,and the difference was not statistically significant ( x2 =2.29,P > 0.05 ) ; Infants with congenital syphilis in treatment group was 4.48% and less than 29.27% in the untreatment group,and the difference was significant ( x2 =13.07,P < 0.01 ) ;Those pregnant women,who did not receive standard treatment and the infant was diagnosed as congenital syphilis,were treated with anti

  18. Medical Student Performance on the National Board of Medical Examiners Emergency Medicine Advanced Clinical Examination and the National Emergency Medicine M4 Exams

    OpenAIRE

    Hiller, Katherine; House, Joseph; Lawson, Luan; Poznanski, Stacey; Morrissey, Thomas K.

    2015-01-01

    Introduction: In April 2013, the National Board of Medical Examiners (NBME) released an Advanced Clinical Examination (ACE) in emergency medicine (EM). In addition to this new resource, CDEM (Clerkship Directors in EM) provides two online, high-quality, internally validated examinations. National usage statistics are available for all three examinations, however, it is currently unknown how students entering an EM residency perform as compared to the entire national cohort. This information m...

  19. Aging Q3: an initiative to improve internal medicine residents' geriatrics knowledge, skills, and clinical performance.

    Science.gov (United States)

    Moran, William P; Zapka, Jane; Iverson, Patty J; Zhao, Yumin; Wiley, M Kathleen; Pride, Pamela; Davis, Kimberly S

    2012-05-01

    A growing number of older adults coupled with a limited number of physicians trained in geriatrics presents a major challenge to ensuring quality medical care for this population. Innovations to incorporate geriatrics education into internal medicine residency programs are needed. To meet this need, in 2009, faculty at the Medical University of South Carolina developed Aging Q(3)-Quality Education, Quality Care, and Quality of Life. This multicomponent initiative recognizes the need for improved geriatrics educational tools and faculty development as well as systems changes to improve the knowledge and clinical performance of residents. To achieve these goals, faculty employ multiple intervention strategies, including lectures, rounds, academic detailing, visual cues, and electronic medical record prompts and decision support. The authors present examples from specific projects, based on care areas including vision screening, fall prevention, and caring for patients with dementia, all of which are based on the Assessing Care of Vulnerable Elders quality indicators. The authors describe the principles driving the design, implementation, and evaluation of the Aging Q(3) program. They present data from multiple sources that illustrate the effectiveness of the interventions to meet the knowledge, skill level, and behavior goals. The authors also address major challenges, including the maintenance of the teaching and modeling interventions over time within the context of demanding primary care and inpatient settings. This organized, evidence-based approach to quality improvement in resident education, as well as faculty leadership development, holds promise for successfully incorporating geriatrics education into internal medicine residencies.

  20. National survey of China's oncologists' knowledge, attitudes, and clinical practice patterns on complementary and alternative medicine.

    Science.gov (United States)

    Yang, Geliang; Lee, Richard; Zhang, Huiqing; Gu, Wei; Yang, Peiying; Ling, Changquan

    2017-02-21

    It is common for cancer patients to use complementary and alternative medicine (CAM). This study was designed to explore China's oncologists' knowledge, attitudes and clinical practices regarding CAM use by their patients. An online survey was conducted of China's oncologists. Among 11,270 participants who completed the online survey, 6,007 (53.3%) were identified as oncologists. Most were men (75.2%), with a mean age of 33.4 (standard deviation: 6.5) years. The 6,007 oncologists discussed with 36.5% of their patients about CAM. Most of them (75.6%) did not want to initiate discussions due to lack of knowledge on CAM. Oncologists estimated that 40.0% of their patients used CAM treatments. Oncologists reported that 28.7% of their patients underwent anticancer therapy with the concurrent use of CAM. Four out of five of the responding oncologists self-reported inadequate knowledge and only 22.0% reported receiving professional education on CAM. Nearly half (44.9%) of the oncologists believed CAM treatment was effective for symptoms and treatment of cancer. Physician factors associated with initiating discussions with patients about CAM use included sex, age (≥ 33 years), medical license for traditional Chinese medicine, enough knowledge and professional education experience. China's oncologists infrequently discussed with their patients about CAM due to lack of knowledge. Most of the oncologists did not encourage CAM use.

  1. Clinically-relevant chemotherapy interactions with complementary and alternative medicines in patients with cancer.

    Science.gov (United States)

    Yap, Kevin Yi-Lwern; See, Cheng Shang; Chan, Alexandre

    2010-01-01

    Complementary and alternative medicines (CAMs), in particular herbal medicines, are commonly used by cancer patients in conjunction with chemotherapy treatment for their anticancer properties and supportive care. However, the effects of many of these herbs are not well-documented due to limited studies done on them. Severe herb-drug interactions (HDIs) have been recorded in some cases, and failure to recognize these harmful HDIs can lead to dire consequences in cancer patients. This study discusses clinically-relevant interactions between anticancer drugs (ACDs) and herbs classified into 7 categories: cancer treatment and prevention, immune-system-related, alopecia, nausea and vomiting, peripheral neuropathy and pain, inflammation, and fatigue. Some promising patents which contain these herbs and thus may manifest these interactions are also presented in this article. Pharmacokinetic interactions involved mainly induction or inhibition of the cytochrome P450 isozymes and p-glycoprotein, while pharmacodynamic interactions were related to increased risks of central nervous system-related effects, hepatotoxicity and bleeding, among others. Clinicians should be vigilant when treating cancer patients who take CAMs with concurrent chemotherapy since they face a high risk of HDIs. These HDIs can be minimized or avoided by selecting herb-drug pairs which are less likely to interact. Furthermore, close monitoring of pharmacological effects and plasma drug levels should be carried out to avoid toxicity and ensure adequate chemotherapeutic coverage in patients with cancer.

