WorldWideScience

Sample records for energy medical therapy

  1. Medical Therapy of Acromegaly

    Directory of Open Access Journals (Sweden)

    U. Plöckinger

    2012-01-01

    Full Text Available This paper outlines the present status of medical therapy of acromegaly. Indications for permanent postoperative treatment, postirradiation treamtent to bridge the interval until remission as well as primary medical therapy are elaborated. Therapeutic efficacy of the different available drugs—somatostatin receptor ligands (SRLs, dopamine agonists, and the GH antagonist Pegvisomant—is discussed, as are the indications for and efficacy of their respective combinations. Information on their mechanism of action, and some pharmakokinetic data are included. Special emphasis is given to the difficulties to define remission criteria of acromegaly due to technical assay problems. An algorithm for medical therapy in acromegaly is provided.

  2. Medical Art Therapy

    Directory of Open Access Journals (Sweden)

    Birgul Aydin

    2012-03-01

    Full Text Available Art therapy is a form of expressive therapy that uses art materials. Art therapy combines traditional psychotherapeutic theories and techniques with an understanding of the psychological aspects of the creative process, especially the affective properties of the different art materials. Medical art therapy has been defined as the clinical application of art expression and imagery with individuals who are physically ill, experiencing physical trauma or undergoing invasive or aggressive medical procedures such as surgery or chemotherapy and is considered as a form of complementary or integrative medicine. Several studies have shown that patients with physical illness benefit from medical art therapy in different aspects. Unlike other therapies, art therapy can take the patients away from their illness for a while by means of creative activities during sessions, can make them forget the illness or lost abilities. Art therapy leads to re-experiencing normality and personal power even with short creative activity sessions. In this article definition, influence and necessity of medical art therapy are briefly reviewed.

  3. Medical therapy in acromegaly.

    LENUS (Irish Health Repository)

    Sherlock, Mark

    2011-05-01

    Acromegaly is a rare disease characterized by excess secretion of growth hormone (GH) and increased circulating insulin-like growth factor 1 (IGF-1) concentrations. The disease is associated with increased morbidity and premature mortality, but these effects can be reduced if GH levels are decreased to <2.5 μg\\/l and IGF-1 levels are normalized. Therapy for acromegaly is targeted at decreasing GH and IGF-1 levels, ameliorating patients\\' symptoms and decreasing any local compressive effects of the pituitary adenoma. The therapeutic options for acromegaly include surgery, radiotherapy and medical therapies, such as dopamine agonists, somatostatin receptor ligands and the GH receptor antagonist pegvisomant. Medical therapy is currently most widely used as secondary treatment for persistent or recurrent acromegaly following noncurative surgery, although it is increasingly used as primary therapy. This Review provides an overview of current and future pharmacological therapies for patients with acromegaly.

  4. Medical leech therapy (Hirudotherapy

    Directory of Open Access Journals (Sweden)

    Uwe Wollina

    2016-01-01

    Full Text Available Leeches have been used in medicine long time before BC. In recent years medical leech therapy has gained increasing interest in reconstructive surgery and pain management and other medical fields. The possible indications and success rates of this treatment are discussed. There is a special interest in salvage of flaps and grafts by the use of medical leeches. Retrospective analysis indicates a success rate of >80%. Randomized controlled trials have been performed in osteoarthritis. Case reports and smaller series are available for the treatment of chronic wounds, post-phlebitic syndrome and inflammatory skin diseases. The most common adverse effects are prolonged bleeding and infection by saprophytic intestinal bacteria of leeches. Medical leech therapy is a useful adjunct to other measures wound management.

  5. High energy medical accelerators

    International Nuclear Information System (INIS)

    Mandrillon, P.

    1990-01-01

    The treatment of tumours with charged particles, ranging from protons to 'light ions' (carbon, oxygen, neon), has many advantages, but up to now has been little used because of the absence of facilities. After the successful pioneering work carried out with accelerators built for physics research, machines dedicated to this new radiotherapy are planned or already in construction. These high energy medical accelerators are presented in this paper. (author) 15 refs.; 14 figs.; 8 tabs

  6. Medication management during electroconvulsant therapy

    Directory of Open Access Journals (Sweden)

    Zolezzi M

    2016-04-01

    Full Text Available Monica Zolezzi Clinical Pharmacy and Practice, College of Pharmacy, Qatar University, Doha, Qatar Abstract: Electroconvulsive therapy (ECT has demonstrated to be highly effective and safe, even life saving for many psychiatric disorders such as major depression, bipolar disorder and schizophrenia. Most patients who require ECT are also on concurrent pharmacotherapy. As such, the objective of this article is to provide a review of the most recent literature focusing on the medications used during an ECT procedure and on the effects of concurrent psychiatric and non-psychiatric medications on the effectiveness and safety of ECT. The review also attempts to summarize the recommendations derived from existing documents to guide pharmacotherapy decisions for patients undergoing ECT. For this purpose, using electronic databases, an extensive search of the current literature was made using ECT and medications or drug classes as keywords. Keywords: ECT, medications, drug interactions

  7. Food therapy and medical diet therapy of Traditional Chinese Medicine

    OpenAIRE

    Qunli Wu; Xiaochun Liang

    2018-01-01

    Food therapy of traditional Chinese medicine aims to maintain balanced nutrition through diet. Medical diet therapy, however, is to achieve the balance of Yin and Yang through the combination of nutrition and medicine. Either “food therapy” or “medical diet therapy” aims to keep health, prevent disease, remove illness and slow aging. In recent years, both food therapy and medical diet therapy have been increasingly applied in clinical nutrition therapy. In terms of traditional Chinese food th...

  8. Compact accelerator for medical therapy

    Science.gov (United States)

    Caporaso, George J.; Chen, Yu-Jiuan; Hawkins, Steven A.; Sampayan, Stephen E.; Paul, Arthur C.

    2010-05-04

    A compact accelerator system having an integrated particle generator-linear accelerator with a compact, small-scale construction capable of producing an energetic (.about.70-250 MeV) proton beam or other nuclei and transporting the beam direction to a medical therapy patient without the need for bending magnets or other hardware often required for remote beam transport. The integrated particle generator-accelerator is actuable as a unitary body on a support structure to enable scanning of a particle beam by direction actuation of the particle generator-accelerator.

  9. Medical therapy of hypothalamic diseases

    International Nuclear Information System (INIS)

    Werder, K. von; Mueller, O.A.

    1985-01-01

    Hormonal disturbances caused by hypothalamic pathology can be treated effectively by target hormone replacement in the case of failure of glandotropic hormone secretion. Hyposomatotropism in children has to be substituted by parenteral administration of growth hormone. In addition gonadotropins respectively gonadotropin releasing factor have to be given in order to restore fertility in hypothalamic hypogonadism. Posterior pituitary failure can be adequately replaced by administration of analogues of antidiuretic hormone. Hypothalamic pathology causing hypersecretion of anterior pituitary hormones may also be accessable to medical treatment. This pertains particularly to hyperprolactinemia and precocious puberty. However, there is no medical therapy so far for hypothalamic disturbances leading to veterative dysfunction like disturbances of temperature regulation and control of thirst and polyphagia. In this situation symptomatic correction of the abnormality represents the only possibility to keep these patients alive. (Author)

  10. Medical information therapy and medical malpractice litigation in ...

    African Journals Online (AJOL)

    2013-11-01

    Nov 1, 2013 ... Instead, the study proposed the concept of medical information therapy – an .... practitioner's obligations, patient autonomy and self-determination ..... Handbook – Guidelines for Good and Ethical Practice in Medicine,.

  11. 78 FR 57159 - Scientific Information Request on Medication Therapy Management

    Science.gov (United States)

    2013-09-17

    ... Information Request on Medication Therapy Management AGENCY: Agency for Healthcare Research and Quality (AHRQ), HHS. ACTION: Request for scientific information submissions. SUMMARY: The Agency for Healthcare... therapy management Scientific information is being solicited to inform our review of Medication Therapy...

  12. What does 'best medical therapy' really mean?

    DEFF Research Database (Denmark)

    Sillesen, H.

    2008-01-01

    reduction to that of endarterectomy, were these effective preventive drugs used systematically, as recommended, in this patient group. This article reviews the evidence that is available concerning medical therapy for patients with carotid stenosis, with special emphasis on antiplatelet and statin therapy...... the use of statins, newer antiplatelet and antihypertensive drugs, and at a time when less emphasis was on lifestyle modification. Therefore, it is likely that, not only would all patients with carotid stenosis benefit from modern medical treatment, in addition, some patients could have similar risk...

  13. Medication-assisted therapy for opioid addiction

    OpenAIRE

    Tai, Betty; Saxon, Andrew J.; Ling, Walter

    2013-01-01

    The “Medication-Assisted Therapy for Opioid Addiction” session was chaired by Dr. Betty Tai and had three presenters. The presenters (and their topics) were: Dr. Andrew J. Saxon (Methadone and Buprenorphine for Treatment of Opioid Addiction and HIV Risk Reduction), Dr. Walter Ling (Opioid Antagonist Treatment for Opioid Addiction), and Dr. Betty Tai (Chronic Care Model for Substance Use Disorder).

  14. Alpha-emitters for medical therapy workshop

    International Nuclear Information System (INIS)

    Feinendegen, L.E.; McClure, J.J.

    1996-01-01

    A workshop on ''Alpha-Emitters for Medical Therapy'' was held May 30-31, 1996 in Denver Colorado to identify research goals and potential clinical needs for applying alpha-particle emitters and to provide DOE with sufficient information for future planning. The workshop was attended by 36 participants representing radiooncology, nuclear medicine, immunotherapy, radiobiology, molecular biology, biochemistry, radiopharmaceutical chemistry, dosimetry, and physics. This report provides a summary of the key points and recommendations arrived at during the conference

  15. Alpha-emitters for medical therapy workshop

    Energy Technology Data Exchange (ETDEWEB)

    Feinendegen, L.E.; McClure, J.J.

    1996-12-31

    A workshop on ``Alpha-Emitters for Medical Therapy`` was held May 30-31, 1996 in Denver Colorado to identify research goals and potential clinical needs for applying alpha-particle emitters and to provide DOE with sufficient information for future planning. The workshop was attended by 36 participants representing radiooncology, nuclear medicine, immunotherapy, radiobiology, molecular biology, biochemistry, radiopharmaceutical chemistry, dosimetry, and physics. This report provides a summary of the key points and recommendations arrived at during the conference.

  16. 42 CFR 410.132 - Medical nutrition therapy.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Medical nutrition therapy. 410.132 Section 410.132 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM SUPPLEMENTARY MEDICAL INSURANCE (SMI) BENEFITS Medical Nutrition Therapy § 410.132 Medical...

  17. Pharmacogenetics in electroconvulsive therapy and adjunctive medications.

    Science.gov (United States)

    Mirzakhani, Hooman; van Noorden, Martijn S; Swen, Jesse; Nozari, Ala; Guchelaar, Henk-Jan

    2015-01-01

    Electroconvulsive therapy (ECT) has shown apparent efficacy in treatment of patients with depression and other mental illnesses who do not respond to psychotropic medications or need urgent control of their symptoms. Pharmacogenetics contributes to an individual's sensitivity and response to a variety of drugs. Clinical insights into pharmacogenetics of ECT and adjunctive medications not only improves its safety and efficacy in the indicated patients, but can also lead to the identification of novel treatments in psychiatric disorders through understanding of potential molecular and biological mechanisms involved. In this review, we explore the indications of pharmacogenetics role in safety and efficacy of ECT and present the evidence for its role in patients with psychiatric disorders undergoing ECT.

  18. 21 CFR 892.5300 - Medical neutron radiation therapy system.

    Science.gov (United States)

    2010-04-01

    ... therapy system. (a) Identification. A medical neutron radiation therapy system is a device intended to... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Medical neutron radiation therapy system. 892.5300... analysis and display equipment, patient and equipment support, treatment planning computer programs...

  19. Medical Yoga Therapy

    Directory of Open Access Journals (Sweden)

    Ina Stephens

    2017-02-01

    Full Text Available Medical yoga is defined as the use of yoga practices for the prevention and treatment of  medical conditions. Beyond the physical elements of yoga, which are important and effective for  strengthening  the  body,  medical  yoga  also  incorporates  appropriate  breathing  techniques,  mindfulness, and meditation in order to achieve the maximum benefits. Multiple studies have  shown that yoga can positively impact the body in many ways, including helping to regulate blood  glucose levels, improve musculoskeletal ailments and keeping the cardiovascular system in tune. It  also has been shown to have important psychological benefits, as the practice of yoga can help to  increase mental energy and positive feelings, and decrease negative feelings of aggressiveness,  depression and anxiety.

  20. Medical therapy cost considerations for glaucoma.

    Science.gov (United States)

    Fiscella, Richard G; Green, Amy; Patuszynski, Daniel H; Wilensky, Jacob

    2003-07-01

    To determine the calculated daily patient cost (cost minimization) of medical glaucoma therapy and review cost trends. Experimental, controlled, prospective study. The actual volume of various glaucoma medications or glaucoma medications with redesigned bottles was determined for most commercially available sizes of the tested products. The drops per milliliter based on the actual volume and the daily costs of the dosage schedules recommended by the manufacturers were compared. The cost of each bottle of medication was determined from the average wholesale price (AWP) in the United States. A comparison to 1999 prices where applicable will be analyzed to review costing trends. The generic timolol products (range, US dollars 0.38-US dollars 0.46 per day) were similar on a cost per day basis vs Betimol (Santen, Napa Valley, California, USA), Optipranolol (Bausch and Lomb Pharmaceuticals, Tampa, Florida, USA) and Timoptic (Merck, West Point, Pennsylvania, USA). Their percentage cost increase ranged from 5% to 22% since 1999, except for generic timolol XE gel-forming solution (48%). Betagan (Allergan, Irvine, California, USA), Betoptic S (Alcon Laboratories, Fort Worth, Texas, USA), and Ocupress (Novartis, Duluth, Georgia, USA) ranged from US dollars 0.88 to US dollars 1.11 per day, and their percentage cost increase ranged from 33% to 53%. Some brand-only products have raised their AWPs a greater percentage, including Betoptic S (37%), Iopidine (Alcon, Fort Worth, Texas, USA) (50%), Ocupress (Novartis Ophthalmics, Duluth, Georgia, USA) (53%), and Pilopine gel (Alcon, Fort Worth, Texas, USA) (32%). The mean cost per day for the topical carbonic anhydrase inhibitors Azopt (Alcon Laboratories; US dollars 1.33 per day) and Trusopt (Merck; US dollars 1.05 per day) differed from 1999 when prices were almost identical. Cosopt (Merck; timolol 0.5% plus dorzolamide 2%, US dollars 1.04 per day) was less than the cost of separate bottles of a topical carbonic anhydrase inhibitor

  1. 42 CFR 414.64 - Payment for medical nutrition therapy.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Payment for medical nutrition therapy. 414.64 Section 414.64 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... Other Practitioners § 414.64 Payment for medical nutrition therapy. (a) Payment under the physician fee...

  2. Recent Progress in the Medical Therapy of Pituitary Tumors

    Directory of Open Access Journals (Sweden)

    Fabienne Langlois

    2017-05-01

    Full Text Available Management of pituitary tumors is multidisciplinary, with medical therapy playing an increasingly important role. With the exception of prolactin-secreting tumors, surgery is still considered the first-line treatment for the majority of pituitary adenomas. However, medical/pharmacological therapy plays an important role in controlling hormone-producing pituitary adenomas, especially for patients with acromegaly and Cushing disease (CD. In the case of non-functioning pituitary adenomas (NFAs, pharmacological therapy plays a minor role, the main objective of which is to reduce tumor growth, but this role requires further studies. For pituitary carcinomas and atypical adenomas, medical therapy, including chemotherapy, acts as an adjuvant to surgery and radiation therapy, which is often required to control these aggressive tumors. In the last decade, knowledge about the pathophysiological mechanisms of various pituitary adenomas has increased, thus novel medical therapies that target specific pathways implicated in tumor synthesis and hormonal over secretion are now available. Advancement in patient selection and determination of prognostic factors has also helped to individualize therapy for patients with pituitary tumors. Improvements in biochemical and “tumor mass” disease control can positively affect patient quality of life, comorbidities and overall survival. In this review, the medical armamentarium for treating CD, acromegaly, prolactinomas, NFA, and carcinomas/aggressive atypical adenomas will be presented. Pharmacological therapies, including doses, mode of administration, efficacy, adverse effects, and use in special circumstances are provided. Medical therapies currently under clinical investigation are also briefly discussed.

  3. The perfect marriage: Solution-focused therapy and motivational interviewing in medical family therapy

    Directory of Open Access Journals (Sweden)

    Gage Stermensky

    2014-01-01

    Full Text Available Medical family therapy has many potential uses in behavioral medicine and primary care. Current research was reviewed to determine the most advantageous way to apply solution-focused therapy and motivational interviewing as a perfect marriage in medical family therapy. An extensive literature review was done in the following databases for medical family therapy: Proquest, EBSCO, Medline, and PsychInfo. The search resulted in 86 relevant articles, of which 46 of the most recent were selected for review. Medical family therapy lacks current research that supports solution-focused therapy or motivational interviewing. However, evidence supports the use of solution-focused therapy as a brief format, as well as the closely related intervention, motivational interviewing. While medical family therapy presents many hopeful possibilities in the fields of behavioral medicine, psychology, and marriage and family therapy, little evidence currently exists for the most effective implementation. This review found evidence supporting solution-focused therapy and motivational interviewing as the perfect marriage of the collaborative team approaches for the future implementation and use of specific interventions in medical family therapy.

  4. [Delegation of medical activities in acute pain therapy].

    Science.gov (United States)

    Erlenwein, J; Moroder, A; Biermann, E; Petzke, F; Ehlers, A P F; Bitter, H; Pogatzki-Zahn, E

    2018-01-01

    Acute pain management is an interprofessional and interdisciplinary task and requires a good and trustful cooperation between stakeholders. Despite provisions in Germany according to which medical treatment can only be rendered by a formally qualified physician ("Arztvorbehalt"), a physician does not have to carry out every medical activity in person. Under certain conditions, some medical activities can be delegated to medical auxiliary personnel but they need to be (1) instructed, (2) supervised and (3) checked by the physician himself; however, medical history, diagnostic assessment and evaluation, indications, therapy planning (e.g. selection, dosage), therapeutic decisions (e. g. modification or termination of therapy) and obtaining informed consent cannot be delegated. With respect to drug therapy, monitoring of the therapy remains the personal responsibility of the physician, while the actual application of medication can be delegated. From a legal perspective, the current practice needs to be stressed about what is within the mandatory requirements and what is not when medical activities are delegated to non-medical staff. The use of standards of care improves treatment quality but like any medical treatment it must be based on the physician's individual assessment and indications for each patient and requires personal contact between physician and patient. Delegation on the ward and in acute pain therapy requires the authorization of the delegator to give instructions in the respective setting. The transfer of non-delegable duties to non-medical personnel is regarded as medical malpractice.

  5. Interest in medical therapy for celiac disease

    Science.gov (United States)

    Tennyson, Christina A.; Simpson, Suzanne; Lebwohl, Benjamin; Lewis, Suzanne

    2013-01-01

    Objectives: A gluten-free diet is the treatment for celiac disease, but pharmaceutical agents are being developed. The level of interest amongst patients in using a medication to treat celiac disease is unknown. This study examined the level of interest amongst patients in medication to treat celiac disease. Methods: A questionnaire was distributed to celiac disease patients and data were collected on demographics, presentation, and interest in medication. Three validated celiac disease-specific instruments were incorporated: Celiac Disease Associated Quality of Life, the Celiac Symptom Index, and the Celiac Dietary Adherence Test. Results: Responses were received from 365 individuals with biopsy-proven celiac disease. Respondents were 78% (n = 276) female, 48% (n = 170) over 50 years of age, and experienced a classical (diarrhea predominant) presentation in 44% (n = 154). Of the 339 individuals answering the question regarding use of a medication to treat celiac disease, 66% were interested. Interest was greatest in older individuals (71% >50 years of age versus 60% symptoms with gluten exposure did not demonstrate any effect. Interest in medication was associated with a worse quality of life (CD-QOL 69.4 versus 80.1, p celiac disease are interested in using a medication. Interest was highest among men, older individuals, frequent restaurant customers, individuals dissatisfied with their weight or concerned with the cost of a gluten-free diet, and those with a worse quality of life. PMID:24003336

  6. Synchrotrons and their applications in medical imaging and therapy

    International Nuclear Information System (INIS)

    Lewis, R.

    2004-01-01

    Full text: Australasia's first synchrotron is being built on the campus of Monash University near Melbourne. Is it of any relevance to the medical imaging and radiation therapy communities? The answer is an unequivocal yes. Synchrotrons overcome many of the problems with conventional X-ray sources and as a result make it possible to demonstrate extraordinary advances in both X-ray imaging and indeed in radio-therapy. Synchrotron imaging offers us a window into what is possible and the results are spectacular. Specific examples include lung images that reveal alveolar structure and computed tomography of single cells. For therapy treatments are being pioneered that seem to be effective on high grade gliomas. An overview of the status of medical applications using synchrotrons will be given and the proposed Australian medical imaging and therapy facilities will be described and some of the proposed research highlighted. Copyright (2004) Australasian College of Physical Scientists and Engineers in Medicine

  7. Radioiodine (I-131) therapy and the influence of antithyroid medication

    International Nuclear Information System (INIS)

    Duldulao, M.

    2007-01-01

    Full text: Radioiodine therapy began to play a major role in the management of hyperthyroidism as early as 1941. It later evolved to become what it is today, the treatment of choice for majority of patients who are suffering from Graves' disease and toxic nodular goiter. It is generally considered safe, inexpensive, effective, and devoid of major side effects. Despite the extensive experience with radioactive therapy, the adjunctive role of antithyroid medication remains controversial. Some authors claim that it has a positive influence on the outcome of radioiodine therapy while others insist otherwise. The reasons behind the adjunctive use of antithyroid medication include a more rapid attainment of euthyroid state and a decrease in the rise of developing thyroid crisis. However, a higher treatment failure rate is observed compared to radioiodine alone. This is due to the reputed radioprotective effect of the antithyroid medication. As a result, higher doses of I-131 are needed in order to obtain the desired effect but, unfortunately, that would also increase the radiation exposure to the rest of the body. The majority of clinicians would require discontinuation of the medication a few days before therapy to overcome these undesirable effects but the question is, is this safe? The issue of when antithyroid medication is warranted is a big question to the clinician. For optimal use of radioiodine therapy, appropriate selection criteria and good clinical judgment concerning pretreatment with antithyroid medication are required. Otherwise, we may put some patients into unnecessary increased risk and added cost. (author)

  8. Medical applications of the nuclear energy

    International Nuclear Information System (INIS)

    Ugarte, Valentin E.

    2001-01-01

    The Nuclear Medicine School Foundation, in Mendoza (Argentina) was created in 1986 by the National Atomic Energy Commission (CNEA) and is supported by the Government of the Mendoza Province, the CNEA, and the National University of Cuyo. The main activities of the school are medical diagnosis using nuclear techniques and the training of physicians and technicians in nuclear medicine. Teletherapy and brachytherapy are also performed. The use of the PET is described in some detail

  9. The application of accelerator for medical therapy in Indonesia

    International Nuclear Information System (INIS)

    Yunasfi; Mudjiono; Irwati, Dwi; Hanifa

    2003-01-01

    The study of the application of accelerator for medical therapy in Indonesia was carried out. Accelerator that used for therapy is an electron lintier accelerator (Linac) which can radiate electron beam and X-ray. This study shows that there are 8 unit of Linac distributed at 6 big hospitals in Indonesia, especially in Jakarta. This study also shows that radiotherapy facilities in Indonesia is un sufficient of. Therefore, providing radiotherapy facilities for hospitals, especially the big hospitals in Indonesia is necessary

  10. ELECTROCONVULSIVE THERAPY EXPERIENCES AT NARA MEDICAL UNIVERSITY HOSPITAL

    OpenAIRE

    Kishimoto, Toshifumi; Ueda, Atsushi; Noriyama, Yoshinobu; Nagai, Toshiya; Hirayama, Tomohide; Kirita, Ikuhiro; Hata, Kazuya; Ikawa, Genro

    1995-01-01

    We surveyed the clinical electroconvulsive therapy (ECT) treatment expe- riences between 1987 and 1992 at Nara Medical University Hospital. ECT is restrictedly applied to severely ill patients who have no response to other somatic therapies. For 5 years, 43 cases were treated with ECT, of which 27 suffered from depressive disorders, 3 from schizophrenia, 3 from somatoform disorders, and 10 from anxiety disorders. ECT was selected by psychiatrists for severe depressive states after failure of ...

  11. Elderly\\'s Medical Therapy Status

    Directory of Open Access Journals (Sweden)

    Malihe Saboor

    2007-04-01

    Full Text Available Studies show that the elderly are more prone to chronic diseases in comparison to other age groups. Medical treatment is very common in aged people. On average, every aged person uses 4.5 prescribed and 2.1 over the counter medicines. And every year they have 12 to 17 prescriptions. Indeed, medicines are mostly used in hospitals and geriatrics. (1 the most common used medicines are: analgesics, anti-inflammatory, hypertensive drugs, cardiovascular medicines & tranquilizers. Natural trend of aging emphasizes on need of change in the way of drug administration in aged people. Because of different age-related diseases, the prescriptions and dosing of different drugs has been changed specially in hospitals and geriatrics. The changing in quality of life style in aged people has also affected the way of drug administration. In this article we emphasize treatment problems, drug side effects, physiological variations and their effects on pharmacokinetic and pharmacodynamic of drugs in aging population and we also have many suggestions for increasing health in the aged and their quality of life.

  12. Percutaneous coronary intervention with optimal medical therapy vs. optimal medical therapy alone for patients with stable angina pectoris

    Directory of Open Access Journals (Sweden)

    Gorenoi, Vitali

    2011-01-01

    Full Text Available Scientific background: Stable Angina Pectoris (AP is a main syndrome of chronic coronary artery disease (CAD, a disease with enormous epidemiological and health economic relevance. Medical therapy and percutaneous coronary interventions (PCI are the most important methods used in the treatment of chronic CAD. Research questions: The evaluation addresses questions on medical efficacy, incremental cost-effectiveness as well as ethic, social and legal aspects in the use of PCI in CAD patients in comparison to optimal medical therapy alone. Methods: A systematic literature search was conducted in June 2010 in the electronic databases (MEDLINE, EMBASE etc. and was completed by a hand search. The medical analysis was initially based on systematic reviews of randomized controlled trials (RCT and was followed by the evaluation of RCT with use of current optimal medical therapy. The results of the RCT were combined using meta-analysis. The strength and the applicability of the determined evidence were appraised. The health economic analysis was initially focused on the published studies. Additionally, a health economic modelling was performed with clinical assumptions derived from the conducted meta-analysis and economic assumptions derived from the German Diagnosis Related Groups 2011. Results: Seven systematic reviews (applicability of the evidence low and three RCT with use of optimal medical therapy (applicability of the evidence for the endpoints AP and revascularisations moderate, for further endpoints high were included in the medical analysis. The results from RCT are used as a base of the evaluation. The routine use of the PCI reduces the proportion of patients with AP attacks in the follow-up after one and after three years in comparison with optimal medical therapy alone (evidence strength moderate; however, this effect was not demonstrated in the follow-up after five years (evidence strength low. The difference in effect in the follow

  13. Knowledge, attitude and use of alternative medical therapy amongst ...

    African Journals Online (AJOL)

    Alternate medicine which has a long history has been relegated to the background by the evolution of modern medicine. In recent times, however, alternative medical therapy has been growing in popularity and getting increasing attention and interest. This study assessed the knowledge, attitude and use by urban dwellers ...

  14. Music as a complementary therapy in medical treatment

    Directory of Open Access Journals (Sweden)

    Samuel Halim

    2002-12-01

    Full Text Available Music can act not only as a source of enjoyable sound that gives pleasant feeling, but also a source of healing. Music as a therapy has developed, supported by many researches conducted by experts in music, education and medicine. The impact of music therapy can be observed in many case studies, showing the positive effects of music to the betterment of human’s neuro-behavior, emotional and physical states. Some reasons to use music as a therapy are: toget audioanalgesic response, to focus attention, to reinforce learning, to enhance interpersonal relationships, and to promote mind-body health in the medical staff. The use of music to help patients with non-infectious diseases such as Alzheimer disease, autism, cancer, headache, heart disease and stroke are described along with experiments and case studies on these diseases. However controversies around music therapy occurred. Therefore, more experiments need to be taken in order to clear the controversies and to use music as a therapy in the present and future medical treatment. (Med J Indones 2002; 11: 250-7.Keywords: therapeutic effect, music therapy, Alzheimer, autism, cancer, stroke

  15. Effectiveness of medication / auricular therapy / phyto-therapy combination in the treatment of hypertensive patients

    Directory of Open Access Journals (Sweden)

    José Ramón Martínez Pérez

    2015-10-01

    Full Text Available Background: hypertension is one of the main cardiovascular risk factors, so its control improves the life expectancy of patients.Objective: to assess the effects of a treatment combining medication with auricular therapy and phyto-therapy in hypertensive patients assisted at the health area of ”Romárico Oro” Polyclinic, in Puerto Padre, Las Tunas province.Methods: an intervention study was carried out in 68 hypertensive patients of the health area of “Romárico Oro” Polyclinic in Puerto Padre from April, 2013 to April, 2014. The patients were distributed at random into two equal groups; the first received medication combined with auricular therapy and phyto-therapy, while the second one received only medication. The statistical analysis was done by means of Statistic system, t-student and Chi-Square tests were used and p< or =0.05 was considered as level of statistical significance.Results: by the end of the intervention, 73, 53% of the patients of the group with the combination of drug treatment and auricular therapy and phyto-therapy were controlled. In this group, the diastolic filling pressure diminished to 2, 2 mm Hg and the systolic gradient to 3, 66 mm, regarding the group treated only with drugs. Only one patient, representing the 2, 94% showed adverse reaction to the natural and traditional treatment.Conclusions: the combination of medication with auricular therapy and phyto-therapy proved to be effective, corroborated by a significant decrease of quantity of crisis, diastolic and systolic filling pressure values and increase of number of patients with their disease controlled; the report of only one complication shows the innocuousness of the auricular therapy and phyto-therapy treatment.

  16. Converting energy to medical progress [nuclear medicine

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2001-04-01

    For over 50 years the Office of Biological and Environmental Research (BER) of the United States Department of Energy (DOE) has been investing to advance environmental and biomedical knowledge connected to energy. The BER Medical Sciences program fosters research to develop beneficial applications of nuclear technologies for medical diagnosis and treatment of many diseases. Today, nuclear medicine helps millions of patients annually in the United States. Nearly every nuclear medicine scan or test used today was made possible by past BER-funded research on radiotracers, radiation detection devices, gamma cameras, PET and SPECT scanners, and computer science. The heart of biological research within BER has always been the pursuit of improved human health. The nuclear medicine of tomorrow will depend greatly on today's BER-supported research, particularly in the discovery of radiopharmaceuticals that seek specific molecular and genetic targets, the design of advanced scanners needed to create meaningful images with these future radiotracers, and the promise of new radiopharmaceutical treatments for cancers and genetic diseases.

  17. Converting energy to medical progress [nuclear medicine

    International Nuclear Information System (INIS)

    2001-01-01

    For over 50 years the Office of Biological and Environmental Research (BER) of the United States Department of Energy (DOE) has been investing to advance environmental and biomedical knowledge connected to energy. The BER Medical Sciences program fosters research to develop beneficial applications of nuclear technologies for medical diagnosis and treatment of many diseases. Today, nuclear medicine helps millions of patients annually in the United States. Nearly every nuclear medicine scan or test used today was made possible by past BER-funded research on radiotracers, radiation detection devices, gamma cameras, PET and SPECT scanners, and computer science. The heart of biological research within BER has always been the pursuit of improved human health. The nuclear medicine of tomorrow will depend greatly on today's BER-supported research, particularly in the discovery of radiopharmaceuticals that seek specific molecular and genetic targets, the design of advanced scanners needed to create meaningful images with these future radiotracers, and the promise of new radiopharmaceutical treatments for cancers and genetic diseases

  18. Adjuvant Medications That Improve Survival after Locoregional Therapy.

    Science.gov (United States)

    Boas, F Edward; Ziv, Etay; Yarmohammadi, Hooman; Brown, Karen T; Erinjeri, Joseph P; Sofocleous, Constantinos T; Harding, James J; Solomon, Stephen B

    2017-07-01

    To determine if outpatient medications taken at the time of liver tumor embolization or ablation affect survival. A retrospective review was done of 2,032 liver tumor embolization, radioembolization, and ablation procedures performed in 1,092 patients from June 2009 to April 2016. Pathology, hepatocellular carcinoma (HCC) stage (American Joint Committee on Cancer), neuroendocrine tumor (NET) grade, initial locoregional therapy, overall survival after initial locoregional therapy, Child-Pugh score, Eastern Cooperative Oncology Group performance status, Charlson Comorbidity Index, and outpatient medications taken at the time of locoregional therapy were analyzed for each patient. Kaplan-Meier survival curves were calculated for patients taking 29 medications or medication classes (including prescription and nonprescription medications) for reasons unrelated to their primary cancer diagnosis. Kaplan-Meier curves were compared using the log-rank test. For patients with HCC initially treated with embolization (n = 304 patients), the following medications were associated with improved survival when taken at the time of embolization: beta-blockers (P = .0007), aspirin (P = .0008) and other nonsteroidal antiinflammatory drugs (P = .009), proton pump inhibitors (P = .004), and antivirals for hepatitis B or C (P = .01). For colorectal liver metastases initially treated with ablation (n = 172 patients), beta-blockers were associated with improved survival when taken at the time of ablation (P = .02). Aspirin and beta-blockers are associated with significantly improved survival when taken at the time of embolization for HCC. Aspirin was not associated with survival differences after locoregional therapy for NET or colorectal liver metastases, suggesting an HCC-specific effect. Copyright © 2017 SIR. Published by Elsevier Inc. All rights reserved.

  19. Contemporary medical therapies of atherosclerotic carotid artery disease.

    Science.gov (United States)

    Cheng, Suk F; Brown, Martin M

    2017-03-01

    Contemporary medical therapy consists of identification and treatment of all patient-modifiable vascular risk factors. Specific atherosclerotic disease therapies are designed to reduce the risk of thrombosis, and the disease progression in order to reduce the risk of future cardiovascular events. Contemporary medical management emphasizes the need to support the patient in achieving lifestyle modifications and to adjust medication to achieve individualized target values for specific quantifiable risk factors. Antiplatelet therapy in the form of aspirin or clopidogrel is routinely used for the prevention of ischemic stroke in patients who have had a transient ischemic attack or stroke. There is evidence from a recent trial that the use of combination antiplatelet therapy with aspirin and clopidogrel started within 24 hours of minor stroke or transient ischemic attack reduces the risk of recurrent stroke compared to the use of aspirin alone, and therefore we use aspirin plus clopidogrel in recently symptomatic patients with carotid stenosis pending carotid revascularization. Anticoagulation with heparins or vitamin K antagonist is not recommended except in patients at risk for cardio-embolic events. Lowering blood pressure to target levels has been shown to slow down the progression of carotid artery stenosis and reduces the intima-media thickness of the carotid plaque, while lowering lipid levels with statins has become an essential element in the medical therapy of carotid artery stenosis. Diabetes management should be optimized. Lifestyle choices, including tobacco smoking, physical inactivity, unhealthy diet, obesity, and excessive alcohol intake, are all important modifiable vascular risk factors. The combination of dietary modification, physical exercise, and use of aspirin, a statin, and an antihypertensive agent can be expected to give a cumulative relative stroke risk reduction of 80%. The evidence suggests that intensive medical therapy is so effective that

  20. Single-energy intensity modulated proton therapy

    Science.gov (United States)

    Farace, Paolo; Righetto, Roberto; Cianchetti, Marco

    2015-09-01

    In this note, an intensity modulated proton therapy (IMPT) technique, based on the use of high single-energy (SE-IMPT) pencil beams, is described. The method uses only the highest system energy (226 MeV) and only lateral penumbra to produce dose gradient, as in photon therapy. In the study, after a preliminary analysis of the width of proton pencil beam penumbras at different depths, SE-IMPT was compared with conventional IMPT in a phantom containing titanium inserts and in a patient, affected by a spinal chordoma with fixation rods. It was shown that SE-IMPT has the potential to produce a sharp dose gradient and that it is not affected by the uncertainties produced by metal implants crossed by the proton beams. Moreover, in the chordoma patient, target coverage and organ at risk sparing of the SE-IMPT plan resulted comparable to that of the less reliable conventional IMPT technique. Robustness analysis confirmed that SE-IMPT was not affected by range errors, which can drastically affect the IMPT plan. When accepting a low-dose spread as in modern photon techniques, SE-IMPT could be an option for the treatment of lesions (e.g. cervical bone tumours) where steep dose gradient could improve curability, and where range uncertainty, due for example to the presence of metal implants, hampers conventional IMPT.

  1. Single-energy intensity modulated proton therapy.

    Science.gov (United States)

    Farace, Paolo; Righetto, Roberto; Cianchetti, Marco

    2015-10-07

    In this note, an intensity modulated proton therapy (IMPT) technique, based on the use of high single-energy (SE-IMPT) pencil beams, is described.The method uses only the highest system energy (226 MeV) and only lateral penumbra to produce dose gradient, as in photon therapy. In the study, after a preliminary analysis of the width of proton pencil beam penumbras at different depths, SE-IMPT was compared with conventional IMPT in a phantom containing titanium inserts and in a patient, affected by a spinal chordoma with fixation rods.It was shown that SE-IMPT has the potential to produce a sharp dose gradient and that it is not affected by the uncertainties produced by metal implants crossed by the proton beams. Moreover, in the chordoma patient, target coverage and organ at risk sparing of the SE-IMPT plan resulted comparable to that of the less reliable conventional IMPT technique. Robustness analysis confirmed that SE-IMPT was not affected by range errors, which can drastically affect the IMPT plan.When accepting a low-dose spread as in modern photon techniques, SE-IMPT could be an option for the treatment of lesions (e.g. cervical bone tumours) where steep dose gradient could improve curability, and where range uncertainty, due for example to the presence of metal implants, hampers conventional IMPT.

  2. Single-energy intensity modulated proton therapy

    International Nuclear Information System (INIS)

    Farace, Paolo; Righetto, Roberto; Cianchetti, Marco

    2015-01-01

    In this note, an intensity modulated proton therapy (IMPT) technique, based on the use of high single-energy (SE-IMPT) pencil beams, is described.The method uses only the highest system energy (226 MeV) and only lateral penumbra to produce dose gradient, as in photon therapy. In the study, after a preliminary analysis of the width of proton pencil beam penumbras at different depths, SE-IMPT was compared with conventional IMPT in a phantom containing titanium inserts and in a patient, affected by a spinal chordoma with fixation rods.It was shown that SE-IMPT has the potential to produce a sharp dose gradient and that it is not affected by the uncertainties produced by metal implants crossed by the proton beams. Moreover, in the chordoma patient, target coverage and organ at risk sparing of the SE-IMPT plan resulted comparable to that of the less reliable conventional IMPT technique. Robustness analysis confirmed that SE-IMPT was not affected by range errors, which can drastically affect the IMPT plan.When accepting a low-dose spread as in modern photon techniques, SE-IMPT could be an option for the treatment of lesions (e.g. cervical bone tumours) where steep dose gradient could improve curability, and where range uncertainty, due for example to the presence of metal implants, hampers conventional IMPT. (note)

  3. Verification of radiodynamic therapy by medical linear accelerator using a mouse melanoma tumor model.

    Science.gov (United States)

    Takahashi, Junko; Murakami, Mami; Mori, Takashi; Iwahashi, Hitoshi

    2018-02-09

    Combined treatment with 5-aminolevulinic acid (5-ALA) and X-rays improves tumor suppression in vivo. This is because the accumulated protoporphyrin IX from 5-ALA enhances the generation of ROS by the X-ray irradiation. In the present study, a high-energy medical linear accelerator was used instead of a non-medical low energy X-ray irradiator, which had been previously used. Tumor-bearing mice implanted with B16-BL6 melanoma cells were treated with fractionated doses of irradiation (in total, 20 or 30 Gy), using two types of X-ray irradiator after 5-ALA administration. Suppression of tumor growth was enhanced with X-ray irradiation in combination with 5-ALA treatment compared with X-ray treatment alone, using both medical and non-medical X-ray irradiators. 5-ALA has been used clinically for photodynamic therapy. Thus, "radiodynamic therapy", using radiation from medical linacs as a physical driving force, rather than the light used in photodynamic therapy, may have potential clinical applications.

  4. Capacitive micromachined ultrasonic transducers for medical imaging and therapy

    International Nuclear Information System (INIS)

    Khuri-Yakub, Butrus T; Oralkan, Ömer

    2011-01-01

    Capacitive micromachined ultrasonic transducers (CMUTs) have been subject to extensive research for the last two decades. Although they were initially developed for air-coupled applications, today their main application space is medical imaging and therapy. This paper first presents a brief description of CMUTs, their basic structure and operating principles. Our progression of developing several generations of fabrication processes is discussed with an emphasis on the advantages and disadvantages of each process. Monolithic and hybrid approaches for integrating CMUTs with supporting integrated circuits are surveyed. Several prototype transducer arrays with integrated front-end electronic circuits we developed and their use for 2D and 3D, anatomical and functional imaging, and ablative therapies are described. The presented results prove the CMUT as a micro-electro-mechanical systems technology for many medical diagnostic and therapeutic applications

  5. Capacitive micromachined ultrasonic transducers for medical imaging and therapy.

    Science.gov (United States)

    Khuri-Yakub, Butrus T; Oralkan, Omer

    2011-05-01

    Capacitive micromachined ultrasonic transducers (CMUTs) have been subject to extensive research for the last two decades. Although they were initially developed for air-coupled applications, today their main application space is medical imaging and therapy. This paper first presents a brief description of CMUTs, their basic structure, and operating principles. Our progression of developing several generations of fabrication processes is discussed with an emphasis on the advantages and disadvantages of each process. Monolithic and hybrid approaches for integrating CMUTs with supporting integrated circuits are surveyed. Several prototype transducer arrays with integrated frontend electronic circuits we developed and their use for 2-D and 3-D, anatomical and functional imaging, and ablative therapies are described. The presented results prove the CMUT as a MEMS technology for many medical diagnostic and therapeutic applications.