  2. On first looking into Kutcher's "Contested Medicine": ethical tensions in clinical research.

    Science.gov (United States)

    Hellman, Samuel

    2010-01-01

    Contested Medicine examines the experiments done at the University of Cincinnati by Eugene Saenger and his colleagues during the 1960s, a time of great fear that the Cold War between the United States and the Soviet Union would become a hot war using nuclear weapons. These studies were to provide the Department of Defense information relevant to the consequences of exposure of military personnel to ionizing radiation in such circumstances. Kutcher, a radiation physicist turned historian of science, is especially well prepared to put these studies into the context of the evolving bioethics of the time. He reviews the essential ethical reviews, beginning with the Nuremberg Code and extending to those of the Advisory Committee on Human Radiation Experiments appointed by President Clinton. These evolving ethical standards provide a cautionary note to today's methods of clinical experimentation in search of proper evidence-based medicine. There has been an ascendance of the priority of patient rights over societal good except in increasingly limited special circumstances. Some of what was considered good and necessary science in the 1960s and 1970s is no longer considered proper. Similarly, future ethical norms may well find current trial methodology to be flawed.

  3. Managing chronic pathologies with a stepped mHealth-based approach in clinical psychology and medicine

    Directory of Open Access Journals (Sweden)

    Gianluca eCastelnuovo

    2015-04-01

    Full Text Available Chronic diseases and conditions typically require long-term monitoring and treatment protocols both in traditional settings and in out-patient frameworks. The economic burden of chronic conditions is a key challenge and new and mobile technologies could offer good solutions. mHealth could be considered an evolution of ehealth and could be defined as the practice of medicine and public health supported by mobile communication devices. mHealth approach could overcome limitations linked with the traditional, restricted and highly expensive in-patient treatment of many chronic pathologies. Possible applications include stepped mHealth approach, where patients can be monitored and treated in their everyday contexts. Unfortunately, many barriers for the spread of mHealth are still present. Due the significant impact of psychosocial factors on disease evolution, psychotherapies have to be included into the chronic disease protocols. Existing psychological theories of health behavior change have to be adapted to the new technological contexts and requirements. In conclusion, clinical psychology and medicine have to face the chronic care management challenge in both traditional and mHealth settings.

  4. Radiologists' perspectives about evidence-based medicine and their clinical practice: a semistructured interview study.

    Science.gov (United States)

    Tong, Allison; Mahady, Suzanne E; Craig, Jonathan C; Lau, Gabes; Peduto, Anthony J; Loy, Clement

    2014-12-10

    To describe radiologist's attitudes and perspectives on evidence-based medicine (EBM) and their practice. Face-to-face semistructured interviews, thematic analysis. 24 institutions across six Australian states and New Zealand. Transcripts were imported into HyperRESEARCH software and thematically analysed. 25 radiologists. Six themes were identified: legitimising decisions (validated justification, prioritising patient preferences, reinforcing protocols), optimising outcomes (ensuring patient safety, maximising efficiency), availability of access (requiring immediacy, inadequacy of evidence, time constraints, proximity of peer networks, grasping information dispersion), over-riding pragmatism (perceptibly applicability, preserving the art of medicine, technical demands), limited confidence (conceptual obscurity, reputation-based trust, demands constant practice, suspicion and cynicism), and competing powers (hierarchical conflict, prevailing commercial interests). Radiologists believe EBM can support clinical decision-making for optimal patient outcomes and service efficiency but feel limited in their capacities to assimilate and apply EBM in practice. Improving access to evidence, providing ongoing education and training supplemented with practical tools for appraising evidence; and developing evidence-based guidelines and protocols may enhance feasibility and promote the confidence and skills among radiologists in applying EBM in radiology practice for better patient care. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  5. Radiologists’ perspectives about evidence-based medicine and their clinical practice: a semistructured interview study

    Science.gov (United States)

    Tong, Allison; Mahady, Suzanne E; Craig, Jonathan C; Lau, Gabes; Peduto, Anthony J; Loy, Clement

    2014-01-01

    Objectives To describe radiologist's attitudes and perspectives on evidence-based medicine (EBM) and their practice. Design Face-to-face semistructured interviews, thematic analysis. Setting 24 institutions across six Australian states and New Zealand. Transcripts were imported into HyperRESEARCH software and thematically analysed. Participants 25 radiologists. Results Six themes were identified: legitimising decisions (validated justification, prioritising patient preferences, reinforcing protocols), optimising outcomes (ensuring patient safety, maximising efficiency), availability of access (requiring immediacy, inadequacy of evidence, time constraints, proximity of peer networks, grasping information dispersion), over-riding pragmatism (perceptibly applicability, preserving the art of medicine, technical demands), limited confidence (conceptual obscurity, reputation-based trust, demands constant practice, suspicion and cynicism), and competing powers (hierarchical conflict, prevailing commercial interests). Conclusions Radiologists believe EBM can support clinical decision-making for optimal patient outcomes and service efficiency but feel limited in their capacities to assimilate and apply EBM in practice. Improving access to evidence, providing ongoing education and training supplemented with practical tools for appraising evidence; and developing evidence-based guidelines and protocols may enhance feasibility and promote the confidence and skills among radiologists in applying EBM in radiology practice for better patient care. PMID:25500161

  6. Pain in the Blood? Envisioning Mechanism-Based Diagnoses and Biomarkers in Clinical Pain Medicine

    Directory of Open Access Journals (Sweden)