  6. OFFICIAL MEDICATIONS FOR ANTI-TUMOR GENE THERAPY

    Directory of Open Access Journals (Sweden)

    E. R. Nemtsova

    2016-01-01

    Full Text Available This is a review of modern literature data of official medications for anti-tumor gene therapy as well as of medications that finished clinical trials.The article discusses the concept of gene therapy, the statistical analysis results of initiated clinical trials of gene products, the most actively developing directions of anticancer gene therapy, and the characteristics of anti-tumor gene medications.Various delivery systems for gene material are being examined, including viruses that are defective in  replication (Gendicine™ and Advexin and oncolytic (tumor specific conditionally replicating viruses (Oncorine™, ONYX-015, Imlygic®.By now three preparations for intra-tumor injection have been introduced into oncology clinical practice: two of them – Gendicine™ and Oncorine™ have been registered in China, and one of them – Imlygic® has been registered in the USA. Gendicine™ and Oncorine™ are based on the wild type p53 gene and are designed for treatment of patients with head and neck malignancies. Replicating adenovirus is the delivery system in Gendicine™, whereas oncolytic adenovirus is the vector for gene material in Oncorine™. Imlygic® is based on the  recombinant replicating HSV1 virus with an introduced GM–CSF gene and is designed for treatment of  melanoma patients. These medications are well tolerated and do not cause any serious adverse events. Gendicine™ and Oncorine™ are not effective in monotherapy but demonstrate pronounced synergism with chemoand radiation therapy. Imlygic® has just started the post marketing trials.

  7. Home Healthcare Medical Devices: Infusion Therapy - Getting the Most Out of Your Pump

    Science.gov (United States)

    ... Medical Procedures Home Health and Consumer Devices Brochure - Home Healthcare Medical Devices: Infusion Therapy - Getting the Most ... if needed. What is the role of your home healthcare provider and supplier in your infusion therapy? ...

  8. MEDICAL NUTRITION THERAPY IN MANAGEMENT OF EATING DISORDERS

    Directory of Open Access Journals (Sweden)

    Miloš Pavlović

    2009-01-01

    Full Text Available The treatment of eating disorders demands a comprehensive medical approach, where a dietitian has an important role, primarily due to numerous instances of malnutrition. The objective of this paper was to recapitulate the research findings and clinical evidence which show the importance of medical nutrition therapy in the treatment of eating disorders; furthermore, they present significant guidelines for clinical practice. The research methods have entailed a thorough exploration of literature available at research data bases. The results of the research studies published so far have unambiguously pointed out that, when eating disorders are concerned, there is an urgent need for a diet therapy in order for the patient to restore the appropriate body weight as well as normal eating habits. On the one hand, certain authors suggest returning to normal nutritional habits immediately, whereas, on the other hand, certain others advocate a diet therapy program, that is, a gradual process of recovery. Patients incapable of oral food intake receive enteral nutrition. Parenteral nutrition is applied for recovering the lost electrolytes and fluids, but it should be applied rarely, primarily in states of urgency. For patients suffering from eating disorders the increase in weight indicates good chances of recovery; therefore, the patient’s nutritional status should be carefully and continuously noted. Finally, it is important that our country, too, should adopt a carefully prescribed and conducted diet therapy as an obligatory step in the treatment of patients with eating disorders.

  9. Retrospective Analysis of Medication Adherence and Cost Following Medication Therapy Management

    Directory of Open Access Journals (Sweden)

    Ashley Branham, PharmD

    2010-01-01

    Full Text Available Objective: To determine if pharmacist-provided medication therapy management (MTM improves medication adherence in Medicare patients. A secondary objective is to compare the total monthly cost of a patient’s prescription medication regimen 6 months before and 6 months following a comprehensive medication review (CMR. Design: Retrospective analysis of medication adherence, pre-post comparison. Setting: Three independent pharmacies in North Carolina. Patients: 97 Medicare Part D beneficiaries with one or more chronic disease states who participated in a comprehensive medication review (CMR. Intervention: MTM services provided by community pharmacists. Main outcome measure: Change in adherence as measured by the proportion of days covered (PDC and change in medication costs for patients and third party payers. Results: Patients were adherent to chronic disease-state medications before and after MTM (PDC≥ 0.8. Overall, change in mean adherence before and after MTM did not change significantly (0.87 and 0.88, respectively; p = 0.43. However, patients taking medications for cholesterol management, GERD, thyroid and BPH demonstrated improved adherence following a CMR. No change in adherence was noted for patients using antihypertensives and antidiabetic agents. Average total chronic disease-state medication costs for participants were reduced from $210.74 to $193.63 (p=0.08 following the comprehensive medication review. Total costs for patient and third party payers decreased from patients prescribed antilipemics, antihypertensives, GERD and thyroid disorders following a CMR. Conclusions: Pharmacist-provided MTM services were effective at improving medication adherence for some patients managed with chronic medications. Pharmacist-provided MTM services also were effective in decreasing total medication costs.

  10. Medication Therapy Management and Preconception Care: Opportunities for Pharmacist Intervention

    Directory of Open Access Journals (Sweden)

    Natalie A. DiPietro

    2014-01-01

    Full Text Available As medication therapy management (MTM continues to grow in the profession of pharmacy, careful consideration as to areas for positive patient impact is warranted. Given the current gaps in preconception care in the United States, and the accessibility and expertise of the pharmacist, MTM interventions related to preconception care may be valuable. This paper describes potential for pharmacist intervention in several different areas of preconception care. Notably, targeted medication reviews may be appropriate for interventions such as folic acid recommendations, teratogenic/category X medication management, immunizations, and disease state management. Comprehensive medication reviews may be warranted for selected disease states due to complexity of interventions, such the management of diabetes. Comprehensive medication reviews may also be warranted if several targeted interventions are necessary, or if there are a several medications or disease states requiring intervention. Pharmacists also have important roles in screening, support, and referrals needed for preconception care in the context of MTM. Patients may benefit substantially from pharmacist-directed MTM services related to preconception care. In addition, depending on clinical pharmacy service contracts and billing opportunities, pharmacists may be reimbursed for providing these services, generating sustainable revenue while fulfilling an important public health need.   Type: Idea Paper

  11. Medical Therapy for Cushing's Syndrome in the Twenty-first Century.

    Science.gov (United States)

    Tritos, Nicholas A; Biller, Beverly M K

    2018-06-01

    Medical therapy has a useful adjunctive role in many patients with Cushing's syndrome. Patients with pituitary corticotroph adenomas who have received radiation therapy to the sella require medical therapy until the effects of radiation therapy occur. In addition, patients with Cushing's syndrome who cannot undergo surgery promptly, including those who are acutely ill and cannot safely undergo tumor resection, may benefit from medical therapy as a bridge to surgery. Other possible candidates for medical therapy are those with unresectable tumors or those whose tumor location remains unknown despite adequate diagnostic evaluation. Copyright © 2018 Elsevier Inc. All rights reserved.

  12. Home iv antibiotic therapy through a medical day care unit

    OpenAIRE

    Gourdeau, Marie; Deschênes, Louise; Caron, Martine; Desmarais, Marc

    1993-01-01

    An out-patient parenteral antibiotic therapy program provided through a medical day care unit was evaluated in a tertiary care hospital. From July 11, 1988 to December 31, 1990, 122 patients were treated either on site at the unit or at home with self-administered intravenous antibiotics. In all, 142 courses of parenteral antibiotics (mostly cephalosporins and clindamycin) were given for a total of 124 infections, mostly bone and soft tissue infections (67 of 124, 54%). The duration of out-pa...

  13. Nonadherence with pediatric human immunodeficiency virus therapy as medical neglect.

    Science.gov (United States)

    Roberts, Gretchen M; Wheeler, J Gary; Tucker, Nancy C; Hackler, Chris; Young, Karen; Maples, Holly D; Darville, Toni

    2004-09-01

    To examine the results of an interventionist approach applied to human immunodeficiency virus (HIV)-infected children for whom caregiver nonadherence was suspected as the cause of treatment failure. The medical records of a cohort of 16 perinatally HIV-infected children whose care was managed at the Arkansas Children's Hospital Pediatric HIV Clinic for an uninterrupted period of >or=3 years were reviewed through July 2003. Data collected included date of birth, dates of and explanations for clinic visits and hospitalizations, dates of laboratory evaluations, CD4(+) T cell percentages, plasma HIV-1 RNA levels, antiretroviral medications, viral resistance tests (eg, phenotype and genotype), and physician-initiated interventions to enhance adherence to the medication regimen. A stepwise interventionist approach was undertaken when patients continued to demonstrate high viral loads, despite documented viral sensitivity to the medication regimen and caregivers' insistence that medications were being administered regularly. Step 1 was prescribing a home health nurse referral, step 2 was administering directly observed therapy (DOT) while the patient was hospitalized for 4 days, and step 3 was submitting a physician-initiated medical neglect report to the Arkansas Department of Human Services. The results for 6 patients for whom this stepwise approach was initiated are reported. Home health nurse referrals failed to result in sustained improvements in adherence in all 6 cases. Viral load assays performed before and after DOT provided an objective measure of the effect of adherence, with 12 hospitalizations resulting in a mean +/- SD decrease in HIV RNA levels of 1.09 +/- 0.5 log(10) copies per mL, with a range of 0.6 to 2.1 log(10) copies per mL. Four families responded to DOT hospitalization, and sustained decreases in the respective patients' viral loads were noted. In 2 cases, medical neglect reports were submitted when DOT did not result in improved adherence. These

  14. Physical engineering and medical physics on boron neutron capture therapy

    International Nuclear Information System (INIS)

    Sakurai, Yoshinori

    2011-01-01

    The contents of physical engineering and medical physics that support boron neutron capture therapy (BNCT) can be roughly classified to the four items, (1) neutron irradiation system, (2) development and improvement of dose assessment techniques, (3) development and improvement of dose planning system, and (4) quality assurance and quality control. This paper introduces the BNCT at Kyoto University Research Reactor Institute, with a focus on the basic physics of BNCT, thermal neutron irradiation and epithermal neutron irradiation, heavy water neutron irradiation facilities of KUR, and medical irradiation system of KUR. It also introduces the world's first BNCT clinical cyclotron irradiation system (C-BENS) of Kyoto University Research Reactor Institute, BNCT dose assessment techniques, dose planning system, and quality assurance and quality control. (A.O.)

  15. MEDICAL EXPULSIVE THERAPY OF URETERIC CALCULI - OUR EXPERIENCE

    Directory of Open Access Journals (Sweden)

    Ramesh

    2015-09-01

    Full Text Available INTRODUCTION: Uretric stones can be treated with multiple modalities including medical therapy, uretroscopy, shockwave lithotripsy (SWS, percutaneous nephrolithotomy, open/laparoscopic stone removal, and/or combinations of these modalities. The aim is to study the effectivene ss of medical management of uretric stones and to compare the effectiveness of Tamsulosin and Tamsulosin with steroid . MATERIALS & METHODS: 120 Patients who came with acute uretric colic were categorized into III categories of less than 5mm, 5mm to 7mm and more than 7mm based on NCCT. They were consecutively allotted to one of the three groups, the group I patients received Anti - Biotics with NSAIDs group II received Tamsulosin in addition Anti - Biotics and NSAIDs and III rd group received Anti - Biotics, Tamsu losin, NSAIDs in addition Deflazacart 30mg for a period of 10 days. The results were evaluated at the end of 10 days medical treatment. RESULTS : 90 out of 120 patients were re - evaluated at the end of 10 days. The calculi of 7mm should be removed as the chances of passage is <20%. The medical treatment with Tamsulosin or Tamsulosin with Deflazacart does not offer significant benefit.

  16. Energy functionals for medical image segmentation: choices and consequences

    OpenAIRE

    McIntosh, Christopher

    2011-01-01

    Medical imaging continues to permeate the practice of medicine, but automated yet accurate segmentation and labeling of anatomical structures continues to be a major obstacle to computerized medical image analysis. Though there exists numerous approaches for medical image segmentation, one in particular has gained increasing popularity: energy minimization-based techniques, and the large set of methods encompassed therein. With these techniques an energy function must be chosen, segmentations...

  17. Nuclear energy and its medical application

    International Nuclear Information System (INIS)

    Jain, S.K.

    2010-01-01

    Ionising radiation is used in radiotherapy to treat cancer and to sterilise medical equipment because it destroys cells. Radioactive tracers are used in nuclear medicine because the ionising radiation it emits is easy to detect. There are three main uses of ionising radiation in medicine: treatment, diagnosis and sterilisation. Radiotherapy is used to treat cancers by irradiating them with ionising radiation. Radioactive tracers are used to diagnose and investigate several medical conditions. Ionising radiation is used to sterilise medical equipment as it kills germs and/or bacteria

  18. Traditional Chinese medical comprehensive therapy for cancer-related fatigue.

    Science.gov (United States)

    Yang, Lu; Li, Tian-Tian; Chu, Yu-Ting; Chen, Ke; Tian, Shao-Dan; Chen, Xin-Yi; Yang, Guo-Wang

    2016-01-01

    Cancer-related fatigue (CRF) is a common and one of the most severe symptom in the period of onset, diagnosis, treatment and rehabilitation process of cancer. But there are no confirmed measures to relieve this problem at present. Traditional Chinese medical comprehensive therapy has its advantages in dealing with this condition. Based on the research status of CRF, the following problems have been analyzed and solved: the term of CRF has been defined and recommended, and the definition has been made clear; the disease mechanism is proposed, i.e. healthy qi has been impaired in the long-term disease duration, in the process of surgery, chemotherapy, radiotherapy and biology disturbing; it is clear that the clinical manifestations are related to six Chinese medicine patterns: decreased functioning of the Pi (Spleen) and Wei (Stomach), deficiency of the Pi with dampness retention, deficiency of the Xin (Heart) and Pi, disharmony between the Gan (Liver) and Pi, deficiency of the Pi and Shen (Kidney), and deficiency of the Fei (Lung) and Shen. Based on its severity, the mild patients are advised to have non-drug psychological intervention and sleep treatment in cooperation with appropriate exercise; diet therapy are recommended to moderate patients together with sleep treatment and acupuncture, severe patients are recommended to have herbal treatment based on pattern differentiation together with physiological sleep therapy.

  19. Home iv Antibiotic Therapy through a Medical Day Care Unit

    Directory of Open Access Journals (Sweden)

    Marie Gourdeau

    1993-01-01

    Full Text Available An out-patient parenteral antibiotic therapy program provided through a medical day care unit was evaluated in a tertiary care hospital. From July 11, 1988 to December 31, 1990, 122 patients were treated either on site at the unit or at home with self-administered intravenous antibiotics. In all, 142 courses of parenteral antibiotics (mostly cephalosporins and clindamycin were given for a total of 124 infections, mostly bone and soft tissue infections (67 of 124, 54%. The duration of out-patient therapy ranged from two to 62 days with a mean duration of 9.4 days if treated at the unit, or 13.2 days in the home care model (1476 patient-days. Vein access was peripheral and catheters remained functional for an average of 4.9 days (range 0.5 to 22 days. Only two patients experienced adverse drug reactions that necessitated modification of treatment. One other case was readmitted to the hospital for surgical debridement. The average cost per patient-day was $66 compared with $375 for in-hospital therapy. This program proved to be safe, efficient, and cost-effective.

  20. 21 CFR 892.5050 - Medical charged-particle radiation therapy system.

    Science.gov (United States)

    2010-04-01

    ...-particle radiation therapy system. (a) Identification. A medical charged-particle radiation therapy system... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Medical charged-particle radiation therapy system... equipment, patient and equipment supports, treatment planning computer programs, component parts, and...

  1. MR imaging in epilepsy that is refractory to medical therapy

    International Nuclear Information System (INIS)

    Cakirer, S.; Basak, M.; Mutlu, A.; Galip, G.M.

    2002-01-01

    The aim of this study was the assessment of detection rate on MRI and description of MRI findings in patients with medically intractable epilepsy. Seventy-three patients with medically intractable epilepsy between the ages of 0 and 68 years old were evaluated by MRI, on three planes with spin-echo T1, fast spin-echo T2, and fluid-attenuated inversion recovery sequences, and, if necessary, with contrast-enhanced SE T1 sequences. Cerebral infarct regions with atrophy and gliosis in 8 patients, cerebral tumors in 5 patients, hippocampal sclerosis in 16 patients, radial microbrain in 1 patient, cortical dysplasia in 3 patients, pachygyria in 2 patients, subcortical heterotopia in 2 patients, schizencephaly in 3 patients, cerebral hemiatrophy in 2 patients, tuberous sclerosis in 1 patient, herpes encephalitis in 2 patients, Rasmussen's encephalitis in 1 patient, vascular malformations in 5 patients, and no abnormality in 22 patients were detected. Magnetic resonance imaging has a high success rate in detecting structural brain abnormalities, of both temporal and extratemporal locations, associated with medically intractable epilepsy syndromes. So MRI plays a primary role in planning of the treatment, primarily surgical therapy, by detecting structural epileptogenic lesions. (orig.)

  2. Several methods and apparatus of low-energy laser therapy in veterinary practice

    Science.gov (United States)

    Svirin, Vaytcheslav N.; Rogatkin, Dmitrii A.; Barybin, Vitalii F.

    1998-12-01

    During same years various medical effect of low-energy laser therapy in veterinary were tested. We established that the laser low-energy therapy can be very effective for treatment such animal's diseases as mastitis and demodekose when certain combinations of laser beam parameters are used. This combinations were taken as the principle of a number of laser veterinary apparatus, which we started to produce at `POLUS'. It is our series of apparatus `VEGA-MB' and `VETLAS-3', which is real used today for dogs and cows treatment in Russia.

  3. Energy expenditure in growing preterm infants receiving massage therapy.

    Science.gov (United States)

    Lahat, Sharon; Mimouni, Francis B; Ashbel, Gina; Dollberg, Shaul

    2007-08-01

    Massage therapy has been consistently shown to increase weight gain in preterm infants. The mechanism of this presumed improved metabolic efficiency is unknown. We conducted the following trial to test the hypothesis that massage therapy reduces energy expenditure in growing healthy preterm infants. A prospective, randomized, cross-over design study was conducted in 10 healthy, appropriate weights for gestational age, gavage fed preterm infants. Each infant was studied twice: after a period of either 5 days of massage therapy, or after a period of 5 days without massage therapy. Infants were randomized to 5 days of massage followed by 5 days of no massage (n = 5) or the opposite sequence (n = 5). During the massage therapy period, massage was provided daily for three 15 minute periods at the beginning of each 3 hour period every morning. Metabolic measurements were performed by indirect calorimetry, using the Deltatrac II Metabolic cart. Energy expenditure was significantly lower in infants after the 5 day massage therapy period (59.6 +/- 3.6 Kcal/Kg/ 24 hours) than after the period without (63.1 +/- 5.4 Kcal/Kg/ 24 hours) (p = 0.05). Energy expenditure is significantly lowered by 5 days of massage therapy in metabolically and thermally stable preterm infants. This decrease in energy expenditure may be in part responsible for the enhanced growth caused by massage therapy.

  4. Optimal medical therapy in chronic heart failure-an audit

    International Nuclear Information System (INIS)

    Hussain, S.; Kayani, A.M.; Munir, R.

    2013-01-01

    Objective: Systolic heart failure is a chronic condition with significant morbidity and mortality. Evidence based optimal medical therapy (OMT) has been shown to reduce mortality. Underuse of OMT due to multiple reasons has been a consistent problem. The study objective was to audit the use of OMT in patients with heart Failure. Study Design: Descriptive study. Place and Duration of study: This audit was carried out in AFIC-NIHD from April 2011- February 2012. Material and Methods: Seventy consecutive stage D heart failure patients were included in the study. The patients were assessed clinically by a cardiologist and all previous documentations, referral letters, prescriptions, and purchase receipts were reviewed. To identify any other medication patients might have been taking (which did not appear on the prescriptions) patients were asked to identify common medicine packs. The patients underwent a detailed clinical evaluation including history, physical examination. Relevant investigations were done. ACCF/AHA (American College of Cardiology Foundation / American Heart Association) and ESC (European Society of Cardiology) guidelines for the diagnosis and treatment of acute and chronic heart failure were taken as standard of care. Results: In our audit we found that a large proportion of patients who were at high risk as per the Seattle Heart Failure Model (SHFM) were not on OMT, only 4.3% of the patients were on beta blockers that have been shown to improve mortality in the large randomized clinical trials, 64.3% were not taking any beta blockers where as 55.7% were not on ACE inhibitors and adding the OMT greatly reduced their mortality risk. Conclusions: We concluded that a large proportion of patients were not on OMT despite not having any contraindication to such therapy. This deprives them of significant survival benefit. (author)

  5. Medication therapy disease management: Geisinger's approach to population health management.

    Science.gov (United States)

    Jones, Laney K; Greskovic, Gerard; Grassi, Dante M; Graham, Jove; Sun, Haiyan; Gionfriddo, Michael R; Murray, Michael F; Manickam, Kandamurugu; Nathanson, Douglas C; Wright, Eric A; Evans, Michael A

    2017-09-15

    Pharmacists' involvement in a population health initiative focused on chronic disease management is described. Geisinger Health System has cultivated a culture of innovation in population health management, as highlighted by its ambulatory care pharmacy program, the Medication Therapy Disease Management (MTDM) program. Initiated in 1996, the MTDM program leverages pharmacists' pharmacotherapy expertise to optimize care and improve outcomes. MTDM program pharmacists are trained and credentialed to manage over 16 conditions, including atrial fibrillation (AF) and multiple sclerosis (MS). Over a 15-year period, Geisinger Health Plan (GHP)-insured patients with AF whose warfarin therapy was managed by the MTDM program had, on average, 18% fewer emergency department (ED) visits and 18% fewer hospitalizations per year than GHP enrollees with AF who did not receive MTDM services, with 23% lower annual total care costs. Over a 2-year period, GHP-insured patients with MS whose pharmacotherapy was managed by pharmacists averaged 28% fewer annual ED visits than non-pharmacist-managed patients; however, the mean annual total care cost was 21% higher among MTDM clinic patients. The Geisinger MTDM program has evolved over 20 years from a single pharmacist-run anticoagulation clinic into a large program focused on managing the health of an ever-growing population. Initial challenges in integrating pharmacists into the Geisinger patient care framework as clinical experts were overcome by demonstrating the MTDM program's positive impact on patient outcomes. Copyright © 2017 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

  6. Stroke: advances in medical therapy and acute stroke intervention.

    Science.gov (United States)

    Barrett, Kevin M; Lal, Brajesh K; Meschia, James F

    2015-10-01

    Evidence-based therapeutic options for stroke continue to emerge based on results from well-designed clinical studies. Ischemic stroke far exceeds hemorrhagic stroke in terms of prevalence and incidence, both in the USA and worldwide. The public health effect of reducing death and disability related to ischemic stroke justifies the resources that have been invested in identifying safe and effective treatments. The emergence of novel oral anticoagulants for ischemic stroke prevention in atrial fibrillation has introduced complexity to clinical decision making for patients with this common cardiac arrhythmia. Some accepted ischemic stroke preventative strategies, such as carotid revascularization for asymptomatic carotid stenosis, require reassessment, given advances in risk factor management, antithrombotic therapy, and surgical techniques. Intra-arterial therapy, particularly with stent retrievers after intravenous tissue plasminogen activator, has recently been demonstrated to improve functional outcomes and will require investment in system-based care models to ensure that effective treatments are received by patients in a timely fashion. The purpose of this review is to describe recent advances in medical and surgical approaches to ischemic stroke prevention and acute treatment. Results from recently published clinical trials will be highlighted along with ongoing clinical trials addressing key questions in ischemic stroke management and prevention where equipoise remains.

  7. Preliminary safety evaluation for a medical therapy reactor

    International Nuclear Information System (INIS)

    Jones, J.L.; Neuman, W.A.

    1989-01-01

    A conceptual design of a passively safe reactor facility for boron neutron capture therapy has been previously described. The medical therapy reactor (MTR) has a maximum power level of 10 MW(thermal) and utilizes 45 wt% uranium in UZrH, 20 wt% 235 U enriched hydride fuel matrix with 1 wt% erbium, which is a burnable poison and provides prompt negative reactivity feedback. The facility has five beam ports for patient treatment and advanced neutron beam research and is capable of 2,000 to 10,000 treatments per year, assuming single 8h/day, 5 day/week operation. The epithermal treatment flux from the beam ports is large, enabling single-session treatment of brain cancers of <10-min duration, with minimal fast neutron and gamma contaminants. The reactor core is designed with sufficient excess reactivity to yield a core lifetime equal to a facility lifetime of 30 yr. A preliminary safety evaluation was performed using the RELAP5 thermal-hydraulic code. The analysis addressed accidents in several major categories, including a pump coastdown, a loss of secondary heat sink, and a $0.5 step reactivity insertion

  8. Medication therapy management clinic: perception of healthcare professionals in a University medical center setting

    Directory of Open Access Journals (Sweden)

    Shah M

    2013-09-01

    Full Text Available Objective: To determine the overall perception and utilization of the pharmacist managed medication therapy management (MTM clinic services, by healthcare professionals in a large, urban, university medical care setting.Methods: This was a cross-sectional, anonymous survey sent to 195 healthcare professionals, including physicians, nurses, and pharmacists at The University of Illinois Outpatient Care Center to determine their perception and utilization of the MTM clinic. The survey consisted of 12 questions and was delivered through a secure online application. Results: Sixty-two healthcare professionals (32% completed the survey. 82% were familiar with the MTM clinic, and 63% had referred patients to the clinic. Medication adherence and disease state management was the most common reason for referral. Lack of knowledge on the appropriate referral procedure was the prominent reason for not referring patients to the MTM clinic. Of the providers that were aware of MTM services, 44% rated care as ‘excellent’, 44% as ‘good’, 5% as ‘fair’, and 0% stated ‘poor’. Strengths of MTM clinic identified by healthcare providers included in-depth education to patients, close follow-up, and detailed medication reconciliation provided by MTM clinic pharmacists. Of those familiar with MTM clinic, recommendations included; increase marketing efforts to raise awareness of the MTM clinic service, create collaborative practice agreements between MTM pharmacists and physicians, and ensure that progress notes are more concise.Conclusion: In a large, urban, academic institution MTM clinic is perceived as a valuable resource to optimize patient care by providing patients with in-depth education as it relates to their prescribed medications and disease states. These identified benefits of MTM clinic lead to frequent patient referrals specifically for aid with medication adherence and disease state management.

  9. Radioiodine therapy versus antithyroid medications for Graves' disease.

    Science.gov (United States)

    Ma, Chao; Xie, Jiawei; Wang, Hui; Li, Jinsong; Chen, Suyun

    2016-02-18

    Graves' disease is the most common cause of hyperthyroidism. Both antithyroid medications and radioiodine are commonly used treatments but their frequency of use varies between regions and countries. Despite the commonness of the diagnosis, any possible differences between the two treatments with respect to long-term outcomes remain unknown. To assess the effects of radioiodine therapy versus antithyroid medications for Graves' disease. We performed a systematic literature search in the Cochrane Library, MEDLINE and EMBASE and the trials registers ICTRP Search Portal and ClinicalTrials.gov. The date of the last search was September 2015 for all databases. Randomised controlled trials (RCTs) comparing the effects of radioiodine therapy versus antithyroid medications for Graves' disease with at least two years follow-up. Two authors independently screened titles and abstracts for relevance. One author carried out screening for inclusion, data extraction and 'Risk of bias' assessment and a second author checked this. We presented data not suitable for meta-analysis as descriptive data. We analysed the overall quality of evidence utilising the GRADE instrument. We included two RCTs involving 425 adult participants with Graves' disease in this review. Altogether 204 participants were randomised to radioiodine therapy and 221 to methimazole therapy. A single dose of radioiodine was administered. The duration of methimazole medication was 18 months. The period of follow-up was at least two years, depending on the outcome measured. For most outcome measures risk of bias was low; for the outcomes health-related quality of life as well as development and worsening of Graves' ophthalmopathy risks of performance bias and detection bias were high in at least one of the two RCTs.Health-related quality of life appeared to be similar in the radioiodine and methimazole treatment groups, however no quantitative data were reported (425 participants; 2 trials; low quality evidence

  10. [Comparison between Endoscopic Therapy and Medical Therapy in Peptic Ulcer Patients with Adherent Clot: A Multicenter Prospective Observational Cohort Study].

    Science.gov (United States)

    Kim, Si Hye; Jung, Jin Tae; Kwon, Joong Goo; Kim, Eun Young; Lee, Dong Wook; Jeon, Seong Woo; Park, Kyung Sik; Lee, Si Hyung; Park, Jeong Bae; Ha, Chang Yoon; Park, Youn Sun

    2015-08-01

    The optimal management of bleeding peptic ulcer with adherent clot remains controversial. The purpose of this study was to compare clinical outcome between endoscopic therapy and medical therapy. We also evaluated the risk factors of rebleeding in Forrest type IIB peptic ulcer. Upper gastrointestinal (UGI) bleeding registry data from 8 hospitals in Korea between February 2011 and December 2013 were reviewed and categorized according to the Forrest classification. Patients with acute UGI bleeding from peptic ulcer with adherent clots were enrolled. Among a total of 1,101 patients diagnosed with peptic ulcer bleeding, 126 bleedings (11.4%) were classified as Forrest type IIB. Of the 126 patients with adherent clots, 84 (66.7%) received endoscopic therapy and 42 (33.3%) were managed with medical therapy alone. The baseline characteristics of patients in two groups were similar except for higher Glasgow Blatchford Score and pre-endoscopic Rockall score in medical therapy group. Bleeding related mortality (1.2% vs.10%; p=0.018) and all cause mortality (3.7% vs. 20.0%; p=0.005) were significantly lower in the endoscopic therapy group. However, there was no difference between endoscopic therapy and medical therapy regarding rebleeding (7.1% vs. 9.5%; p=0.641). In multivariate analysis, independent risk factors of rebleeding were previous medication with aspirin and/or NSAID (OR, 13.1; p=0.025). In patients with Forrest type IIB peptic ulcer bleeding, endoscopic therapy was associated with a significant reduction in bleeding related mortality and all cause mortality compared with medical therapy alone. Important risk factor of rebleeding was use of aspirin and/or NSAID.

  11. Therapy with 90Y microspheres: radiation protection in new medical therapies

    International Nuclear Information System (INIS)

    Rojo, Ana; Puerta, Nancy

    2013-01-01

    Primary liver cancer is one of the most frequent in the world and with a low cure rate. Radioembolization using 90y spheres is a promising treatment of this pathology and involves the percutaneous vascular application of radioisotope-labeled the order of Micron size particles. The advantages of this technique include the permit administered high doses of radiation to small volumes with low relative toxicity, offer the possibility of treating all the liver including microscopic tumors, and finally, the feasibility of combined with other therapies. Radiation protection in new medical therapies requires justification and optimization, as requirements for their implementation. The application of the principle of optimization in the context of the protection of the patient must be the minimum that it can be reasonably reached compatible with the required doses of treatment dose to healthy tissue. With 90 Y microspheres therapy this optimization applies to the activity of 90y which is administered to the patient, and estimation methods are postulated. in this work are analyzed comparatively these methods, described the early physicists, equations and the limitations of each. Finally, it is concluded that the optimal method to be implemented for the evaluation of the activity of 90 Y manage must be based in a voxel dosimetric model specific for each patient, however, the partitional method may be a good alternative if you don't have the tools to apply the method

  12. Comparison of Medical and Voice Therapy for reflux Laryngitis Based on Acoustic and Laryngeal Characteristics

    Directory of Open Access Journals (Sweden)

    Abbas Dehestani Ardakani

    2011-12-01

    Full Text Available Background and Aim: Reflux laryngitis is extremely common among patients with voice disorder. Medical therapy approaches are not efficient enough. The main goal of this study is to assess the acoustic and laryngeal characteristics of patients with dysphonia before and after medical or voice therapy, and to evaluate the effectiveness of each.Methods: In this retrospective study, 16 reflux laryngitis patients were assessed. Five received complete voice therapy, tow ceased voice therapy and nine received medication. Perceptual voice evaluation was performed by a speech-language pathologist, the severity of voice problem was calculated, based on the affected acoustic and laryngeal characteristics pre- and post-treatment.Results: Post-treatment evaluation in patients who received complete voice therapy indicates 80 percent improvement in the severity of disorder and 100 percent improvement in the perceptual voice evaluation. After medical therapy, we observed that voice disorder and perceptual voice evaluation are improved 44 and 66 percent respectively. The improvement was statistically significant in both treatment approaches: complete voice therapy (P=0.039 and medical therapy (p=0.017.Conclusion: In patients with reflux laryngitis, most acoustic and laryngeal characteristics were normal and satisfying after the treatment. It can be concluded that the proficiency of voice therapy in improving the acoustic and laryngeal characteristics is comparable to medical therapy

  13. A System Approach to Navy Medical Education and Training. Appendix 8 Occupational/Physical Therapy Technician.

    Science.gov (United States)

    1974-08-31

    job analysis was implemented to a level of methodology determination. These methods and curriculum materials constituted a third (instructional) sub...Technician 8494 Physical Therapy Technician 8495 Dermatology Technician 8496 Embalming Technician 8497 Medical Illustration Technician 8498 Medical...IGIVE ICE PACK TREATMENT 9 IAPPLY WET COMPRESSESISOAKSIPACKS I 10 IGIVE INFRARED TREATMENT 11 IGIVE ULTRAVIOLET TREATMENT 12 EXPLAIN UVL THERAPY

  14. Fixed Field Alternating Gradient (FFAG)accelerators and their medical application in proton therapy

    International Nuclear Information System (INIS)

    Fourrier, J.

    2008-10-01

    Radiotherapy uses particle beams to irradiate and kill cancer tumors while sparing healthy tissues. Bragg peak shape of the proton energy loss in matter allows a ballistic improvement of the dose deposition compared with X rays. Thus, the irradiated volume can be precisely adjusted to the tumour. This thesis, in the frame of the RACCAM project, aims to the study and the design of a proton therapy installation based on a fixed field alternating gradient (FFAG) accelerator in order to build a spiral sector FFAG magnet for validation. First, we present proton therapy to define medical specifications leading to the technical specifications of a proton therapy installation. Secondly, we introduce FFAG accelerators through their past and on-going projects which are on their way around the world before developing the beam dynamic theories in the case of invariant focusing optics (scaling FFAG). We describe modelling and simulation tools developed to study the dynamics in a spiral scaling FFAG accelerator. Then we explain the spiral optic parameter search which has leaded to the construction of a magnet prototype. Finally, we describe the RACCAM project proton therapy installation starting from the injector cyclotron and ending with the extraction system. (author)

  15. Paired-eye comparison of medical therapies for glaucoma

    Directory of Open Access Journals (Sweden)

    Alfred M Solish

    2010-09-01

    Full Text Available Alfred M Solish1,2, Friedericke James1, John G Walt3, Tina H Chiang31Southern California Glaucoma Consultants, Pasadena CA, USA; 2Jules Stein Eye Institute, University of California Los Angeles, Los Angeles, 3Allergan Inc., Irvine, CA, USA Objective: To evaluate efficacy and patient preference retrospectively among intraocular pressure (IOP-lowering prostamide and prostaglandin medications in a real-world clinical setting.Methods: Chart review of patients with uncontrolled glaucoma or ocular hypertension seen at a private practice clinic (n = 55 who received bimatoprost 0.03% once daily in one eye and either travoprost 0.004% or latanoprost 0.005% once daily in the fellow eye. IOP was evaluated at the initial visit and at a follow-up visit scheduled 4–6 weeks later. At the follow-up visit, each patient discussed the clinical results with their physician, chose which medication they preferred to continue using, and were queried regarding the reason for their choice. This paired-eye comparison method is used routinely in clinical practice to assess clinical response and involve patients in decisions regarding treatment. Change in mean IOP from baseline and patient medication choice were the outcome measures.Results: Bimatoprost-treated eyes (n = 52 had a mean IOP reduction of 2.7 mmHg and travoprost-treated eyes (n = 47 had an average decrease of 1.7 mmHg (P = 0.230. Bimatoprost significantly reduced mean IOP (from 19.8 mmHg at baseline to 17.1 mmHg at follow-up, P < 0.0001, as did travoprost (from 19.4 mmHg at baseline to 17.7 mmHg at follow-up, P = 0.009. Latanoprost-treated eyes were excluded from the efficacy analysis due to small sample size (n = 5. For continued therapy, patients chose bimatoprost over travoprost by a factor of 2.4 to 1. Of the 15 patients who gave a reason for their choice, 80% said their decision was based primarily on IOP change.Conclusions: Bimatoprost and travoprost were efficacious in reducing IOP among patients with

  16. Medical expulsive therapy for distal ureteric stones: tamsulosin versus silodosin

    Directory of Open Access Journals (Sweden)

    Vittorio Imperatore

    2014-06-01

    Full Text Available Objectives: To compare the efficacy and safety of tamsulosin and silodosin in the context of medical expulsive therapy (MET of distal ureteric stones. Patients and methods: Observational data were collected retrospectively from patients who received silodosin (N = 50 or tamsulosin (N = 50 as MET from January 2012 to January 2013. Inclusion criteria were: patients aged ≥ 18 years with a single, unilateral, symptomatic, radiopaque ureteric stone of 10 mm or smaller in the largest dimension located between the lower border of the sacroiliac joint and the vesico-ureteric junction. Stone expulsion rate, stone expulsion time, number of pain episodes, need for analgesics use, incidence of side effects were compared. Results: Stone-expulsion rate in the silodosin and in the tamsulosin groups were 88% and 82%, respectively (p not significant. Mean expulsion times were 6.7 and 6.5 days in the silodosin and tamsulosin group, respectively (p not significant. Mean number of pain episodes were 1.6 and 1.7 in the silodosin and tamsulosin group, respectively (p not significant. The mean number of analgesic requirement was 0.84 and 0.9 for the silodosin and tamsulosin group, respectively (p not significant. Overall, incidence of side effects was similar in both groups. Patients taking silodosin experienced an higher incidence of retrograde ejaculation but a lower incidence of side effects related to peripheral vasodilation when compared to patients taking tamsulosin. Subgroup analysis demonstrated significantly lower mean expulsion times and pain episodes in patients with stones ≤ 5 mm in both groups. Conclusions: Tamsulosin and silodosin are equally effective as MET for distal ureteric stones sized 10 mm or smaller. MET with silodosin is associatd with a lower incidence of side effects related to peripheral vasodilation but an higher incidence of retrograde ejaculation when compared to tamsulosin.

  17. Pharmacy technician involvement in community pharmacy medication therapy management.

    Science.gov (United States)

    Lengel, Matthew; Kuhn, Catherine H; Worley, Marcia; Wehr, Allison M; McAuley, James W

    To assess the impact of technician involvement on the completion of medication therapy management (MTM) services in a community pharmacy setting and to describe pharmacists' and technicians' perceptions of technician involvement in MTM-related tasks and their satisfaction with the technician's role in MTM. Prospective observational study. In the fall of 2015, pharmacists and selected technicians from 32 grocery store-based community pharmacies were trained to use technicians within MTM services. Completed MTM claims were evaluated at all pharmacies for 3 months before training and 3 months after training. An electronic survey, developed with the use of competencies taught in the training and relevant published literature, was distributed via e-mail to trained employees 3 months after training. The total number of completed MTM claims at the 32 pharmacy sites was higher during the posttraining time period (2687 claims) versus the pretraining period (1735 claims). Of the 182 trained participants, 112 (61.5%) completed the survey. Overall, perceived technician involvement was lower than expected. However, identifying MTM opportunities was the most commonly reported technician MTM task, with 62.5% of technicians and 47.2% of pharmacists reporting technician involvement. Nearly one-half of technicians (42.5%) and pharmacists (44.0%) agreed or strongly agreed they were satisfied with the technician's role in MTM services, and 40.0% of technicians agreed that they were more satisfied with their work in the pharmacy after involvement in MTM. Three months after initial training of technicians in MTM, participation of technicians was lower than expected. However, the technicians involved most often reported identifying MTM opportunities for pharmacists, which may be a focus for future technician trainings. In addition, technician involvement in MTM services may increase satisfaction with many aspects of work for actively involved technicians. Copyright © 2018 American

  18. Medical expulsive therapy for distal ureteric stones: tamsulosin versus silodosin.

    Science.gov (United States)

    Imperatore, Vittorio; Fusco, Ferdinando; Creta, Massimiliano; Di Meo, Sergio; Buonopane, Roberto; Longo, Nicola; Imbimbo, Ciro; Mirone, Vincenzo

    2014-06-30

    To compare the efficacy and safety of tamsulosin and silodosin in the context of medical expulsive therapy (MET) of distal ureteric stones. Observational data were collected retrospectively from patients who received silodosin (N = 50) or tamsulosin (N = 50) as MET from January 2012 to January 2013. Inclusion criteria were: patients aged ≥ 18 years with a single, unilateral, symptomatic, radiopaque ureteric stone of 10 mm or smaller in the largest dimension located between the lower border of the sacroiliac joint and the vesico-ureteric junction. Stone expulsion rate, stone expulsion time, number of pain episodes, need for analgesics use, incidence of side effects were compared. Stone-expulsion rate in the silodosin and in the tamsulosin groups were 88% and 82%, respectively (p not significant). Mean expulsion times were 6.7 and 6.5 days in the silodosin and tamsulosin group, respectively (p not significant). Mean number of pain episodes were 1.6 and 1.7 in the silodosin and tamsulosin group, respectively (p not significant). The mean number of analgesic requirement was 0.84 and 0.9 for the silodosin and tamsulosin group, respectively (p not significant). Overall, incidence of side effects was similar in both groups. Patients taking silodosin experienced an higher incidence of retrograde ejaculation but a lower incidence of side effects related to peripheral vasodilation when compared to patients taking tamsulosin. Subgroup analysis demonstrated significantly lower mean expulsion times and pain episodes in patients with stones ≤ 5 mm in both groups. Tamsulosin and silodosin are equally effective as MET for distal ureteric stones sized 10 mm or smaller. MET with silodosin is associatd with a lower incidence of side effects related to peripheral vasodilation but an higher incidence of retrograde ejaculation when compared to tamsulosin.

  19. Variable-Energy Cyclotron for Proton Therapy Application

    CERN Document Server

    Alenitsky, Yu G; Vorozhtsov, A S; Glazov, A A; Mytsyn, G V; Molokanov, A G; Onishchenko, L M

    2004-01-01

    The requirements to characteristics of the beams used for proton therapy are considered. The operation and proposed cyclotrons for proton therapy are briefly described. The technical decisions of creation of the cyclotron with energy variation in the range 70-230 MeV and with current up to 100 nA are estimated. Taking into account the fact, that the size and cost of the cyclotron are approximately determined by the maximum proton energy, it is realistically offered to limit the maximum proton energy to 190 MeV and to elaborate a cyclotron project with a warm winding of the magnet for acceleration of H^{-} ions. The energy of the extracted protons for each run is determined by a stripped target radius in the vacuum chamber of the accelerator, and the radiation dose field for the patient is created by the external devices using the developed techniques.