    Emmanuel Bäckryd

    2015-03-01

    Full Text Available Chronic pain is highly prevalent, and pain medicine lacks objective biomarkers to guide diagnosis and choice of treatment. The current U.S. “opioid epidemic” is a reminder of the paucity of effective and safe treatment options. Traditional pain diagnoses according to the International Classification of Diseases are often unspecific, and analgesics are often prescribed on a trial-and-error basis. In contrast to this current state of affairs, the vision of future mechanism-based diagnoses of chronic pain conditions is presented in this non-technical paper, focusing on the need for biomarkers and the theoretical complexity of the task. Pain is and will remain a subjective experience, and as such is not objectively measurable. Therefore, the concept of “noci-marker” is presented as an alternative to “pain biomarker”, the goal being to find objective, measurable correlates of the pathophysiological processes involved in different chronic pain conditions. This vision entails a call for more translational pain research in order to bridge the gap between clinical pain medicine and preclinical science.

  7. Laboratory hematology in the history of Clinical Chemistry and Laboratory Medicine.

    Science.gov (United States)

    Hoffmann, Johannes J M L

    2013-01-01

    For the occasion of the 50th anniversary of the journal Clinical Chemistry and Laboratory Medicine (CCLM), an historic overview of papers that the journal has published in the field of laboratory hematology (LH) is presented. All past volumes of CCLM were screened for papers on LH and these were categorized. Bibliographic data of these papers were also analyzed. CCLM published in total 387 LH papers. The absolute number of LH papers published annually showed a significant increase over the years since 1985. Also the share of LH papers demonstrated a steady increase (overall mean 5%, but mean 8% over the past 4 years). The most frequent category was coagulation and fibrinolysis (23.5%). Authors from Germany contributed the most LH papers to the journal (22.7%), followed by the Netherlands and Italy (16.3 and 13.2%, respectively). Recent citation data indicated that other publications cited LH review papers much more frequently than other types of papers. The history of the journal reflects the emergence and development of laboratory hematology as a separate discipline of laboratory medicine.

  8. Abstract bodies, concrete risks: clinical devices and the health of ova donors in Argentine reproductive medicine

    Directory of Open Access Journals (Sweden)

    Lucía Ariza

    2016-10-01

    Full Text Available Using a methodological perspective grounded in science and technology studies, this article analyzes two sociotechnical devices used in Argentine reproductive medicine (biostatistical measures and donation registries with the aim of controlling both the so-called “genetic risk” arising from the use of donated ova as well as the health risks to female donors. By examining how the deployment of monitoring criteria disregards the specificity of ova donation, the article suggests that it is not the absence of control measures and clinical criteria that produces an inadequate monitoring of such risks, but rather the concrete ways in which such measures are implemented that results in potential harms to the health of female donors.

  9. Moral Expertise in the Clinic: Lessons Learned from Medicine and Science.

    Science.gov (United States)

    McClimans, Leah; Slowther, Anne

    2016-08-01

    Philosophers and others have questioned whether or not expertise in morality is possible. This debate is not only theoretical, but also affects the perceived legitimacy of clinical ethicists. One argument against moral expertise is that in a pluralistic society with competing moral theories no one can claim expertise regarding what another ought morally to do. There are simply too many reasonable moral values and intuitions that affect theory choice and its application; expertise is epistemically uniform. In this article, we discuss how similar concerns have recently threatened to undermine expertise in medicine and science. In contrast, we argue that the application of values is needed to exercise medical, scientific, and moral expertise. As long as these values are made explicit, worries about a pretense to authority in the context of a liberal democracy are ill-conceived. In conclusion, we argue for an expertise that is epistemically diverse.

  10. Definition of major bleeding in clinical investigations of antihemostatic medicinal products in surgical patients

    DEFF Research Database (Denmark)

    Schulman, S; Angerås, U; Bergqvist, D

    2010-01-01

    The definition of major bleeding varies between studies on surgical patients, particularly regarding the criteria for surgical wound-related bleeding. This diversity contributes to the difficulties in comparing data between trials. The Scientific and Standardization Committee (SSC), through its...... subcommittee on Control of Anticoagulation, of the International Society on Thrombosis and Haemostasis has previously published a recommendation for a harmonized definition of major bleeding in non-surgical studies. That definition has been adopted by the European Medicines Agency and is currently used...... in several non-surgical trials. A preliminary proposal for a parallel definition for surgical studies was presented at the 54(th) Annual Meeting of the SSC in Vienna, July 2008. Based on those discussions and further consultations with European and North American surgeons with experience from clinical trials...

  11. About signs and symptoms: can semiotics expand the view of clinical medicine?

    Science.gov (United States)

    Nessa, J

    1996-12-01

    Semiotics, the theory of sign and meaning, may help physicians complement the project of interpreting signs and symptoms into diagnoses. A sign stands for something. We communicate indirectly through signs, and make sense of our world by interpreting signs into meaning. Thus, through association and inference, we transform flowers into love, Othello into jealousy, and chest pain into heart attack. Medical semiotics is part of general semiotics, which means the study of life of signs within society. With special reference to a case story, elements from general semiotics, together with two theoreticians of equal importance, the Swiss linguist Ferdinand de Saussure and the American logician Charles Sanders Peirce, are presented. Two different modes of understanding clinical medicine are contrasted to illustrate the external link between what we believe or suggest, on the one hand, and the external reality on the other hand.

  12. [History, current state and future perspective of tuberculosis research and clinical medicine].

    Science.gov (United States)

    Ito, Yutaka; Mishima, Michiaki

    2011-08-01

    Since Robert Koch identified Mycobacterium tuberculosis as causative agent of tuberculosis (TB) in 1882, TB research has developed in various fields, such as bacteriology, immunology, genomic study and genetic susceptibility. These research results have led to the knowledge concerning cellular immunity and the development of biochemical and gene diagnostic approach for M. tuberculosis, interferon-gamma release assay for latent TB infection and epidemiologic study using variable numbers of tandem repeats. After Selman A. Waksman isolated streptomycin, various drugs came to be used. Standard of the TB treatments has been revised several times up to now. Discovery of the novel drugs potential for multidrug-resistant TB is challenged. Close relationships among basic research, clinical medicine and health service are crucial to improving global control of TB.

  13. 3-D Reconstruction From 2-D Radiographic Images and Its Application to Clinical Veterinary Medicine

    Science.gov (United States)

    Hamamoto, Kazuhiko; Sato, Motoyoshi

    3D imaging technique is very important and indispensable in diagnosis. The main stream of the technique is one in which 3D image is reconstructed from a set of slice images, such as X-ray CT and MRI. However, these systems require large space and high costs. On the other hand, a low cost and small size 3D imaging system is needed in clinical veterinary medicine, for example, in the case of diagnosis in X-ray car or pasture area. We propose a novel 3D imaging technique using 2-D X-ray radiographic images. This system can be realized by cheaper system than X-ray CT and enables to get 3D image in X-ray car or portable X-ray equipment. In this paper, a 3D visualization technique from 2-D radiographic images is proposed and several reconstructions are shown. These reconstructions are evaluated by veterinarians.

  14. Virtual anthropology: useful radiological tools for age assessment in clinical forensic medicine and thanatology.

    Science.gov (United States)

    Dedouit, Fabrice; Saint-Martin, Pauline; Mokrane, Fatima-Zohra; Savall, Frédéric; Rousseau, Hervé; Crubézy, Eric; Rougé, Daniel; Telmon, Norbert

    2015-09-01

    Virtual anthropology consists of the introduction of modern slice imaging to biological and forensic anthropology. Thanks to this non-invasive scientific revolution, some classifications and staging systems, first based on dry bone analysis, can be applied to cadavers with no need for specific preparation, as well as to living persons. Estimation of bone and dental age is one of the possibilities offered by radiology. Biological age can be estimated in clinical forensic medicine as well as in living persons. Virtual anthropology may also help the forensic pathologist to estimate a deceased person's age at death, which together with sex, geographical origin and stature, is one of the important features determining a biological profile used in reconstructive identification. For this forensic purpose, the radiological tools used are multislice computed tomography and, more recently, X-ray free imaging techniques such as magnetic resonance imaging and ultrasound investigations. We present and discuss the value of these investigations for age estimation in anthropology.

  15. Nonadherence to antihypertensive medications and associated factors in general medicine clinics

    Directory of Open Access Journals (Sweden)

    Al Ghobain M

    2016-08-01

    Full Text Available Mohammed Al Ghobain,1,2 H Alhashemi,1,2 A Aljama,3 S Bin Salih,1,2 Z Assiri,4 A Alsomali,4 Gamal Mohamed5 1Department of Medicine, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, 2King Abdullah International Medical Research Centre, 3Department of Medicine, King Abdulaziz Medical City, 4College of Nursing, 5College of Public Health, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia Objectives: Nonadherence to antihypertensive medications has not been assessed in the Saudi population. The aim of this study was to address and evaluate the magnitude of nonadherence among hypertensive patients and the risk factors associated with it. Methods: A cross-sectional survey was conducted on hypertensive patients who attended the general internal medicine clinics at King Abdulaziz Medical City, Riyadh, Saudi Arabia, using a questionnaire that was modified after reviewing the literature. Hypertensive patients were labeled as nonadherent if they missed their medications for a total of 7 days during the previous month. Results: A total of 302 patients participated in the study, of whom 63% were females with a mean age of 64 years, and 64% were illiterate. The prevalence of nonadherence to medications among hypertensive patients was found to be 12.3%. Poor disease knowledge was reported in 80% of patients, while 66% of the patients had poor monitoring of their disease. Younger age (≤65 years, poor monitoring, and uncontrolled blood pressure (BP ≥140/90 mmHg were the predictor factors associated with nonadherence (odds ratio [OR] =2.04, P=0.025; OR=2.39, P=0.004; and OR=2.86, P=0.003, respectively. Conclusion: Nonadherence to antihypertensive medications is lower than that previously reported in the literature. Younger age, uncontrolled BP, and poor monitoring are the main risk factors associated with nonadherence. Keywords: nonadherence, hypertension, Saudi Arabia, uncontrolled blood

  16. Educational impact of using smartphones for clinical communication on general medicine: more global, less local.

    Science.gov (United States)

    Wu, Robert C; Tzanetos, Katina; Morra, Dante; Quan, Sherman; Lo, Vivian; Wong, Brian M

    2013-07-01

    Medical trainees increasingly use smartphones in their clinical work. Similar to other information technology implementations, smartphone use can result in unintended consequences. This study aimed to examine the impact of smartphone use for clinical communication on medical trainees' educational experiences. Qualitative research methodology using interview data, ethnographic data, and analysis of e-mail messages. We analyzed the interview transcripts, ethnographic data, and e-mails by applying a conceptual framework consisting of 5 educational domains. Smartphone use increased connectedness and resulted in a high level of interruptions. These 2 factors impacted 3 discrete educational domains: supervision, teaching, and professionalism. Smartphone use increased connectedness to supervisors and may improve supervision, making it easier for supervisors to take over but can limit autonomy by reducing learner decision making. Teaching activities may be easier to coordinate, but smartphone use interrupted learners and reduced teaching effectiveness during these sessions. Finally, there may be professionalism issues in relation to how residents use smartphones during encounters with patients and health professionals and in teaching sessions. We summarized the impact of a rapidly emerging information technology-smartphones-on the educational experience of medical trainees. Smartphone use increase connectedness and allow trainees to be more globally available for patient care but creates interruptions that cause trainees to be less present in their local interactions with staff during teaching sessions. Educators should be aware of these findings and need to develop curriculum to address the negative impacts of smartphone use in the clinical training environment. © 2013 Society of Hospital Medicine.