  20. Medical Therapy Versus Balloon Angioplasty for CTEPH: A Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Phan, Kevin; Jo, Helen E; Xu, Joshua; Lau, Edmund M

    2018-01-01

    A significant number of chronic thromboembolic pulmonary hypertension (CTEPH) patients will have an inoperable disease. Medical therapy and balloon pulmonary angioplasty (BPA) have provided alternate therapeutic options for patients with inoperable CTEPH, although there are a limited number of published studies examining the outcomes. Thus, our study aims to evaluate and compare the efficacy of medical therapy and BPA in patients with inoperable CTEPH. An electronic search of six databases was performed and the search results were screened against established criteria for inclusion into this study. Data was extracted and meta-analytical techniques were used to analyse the data. Pooled data from RCTs revealed that medical therapy, compared with a placebo, was associated with a significant improvement of at least one functional class (p=0.038). With regards to pulmonary haemodynamics, medical therapy also resulted in a significant reduction in both mean pulmonary arterial pressure (mPAP) (p=0.002) and pulmonary vascular resistance (PVR) (pmedical therapy by an average of 22.8% (pmedical therapy for CTEPH (p=0.001). Pooled data from available observational studies of medical therapy or BPA all demonstrated significant improvements in mPAP and PVR for pre versus post intervention comparisons. The improvement in mPAP (p=0.002) and PVR (p=0.002) were significantly greater for BPA intervention when compared to medical therapy. High-quality evidence supports the use of targeted medical therapy in improving haemodynamics in patients with inoperable CTEPH. There is only moderate-quality evidence from observational studies supporting the efficacy of BPA in improving both haemodynamics and exercise capacity. Further RCTs and prospective observational studies comparing medical therapy and BPA in patients with inoperable CTEPH are required. Copyright © 2017 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New

  1. A Variable Energy CW Compact Accelerator for Ion Cancer Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Johnstone, Carol J. [Fermilab; Taylor, J. [Huddersfield U.; Edgecock, R. [Huddersfield U.; Schulte, R. [Loma Linda U.

    2016-03-10

    Cancer is the second-largest cause of death in the U.S. and approximately two-thirds of all cancer patients will receive radiation therapy with the majority of the radiation treatments performed using x-rays produced by electron linacs. Charged particle beam radiation therapy, both protons and light ions, however, offers advantageous physical-dose distributions over conventional photon radiotherapy, and, for particles heavier than protons, a significant biological advantage. Despite recognition of potential advantages, there is almost no research activity in this field in the U.S. due to the lack of clinical accelerator facilities offering light ion therapy in the States. In January, 2013, a joint DOE/NCI workshop was convened to address the challenges of light ion therapy [1], inviting more than 60 experts from diverse fields related to radiation therapy. This paper reports on the conclusions of the workshop, then translates the clinical requirements into accelerat or and beam-delivery technical specifications. A comparison of available or feasible accelerator technologies is compared, including a new concept for a compact, CW, and variable energy light ion accelerator currently under development. This new light ion accelerator is based on advances in nonscaling Fixed-Field Alternating gradient (FFAG) accelerator design. The new design concepts combine isochronous orbits with long (up to 4m) straight sections in a compact racetrack format allowing inner circulating orbits to be energy selected for low-loss, CW extraction, effectively eliminating the high-loss energy degrader in conventional CW cyclotron designs.

  2. Feasibility of energy harvesting techniques for wearable medical devices.

    Science.gov (United States)

    Voss, Thaddaeus J; Subbian, Vignesh; Beyette, Fred R

    2014-01-01

    Wearable devices are arguably one of the most rapidly growing technologies in the computing and health care industry. These systems provide improved means of monitoring health status of humans in real-time. In order to cope with continuous sensing and transmission of biological and health status data, it is desirable to move towards energy autonomous systems that can charge batteries using passive, ambient energy. This not only ensures uninterrupted data capturing, but could also eliminate the need to frequently remove, replace, and recharge batteries. To this end, energy harvesting is a promising area that can lead to extremely power-efficient portable medical devices. This paper presents an experimental prototype to study the feasibility of harvesting two energy sources, solar and thermoelectric energy, in the context of wearable devices. Preliminary results show that such devices can be powered by transducing ambient energy that constantly surrounds us.

  3. ALARA in diagnosis and therapy: for an equilibrium medically reasonable

    International Nuclear Information System (INIS)

    Aurengo, A.; Fraboulet, P.

    1998-01-01

    After a recall about the differences of conceptions in radiation protection in the medical field it is shown how it is possible to make with efficiency an optimization approach and to lead towards an equilibrium medically acceptable between the therapeutic necessity and the protection of medical personnel. The problem of the patients radiation protection is out of this frame. (N.C.)

  4. The effects of home oxygen therapy on energy metabolism in patients with COPD

    Science.gov (United States)

    Kırıcı Berber, Nurcan; Yetkin, Özkan; Kılıç, Talat; Berber, Ilhami; Özgel, Mehmet

    2018-01-01

    Background COPD is preventable and treatable and is characterized by completely nonreversible airflow obstruction. In this study, we aimed to investigate the effect of long-term oxygen therapy on patients with stage 4 COPD who were followed up and treated at the polyclinic or clinic service. We evaluated the effects of oxygen therapy on energy metabolism and physical activity in patients with COPD. Methods Nineteen patients with COPD (16 male/3 female), treated with oxygen therapy for the first time, were included in this study. Analysis of arterial blood gases and pulmonary function test was performed. Metabolic Holter device (SenseWear® Armband) was placed pre- and post-oxygen therapy on the patients’ arm for at least 3 days. This device captures Holter data in a digitized electronic system, and the daily average value was calculated from the data. Results Post-oxygen treatment showed a significant increase in energy expenditure by patients with COPD (pretreatment, 1,497±596 joule; posttreatment, 2,977±5,985 joule; P=0.044). Moreover, number of steps during walking (pretreatment, 2,056±256; posttreatment, 2,120±195; P=0.03), resting (pretreatment, 6.36±3.31 hours; posttreatment, 3.47±2.19 hours; P<0.03), and sleeping (pretreatment, 4.23±2.13 hours; posttreatment, 2.33±1.42 hours; P<0.00) showed significant differences. Increased daily energy expenditure in patients with respiratory failure was detected with long-term oxygen therapy. In addition, the immobility of patients decreased and duration of physical activity increased in patients with COPD. Conclusion In this study, positive effects of long-term oxygen therapy have been demonstrated with respect to energy metabolism and physical activity of patients with COPD. Thus, we recommend that medication adherence and long-term oxygen therapy should begin early in patients with COPD.

  5. Radiation therapy. 1990-2001. International Atomic Energy Agency publications

    International Nuclear Information System (INIS)

    2001-04-01

    This catalog lists all sales publications of the International Atomic Energy Agency dealing with Radiation Therapy, and issued during the period 1 January 1990 - 30 April 2001. Most publications are issued in English, though some are also available in other languages. These are noted in the catalogue

  6. Cognitive-Behavioral Therapy for HIV Medication Adherence and Depression

    Science.gov (United States)

    Safren, Steven A.; Hendriksen, Ellen S.; Mayer, Kenneth H.; Mimiaga, Matthew J.; Pickard, Robert; Otto, Michael W.

    2004-01-01

    For patients with HIV, depression is a common, distressing condition that can interfere with a critical self-care behavior--adherence to antiretroviral therapy. The present study describes a cognitive-behavioral treatment designed to integrate cognitive-behavioral therapy for depression with our previously tested approach to improving adherence to…

  7. Integrating pharmacogenomics into pharmacy practice via medication therapy management.

    Science.gov (United States)

    Reiss, Susan M

    2011-01-01

    To explore the application and integration of pharmacogenomics in pharmacy clinical practice via medication therapy management (MTM) to improve patient care. Department of Health & Human Services (HHS) Personalized Health Care Initiative, Food and Drug Administration (FDA) pharmacogenomics activity, and findings from the Utilizing E-Prescribing Technologies to Integrate Pharmacogenomics into Prescribing and Dispensing Practices Stakeholder Workshop, convened by the American Pharmacists Association (APhA) on March 5, 2009. Participants at the Stakeholder Workshop included diverse representatives from pharmacy, medicine, pathology, health information technology (HIT), standards, science, academia, government, and others with a key interest in the clinical application of pharmacogenomics. In 2006, HHS initiated the Personalized Health Care Initiative with the goal of building the foundation for the delivery of gene-based care, which may prove to be more effective for large patient subpopulations. In the years since the initiative was launched, drug manufacturers and FDA have begun to incorporate pharmacogenomic data and applications of this information into the drug development, labeling, and approval processes. New applications and processes for using this emerging pharmacogenomics data are needed to effectively integrate this information into clinical practice. Building from the findings of a stakeholder workshop convened by APhA and the advancement of the pharmacist's collaborative role in patient care through MTM, emerging roles for pharmacists using pharmacogenomic information to improve patient care are taking hold. Realizing the potential role of the pharmacist in pharmacogenomics through MTM will require connectivity of pharmacists into the electronic health record infrastructure to permit the exchange of pertinent health information among all members of a patient's health care team. Addressing current barriers, concerns, and system limitations and developing

  8. Wireless energy transfer platform for medical sensors and implantable devices.

    Science.gov (United States)

    Zhang, Fei; Hackworth, Steven A; Liu, Xiaoyu; Chen, Haiyan; Sclabassi, Robert J; Sun, Mingui

    2009-01-01

    Witricity is a newly developed technique for wireless energy transfer. This paper presents a frequency adjustable witricity system to power medical sensors and implantable devices. New witricity resonators are designed for both energy transmission and reception. A prototype platform is described, including an RF power source, two resonators with new structures, and inductively coupled input and output stages. In vitro experiments, both in open air and using a human head phantom consisting of simulated tissues, are employed to verify the feasibility of this platform. An animal model is utilized to evaluate in vivo energy transfer within the body of a laboratory pig. Our experiments indicate that witricity is an effective new tool for providing a variety of medical sensors and devices with power.

  9. Cost-Benefit Analysis of Radiation Therapy Services at Tripler Army Medical Center

    National Research Council Canada - National Science Library

    Diehl, Diane S

    2004-01-01

    The purpose of this analysis was to examine the costs and benefits associated with continuance of "in-house" radiation therapy services to eligible beneficiaries at Tripler Army Medical Center (TAMC...

  10. Concomitant medication polypharmacy, interactions and imperfect adherence are common in Australian adults on suppressive antiretroviral therapy

    NARCIS (Netherlands)

    Siefried, Krista J; Mao, Limin; Cysique, Lucette A; Rule, John; Giles, Michelle L; Smith, Don E; McMahon, James E.; Read, Tim R; Ooi, Catriona; Tee, Ban K; Bloch, Mark; de Wit, John; Carr, Andrew

    2018-01-01

    OBJECTIVES: We quantified concomitant medication polypharmacy, pharmacokinetic and pharmacodynamic interactions, adverse effects and adherence in Australian adults on effective antiretroviral therapy. DESIGN: Cross-sectional. METHODS: Patients recruited into a nationwide cohort and assessed for

  11. Germ-line gene therapy and the medical imperative.

    Science.gov (United States)

    Munson, Ronald; Davis, Lawrence H

    1992-06-01

    Somatic cell gene therapy has yielded promising results. If germ cell gene therapy can be developed, the promise is even greater: hundreds of genetic diseases might be virtually eliminated. But some claim the procedure is morally unacceptable. We thoroughly and sympathetically examine several possible reasons for this claim but find them inadequate. There is no moral reason, then, not to develop and employ germ-line gene therapy. Taking the offensive, we argue next that medicine has a prima facie moral obligation to do so.

  12. Music as a complementary therapy in medical treatment

    OpenAIRE

    Samuel Halim

    2002-01-01

    Music can act not only as a source of enjoyable sound that gives pleasant feeling, but also a source of healing. Music as a therapy has developed, supported by many researches conducted by experts in music, education and medicine. The impact of music therapy can be observed in many case studies, showing the positive effects of music to the betterment of human’s neuro-behavior, emotional and physical states. Some reasons to use music as a therapy are: toget audioanalgesic response, to focus at...

  13. Development of a Hospital-based Massage Therapy Course at an Academic Medical Center.

    Science.gov (United States)

    Dion, Liza J; Cutshall, Susanne M; Rodgers, Nancy J; Hauschulz, Jennifer L; Dreyer, Nikol E; Thomley, Barbara S; Bauer, Brent

    2015-03-01

    Massage therapy is offered increasingly in US medical facilities. Although the United States has many massage schools, their education differs, along with licensure and standards. As massage therapy in hospitals expands and proves its value, massage therapists need increased training and skills in working with patients who have various complex medical concerns, to provide safe and effective treatment. These services for hospitalized patients can impact patient experience substantially and provide additional treatment options for pain and anxiety, among other symptoms. The present article summarizes the initial development and description of a hospital-based massage therapy course at a Midwest medical center. A hospital-based massage therapy course was developed on the basis of clinical experience and knowledge from massage therapists working in the complex medical environment. This massage therapy course had three components in its educational experience: online learning, classroom study, and a 25-hr shadowing experience. The in-classroom study portion included an entire day in the simulation center. The hospital-based massage therapy course addressed the educational needs of therapists transitioning to work with interdisciplinary medical teams and with patients who have complicated medical conditions. Feedback from students in the course indicated key learning opportunities and additional content that are needed to address the knowledge and skills necessary when providing massage therapy in a complex medical environment. The complexity of care in medical settings is increasing while the length of hospital stay is decreasing. For this reason, massage provided in the hospital requires more specialized training to work in these environments. This course provides an example initial step in how to address some of the educational needs of therapists who are transitioning to working in the complex medical environment.

  14. Optimizing proton therapy at the LBL medical accelerator

    Energy Technology Data Exchange (ETDEWEB)

    Alonso, J.

    1992-03-01

    This Grant has marked the beginning of a multi-year study process expected to lead to design and construction of at least one, possibly several hospital-based proton therapy facilities in the United States.

  15. Optimizing proton therapy at the LBL medical accelerator. Final report

    Energy Technology Data Exchange (ETDEWEB)

    Alonso, J.

    1992-03-01

    This Grant has marked the beginning of a multi-year study process expected to lead to design and construction of at least one, possibly several hospital-based proton therapy facilities in the United States.

  16. Therapy 101: A Psychotherapy Curriculum for Medical Students

    Science.gov (United States)

    Aboul-Fotouh, Frieda; Asghar-Ali, Ali Abbas

    2010-01-01

    Objective: This pilot project, designed and taught by a resident, created a curriculum to introduce medical students to the practice of psychotherapy. Medical students who are knowledgeable about psychotherapy can become physicians who are able to refer patients to psychotherapeutic treatments. A search of the literature did not identify a…

  17. Supervising Family Therapy Trainees in Primary Care Medical Settings: Context Matters

    Science.gov (United States)

    Edwards, Todd M.; Patterson, Jo Ellen

    2006-01-01

    The purpose of this article is to identify and describe four essential skills for effective supervision of family therapy trainees in primary care medical settings. The supervision skills described include: (1) Understand medical culture; (2) Locate the trainee in the treatment system; (3) Investigate the biological/health issues; and (4) Be…

  18. Energy, emissions and emergency medical services: Policy matters

    International Nuclear Information System (INIS)

    Brown, Lawrence H.; Blanchard, Ian E.

    2012-01-01

    Understanding the energy consumption and emissions associated with health services is important for minimizing their environmental impact and guiding their adaptation to a low-carbon economy. In this post-hoc analysis, we characterize the energy burden of North American emergency medical services (EMS) agencies and estimate the potential marginal damage costs arising from their emissions as an example of how and why health services matter in environmental and energy policy, and how and why environmental and energy policy matter to health services. We demonstrate EMS systems are energy intensive, and that vehicle fuels represent 80% of their energy burden while electricity and natural gas represent 20%. We also demonstrate that emissions from EMS operations represent only a small fraction of estimated health sector emissions, but for EMS systems in the United States the associated marginal damage costs are likely between $2.7 million and $9.7 million annually. Significant changes in the supply or price of energy, including changes that arise from environmental and energy policy initiatives designed to constrain fossil fuel consumption, could potentially affect EMS agencies and other health services. We encourage cross disciplinary research to proactively facilitate the health system's adaptation to a low-carbon economy. - Highlights: ► Estimated EMS-related emissions less than 1% of health sector emissions. ► Damage costs of U.S. EMS-related emissions estimated at $2.7 to $9.7 million. ► EMS energy burden is approximately 442 MJ per ambulance response. ► Approximately 80% of EMS energy burden is vehicle fuels. ► Energy supply, price and policy could impact EMS (and other health) services. ► Research needed to facilitate health services’ adaptation to a low carbon economy.

  19. Prolactinomas, Cushing's disease and acromegaly: debating the role of medical therapy for secretory pituitary adenomas

    Directory of Open Access Journals (Sweden)

    Bonert Vivien S

    2010-05-01

    Full Text Available Abstract Pituitary adenomas are associated with a variety of clinical manifestations resulting from excessive hormone secretion and tumor mass effects, and require a multidisciplinary management approach. This article discusses the treatment modalities for the management of patients with a prolactinoma, Cushing's disease and acromegaly, and summarizes the options for medical therapy in these patients. First-line treatment of prolactinomas is pharmacotherapy with dopamine agonists; recent reports of cardiac valve abnormalities associated with this class of medication in Parkinson's disease has prompted study in hyperprolactinemic populations. Patients with resistance to dopamine agonists may require other treatment. First-line treatment of Cushing's disease is pituitary surgery by a surgeon with experience in this condition. Current medical options for Cushing's disease block adrenal cortisol production, but do not treat the underlying disease. Pituitary-directed medical therapies are now being explored. In several small studies, the dopamine agonist cabergoline normalized urinary free cortisol in some patients. The multi-receptor targeted somatostatin analogue pasireotide (SOM230 shows promise as a pituitary-directed medical therapy in Cushing's disease; further studies will determine its efficacy and safety. Radiation therapy, with medical adrenal blockade while awaiting the effects of radiation, and bilateral adrenalectomy remain standard treatment options for patients not cured with pituitary surgery. In patients with acromegaly, surgery remains the first-line treatment option when the tumor is likely to be completely resected, or for debulking, especially when the tumor is compressing neurovisual structures. Primary therapy with somatostatin analogues has been used in some patients with large extrasellar tumors not amenable to surgical cure, patients at high surgical risk and patients who decline surgery. Pegvisomant is indicated in patients

  20. Laser-Driven Very High Energy Electron/Photon Beam Radiation Therapy in Conjunction with a Robotic System

    Directory of Open Access Journals (Sweden)

    Kazuhisa Nakajima

    2014-12-01

    Full Text Available We present a new external-beam radiation therapy system using very-high-energy (VHE electron/photon beams generated by a centimeter-scale laser plasma accelerator built in a robotic system. Most types of external-beam radiation therapy are delivered using a machine called a medical linear accelerator driven by radio frequency (RF power amplifiers, producing electron beams with an energy range of 6–20 MeV, in conjunction with modern radiation therapy technologies for effective shaping of three-dimensional dose distributions and spatially accurate dose delivery with imaging verification. However, the limited penetration depth and low quality of the transverse penumbra at such electron beams delivered from the present RF linear accelerators prevent the implementation of advanced modalities in current cancer treatments. These drawbacks can be overcome if the electron energy is increased to above 50 MeV. To overcome the disadvantages of the present RF-based medical accelerators, harnessing recent advancement of laser-driven plasma accelerators capable of producing 1-GeV electron beams in a 1-cm gas cell, we propose a new embodiment of the external-beam radiation therapy robotic system delivering very high-energy electron/photon beams with an energy of 50–250 MeV; it is more compact, less expensive, and has a simpler operation and higher performance in comparison with the current radiation therapy system.

  1. Development of medical application methods using radiation. Radionuclide therapy

    International Nuclear Information System (INIS)

    Choi, Chang Woon; Lim, S. M.; Kim, E.H.; Woo, K. S.; Chung, W. S.; Lim, S. J.; Choi, T. H.; Hong, S. W.; Chung, H. Y.; No, W. C.; Oh, B. H.; Hong, H. J.

    1999-04-01

    In this project, we studied following subjects: 1. development of monoclonal antibodies and radiopharmaceuticals 2. clinical applications of radionuclide therapy 3. radioimmunoguided surgery 4. prevention of restenosis with intracoronary radiation. The results can be applied for the following objectives: 1) radionuclide therapy will be applied in clinical practice to treat the cancer patients or other diseases in multi-center trial. 2) The newly developed monoclonal antibodies and biomolecules can be used in biology, chemistry or other basic life science research. 3) The new methods for the analysis of therapeutic effects, such as dosimetry, and quantitative analysis methods of radioactivity, can be applied in basic research, such as radiation oncology and radiation biology

  2. Medical and biological requirements for boron neutron capture therapy

    International Nuclear Information System (INIS)

    Gahbauer, R.; Goodman, J.H.; Kanellitsas, C.; Clendenon, N.; Blue, J.

    1986-01-01

    In conventional radiation therapy, tumor doses applied to most solid tumors are limited by the tolerance of normal tissues. The promise of Boron Neutron Capture Therapy lies in its potential to deposit high doses of radiation very specifically to tumor tissue. Theoretically ratios of tumor to normal tissue doses can be achieved significantly higher than conventional radiotherapeutic techniques would allow. Effective dose distributions obtainable are a complex function of the neutron beam characteristics and the macro and micro distributions of boron in tumor and normal tissues. Effective RBE doses are calculated in tumors and normal tissue for thermal, epithermal and 2 keV neutrons

  3. Development of medical application methods using radiation. Radionuclide therapy

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Chang Woon; Lim, S. M.; Kim, E.H.; Woo, K. S.; Chung, W. S.; Lim, S. J.; Choi, T. H.; Hong, S. W.; Chung, H. Y.; No, W. C. [Korea Atomic Energy Research Institute. Korea Cancer Center Hospital, Seoul, (Korea, Republic of); Oh, B. H. [Seoul National University. Hospital, Seoul (Korea, Republic of); Hong, H. J. [Antibody Engineering Research Unit, Taejon (Korea, Republic of)

    1999-04-01

    In this project, we studied following subjects: 1. development of monoclonal antibodies and radiopharmaceuticals 2. clinical applications of radionuclide therapy 3. radioimmunoguided surgery 4. prevention of restenosis with intracoronary radiation. The results can be applied for the following objectives: (1) radionuclide therapy will be applied in clinical practice to treat the cancer patients or other diseases in multi-center trial. (2) The newly developed monoclonal antibodies and biomolecules can be used in biology, chemistry or other basic life science research. (3) The new methods for the analysis of therapeutic effects, such as dosimetry, and quantitative analysis methods of radioactivity, can be applied in basic research, such as radiation oncology and radiation biology.

  4. [Exercise Therapy in German Medical Rehabilitation - an Analysis based on Quantitative Routine Data].

    Science.gov (United States)

    Brüggemann, Silke; Sewöster, Daniela; Kranzmann, Angela

    2018-02-01

    This study describes the quantitative importance of exercise therapy in German medical rehabilitation based on 2014 routine data of the German Pension Insurance. It also shows changes in comparison with data from 2007. Data from 710012 rehabilitation discharge letters comprising 83677802 treatments from central indications in medical rehabilitation were analysed descriptively. Overall 35.4% of treatments could be classified as exercise therapy. Total and relative duration, percentage of individual treatment and kind of exercise treatment varied between indications in 2007 as well as in 2014. There were also differences between sexes, age groups and settings. During the period examined the high importance of exercise therapy in German medical rehabilitation has increased. The results point at a meaningful concept behind the composition of exercise therapy taking indications and disease related factors into account. © Georg Thieme Verlag KG Stuttgart · New York.

  5. Study on medical economic evaluation methods for metastatic brain tumors therapy

    International Nuclear Information System (INIS)

    Takura, Tomoyuki; Hayashi, Motohiro; Muragaki, Yoshihiro; Iseki, Hiroshi; Uetsuka, Yoshio

    2010-01-01

    Treatment design for metastatic brain tumors is required to firstly care about the life and function for which the patient hopes because it is terminal care. Therefore, to discuss the value of the therapy, a viewpoint of the quality of life (QOL) and the socioeconomic factors other than the survival rate is important. However, examination that applies these factors to the therapy needs to be carried out more thoroughly. With this in mind, we discuss cost effectiveness of therapy for metastatic brain tumor, through a pilot study on gamma knife therapy. We studied 18 patients (mean age 61.6 years old) undergoing therapy for metastatic brain tumors. The health rate QOL was assessed by the profile-type measure SF-36 (Short-Form 36-Item Ver1.2) and the preference-based measure EQ-5D (EuroQoL-5D), before and six months after gamma knife therapy. Cost-utility-analysis (yen/Qaly) was carried out from quality adjusted life years (Qalys) and medical fee claims. In addition, we made a correlation analysis of the irradiation procedure and the gains attained. The observation by SF-36 for six months was useful for metastatic brain tumor. As a result, the QOL indicators showed increased mental health (MH: p=0.040) and role emotional (RE: p=0.029) with significant difference. In the measurement of EQ-5D, it was added only for one month based on the significant difference (p=0.022) from the pre-therapy QOL. The utilities that were analyzed became 0.052±0.175 standard deviation (SD) (score), and Qalys were 0.135. Because the cost was 721.4±5.2 SD (thousand yen), the performance of cost-utility-analysis was estimated as 5,330,000 (yen/Qaly). In addition, positive correlation (r=0.845/p=0.034) was found between the EQ-5D utility score and the tumor irradiation energy (mJ), etc. We established a new value over and above mere survival rate concerning metastatic brain tumor therapy. The socioeconomics and efficacy of therapy are more difficult to discuss in this disease than in other

  6. Graphene-based nanovehicles for photodynamic medical therapy

    Directory of Open Access Journals (Sweden)

    Li Y

    2015-03-01

    Full Text Available Yan Li,1 Haiqing Dong,1 Yongyong Li,1 Donglu Shi1,2 1Shanghai East Hospital, The Institute for Biomedical Engineering and Nano Science (iNANO, Tongji University School of Medicine, Shanghai, People’s Republic of China; 2The Materials Science and Engineering Program, Department of Mechanical and Materials Engineering, College of Engineering and Applied Science, University of Cincinnati, Cincinnati, OH, USA Abstract: Graphene and its derivatives such as graphene oxide (GO have been widely explored as promising drug delivery vehicles for improved cancer treatment. In this review, we focus on their applications in photodynamic therapy. The large specific surface area of GO facilitates efficient loading of the photosensitizers and biological molecules via various surface functional groups. By incorporation of targeting ligands or activatable agents responsive to specific biological stimulations, smart nanovehicles are established, enabling tumor-triggering release or tumor-selective accumulation of photosensitizer for effective therapy with minimum side effects. Graphene-based nanosystems have been shown to improve the stability, bioavailability, and photodynamic efficiency of organic photosensitizer molecules. They have also been shown to behave as electron sinks for enhanced visible-light photodynamic activities. Owing to its intrinsic near infrared absorption properties, GO can be designed to combine both photodynamic and photothermal hyperthermia for optimum therapeutic efficiency. Critical issues and future aspects of photodynamic therapy research are addressed in this review. Keywords: graphene, nanovehicle, photodynamic therapy, photosensitizer, hyperthermia

  7. Report on Disaster Medical Operations with Acupuncture/Massage Therapy after the Great East Japan Earthquake

    Directory of Open Access Journals (Sweden)

    Shin Takayama

    2012-01-01

    Full Text Available The Great East Japan Earthquake inflicted immense damage over a wide area of eastern Japan with the consequent tsunami. Department of Traditional Asian Medicine, Tohoku University, started providing medical assistance to the disaster-stricken regions mainly employing traditional Asian therapies. We visited seven evacuation centers in Miyagi and Fukushima Prefecture and provided acupuncture/massage therapy. While massage therapy was performed manually, filiform needles and press tack needles were used to administer acupuncture. In total, 553 people were treated (mean age, 54.0 years; 206 men, 347 women. Assessment by interview showed that the most common complaint was shoulder/back stiffness. The rate of therapy satisfaction was 92.3%. Many people answered that they experienced not only physical but also psychological relief. At the time of the disaster, acupuncture/massage therapy, which has both mental and physical soothing effects, may be a therapeutic approach that can be effectively used in combination with Western medical practices.

  8. Long-Term Outcomes of Patent Foramen Ovale Closure or Medical Therapy after Stroke.

    Science.gov (United States)

    Saver, Jeffrey L; Carroll, John D; Thaler, David E; Smalling, Richard W; MacDonald, Lee A; Marks, David S; Tirschwell, David L

    2017-09-14

    Whether closure of a patent foramen ovale reduces the risk of recurrence of ischemic stroke in patients who have had a cryptogenic ischemic stroke is unknown. In a multicenter, randomized, open-label trial, with blinded adjudication of end-point events, we randomly assigned patients 18 to 60 years of age who had a patent foramen ovale (PFO) and had had a cryptogenic ischemic stroke to undergo closure of the PFO (PFO closure group) or to receive medical therapy alone (aspirin, warfarin, clopidogrel, or aspirin combined with extended-release dipyridamole; medical-therapy group). The primary efficacy end point was a composite of recurrent nonfatal ischemic stroke, fatal ischemic stroke, or early death after randomization. The results of the analysis of the primary outcome from the original trial period have been reported previously; the current analysis of data from the extended follow-up period was considered to be exploratory. We enrolled 980 patients (mean age, 45.9 years) at 69 sites. Patients were followed for a median of 5.9 years. Treatment exposure in the two groups was unequal (3141 patient-years in the PFO closure group vs. 2669 patient-years in the medical-therapy group), owing to a higher dropout rate in the medical-therapy group. In the intention-to-treat population, recurrent ischemic stroke occurred in 18 patients in the PFO closure group and in 28 patients in the medical-therapy group, resulting in rates of 0.58 events per 100 patient-years and 1.07 events per 100 patient-years, respectively (hazard ratio with PFO closure vs. medical therapy, 0.55; 95% confidence interval [CI], 0.31 to 0.999; P=0.046 by the log-rank test). Recurrent ischemic stroke of undetermined cause occurred in 10 patients in the PFO closure group and in 23 patients in the medical-therapy group (hazard ratio, 0.38; 95% CI, 0.18 to 0.79; P=0.007). Venous thromboembolism (which comprised events of pulmonary embolism and deep-vein thrombosis) was more common in the PFO closure group

  9. [Medical treatment of breast cancer: chemotherapy and tailored therapy].

    Science.gov (United States)

    Dalenc, Florence

    2013-12-01

    The utility of adjuvant chemotherapy is clearly demonstrated because she significantly improved relapse and mortality. Globally, we report a one-third breast cancer mortality reduction. Nevertheless, the absolute or individual benefit is uncertain and the final decision depends on benefit-risk balance, integrating tumor biologic characteristics and comorbidities. The most effective regimen must contain an anthracycline and a taxane. This regimen must be proposed if chemotherapy indication is considered: this concerns the majority of triple-negative and HER2-positive cancer For hormone-receptor-positive and HER2-negative breast cancer, the decision of adjuvant or not (in addition to hormonal therapy) is most difficult, particularly for grade 2 tumors. The trastuzumab is an essential treatment for HER2-positive breast cancer, because this tailored therapy has considerably improved the prognosis.

  10. Acceptance-based behavior therapy to promote HIV medication adherence.

    Science.gov (United States)

    Moitra, Ethan; Herbert, James D; Forman, Evan M

    2011-12-01

    A significant number of adults with HIV in the USA do not maintain adherence to highly active antiretroviral therapy (HAART) at adequate levels. Although traditional cognitive behavioral interventions have shown promise in promoting HAART adherence, acceptance-based behavior therapy (ABBT) may be particularly useful in this population. ABBT has the potential to overcome common avoidance-based barriers associated with poor adherence, including denial of various illness-related factors and avoidance of stigmatization. We describe the rationale for promoting psychological and behavioral acceptance in HIV-positive populations; outline an ABBT to promote HAART adherence targeting primary care patients from urban, minority, low socioeconomic backgrounds; and report preliminary qualitative observations of treatment feasibility and acceptability.

  11. Improvement of cardiac function persists long term with medical therapy for left ventricular systolic dysfunction.

    Science.gov (United States)

    Chen, David; Chang, Richard; Umakanthan, Branavan; Stoletniy, Liset N; Heywood, J Thomas

    2007-09-01

    In certain patients with left ventricular (LV) systolic dysfunction, improvements in cardiac function are seen after initiation of medical therapy; however, the long-term stability of ventricular function in such patients is not well described. We retrospectively analyzed 171 patients who had a baseline ejection fraction of 45% or less, a follow-up echocardiogram at 2 to 12 months after initiation of medical therapy, and a final echocardiogram. We found that 48.5% of the patients demonstrated initial improvements in LV function after initiation of medical therapy, and the improvements appear to be sustained (88% of patients) at 44 +/- 21 months follow-up. A nonischemic etiology and younger age were the only independent predictors of change of LV ejection fraction of 10 or more at a mean 8.4 +/- 3.4 months after optimal medical therapy. Our study revealed a trend toward improved long-term survival in individuals with an early improvement in LV ejection fraction with medical therapy, especially in those with sustained improvement.

  12. Bluetooth low energy: wireless connectivity for medical monitoring.

    Science.gov (United States)

    Omre, Alf Helge

    2010-03-01

    Electronic wireless sensors could cut medical costs by enabling physicians to remotely monitor vital signs such as blood pressure, blood glucose, and blood oxygenation while patients remain at home. According to the IDC report "Worldwide Bluetooth Semiconductor 2008-2012 Forecast," published November 2008, a forthcoming radio frequency communication ("wireless connectivity") standard, Bluetooth low energy, will link wireless sensors via radio signals to the 70% of cell phones and computers likely to be fitted with the next generation of Bluetooth wireless technology, leveraging a ready-built infrastructure for data transmission. Analysis of trends indicated by this data can help physicians better manage diseases such as diabetes. The technology also addresses the concerns of cost, compatibility, and interoperability that have previously stalled widespread adoption of wireless technology in medical applications. (c) 2010 Diabetes Technology Society.

  13. The FLUKA Code: Developments and Challenges for High Energy and Medical Applications

    CERN Document Server

    Böhlen, T T; Chin, M P W; Fassò, A; Ferrari, A; Ortega, P G; Mairani, A; Sala, P R; Smirnov, G; Vlachoudis, V

    2014-01-01

    The FLUKA Monte Carlo code is used extensively at CERN for all beam-machine interactions, radioprotection calculations and facility design of forthcoming projects. Such needs require the code to be consistently reliable over the entire energy range (from MeV to TeV) for all projectiles (full suite of elementary particles and heavy ions). Outside CERN, among various applications worldwide, FLUKA serves as a core tool for the HIT and CNAO hadron-therapy facilities in Europe. Therefore, medical applications further impose stringent requirements in terms of reliability and predictive power, which demands constant refinement of sophisticated nuclear models and continuous code improvement. Some of the latest developments implemented in FLUKA are presented in this paper, with particular emphasis on issues and concerns pertaining to CERN and medical applications.

  14. Acute effects of energy drinks in medical students.

    Science.gov (United States)

    García, Andrés; Romero, César; Arroyave, Cristhian; Giraldo, Fabián; Sánchez, Leidy; Sánchez, Julio

    2017-09-01

    To determine the acute effects of a variety of recognized energy drinks on medical students, based on the hypothesis that these beverages may affect negatively cardiovascular parameters, stress levels and working memory. Eighty young healthy medical students were included in the study. 62.5 % of the participants were male, and the age mean was 21.45 years. Each person was evaluated via measurement of systolic and diastolic blood pressure, electrocardiogram (ECG), heart rate, oxygen saturation, breath rate, temperature, STAI score (to assess anxiety state), salivary cortisol and N-back task score (to determine cognitive enhancement). These evaluations were performed before and following the intake of either carbonated water or one of three energy drinks containing caffeine in similar concentrations and an undetermined energy blend; A contained less sugar and no taurine. Thirty-minute SBP increased significantly in the A and C groups. The B group exhibited a diminution of the percentage of the 1-h SBP increase, an increase of 1-h DBP and QTc shortening. HR showed an increase in the percent change in the A and C groups. Cortisol salivary levels increased in the B group. The STAI test score decreased in the C group. The percent change in N-back scores increased in the A group. The data reinforce the need for further research on the acute and chronic effects of energy drinks to determine the actual risks and benefits. Consumers need to be more informed about the safety of these energy drinks, especially the young student population.

  15. Medication-Related Osteonecrosis of Jaws: A Low-Level Laser Therapy and Antimicrobial Photodynamic Therapy Case Approach

    Directory of Open Access Journals (Sweden)

    Mariana Comparotto Minamisako

    2016-01-01

    Full Text Available Medication-related osteonecrosis of the jaws (MRONJ can be considered an inability of the alveolar bone to respond to an injury, which frequently leads to severe local and systemic complications. Once the problem is installed, dentist must use all therapeutic approaches recommended. This manuscript reports a successful management of MRONJ handled with antibiotics, conservative debridement, low-level laser therapy (LLLT, and photodynamic therapy (PDT up to 12 months. As healing of MRONJ may be very slow, combined therapeutic approaches are required. Besides the recommended conventional treatment protocol, LLLT and PDT are important tools to contribute to healing and improvement of patient’s quality of life.

  16. Electron beam ion sources for use in second generation synchrotrons for medical particle therapy

    Science.gov (United States)

    Zschornack, G.; Ritter, E.; Schmidt, M.; Schwan, A.

    2014-02-01

    Cyclotrons and first generation synchrotrons are the commonly applied accelerators in medical particle therapy nowadays. Next generation accelerators such as Rapid Cycling Medical Synchrotrons (RCMS), direct drive accelerators, or dielectric wall accelerators have the potential to improve the existing accelerator techniques in this field. Innovative accelerator concepts for medical particle therapy can benefit from ion sources which meet their special requirements. In the present paper we report on measurements with a superconducting Electron Beam Ion Source, the Dresden EBIS-SC, under the aspect of application in combination with RCMS as a well proven technology. The measurements indicate that this ion source can offer significant advantages for medical particle therapy. We show that a superconducting EBIS can deliver ion pulses of medically relevant ions such as protons, C4 + and C6 + ions with intensities and frequencies required for RCMS [S. Peggs and T. Satogata, "A survey of Hadron therapy accelerator technology," in Proceedings of PAC07, BNL-79826- 2008-CP, Albuquerque, New Mexico, USA, 2007; A. Garonna, U. Amaldi et al., "Cyclinac medical accelerators using pulsed C6 +/H+_2 ion sources," in Proceedings of EBIST 2010, Stockholm, Sweden, July 2010]. Ion extraction spectra as well as individual ion pulses have been measured. For example, we report on the generation of proton pulses with up to 3 × 109 protons per pulse and with frequencies of up to 1000 Hz at electron beam currents of 600 mA.

  17. Fostering a culture of interprofessional education for radiation therapy and medical dosimetry students

    International Nuclear Information System (INIS)

    Lavender, Charlotte; Miller, Seth; Church, Jessica; Chen, Ronald C.; Muresan, Petronella A.; Adams, Robert D.

    2014-01-01

    A less-studied aspect of radiation therapy and medical dosimetry education is experiential learning through attendance at interprofessional conferences. University of North Carolina radiation therapy and medical dosimetry students regularly attended morning conferences and daily pretreatment peer review, including approximately 145 hours of direct interaction with medical attending physicians and residents, medical physicists, and other faculty. We herein assessed the effect of their participation in these interprofessional conferences on knowledge and communication. The students who graduated from our radiation therapy and medical dosimetry programs who were exposed to the interprofessional education initiative were compared with those who graduated in the previous years. The groups were compared with regard to their knowledge (as assessed by grades on end-of-training examinations) and team communication (assessed via survey). The results for the 2 groups were compared via exact tests. There was a trend for the examination scores for the 2012 cohort to be higher than for the 2007 to 2011 groups. Survey results suggested that students who attended the interprofessional education sessions were more comfortable speaking with attending physicians, residents, physicists, and faculty compared with earlier students who did not attend these educational sessions. Interprofessional education, particularly vertical integration, appears to provide an enhanced educational experience both in regard to knowledge (per the examination scores) and in building a sense of communication (via the survey results). Integration of interprofessional education into radiation therapy and medical dosimetry educational programs may represent an opportunity to enrich the learning experience in multiple ways and merits further study

  18. Fostering a culture of interprofessional education for radiation therapy and medical dosimetry students

    Energy Technology Data Exchange (ETDEWEB)

    Lavender, Charlotte, E-mail: charlavender@gmail.com; Miller, Seth; Church, Jessica; Chen, Ronald C.; Muresan, Petronella A.; Adams, Robert D.

    2014-04-01

    A less-studied aspect of radiation therapy and medical dosimetry education is experiential learning through attendance at interprofessional conferences. University of North Carolina radiation therapy and medical dosimetry students regularly attended morning conferences and daily pretreatment peer review, including approximately 145 hours of direct interaction with medical attending physicians and residents, medical physicists, and other faculty. We herein assessed the effect of their participation in these interprofessional conferences on knowledge and communication. The students who graduated from our radiation therapy and medical dosimetry programs who were exposed to the interprofessional education initiative were compared with those who graduated in the previous years. The groups were compared with regard to their knowledge (as assessed by grades on end-of-training examinations) and team communication (assessed via survey). The results for the 2 groups were compared via exact tests. There was a trend for the examination scores for the 2012 cohort to be higher than for the 2007 to 2011 groups. Survey results suggested that students who attended the interprofessional education sessions were more comfortable speaking with attending physicians, residents, physicists, and faculty compared with earlier students who did not attend these educational sessions. Interprofessional education, particularly vertical integration, appears to provide an enhanced educational experience both in regard to knowledge (per the examination scores) and in building a sense of communication (via the survey results). Integration of interprofessional education into radiation therapy and medical dosimetry educational programs may represent an opportunity to enrich the learning experience in multiple ways and merits further study.

  19. Some advances in medical applications of low energy accelerators

    Science.gov (United States)

    Valković, V.; Moschini, G.

    1991-05-01

    Medical applications of low energy accelerators include: the use of nuclear analytical methods and procedures for laboratory studies and routine measurements; material productions and modifications to meet special requirements; radioisotope productions and their applications in radiopharmaceuticals as well as in positron emission tomography; and radiotherapy with ions, based on improved understanding of the interaction of charged particles with living tissue. Some of the recent advances in these fields are critically summarized. The plan for an improved charged particle facility in a hospital environment dedicated to applications in biology and medicine is presented.

  20. Medical therapy, percutaneous coronary intervention and prognosis in patients with chronic total occlusions.

    Science.gov (United States)

    Ladwiniec, Andrew; Allgar, Victoria; Thackray, Simon; Alamgir, Farquad; Hoye, Angela

    2015-12-01

    There is little published data reporting outcomes for those found to have a chronic total coronary occlusion (CTO) that is electively treated medically versus those treated by percutaneous coronary intervention (PCI). We sought to compare long-term clinical outcomes between patients treated by PCI and elective medical therapy in a consecutive cohort of patients with an identified CTO. Patients found to have a CTO on angiography between January 2002 and December 2007 in a single tertiary centre were identified using a dedicated database. Those undergoing CTO PCI and elective medical therapy to the CTO were propensity matched to adjust for baseline clinical and angiographic differences. In total, 1957 patients were identified, a CTO was treated by PCI in 405 (20.7%) and medical therapy in 667 (34.1%), 885 (45.2%) patients underwent coronary artery bypass graft surgery. Of those treated by PCI or medical therapy, propensity score matching identified 294 pairs of patients, PCI was successful in 177 patients (60.2%). All-cause mortality at 5 years was 11.6% for CTO PCI and 16.7% for medical therapy HR 0.63 (0.40 to 1.00, p=0.052). The composite of 5-year death or myocardial infarction occurred in 13.9% of the CTO PCI group and 19.6% in the medical therapy group, HR 0.64 (0.42 to 0.99, p=0.043). Among the CTO PCI group, if the CTO was revascularised by any means during the study period, 5-year mortality was 10.6% compared with 18.3% in those not revascularised in the medical therapy group, HR 0.50 (0.28-0.88, p=0.016). Revascularisation, but not necessarily PCI of a CTO, is associated with improved long-term survival relative to medical therapy alone. 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/

  1. A questionnaire survey of medical physicist and quality manager for radiation therapy

    International Nuclear Information System (INIS)

    Nishio, Teiji; Ashino, Yasuo; Onishi, Hiroshi

    2008-01-01

    A questionnaire survey of medical physicists and quality managers for radiation therapy was performed by the Japanese Society for Therapeutic Radiology and Oncology (JASTRO) Future Planning Committee. We mailed the questionnaire to 726 radiotherapy facilities with the answers returned from 353 radiotherapy facilities. The result showed 178 facilities were staffed by radiotherapy workers who were licensed medical physicists or quality managers. A staff of 289 was licensed radiotherapy workers. Most of the staff were radiotherapy technologists. Quality control for radiation therapy was rated satisfactory according to each facility's assessment. Radiation therapy of high quality requires continued education of medical physicists and quality managers, in addition to keeping up with times for quality control. (author)

  2. Medication adherence to oral iron therapy in patients with iron deficiency anemia

    Science.gov (United States)

    Gereklioglu, Cigdem; Asma, Suheyl; Korur, Asli; Erdogan, Ferit; Kut, Altug

    2016-01-01

    Objective: This study aimed at investigating the factors affecting medication adherence in patients who use oral iron therapy due to iron deficiency anemia. Methods: A total of 96 female patients in fertile age with mean age of 30±10.1 years (range 18-53) who were admitted to Family Medicine Clinic between 01 January and 31 March 2015 and who had received iron therapy within the recent three years were enrolled in the study. Data were collected through a questionnaire form. Results: Of the patients, 39 (40,6%) were detected not to use the medication regularly or during the recommended period. A statistically significant relationship was found between non-adherence to therapy and gastrointestinal side effects and weight gain (p<0.05). Conclusion: Medication adherence is deficient in patients with iron deficiency anemia. The most important reason for this seems gastrointestinal side effects, in addition to weight gain under treatment. PMID:27375698

  3. Medication adherence to oral iron therapy in patients with iron deficiency anemia.

    Science.gov (United States)

    Gereklioglu, Cigdem; Asma, Suheyl; Korur, Asli; Erdogan, Ferit; Kut, Altug

    2016-01-01

    This study aimed at investigating the factors affecting medication adherence in patients who use oral iron therapy due to iron deficiency anemia. A total of 96 female patients in fertile age with mean age of 30±10.1 years (range 18-53) who were admitted to Family Medicine Clinic between 01 January and 31 March 2015 and who had received iron therapy within the recent three years were enrolled in the study. Data were collected through a questionnaire form. Of the patients, 39 (40,6%) were detected not to use the medication regularly or during the recommended period. A statistically significant relationship was found between non-adherence to therapy and gastrointestinal side effects and weight gain (p<0.05). Medication adherence is deficient in patients with iron deficiency anemia. The most important reason for this seems gastrointestinal side effects, in addition to weight gain under treatment.

  4. Medical radiation dosimetry theory of charged particle collision energy loss

    CERN Document Server

    McParland, Brian J

    2014-01-01

    Accurate radiation dosimetry is a requirement of radiation oncology, diagnostic radiology and nuclear medicine. It is necessary so as to satisfy the needs of patient safety, therapeutic and diagnostic optimisation, and retrospective epidemiological studies of the biological effects resulting from low absorbed doses of ionising radiation. The radiation absorbed dose received by the patient is the ultimate consequence of the transfer of kinetic energy through collisions between energetic charged particles and atoms of the tissue being traversed. Thus, the ability of the medical physicist to both measure and calculate accurately patient dosimetry demands a deep understanding of the physics of charged particle interactions with matter. Interestingly, the physics of charged particle energy loss has an almost exclusively theoretical basis, thus necessitating an advanced theoretical understanding of the subject in order to apply it appropriately to the clinical regime. ​ Each year, about one-third of the worl...

  5. Experiences of antidepressant medication and cognitive-behavioural therapy for depression: a grounded theory study.

    Science.gov (United States)

    Bayliss, Paul; Holttum, Sue

    2015-09-01

    To develop a preliminary model of the experiences of people undergoing combined treatment with antidepressant medication and cognitive-behavioural therapy (CBT) for depression. The study used a qualitative methodology informed by grounded theory. Participants were 12 adults who had received treatment with antidepressant medication and CBT for depression. Participants engaged in a semistructured interview about their experiences. Interviews were transcribed and analysed using components of grounded theory methodology. Medication was often seen as an initial aid to surviving a crisis. Staying on medication longer term resulted in some participants feeling caught in a 'drug loop'. Feeling that medication was unhelpful or actively harmful could contribute to participants seeking CBT. Medics also offered information on CBT and acted as gatekeepers, meaning that negotiation was sometimes necessary. CBT was described as a process of being guided towards skilled self-management. Occasionally, participants felt that medication had facilitated CBT at one or more stages. Conversely, developing skilled self-management through CBT could reduce feelings of dependency on medication and affect several of the other elements maintaining the 'drug loop'. Antidepressant medication and CBT are perceived and experienced differently, with CBT often being seen as an alternative to medication, or even as a means to discontinue medication. Service users' experiences and beliefs about medication may thus affect their engagement and goals in CBT, and it may be important for therapists to consider this. Practitioners who prescribe medication should ensure that they also provide information on the availability and appropriateness of CBT, and engage in an open dialogue about treatment options. CBT practitioners should explore aspects of clients' experiences and beliefs about medication. This would particularly include clients' experiences of the effects of medication, their beliefs about

  6. Medical therapy v. PCI in stable coronary artery disease: a cost-effectiveness analysis.

    Science.gov (United States)

    Wijeysundera, Harindra C; Tomlinson, George; Ko, Dennis T; Dzavik, Vladimir; Krahn, Murray D

    2013-10-01

    Percutaneous coronary intervention (PCI) with either drug-eluting stents (DES) or bare metal stents (BMS) reduces angina and repeat procedures compared with optimal medical therapy alone. It remains unclear if these benefits are sufficient to offset their increased costs and small increase in adverse events. Cost utility analysis of initial medical therapy v. PCI with either BMS or DES. . Markov cohort decision model. Data Sources. Propensity-matched observational data from Ontario, Canada, for baseline event rates. Effectiveness and utility data obtained from the published literature, with costs from the Ontario Case Costing Initiative. Patients with stable coronary artery disease, confirmed after angiography, stratified by risk of restenosis based on diabetic status, lesion size, and lesion length. Time Horizon. Lifetime. Perspective. Ontario Ministry of Health and Long Term Care. Interventions. Optimal medical therapy, PCI with BMS or DES. Lifetime costs, quality-adjusted life years (QALYs), and the incremental cost-effectiveness ratio (ICER). of Base Case Analysis. In the overall population, medical therapy had the lowest lifetime costs at $22,952 v. $25,081 and $25,536 for BMS and DES, respectively. Medical therapy had a quality-adjusted life expectancy of 10.1 v. 10.26 QALYs for BMS, producing an ICER of $13,271/QALY. The DES strategy had a quality-adjusted life expectancy of only 10.20 QALYs and was dominated by the BMS strategy. This ranking was consistent in all groups stratified by restenosis risk, except diabetic patients with long lesions in small arteries, in whom DES was cost-effective compared with medical therapy (ICER of $18,826/QALY). Limitations. There is the possibility of residual unobserved confounding. In patients with stable coronary artery disease, an initial BMS strategy is cost-effective.

  7. Management of endocrine disease: GH excess: diagnosis and medical therapy

    DEFF Research Database (Denmark)

    Andersen, Marianne

    2014-01-01

    Acromegaly is predominantly caused by a pituitary adenoma, which secretes an excess of GH resulting in increased IGF-I levels. Most of the GH assays used currently measure only the 22 kDa form of GH. In theory, the diagnostic sensitivity may be lower compared to the previous assays, which used...... polyclonal antibodies. Many GH-secreting adenomas are plurihormonal and may co-secrete prolactin, TSH and α-subunit. Hyperprolactinemia is found in 30-40% of patients with acromegaly and hyperprolactinemia may occasionally be diagnosed before acromegaly is apparent.Although trans-sphenoidal surgery of a GH......-secreting adenoma remains the first treatment at most centres, the role of somatostatin analogues, octreotide LAR and lanreotide Autogel, as primary therapy is still the subject of some debate. While normalization of GH and IGF-I levels is the main objective in all patients with acromegaly, GH and IGF-I levels may...

  8. Impact of a medication therapy management intervention targeting medications associated with falling: Results of a pilot study.

    Science.gov (United States)

    Mott, David A; Martin, Beth; Breslow, Robert; Michaels, Barb; Kirchner, Jeff; Mahoney, Jane; Margolis, Amanda

    2016-01-01

    The use of fall risk-increasing drugs (FRIDs) by older adults is one factor associated with falling, and FRID use is common among older adults. A targeted medication therapy management intervention focused on FRID use that included prescription and over-the-counter (OTC) medications, along with follow-up telephone calls was designed. The purpose of this pilot study was to examine preliminary effects of a medication therapy management (MTM) intervention focused on FRIDs provided by a community pharmacist to older adults. Randomized, controlled trial. One community pharmacy. Eighty older adults who completed a fall prevention workshop. The main outcome measures were the rate of discontinuing FRIDs, the proportion of older adults falling, and the number of falls. A secondary outcome was the acceptance rate of medication recommendations by patients and prescribers. Thirty-eight older adults received the targeted MTM intervention. Of the 31 older adults using a FRID, a larger proportion in the intervention group had FRID use modified relative to controls (77% and 28%, respectively; P FRID use among older adults was effective in modifying FRID use. This result supports the preliminary conclusion that community pharmacists can play an important role in modifying FRID use among older adults. Copyright © 2016 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.

  9. Immediate Dose-Response Effect of High-Energy Versus Low-Energy Extracorporeal Shock Wave Therapy on Cutaneous Microcirculation.

    Science.gov (United States)

    Kraemer, Robert; Sorg, Heiko; Forstmeier, Vinzent; Knobloch, Karsten; Liodaki, Eirini; Stang, Felix Hagen; Mailaender, Peter; Kisch, Tobias

    2016-12-01

    Elucidation of the precise mechanisms and therapeutic options of extracorporeal shock wave therapy (ESWT) is only at the beginning. Although immediate real-time effects of ESWT on cutaneous hemodynamics have recently been described, the dose response to different ESWT energies in cutaneous microcirculation has never been examined. Thirty-nine Sprague-Dawley rats were randomly assigned to three groups that received either focused high-energy shock waves (group A: total of 1000 impulses, 10 J) to the lower leg of the hind limb, focused low-energy shock waves (group B: total of 300 impulses, 1 J) or placebo shock wave treatment (group C: 0 impulses, 0 J) using a multimodality shock wave delivery system (Duolith SD-1 T-Top, Storz Medical, Tägerwilen, Switzerland). Immediate microcirculatory effects were assessed with the O2C (oxygen to see) system (LEA Medizintechnik, Giessen, Germany) before and for 20 min after application of ESWT. Cutaneous tissue oxygen saturation increased significantly higher after high-energy ESWT than after low-energy and placebo ESWT (A: 29.4% vs. B: 17.3% vs. C: 3.3%; p = 0.003). Capillary blood velocity was significantly higher after high-energy ESWT and lower after low-energy ESWT versus placebo ESWT (group A: 17.8% vs. group B: -22.1% vs. group C: -5.0%, p = 0.045). Post-capillary venous filling pressure was significantly enhanced in the high-energy ESWT group in contrast to the low-energy ESWT and placebo groups (group A: 25% vs. group B: 2% vs. group C: -4%, p = 0.001). Both high-energy and low-energy ESWT affect cutaneous hemodynamics in a standard rat model. High-energy ESWT significantly increases parameters of cutaneous microcirculation immediately after application, resulting in higher tissue oxygen saturation, venous filling pressure and blood velocity, which suggests higher tissue perfusion with enhanced oxygen saturation, in contrast to low-energy as well as placebo ESWT. Low-energy ESWT also increased tissue oxygen

  10. Energy-rich therapy for chronic fatigue syndrome

    Directory of Open Access Journals (Sweden)

    M. T. Baedilova

    2015-01-01

    Full Text Available The study included 84 children aged 12—16 years with chronic fatigue syndrome in the presence of mitral valve prolapse (MVP, who were treated with L-carnitine (Elcar 30% and Coenzyme Q10 (Kudevita. L-carnitine is involved in metabolic processes as a carrier of long-chain fatty acids from the cytoplasm to the mitochondria to produce ATP and acetyl-CoA. Coenzyme Q10 stimulates tissue respiration (aerobic processes and participates in electron transfer in the mitochondrial electron transport chain. The clinical efficacy of energy-rich drugs was investigated before and after their treatment. The therapy was based on the data of an investigation by M. Trivellato et al. on carnitine deficiency and on those of our trials: the children with MVP were observed to have a significant increase in malondialdehyde levels and conjugated diene oxidation indices, which underlie mitochondrial insufficiency. The investigation indicated that prior to their treatment 100% of the children had been observed to have fatigue after exercise, as well as headache, memory and attention focusing impairments, and idiopathic hypersomnia, 34% of the patients complained of palpitation, and 43% had stabbing cardialgia. Three months later, the children who had received combined energy-rich therapy were noted to have a pronounced positive effect: 82% of them had no clinical symptoms of chronic fatigue. 

  11. Medical Therapies for Endometriosis Differentially Inhibit Stem Cell Recruitment.

    Science.gov (United States)

    Ersoy, Gulcin Sahin; Zolbin, Masoumeh Majidi; Cosar, Emine; Mamillapalli, Ramanaiah; Taylor, Hugh S

    2017-06-01

    To determine the effect of the 3 well-known endometriosis treatments on stem cell recruitment to endometriotic lesions. C57BL/6 mice (aged 8 weeks, n = 20) underwent bone marrow transplant following submyeloablation with 5-fluorouracil using 20 × 10 6 bone marrow stem cells from green fluorescent protein (GFP) mice. Two weeks after transplantation, experimental endometriosis was created in mice by suturing segments of the uterine horn into the peritoneal cavity. Mice were then randomized to receive treatment with medroxyprogesterone acetate (MPA), leuprolide acetate (Gonadotrophin-Releasing Hormone Analogue [GnRHa]), letrozole, or vehicle control (dimethyl sulfoxide). After 3 weeks of treatment, the mice were killed and the endometriosis lesions evaluated. All 3 treatments resulted in a significant reduction in lesion volume and weight. Estrogen deprivation using GnRHa or letrozole resulted in greater lesion regression than the progestin MPA. The GFP + /CD45 - bone marrow-derived stem cells (BMDSCs) engrafted the lesions of endometriosis. Estrogen deprivation using GnRHa or letrozole significantly reduced BMDSC engraftment in the endometriosis lesions. MPA failed to significantly reduce stem cell number in endometriosis. The superiority of estrogen deprivation over progestin therapy in depriving the lesions of stem cells may have implications for the long-term treatment of endometriosis. Reduced stem cell engraftment is likely to result in long-term regression of the lesions, whereas progestins may only prevent their growth acutely.

  12. The evaluation of gastroesophageal reflux before and after medical therapies

    International Nuclear Information System (INIS)

    Malmud, L.S.; Fisher, R.S.

    1981-01-01

    Gastroesophageal scintigraphy is a quantitative technique that can be employed to detect and quantitate gastroesophageal reflux before and after the application of therapeutic modalities, including change in body position, bethanechol, atropine, antacids, and antacid-alginate compounds. Five groups of 10-15 patients each were studied before and after using each therapeutic modality and before and after atropine. The results were compared to the patient's symptomatology and to the acid reflux test. Gastroesophageal scintigraphy was performed following oral administration of 300 microCi 99mTc-sulfur colloid in 300 ml acidified orange juice. Thirty-second gamma camera images were obtained as the gastroesophageal gradient was increased from approximately 10 to 35 mm Hg at 5 mm Hg increments using an inflatable abdominal binder. Data were processed using a digital computer. Reflux was reduced by change in position from recumbent to upright, and by the use of subcutaneous bethanechol, oral antacid, or oral antacidalginate compound. Atropine increased reflux. Gastroesophageal scintigraphy is more sensitive than fluoroscopy, correlates well with clinical symptomatology, and is a reliable and convenient technique for the quantitative estimation of reflux before and after therapy

  13. The role of combination medical therapy in the treatment of acromegaly.

    Science.gov (United States)

    Lim, Dawn Shao Ting; Fleseriu, Maria

    2017-02-01

    Uncontrolled acromegaly results in approximately 2-fold excess mortality. Pituitary surgery is first-line therapy, and medical treatment is indicated for persistent disease. While cabergoline and pegvisomant are used in select patients, somatostatin receptor ligands (SRLs) remain the cornerstone of medical treatment. Management of patients poorly responsive to SRLs is therefore, challenging. The purpose of this review is to highlight the options for combination medical therapy in the treatment of acromegaly, with an emphasis on efficacy and safety. All original articles/abstracts detailing combination medical therapy in acromegaly were identified from a PubMed search. Studies reviewed included retrospective and open-label prospective studies. While the combination of SRL and cabergoline was generally well tolerated, a lower baseline insulin-like growth factor-1 (IGF-1) level was the best predictor of efficacy; this combination may be most effective in patients with mildly elevated IGF-1. SRL-pegvisomant combination normalized IGF-1 in the majority of patients; continued efficacy despite individual drug dosing reduction was also reported. The risk of significant liver enzyme elevation was, however, higher than that reported with SRL monotherapy; close monitoring is recommended. Data on pegvisomant-cabergoline combination is limited, but this may be an option in the setting of SRL intolerance. Reports on temozolomide used in combination with other medical therapies in patients with aggressive GH-secreting tumors are also summarized. While more prospective, randomized controlled trials on long-term efficacy and safety are needed, combination medical therapy remains a treatment strategy that should be considered for acromegaly patients poorly responsive to SRLs.

  14. Neuronal dysfunction and medical therapy in heart failure: can an imaging biomarker help to "personalize" therapy?

    Science.gov (United States)

    Wessler, Benjamin S; Udelson, James E

    2015-06-01

    (123)I-metaiodobenzylguanidine ((123)I-MIBG) imaging is a tool for evaluating one of the fundamental pathophysiologic abnormalities seen in heart failure (HF), that of an upregulated sympathetic nervous system and its effect on the myocardium. Although this imaging technique offers information about prognosis for patients treated with contemporary guideline-based HF therapies and improves risk stratification, there are neither rigorous nor sufficient outcome data to suggest that this imaging tool can guide therapeutic decision making or better target subsets of patients with HF for particular therapies. © 2015 by the Society of Nuclear Medicine and Molecular Imaging, Inc.

  15. Design study of a medical proton linac for neutron therapy

    International Nuclear Information System (INIS)

    Machida, S.; Raparia, D.

    1988-01-01

    This paper describes a design study which establishes the physical parameters of the low energy beam transport, radiofrequency quadrupole, and linac, using computer programs available at Fermilab. Beam dynamics studies verify that the desired beam parameters can be achieved. The machine described here meets the aforementioned requirements and can be built using existing technology. Also discussed are other technically feasible options which could be attractive to clinicians, though they would complicate the design of the machine and increase construction costs. One of these options would allow the machine to deliver 2.3 MeV protons to produce epithermal neutrons for treating brain tumors. A second option would provide 15 MeV protons for isotope production. 21 refs., 33 figs

  16. Evaluation of conditions of radiation protection of medical personnel in intracavitary neutron therapy of cervical cancer

    International Nuclear Information System (INIS)

    Kostromina, K.N.; Korenkov, I.P.; Bocharov, A.L.; Gladkikh, N.N.

    1991-01-01

    Combined radiation therapy was provided to cervical cancer patients. Working conditions of personnel were examined, the rate of exposure doses and flows of neutrons at working places were measured, dose exposures of the personnel were evaluated. It has been concluded that occupational conditions for the medical personnel are considered to be relatively safe

  17. Medical Family Therapy for a Woman with End-stage Crohn's Disease and Her Son.

    Science.gov (United States)

    McDaniel, Susan H.; Harkness, Jennifer L.; Epstein, Ronald M.

    2001-01-01

    Medical family therapy grew out of the experiences of family therapists working with other professionals to provide comprehensive, integrated healthcare for patients. This is the story of one such patient and provides an account of the experience through quotes from videotaped sessions and electronic mail communications that occurred throughout…

  18. 78 FR 61363 - Correction-Scientific Information Request on Medication Therapy Management

    Science.gov (United States)

    2013-10-03

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Agency for Healthcare Research and Quality Correction--Scientific Information Request on Medication Therapy Management The original date of publication for this....AHRQ.gov/index.cfm/submit-scientific-information-packets/ Dated: September 27, 2013. Richard Kronick...

  19. 42 CFR 423.153 - Drug utilization management, quality assurance, and medication therapy management programs (MTMPs).

    Science.gov (United States)

    2010-10-01

    ... PRESCRIPTION DRUG BENEFIT Cost Control and Quality Improvement Requirements § 423.153 Drug utilization... 42 Public Health 3 2010-10-01 2010-10-01 false Drug utilization management, quality assurance, and medication therapy management programs (MTMPs). 423.153 Section 423.153 Public Health CENTERS FOR MEDICARE...

  20. Prediction of Response to Medication and Cognitive Therapy in the Treatment of Moderate to Severe Depression

    Science.gov (United States)

    Fournier, Jay C.; DeRubeis, Robert J.; Shelton, Richard C.; Hollon, Steven D.; Amsterdam, Jay D.; Gallop, Robert

    2009-01-01

    A recent randomized controlled trial found nearly equivalent response rates for antidepressant medications and cognitive therapy in a sample of moderate to severely depressed outpatients. In this article, the authors seek to identify the variables that were associated with response across both treatments as well as variables that predicted…

  1. Problems of elderly patients on inhalation therapy: Difference in problem recognition between patients and medical professionals

    Directory of Open Access Journals (Sweden)

    Daiki Hira

    2016-10-01

    Conclusions: Elderly patients are apt to assume that they “understand well”, therefore, in order to recognize and close the perception gap between elderly patients and medical professionals, it is necessary to provide them with more aggressive (frequent instructions on inhalation therapy.

  2. Ritanserin as add-on medication to neuroleptic therapy for patients with chronic or subchronic schizophrenia

    NARCIS (Netherlands)

    Den Boer, JA; Vahlne, JO; Post, P; Heck, AH; Daubenton, F; Olbrich, R

    The effect of ritanserin, a potent 5HT(2A/2C) receptor antagonist, used as an add-on medication to neuroleptic treatmentin patients with schizophrenia, was compared with that of placebo, in an international, double-blind, parallel-group study. Previously established neuroleptic therapy was

  3. Medical expulsive therapy for ureteral stones: where do we go from here?

    NARCIS (Netherlands)

    Somani, Bhaskar K.; Aboumarzouk, Omar; Traxer, Olivier; Baard, Joyce; Kamphuis, Guido; de la Rosette, Jean

    2016-01-01

    Despite two decades of clinical use, the effectiveness of medical expulsive therapy (MET) for the noninvasive management of patients with ureteral stones has, in the past year, been called into in question. The primary aim of MET is to expedite stone passage, although it has also shown effectiveness

  4. Long term follow up of medical therapy of thyroid cancer

    International Nuclear Information System (INIS)

    Jaffiol, C.; Daures, J.P.; Nsakala, N.; Guerenova, J.; Baldet, L.; Pujol, P.; Vannereau, D.; Bringer, J.

    1995-01-01

    106 patients, 114 W, 27 M, were thyroidectomized for differentiated thyroid cancer (follicular 29.3% - papillary 54.3%) with different stages of gravity (N O: 48.2% - N 1: 32.8% - N 2: 19%). Neck dissection was used in cases of involved nodes. One or several doses of 131 I were given to 126 subjects, 106 patients were treated with L thyroxine (LT4) (mean daily dose: 2.5 μg/kg BW). 23 patients presenting intolerance to LT4 with non suppressed TSH for 13 of them were treated by an association of tiratricol (TRIAC) + LT4. The follow up included a yearly check up involving clinical examination, plasma thyroglobulin (Tg) and thyroid stimulating hormone (TSH) assessment, neck ultrasonography and X ray of the chest. Therapy was stopped for 4 weeks in cases with Tg above its detectable value and a total body scan performed with Tg and TSH controls. The mean duration of follow up was 94.5 ± 67.7 months and extended to more than 5 years for 61% of the patients. We observed 22 relapses of the tumor with 4 deaths. Age less then 45 years, appears as the best factor of prognosis. 2 groups of patients were compared to evaluate the incidence of TSH suppression on the relapse free survival (group 1 n = 30 with a TSH ≤ 0.10 mU/1 and group 2 n = 15 with a TSH always > 1 mU/1 during the follow up). The relapse free survival was shorter in group 2 (p 0.01). Association of TRIAC with LT4 leads to a reduction of the daily dose of LT4 (m 25μg/day) with a significant improvement of TSH suppression and clinical tolerance. In conclusion, TSH suppression improves the prognosis in thyroidectomized patients for differentiated carcinoma. Association of TRIAC with LT4 seems able to approve TSH suppression and therapeutic tolerance. (authors). 40 refs., 5 tabs

  5. Energy efficiency improvement of medical electric tools and devices

    Directory of Open Access Journals (Sweden)

    Meshkov Aleksandr S.

    2014-01-01

    Full Text Available With the ever-increasing volume of applications of various kinds of electric drives in all spheres of human activity, the issues in improving the efficiency of the electromechanical converters of electric energy, one of the most important components of the electric drive (ED, are becoming increasingly important. Such issues include reducing their weight and size, improving the functional characteristics of these devices to increase their operational life and reducing the cost of manufacture. Taking full advantage of these opportunities relates to the AC and DC single-phase commutator motor (SCM, which is widely used in regulated and high-speed motor drives in medical electric hand tools. The SCM is used in machinery where the load torque has a hyperbolic dependence on the rotational speed and the need to work with a large motor overload due to the “soft” mechanical characteristics of such motors.

  6. The charisma and deception of reparative therapies: when medical science beds religion.

    Science.gov (United States)

    Grace, André P

    2008-01-01

    In this article, I examine the history and resurgence of interest in sexual reorientation or reparative therapies. I begin with a critique of the contemporary "ex-gay" movement, interrogating Exodus as the prototype of a politico-religious transformational ministry that works to "cure" homosexuals, and examine how Exodus utilizes ex-gay testimony to deceive harried homosexuals looking for escape from the effects of internalized and cultural homophobia. Next, I investigate how reparative therapies function as orthodox treatments that charismatically meld conservative religious perspectives with medical science to produce a pseudoscience promising to treat homosexuality effectively. In this regard, I assess the ongoing debate regarding gay-affirming versus reparative therapies by first looking at the history of medicalizing homosexuality and then surveying the debate spurred by Robert L. Spitzer's research. I conclude with a consideration of research needed to measure whether efficacious change in sexual orientation is possible.

  7. Encountering Challenges with the EU Regulation on Advance Therapy Medical Products.

    Science.gov (United States)

    Mansnérus, Juli

    2015-12-01

    This article aims at analysing how well the Advanced Therapy Medical Product Regulation (EC) No. 1394/2007 (ATMP Regulation) meets the needs of small and medium-sized enterprises (SMES), academia and public tissue establishments developing advanced therapy medical products (ATMPS). Benefits and shortcomings of the ATMP Regulation are identified, and possible amendments are proposed to accelerate the translation of research into advanced therapies and to facilitate the commercialisation of ATMPS whilst ensuring safety. It was set up as a lex specialis to ensure the free movement of ATMPS within the EU in order to facilitate their access to the internal market and to foster the competitiveness of European pharmaceutical companies, while guaranteeing the highest level protection of public health. Since the adoption of the ATMP Regulation in late 2008, only 5 ATMPS have been granted marketing authorisations thus far. Hence, there is a need to analyse whether the ATMP Regulation meets its objectives.

  8. Preliminary studies of plasma growth hormone releasing activity during medical therapy of acromegaly

    International Nuclear Information System (INIS)

    Hagen, T.C.; Lawrence, A.M.; Kirsteins, L.

    1978-01-01

    The in vitro growth hormone releasing activity of plasma obtained from six acromegalic subjects was measured before and during therapy. In five subjects, plasmas were obtained before and during successful medical therapy with medroxyprogesterone acetate (MPA). The sixth subject was sampled before and after transphenoidal Sr 90 -induced hypopituitarism. All subjects had a decrement in fasting growth hormone levels with respective therapies (29-88%). The in vitro growth hormone released from Rhesus monkey anterior pituitaries was assessed after incubating one lateral half in control plasma (pre-therapy) and the contralateral pituitary half in plasma obtained during or after therapy. Studies with plasmas obtained from the five patients successfully treated with MPA showed a decrease in growth hormone releasing activity during therapy in all (18-57%). Plasma obtained after Sr 90 pituitary ablation in the sixth subject had 35% more growth hormone releasing activity than obtained before therapy. These results suggest that active acromegalics who respond to MPA with significantly lowered growth hormone levels may actually achieve this response because of a decrease in growth hormone releasing factor measured peripherally. The opposite response in one acromegalic subject, following Sr 90 pituitary ablation and hypopituitarism, suggests that growth hormone releasing factor secretion may increase when growth hormone levels are lowered by ablative therapy. (orig.) [de

  9. Energy minimization in medical image analysis: Methodologies and applications.

    Science.gov (United States)

    Zhao, Feng; Xie, Xianghua

    2016-02-01

    Energy minimization is of particular interest in medical image analysis. In the past two decades, a variety of optimization schemes have been developed. In this paper, we present a comprehensive survey of the state-of-the-art optimization approaches. These algorithms are mainly classified into two categories: continuous method and discrete method. The former includes Newton-Raphson method, gradient descent method, conjugate gradient method, proximal gradient method, coordinate descent method, and genetic algorithm-based method, while the latter covers graph cuts method, belief propagation method, tree-reweighted message passing method, linear programming method, maximum margin learning method, simulated annealing method, and iterated conditional modes method. We also discuss the minimal surface method, primal-dual method, and the multi-objective optimization method. In addition, we review several comparative studies that evaluate the performance of different minimization techniques in terms of accuracy, efficiency, or complexity. These optimization techniques are widely used in many medical applications, for example, image segmentation, registration, reconstruction, motion tracking, and compressed sensing. We thus give an overview on those applications as well. Copyright © 2015 John Wiley & Sons, Ltd.

  10. Evaluation of a pilot medication therapy management project within the North Carolina State Health Plan.

    Science.gov (United States)

    Christensen, Dale B; Roth, Mary; Trygstad, Troy; Byrd, John

    2007-01-01

    To assess the feasibility of a pharmacist-based medication therapy management (MTM) service for North Carolina State Health Plan enrollees. Before/after design with two control groups. Community pharmacies and an ambulatory care clinic in North Carolina serving patients from October 2004 to March 2005. 67 patients who used a large number of prescription drugs, 10 community/ambulatory care pharmacists, and more than 600 participants from two control groups. Pharmacist-conducted MTM reviews for volunteering patients. Process measures (type and frequency of drug therapy problems detected and services performed), economic measures (number and cost of medications dispensed), and humanistic measures (patient satisfaction with services). Pharmacists identified an average of 3.6 potential drug therapy problems (PDTPs) per patient at the first visit. The most common PDTP categories were "potential underuse" and "more cost-effective drug available." Pharmacist actions were divided nearly equally between activities that would result in increased and decreased drug use. Pharmacists recommended a drug therapy change in about 50% of patients and contacted the prescriber more than 85% of the time. About 50% of patients with PDTPs had a change in drug therapy. Prescription use during the postintervention period decreased in both the study and control groups but was statistically significant only among the control groups. No significant differences were observed in patient co-payment or insurer prescription costs. Pharmacists provided the following educational services: medication use (90%), disease management (88%), adherence, and self-care (60%). Survey results indicated that patients highly valued the service. A voluntary MTM program targeted at ambulatory patients using a large number of medications reduced the number of PDTPs but did not necessarily result in reductions in prescription drug use or cost. Nearly all patients received some form of medication adherence or disease

  11. Psychological therapies versus antidepressant medication, alone and in combination for depression in children and adolescents.

    Science.gov (United States)

    Cox, Georgina R; Callahan, Patch; Churchill, Rachel; Hunot, Vivien; Merry, Sally N; Parker, Alexandra G; Hetrick, Sarah E

    2014-11-30

    Depressive disorders are common in children and adolescents and, if left untreated, are likely to recur in adulthood. Depression is highly debilitating, affecting psychosocial, family and academic functioning. To evaluate the effectiveness of psychological therapies and antidepressant medication, alone and in combination, for the treatment of depressive disorder in children and adolescents. We have examined clinical outcomes including remission, clinician and self reported depression measures, and suicide-related outcomes. We searched the Cochrane Depression, Anxiety and Neurosis Review Group's Specialised Register (CCDANCTR) to 11 June 2014. The register contains reports of relevant randomised controlled trials (RCTs) from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (1950 to date), EMBASE (1974 to date), and PsycINFO (1967 to date). RCTs were eligible for inclusion if they compared i) any psychological therapy with any antidepressant medication, or ii) a combination of psychological therapy and antidepressant medication with a psychological therapy alone, or an antidepressant medication alone, or iii) a combination of psychological therapy and antidepressant medication with a placebo or'treatment as usual', or (iv) a combination of psychological therapy and antidepressant medication with a psychological therapy or antidepressant medication plus a placebo.We included studies if they involved participants aged between 6 and 18 years, diagnosed by a clinician as having Major Depressive Disorder (MDD) based on Diagnostic and Statistical Manual (DSM) or International Classification of Diseases (ICD) criteria. Two review authors independently selected studies, extracted data and assessed the quality of the studies. We applied a random-effects meta-analysis, using the odds ratio (OR) to describe dichotomous outcomes, mean difference (MD) to describe continuous outcomes when the same measures were used, and standard mean difference (SMD) when

  12. Randomised controlled trial examining the effect of exercise in people with rheumatoid arthritis taking anti-TNFα therapy medication.

    LENUS (Irish Health Repository)

    Reid, Angela

    2011-01-01

    Substantial progress has been made in the medical management of rheumatoid arthritis (RA) over the past decade with the introduction of biologic therapies, including anti-tumour necrosis factor alpha (anti-TNFα) therapy medications. However, individuals with RA taking anti-TNFα medication continue to experience physical, psychological and functional consequences, which could potentially benefit from rehabilitation. There is evidence that therapeutic exercise should be included as an intervention for people with RA, but to date there is little evidence of the benefits of therapeutic exercise for people with RA on anti-TNFα therapy medication. A protocol for a multicentre randomised controlled three-armed study which aims to examine the effect of dynamic group exercise therapy on land or in water for people with RA taking anti-TNFα therapy medication is described.

  13. Medical nutrition therapy in chronic kidney disease; from dialysis to transplant: A case report

    Directory of Open Access Journals (Sweden)

    Gabriela Leal-Escobar

    2016-01-01

    Full Text Available Chronic kidney disease has direct implications in nutritional status, causing anorexia and muscular catabolism. These situations are frequent in kidney renal replacement therapy in which nutritional disorders and inflammatory mechanisms associated with therapy often lead to the development of protein-energy wasting. Nutrition therapy has shown an adequate therapeutic strategy to prevent and treat metabolic alterations, reducing surgical and nutritional complication risks in kidney transplantation patients. The current case reports nutritional intervention on a continuous ambulatory peritoneal dialysis patient who was subsequently prescribed to automatic peritoneal dialysis and, finally, kidney transplant from a living donor.

  14. Behavioural outcomes of subthalamic stimulation and medical therapy versus medical therapy alone for Parkinson's disease with early motor complications (EARLYSTIM trial): secondary analysis of an open-label randomised trial.

    Science.gov (United States)

    Lhommée, Eugénie; Wojtecki, Lars; Czernecki, Virginie; Witt, Karsten; Maier, Franziska; Tonder, Lisa; Timmermann, Lars; Hälbig, Thomas D; Pineau, Fanny; Durif, Franck; Witjas, Tatiana; Pinsker, Marcus; Mehdorn, Maximilian; Sixel-Döring, Friederike; Kupsch, Andreas; Krüger, Rejko; Elben, Saskia; Chabardès, Stephan; Thobois, Stéphane; Brefel-Courbon, Christine; Ory-Magne, Fabienne; Regis, Jean-Marie; Maltête, David; Sauvaget, Anne; Rau, Jörn; Schnitzler, Alfons; Schüpbach, Michael; Schade-Brittinger, Carmen; Deuschl, Gunther; Houeto, Jean-Luc; Krack, Paul

    2018-03-01

    Although subthalamic stimulation is a recognised treatment for motor complications in Parkinson's disease, reports on behavioural outcomes are controversial, which represents a major challenge when counselling candidates for subthalamic stimulation. We aimed to assess changes in behaviour in patients with Parkinson's disease receiving combined treatment with subthalamic stimulation and medical therapy over a 2-year follow-up period as compared with the behavioural evolution under medical therapy alone. We did a parallel, open-label study (EARLYSTIM) at 17 surgical centres in France (n=8) and Germany (n=9). We recruited patients with Parkinson's disease who were disabled by early motor complications. Participants were randomly allocated (1:1) to either medical therapy alone or bilateral subthalamic stimulation plus medical therapy. The primary outcome was mean change in quality of life from baseline to 2 years. A secondary analysis was also done to assess behavioural outcomes. We used the Ardouin Scale of Behavior in Parkinson's Disease to assess changes in behaviour between baseline and 2-year follow-up. Apathy was also measured using the Starkstein Apathy Scale, and depression was assessed with the Beck Depression Inventory. The secondary analysis was done in all patients recruited. We used a generalised estimating equations (GEE) regression model for individual items and mixed model regression for subscores of the Ardouin scale and the apathy and depression scales. This trial is registered with ClinicalTrials.gov, number NCT00354133. The primary analysis has been reported elsewhere; this report presents the secondary analysis only. Between July, 2006, and November, 2009, 251 participants were recruited, of whom 127 were allocated medical therapy alone and 124 were assigned bilateral subthalamic stimulation plus medical therapy. At 2-year follow-up, the levodopa-equivalent dose was reduced by 39% (-363·3 mg/day [SE 41·8]) in individuals allocated bilateral

  15. Utilization of Emergency Medical Service Increases Chance of Thrombolytic Therapy in Patients with Acute Ischemic Stroke

    Science.gov (United States)

    Hsieh, Ming-Ju; Tang, Sung-Chun; Chiang, Wen-Chu; Huang, Kuang-Yu; Chang, Anna Marie; Ko, Patrick Chow-In; Tsai, Li-Kai; Jeng, Jiann-Shing; Ma, Matthew Huei-Ming

    2014-01-01

    Objective To determine whether utilization of emergency medical service (EMS) can expedite and improve the rate of thrombolytic therapy administration in acute ischemic stroke patients. Methods This is a prospective observational study of consecutive patients presenting to the emergency department (ED) with an ischemic stroke within 72 hours of symptom onset. Variables associated with early ED arrival (within 3 hours of stroke onset), and administration of thrombolytic therapy were analyzed. We also evaluated the factors related to onset-to-needle time in patients receiving thrombolytic therapy. Results From January 1, 2010 to July 31, 2011, there were 1081 patients (62.3% men, age 69.6 ± 13 years) included in this study. Among them, 289 (26.7%) arrived in the ED within 3 hours, and 88 (8.1%) received intravenous thrombolytic therapy. Patients who arrived to the ED by EMS (n=279, 25.8 %) were independently associated with earlier ED arrival (adjusted odds ratio [OR] = 3.68, 95% confidence interval [CI] = 2.54 to 5.33), and higher chance of receiving thrombolytic therapy (adjusted OR = 3.89, 95% CI= 1.86 to 8.17). Furthermore, utilization of EMS decreased onset-to-needle time by 26 minutes in patients receiving thrombolytic therapy. Conclusion Utilization of EMS can help acute ischemic stroke patients in early presentation to ED, facilitate thrombolytic therapy, and reduce the onset to needle time. PMID:24296308

  16. Construction of an Occupational Therapy Screenings Assessment for elderly medical patients

    DEFF Research Database (Denmark)

    Holsbæk, Jonas

    there for demands a validated Occupational Therapy Screening Assessment, that fast and easy can tell if more Occupational Therapy is needed. Aim: The aim of the study is to develop a Screening Assessment which can be used in the Occupational Therapist practice screening Hospitalized Elderly medical inpatients...... by means of the Content Validity Index (CVI) – Questionaire. Result: The result was a Screening Assessment and a Manual, which was built up using ICF and the ADL-Taxonomy as References. The Screening Instrument should be a support for the working Occupational Therapist in their Clinical Reasoning. CVI...

  17. Computational Modeling of Medical Images of Brain Tumor Patients for Optimized Radiation Therapy Planning

    DEFF Research Database (Denmark)

    Agn, Mikael

    In brain tumor radiation therapy, the aim is to maximize the delivered radiation dose to the targeted tumor and at the same time minimize the dose to sensitive healthy structures – so-called organs-at-risk (OARs). When planning a radiation therapy session, the tumor and the OARs therefore need...... to be delineated on medical images of the patient’s head, to be able to optimize a radiation dose plan. In clinical practice, the delineation is performed manually with limited assistance from automatic procedures, which is both time-consuming and typically suffers from poor reproducibility. There is, therefore...

  18. Medication therapy management and complex patients with disability: a randomized controlled trial.

    Science.gov (United States)

    Chrischilles, Elizabeth A; Doucette, William; Farris, Karen; Lindgren, Scott; Gryzlak, Brian; Rubenstein, Linda; Youland, Kelly; Wallace, Robert B

    2014-02-01

    Drug therapy problems, adverse drug events (ADEs), and symptom burden are high among adults with disabilities. To compare the effects of a modified medication therapy management (MTM) program within a self-efficacy workshop versus the workshop alone or usual care on symptom burden among adults with activity limitations. Three-group randomized controlled trial among adults (age 40 and older) with self-reported activity limitations in community practice. 8 weekly Living Well With a Disability (LWD) 2-hour workshop sessions with and without a collaborative medication management (CMM) module. mean number of moderate to very severe symptoms from a list of 11 physical and mental symptoms. Process measures: changes in medication regimens and self-reported ADEs. general linear mixed models (continuous outcomes) and generalized estimating equations (categorical outcomes). Participants had high symptom burden, low physical health, and took many medications. There was a significant increase in ADE reporting in the LWD + CMM group relative to the other 2 groups (Study group × Time P = .014), and there were significantly more changes in medication regimens in the LWD + CMM group (P = .013 LWD only vs LWD + CMM). The oldest third of participants had significantly fewer mean symptoms but received more intense CMM. There was no difference between the LWD-only, LWD + CMM, and usual care groups in symptom burden over time. Pharmacist MTM practices and MTM guidelines may need to be modified to affect symptom burden in a population with physical activity limitations.