  17. Advance of Cellular Immunotherapy in Clinical and Translational Medicine of Lung Cancer

    Institute of Scientific and Technical Information of China (English)

    YAN Fei; YU Shao-rong; FENG Ji-feng

    2016-01-01

    Lung cancer is one of the most common cancers and ranks the ifrst in the mortality worldwide. The core of immunotherapy, especially cellular immunotherapy, is to activate the T cell-mediated tumor-killing effect in patients with tumors, so as to increase their anti-tumor effect. Surgery and radio- and chemotherapy cannot radically eliminate cancerous cells, but immunotherapy is an important supplementary method in killing tumor stem cells and non-proliferating cells. Cellular immunotherapy contains dendritic cells (DC), cytokine-induced killer (CIK), DC-CIK, natural killer T cells (NKT) and γδ T cells, which provides new techniques for the comprehensive treatment of lung cancer. Using CIK combined with DC, radiochemotherapy, radiofrequency ablation and monomers of Chinese medicine to induce CIK cells that directionally migrate to cancerous nest can increase tumor-killing ability and immunoregulatory ability of CIK cells, reduce adverse and toxic reactions and increase patients’ quality of life, and NKT cell and γδ T cell therapies have also been gradually perfected and promoted in clinical translation. This study mainly introduced the clinical translation of DC vaccines, CIK cells and DC-CIK treatment for lung cancer, hoping to provide new pathways and reference for the clinical treatment of lung cancer.

  18. The portfolio approach to competency-based assessment at the Cleveland Clinic Lerner College of Medicine.

    Science.gov (United States)

    Dannefer, Elaine F; Henson, Lindsey C

    2007-05-01

    Despite the rapid expansion of interest in competency-based assessment, few descriptions of assessment systems specifically designed for a competency-based curriculum have been reported. The purpose of this article is to describe the design of a portfolio approach to a comprehensive, competency-based assessment system that is fully integrated with the curriculum to foster an educational environment focused on learning. The educational design goal of the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University was to create an integrated educational program-curriculum and instructional methods, student assessment processes, and learning environment-to prepare medical students for success in careers as physician investigators. The first class in the five-year program matriculated in 2004. To graduate, a student must demonstrate mastery of nine competencies: research, medical knowledge, communication, professionalism, clinical skills, clinical reasoning, health care systems, personal development, and reflective practice. The portfolio provides a tool for collecting and managing multiple types of assessment evidence from multiple contexts and sources within the curriculum to document competence and promote reflective practice skills. This article describes how the portfolio was developed to provide both formative and summative assessment of student achievement in relation to the program's nine competencies.

  19. Vitamin D, Essential Minerals, and Toxic Elements: Exploring Interactions between Nutrients and Toxicants in Clinical Medicine.

    Science.gov (United States)

    Schwalfenberg, Gerry K; Genuis, Stephen J

    2015-01-01

    In clinical medicine, increasing attention is being directed towards the important areas of nutritional biochemistry and toxicant bioaccumulation as they relate to human health and chronic disease. Optimal nutritional status, including healthy levels of vitamin D and essential minerals, is requisite for proper physiological function; conversely, accrual of toxic elements has the potential to impair normal physiology. It is evident that vitamin D intake can facilitate the absorption and assimilation of essential inorganic elements (such as calcium, magnesium, copper, zinc, iron, and selenium) but also the uptake of toxic elements (such as lead, arsenic, aluminum, cobalt, and strontium). Furthermore, sufficiency of essential minerals appears to resist the uptake of toxic metals. This paper explores the literature to determine a suitable clinical approach with regard to vitamin D and essential mineral intake to achieve optimal biological function and to avoid harm in order to prevent and overcome illness. It appears preferable to secure essential mineral status in conjunction with adequate vitamin D, as intake of vitamin D in the absence of mineral sufficiency may result in facilitation of toxic element absorption with potential adverse clinical outcomes.

  20. The role of 3DCT for the evaluation of chop injuries in clinical forensic medicine.

    Science.gov (United States)

    Wittschieber, Daniel; Beck, Laura; Vieth, Volker; Hahnemann, Maria L

    2016-09-01

    As hatchet blows to the human head frequently cause fatal injuries, the forensic examination of survivors with cranial chop injuries is a rare phenomenon in forensic casework. Besides evaluation of clinical records, photographs, and medico-legal physical examination, the analysis and 3-dimensional reconstruction of pre-treatment computed tomography data (3DCT) must be considered an important and indispensable tool for the assessment of those cases because the characteristics of chopping trauma often appear masked or changed by clinical treatment. In the present article, the role of 3DCT for the evaluation of chop wounds in clinical forensic medicine is demonstrated by an illustrative case report of a young man who was attacked with a hatchet. 3DCT provides additional possibilities for supplementing missing information, such as number and direction of blows as well as weapon identification. Furthermore, 3DCT facilitates demonstration in court and understanding of medical lay people. We conclude that 3DCT is of particular value for the evaluation of survivors of life-threatening head and face injury. An increasing significance of this technique may be expected.