  19. Role of medical therapy in the management of deep rectovaginal endometriosis.

    Science.gov (United States)

    Vercellini, Paolo; Buggio, Laura; Somigliana, Edgardo

    2017-12-01

    Defining whether medical therapy is effective in women with deep rectovaginal endometriosis and in which circumstances it can be considered an alternative to surgery is important for patients and physicians. Numerous observational and some randomized controlled studies demonstrated that different hormonal drugs improved pain and other symptoms in approximately two-thirds of women with deep rectovaginal endometriosis. Because major differences in the effect size of various compounds were not observed, much importance should be given to safety, tolerability, and cost of medications when counseling patients. Progestins seem to offer the best therapeutic balance when long-term treatments are planned. Women should be informed that hormonal drugs control but do not cure endometriosis and that, to avoid surgery, they should be used for years. Medical therapy is not an alternative to surgery in women with hydronephrosis, severe subocclusive bowel symptoms, and in those wishing a natural conception. A progestin should systematically be chosen as a comparator in future randomized trials on novel medications for deep endometriosis. In the meantime, the use of existing drugs should be optimized, and medical and surgical treatments could be viewed as subsequent stages of a stepwise approach. In general, there is no absolute "best" choice, and women must be thoroughly informed of potential benefits, potential harms, and costs of different therapeutic options and allowed to choose what they deem is better for them. Copyright © 2017 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  20. The Therapy Beneath the Fun: Medical Clowning During Invasive Examinations on Children.

    Science.gov (United States)

    Ofir, Shoshi; Tener, Dafna; Lev-Wiesel, Rachel; On, Avi; Lang-Franco, Nessia

    2016-01-01

    The qualitative research presented here is part of a larger project on the significance of medical clowning during invasive examinations in children in the Department of Gastroenterology and the Center for the Sexually Abused in a hospital in Israel. It investigated what makes up the essence of medical clowning, what skills and techniques are used by medical clowns, and whether their work contains therapeutic elements. A total of 9 children undergoing invasive examinations and 9 of their accompanying parents participated in semistructured interviews, which were analyzed using a thematic analysis methodology assisted by an Atlas-ti software program. The interviews revealed that the medical clowning intervention during invasive examinations was essentially therapeutic, with the clown using theatrical and clowning tools to incorporate therapeutic elements such as empowerment, reversal of role, reframing, and building a therapeutic alliance. In addition, during the invasive examinations, the medical clowning followed the model of brief crisis intervention therapy. The study advances the need to incorporate medical clowns as an integral part of medical teams performing invasive procedures and to include clowns in all stages of the hospital visit when children undergo invasive examinations. © The Author(s) 2015.

  1. High-energy extracorporeal shock wave therapy as a treatment for chronic noninsertional Achilles tendinopathy.

    Science.gov (United States)

    Furia, John P

    2008-03-01

    High-energy extracorporeal shock wave therapy has been shown to be an effective treatment for chronic insertional Achilles tendinopathy. The results of high-energy shock wave therapy for chronic noninsertional Achilles tendinopathy have not been determined. Shock wave therapy is an effective treatment for noninsertional Achilles tendinopathy. Case control study; Level of evidence, 3. Thirty-four patients with chronic noninsertional Achilles tendinopathy were treated with a single dose of high-energy shock wave therapy (shock wave therapy group; 3000 shocks; 0.21 mJ/mm(2); total energy flux density, 604 mJ/mm(2)). Thirty-four patients with chronic noninsertional Achilles tendinopathy were treated not with shock wave therapy but with additional forms of nonoperative therapy (control group). All shock wave therapy procedures were performed using regional anesthesia. Evaluation was by change in visual analog score and by Roles and Maudsley score. One month, 3 months, and 12 months after treatment, the mean visual analog scores for the control and shock wave therapy groups were 8.4 and 4.4 (P wave therapy and control groups were 12 and 0 (P wave therapy group than in the control group (P wave therapy is an effective treatment for chronic noninsertional Achilles tendinopathy.

  2. Left ventricular remodelling in chronic primary mitral regurgitation: implications for medical therapy.

    Science.gov (United States)

    McCutcheon, Keir; Manga, Pravin

    Surgical repair or replacement of the mitral valve is currently the only recommended therapy for severe primary mitral regurgitation. The chronic elevation of wall stress caused by the resulting volume overload leads to structural remodelling of the muscular, vascular and extracellular matrix components of the myocardium. These changes are initially compensatory but in the long term have detrimental effects, which ultimately result in heart failure. Understanding the changes that occur in the myocardium due to volume overload at the molecular and cellular level may lead to medical interventions, which potentially could delay or prevent the adverse left ventricular remodelling associated with primary mitral regurgitation. The pathophysiological changes involved in left ventricular remodelling in response to chronic primary mitral regurgitation and the evidence for potential medical therapy, in particular beta-adrenergic blockers, are the focus of this review.

  3. Severe hepatocytolisis syndrome - a challenge in medical therapy of Cushing’s disease

    Directory of Open Access Journals (Sweden)

    Valea Ana

    2015-08-01

    Full Text Available Introduction Cushing’s disease is a rare endocrine disorder characterized by persistent hypercortisolism due to excessive, autonomous ACTH secretion by a pituitary adenoma. Transsphenoidal adenomectomy is the main therapeutic option in Cushing’s disease. When imaging studies are unable to demonstrate an obvious pituitary mass complete tumor resection is difficult and often encumbered by risk of relapse. Medical therapy is a second-line option or the first-line treatment for patients with high surgical risk, incomplete surgical resection or relapse. Rarely classic clinical manifestations limit the selection of medical therapy for Cushing’s disease. Case presentation We present the case of a male patient with Cushing’s disease complicated with diabetes mellitus and severe hepatocytolisis syndrome with no visible pituitary adenoma on MRI studies. In the absence of technical equipment petrosal sinus sampling could not be performed in order to improve surgery outcome

  4. A urinary test procedure for identification of cannabidiol in patients undergoing medical therapy with marijuana

    Directory of Open Access Journals (Sweden)

    Wertlake PT

    2016-02-01

    Full Text Available Paul T Wertlake, Michael D Henson Pacific Toxicology Laboratories, Chatsworth, CA, USA Abstract: Marijuana is classified by the Drug Enforcement Agency (DEA as Schedule I, drugs having no accepted medical value. Twenty-three states and the District of Columbia have legalized medical marijuana. This conflict inhibits physicians from prescribing marijuana and the systematic study of marijuana in medical care. This study concerns the use of the clinical laboratory as a resource for physicians recommending cannabidiol (CBD to patients, or for patients using medical marijuana. Marijuana containing delta-9-tetrahydrocannabinol (THC is psychoactive. CBD is not psychoactive. CBD is reported to have medical benefit for seizure control, neurologic disorders including multiple sclerosis, neuropathic pain and pain associated with cancer. Use of opiates leads to increasing dosage over time that may cause respiratory depression. The Medical Board of California has termed this a serious public health crisis of addiction, overdose, and death. Is it feasible that CBD might alleviate persistent, severe pain and therefore diminished opiate use? Further study is needed to determine medical effectiveness of CBD including the effect on concurrent opiate therapy due to competition for receptor sites. This study is the application of a gas chromatography mass spectrometry procedure adapted for use in our laboratory, to detect CBD in urine. The intended use is as a tool for physicians to assess that marijuana being used by a patient is of a composition likely to be medically effective. A law ensuring physicians freedom from federal prosecution would provide confidence essential to formal study of medical uses of marijuana and treatment of clinical problems. Detection of CBD in a urine sample would be a convenient test for such confirmation. Keywords: laboratory test, assay, medical management 

  5. Medication Therapy Management after Hospitalization in CKD: A Randomized Clinical Trial.

    Science.gov (United States)

    Tuttle, Katherine R; Alicic, Radica Z; Short, Robert A; Neumiller, Joshua J; Gates, Brian J; Daratha, Kenn B; Barbosa-Leiker, Celestina; McPherson, Sterling M; Chaytor, Naomi S; Dieter, Brad P; Setter, Stephen M; Corbett, Cynthia F

    2018-02-07

    CKD is characterized by remarkably high hospitalization and readmission rates. Our study aim was to test a medication therapy management intervention to reduce subsequent acute care utilization. The CKD Medication Intervention Trial was a single-blind (investigators), randomized clinical trial conducted at Providence Health Care in Spokane, Washington. Patients with CKD stages 3-5 not treated by dialysis who were hospitalized for acute illness were recruited. The intervention was designed to improve posthospitalization care by medication therapy management. A pharmacist delivered the intervention as a single home visit within 7 days of discharge. The intervention included these fundamental elements: comprehensive medication review, medication action plan, and a personal medication list. The primary outcome was a composite of acute care utilization (hospital readmissions and emergency department and urgent care visits) for 90 days after hospitalization. Baseline characteristics of participants ( n =141) included the following: age, 69±11 (mean±SD) years old; women, 48% (67 of 141); diabetes, 56% (79 of 141); hypertension, 83% (117 of 141); eGFR, 41±14 ml/min per 1.73 m 2 (serum creatinine-based Chronic Kidney Disease Epidemiology Collaboration equation); and urine albumin-to-creatinine ratio median, 43 mg/g (interquartile range, 8-528) creatinine. The most common primary diagnoses for hospitalization were the following: cardiovascular events, 36% (51 of 141); infections, 18% (26 of 141); and kidney diseases, 12% (17 of 141). The primary outcome occurred in 32 of 72 (44%) of the medication intervention group and 28 of 69 (41%) of those in usual care (log rank P =0.72). For only hospital readmission, the rate was 19 of 72 (26%) in the medication intervention group and 18 of 69 (26%) in the usual care group (log rank P =0.95). There was no between-group difference in achievement of guideline-based goals for use of renin-angiotensin system inhibition or for BP

  6. Effectiveness of an Educational Intervention on Medical Students' Knowledge About and Attitude Towards Electroconvulsive Therapy.

    Science.gov (United States)

    Solomon, Susan; Simiyon, Manjula; Vedachalam, Ahalya

    2016-04-01

    This study was done to determine the effectiveness of a lecture and exposure to electroconvulsive therapy (ECT) followed by interaction with patient, on medical students' knowledge about and attitude towards electroconvulsive therapy. A questionnaire was administered to second year medical students to determine their baseline knowledge about and attitude towards electroconvulsive therapy. Following this, they underwent two educational interventions, a lecture on ECT and exposure to the procedure and interaction with the patient and relative, and their knowledge and attitude were reassessed after each intervention using the same questionnaire. Eighty-one students completed all the three assessments. Students' knowledge about ECT at baseline was minimal (mean 3.58 out of 12). Their knowledge increased significantly after the lecture (mean 10.3), and there was further increase following exposure to the procedure and subsequent interaction with the patient and relative (mean 11.1). At baseline, students had an overall negative attitude towards ECT. There was significant improvement on all attitude items following the lecture. Exposure to the procedure resulted in further improvement in attitude regarding whether ECT is a cruel treatment and has to be used as a last resort. Exposure to ECT in lecture and clinical scenarios followed by interaction with the patient should be included in the undergraduate medical curriculum to improve students' knowledge and attitude about this safe, effective, and potentially lifesaving treatment modality.

  7. Clinical importance of achieving biochemical control with medical therapy in adult patients with acromegaly

    Science.gov (United States)

    Christofides, Elena A

    2016-01-01

    In acromegaly, achieving biochemical control (growth hormone [GH] level acromegaly is challenging because it is rooted in observing subtle clinical manifestations, and it is typical for acromegaly to evolve for up to 10 years before it is recognized. This results in chronic exposure to elevated levels of GH and IGF-1 and delay in patients receiving appropriate treatment, which consequently increases mortality risk. In this review, the clinical impact of elevated GH and IGF-1 levels, the effectiveness of current therapies, and the potential role of novel treatments for acromegaly will be discussed. Clinical burden of acromegaly and benefits associated with management of GH and IGF-1 levels will be reviewed. Major treatment paradigms in acromegaly include surgery, medical therapy, and radiotherapy. With medical therapies, such as somatostatin analogs, dopamine agonists, and GH receptor antagonists, a substantial proportion of patients achieve reduced GH and normalized IGF-1 levels. In addition, signs and symptoms, quality of life, and comorbidities have also been reported to improve to varying degrees in patients who achieve biochemical control. Currently, there are several innovative therapies in development to improve patient outcomes, patient use, and access. Timely biochemical control of acromegaly ensures that the patient can ultimately improve morbidity and mortality from this disease and its extensive consequences. PMID:27471378

  8. A urinary test procedure for identification of cannabidiol in patients undergoing medical therapy with marijuana.

    Science.gov (United States)

    Wertlake, Paul T; Henson, Michael D

    2016-01-01

    Marijuana is classified by the Drug Enforcement Agency (DEA) as Schedule I, drugs having no accepted medical value. Twenty-three states and the District of Columbia have legalized medical marijuana. This conflict inhibits physicians from prescribing marijuana and the systematic study of marijuana in medical care. This study concerns the use of the clinical laboratory as a resource for physicians recommending cannabidiol (CBD) to patients, or for patients using medical marijuana. Marijuana containing delta-9-tetrahydrocannabinol (THC) is psychoactive. CBD is not psychoactive. CBD is reported to have medical benefit for seizure control, neurologic disorders including multiple sclerosis, neuropathic pain and pain associated with cancer. Use of opiates leads to increasing dosage over time that may cause respiratory depression. The Medical Board of California has termed this a serious public health crisis of addiction, overdose, and death. Is it feasible that CBD might alleviate persistent, severe pain and therefore diminished opiate use? Further study is needed to determine medical effectiveness of CBD including the effect on concurrent opiate therapy due to competition for receptor sites. This study is the application of a gas chromatography mass spectrometry procedure adapted for use in our laboratory, to detect CBD in urine. The intended use is as a tool for physicians to assess that marijuana being used by a patient is of a composition likely to be medically effective. A law ensuring physicians freedom from federal prosecution would provide confidence essential to formal study of medical uses of marijuana and treatment of clinical problems. Detection of CBD in a urine sample would be a convenient test for such confirmation.

  9. [Staffing levels in medical radiation physics in radiation therapy in Germany. Summary of a questionnaire].

    Science.gov (United States)

    Leetz, Hans-Karl; Eipper, Hermann Hans; Gfirtner, Hans; Schneider, Peter; Welker, Klaus

    2003-10-01

    To get a general idea of the actual staffing level situation in medical radiation physics in 1999 a survey was carried out by the task-group "Personalbedarf" of Deutsche Gesellschaft für Medizinische Physik (DGMP) among all DGMP-members who are active in this field. Main components for equipment and activities are defined in Report 8 and 10 of DGMP for staffing requirements in medical radiation physics. 322 forms were sent out, 173 of them have been evaluated. From the answers regarding equipment and activities numbers for staff are calculated by the methods given in Report 8 and 10 for this spot check target and compared with effective staffing levels. The data of the spot check are then extrapolated on total Germany. The result is a calculated deficit of 865 medical physicists for the whole physics staff, 166 of them in radiation therapy. From the age distribution of DGMP-members and the calculated deficit resulted a training capacity of about 100 medical physicists at all per year (19 in radiation therapy) if the deficit shall be cut back in 10 years.

  10. Knowledge of and attitudes toward electroconvulsive therapy among medical students, psychology students, and the general public.

    Science.gov (United States)

    Aki, Ozlem Erden; Ak, Sertac; Sonmez, Yunus Emre; Demir, Basaran

    2013-03-01

    Electroconvulsive therapy (ECT) is safe and effective for the treatment of various psychiatric disorders. Despite being a well-known treatment method among health care professionals, lay people generally have a negative opinion of ECT. The present study aimed to examine knowledge of and attitudes toward ECT among medical students, psychology students, and the general public. Psychology students were included because they are among the important groups in mental health care in Turkey. A Likert-type questionnaire was administered to fifth-year medical students (n = 28), master of science and doctor of philosophy clinical psychology students (n = 35), and a sample of the general public (n = 26). The questionnaire included questions about the general principles of and indications for ECT, and sources of knowledge of and attitudes toward ECT. The medical students were the most knowledgeable about ECT, as expected. The medical students also had a more positive attitude toward ECT than the other 2 groups. More psychology students had negative attitudes on some aspects than general public sample, despite being more knowledgeable. Medical school theoretical and practical training in ECT played an important role in increasing the level of knowledge of and decreasing the prevalence of negative attitudes toward ECT among the medical students; similar training for psychology students is required to achieve similar results.

  11. Generating demand for pharmacist-provided medication therapy management: identifying patient-preferred marketing strategies.

    Science.gov (United States)

    Garcia, Gladys M; Snyder, Margie E; McGrath, Stephanie Harriman; Smith, Randall B; McGivney, Melissa Somma

    2009-01-01

    To identify effective strategies for marketing pharmacist-provided medication therapy management (MTM) services to patients in a self-insured employer setting. Qualitative study. University of Pittsburgh during March through May 2008. 26 university employees taking at least one chronic medication. Three focus group sessions were conducted using a semistructured topic guide to facilitate the discussion. Employees' perceived medication-related needs, perceived benefits of pharmacist-provided MTM, potential barriers for employee participation in MTM, and effective strategies for marketing MTM. Participants reported concerns with timing of doses, medication costs, access, and ensuring adherence. Participants generally felt positively toward pharmacists; however, the level of reported patient contact with pharmacists varied among participants. Some participants questioned pharmacists' education and qualifications for this enhanced role in patient care. Perceived benefits of MTM noted by participants included the opportunity to obtain personalized information about their medications and the potential for improved communication among their health providers. Barriers to patient participation were out-of-pocket costs and lack of time for MTM visits. Participants suggested use of alternative words to describe MTM and marketing approaches that involve personal contact. Pharmacists should emphasize parts of MTM that patients feel are most beneficial (i.e., provision of a personal medication record) and use patient-friendly language to describe MTM when marketing their practice. Patients will need greater exposure to the concept of MTM and the pharmacists' role in order to correctly describe and assign value to this type of pharmacist patient care practice.

  12. Prevalence of major depressive disorder in patients receiving beta-blocker therapy versus other medications.

    Science.gov (United States)

    Carney, R M; Rich, M W; teVelde, A; Saini, J; Clark, K; Freedland, K E

    1987-08-01

    Depression is believed to be a common side effect in patients receiving beta-blocker therapy. However, diagnoses of depression defined by current diagnostic criteria may not be more common in patients receiving beta-blockers than in patients with the same medical disorder receiving other medications. Seventy-seven patients undergoing elective cardiac catheterization for evaluation of chest pain received a semi-structured diagnostic psychiatric interview. Twenty-one percent of the patients receiving beta-blockers and 33 percent of the patients receiving medications other than beta-blockers met the current American Psychiatric Association criteria for major depressive disorder (DSM-III) (p = NS). The mean heart rate and state anxiety scores for patients taking beta-blockers were significantly lower than those measured in patients taking medications other than beta-blockers. No other medical or demographic differences were observed between the two groups. Despite the methodologic limitations of the study, there does not appear to be a difference in the point prevalence of depression between patients receiving beta-blockers and those receiving other medications.

  13. Linear energy transfer incorporated intensity modulated proton therapy optimization

    Science.gov (United States)

    Cao, Wenhua; Khabazian, Azin; Yepes, Pablo P.; Lim, Gino; Poenisch, Falk; Grosshans, David R.; Mohan, Radhe

    2018-01-01

    The purpose of this study was to investigate the feasibility of incorporating linear energy transfer (LET) into the optimization of intensity modulated proton therapy (IMPT) plans. Because increased LET correlates with increased biological effectiveness of protons, high LETs in target volumes and low LETs in critical structures and normal tissues are preferred in an IMPT plan. However, if not explicitly incorporated into the optimization criteria, different IMPT plans may yield similar physical dose distributions but greatly different LET, specifically dose-averaged LET, distributions. Conventionally, the IMPT optimization criteria (or cost function) only includes dose-based objectives in which the relative biological effectiveness (RBE) is assumed to have a constant value of 1.1. In this study, we added LET-based objectives for maximizing LET in target volumes and minimizing LET in critical structures and normal tissues. Due to the fractional programming nature of the resulting model, we used a variable reformulation approach so that the optimization process is computationally equivalent to conventional IMPT optimization. In this study, five brain tumor patients who had been treated with proton therapy at our institution were selected. Two plans were created for each patient based on the proposed LET-incorporated optimization (LETOpt) and the conventional dose-based optimization (DoseOpt). The optimized plans were compared in terms of both dose (assuming a constant RBE of 1.1 as adopted in clinical practice) and LET. Both optimization approaches were able to generate comparable dose distributions. The LET-incorporated optimization achieved not only pronounced reduction of LET values in critical organs, such as brainstem and optic chiasm, but also increased LET in target volumes, compared to the conventional dose-based optimization. However, on occasion, there was a need to tradeoff the acceptability of dose and LET distributions. Our conclusion is that the

  14. Future of medical physics: Real-time MRI-guided proton therapy.

    Science.gov (United States)

    Oborn, Bradley M; Dowdell, Stephen; Metcalfe, Peter E; Crozier, Stuart; Mohan, Radhe; Keall, Paul J

    2017-08-01

    With the recent clinical implementation of real-time MRI-guided x-ray beam therapy (MRXT), attention is turning to the concept of combining real-time MRI guidance with proton beam therapy; MRI-guided proton beam therapy (MRPT). MRI guidance for proton beam therapy is expected to offer a compelling improvement to the current treatment workflow which is warranted arguably more than for x-ray beam therapy. This argument is born out of the fact that proton therapy toxicity outcomes are similar to that of the most advanced IMRT treatments, despite being a fundamentally superior particle for cancer treatment. In this Future of Medical Physics article, we describe the various software and hardware aspects of potential MRPT systems and the corresponding treatment workflow. Significant software developments, particularly focused around adaptive MRI-based planning will be required. The magnetic interaction between the MRI and the proton beamline components will be a key area of focus. For example, the modeling and potential redesign of a magnetically compatible gantry to allow for beam delivery from multiple angles towards a patient located within the bore of an MRI scanner. Further to this, the accuracy of pencil beam scanning and beam monitoring in the presence of an MRI fringe field will require modeling, testing, and potential further development to ensure that the highly targeted radiotherapy is maintained. Looking forward we envisage a clear and accelerated path for hardware development, leveraging from lessons learnt from MRXT development. Within few years, simple prototype systems will likely exist, and in a decade, we could envisage coupled systems with integrated gantries. Such milestones will be key in the development of a more efficient, more accurate, and more successful form of proton beam therapy for many common cancer sites. © 2017 American Association of Physicists in Medicine.

  15. Competence of medical students in communicating drug therapy: Value of role-play demonstrations.

    Science.gov (United States)

    Tayem, Yasin I; Altabtabaei, Abdulaziz S; Mohamed, Mohamed W; Arrfedi, Mansour M; Aljawder, Hasan S; Aldebous, Fahad A; James, Henry; Al Khaja, Khalid A J; Sequeira, Reginald P

    2016-01-01

    This study used role-play demonstrations to train medical students to communicate drug therapy and evaluated the perceptions on this instructional approach. The second-year medical students who attended a prescription writing session (n = 133), participated in this study. Prescription communication was introduced by using role-play demonstrations. Participant's perceptions were explored by a self-administered questionnaire and focus group discussion. The academic achievement of attendees and nonattendees was compared with an objective structured performance evaluation (OSPE) station that tested students' competence in this skill. Most attendees responded to the questionnaire (81.2%). Almost all respondents expressed their desire to have similar demonstrations in other units. A large proportion of participants reported that role-play demonstrations helped them develop their communication skills, in general, confidence to communicate drug-related information in a prescription, and the ability to explain the aim of drug therapy to patients. Most trainees thought also that they developed skills to communicate instructions on drug use including drug dose, frequency of administration, duration of therapy, adverse drug reactions, and warnings. During the focus group interviews, students thought that role-play was useful but would be more beneficial if conducted frequently in small group as part of the curriculum implementation. The majority of students also reported improved competence in writing a complete prescription. Analysis of attendees and nonattendees grades in the OSPE showed that the former scored higher than the latter group (P = 0.016). Role-play demonstrations were well accepted by medical students and led to the development of their competence in communicating drug therapy to patients.

  16. Sialadenitis after radioiodine therapy. Analysis of factors that influence the response to medical treatment.

    Science.gov (United States)

    Geres, Alejandra E; Mereshian, Paula Szafryk; Fernández, Silvia; Rey Caro, Daniel Gonzalo; Castro, Ricardo; Podio, Ricardo; Ojeda, Silvia

    2015-12-01

    To assess the incidence of 131I-induced sialadenitis (SD) in patients with differentiated thyroid cancer (DTC), to analyze clinical and other factors related to metabolic radiotherapy that may predict the lack of response to conventional medical therapy (CMT), and to determine the effectiveness of intraductal steroid instillation in patients failing CMT. Fifty-two patients with DTC, 45 females (86.5%) and 7 males (13.5%) with a mean age of 44.21±13.3 years (r=17-74) who received ablation therapy with 131I after total thyroidectomy. Patients with diseases and/or medication causing xerostomia were excluded. Patients underwent salivary gland scintigraphy with 99Tc (10mCi). Eighteen patients (34.62%) had SD and received antibiotics, antispasmodics, and oral steroids for 15 days. They were divided into two groups: responders to medical therapy (n=12, age 44.3±14.4 years, 2 men [17%], 10 women [83%], cumulative dose 225±167.1 mCi) and non-responders to medical treatment, who underwent steroid instillation into the Stensen's duct (n=6 [33%], 2 men [33%], 4 women [67%], age 50±13.8 years, cumulative dose 138.3±61.7 mCi). Scintigraphy showed damage to the parotid and submaxillary glands. Incidence of 131I-induced sialadenitis was similar to that reported by other authors. Age, mean cumulative dose of 131I, and involvement of parotid and submaxillary glands did not condition response to CMT; however, male sex was a conditioning factor. Symptom persistence for more than 15 days makes instillation into the Stensen's duct advisable. This is an effective and safe method to avoid surgical excision of salivary glands. Copyright © 2015 SEEN. Published by Elsevier España, S.L.U. All rights reserved.

  17. X-ray diagnostics, X-ray therapy, diagnostics and therapy with radioactive materials in free medical practice

    International Nuclear Information System (INIS)

    Setzer, H.D.

    1976-01-01

    On the basis of the documents of the Kassenaerztliche Vereinigung Niederbayerns in Straubing, the work of the established general practicioners in the fields of X-ray and nuclear medicine was investigated for the 1st quarter of 1971, and the X-ray diagnostic services rendered were evaluated according to age and sex. 2/3 of all doctors participating in a health insurance plan in Lower Bavaria are general practitioners; all other fields are represented less often than in Munich. The values for the whole Federal Republic are in between. Internal specialists, radiologists, and urologists together carry out 85.7% of the ten examinations which contribute most to the total gonadal dose. An application of the data on the 1st quarter to the annual value is only possible by allowing for an error of 13.1%. All in all, 6% more X-ray services are administered to men than to women. For both sexes, the genetically most important group of 15-34 resp. 15-39 years of age is highly represented, although young men receive X-ray diagnostics more frequently. X-ray therapy makes up only about 0.5% of all services. Nuclear medical diagnostics is employed to the same extent by radiologists and internal specialists, while therapy with radioactive substances is almost exclusively provided by radiologists. Relative to the population density, radioactive substances are more often used in Lower Bavaria than in West Berlin. (orig.) [de

  18. Manual therapy intervention in the treatment of patients with carpal tunnel syndrome: median nerve mobilization versus medical treatment

    Directory of Open Access Journals (Sweden)

    Faten I Mohamed

    2016-01-01

    Conclusion CTS improves after median nerve mobilization, which is better than conventional medical treatment. It provides support for the use of manual therapy in conservative management of CTS with satisfactory Results .

  19. Cellular Energy Pathways as Novel Targets for the Therapy of Autosomal Dominant Polycystic Kidney Disease

    Science.gov (United States)

    2017-09-01

    AWARD NUMBER: W81XWH-15-1-0419 TITLE: Cellular Energy Pathways as Novel Targets for the Therapy of Autosomal Dominant Polycystic Kidney Disease...COVERED 1 Sep 2016 - 31 Aug 2017 4. TITLE AND SUBTITLE 5a. CONTRACT NUMBER Cellular Energy Pathways as Novel Targets for the Therapy of Autosomal...inappropriate cell growth, fluid secretion, and dysregulation of cellular energy metabolism. The enzyme AMPK regulates a number of cellular pathways, including

  20. Treatment of Chronic Thromboembolic Pulmonary Hypertension: The Role of Medical Therapy and Balloon Pulmonary Angioplasty.

    Science.gov (United States)

    Fernandes, Timothy M; Poch, David S; Auger, William R

    2016-01-01

    Chronic thromboembolic pulmonary hypertension (CTEPH) is a potentially curable disease when treated with pulmonary thromboendarterectomy (PTE). However, even at experienced surgical centers, nearly one-third of patients with CTEPH will be deemed inoperable for reasons including distal disease, comorbidities, or out-of-proportion pulmonary hypertension. It is in these patients with inoperable CTEPH that pulmonary hypertension (PH)-targeted medical therapy and balloon pulmonary angioplasty have potential therapeutic value. Previous unblinded cohort trials have assessed PH-targeted medical therapy in various subpopulations of CTEPH patients using epoprostenol, treprostinil, sildenafil, bosentan, and iloprost, each demonstrating measurable pulmonary hemodynamic effects. However, riociguat, a soluble guanylate cyclase stimulator, is the first FDA-approved therapy for inoperable CTEPH to demonstrate both an improvement in functional capabilities (6-minute walk time) as well as significant gains in secondary pulmonary hemodynamic end points in a large placebo-controlled trial. Balloon pulmonary angioplasty is an interventional procedure using telescoping catheters placed in the pulmonary arteries, through which wires and balloons are used to mechanically disrupt chronic clot material and relieve pulmonary vascular obstruction. Contemporary case series from multiple centers worldwide have demonstrated pulmonary hemodynamic improvement with this approach. As a result of these advances, patients with inoperable CTEPH who had few options as recently as 5 years ago now have alternatives with emerging evidence of therapeutic efficacy.

  1. Assessing Medicare beneficiaries' willingness-to-pay for medication therapy management services.

    Science.gov (United States)

    Woelfel, Joseph A; Carr-Lopez, Sian M; Delos Santos, Melanie; Bui, Ann; Patel, Rajul A; Walberg, Mark P; Galal, Suzanne M

    2014-02-01

    To assess Medicare beneficiaries' willingness-to-pay (WTP) for medication therapy management (MTM) services and determine sociodemographic and clinical characteristics influencing this payment amount. A cross-sectional, descriptive study design was adopted to elicit Medicare beneficiaries' WTP for MTM. Nine outreach events in cities across Central/Northern California during Medicare's 2011 open-enrollment period. A total of 277 Medicare beneficiaries participated in the study. Comprehensive MTM was offered to each beneficiary. Pharmacy students conducted the MTM session under the supervision of licensed pharmacists. At the end of each MTM session, beneficiaries were asked to indicate their WTP for the service. Medication, self-reported chronic conditions, and beneficiary demographic data were collected and recorded via a survey during the session. The mean WTP for MTM was $33.15 for the 277 beneficiaries receiving the service and answering the WTP question. WTP by low-income subsidy recipients (mean ± standard deviation; $12.80 ± $24.10) was significantly lower than for nonsubsidy recipients ($41.13 ± $88.79). WTP was significantly (positively) correlated with number of medications regularly taken and annual out-of-pocket drug costs. The mean WTP for MTM was $33.15. WTP for MTM significantly varied by race, subsidy status, and number of prescription medications taken. WTP was significantly higher for nonsubsidy recipients than subsidy recipients, and significantly positively correlated with the number of medications regularly taken and the beneficiary rating of the delivered services.

  2. Stimulant medication use and response to growth hormone therapy: an NCGS database analysis.

    Science.gov (United States)

    Frindik, J Paul; Morales, Alba; Fowlkes, John; Kemp, Stephen; Thrailkill, Kathryn; Lippe, Barbara; Dana, Ken

    2009-01-01

    Determine (1) frequency of attention-deficit hyperactivity disorder (ADHD) treatment and (2) growth responses in growth hormone (GH)-treated children who are receiving ADHD medication versus GH alone. Prepubertal children with idiopathic short stature (ISS) or GH deficiency (IGHD) enrolled in Genentech's National Cooperative Growth Study. ADHD treatment was determined by documentation of psycho-stimulant medication use at enrollment. ADHD medication use increased from 0.8% (7/850) in 1985 to 5.8% (752/12,113) in 2005. First-year GH treatment response for ADHD + IGHD versus IGHD: 8.5 +/- 2.0 vs. 9.4 +/- 2.6 cm/year, but when adjusted for age, sex, and enrollment body mass index, the difference is clinically insignificant (-0.4 cm/year). First-year growth was similar in all ISS: 8.1 +/- 1.9 versus 8.6 +/- 2.1 cm/year (ADHD + ISS vs. ISS, an adjusted -0.2-cm/year difference). Increasing numbers of GH-treated children are taking ADHD medications and their growth responses during the first year of GH therapy are similar to those not taking ADHD medications. Copyright 2009 S. Karger AG, Basel.

  3. Medication therapy management and condition care services in a community-based employer setting.

    Science.gov (United States)

    Johannigman, Mark J; Leifheit, Michael; Bellman, Nick; Pierce, Tracey; Marriott, Angela; Bishop, Cheryl

    2010-08-15

    A program in which health-system pharmacists and pharmacy technicians provide medication therapy management (MTM), wellness, and condition care (disease management) services under contract with local businesses is described. The health-system pharmacy department's Center for Medication Management contracts directly with company benefits departments for defined services to participating employees. The services include an initial wellness and MTM session and, for certain patients identified during the initial session, ongoing condition care. The initial appointment includes a medication history, point-of-care testing for serum lipids and glucose, body composition analysis, and completion of a health risk assessment. The pharmacist conducts a structured MTM session, reviews the patient's test results and risk factors, provides health education, discusses opportunities for cost savings, and documents all activities on the patient's medication action plan. Eligibility for the condition care program is based on a diagnosis of diabetes, hypertension, asthma, heart failure, or hyperlipidemia or elevation of lipid or glucose levels. Findings are summarized for employers after the initial wellness screening and at six-month intervals. Patients receiving condition care sign a customized contract, establish goals, attend up to four MTM sessions per year, and track their information on a website; employers may offer incentives for participation. When pharmacists recommend adjustments to therapy or cost-saving changes, it is up to patients to discuss these with their physician. A survey completed by each patient after the initial wellness session has indicated high satisfaction. Direct cost savings related to medication changes have averaged $253 per patient per year. Total cost savings to companies in the first year of the program averaged $1011 per patient. For the health system, the program has been financially sustainable. Key laboratory values indicate positive clinical

  4. Medical image computing for computer-supported diagnostics and therapy. Advances and perspectives.

    Science.gov (United States)

    Handels, H; Ehrhardt, J

    2009-01-01

    Medical image computing has become one of the most challenging fields in medical informatics. In image-based diagnostics of the future software assistance will become more and more important, and image analysis systems integrating advanced image computing methods are needed to extract quantitative image parameters to characterize the state and changes of image structures of interest (e.g. tumors, organs, vessels, bones etc.) in a reproducible and objective way. Furthermore, in the field of software-assisted and navigated surgery medical image computing methods play a key role and have opened up new perspectives for patient treatment. However, further developments are needed to increase the grade of automation, accuracy, reproducibility and robustness. Moreover, the systems developed have to be integrated into the clinical workflow. For the development of advanced image computing systems methods of different scientific fields have to be adapted and used in combination. The principal methodologies in medical image computing are the following: image segmentation, image registration, image analysis for quantification and computer assisted image interpretation, modeling and simulation as well as visualization and virtual reality. Especially, model-based image computing techniques open up new perspectives for prediction of organ changes and risk analysis of patients and will gain importance in diagnostic and therapy of the future. From a methodical point of view the authors identify the following future trends and perspectives in medical image computing: development of optimized application-specific systems and integration into the clinical workflow, enhanced computational models for image analysis and virtual reality training systems, integration of different image computing methods, further integration of multimodal image data and biosignals and advanced methods for 4D medical image computing. The development of image analysis systems for diagnostic support or

  5. Comparing Effects of Medication Therapy and Exercise Training with Diet on Liver enzyme Levels and Liver Sonography in Patients with Non-Alcoholic Fatty Liver Disease (NAFLD

    Directory of Open Access Journals (Sweden)

    Azadeh Nabizadeh Haghighi

    2016-03-01

    Full Text Available Background & Objectives: Non-alcoholic fatty liver disease, characterized by the deposition of fat in liver cells, can cause fibrosis, cirrhosis, and liver cell damage if not controlled. The aim of this study is to compare the effects of medication therapy and exercise training with diet on liver enzyme levels and liver sonography in patients with non-alcoholic fatty liver disease (NAFLD. Materials & Methods :In this quasi-experimental study, female patients with non-alcoholic fatty liver were randomly divided into two groups: medication therapy (n = 10 and exercise therapy (n = 10 for 8 weeks. During this period, the exercise group performed exercise training three days a week for 90 minutes per session. The drug was given to the medication group. In both groups, the diet was 500 calories less than their daily energy. Before and after intervention, blood tests and liver sonography were executed. All statistical analyses were done using SPSS for Windows version 20. Comparisons between and within groups were performed by Student's t-test and Wilcoxon test on paired and unpaired data. P < 0.05 was considered statistically significant. Results :In both groups, liver enzyme levels and disease severity in sonography reduced significantly (p<0.05. Conclusion: The findings of the present research showed that both methods of therapy have the same effect on reducing the severity of NAFLD.

  6. The first private-hospital based proton therapy center in Korea; Status of the proton therapy center at Samsung Medical Center

    International Nuclear Information System (INIS)

    Chung, Kwang Zoo; Han, Young Yih; Kim, Jin Sung

    2015-01-01

    The purpose of this report is to describe the proton therapy system at Samsung Medical Center (SMC-PTS) including the proton beam generator, irradiation system, patient positioning system, patient position verification system, respiratory gating system, and operating and safety control system, and review the current status of the SMC-PTS. The SMC-PTS has a cyclotron (230 MeV) and two treatment rooms: one treatment room is equipped with a multi-purpose nozzle and the other treatment room is equipped with a dedicated pencil beam scanning nozzle. The proton beam generator including the cyclotron and the energy selection system can lower the energy of protons down to 70 MeV from the maximum 230 MeV. The multi-purpose nozzle can deliver both wobbling proton beam and active scanning proton beam, and a multi-leaf collimator has been installed in the downstream of the nozzle. The dedicated scanning nozzle can deliver active scanning proton beam with a helium gas filled pipe minimizing unnecessary interactions with the air in the beam path. The equipment was provided by Sumitomo Heavy Industries Ltd., RayStation from RaySearch Laboratories AB is the selected treatment planning system, and data management will be handled by the MOSAIQ system from Elekta AB. The SMC-PTS located in Seoul, Korea, is scheduled to begin treating cancer patients in 2015

  7. The first private-hospital based proton therapy center in Korea; status of the Proton Therapy Center at Samsung Medical Center.

    Science.gov (United States)

    Chung, Kwangzoo; Han, Youngyih; Kim, Jinsung; Ahn, Sung Hwan; Ju, Sang Gyu; Jung, Sang Hoon; Chung, Yoonsun; Cho, Sungkoo; Jo, Kwanghyun; Shin, Eun Hyuk; Hong, Chae-Seon; Shin, Jung Suk; Park, Seyjoon; Kim, Dae-Hyun; Kim, Hye Young; Lee, Boram; Shibagaki, Gantaro; Nonaka, Hideki; Sasai, Kenzo; Koyabu, Yukio; Choi, Changhoon; Huh, Seung Jae; Ahn, Yong Chan; Pyo, Hong Ryull; Lim, Do Hoon; Park, Hee Chul; Park, Won; Oh, Dong Ryul; Noh, Jae Myung; Yu, Jeong Il; Song, Sanghyuk; Lee, Ji Eun; Lee, Bomi; Choi, Doo Ho

    2015-12-01

    The purpose of this report is to describe the proton therapy system at Samsung Medical Center (SMC-PTS) including the proton beam generator, irradiation system, patient positioning system, patient position verification system, respiratory gating system, and operating and safety control system, and review the current status of the SMC-PTS. The SMC-PTS has a cyclotron (230 MeV) and two treatment rooms: one treatment room is equipped with a multi-purpose nozzle and the other treatment room is equipped with a dedicated pencil beam scanning nozzle. The proton beam generator including the cyclotron and the energy selection system can lower the energy of protons down to 70 MeV from the maximum 230 MeV. The multi-purpose nozzle can deliver both wobbling proton beam and active scanning proton beam, and a multi-leaf collimator has been installed in the downstream of the nozzle. The dedicated scanning nozzle can deliver active scanning proton beam with a helium gas filled pipe minimizing unnecessary interactions with the air in the beam path. The equipment was provided by Sumitomo Heavy Industries Ltd., RayStation from RaySearch Laboratories AB is the selected treatment planning system, and data management will be handled by the MOSAIQ system from Elekta AB. The SMC-PTS located in Seoul, Korea, is scheduled to begin treating cancer patients in 2015.

  8. Therapy by electromagnetic wave of millimeter energy range (EFH-therapy, MRT, IWT). Scientific and practical materials on the use of physical factors in clinical and health resort practice

    International Nuclear Information System (INIS)

    Samosyuk, I.Z.; Fisenko, L.I.; Kolesnik, K.Eh.; Chukhraev, N.V.; Shimkov, G.E.

    1998-01-01

    Problems of extremely high frequency (EHF) therapy, microwave resonance therapy (MRT) and information-wave therapy (IWT) are considered. Possibilities of electromagnetic waves in millimeter energy range use in clinical and health resort practice are systematized. Recommendations on their use in treatment of different diseases are given. The main principles of selection of zones for meridian correction with the help of electromagnetic waves in millimeter energy range are exposed. The results of EFH-therapy clinical use indicate the possibility of its application practically in all cases, since positive results were obtained in most cases. The recommendations are prepared with account of possibilities and parameters of the apparatus ''MIT-1'' for reflexotherapy which was designed and produced by the Medical Innovative Centre in Kiev

  9. Insight into team competence in medical, nursing and respiratory therapy students.

    Science.gov (United States)

    Sigalet, Elaine L; Donnon, Tyrone L; Grant, Vincent

    2015-01-01

    This study provides information for educators about levels of competence in teams comprised of medical, nursing and respiratory therapy students after receiving a simulation-based team-training (SBT) curriculum with and without an additional formalized 30-min team-training (TT) module. A two-group pre- and post-test research design was used to evaluate team competence with respect to leadership, roles and responsibilities, communication, situation awareness and resource utilization. All scenarios were digitally recorded and evaluated using the KidSIM Team Performance Scale by six experts from medicine, nursing and respiratory therapy. The lowest scores occurred for items that reflected situation awareness. All teams improved their aggregate scores from Time 1 to Time 2 (p performance scores at Time 1 (Cohen's d = 0.92, p performances at Time 1 and 2.

  10. Feasibility and safety of early combined cognitive and physical therapy for critically ill medical and surgical patients: the Activity and Cognitive Therapy in ICU (ACT-ICU) trial

    Science.gov (United States)

    Brummel, N.E.; Girard, T.D.; Ely, E.W.; Pandharipande, P.P.; Morandi, A.; Hughes, C.G.; Graves, A.J.; Shintani, A.K.; Murphy, E.; Work, B.; Pun, B.T.; Boehm, L.; Gill, T.M.; Dittus, R.S.; Jackson, J.C.

    2013-01-01

    PURPOSE Cognitive impairment after critical illness is common and debilitating. We developed a cognitive therapy program for critically ill patients and assessed the feasibility and safety of administering combined cognitive and physical therapy early during a critical illness. METHODS We randomized 87 medical and surgical ICU patients with respiratory failure and/or shock in a 1:1:2 manner to three groups: usual care, early once-daily physical therapy, or early once-daily physical therapy plus a novel, progressive, twice-daily cognitive therapy protocol. Cognitive therapy included orientation, memory, attention, and problem solving exercises, and other activities. We assessed feasibility outcomes of the early cognitive plus physical therapy intervention. At 3-months, we also assessed cognitive, functional and health-related quality of life outcomes. Data are presented as median [interquartile range] or frequency (%). RESULTS Early cognitive therapy was a delivered to 41/43 (95%) of cognitive plus physical therapy patients on 100% [92–100%] of study days beginning 1.0 [1.0–1.0] day following enrollment. Physical therapy was received by 17/22 (77%) of usual care patients, by 21/22 (95%) of physical therapy only patients and 42/43 (98%) of cognitive plus physical therapy patients on 17% [10–26%], 67% [46–87%] and 75% [59–88%] of study days, respectively. Cognitive, functional and health-related quality of life outcomes did not differ between groups at 3-month follow-up. CONCLUSIONS This pilot study demonstrates that early rehabilitation can be extended beyond physical therapy to include cognitive therapy. Future work to determine optimal patient selection, intensity of treatment and benefits of cognitive therapy in the critically ill is needed. PMID:24257969

  11. Analysis of pharmacist-provided medication therapy management (MTM) services in community pharmacies over 7 years.

    Science.gov (United States)

    Barnett, Mitchell J; Frank, Jessica; Wehring, Heidi; Newland, Brand; VonMuenster, Shannon; Kumbera, Patty; Halterman, Tom; Perry, Paul J

    2009-01-01

    Although community pharmacists have historically been paid primarily for drug distribution and dispensing services, medication therapy management (MTM) services evolved in the 1990s as a means for pharmacists and other providers to assist physicians and patients in managing clinical, service, and cost outcomes of drug therapy. The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA 2003) and the subsequent implementation of Medicare Part D in January 2006 for the more than 20 million Medicare beneficiaries enrolled in the Part D benefit formalized MTM services for a subset of high-cost patients. Although Medicare Part D has provided a new opportunity for defining the value of pharmacist-provided MTM services in the health care system, few publications exist which quantify changes in the provision of pharmacist-provided MTM services over time. To (a) describe the changes over a 7-year period in the primary types of MTM services provided by community pharmacies that have contracted with drug plan sponsors through an MTM administrative services company, and (b) quantify potential MTM-related cost savings based on pharmacists' self-assessments of the likely effects of their interventions on health care utilization. Medication therapy management claims from a multistate MTM administrative services company were analyzed over the 7-year period from January 1, 2000, through December 31, 2006. Data extracted from each MTM claim included patient demographics (e.g., age and gender), the drug and type that triggered the intervention (e.g., drug therapeutic class and therapy type as either acute, intermittent, or chronic), and specific information about the service provided (e.g., Reason, Action, Result, and Estimated Cost Avoidance [ECA]). ECA values are derived from average national health care utilization costs, which are applied to pharmacist self-assessment of the "reasonable and foreseeable" outcome of the intervention. ECA values are updated

  12. NONSTEROIDAL TOPICAL MEDICATION IN THE THERAPY OF ATOPIC DERMATITIS IN CHILDREN

    Directory of Open Access Journals (Sweden)

    L. S. Namazova-Baranova

    2012-01-01

    Full Text Available Article is devoted to atopic dermatitis (AD in children. The high prevalence of this pathology and significant social and economic burden are responsible for the relevance of search for new medications for the treatment of AD, which will accelerate the achievement of remission. Inclusion of emollient in basic therapy for patients with atopic dermatitis of any severity is necessary element of improvement treatment efficacy, shorten duration of steroid consumption, lengthen the period of remission and reduce the number of exacerbations. 

  13. [Memantine as add-on medication to acetylcholinesterase inhibitor therapy for Alzheimer dementia].

    Science.gov (United States)

    Haussmann, R; Donix, M

    2017-01-01

    Currently available data indicate superior therapeutic effects of combination treatment for Alzheimer dementia with memantine and acetylcholine esterase inhibitors in certain clinical contexts. Out of five randomized, placebo-controlled, double-blind trials two showed superior therapeutic effects in comparison to monotherapy with acetylcholinesterase inhibitors regarding various domains. Recently published meta-analyses and cost-benefit analyses also showed positive results. Recently published German guidelines for dementia treatment also take these new data into account and recommend combination treatment in patients with severe dementia on stable donepezil medication. This article gives an overview of current evidence for combination therapy.

  14. Medical attention proposal for patients under the iodo therapy in cardiac arrest cases

    International Nuclear Information System (INIS)

    Pinto, A.L.; Bacelar, A.; Campomar, A.; Fialkowski, S.; Zaluski, M.A.; Lucena, A.F.

    1996-01-01

    This research has like aim to present a proposition about how to attend the patients which are under the iodo therapy, and the possibility they can show a cardiac arrest during their hospitalization. The physical medical department with the nurse group and the team of ICU (Intensive Care Unit) looked for to establish basic norms of radiological protection in order to avoid the radiation and contamination of all workers involved with one patient, without changing the routine of attendance service. We analyzed all rules of service including the attendance the hospital room and mainly if it is necessary to lead the patient to the ICU. (authors). 4 refs

  15. Guidelines on the medical therapy of persons accidentally overexposed to ionizing radiations. External contamination

    International Nuclear Information System (INIS)

    Perez, M.R.; Di Trano, J.L.; Gisone, P.

    1998-01-01

    The document represents a guide for the external decontamination of persons accidentally radio contaminated due to the use, production or transport of radioactive materials. The general conditions, from the medical point of view, to be kept in mind, in the event of accidental overexposures as decontamination treatment and the handling of samples are detailed throughout report. The external contamination without injury in skin or with wound its considered. The distribution of measures and responsibilities for the therapy of the irradiated patients with radioactive materials are enumerated. The preparations of decontaminate solutions are detailed in this work. Moreover, forms for the reception, physical evaluation of the patient and external contamination are presented. (author)

  16. Radiation therapy for esophageal cancer: The Medical College of Virginia Experience

    International Nuclear Information System (INIS)

    Amendola, B.; Hazra, T.A.; Belgrad, R.; King, E.R.

    1980-01-01

    In a retrospective review of 70 patients with carcinoma of the esophagus treated by external beam irradiation therapy from 1968 to 1977 at the Medical College of Virginia, we correlated survival with race, age, sex, histology, and site of tumor. Results of treatment were also analyzed in relation to the length of the esophagus treated, the total area of the treatment field, and the total tumor dose. From this analysis it appears that radiotherapy has a place in the palliative treatment of esophageal cancer and that palliation is independent of the total volume and dose. There is indication that with higher dosage the survival rate is slightly higher

  17. Magnetic resonance imaging and spectroscopy- emerging trends in medical diagnostics and therapy

    International Nuclear Information System (INIS)

    Deshmukh, Sudha

    1997-01-01

    A dramatic acceleration in the application of magnetic resonance techniques in the field of medical sciences has been witnessed over the past decade. Magnetic Resonance Imaging (MRI) has been called the most significant development since the discovery of x-rays. As a method of visualizing cross-sectional anatomy, MRI is without peer. MRI images can now provide in-vivo anatomical details that were earlier available only with invasive procedures. Yet, despite its extraordinary potential, MRI has had limited success, if any, in tissue characterization using the three image parameters T 1 , T 2 and proton density ρ. MR spectroscopy has however bridged this gap to a large extent and opened up the possibility of studying in vivo chemistry. In the present article an attempt has been made to give a brief account of the application of magnetic resonance imaging and spectroscopy in medical diagnostics and therapy. The basic principles pertaining to MRI and MRS are also discussed in brief. (author)

  18. Regional variation in medication-taking behaviour of new users of oral anti-hyperglycaemic therapy in Ireland

    LENUS (Irish Health Repository)

    O’Shea, M. P.

    2014-05-01

    Few studies have investigated regional variation in medication-taking behaviour. The purpose of this study was to investigate whether there are regional differences in non-persistence and non-adherence to oral anti-hyperglycaemic agents in patients initiating therapy and examine if any association exists between different types of comorbidity in terms of medication-taking behaviour.\\r\

  19. Dual energy CT: New horizon in medical imaging

    Energy Technology Data Exchange (ETDEWEB)

    Goo, Hyun Woo [Dept. of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of); Goo, Jin Mo [Dept. of Radiology, Seoul National University College of Medicine, Seoul (Korea, Republic of)

    2017-08-01

    Dual-energy CT has remained underutilized over the past decade probably due to a cumbersome workflow issue and current technical limitations. Clinical radiologists should be made aware of the potential clinical benefits of dual-energy CT over single-energy CT. To accomplish this aim, the basic principle, current acquisition methods with advantages and disadvantages, and various material-specific imaging methods as clinical applications of dual-energy CT should be addressed in detail. Current dual-energy CT acquisition methods include dual tubes with or without beam filtration, rapid voltage switching, dual-layer detector, split filter technique, and sequential scanning. Dual-energy material-specific imaging methods include virtual monoenergetic or monochromatic imaging, effective atomic number map, virtual non-contrast or unenhanced imaging, virtual non-calcium imaging, iodine map, inhaled xenon map, uric acid imaging, automatic bone removal, and lung vessels analysis. In this review, we focus on dual-energy CT imaging including related issues of radiation exposure to patients, scanning and post-processing options, and potential clinical benefits mainly to improve the understanding of clinical radiologists and thus, expand the clinical use of dual-energy CT; in addition, we briefly describe the current technical limitations of dual-energy CT and the current developments of photon-counting detector.

  20. Dual-Energy CT: New Horizon in Medical Imaging.

    Science.gov (United States)

    Goo, Hyun Woo; Goo, Jin Mo

    2017-01-01

    Dual-energy CT has remained underutilized over the past decade probably due to a cumbersome workflow issue and current technical limitations. Clinical radiologists should be made aware of the potential clinical benefits of dual-energy CT over single-energy CT. To accomplish this aim, the basic principle, current acquisition methods with advantages and disadvantages, and various material-specific imaging methods as clinical applications of dual-energy CT should be addressed in detail. Current dual-energy CT acquisition methods include dual tubes with or without beam filtration, rapid voltage switching, dual-layer detector, split filter technique, and sequential scanning. Dual-energy material-specific imaging methods include virtual monoenergetic or monochromatic imaging, effective atomic number map, virtual non-contrast or unenhanced imaging, virtual non-calcium imaging, iodine map, inhaled xenon map, uric acid imaging, automatic bone removal, and lung vessels analysis. In this review, we focus on dual-energy CT imaging including related issues of radiation exposure to patients, scanning and post-processing options, and potential clinical benefits mainly to improve the understanding of clinical radiologists and thus, expand the clinical use of dual-energy CT; in addition, we briefly describe the current technical limitations of dual-energy CT and the current developments of photon-counting detector.

  1. ENERGY MEDICINE

    OpenAIRE

    Srinivasan, T. M.

    1987-01-01

    Energy medicine is the most comprehensive concept introduced in medical diagnostics and therapy to account for a whole range of phenomena and methods available to help an individual proceed from sickness to health. The modern medical theories do not account for, much less accept many traditional therapies due to deep suspicion that the older methods are not scientific. However, the Holistic Health groups around the world have now created an environment for therapies which work at subtle energ...

  2. CHAMP: Cognitive behaviour therapy for health anxiety in medical patients, a randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Murphy David

    2011-06-01

    Full Text Available Abstract Background Abnormal health anxiety, also called hypochondriasis, has been successfully treated by cognitive behaviour therapy (CBT in patients recruited from primary care, but only one pilot trial has been carried out among those attending secondary medical clinics where health anxiety is likely to be more common and have a greater impact on services. The CHAMP study extends this work to examine both the clinical and cost effectiveness of CBT in this population. Method/Design The study is a randomized controlled trial with two parallel arms and equal randomization of 466 eligible patients (assuming a 20% drop-out to an active treatment group of 5-10 sessions of cognitive behaviour therapy and to a control group. The aim at baseline, after completion of all assessments but before randomization, was to give a standard simple explanation of the nature of health anxiety for all participants. Subsequently the control group was to receive whatever care might usually be available in the clinics, which is normally a combination of clinical assessment, appropriate tests and reassurance. Those allocated to the active treatment group were planned to receive between 5 and 10 sessions of an adapted form of cognitive behaviour therapy based on the Salkovskis/Warwick model, in which a set of treatment strategies are chosen aimed at helping patients understand the factors that drive and maintain health anxiety. The therapy was planned to be given by graduate research workers, nurses or other health professionals trained for this intervention whom would also have their competence assessed independently during the course of treatment. The primary outcome is reduction in health anxiety symptoms after one year and the main secondary outcome is the cost of care after two years. Discussion This represents the first trial of adapted cognitive behaviour therapy in health anxiety that is large enough to test not only the clinical benefits of treatment but also

  3. Factors Influencing Enrollment in the Medication Therapy Management Clinic at an Academic Ambulatory Care Clinic.

    Science.gov (United States)

    Shah, Mansi; Tilton, Jessica; Kim, Shiyun

    2016-04-01

    In 2001, the University of Illinois Hospital and Health Sciences System (UI Health) established a pharmacist-run, referral-based medication therapy management clinic (MTMC). Referrals are obtained from any UI Health provider or by self-referral. Although there is a high volume of referrals, a large percentage of patients do not enroll. This study was designed to determine the various factors that influence patient enrollment in the MTMC. This study was a retrospective chart review of demographic and patient variable data during years 2010 and 2011. Disabilities, distance from MTMC, mode of transportation, past medical history, and appointment dates were extracted from the medical records. Results were analyzed using descriptive statistics and logistic regression analysis. A total of 103 referrals were made; however, only 17% of patients remain enrolled in MTMC. The baseline demographics included a mean age of 63 years, 68% female, 70% African American, and 81% English speaking. Patients lived an average of 8 miles from MTMC; most utilized public or government-supplemented transport services; 24% of patients reported some type of disability, most commonly utilizing a walker or a wheelchair. On average, patients were prescribed 13 medications with hypertension (70%), diabetes (56%), and hyperlipidemia (48%) being the most common chronic disease states. The reason for referral included medication management, education, medication reconciliation, and disease state management. Five patients were unable to be contacted to schedule an initial appointment. Additionally, 18 patients failed their scheduled initial appointment and did not reschedule. Logistic regression analysis demonstrated distance traveled for clinic visit, age, and history of hypertension affected the probability of patients showing for their appointments (chi-square = 19.7, P < .001). This study demonstrated that distance from MTMC is the most common barrier in patient enrollment; therefore, strategies

  4. Medication therapy management services in community pharmacy: a pilot programme in HIV specialty pharmacies.

    Science.gov (United States)

    Rosenquist, Ashley; Best, Brookie M; Miller, Teresa A; Gilmer, Todd P; Hirsch, Jan D

    2010-12-01

    Pharmacist-provided medication therapy management services (MTMS) have been shown to increase patient's adherence to medications, improve health outcomes and reduce overall medical costs. The purpose of this study was to describe a pilot programme that provided pharmacy-based MTMS for patients with HIV/AIDS in the state of California, USA. Pharmacists from the 10 pilot pharmacies were surveyed using an online data collection tool. Information was collected to describe the types of MTMS offered, proportion of patients actively using specific MTMS, pharmacist beliefs regarding effect on patient outcomes and barriers to providing MTMS, ability to offer MTMS without pilot programme funding and specialized pharmacist or staff training. Each responding pharmacy (7 of 10) varied in the number of HIV/AIDS patients served and prescription volume. All pharmacists had completed HIV/AIDS-related continuing education programmes, and some had other advanced training. The type of MTMS being offered varied at each pharmacy with 'individualized counselling by a pharmacist when overuse or underuse was detected' and 'refill reminders by telephone' being actively used by the largest proportion of patients. Most, but not all, pharmacists cited reimbursement as a barrier to MTMS provision. Pharmacists believed the MTMS they provide resulted in improved satisfaction (patient and provider), medication usage, therapeutics response and patient quality of life. The type of MTMS offered, and proportion of patients actively using, varied among participating pilot pharmacies. © 2010 Blackwell Publishing Ltd.

  5. Survey of Attitudes and Ethical Concerns Related to Gene Therapy Among Medical Students and Postgraduates in China.

    Science.gov (United States)

    Xiang, Liangcheng; Xiao, Lihong; Gou, Zhongping; Li, Mei; Zhang, Wei; Wang, Haiping; Feng, Ping

    2015-12-01

    Gene therapy is becoming an important treatment modality for gravely ill patients, and today's medical students and postgraduates are both potential consumers and future providers of gene therapy. Therefore, their attitudes and concerns about gene therapy may directly influence its long-term development and implementation in the clinic. We performed a cross-sectional survey of medical students and postgraduates at West China Medical School of Sichuan University. A custom-designed questionnaire was distributed to 600 students, and 579 were valid (96.98% response). Most respondents (84.46%) indicated little prior knowledge about gene therapy. The proportion of respondents considering gene therapy as acceptable ranged from 63.73% for serious illness to 17.72% for genetic enhancement. Adverse side effects were the most frequent concern among respondents when asked to imagine that they would receive gene therapy to treat a severe brain-related illness. These results suggest that medical students in China consider gene therapy's acceptability to be rather low, and are most concerned about its adverse side effects.

  6. Complex antithrombotic therapy: determinants of patient preference and impact on medication adherence

    Directory of Open Access Journals (Sweden)

    Abraham NS

    2015-11-01

    Full Text Available Neena S Abraham,1,2 Aanand D Naik,3,4 Richard L Street Jr,3–5 Diana L Castillo,3 Anita Deswal,6 Peter A Richardson,3,4 Christine M Hartman,3 George Shelton Jr,3,4 Liana Fraenkel7,8 1Division of Gastroenterology, Mayo Clinic, Scottsdale, AZ, USA; 2Divison of Healthcare Policy and Research, Department of Health Services Research, Rochester, MN, USA; 3Center for Innovations in Quality, Effectiveness, and Safety at the Michael E DeBakey VA Medical Center, Houston, TX, USA; 4Department of Medicine, Baylor College of Medicine, Houston, TX, USA; 5Department of Communication, Texas A&M University, College Station, TX, USA; 6Cardiology, Michael E DeBakey VAMC, Houston, TX, USA; 7Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA; 8Department of Medicine, Yale University, New Haven, CT, USA Purpose: For years, older patients have been prescribed multiple blood-thinning medications (complex antithrombotic therapy [CAT] to decrease their risk of cardiovascular events. These therapies, however, increase risk of adverse bleeding events. We assessed patient-reported trade-offs between cardioprotective benefit, gastrointestinal bleeding risk, and burden of self-management using adaptive conjoint analysis (ACA. As ACA could be a clinically useful tool to obtain patient preferences and guide future patient-centered care, we examined the clinical application of ACA to obtain patient preferences and the impact of ACA on medication adherence.Patients and methods: An electronic ACA survey led 201 respondents through medication risk–benefit trade-offs, revealing patients’ preferences for the CAT risk/benefit profile they valued most. The post-ACA prescription regimen was categorized as concordant or discordant with elicited preferences. Adherence was measured using VA pharmacy refill data to measure persistence of use prior to and 1 year following preference-elicitation. Additionally, we analyzed qualitative interviews of 56 respondents

  7. Cognitive-behavior therapy singly and combined with medication for persistent insomnia: Impact on psychological and daytime functioning.

    Science.gov (United States)

    Morin, Charles M; Beaulieu-Bonneau, Simon; Bélanger, Lynda; Ivers, Hans; Sánchez Ortuño, Montserrat; Vallières, Annie; Savard, Josée; Guay, Bernard; Mérette, Chantal

    2016-12-01

    While impairment of daytime functioning due to poor sleep is often the main determinant for seeking treatment, few studies have examined the clinical impact of insomnia therapies on daytime outcomes. The main objective of this study was to evaluate the impact of cognitive-behavior therapy (CBT), alone and combined with medication, on various indices of daytime and psychological functioning. Participants were 160 individuals with chronic insomnia who received CBT alone or CBT plus medication (zolpidem) for an initial six-week therapy, followed by an extended six-month therapy. Participants treated with CBT initially received maintenance CBT or no additional treatment and those treated with combined therapy initially continued with CBT plus intermittent medication (prn) or CBT without medication (taper). Measures of anxiety and depressive symptoms, fatigue, quality of life, and perceived impact of sleep difficulties on various indices of daytime functioning were completed at baseline, after each treatment stage, and at six-month follow-up. Following acute treatment, significant improvements of fatigue, quality of life (mental component), anxiety, and depression were obtained in the CBT alone condition but not in the combined CBT plus medication condition. Following extended treatment, further improvements were noted for the subgroup receiving extended CBT relative to that with no additional treatment, and for the subgroup receiving CBT and intermittent medication relative to that with CBT but no medication. Improvements were well maintained at the 6-month follow-up. These findings indicate that insomnia-specific therapy is effective at improving daytime and psychological functioning in the short term, and that maintenance therapy produces an added value to optimize long-term outcomes. www.clinicaltrials.gov (#NCT 00042146). Copyright © 2016 Elsevier Ltd. All rights reserved.

  8. Simulation and virtual reality in medical education and therapy: a protocol.

    Science.gov (United States)

    Roy, Michael J; Sticha, Deborah L; Kraus, Patricia L; Olsen, Dale E

    2006-04-01

    Continuing medical education has historically been provided primarily by didactic lectures, though adult learners prefer experiential or self-directed learning. Young physicians have extensive experience with computer-based or "video" games, priming them for medical education--and treating their patients--via new technologies. We report our use of standardized patients (SPs) to educate physicians on the diagnosis and treatment of biological and chemical warfare agent exposure. We trained professional actors to serve as SPs representing exposure to biological agents such as anthrax and smallpox. We rotated workshop participants through teaching stations to interview, examine, diagnose and treat SPs. We also trained SPs to simulate a chemical mass casualty (MASCAL) incident. Workshop participants worked together to treat MASCAL victims, followed by discussion of key teaching points. More recently, we developed computer-based simulation (CBS) modules of patients exposed to biological agents. We compare the strengths and weaknesses of CBS vs. live SPs. Finally, we detail plans for a randomized controlled trial to assess the efficacy of virtual reality (VR) exposure therapy compared to pharmacotherapy for post-traumatic stress disorder (PTSD). PTSD is associated with significant disability and healthcare costs, which may be ameliorated by the identification of more effective therapy.

  9. [The application of laser therapy for the medical rehabilitation of the children presenting with chronic osteomyelitis].

    Science.gov (United States)

    Trunova, O V; Mashkov, A E; Khan, M A; Prikuls, V F; Nazarenko, N N; Supova, M V; Smirnova, S N; Larionov, K S

    2015-01-01

    The objective of the present study was to develop a scientifically sound rationale for the application of infrared laser radiation (IRLR) either separately or in the combination with fluctuation magnetic therapy in the medical rehabilitation of the children presenting with chronic hematogenous osteomyelitis. Another objective was to evaluate the clinical effectiveness of this therapeutic modality. Two achieve these goals, the clinical observations and special research studies were conducted in two directions with the participation of 95 patients at the age varying from 1 to 15 years. The study has demonstrated the effectiveness of the inclusion of IRLR in the medical rehabilitation program for the children with chronic hematogenous osteomyelitis in different periods of the disease. It was shown that the transcutaneous infrared irradiation of the affected area during the exacerbation of chronic osteomyelitis had a well apparent immunostimulatory effect and reduced the activity of the inflammatory process. The application of IRLR in combination with fluctuation magnetic therapy during the period of partial remission, had a more pronounced influence on the microcirculation and stimulated the regenerative and trophic processes.

  10. Impact of Medical Therapy on Atheroma Volume Measured by Different Cardiovascular Imaging Modalities

    Directory of Open Access Journals (Sweden)

    Mohamad C. N. Sinno

    2010-01-01

    Full Text Available Atherosclerosis is a systemic disease that affects most vascular beds. The gold standard of atherosclerosis imaging has been invasive intravascular ultrasound (IVUS. Newer noninvasive imaging modalities like B-mode ultrasound, cardiac computed tomography (CT, positron emission tomography (PET, and magnetic resonance imaging (MRI have been used to assess these vascular territories with high accuracy and reproducibility. These imaging modalities have lately been used for the assessment of the atherosclerotic plaque and the response of its volume to several medical therapies used in the treatment of patients with cardiovascular disease. To study the impact of these medications on atheroma volume progression or regression, imaging modalities have been used on a serial basis providing a unique opportunity to monitor the effect these antiatherosclerotic strategies exert on plaque burden. As a result, studies incorporating serial IVUS imaging, quantitative coronary angiography (QCA, B-mode ultrasound, electron beam computed tomography (EBCT, and dynamic contrast-enhanced magnetic resonance imaging have all been used to evaluate the impact of therapeutic strategies that modify cholesterol and blood pressure on the progression/regression of atherosclerotic plaque. In this review, we intend to summarize the impact of different therapies aimed at halting the progression or even result in regression of atherosclerotic cardiovascular disease evaluated by different imaging modalities.

  11. Use of acupuncture therapy as a supplement to conventional medical treatments for acute ischaemic stroke patients in an academic medical centre in Korea.

    Science.gov (United States)

    Chang, Hyejung; Kwon, Young Dae; Yoon, Sung Sang

    2011-10-01

    Acupuncture has served as a major complementary and alternative therapy that supplements conventional medicine and is the subject of growing public interest. This study was conducted to estimate the usage rate of acupuncture as a supplemental treatment in acute ischaemic stroke patients and to identify factors associated with the choice to use this therapy. Using the registry of stroke patients admitted to an academic medical centre in Korea, the use of acupuncture therapy was recorded and analysed, along with the patients' socio-demographic characteristics, hospital access variables, risk factors for ischaemic stroke and clinical characteristics. The data were analysed using descriptive statistics, chi-square tests and multiple logistic regression analyses. Of 2167 patients, 18% received acupuncture therapy. The choice of acupuncture therapy was significantly associated with stroke severity as well as gender, age, geographical residence and previous history of stroke. After controlling for other significant factors, there was an approximately 3.4-fold greater usage in patients with moderately severe strokes (95% confidence interval (CI)=2.5-4.6) and 4.1-fold greater usage in patients with severe strokes (95% CI=2.7-6.4). The findings provide a better understanding of patients' utilization of acupuncture therapy as a supplement to conventional medical treatments and of factors associated with the utilization of acupuncture in patients with acute ischemic stroke. Strategic implications of acupuncture therapy are suggested for both health-care providers and policy makers. Copyright © 2011 Elsevier Ltd. All rights reserved.

  12. Budget impact analysis of conversion from cyclosporine to sirolimus as immunosuppressive medication in renal transplantation therapy

    Directory of Open Access Journals (Sweden)

    Foroutan N

    2013-10-01

    Full Text Available Naghmeh Foroutan,1 Hamid R Rasekh,1 Jamshid Salamzadeh,1 Hamid R Jamshidi,1 Mohsen Nafar2 1Department of Pharmacoeconomics and Pharmaceutical Management, School of Pharmacy, Shahid Beheshti University of Medical Sciences, 2Department of Kidney Transplantation, Urinary Nephrology Research Center (UNRC, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran Objectives: The aim of this study was to determine budget impact of conversion from cyclosporine (CsA to sirolimus (SRL in renal transplant therapy (RTT from the perspective of insurance organizations in Iran. Methods: An Excel-based model was developed to determine cost of RTT, comparing current CsA based therapy to an mTOR inhibitor-based therapy regimen. Total cost included both cost of immunosuppressive agents and relative adverse events. The inputs were derived from database of Ministry of Health and insurance organizations, hospital and pharmacy based registries, and available literature that were varied through a one-way sensitivity analysis. According to the model, there were almost 17,000 patients receiving RTT in Iran, out of which about 2,200 patients underwent the operation within the study year. The model was constructed based on the results of a local RCT, in which test and control groups received CsA, SRL, and steroids over the first 3 months posttransplantation and, from the fourth month on, CsA, mycophenolate mofetil (MMF, and steroids were used in the CsA group and SRL, MMF, and steroids were administered in the SRL group, respectively. Results: The estimated cost of RTT with CsA was US$4,850,000 versus US$4,300,000 receiving SRL. These costs corresponded to the cost saving of almost US$550,000 for the payers. Conclusion: To evaluate the financial consequence of adding mTOR inhibitors to the insurers’ formulary, in the present study, a budget impact analysis was conducted on sirolimus. Fewer cases of costly adverse events along with

  13. Medical Therapies for Stricturing Crohn's Disease: Efficacy and Cross-Sectional Imaging Predictors of Therapeutic Failure.

    Science.gov (United States)

    Campos, Cécile; Perrey, Antoine; Lambert, Céline; Pereira, Bruno; Goutte, Marion; Dubois, Anne; Goutorbe, Felix; Dapoigny, Michel; Bommelaer, Gilles; Hordonneau, Constance; Buisson, Anthony

    2017-06-01

    Medical therapy efficacy remains controversial in stricturing Crohn's disease. Cross-sectional imaging, especially magnetic resonance imaging, has been suggested as very helpful to guide therapeutic decision making. To assess efficacy and predictors of therapeutic failure in patients receiving medical treatments for stricturing Crohn's disease. In this retrospective study, therapeutic failure was defined as symptomatic stricture leading to surgical or endoscopic therapeutics, hospitalization, treatment discontinuation or additional therapy and short-term clinical response as clinical improvement assessed by two physicians. The 55 cross-sectional imaging examinations (33 magnetic resonance imaging and 22 CT scan) before starting medical therapy were analyzed independently by two radiologists. Results were expressed as hazard ratio (HR) or odds ratio (OR) with 95% confidence intervals (95% CI). Among 84 patients, therapeutic failure rate within 60 months was 66.6%. In multivariate analysis, Crohn's disease diagnosis after 40 years old (HR 3.9, 95% CI [1.37-11.2], p = 0.011), small stricture luminal diameter (HR 1.34, 95% CI [1.01-1.80], p = 0.046), increased stricture wall thickness (HR 1.23, 95% CI [1.04-1.46], p = 0.013) and fistula with abscess (HR 5.63, 95% CI [1.64-19.35], p = 0.006) were associated with therapeutic failure, while anti-TNF combotherapy (HR 0.17, 95% CI [0.40-0.71], p = 0.015) prevented it. Considering 108 therapeutic sequences, the short-term clinical response rate was 65.7%. In multivariate analysis, male gender (OR 0.15, 95% CI [0.03-0.64], p = 0.011), fistula with abscess (OR 0.09, 95% CI [0.01-0.77], p = 0.028) and comb sign (OR 0.23, 95% CI [0.005-0.97], p = 0.047) were associated with short-term clinical failure. Anti-TNF combotherapy seemed to prevent therapeutic failure, and cross-sectional imaging should be systematically performed to help medical management in stricturing Crohn's disease.

  14. Risks and benefits of hormone therapy: has medical dogma now been overturned?

    Science.gov (United States)

    Shapiro, S; de Villiers, T J; Pines, A; Sturdee, D W; Baber, R J; Panay, N; Stevenson, J C; Mueck, A O; Burger, H G

    2014-06-01

    In an integrated overview of the benefits and risks of menopausal hormone therapy (HT), the Women's Health Initiative (WHI) investigators have claimed that their 'findings … do not support use of this therapy for chronic disease prevention'. In an accompanying editorial, it was claimed that 'the WHI overturned medical dogma regarding menopausal [HT]'. To evaluate those claims. Epidemiological criteria of causation were applied to the evidence. A 'global index' purporting to summarize the overall benefit versus the risk of HT was not valid, and it was biased. For coronary heart disease, an increased risk in users of estrogen plus progestogen (E + P), previously reported by the WHI, was not confirmed. The WHI study did not establish that E+ P increases the risk of breast cancer; the findings suggest that unopposed estrogen therapy (ET) does not increase the risk, and may even reduce it. The findings for stroke and pulmonary embolism were compatible with an increased risk, and among E+ P users there were credible reductions in the risk of colorectal and endometrial cancer. For E+ P and ET users, there were credible reductions in the risk of hip fracture. Under 'worst case' and 'best case' assumptions, the changes in the incidence of the outcomes attributable to HT were minor. Over-interpretation and misrepresentation of the WHI findings have damaged the health and well-being of menopausal women by convincing them and their health professionals that the risks of HT outweigh the benefits.

  15. Report on proton therapy according to good clinical practice at Hyogo Ion Beam Medical Center

    International Nuclear Information System (INIS)

    Murakami, Masao; Kagawa, Kazufumi; Hishikawa, Yoshio; Abe, Mitsuyuki

    2002-01-01

    The Hyogo Ion Beam Medical Center (HIBMC) is a hospital-based charged particle treatment facility. Having two treatment ion beams (proton and carbon) and five treatment rooms, it is a pioneer among particle institutes worldwide. In May 2001, proton therapy was started as a clinical study for patients with localized cancer originating in the head and neck, lung, liver, and prostate. The aim of this study was to investigate the safety, effectiveness, and stability of the treatment units and systems based on the evaluation of acute toxicity, tumor response, and working ratio of the machine, respectively. Six patients, including liver cancer in three, prostate cancer in two, and lung cancer in one, were treated. There was no cessation of therapy owing to machine malfunction. Full courses of proton therapy consisting of 154 portals in all six patients were given exactly as scheduled. None of the patients experienced severe acute reactions of more than grade 3 according to NCI-CTC criteria. Tumor response one month post-treatment was evaluable in five of the six patients, and was CR in 1 (prostate cancer), PR in 2 (lung cancer: 1, liver cancer: 1), and NC in 2 (liver cancer: 2). These results indicate that our treatment units and systems are safe and reliable enough for proton irradiation to be used for several malignant tumors localized in the body. (author)

  16. The proton therapy nozzles at Samsung Medical Center: A Monte Carlo simulation study using TOPAS

    Science.gov (United States)

    Chung, Kwangzoo; Kim, Jinsung; Kim, Dae-Hyun; Ahn, Sunghwan; Han, Youngyih

    2015-07-01

    To expedite the commissioning process of the proton therapy system at Samsung Medical Center (SMC), we have developed a Monte Carlo simulation model of the proton therapy nozzles by using TOol for PArticle Simulation (TOPAS). At SMC proton therapy center, we have two gantry rooms with different types of nozzles: a multi-purpose nozzle and a dedicated scanning nozzle. Each nozzle has been modeled in detail following the geometry information provided by the manufacturer, Sumitomo Heavy Industries, Ltd. For this purpose, the novel features of TOPAS, such as the time feature or the ridge filter class, have been used, and the appropriate physics models for proton nozzle simulation have been defined. Dosimetric properties, like percent depth dose curve, spreadout Bragg peak (SOBP), and beam spot size, have been simulated and verified against measured beam data. Beyond the Monte Carlo nozzle modeling, we have developed an interface between TOPAS and the treatment planning system (TPS), RayStation. An exported radiotherapy (RT) plan from the TPS is interpreted by using an interface and is then translated into the TOPAS input text. The developed Monte Carlo nozzle model can be used to estimate the non-beam performance, such as the neutron background, of the nozzles. Furthermore, the nozzle model can be used to study the mechanical optimization of the design of the nozzle.

  17. Medical Rehabilitation and Occupational Therapy in Patients with Lesion of Plexus Brachialis

    Directory of Open Access Journals (Sweden)

    Vacheva D.

    2015-05-01

    Full Text Available Causes for plexus brachialis damage are versatile, and in some cases remain unknown, but mostly result from degenerative and inflammatory processes. Treatment of brachial plexus dysfunction is often conservative and is subject to a team of specialists - neurologists, traumatologists, rehabilitation physicians, kinesitherapists and occupational therapists. The objective of the research is to report the recovery of patients with lesion of plexus brachialis after a complex physiotherapy and rehabilitation treatment program that includes electrostimulation, remedial massage, kinesitherapy, electrotherapy and occupational therapy. A total of 159 patients, treated at the Clinic of Physical Therapy, University Hospital of Pleven, were included in the study. Improvement of measured indexes: pain assessment, centimetry, assessment of upper limb muscle weakness, dynamometry and functional test of activities of daily living, was registered in all patients under observation. In order to achieve good results in the rehabilitation of patients with injured plexus brachialis, timely diagnosis, good medication therapy and early start of complex physiotherapy and rehabilitation are of crucial importance, so that performance of daily living activities improves. The good results come slowly and with difficulties, but the quality of life of patients and the quality of labor performed by them, improves significantly.

  18. Observation of the effect of physical rehabilitation therapy combined with the medication on pelvic floor dysfunction.

    Science.gov (United States)

    Han, Wei; Wang, Yongmei; Qi, Shengbo; Li, Tingting; Cao, Jiang; Zheng, Tinghua; Su, Yan

    2018-02-01

    We observed the effects of physical rehabilitation therapy combined with medication on pelvic floor dysfunction (PFD). We collected the medical records of 84 maternal patients with PFD who received treatment at the Affiliated Hospital of Hebei University between May 2015 and October 2016. These patients were randomly divided into two groups, the control group (n=42) and observation group (n=42). In the control group, patients received conventional physical rehabilitation therapy while in observation group, patients received the shixiao powder combined with siwu decoction in addition to the physical rehabilitation. The therapeutic effects were compared between the two groups. The total effective rate of the observation group was 97.6%, which was significantly higher than 78.6% in the control group (Ppelvic floor function under rest state, such as electromyo-graphy amplitude, contraction force, coordinate strength and urine flow rate, were significantly higher than those in control group (P0.05). In observation group, after treatment, the rehabilitation effects of urinary incontinence and sexual life quality at 3 months post-delivery were significantly better than those in control group (P0.05), however, after treatment, the levels of CRP and IL-10 of patients in observation group were significantly lower than those in control group (Pphysical rehabilitation therapy combined with the shixiao powder and siwu decoction exhibits significant efficacy in the treatment of PFD by effectively improving the pelvic floor functions, increasing perineal muscle strength, and decreasing expression levels of inflammatory factors, which can significantly ameliorate life quality and reduce the incidence rate of complications. Thus, this treatment method shows great application value in clinical practice.

  19. Junior medical students’ knowledge about and attitudes towards electroconvulsive therapy in a South African setting

    Directory of Open Access Journals (Sweden)

    Matthew B. Mausling

    2017-07-01

    Full Text Available Background: Although electroconvulsive therapy (ECT is a safe and effective treatment modality with a long history of use in psychiatry, it remains controversial owing to misconceptions and negative attitudes among the public and medical profession. The aim of this study was to explore the state of knowledge and attitudes towards ECT among a sample of South African medical students. Method: Prior to their theoretical psychiatry module, 131 second-year medical students responded to an anonymous online survey designed to assess the source and extent of their ECT knowledge as well as their attitude towards ECT and psychiatry in general. Results: The Internet (46.6% and TV and/or movies (30.5% were the principal sources of knowledge of ECT while ‘professional publication’ was the least common (0%. The students’ attitudes towards psychiatry were generally positive and nearly one-third (29.8% would consider specialising in the field. Overall, perception towards ECT was mixed, with many respondents approving of its use albeit only as a last resort. Notably, low ECT knowledge scores were associated with more negative attitudes towards this treatment modality and a lower perception of psychiatry as a medical speciality. Conclusion: The findings indicate that for these students, media is the main source of ECT knowledge. While they are generally knowledgeable about ECT, they still harbour some misconceptions and negative attitudes about the treatment. Knowledge appears able to amend these attitudes, thus underlining the importance of integrating accurate information about ECT into the preclinical medical curriculum rather than leaving it to mass media to forge warped perceptions and attitudes for these future clinicians.

  20. Community pharmacy-based medication therapy management services: financial impact for patients

    Directory of Open Access Journals (Sweden)

    Ruisinger JF

    2012-09-01

    Full Text Available Objective: To determine the direct financial impact for patients resulting from Medication Therapy Management (MTM interventions made by community pharmacists. Secondary objectives include evaluating the patient and physician acceptance rates of the community pharmacists’ recommended MTM interventions.Methods: This was a retrospective observational study conducted at 20 Price Chopper and Hen House grocery store chain pharmacies in the Kansas City metro area from January 1, 2010 to December 31, 2010. Study patients were Medicare Part D beneficiaries eligible for MTM services. The primary outcome was the change in patient out-of-pocket prescription medication expense as a result of MTM services.Results: Of 128 patients included in this study, 68% experienced no out-of-pocket financial impact on their medication expenses as a result of MTM services. A total of 27% of the patients realized a cost-savings (USD440.50 per year, (SD=289.69 while another 5% of patients saw a cost increase in out-of-pocket expense (USD255.66 per year, (SD=324.48. The net financial impact for all 128 patients who participated in MTM services was an average savings of USD102.83 per patient per year (SD=269.18, p<0.0001. Pharmacists attempted a total of 732 recommendations; 391 (53% were accepted by both the patient and their prescriber. A total of 341 (47% recommendations were not accepted because of patient refusal (290, 85% or prescriber refusal (51, 15%.Conclusions: Patient participation in MTM services reduces patient out-of-pocket medication expense. However, this savings is driven by only 32% of subjects who are experiencing a financial impact on out-of-pocket medication expense. Additionally, the majority of the pharmacists’ recommended interventions (53% were accepted by patients and prescribers.

  1. Increased physical activity not decreased energy intake is associated with inpatient medical treatment for anorexia nervosa in adolescent females.