  1. Tacit knowledge as the unifying factor in evidence based medicine and clinical judgement.

    Science.gov (United States)

    Thornton, Tim

    2006-03-17

    The paper outlines the role that tacit knowledge plays in what might seem to be an area of knowledge that can be made fully explicit or codified and which forms a central element of Evidence Based Medicine. Appeal to the role the role of tacit knowledge in science provides a way to unify the tripartite definition of Evidence Based Medicine given by Sackett et al: the integration of best research evidence with clinical expertise and patient values. Each of these three elements, crucially including research evidence, rests on an ineliminable and irreducible notion of uncodified good judgement. The paper focuses on research evidence, drawing first on the work of Kuhn to suggest that tacit knowledge contributes, as a matter of fact, to puzzle solving within what he calls normal science. A stronger argument that it must play a role in research is first motivated by looking to Collins' first hand account of replication in applied physics and then broader considerations of replication in justifying knowledge claims in scientific research. Finally, consideration of an argument from Wittgenstein shows that whatever explicit guidelines can be drawn up to guide judgement the specification of what counts as correctly following them has to remain implicit.Overall, the paper sets out arguments for the claim that even though explicit guidelines and codifications can play a practical role in informing clinical practice, they rest on a body of tacit or implicit skill that is in principle ineliminable. It forms the bedrock of good judgement and unites the integration of research, expertise and values.

  2. Clinical Holistic Medicine: Teaching Orgasm for Females with Chronic Anorgasmia using the Betty Dodson Method

    Directory of Open Access Journals (Sweden)

    Pia Struck

    2008-01-01

    Full Text Available The objective of this study was to test the Betty Dodson method of breaking the female orgasm barrier in chronic anorgasmic women. The aim was sexual and existential healing (salutogenesis through direct confrontation and integration of both the repressed shame, guilt, and other negative feelings associated with body, genitals, and sexuality, and the repressed sexual pleasure and desire. We conducted a retrospective analysis of clinic data from holistic sexological manual therapeutic intervention, an intensive subtype of clinical holistic medicine (CHM. The patients received 3 × 5 h of group therapy, integrating short-term psychodynamic psychotherapy (STPP and complementary medicine (CAM bodywork, manual sexology similar to the “sexological examination”. The therapy used the advanced tools of reparenting, genital acceptance, acceptance through touch, and direct sexual clitoral stimulation. A clitoral vibrator was used. Participants were 500 female patients between 18 and 88 years of age (mean of 35 years with chronic anorgasmia (for 12 years on average who were participating in the “orgasm course for anorgasmic women”; 25% of the patients had never experienced an orgasm. Our results show that 465 patients (93% had an orgasm during therapy, witnessed by the therapist, and 35 patients (7% did not. Postmenopausal women were as able to achieve orgasm as fertile women, as were women who never had an orgasm. No patients had detectable negative side effects or adverse effects. NNT: 1.04 500. Therapeutic value: TV = NNH/NNT > 446. Our conclusions are that holistic sexological manual therapy may be rational, safe, ethical, and efficient.

  3. Clinical holistic medicine: teaching orgasm for females with chronic anorgasmia using the Betty Dodson method.

    Science.gov (United States)

    Struck, Pia; Ventegodt, Søren

    2008-09-21

    The objective of this study was to test the Betty Dodson method of breaking the female orgasm barrier in chronic anorgasmic women. The aim was sexual and existential healing (salutogenesis) through direct confrontation and integration of both the repressed shame, guilt, and other negative feelings associated with body, genitals, and sexuality, and the repressed sexual pleasure and desire. We conducted a retrospective analysis of clinic data from holistic sexological manual therapeutic intervention, an intensive subtype of clinical holistic medicine (CHM). The patients received 3 "e 5 h of group therapy, integrating short-term psychodynamic psychotherapy (STPP) and complementary medicine (CAM bodywork, manual sexology similar to the inverted exclamation mark section signsexological examination inverted exclamation mark ). The therapy used the advanced tools of reparenting, genital acceptance, acceptance through touch, and direct sexual clitoral stimulation. A clitoral vibrator was used. Participants were 500 female patients between 18 and 88 years of age (mean of 35 years) with chronic anorgasmia (for 12 years on average) who were participating in the inverted exclamation mark section signorgasm course for anorgasmic women inverted exclamation mark ; 25% of the patients had never experienced an orgasm. Our results show that 465 patients (93%) had an orgasm during therapy, witnessed by the therapist, and 35 patients (7%) did not. Postmenopausal women were as able to achieve orgasm as fertile women, as were women who never had an orgasm. No patients had detectable negative side effects or adverse effects. NNT: 1.04 500. Therapeutic value: TV = NNH/NNT > 446. Our conclusions are that holistic sexological manual therapy may be rational, safe, ethical, and efficient.