    Directory of Open Access Journals (Sweden)

    Janine Higgins

    Full Text Available There is a dearth of data regarding changes in dietary intake and physical activity over time that lead to inpatient medical treatment for anorexia nervosa (AN. Without such data, more effective nutritional therapies for patients cannot be devised. This study was undertaken to describe changes in diet and physical activity that precede inpatient medical hospitalization for AN in female adolescents. This data can be used to understand factors contributing to medical instability in AN, and may advance rodent models of AN to investigate novel weight restoration strategies. It was hypothesized that hospitalization for AN would be associated with progressive energy restriction and increased physical activity over time. 20 females, 11-19 years (14.3±1.8 years, with restricting type AN, completed retrospective, self-report questionnaires to assess dietary intake and physical activity over the 6 month period prior to inpatient admission (food frequency questionnaire, Pediatric physical activity recall and 1 week prior (24 hour food recall, modifiable activity questionnaire. Physical activity increased acutely prior to inpatient admission without any change in energy or macronutrient intake. However, there were significant changes in reported micronutrient intake causing inadequate intake of Vitamin A, Vitamin D, and pantothenic acid at 1 week versus high, potentially harmful, intake of Vitamin A over 6 months prior to admission. Subject report of significantly increased physical activity, not decreased energy intake, were associated with medical hospitalization for AN. Physical activity and Vitamin A and D intake should be carefully monitored following initial AN diagnosis, as markers of disease progression as to potentially minimize the risk of medical instability.

  2. The impact of pharmacist-led medication therapy management on medication adherence in patients with type 2 diabetes mellitus: a randomized controlled study

    Directory of Open Access Journals (Sweden)

    Erku DA

    2017-09-01

    Full Text Available Background: Poor adherence to antidiabetic medications leads to a higher rate of hospital admissions and adverse health outcomes in type 2 diabetes mellitus patients. Objective: This study aims to evaluate whether a pharmacist-led medication therapy management, compared to the usual care, could enhance medication adherence and reduce hospital admission in patients with type 2 diabetes mellitus. Methods: A prospective randomized controlled study was conducted in patients with type 2 diabetes mellitus from February 1 to July 30, 2016. Patients in the control group (n=65 received the usual care while patients in the intervention group (n=62 received a personalized pharmacotherapeutic care plan and diabetes education. The two groups were compared by repeated measure ANOVA at 3 and 6‐months with medication adherence (using Morisky medication adherence scale and number of hospital admissions as the main outcome variables. Results: A total of 127 patients were included in the study. A marked and statistically significant increase in medication adherence from baseline to 3 and 6 months were noted in the intervention group (increased from 9.2% at baseline to 61% at 6 month compared with the control group (increased from 13.2% at baseline (to 30.2% at 6 month; p-value<0.01. Furthermore, at the 6-month follow-up, only 23 patients in MTM group with poorly controlled blood glucose levels resulted in hospital admissions compared to 48 patients in non-MTM group, resulting in a 52.1% fewer hospital admissions (p< 0.001. Conclusions: The findings of this study implied that pharmacist-led medication therapy management might improve medication adherence and reduce number of hospitalizations in patients with type 2 diabetes mellitus. Hence, policies and guidelines should be in place in order for clinical pharmacists to fully engage in patient care and improve the medication therapy outcomes.

  3. Energy Survey of Eisenhower Army Medical Center, Fort Gordon, Augusta, Georgia. Volume 2. Appendices

    National Research Council Canada - National Science Library

    1996-01-01

    ...) including low cost/no cost ECO's and perform complete evaluations of each. Energy equipment replacement projects already underway, approved, or planned by the Medical Center staff will be factored into the evaluations...

  4. Recent topical research on global, energy, health & medical, and tourism economics, and global software: An overview

    OpenAIRE

    Chang, Chia-Lin; McAleer, Michael

    2017-01-01

    textabstractThe paper presents an overview of recent topical research on global, energy, health & medical, and tourism economics, and global software. We have interpreted "global" in the title of the Journal of Reviews on Global Economics to cover contributions that have a global impact on economics, thereby making it "global economics". In this sense, the paper is concerned with papers on global, energy, health & medical, and tourism economics, as well as global software algorithms that have...

  5. Recent Topical Research on Global, Energy, Health & Medical, and Tourism Economics, and Global Software

    OpenAIRE

    Chang, Chia-Lin; McAleer, Michael

    2017-01-01

    textabstractThe paper presents an overview of recent topical research on global, energy, health & medical, and tourism economics, and global software. We have interpreted “global” in the title of the Journal of Reviews on Global Economics to cover contributions that have a global impact on economics, thereby making it “global economics”. In this sense, the paper is concerned with papers on global, energy, health & medical, and tourism economics, as well as global software algorithms that have...

  6. "How do I say that?": Using communication principles to enhance medication therapy management instruction.

    Science.gov (United States)

    Denvir, Paul M; Cardone, Katie E; Parker, Wendy M; Cerulli, Jennifer

    2018-02-01

    Medication therapy management (MTM) is a comprehensive, patient-centered approach to improving medication use, reducing the risk of adverse events and improving medication adherence. Given the service delivery model and required outputs of MTM services, communication skills are of utmost importance. The objectives of this study were to identify and describe communication principles and instructional practices to enhance MTM training. Drawing on formative assessment data from interviews of both pharmacy educators and alumni, this article identifies and describes communication principles and instructional practices that pharmacy educators can use to enhance MTM training initiatives to develop student communication strategies. Analysis revealed five key communication challenges of MTM service delivery, two communication principles that pharmacy teachers and learners can use to address those challenges, and a range of specific strategies, derived from communication principles, that students can use when challenges emerge. Implications of the analysis for pharmacy educators and researchers are described. Proactive communication training provided during MTM advanced pharmacy practice experiences enabled students to apply the principles and instructional strategies to specific patient interactions during the advanced pharmacy practice experiences and in their post-graduation practice settings. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. Comparison of Transplant Waitlist Outcomes for Pediatric Candidates Supported by Ventricular Assist Devices Versus Medical Therapy.

    Science.gov (United States)

    Law, Sabrina P; Oron, Assaf P; Kemna, Mariska S; Albers, Erin L; McMullan, D Michael; Chen, Jonathan M; Law, Yuk M

    2018-05-01

    Ventricular assist devices have gained popularity in the management of refractory heart failure in children listed for heart transplantation. Our primary aim was to compare the composite endpoint of all-cause pretransplant mortality and loss of transplant eligibility in children who were treated with a ventricular assist device versus a medically managed cohort. This was a retrospective cohort analysis. Data were obtained from the Scientific Registry of Transplant Recipients. The at-risk population (n = 1,380) was less than 18 years old, either on a ventricular assist device (605 cases) or an equivalent-severity, intensively medically treated group (referred to as MED, 775 cases). None. The impact of ventricular assist devices was estimated via Cox proportional hazards regression (hazard ratio), dichotomizing 1-year outcomes to "poor" (22%: 193 deaths, 114 too sick) versus all others (940 successful transplants, 41 too healthy, 90 censored), while adjusting for conventional risk factors. Among children 0-12 months old, ventricular assist device was associated with a higher risk of poor outcomes (hazard ratio, 2.1; 95% CI, 1.5-3.0; p comparative study of ventricular assist devices versus medical therapy in children. Age is a significant modulator of waitlist outcomes for children with end-stage heart failure supported by ventricular assist device, with the impact of ventricular assist devices being more beneficial in adolescents.

  8. Medical nutrition therapy as a potential complementary treatment for psoriasis--five case reports.

    Science.gov (United States)

    Brown, Amy C; Hairfield, Michelle; Richards, Douglas G; McMillin, David L; Mein, Eric A; Nelson, Carl D

    2004-09-01

    This research evaluated five case studies of patients with psoriasis following a dietary regimen. There is no cure for psoriasis and the multiple treatments currently available only attempt to reduce the severity of symptoms. Treatments range from topical applications, systemic therapies, and phototherapy; while some are effective, many are associated with significant adverse effects. There is a need for effective, affordable therapies with fewer side effects that address the causes of the disorder. Evaluation consisted of a study group of five patients diagnosed with chronic plaque psoriasis (two men and three women, average age 52 years; range 40-68 years) attending a 10-day, live-in program during which a physician assessed psoriasis symptoms and bowel permeability. Subjects were then instructed on continuing the therapy protocol at home for six months. The dietary protocol, based on Edgar Cayce readings, included a diet of fresh fruits and vegetables, small amounts of protein from fish and fowl, fiber supplements, olive oil, and avoidance of red meat, processed foods, and refined carbohydrates. Saffron tea and slippery elm bark water were consumed daily. The five psoriasis cases, ranging from mild to severe at the study onset, improved on all measured outcomes over a six-month period when measured by the Psoriasis Area and Severity Index (PASI) (average pre- and post-test scores were 18.2 and 8.7, respectively), the Psoriasis Severity Scale (PSS) (average pre- and post-test scores were 14.6 and 5.4, respectively), and the lactulose/mannitol test of intestinal permeability (average pre- and post-test scores were 0.066 to 0.026, respectively). These results suggest a dietary regimen based on Edgar Cayce's readings may be an effective medical nutrition therapy for the complementary treatment of psoriasis; however, further research is warranted to confirm these results.

  9. Medical set-up of boron neutron capture therapy (BNCT) for malignant glioma at the Japan research reactor (JRR)-4

    International Nuclear Information System (INIS)

    Yamamoto, T.; Matsumura, A.; Nose, T.; Shibata, Y.; Nakai, K.; Sakurai, F.; Kishi, T.; Kumada, H.; Yamamoto, K.; Torii, Y.

    2001-01-01

    The University of Tsukuba project for boron neutron capture therapy (BNCT) was initiated at the Japan Atomic Energy Research Institute (JAERI) in 1992. The clinical study for BNCT began at the Japan Research Reactor (JRR)-2 of the JAERI in November 1995. By the end of 1998, a new medical irradiation facility had been installed in JRR-4 of that included a new medical treatment room and patient-monitoring area adjacent to the irradiation room. The medical treatment room was built to reflect a hospital-type operation room that includes an operating table with a carbon head frame, anesthesia apparatus with several cardiopulmonary monitors, etc. Following craniotomy in the treatment room, a patient under anesthesia is transported into the irradiation room for BNCT. The boron concentration in tissue is measured with prompt gamma ray analysis (PGA) and simultaneously by inductively coupled plasma atomic emission spectroscopy (ICP-AES) methods. For the immediate pre- and post-BNCT care, a collaborating neurosurgical department of the University of Tsukuba was prepared in the vicinity of the JAERI. The long term follow-up is done at the University of Tsukuba Hospital. Epithermal neutron beam also became available at the new JRR-4. By changing the thickness and/or the configuration of heavy water, a cadmium plate, and a graphite reflector, the JRR-4 provides a variety of neutron beams, including three typical beams (Epithermal mode and Thermal modes I and II). Intraoperative BNCT using the thermal beam is planned to study at the beginning of the clinical trial. The ongoing development of the JAERI Computational Dosimetry System (JCDS) and radiobiological studies have focused in the application of the epithermal beam for BNCT. After obtaining these basic data, we are planning to use the epithermal beam for intraoperative BNCT. (author)

  10. Additive, control, energy, medical and other hot topics

    NARCIS (Netherlands)

    Brouwer, Dannis Michel

    2014-01-01

    The 14th International Conference of the European Society for Precision Engineering and Nanotechnology (euspen) was held in Dubrovnik, Croatia, on 2-6 June 2014. Among the hot topics discussed were additive manufacturing (AM), motion control in precision systems, renewable energy technologies, and

  11. Radiation therapy using high-energy heavy-ion

    International Nuclear Information System (INIS)

    Kanai, Tatsuaki

    1995-01-01

    The clinical trial of the heavy-ion radiotherapy was started at June 1994 after pre-clinical experiments using 290 MeV/u carbon beam. In this paper, an irradiation system for the heavy-ion radiotherapy installed at HIMAC (Heavy Ion Medical Accelerator in Chiba) and the physical characteristics of the therapeutic beam were discussed. (author)

  12. Early response in cognitive-behavior therapy for syndromes of medically unexplained symptoms.

    Science.gov (United States)

    Kleinstäuber, Maria; Lambert, Michael J; Hiller, Wolfgang

    2017-05-25

    Early dramatic treatment response suggests a subset of patients who respond to treatment before most of it has been offered. These early responders tend to be over represented among those who are well at termination and at follow-up. Early response patterns in psychotherapy have been investigated only for a few of mental disorders so far. The main aim of the current study was to examine early response after five therapy-preparing sessions of a cognitive behavior therapy (CBT) for syndromes of medically unexplained symptoms (MUS). In the context of a randomized, waiting-list controlled trial 48 patients who suffered from ≥3 MUS over ≥6 months received 5 therapy-preparing sessions and 20 sessions of CBT for somatoform disorders. They completed self-report scales of somatic symptom severity (SOMS-7 T), depression (BDI-II), anxiety (BSI), illness anxiety and behavior (IAS) at pre-treatment, after 5 therapy-preparing sessions (FU-5P) and at therapy termination (FU-20 T). The current analyses are based on data from the treatment arm only. Repeated measure ANOVAs revealed a significant decrease of depression (d = 0.34), anxiety (d = 0.60), illness anxiety (d = 0.38) and illness behavior (d = 0.42), but no change of somatic symptom severity (d = -0.03) between pre-treatment and FU-5P. Hierarchical linear multiple regression analyses showed that symptom improvements between pre-treatment and FU-5P predict a better outcome at therapy termination for depression and illness anxiety, after controlling for pre-treatment scores. Mixed-effect ANOVAs revealed significant group*time interaction effects indicating differences in the course of symptom improvement over the therapy between patients who fulfilled a reliable change (i.e., early response) during the 5 therapy-preparing sessions and patients who did not reach an early reliable change. Demographic or clinical variables at pre-treatment were not significantly correlated with differential scores between pre

  13. Machine Learning Approach to Optimizing Combined Stimulation and Medication Therapies for Parkinson's Disease.

    Science.gov (United States)

    Shamir, Reuben R; Dolber, Trygve; Noecker, Angela M; Walter, Benjamin L; McIntyre, Cameron C

    2015-01-01

    Deep brain stimulation (DBS) of the subthalamic region is an established therapy for advanced Parkinson's disease (PD). However, patients often require time-intensive post-operative management to balance their coupled stimulation and medication treatments. Given the large and complex parameter space associated with this task, we propose that clinical decision support systems (CDSS) based on machine learning algorithms could assist in treatment optimization. Develop a proof-of-concept implementation of a CDSS that incorporates patient-specific details on both stimulation and medication. Clinical data from 10 patients, and 89 post-DBS surgery visits, were used to create a prototype CDSS. The system was designed to provide three key functions: (1) information retrieval; (2) visualization of treatment, and; (3) recommendation on expected effective stimulation and drug dosages, based on three machine learning methods that included support vector machines, Naïve Bayes, and random forest. Measures of medication dosages, time factors, and symptom-specific pre-operative response to levodopa were significantly correlated with post-operative outcomes (P < 0.05) and their effect on outcomes was of similar magnitude to that of DBS. Using those results, the combined machine learning algorithms were able to accurately predict 86% (12/14) of the motor improvement scores at one year after surgery. Using patient-specific details, an appropriately parameterized CDSS could help select theoretically optimal DBS parameter settings and medication dosages that have potential to improve the clinical management of PD patients. Copyright © 2015 Elsevier Inc. All rights reserved.

  14. Quality of life of glaucoma patients under medical therapy with different prostaglandins

    Directory of Open Access Journals (Sweden)

    Paletta Guedes RA

    2012-10-01

    Full Text Available Ricardo Augusto Paletta Guedes,1–3 Vanessa Maria Paletta Guedes,1–3, Sirley Maria Freitas,2 Alfredo Chaoubah11Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil; 2Paletta Guedes Ophthalmological Center, Juiz de Fora, MG, Brazil; 3Santa Casa de Misericórdia Hospital, Juiz de Fora, Minas Gerais, BrazilPurpose: To assess the quality of life of glaucoma patients under medical therapy with different prostaglandin analogs.Methods: A cross-sectional study of consecutive glaucoma patients was designed. We assessed the patients' quality of life through the Brazilian 25-question version of the National Eye Institute Visual Functioning Questionnaire, comprising 12 subscales (general health, general vision, ocular pain, near vision, distance vision, social function, mental health, role limitations, dependency, driving, color vision, and peripheral vision and a total composite score. Clinical features, including current medical treatment, were obtained from each patient's medical record. Three groups of patients were identified according to the prostaglandin in use: bimatoprost, latanoprost, or travoprost. The main outcome measures were: mean score in each subscale and mean total composite score.Results: The mean total composite score for the whole group was 70.60. The bimatoprost, latanoprost, and travoprost groups had the following mean composite scores, respectively: 56.56, 77.36, and 71.08 (P = 0.001, analysis of variance [ANOVA]. Latanoprost and travoprost results were similar, and both were superior to bimatoprost. Most subscales had similar results. The subscale with the lowest score for all groups was general health. Groups were homogenous and comparable.Conclusion: There is a difference in the quality of life between glaucoma patients using prostaglandin analogs. It seems that bimatoprost users have lower QoL when compared to latanoprost and travoprost users.Keywords: glaucoma, medical treatment, prostaglandin analogs

  15. Medical risks presented by different types of energy

    Energy Technology Data Exchange (ETDEWEB)

    1980-03-01

    This article reports on discussions held during the conference which took place in Paris from 24th to 28th January 1980 and covered the following topics:- The risk concept from the point of view of the epidemiologist and the engineer - perception of the risk. The gulf which exists between the objective risk and that perceived by the public. The need to realize this phenomenon. The particular problems of each type of energy: coal (industrial diseases) - oil - gas - nuclear power (irradiation). Long-term effects and problems: air pollution and effects on health, the growth effect on stocks of atmospheric carbon, water pollution. The methodology of comparative studies of the risks presented by different types of energy. (In French)

  16. Boron neutron capture therapy of malignant brain tumors at the Brookhaven Medical Research Reactor

    Energy Technology Data Exchange (ETDEWEB)

    Joel, D.D.; Coderre, J.A.; Chanana, A.D. [Brookhaven National Lab., Upton, NY (United States). Medical Dept.

    1996-12-31

    Boron neutron capture therapy (BNCT) is a bimodal form of radiation therapy for cancer. The first component of this treatment is the preferential localization of the stable isotope {sup 10}B in tumor cells by targeting with boronated compounds. The tumor and surrounding tissue is then irradiated with a neutron beam resulting in thermal neutron/{sup 10}B reactions ({sup 10}B(n,{alpha}){sup 7}Li) resulting in the production of localized high LET radiation from alpha and {sup 7}Li particles. These products of the neutron capture reaction are very damaging to cells, but of short range so that the majority of the ionizing energy released is microscopically confined to the vicinity of the boron-containing compound. In principal it should be possible with BNCT to selectively destroy small nests or even single cancer cells located within normal tissue. It follows that the major improvements in this form of radiation therapy are going to come largely from the development of boron compounds with greater tumor selectivity, although there will certainly be advances made in neutron beam quality as well as the possible development of alternative sources of neutron beams, particularly accelerator-based epithermal neutron beams.

  17. Boron neutron capture therapy of malignant brain tumors at the Brookhaven Medical Research Reactor

    International Nuclear Information System (INIS)

    Joel, D.D.; Coderre, J.A.; Chanana, A.D.

    1996-01-01

    Boron neutron capture therapy (BNCT) is a bimodal form of radiation therapy for cancer. The first component of this treatment is the preferential localization of the stable isotope 10 B in tumor cells by targeting with boronated compounds. The tumor and surrounding tissue is then irradiated with a neutron beam resulting in thermal neutron/ 10 B reactions ( 10 B(n,α) 7 Li) resulting in the production of localized high LET radiation from alpha and 7 Li particles. These products of the neutron capture reaction are very damaging to cells, but of short range so that the majority of the ionizing energy released is microscopically confined to the vicinity of the boron-containing compound. In principal it should be possible with BNCT to selectively destroy small nests or even single cancer cells located within normal tissue. It follows that the major improvements in this form of radiation therapy are going to come largely from the development of boron compounds with greater tumor selectivity, although there will certainly be advances made in neutron beam quality as well as the possible development of alternative sources of neutron beams, particularly accelerator-based epithermal neutron beams

  18. Sustainable emergency medical service systems: how much energy do we need?

    Science.gov (United States)

    Brown, Lawrence H; Blanchard, Ian E

    2015-02-01

    Modern emergency medical service (EMS) systems are vulnerable to both rising energy prices and potential energy shortages. Ensuring the sustainability of EMS systems requires an empirical understanding of the total energy requirements of EMS operations. This study was undertaken to determine the life cycle energy requirements of US EMS systems. Input-output-based energy requirement multipliers for the US economy were applied to the annual budgets for a random sample of 19 metropolitan or county-wide EMS systems. Calculated per capita energy requirements of the EMS systems were used to estimate nationwide EMS energy requirements, and the leading energy sinks of the EMS supply chain were determined. Total US EMS-related energy requirements are estimated at 30 to 60 petajoules (10(15) J) annually. Direct ("scope 1") energy consumption, primarily in the form of vehicle fuels but also in the form of natural gas and heating oil, accounts for 49% of all EMS-related energy requirements. The energy supply chain-including system electricity consumption ("scope 2") as well as the upstream ("scope 3") energy required to generate and distribute liquid fuels and natural gas-accounts for 18% of EMS energy requirements. Scope 3 energy consumption in the materials supply chain accounts for 33% of EMS energy requirements. Vehicle purchases, leases, maintenance, and repair are the most energy-intense components of the non-energy EMS supply chain (23%), followed by medical supplies and equipment (21%). Although less energy intense than other aspects of the US healthcare system, ground EMS systems require substantial amounts of energy each year. Copyright © 2014 Elsevier Inc. All rights reserved.

  19. Cytoreductive nephrectomy vs medical therapy as initial treatment: a rational approach to the sequence question in metastatic renal cell carcinoma.

    Science.gov (United States)

    Spiess, Philippe E; Fishman, Mayer N

    2010-10-01

    Renal cell carcinoma (RCC) can be considered as two distinct entities: localized and metastatic disease. We conducted a review of the scientific literature published within the past decade pertaining to cytoreductive nephrectomy for metastatic RCC. Retrospective data and historical prospective series have demonstrated the survival benefit of debulking nephrectomy in well-selected RCC patients. New medical therapies, including vascular endothelial growth factor and mTOR pathway blocking drugs, are active biological agents, with survival improvement and potential regression of metastatic and primary tumors. Our current therapeutic challenge is the optimal integration of multimodal therapy consisting of systemic therapy and surgery including cytoreductive nephrectomy, debulking, and metastasectomy. Empiric data to guide this decision are limited. The decision concerning whether medical or surgical therapy should be the primary treatment approach selected must be made on an individual basis, taking into account patient performance status, clinical parameters, and physician expertise and recommendations, thus making each case a unique therapeutic challenge.

  20. Can cellulite be treated with low-energy extracorporeal shock wave therapy?

    Science.gov (United States)

    Angehrn, Fiorenzo; Kuhn, Christoph; Voss, Axel

    2007-01-01

    The present study investigates the effects of low-energy defocused extracorporeal generated shock waves on collagen structure of cellulite afflicted skin. Cellulite measurement using high-resolution ultrasound technology was performed before and after low-energy defocused extracorporeal shock wave therapy (ESWT) in 21 female subjects. ESWT was applied onto the skin at the lateral thigh twice a week for a period of six weeks. Results provide evidence that low-energy defocused ESWT caused remodeling of the collagen within the dermis of the tested region. Improving device-parameters and therapy regimes will be essential for future development of a scientific based approach to cellulite treatment. PMID:18225463

  1. Design study of a medical reactor for Boron Neutron Capture Therapy

    International Nuclear Information System (INIS)

    Sasaki, M.; Hirota, J.; Tamao, S.; Kanda, K.; Mishima, Y.

    1992-01-01

    A new design study of a medical reactor for Boron Neutron Capture Therapy (BNCT) has been carried out. The reactor is to be used exclusively for the treatment of malignant melanoma and other cancers as well as for the further biomedical research. Main specifications of the reactor are as follows; thermal power of 2 MW, water cooling by natural convection, semitight core of triangular lattice, UO 2 fuel rod of 9.5 mm diameter and no refueling in the reactor-life. Three horizontal and one vertical neutron beam hole are to be provided to deliver thermal and epithermal neutrons. N-γ coupling Sn transport calculations indicate that the patient treatment period will be about 30 minutes with minimal fast neutron and gamma contaminants. (author)

  2. Progress in study of a medical reactor for boron neutron capture therapy

    International Nuclear Information System (INIS)

    Sasaki, Makoto; Hirota, Jitsuya; Tamao, Shigeo; Kanda, Keiji; Mishima, Yutaka.

    1993-01-01

    A design study of a medical reactor for Boron Neutron Capture Therapy has made progress. Main specifications of the reactor are as follows; thermal power of 2 MW, water cooling by natural convection, semitight core of hexagonal lattice, UO 2 fuel rod of 9.5 mm diameter and no refueling in the reactor-life. Three horizontal and one vertical neutron beam holes are to be provided for simultaneous treatments by thermal and epithermal neutrons and for further biomedical research. The design objectives for the beam holes are to deliver the therapeutic doses in a modest time (30 to 60 min) with minimal fast neutron and gamma contaminants. The n-γ coupling Sn transport calculations have been carried out using n-21 and γ-9 group cross sections on 2-dim. practical models. The calculated results indicate that the design objectives will be achievable even if the thermal power of the reactor is reduced to 1 MW. (author)

  3. Indigenous development of integrated medical Linac system for cancer therapy - Jai Vigyan programme

    International Nuclear Information System (INIS)

    Singh, G.S.; Sehgal, Vijay

    2012-01-01

    6 MV integrated medical LINAC system was developed for cancer therapy jointly by CSIR-CSIO Chandigarh and SAMEER Mumbai under the Jai Vigyan Programme of the Government of India. Six machines were originally planned to be commissioned in six cancer hospitals in the country. Two machines, namely SIDDARTH I and SIDDARTH II, have already been developed and deployed at MGIMS, Sevagram, Wardha (Maharashtra) and at Cancer Institute (WIA), Adyar, Chennai. These machines are working satisfactorily since their installation. Four more machines namely SIDDARTH III-IV, are underway which will be commissioned in four national cancer institutes by the end of next year. This paper describes in brief the scientific principles of LINAC machines and technological challenges involved in the design and development of such a system of multi-disciplinary activities. (author)

  4. Promotion of ethical principles in provision of medication therapy management services

    Directory of Open Access Journals (Sweden)

    Sarah E. Kelling

    2014-01-01

    Full Text Available As pharmacists move toward more patient-centered care through medication therapy management (MTM, important issues and conflicts may arise within the therapeutic relationship, requiring pharmacists to use ethical knowledge and skills toward conflict-resolution. The purpose of this paper is to explore practical strategies that pharmacists and other champions of MTM may utilize to support the ethical principles of autonomy, veracity, nonmaleficence, beneficence, and justice, along with an ethic of care during the provision of MTM services. With a deeper understanding of ethical principles and the Code of Ethics for Pharmacists, pharmacists may be more prepared to make difficult ethical decisions, and ultimately, guide better patient care.   Type: Idea Paper

  5. Adding chiropractic to standard medical therapy for nonspecific low back pain

    DEFF Research Database (Denmark)

    Goertz, Christine M; Long, Cynthia R; Hondras, Maria

    2013-01-01

    Study Design. Randomized controlled trial.Objective. To assess changes in pain levels and physical functioning in response to standard medical care (SMC) versus SMC plus chiropractic manipulative therapy (CMT) for the treatment of low back pain (LBP) among 18 to 35-year-old active-duty military...... physical functioning when compared with only standard care, for men and women between 18 and 35 years of age with acute LBP........ The primary outcome measures were changes in back-related pain on the numerical rating scale and physical functioning at 4 weeks on the Roland-Morris Disability Questionnaire and back pain functional scale (BPFS).Results. Mean Roland-Morris Disability Questionnaire scores decreased in both groups during...

  6. Designing Dendrimer and Miktoarm Polymer Based Multi-Tasking Nanocarriers for Efficient Medical Therapy.

    Science.gov (United States)

    Sharma, Anjali; Kakkar, Ashok

    2015-09-17

    To address current complex health problems, there has been an increasing demand for smart nanocarriers that could perform multiple complimentary biological tasks with high efficacy. This has provoked the design of tailor made nanocarriers, and the scientific community has made tremendous effort in meeting daunting challenges associated with synthetically articulating multiple functions into a single scaffold. Branched and hyper-branched macromolecular architectures have offered opportunities in enabling carriers with capabilities including location, delivery, imaging etc. Development of simple and versatile synthetic methodologies for these nanomaterials has been the key in diversifying macromolecule based medical therapy and treatment. This review highlights the advancement from conventional "only one function" to multifunctional nanomedicine. It is achieved by synthetic elaboration of multivalent platforms in miktoarm polymers and dendrimers by physical encapsulation, covalent linking and combinations thereof.

  7. Designing Dendrimer and Miktoarm Polymer Based Multi-Tasking Nanocarriers for Efficient Medical Therapy

    Directory of Open Access Journals (Sweden)

    Anjali Sharma

    2015-09-01

    Full Text Available To address current complex health problems, there has been an increasing demand for smart nanocarriers that could perform multiple complimentary biological tasks with high efficacy. This has provoked the design of tailor made nanocarriers, and the scientific community has made tremendous effort in meeting daunting challenges associated with synthetically articulating multiple functions into a single scaffold. Branched and hyper-branched macromolecular architectures have offered opportunities in enabling carriers with capabilities including location, delivery, imaging etc. Development of simple and versatile synthetic methodologies for these nanomaterials has been the key in diversifying macromolecule based medical therapy and treatment. This review highlights the advancement from conventional “only one function” to multifunctional nanomedicine. It is achieved by synthetic elaboration of multivalent platforms in miktoarm polymers and dendrimers by physical encapsulation, covalent linking and combinations thereof.

  8. Transcatheter Closure of Patent Foramen Ovale versus Medical Therapy after Cryptogenic Stroke: A Meta-Analysis of Randomized Controlled Trials.

    Science.gov (United States)

    Darmoch, Fahed; Al-Khadra, Yasser; Soud, Mohamad; Fanari, Zaher; Alraies, M Chadi

    2018-01-01

    Patent foramen ovale (PFO) with atrial septal aneurysm is suggested as an important potential source for cryptogenic strokes. Percutaneous PFO closure to reduce the recurrence of stroke compared to medical therapy has been intensely debated. The aim of this study is to assess whether PFO closure in patients with cryptogenic stroke is safe and effective compared with medical therapy. A search of PubMed, Medline, and Cochrane Central Register from January 2000 through September 2017 for randomized controlled trails (RCT), which compared PFO closure to medical therapy in patients with cryptogenic stroke was conducted. We used the items "PFO or patent foramen ovale", "paradoxical embolism", "PFO closure" and "stroke". Data were pooled for the primary outcome measure using the random-effects model as pooled rate ratio (RR). The primary outcome was reduction in recurrent strokes. Among 282 studies, 5 were selected. Our analysis included 3,440 patients (mean age 45 years, 55% men, mean follow-up 2.9 years), 1,829 in the PFO closure group and 1,611 in the medical therapy group. The I2 heterogeneity test was found to be 48%. A random effects model combining the results of the included studies demonstrated a statistically significant risk reduction in risk of recurrent stroke in the PFO closure group when compared with medical therapy (RR 0.42; 95% CI 0.20-0.91, p = 0.03). Pooled data from 5 large RCTs showed that PFO closure in patients with cryptogenic stroke is safe and effective intervention for prevention of stroke recurrence compared with medical therapy. © 2018 S. Karger AG, Basel.

  9. Energy and intensity modulated radiation therapy with electrons

    OpenAIRE

    Olofsson, Lennart

    2005-01-01

    In recent years intensity modulated radiation therapy with photons (xIMRT) has gained attention due to its ability to reduce the dose in the tissues close to the tumour volume. However, this technique also results in a large low dose volume. Electron IMRT (eIMRT) has the potential to reduce the integral dose to the patient due to the dose fall off in the electron depth dose curves. This dose fall off makes it possible to modulate the dose distribution in the direction of the beam by selecting...

  10. Efficacy and safety of tamsulosin as a medical expulsive therapy for stones in children.

    Science.gov (United States)

    Aldaqadossi, Hussein A; Shaker, Hossam; Saifelnasr, Mohammed; Gaber, Mohammed

    2015-06-01

    To evaluate the efficacy of tamsulosin for promoting ureteric stone expulsion in children, based on the confirmed efficacy of tamsulosin as a medical expulsive therapy in adults. From February 2010 to July 2013, 67 children presenting with a distal ureteric stone of <1 cm as assessed on unenhanced computed tomography were included in the study. The patients were randomised into two groups, with group 1 (33 patients) receiving tamsulosin 0.4 mg and ibuprofen, and group 2 (34) receiving ibuprofen only. They were followed up for 4 weeks. Endoscopic intervention was indicated for patients with uncontrolled pain, recurrent urinary tract infection, hypersensitivity to tamsulosin and failure of stone passage after 4 weeks of conservative treatment. Sixty-three patients completed the study. There were no statistically significant differences between the groups in patient age, body weight and stone size, the mean (SD) of which was 6.52 (1.8) mm in group 1 vs. 6.47 (1.79) mm in group 2 (P = 0.9). The mean (SD) time to stone expulsion in group 1 was 7.7 (1.9) days, vs. 18 (1.73) days in group 2 (P < 0.001). The analgesic requirement (mean number of ketorolac injections) in group 1 was significantly less than in group 2, at 0.55 (0.8) vs. 1.8 (1.6) (P < 0.001). The stone-free rate was 87% in group 1 and 63% in group 2 (P = 0.025). Tamsulosin used as a medical expulsive therapy for children with ureteric stones is safe and effective, as it facilitates spontaneous expulsion of the stone.

  11. Tamsulosin versus tadalafil as a medical expulsive therapy for distal ureteral stones: A prospective randomized study.

    Science.gov (United States)

    Kc, Hari Bahadur; Shrestha, Anil; Acharya, Ganesh Bhakta; Basnet, Robin Bahadur; Shah, Arvind Kumar; Shrestha, Parash Mani

    2016-09-01

    This study aimed to compare the safety and efficacy of tamsulosin and tadalafil as medical expulsive therapy for distal ureteral stones. This prospective randomized study was conducted at the Department of Urology of Bir Hospital over a period of 12 months in patients with distal ureteral stones sized 5 to 10 mm. Patients were randomly divided into 2 groups: group A received tamsulosin 0.4 mg and group B received tadalafil 10 mg at bedtime for 2 weeks. Stone expulsion rate, number of ureteric colic episodes and pain score, analgesic requirements, and adverse drug effects were noted in both groups. Statistical analyses were performed by using Student t-test and chi-square test. Altogether 85 patients, 41 in group A and 44 in group B, were enrolled in the study. The patients' average age was 31.72±12.63 years, and the male-to-female ratio was 1.5:1. Demographic profiles, stone size, and baseline investigations were comparable between the 2 groups. The stone expulsion rate was significantly higher in the tadalafil group than in the tamsulosin group (84.1% vs. 61.0%, p=0.017). Although the occurrence of side effects was higher with tadalafil, this difference was not significant (p=0.099). There were no serious adverse effects. Tadalafil has a significantly higher stone expulsion rate than tamsulosin when used as a medical expulsive therapy for distal ureteral stones sized 5-10 mm. Both drugs are safe, effective, and well tolerated with minor side effects.

  12. Efficacy and safety of traditional medical therapies for chronic constipation: systematic review.

    Science.gov (United States)

    Ramkumar, Davendra; Rao, Satish S C

    2005-04-01

    Constipation is common, and its treatment is unsatisfactory. Although many agents have been tried, there are limited data to support their use. Our aim was to undertake a systematic review of the efficacy and safety of traditional medical therapies for chronic constipation and to make evidence-based recommendations. We searched the English literature for drug trials evaluating treatment of constipation by using MEDLINE and PUBMED databases from 1966 to 2003. Only studies that were randomized, conducted on adult subjects, and published as full manuscripts were included. Studies were assigned a quality score based on published methodology. Standard forms were used to abstract data regarding study design, duration, outcome measures, and adverse events. By using the cumulative evidence of published data for each agent, recommendations were made regarding their use following the United States Preventive Services Task Force guidelines. Good evidence (Grade A) was found to support the use of polyethylene glycol (PEG) and tegaserod. Moderate evidence (Grade B) was found to support the use of psyllium, and lactulose. There was a paucity of quality data regarding many commonly used agents including milk of magnesia, senna, bisacodyl, and stool softeners. There is good evidence to support the use of PEG, tegaserod, lactulose, and psyllium. Surprisingly, there is a paucity of trials for many commonly used agents. These aspects should be considered when designing trials comparing new agents with traditional therapies because their use may not be well validated.

  13. Review of survey articles regarding medication therapy management (MTM) services/programs in the United States.

    Science.gov (United States)

    Oladapo, Abiola O; Rascati, Karen L

    2012-08-01

    To provide a summary of published survey articles regarding the provision of medication therapy management (MTM) services in the United States. A literature search was conducted to identify original articles on MTM-related surveys conducted in the United States, involving community and outpatient pharmacists, physicians, patients, or pharmacy students and published by the primary researchers who conducted the study. Search engines used included PubMed, Medline, and International Pharmaceutical Abstracts (IPA). If MTM was in the keyword list, mesh heading, title, or abstract, the article was reviewed. References from these articles were searched to determine whether other relevant articles were available. A total of 405 articles were initially reviewed; however, only 32 articles met the study requirements. Of the 32 articles, 17 surveyed community/outpatient pharmacists, 3 surveyed pharmacy students, 4 surveyed physicians, and 8 surveyed patients. The survey periods varied across the different studies, with the earliest survey conducted in 2004 and the most recent survey conducted in 2009. The surveys were conducted via the telephone, US mail, interoffice mail, e-mails, Internet/Web sites, hand-delivered questionnaires, and focus groups. Despite the identified barriers to the provision of MTM services, pharmacists reportedly found it professionally rewarding to provide these services. Pharmacists claimed to have adequate clinical knowledge, experience, and access to information required to provide MTM services. Pharmacy students were of the opinion that the provision of MTM services was important to the advancement of the pharmacy profession and in providing patients with a higher level of care. Physicians supported having pharmacists adjust patients’ drug therapy and educate patients on general drug information but not in selecting patients’ drug therapy. Finally, patients suggested that alternative ways need to be explored in describing and marketing MTM

  14. Satisfaction With Medication Therapy Management Services at a University Ambulatory Care Clinic.

    Science.gov (United States)

    Kim, Shiyun; Martin, Michelle T; Pierce, Andrea L; Zueger, Patrick

    2016-06-01

    A survey was issued to patients enrolled in the Medication Therapy Management Clinic (MTMC) at University of Illinois Hospital and Health Sciences (June 2011-January 2012) in order to assess satisfaction with pharmacy services provided by pharmacists. A 23-item survey was offered to 65 patients in the MTMC program before or after clinic visits. Since there is a paucity of data indicating the level of satisfaction with MTM services provided by pharmacists, this survey may contribute to the process of building a greater collaboration between the pharmacist and patient. Sixty-two of 65 patients completed the survey; satisfaction with MTMC pharmacists was demonstrated to be significantly positively correlated with overall satisfaction with the MTMC. Patient satisfaction is not significantly different according to age, gender, ethnicity, or number of disease states. Satisfaction with the pillbox service is not significantly different between younger and older patients. It was also noted that patients taking a greater number of medications had higher levels of satisfaction. Most patients indicated that they were satisfied with the MTMC pharmacists and services; further study linking patient satisfaction with MTM services to improved patient outcomes may allow our MTMC to serve as a model for other pharmacist-managed MTMCs serving similar patient populations. © The Author(s) 2014.

  15. A Medical Manipulator System with Lasers in Photodynamic Therapy of Port Wine Stains

    Directory of Open Access Journals (Sweden)

    Xingtao Wang

    2014-01-01

    Full Text Available Port wine stains (PWS are a congenital malformation and dilation of the superficial dermal capillary. Photodynamic therapy (PDT with lasers is an effective treatment of PWS with good results. However, because the laser density is uneven and nonuniform, the treatment is carried out manually by a doctor thus providing little accuracy. Additionally, since the treatment of a single lesion can take between 30 and 60 minutes, the doctor can become fatigued after only a few applications. To assist the medical staff with this treatment method, a medical manipulator system (MMS was built to operate the lasers. The manipulator holds the laser fiber and, using a combination of active and passive joints, the fiber can be operated automatically. In addition to the control input from the doctor over a human-computer interface, information from a binocular vision system is used to guide and supervise the operation. Clinical results are compared in nonparametric values between treatments with and without the use of the MMS. The MMS, which can significantly reduce the workload of doctors and improve the uniformity of laser irradiation, was safely and helpfully applied in PDT treatment of PWS with good therapeutic results.

  16. Feasibility of Exploiting Celution^ System in Autologous Cell Therapy in Dokkyo Medical University Hospital:Safety and Reproducibility

    OpenAIRE

    Ken-ichi, Inoue; Hiroshi, Nomura; Ryoichi, Sohma; Kazumi, Akimoto; Naohiko, Kobayashi; Takao, Kamai; Tomonori, Yamanishi; Isao, Taguchi; Hiroki, Asato; Teruo, Inoue; Tomoyuki, Mitsumori; Hideki, Iwaguro; Ken-ichiro, Yoshida; Research Support Center, Dokkyo Medical University School Of Medicine:Center For Regenerative Medicine, Dokkyo Medical University School Of Medicine; Center For Regenerative Medicine, Dokkyo Medical University School Of Medicine:Department Of Plastic And Reconstructive Surgery, Dokkyo Medical University School Of Medicine

    2014-01-01

    In 2012, we established the Center for Regenerative Medicine in Dokkyo Medical University Hospital, and are now preparing the necessary equipment and preclinical evidence for cell therapy. Liposuction is a commonly used procedure in plastic surgery and the lipoaspirate is discarded as a medical waste. However, the lipoaspirate is known to contain abundant mesenchymal stem cells, and thus, it is currently one of the most feasible options of regenerative medicine. Several ongoing clinical trial...

  17. A decade of building massage therapy services at an academic medical center as part of a healing enhancement program.

    Science.gov (United States)

    Rodgers, Nancy J; Cutshall, Susanne M; Dion, Liza J; Dreyer, Nikol E; Hauschulz, Jennifer L; Ristau, Crystal R; Thomley, Barb S; Bauer, Brent A

    2015-02-01

    The use of complementary and integrative medicine therapies is steadily becoming an integral part of health care. Massage therapy is increasingly offered to hospitalized patients for various conditions to assist with the management of common symptoms such as pain, anxiety, and tension. This article summarizes a decade of building the massage therapy service at a large tertiary care medical center, from the early pilot studies and research to the current program offerings, and the hopes and dreams for the future. Copyright © 2014 Elsevier Ltd. All rights reserved.

  18. [Medical popularization and moral therapy in Plutarch's Treatise de tuenda sanitate praecepta (Ygieina paraggelmata)].