  4. Herbal medicine for depression, anxiety and insomnia: a review of psychopharmacology and clinical evidence.

    Science.gov (United States)

    Sarris, Jerome; Panossian, Alexander; Schweitzer, Isaac; Stough, Con; Scholey, Andrew

    2011-12-01

    Research in the area of herbal psychopharmacology has increased markedly over the past decades. To date however, a comprehensive review of herbal antidepressant, anxiolytic and hypnotic psychopharmacology and applications in depression, anxiety and insomnia has been absent. A search of MEDLINE (PubMed), CINAHL, PsycINFO, and the Cochrane Library databases was conducted (up to February 21st 2011) on commonly used psychotropic herbal medicines. A review of the literature was conducted to ascertain mechanisms of action of these botanicals, in addition to a systematic review of controlled clinical trials for treatment of mood, anxiety and sleep disorders, which are common comorbid psychiatric disorders. Specific emphasis was given to emerging phytomedicines. Analysis of evidence levels was conducted, as were effect sizes (Cohen's d) where data were available. Results provided evidence of a range of neurochemical, endocrinological, and epigenetic effects for 21 individual phytomedicines, which are detailed in this paper. Sixty six controlled studies were located involving eleven phytomedicines. Several of these provide a high level of evidence, such as Hypericum perforatum for major depression, and Piper methysticum for anxiety disorders. Several human clinical trials provide preliminary positive evidence of antidepressant effects (Echium amoenum, Crocus sativus, and Rhodiola rosea) and anxiolytic activity (Matricaria recutita, Ginkgo biloba, Passiflora incanata, E. amoenum, and Scutellaria lateriflora). Caution should however be taken when interpreting the results as many studies have not been replicated. Several herbal medicines with in vitro and in vivo evidence are currently unexplored in human studies, and along with use of emerging genetic technologies "herbomics", are areas of potential future research.

  5. Ethical standards for clinical trials conducted in third countries: the new strategy of the European Medicines Agency.

    Science.gov (United States)

    Altavilla, Annagrazia

    2011-01-01

    Clinical trials increasingly occur on a global scale as industry and government sponsors in wealthy countries move trials to low- and middle-income countries. The globalization of clinical research raises important questions about the economical and ethical aspects of clinical research and the translation of trial results to clinical practice: which ethical standards are applied? Are trials results accurate and valid, and can they be extrapolated to other settings? This article provides an overview of the strategy approved by the European Medicines Agency (EMA) to clarify ethical standards for clinical research conducted outside the European Economic Area (EEA) and included in Marketing Authorization Applications. Reference to the EMA Reflection paper is made.

  6. Human Amniotic Membrane-Derived Products in Sports Medicine: Basic Science, Early Results, and Potential Clinical Applications.

    Science.gov (United States)

    Riboh, Jonathan C; Saltzman, Bryan M; Yanke, Adam B; Cole, Brian J

    2016-09-01

    Amniotic membrane (AM)-derived products have been successfully used in ophthalmology, plastic surgery, and wound care, but little is known about their potential applications in orthopaedic sports medicine. To provide an updated review of the basic science and preclinical and clinical data supporting the use of AM-derived products and to review their current applications in sports medicine. Systematic review. A systematic search of the literature was conducted using the Medline, EMBASE, and Cochrane databases. The search term amniotic membrane was used alone and in conjunction with stem cell, orthopaedic, tissue engineering, scaffold, and sports medicine. The search identified 6870 articles, 80 of which, after screening of the titles and abstracts, were considered relevant to this study. Fifty-five articles described the anatomy, basic science, and nonorthopaedic applications of AM-derived products. Twenty-five articles described preclinical and clinical trials of AM-derived products for orthopaedic sports medicine. Because the level of evidence obtained from this search was not adequate for systematic review or meta-analysis, a current concepts review on the anatomy, physiology, and clinical uses of AM-derived products is presented. Amniotic membranes have many promising applications in sports medicine. They are a source of pluripotent cells, highly organized collagen, antifibrotic and anti-inflammatory cytokines, immunomodulators, and matrix proteins. These properties may make it beneficial when applied as tissue engineering scaffolds, improving tissue organization in healing, and treatment of the arthritic joint. The current body of evidence in sports medicine is heavily biased toward in vitro and animal studies, with little to no human clinical data. Nonetheless, 14 companies or distributors offer commercial AM products. The preparation and formulation of these products alter their biological and mechanical properties, and a thorough understanding of these

  7. [Impact on evaluation of clinical efficacy of traditional Chinese medicine for level in soft targets of processing technology].

    Science.gov (United States)

    Shao, Ming-Yi; Wei, Ming; Yan, Bo-Hua

    2014-04-01

    Traditional Chinese medicine (TCM) is a very practical subject, which has its unique theoretical system and clinical characteristics. In the course of clinical practice, the exact clinical efficacy is the key of existence and development. But the existing evaluation system is difficult to objectively evaluate the clinical efficacy of TCM. Therefore, how to objectively evaluate the clinical efficacy and get definitive evidence is the focus of the evaluation of clinical efficacy of TCM. Relative to modern medicine, TCM is more concerned about the changes of feelings and clinical symptoms of the patient in the course of the evolution of the disease. Soft targets mainly used for the evaluation of the clinical efficacy of symptoms and functional activity of the disease. The level in soft targets of processing technology is often used methods in clinical evaluation. But it has often produced the phenomenon which the results of the evaluation is mutual contradiction, which will ultimately affect the effect of evaluation of clinical efficacy of TCM. In order to better evaluate the clinical efficacy of TCM, in the process of adoption of soft targets, it clearly identify it's role, highlighting the characteristics of interventions on disease, and as much as possibly avoid the level in soft targets of processing technology to real assess clinical efficacy of TCM.

  8. Resourcing the clinical complementary medicine information needs of Australian medical students: Results of a grounded theory study.

    Science.gov (United States)

    Templeman, Kate; Robinson, Anske; McKenna, Lisa

    2016-09-01

    The aim of this study was to identify Australian medical students' complementary medicine information needs. Thirty medical students from 10 medical education faculties across Australian universities were recruited. Data were generated using in-depth semi-structured interviews and constructivist grounded theory method was used to analyze and construct data. Students sought complementary medicine information from a range of inadequate sources, such as pharmacological texts, Internet searches, peer-reviewed medical journals, and drug databases. The students identified that many complementary medicine resources may not be regarded as objective, reliable, differentiated, or comprehensive, leaving much that medical education needs to address. Most students sought succinct, easily accessible, evidence-based information to inform safe and appropriate clinical decisions about complementary medicines. A number of preferred resources were identified that can be recommended and actively promoted to medical students. Therefore, specific, evidence-based complementary medicine databases and secondary resources should be subscribed and recommended to medical schools and students, to assist meeting professional responsibilities regarding complementary medicines. These findings may help inform the development of appropriate medical information resources regarding complementary medicines. © 2016 John Wiley & Sons Australia, Ltd.

  9. Use of complementary medicine by adult patients participating in cancer clinical trials.

    Science.gov (United States)

    Sparber, A; Bauer, L; Curt, G; Eisenberg, D; Levin, T; Parks, S; Steinberg, S M; Wootton, J

    2000-05-01

    To document the prevalence, demographic correlates, patterns of use, and beliefs about complementary and alternative medicine (CAM) therapies of adult patients enrolled in National Cancer Institute (NCI) clinical trials. Prospective, cross-sectional, descriptive survey. W.G. Magnuson Clinical Center of the National Institutes of Health in Bethesda, MD. Convenience sample of 100 English-speaking, adult patients with cancer admitted to intramural clinical trials. A standardized, 99-item questionnaire assessing use of CAM therapies pre- and postcancer diagnosis was administered by face-to-face interview. Use of CAM therapies, beliefs, communication with physician. 63% used at least one CAM therapy, with an average use of two therapies per patient. Men were significantly less likely to use a therapy than women; women were more likely to use numerous therapies. Cancer diagnosis seems to have had no influence overall on the frequency of use of CAM therapies. The major reasons stated for CAM use were for treatment-related medical conditions as well as depression, anxiety, and insomnia. The most frequently reported therapies were spiritual, relaxation, imagery, exercise, lifestyle diet (e.g., macrobiotic, vegetarian), and nutritional supplementation. Patients unanimously believed that these complementary therapies helped to improve their quality of life through more effective coping with stress, decreasing the discomforts of treatment and illness, and giving them a sense of control. Patients with cancer use various complementary therapies to cope with their disease and the rigors of clinical trials. Women and those with higher educational backgrounds were more frequent users. Nurses who provide care to subjects of biomedical research have an opportunity and responsibility regarding their patients' use of CAM therapies. Nurses may use in-house resources to help evaluate subjects' use of a CAM modality or to provide quality-of-life therapies such as relaxation, imagery, or

  10. [Principles of cooperation between the specialties of internal medicine, pathology and clinical biochemistry].

    Science.gov (United States)

    Hölzel, W; Baumgarten, R; Fiedler, H; Zimmermann, S

    1985-12-01

    The optimal utilization of the knowledge and possibilities of pathological and clinical biochemistry presumes a close cooperation between it and the clinical specialties. The common working team of the GDR Society of Internal Medicine and the GDR Society for Clinical Chemistry and Laboratory Diagnostics makes theses of the central points of the cooperation in care, education, further education and postgraduate study and in research a subject for discussion. As essential tasks in the process of medical care are regarded the balance of the examination programme standing at the disposal, the establishment of diagnostic programmes, the establishment of organisational measures, the ascertainment of a use according to indication, the guarantee of the representance of examination material, the control of plausibility and the interpretation of test results. Since the realization of the tasks to a large extent depends on the cooperation of the specialities in education, further education and postgraduate study during the further education the clinician should become acquainted with the possibilities, the limits and the prerequisites for the performance of laboratory diagnostic investigations, the clinical biochemist with the problems of medical care and the value of the laboratory diagnosis in the total process of the treatment. In the field of research the result is a necessary cooperation in the clarification of patho-biochemical mechanisms, in the search for suitable laboratory diagnostic parameters for diagnostics and control of the course as well as in the statement of the validity of laboratory diagnostic parameters and parameter combinations taking into consideration the factors expenses, benefit and risk as well as further diagnostic possibilities.

  11. Internal medicine in the bush: a clinical audit of a rural and remote outreach programme.

    Science.gov (United States)

    Foy, A; Tierney, A

    2014-04-01

    Provision of internal medicine services in rural Australia is always problematic. The aim was to undertake an audit of an outreach service operating in Northern New South Wales since 2006. The service is conducted eight times a year, involving a consultant and an advanced trainee who travel by car to the towns of Moree and Mungindi and conduct clinics in a general practice setting, an Aboriginal medical service and a local health district clinic. Since 2008, a cardiology service and a diabetes service have been added on a fly-in fly-out basis. Case records of all patients enrolled in the service between February 2006 and July 2013 were reviewed in determining the demographics, clinical presentations and level of service coverage. The experience of the authors in establishing the service provided insights into the challenges and the success factors involved. Five hundred and eighty-three patients were seen on a total of 1070 occasions relating to a wide variety of clinical presentations. Of these, 31.3% were indigenous compared with 20% in the local statistical area, and both indigenous and non-indigenous patients were seen in all settings. Patients fell into 15 different diagnostic categories with indigenous patients more likely to present for diabetes (P < 0.001) and hepatitis B (P < 0.01), but less likely to present for treatment of hepatitis C (P < 0.01). In providing an outreach service to a mixed community, flexibility in both setting and personnel are essential. Diabetes and liver disease are highly prevalent in indigenous patients, but the low numbers presenting for hepatitis C requires further study.