    Science.gov (United States)

    Jori, Alberto

    2007-01-01

    In his treatise De tuenda sanitate praecepta (Ygieina paraggelmata: Prescriptions for Health), the Greek philosopher Plutarch of Chaeronea (b. about 45 A.D., d. about 125 A.D.) pursues two aims, which have a deep pedagogical character and are closely connected. To begin with, he would like to provide both his colleagues, "the philosophers" (the equivalent of today's "intellectuals") and politicians with some sanitary/medical suggestions, so that they may adopt a healthy 'life-style', and consequently avoid disease to the best of their ability. Plutarch thus proposes that "philosophers" be made aware of the opportunity, or better yet, of the necessity of learning some medical notions: in their general education (paideia), his colleagues should allow medicine its adequate space, at least in regard to the practical side of the field which relates to a 'life-regimen'. At the same time, Plutarch wishes to impart a moral teaching: in order to remain in good health we must distance ourselves from irrational impulses and social conventions which induce us to practice detrimental behaviours. In this context, the author stresses the need to respect the principles of moderation--both medical and ethical: those of frugality, self-control, and naturalness. His advice is still valid and effective today. Within the background of Plutarch's treatise there is yet a third, implicit aim: to urge the physicians not to imprison themselves in their professional specialization, but rather to also acquire a philosophical education. Such education would indeed allow them to achieve a whole, "holistic" picture of man, who is at the same time soul and body. Many diseases could in fact be avoided if everyone would practice on himself a sort of "moral therapy", which would prevent the soul from falling prey to those deceptive desires from which "self-destructive" behaviours frequently derive.

  19. Intermittent energy restriction in type 2 diabetes: A short discussion of medication management.

    Science.gov (United States)

    Carter, Sharayah; Clifton, Peter M; Keogh, Jennifer B

    2016-12-15

    To discuss type 2 diabetes mellitus (T2DM) medication changes required during the popular 5:2 intermittent energy restriction (IER) diet. A search was conducted in MEDLINE, EMBASE, AMED, CINAHL and Cochrane library for original research articles investigating the use of very low calorie diets (VLCD) in people with T2DM. The search terms used included "VLCD" or "very low energy diet" or "very low energy restriction" or "IER" or "intermittent fasting" or "calorie restriction" or "diabetes mellitus type 2" and "type 2 diabetes". Reference lists of selected articles were also screened for relevant publications. Only research articles written in English, which also included an explanation of medication changes were included. A recent pilot trial using the 5:2 IER method, conducted by our research group, will also be summarized. A total of 8 studies were found that investigated the use of VLCD in T2DM and discussed medication management. Overall these studies indicate that the use of a VLCD for people with T2DM usually require the cessation of medication to prevent hypoglycemia. Therefore, the 5:2 IER method will also require medication changes, but as seen in our pilot trial, may not require total cessation of medication, rather a cessation on the 2 IER days only. Guidelines outlined here can be used in the initial stages of a 2-d IER diet, but extensive blood glucose monitoring is still required to make the necessary individual reductions to medications in response to weight loss.

  20. Medical Physics Staffing Needs in Diagnostic Imaging and Radionuclide Therapy: An Activity Based Approach [Endorsed by International Organization for Medical Physics

    International Nuclear Information System (INIS)

    2018-01-01

    Over the last decades, the rapid technological development of diagnostic and interventional radiology and nuclear medicine has made them major tools of modern medicine. However, at the same time the involved risks, the growing number of procedures and the increasing complexity of the procedures require competent professional staff to ensure safe and effective patient diagnosis, treatment and management. Medical physicists (or clinically qualified medical physicists) have been recognized as vital health professionals with important and clear responsibilities related to quality and safety of applications of ionizing radiation in medicine. This publication describes an algorithm developed to determine the recommended staffing levels for clinical medical physics services in medical imaging and radionuclide therapy, based on current best practice, as described in international guidelines.

  1. The dosimetric effects of photon energy on the quality of prostate volumetric modulated arc therapy.

    Science.gov (United States)

    Mattes, Malcolm D; Tai, Cyril; Lee, Alvin; Ashamalla, Hani; Ikoro, N C

    2014-01-01

    Studies comparing the dosimetric effects of high- and low-energy photons to treat prostate cancer using 3-dimensional conformal and intensity modulated radiation therapy have yielded mixed results. With the advent of newer radiation delivery systems like volumetric modulated arc therapy (VMAT), the impact of changing photon energy is readdressed. Sixty-five patients treated for prostate cancer at our institution from 2011 to 2012 underwent CT simulation. A target volume encompassing the prostate and entire seminal vesicles was treated to 50.4 Gy, followed by a boost to the prostate and proximal seminal vesicles to a total dose of 81 Gy. The VMAT plans were generated for 6-MV and 10-MV photons under identical optimization conditions using the Eclipse system version 8.6 (Varian Medical Systems, Palo Alto, CA). The analytical anisotropic algorithm was used for all dose calculations. Plans were normalized such that 98% of the planning target volume (PTV) received 100% of the prescribed dose. Dose-volumetric data from the treatment planning system was recorded for both 6-MV and 10-MV plans, which were compared for both the entire cohort and subsets of patients stratified according to the anterior-posterior separation. Plans using 10-MV photons had statistically significantly lower relative integral dose (4.1%), gradient measure (4.1%), skin Dmax (16.9%), monitor units (13.0%), and bladder V(30) (3.1%) than plans using 6-MV photons (P photons was more pronounced for thicker patients (anterior-posterior separation >21 cm) for most parameters, with statistically significant differences in bladder V(30), bladder V(65), integral dose, conformity index, and monitor units. The main dosimetric benefits of 10-MV as compared with 6-MV photons are seen in thicker patients, though for the entire cohort 10-MV plans resulted in a lower integral dose, gradient measure, skin Dmax, monitor units, and bladder V(30), possibly at the expense of higher rectum V(81). Copyright © 2014

  2. Managing post-therapy fatigue for cancer survivors using energy conservation training.

    Science.gov (United States)

    Yuen, Hon Keung; Mitcham, Maralynne; Morgan, Larissa

    2006-01-01

    This pilot study evaluated the effectiveness of energy conservation training to help post-therapy cancer survivors manage their fatigue. Twelve post-therapy cancer survivors were randomly assigned to an energy conservation training or usual care control (6 in each group). Participants in the intervention group received 1 to 2 hours of individual, face-to-face energy conservation training from an occupational therapist followed by once-a-week telephone monitoring sessions in the subsequent three weeks. Participants in the control group received standard care from their oncologist. Analysis of pre- and post-training data from the Piper Fatigue Scale (PFS) revealed significant reduction only in the sensory subscale of the PFS (Z = 2.21; p = 0.027) for the intervention group; but no significant reduction in the four subscale or total scores of the PFS for the control group. Findings demonstrate partial support for the effectiveness of energy conservation training in helping post-therapy cancer survivors manage their fatigue. Energy conservation training seems to be a viable strategy for managing cancer-related fatigue, though its efficacy is modest. Incorporating specific energy restoration strategies such as relaxation and meditation for future research may help advance the growing body of knowledge in symptom management for post-therapy cancer survivors.

  3. Energy expenditure, aerodynamics and medical problems in cycling. An update.

    Science.gov (United States)

    Faria, I E

    1992-07-01

    The cyclist's ability to maintain an extremely high rate of energy expenditure for long durations at a high economy of effort is dependent upon such factors as the individual's anaerobic threshold, muscle fibre type, muscle myoglobin concentration, muscle capillary density and certain anthropometric dimensions. Although laboratory tests have had some success predicting cycling potential, their validity has yet to be established for trained cyclists. Even in analysing the forces producing propulsive torque, cycling effectiveness cannot be based solely on the orientation of applied forces. Innovations of shoe and pedal design continue to have a positive influence on the biomechanics of pedalling. Although muscle involvement during a complete pedal revolution may be similar, economical pedalling rate appears to differ significantly between the novice and racing cyclist. This difference emanates, perhaps, from long term adaptation. Air resistance is by far the greatest retarding force affecting cycling. The aerodynamics of the rider and the bicycle and its components are major contributors to cycling economy. Correct body posture and spacing between riders can significantly enhance speed and efficiency. Acute and chronic responses to cycling and training are complex. To protect the safety and health of the cyclist there must be close monitoring and cooperation between the cyclist, coach, exercise scientist and physician.

  4. Experimental study of the energy efficiency of an incinerator for medical waste

    International Nuclear Information System (INIS)

    Bujak, J.

    2009-01-01

    The aim of this paper is to explore the flux of usable energy and the coefficient of energy efficiency of an incinerator for medical waste combustion. The incineration facility incorporates a heat recovery system. The installation consists of a loading unit, a combustion chamber, a thermoreactor chamber, and a recovery boiler. The analysis was carried out in the Oncological Hospital in Bydgoszcz (Poland). The primary fuel was comprised of medical waste, with natural gas used as a secondary fuel. The study shows that one can obtain about 660-800 kW of usable energy from 100 kg of medical waste. This amount corresponds to 1000-1200 kg of saturated steam, assuming that the incinerator operates at a heat load above φ > 65%. The average heat flux in additional fuel used for incinerating 100 kg of waste was 415 kW. The coefficient of energy efficiency was set within the range of 47% and 62% depending on the incinerator load. The tests revealed that the flux of usable energy and the coefficient of energy efficiency depend on the incinerator load. In the investigated range of the heat load, this dependence is significant. When the heat load of the incinerator increases, the flux of usable energy and the coefficient of energy efficiency also increase.

  5. The incidence and types of medication errors in patients receiving antiretroviral therapy in resource-constrained settings.

    Directory of Open Access Journals (Sweden)

    Kenneth Anene Agu

    Full Text Available This study assessed the incidence and types of medication errors, interventions and outcomes in patients on antiretroviral therapy (ART in selected HIV treatment centres in Nigeria.Of 69 health facilities that had program for active screening of medication errors, 14 were randomly selected for prospective cohort assessment. All patients who filled/refilled their antiretroviral medications between February 2009 and March 2011 were screened for medication errors using study-specific pharmaceutical care daily worksheet (PCDW. All potential or actual medication errors identified, interventions provided and the outcomes were documented in the PCDW. Interventions included pharmaceutical care in HIV training for pharmacists amongst others. Chi-square was used for inferential statistics and P0.05. The major medications errors identified were 26.4% incorrect ART regimens prescribed; 19.8% potential drug-drug interaction or contraindication present; and 16.6% duration and/or frequency of medication inappropriate. Interventions provided included 67.1% cases of prescriber contacted to clarify/resolve errors and 14.7% cases of patient counselling and education; 97.4% of potential/actual medication error(s were resolved.The incidence rate of medication errors was somewhat high; and majority of identified errors were related to prescription of incorrect ART regimens and potential drug-drug interactions; the prescriber was contacted and the errors were resolved in majority of cases. Active screening for medication errors is feasible in resource-limited settings following a capacity building intervention.

  6. Impact of Conventional Medical Therapy on Bone Mineral Density and Bone Turnover in Adult Patients with X-Linked Hypophosphatemia

    DEFF Research Database (Denmark)

    Shanbhogue, Vikram Vinod; Hansen, Stinus; Jørgensen, Niklas Rye

    2018-01-01

    X-linked hypophosphatemia (XLH) is a rare, inheritable disorder manifesting as rickets in children and osteomalacia in adults. While conventional medical treatment with oral phosphate and alfacalcidol is recommended in childhood, it is undecided whether adults should continue therapy. The aim...

  7. Predictors and Moderators of Response to Cognitive Behavioral Therapy and Medication for the Treatment of Binge Eating Disorder

    Science.gov (United States)

    Grilo, Carlos M.; Masheb, Robin M.; Crosby, Ross D.

    2012-01-01

    Objective: To examine predictors and moderators of response to cognitive behavioral therapy (CBT) and medication treatments for binge-eating disorder (BED). Method: 108 BED patients in a randomized double-blind placebo-controlled trial testing CBT and fluoxetine treatments were assessed prior, throughout, and posttreatment. Demographic factors,…

  8. The Process of Change in Cognitive Therapy for Depression when Combined with Antidepressant Medication: Predictors of Early Intersession Symptom Gains

    Science.gov (United States)

    Strunk, Daniel R.; Cooper, Andrew A.; Ryan, Elizabeth T.; DeRubeis, Robert J.; Hollon, Steven D.

    2012-01-01

    Objective: Previous studies of cognitive therapy (CT) for depression have examined therapist adherence and the therapeutic alliance as predictors of subsequent symptom change. However, little is known about these CT process variables when CT is delivered in combination with antidepressant medication. Method: In a sample of 176 depressed…

  9. Primary Care Providers' experiences with Pharmaceutical Care-based Medication Therapy Management Services

    Directory of Open Access Journals (Sweden)

    Heather L. Maracle

    2012-01-01

    Full Text Available This study explored primary care providers' (PCPs experiences with the practice of pharmaceutical care-based medication therapy management (MTM. Qualitative, semi-structured interviews were conducted with six PCPs who have experiences working with MTM pharmacists for at least three years. The first author conducted the interviews that were audio-taped, transcribed, and coded independently. The codes were then harmonized via discussion and consensus with the other authors. Data were analyzed for themes using the hermeneutic-phenomenological method as proposed by Max van Manen. Three men and three women were interviewed. On average, the interviewees have worked with MTM pharmacists for seven years. The six (6 themes uncovered from the interviews included: (1 "MTM is just part of our team approach to the practice of medicine": MTM as an integral part of PCPs' practices; (2 "Frankly it's education for the patient but it's also education for me": MTM services as a source of education; (3 "It's not exactly just the pharmacist that passes out the medicines at the pharmacy": The MTM practitioner is different from the dispensing pharmacist; (4 "So, less reactive, cleaning up the mess, and more proactive and catching things before they become so involved": MTM services as preventative health care efforts; (5"I think that time is the big thing": MTM pharmacists spend more time with patients; (6 "There's an access piece, there's an availability piece, there's a finance piece": MTM services are underutilized at the clinics. In conclusion, PCPs value having MTM pharmacists as part of their team in ambulatory clinics. MTM pharmacists are considered an important source of education to patients as well as to providers as they are seen as having a unique body of knowledge äóñmedication expertise. All PCPs highly treasure the time and education provided by the MTM pharmacists, their ability to manage and adjust patients' medications, and their capability to

  10. Primary Care Providers’ experiences with Pharmaceutical Care-based Medication Therapy Management Services

    Directory of Open Access Journals (Sweden)

    Heather L. Maracle, Pharm.D.

    2012-01-01

    Full Text Available This study explored primary care providers’ (PCPs experiences with the practice of pharmaceutical care-based medication therapy management (MTM. Qualitative, semi-structured interviews were conducted with six PCPs who have experiences working with MTM pharmacists for at least three years. The first author conducted the interviews that were audio-taped, transcribed, and coded independently. The codes were then harmonized via discussion and consensus with the other authors. Data were analyzed for themes using the hermeneutic-phenomenological method as proposed by Max van Manen. Three men and three women were interviewed. On average, the interviewees have worked with MTM pharmacists for seven years. The six (6 themes uncovered from the interviews included: (1 “MTM is just part of our team approach to the practice of medicine”: MTM as an integral part of PCPs’ practices; (2 “Frankly it’s education for the patient but it’s also education for me”: MTM services as a source of education; (3 “It’s not exactly just the pharmacist that passes out the medicines at the pharmacy”: The MTM practitioner is different from the dispensing pharmacist; (4 “So, less reactive, cleaning up the mess, and more proactive and catching things before they become so involved”: MTM services as preventative health care efforts; (5“I think that time is the big thing”: MTM pharmacists spend more time with patients; (6 “There’s an access piece, there’s an availability piece, there’s a finance piece”: MTM services are underutilized at the clinics. In conclusion, PCPs value having MTM pharmacists as part of their team in ambulatory clinics. MTM pharmacists are considered an important source of education to patients as well as to providers as they are seen as having a unique body of knowledge –medication expertise. All PCPs highly treasure the time and education provided by the MTM pharmacists, their ability to manage and adjust patients

  11. Perspectives of medical oncologists regarding music therapy for patients with cancer in Turkey - can musicology be integrated into psycho-oncology?

    Science.gov (United States)

    Tanriverdi, Ozgur; Aydemir, Nil Fatma

    2014-01-01

    Music therapy is a common complementary and alternative therapy in addition to medical treatment for patients with cancer. If music therapy, which is known has a positive effect on human emotions and behaviors, is a useful additional therapy, it should be more integrated into pyscho-oncology. In this study, we aimed to determine medical oncologist attitudes to music therapy for patients with cancer and knowledge about musicology and music therapy in Turkey. This survey study included questions about participant attitudes and knowledge regarding music therapy as well as demographic characteristics. The population of the study were 402 physicians working in medical oncology in Turkey and the sample covered 112 participants in the the survey. For statistical analyses the chi-square test, Fischer exact test, and Mann-Whitney U analysis are applied. In our study the rate for medical oncologists who were interested in music therapy was 28% (n=112). Some 30% (n=34) of medical oncologists recommended music therapy for their patients and 55% (n=61) recommended music therapy to prevent anxiety in patients with cancer. In this study, for more harmony with patients and in order to ensure management of adverse effect, it was concluded that music therapy should be regrded as an additional therapy in oncology clinics.

  12. Assessment of pattern for consumption and awareness regarding energy drinks among medical students.

    Science.gov (United States)

    Aslam, Hafiz Muhammad; Mughal, Anum; Edhi, Muhammad Muzzammil; Saleem, Shafaq; Rao, Masood Hussain; Aftab, Anum; Hanif, Maliha; Ahmed, Alina; Khan, Agha Muhammad Hammad

    2013-01-01

    Energy drink is a type of beverage which contains stimulant drugs chiefly caffeine and marketed as mental and physical stimulator. Coffee, tea, soft drinks and other caffeinated beverages are not considered as energy drinks. Purpose of our study was to evaluate the awareness of medical students regarding energy drinks and their pattern and reason of energy drinks consumption. This was a cross sectional and observational study conducted during the period of January - December 2012 at four Medical Colleges (Dow Medical College, Sindh Medical College, Jinnah Medical College and Liaquat National Medical College) of Karachi, Pakistan. Over all 900 M.B.B.S students were invited to participate after taking written consent but viable questionnaire was submitted by 866 students, estimated response rate of 96%. All data was entered and analyzed through SPSS version 19. Out of 866 participants, majority were females 614 (70.9%) and only 252 (28.5%) were males, with a mean age of 21.43 ± 1.51 years. Energy drinks users were 350 (42.89%) and non users were 516 (59.58%). Only 102 (29.3%) users and 159 (30.7%) non users know the correct definition of Energy drinks. Regarding awareness, mostly user and non users thought that usage of energy drinks had been on rise due to its usefulness in reducing sleep hours [users193 (43.9%), nonusers 247 (56.1%) (p energy drinks by non-users were "awareness from its side effects" 247 (47.8%) and "have no specific reason" 265 (51.3%). Most common side effects reported by users were fatigue 111 (31.7%) and weight gain 102 (29.4%). In sum, the fact that despite serious side effects of weight gaining and fatigue, practice of consuming energy drinks is highly prevalent among medical students, particularly because they are ever ready to boost their energy level and reduce sleep hours due to stress of exams and projects. This warrants the creation of continued public health awareness about the appropriate use of caffeinated beverages, their

  13. Medical cyclotron facilities

    International Nuclear Information System (INIS)

    1984-09-01

    This report examines the separate proposals from the Austin Hospital and the Australian Atomic Energy Commission for a medical cyclotron facility. The proponents have argued that a cyclotron facility would benefit Australia in areas of patient care, availability and export of radioisotopes, and medical research. Positron emission tomography (PET) and neutron beam therapy are also examined

  14. Use of the guidelines directed medical therapy after coronary artery bypass graft surgery in Saudi Arabia

    Directory of Open Access Journals (Sweden)

    Khalid A. Alburikan

    2017-09-01

    Full Text Available Background: incidence of cardiovascular diseases in Saudi Arabia is growing and more patients are expected to have cardiac revascularization surgery. Optimal pharmacotherapy management with Guideline Directed Medical Therapy (GDMT post coronary artery bypass grafting (CABG plays an important role in the prevention of adverse cardiovascular outcomes. The objective of this study was to assess the utilization of GDMT for secondary prevention in CABG patients and determine whether specific patients' characteristics can influence GDMT utilization. Method: A retrospective chart review of patients discharged from the hospital after CABG surgery from April 2015 to April 2016. The primary outcome was the utilization of secondary prevention GDMT after CABG surgery - aspirin, B-blockers, statin and angiotensin-converting enzyme inhibitors (ACEI (or angiotensin receptor blockers (ARB in ACEI-intolerant patients. The proportions of eligible and ideal patients who received treatment were calculated, and mixed-effects logistic regression was used to estimate odds ratios (OR for the association of age, gender or patient nationality with the use of GDMT. Results: A total number of 119 patients included in the analysis. The median age of the cohort was 57.3 ± 11 years, and 83% were male (83.2%. Nearly 69.7% of patients had diabetes, and 82% had a previous diagnosis of hypertension. Nearly 91% received aspirin therapy and the rate was lower for B-blocker and statin. The rate of GDMT utilization did not change with the change in patient’s age, gender or nationality. Conclusion: Despite adjustments for contraindications to GDMT, the rate of GDMT utilization was suboptimal.

  15. Physical properties of new collimator cone system for stereotactic radiation therapy developed in samsung medical center.

    Science.gov (United States)

    Kim, D Y; Ahn, Y C; Oh, D G; Choi, D R; Ju, S G; Yeo, I H; Huh, S J

    2000-09-01

    A new collimator cone system has been developed at the Samsung Medical Center that overcomes some of the limitations of present commercially supplied collimator cones. The physical properties of the newly developed cone system are described in this report. The new cones have relatively larger aperture sizes (3.0-7.0 cm in diameter) and are 16 cm in length. Each new cone is fabricated with cerrobend alloy melted and poured into a stainless steel housing that is permanently fixed to a mounting plate. The mounting plate of the new cone is designed to insert into the wedge mount slot of the gantry head. The mechanical accuracy of the central axis of the cone pointing to the isocenter was tested using film, a steel ball positioned at the isocenter by the mechanical isocenter device. For the evaluation of beam flatness and penumbra, off-axis ratios at 5 cm depth were measured by film dosimetry using polystyrene phantom. The average error of the mechanical isocenter was 0.27 mm (+/- 0.16 mm). The beam flatness was excellent in the central region of the beam, and the average penumbra width was 3.35 mm (+/- 0.25 mm). The new cone design has more clearance between the patient's head and the gantry, and can more easily be removed from the gantry head because it slides in and out of the wedge slot. This facilitates changing cone sizes during one treatment session, and makes the process of double exposure port films easier. A new collimator cone system for stereotactic radiation therapy has been developed. The mechanical accuracy and physical properties are satisfactory for clinical use, and the new design permits a wider range of clinical applications for stereotactic radiation therapy.

  16. Comparative efficacy of tamsulosin versus tadalafil as medical expulsive therapy for distal ureteric stones.

    Science.gov (United States)

    Goyal, Suresh Kumar; Singh, Vikash; Pandey, Himanshu; Chhabra, Mahaveer Kumar; Aggarwal, Satinder Pal; Bhat, Amilal

    2018-01-01

    The objective of this study was to compare the relative efficacy of tamsulosin and tadalafil as medical expulsive therapy for distal ureteric stones. This was a prospective study performed between December 2014 and February 2016. A total of 123 adult patients (>18 years of age) presenting with distal ureteric stones sized 6-10 mm were randomized to treatment with tamsulosin 0.4 mg once daily (Group A) or tadalafil10 mg once daily (Group B). Therapy was given for a maximum of 4 weeks. The stone expulsion rate was the primary endpoint. Time to stone expulsion, number of colic episodes, analgesic use, number of hospital visits for pain, endoscopic treatment, and adverse effects of the drugs were noted. Statistical analyses were done using Fisher's exact test and Chi-square test. A total of 61 patients were included in tamsulosin group and 62 patients in tadalafil group. A statistically insignificant difference was found for stone clearance rate between both groups as a whole (Group A-73.77%, Group B-69.35%, P = 0.690) as well as when we considered both subgroups (A1-78.05%, B1-75.0%, P = 0.802; A2-65.0%, B2-55.6%, P = 0.741). All the primary and secondary outcome measures were more in favour of stones ≤8 mm size than stones >8 mm size. No statistical difference was found for adverse drug effects except for retrograde ejaculation, which was significantly high in tamsulosin group ( P tamsulosin is more effective for stone clearance than tadalafil, but this difference was not significant ( P = 0.690).

  17. Comparison of quality assurance for performance and safety characteristics of the facility for Boron Neutron Capture therapy in Petten/NL with medical electron accelerators

    International Nuclear Information System (INIS)

    Rassow, Juergen; Stecher-Rasmussen, Finn; Voorbraak, Wim; Moss, Ray; Vroegindeweij, Corine; Hideghety, Katalin; Sauerwein, Wolfgang

    2001-01-01

    Background and purpose: The European Council Directive on health protection 97/43/EURATOM requires radiotherapy quality assurance programmes for performance and safety characteristics including acceptance and repeated tests. For Boron Neutron Capture therapy (BNCT) at the High Flux Reactor (HFR) in Petten/NL such a programme has been developed on the basis of IEC publications for medical electron accelerators. Results: The fundamental differences of clinical dosimetry for medical electron accelerators and BNCT are presented and the order of magnitude of dose components and their stability and that of the main other influencing parameter 10 B concentration for BNCT patient treatments. A comparison is given for requirements for accelerators and BNCT units indicating items which are not transferable, equal or additional. Preliminary results of in vivo measurements done with a set of 55 Mn, 63 Cu and 197 Au activation foils for all single fields for the four fractions at all 15 treated patients show with <±4% up to now a worse reproducibility than the used dose monitoring systems (±1.5%) caused by influence of hair position on the foil-skull distance. Conclusions: Despite the more complex clinical dosimetry (because of four relevant dose components, partly of different linear energy transfer (LET)) BNCT can be regulated following the principles of quality assurance procedures for therapy with medical electron accelerators. The reproducibility of applied neutron fluence (proportional to absorbed doses) and the main safety aspects are equal for all teletherapy methods including BNCT

  18. Feasibility of dual-energy computed tomography in radiation therapy planning

    Science.gov (United States)

    Sheen, Heesoon; Shin, Han-Back; Cho, Sungkoo; Cho, Junsang; Han, Youngyih

    2017-12-01

    In this study, the noise level, effective atomic number ( Z eff), accuracy of the computed tomography (CT) number, and the CT number to the relative electron density EDconversion curve were estimated for virtual monochromatic energy and polychromatic energy. These values were compared to the theoretically predicted values to investigate the feasibility of the use of dual-energy CT in routine radiation therapy planning. The accuracies of the parameters were within the range of acceptability. These results can serve as a stepping stone toward the routine use of dual-energy CT in radiotherapy planning.

  19. Medical physics in Europe following recommendations of the International Atomic Energy Agency

    International Nuclear Information System (INIS)

    Casar, Bozidar; Lopes, Maria do Carmo; Drljević, Advan; Gershkevitsh, Eduard; Pesznyak, Csilla

    2016-01-01

    Medical physics is a health profession where principles of applied physics are mostly directed towards the application of ionizing radiation in medicine. The key role of the medical physics expert in safe and effective use of ionizing radiation in medicine was widely recognized in recent European reference documents like the European Union Council Directive 2013/59/EURATOM (2014), and European Commission Radiation Protection No. 174, European Guidelines on Medical Physics Expert (2014). Also the International Atomic Energy Agency (IAEA) has been outspoken in supporting and fostering the status of medical physics in radiation medicine through multiple initiatives as technical and cooperation projects and important documents like IAEA Human Health Series No. 25, Roles and Responsibilities, and Education and Training Requirements for Clinically Qualified Medical Physicists (2013) and the International Basic Safety Standards, General Safety Requirements Part 3 (2014). The significance of these documents and the recognition of the present insufficient fulfilment of the requirements and recommendations in many European countries have led the IAEA to organize in 2015 the Regional Meeting on Medical Physics in Europe, where major issues in medical physics in Europe were discussed. Most important outcomes of the meeting were the recommendations addressed to European member states and the survey on medical physics status in Europe conducted by the IAEA and European Federation of Organizations for Medical Physics. Published recommendations of IAEA Regional Meeting on Medical Physics in Europe shall be followed and enforced in all European states. Appropriate qualification framework including education, clinical specialization, certification and registration of medical physicists shall be established and international recommendation regarding staffing levels in the field of medical physics shall be fulfilled in particular. European states have clear legal and moral

  20. Medical physics in Europe following recommendations of the International Atomic Energy Agency.

    Science.gov (United States)

    Casar, Bozidar; Lopes, Maria do Carmo; Drljević, Advan; Gershkevitsh, Eduard; Pesznyak, Csilla

    2016-03-01

    Medical physics is a health profession where principles of applied physics are mostly directed towards the application of ionizing radiation in medicine. The key role of the medical physics expert in safe and effective use of ionizing radiation in medicine was widely recognized in recent European reference documents like the European Union Council Directive 2013/59/EURATOM (2014), and European Commission Radiation Protection No. 174, European Guidelines on Medical Physics Expert (2014). Also the International Atomic Energy Agency (IAEA) has been outspoken in supporting and fostering the status of medical physics in radiation medicine through multiple initiatives as technical and cooperation projects and important documents like IAEA Human Health Series No. 25, Roles and Responsibilities, and Education and Training Requirements for Clinically Qualified Medical Physicists (2013) and the International Basic Safety Standards, General Safety Requirements Part 3 (2014). The significance of these documents and the recognition of the present insufficient fulfilment of the requirements and recommendations in many European countries have led the IAEA to organize in 2015 the Regional Meeting on Medical Physics in Europe, where major issues in medical physics in Europe were discussed. Most important outcomes of the meeting were the recommendations addressed to European member states and the survey on medical physics status in Europe conducted by the IAEA and European Federation of Organizations for Medical Physics. Published recommendations of IAEA Regional Meeting on Medical Physics in Europe shall be followed and enforced in all European states. Appropriate qualification framework including education, clinical specialization, certification and registration of medical physicists shall be established and international recommendation regarding staffing levels in the field of medical physics shall be fulfilled in particular. European states have clear legal and moral

  1. Medical physics in Europe following recommendations of the International Atomic Energy Agency

    Science.gov (United States)

    Lopes, Maria do Carmo; Drljević, Advan; Gershkevitsh, Eduard; Pesznyak, Csilla

    2016-01-01

    Background Medical physics is a health profession where principles of applied physics are mostly directed towards the application of ionizing radiation in medicine. The key role of the medical physics expert in safe and effective use of ionizing radiation in medicine was widely recognized in recent European reference documents like the European Union Council Directive 2013/59/EURATOM (2014), and European Commission Radiation Protection No. 174, European Guidelines on Medical Physics Expert (2014). Also the International Atomic Energy Agency (IAEA) has been outspoken in supporting and fostering the status of medical physics in radiation medicine through multiple initiatives as technical and cooperation projects and important documents like IAEA Human Health Series No. 25, Roles and Responsibilities, and Education and Training Requirements for Clinically Qualified Medical Physicists (2013) and the International Basic Safety Standards, General Safety Requirements Part 3 (2014). The significance of these documents and the recognition of the present insufficient fulfilment of the requirements and recommendations in many European countries have led the IAEA to organize in 2015 the Regional Meeting on Medical Physics in Europe, where major issues in medical physics in Europe were discussed. Most important outcomes of the meeting were the recommendations addressed to European member states and the survey on medical physics status in Europe conducted by the IAEA and European Federation of Organizations for Medical Physics. Conclusions Published recommendations of IAEA Regional Meeting on Medical Physics in Europe shall be followed and enforced in all European states. Appropriate qualification framework including education, clinical specialization, certification and registration of medical physicists shall be established and international recommendation regarding staffing levels in the field of medical physics shall be fulfilled in particular. European states have clear

  2. Maximum dose angle for oblique incidence on primary beam protective barriers in the design of medical radiation therapy facilities

    International Nuclear Information System (INIS)

    Fondevila, Damian; Arbiser, Silvio; Sansogne, Rosana; Brunetto, Monica; Dosoretz, Bernardo

    2008-01-01

    Primary barrier determinations for the shielding of medical radiation therapy facilities are generally made assuming normal beam incidence on the barrier, since this is geometrically the most unfavorable condition for that shielding barrier whenever the occupation line is allowed to run along the barrier. However, when the occupation line (for example, the wall of an adjacent building) runs perpendicular to the barrier (especially roof barrier), then two opposing factors come in to play: increasing obliquity angle with respect to the barrier increases the attenuation, while the distance to the calculation point decreases, hence, increasing the dose. As a result, there exists an angle (α max ) for which the equivalent dose results in a maximum, constituting the most unfavorable geometric condition for that shielding barrier. Based on the usual NCRP Report No. 151 model, this article presents a simple formula for obtaining α max , which is a function of the thickness of the barrier (t E ) and the equilibrium tenth-value layer (TVL e ) of the shielding material for the nominal energy of the beam. It can be seen that α max increases for increasing TVL e (hence, beam energy) and decreases for increasing t E , with a range of variation that goes from 13 to 40 deg for concrete barriers thicknesses in the range of 50-300 cm and most commercially available teletherapy machines. This parameter has not been calculated in the existing literature for radiotherapy facilities design and has practical applications, as in calculating the required unoccupied roof shielding for the protection of a nearby building located in the plane of the primary beam rotation

  3. Maximum dose angle for oblique incidence on primary beam protective barriers in the design of medical radiation therapy facilities.

    Science.gov (United States)

    Fondevila, Damián; Arbiser, Silvio; Sansogne, Rosana; Brunetto, Mónica; Dosoretz, Bernardo

    2008-05-01

    Primary barrier determinations for the shielding of medical radiation therapy facilities are generally made assuming normal beam incidence on the barrier, since this is geometrically the most unfavorable condition for that shielding barrier whenever the occupation line is allowed to run along the barrier. However, when the occupation line (for example, the wall of an adjacent building) runs perpendicular to the barrier (especially roof barrier), then two opposing factors come in to play: increasing obliquity angle with respect to the barrier increases the attenuation, while the distance to the calculation point decreases, hence, increasing the dose. As a result, there exists an angle (alpha(max)) for which the equivalent dose results in a maximum, constituting the most unfavorable geometric condition for that shielding barrier. Based on the usual NCRP Report No. 151 model, this article presents a simple formula for obtaining alpha(max), which is a function of the thickness of the barrier (t(E)) and the equilibrium tenth-value layer (TVL(e)) of the shielding material for the nominal energy of the beam. It can be seen that alpha(max) increases for increasing TVL(e) (hence, beam energy) and decreases for increasing t(E), with a range of variation that goes from 13 to 40 deg for concrete barriers thicknesses in the range of 50-300 cm and most commercially available teletherapy machines. This parameter has not been calculated in the existing literature for radiotherapy facilities design and has practical applications, as in calculating the required unoccupied roof shielding for the protection of a nearby building located in the plane of the primary beam rotation.

  4. Graves' disease in children: long-term outcomes of medical therapy.

    Science.gov (United States)

    Rabon, Shona; Burton, Amy M; White, Perrin C

    2016-10-01

    Management options are limited for the treatment of Graves' disease, and there is controversy regarding optimal treatment. We describe the demographic and biochemical characteristics of children with Graves' disease and the outcomes of its management. This is a retrospective study reviewing medical records from 2001 to 2011 at a tertiary-care paediatric hospital. Diagnostic criteria included elevated free T4 and total T3, suppressed TSH, and either positive thyroid-stimulating immunoglobulin or thyroid receptor antibodies or clinical signs suggestive of Graves' disease, for example exophthalmos. Patients were treated with antithyroid drugs (ATD), radioactive iodine, or thyroidectomy. The main outcome measures were remission after medical therapy for at least 6 months and subsequent relapse. A total of 291 children met diagnostic criteria. A total of 62 were male (21%); 117 (40%) were Hispanic, 90 (31%) Caucasian, and 59 (20%) African American. Mean age (±standard deviation) at diagnosis was 12·3 ± 3·8 (range 3-18·5) years. At diagnosis, 268 patients were started on an antithyroid drug and 23 underwent thyroid ablation or thyroidectomy. Fifty-seven (21%) children achieved remission and 16 (28%) of these patients relapsed, almost all within 16 months. Gender and ethnicity did not affect rates of remission or relapse. Of 251 patients treated with methimazole, 53 (21%) had an adverse reaction, including rash, arthralgias, elevated transaminases, or neutropenia. Most children with Graves' disease treated with ATD do not experience remission, but most remissions do not end in relapse. Adverse reactions to methimazole are common but generally mild. © 2016 John Wiley & Sons Ltd.

  5. Developing a dashboard for benchmarking the productivity of a medication therapy management program.

    Science.gov (United States)

    Umbreit, Audrey; Holm, Emily; Gander, Kelsey; Davis, Kelsie; Dittrich, Kristina; Jandl, Vanda; Odell, Laura; Sweeten, Perry

    To describe a method for internal benchmarking of medication therapy management (MTM) pharmacist activities. Multisite MTM pharmacist practices within an integrated health care system. MTM pharmacists are located within primary care clinics and provide medication management through collaborative practice. MTM pharmacist activity is grouped into 3 categories: direct patient care, nonvisit patient care, and professional activities. MTM pharmacist activities were tracked with the use of the computer-based application Pharmacist Ambulatory Resource Management System (PhARMS) over a 12-month period to measure growth during a time of expansion. A total of 81% of MTM pharmacist time was recorded. A total of 1655.1 hours (41%) was nonvisit patient care, 1185.2 hours (29%) was direct patient care, and 1190.4 hours (30%) was professional activities. The number of patient visits per month increased during the study period. There were 1496 direct patient care encounters documented. Of those, 1051 (70.2%) were face-to-face visits, 257 (17.2%) were by telephone, and 188 (12.6%) were chart reviews. Nonvisit patient care and professional activities also increased during the period. PhARMS reported MTM pharmacist activities and captured nonvisit patient care work not tracked elsewhere. Internal benchmarking data proved to be useful for justifying increases in MTM pharmacist personnel resources. Reviewing data helped to identify best practices from high-performing sites. Limitations include potential for self-reporting bias and lack of patient outcomes data. Implementing PhARMS facilitated internal benchmarking of patient care and nonpatient care activities in a regional MTM program. Copyright © 2017 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.

  6. Effects of medical therapy on insulin resistance and the cardiovascular system in polycystic ovary syndrome.

    Science.gov (United States)

    Meyer, Caroline; McGrath, Barry P; Teede, Helena Jane

    2007-03-01

    We aimed to determine the impact of medical therapy for symptom management on insulin resistance, metabolic profiles, and surrogate markers of cardiovascular disease in polycystic ovary syndrome (PCOS), an insulin-resistant pre-diabetes condition. One hundred overweight women (BMI >27 kg/m2), average age 31 years, who were nonsmokers, were not pregnant, did not have diabetes, and were off relevant medications for 3 months completed this 6-month open-label controlled trial. Randomization was to a control group (higher-dose oral contraceptive [OCP] 35 microg ethinyl estradiol [EE]/2 mg cyproterone acetate, metformin [1 g b.d.] or low-dose OCP [20 microg EE/100 microg levonorgestrel + aldactone 50 mg b.d.]). Primary outcome measures were insulin resistance (area under curve on oral glucose tolerance test) and surrogate markers of cardiovascular disease including arterial stiffness (pulse wave velocity [PWV]) and endothelial function. All treatments similarly and significantly improved symptoms including hirsutism and menstrual cycle length. Insulin resistance was improved by metformin and worsened by the high-dose OCP. Arterial stiffness worsened in the higher-dose OCP group (PWV 7.46 vs. 8.03 m/s, P insulin resistance. In overweight women with PCOS, metformin and low- and high-dose OCP preparations have similar efficacy but differential effects on insulin resistance and arterial function. These findings suggest that a low-dose OCP preparation may be preferable if contraception is needed and that metformin should be considered for symptomatic management, particularly in women with additional metabolic and cardiovascular risk factors.

  7. Lipid Replacement Therapy Drink Containing a Glycophospholipid Formulation Rapidly and Significantly Reduces Fatigue While Improving Energy and Mental Clarity

    Directory of Open Access Journals (Sweden)

    Robert Settineri

    2011-08-01

    Full Text Available Background: Fatigue is the most common complaint of patients seeking general medical care and is often treated with stimulants. It is also important in various physical activities of relatively healthy men and women, such as sports performance. Recent clinical trials using patients with chronic fatigue have shown the benefit of Lipid Replacement Therapy in restoring mitochondrial electron transport function and reducing moderate to severe chronic fatigue. Methods: Lipid Replacement Therapy was administered for the first time as an all-natural functional food drink (60 ml containing polyunsaturated glycophospholipids but devoid of stimulants or herbs to reduce fatigue. This preliminary study used the Piper Fatigue Survey instrument as well as a supplemental questionnaire to assess the effects of the glycophospholipid drink on fatigue and the acceptability of the test drink in adult men and women. A volunteer group of 29 subjects of mean age 56.2±4.5 years with various fatigue levels were randomly recruited in a clinical health fair setting to participate in an afternoon open label trial on the effects of the test drink. Results: Using the Piper Fatigue instrument overall fatigue among participants was reduced within the 3-hour seminar by a mean of 39.6% (p<0.0001. All of the subcategories of fatigue showed significant reductions. Some subjects responded within 15 minutes, and the majority responded within one hour with increased energy and activity and perceived improvements in cognitive function, mental clarity and focus. The test drink was determined to be quite acceptable in terms of taste and appearance. There were no adverse events from the energy drink during the study.Functional Foods in Health and Disease 2011; 8:245-254Conclusions: The Lipid Replacement Therapy functional food drink appeared to be a safe, acceptable and potentially useful new method to reduce fatigue, sustain energy and improve perceptions of mental function.

  8. Energy drinks consumption practices among medical students of a Private sector University of Karachi, Pakistan.

    Science.gov (United States)

    Usman, Asma; Bhombal, Swaleha Tariq; Jawaid, Ambreen; Zaki, Samar

    2015-09-01

    Consumption of energy drinks has become popular among students and athletes over the past few years. To explore the phenomenon, a cross-sectional survey was conducted through a self-administered pilot-tested questionnaire. Frequency of energy drinks consumption was found to be 121(52%) in a sample of 233 medical students. Red bull was the most common brand consumed 101(43%). The major reasons reported for its usage were to gain/replenish energy by 36(15.4%), and studying for examination by 34(14.6%). Television was reported as the major source of information 153(66%) followed by friends 113(48%). There was a high frequency of energy drinks' consumption among medical students of a private university. There is a strong need to create awareness regarding these drinks, especially among adolescents and teenagers.

  9. EFFICIENCY EVALUATION OF THE TOPICAL THERAPY OF ACUTE PHARYNGITISES AMONG CHILDREN BY MEANS OF BICLOTYMOL CONTAINED MEDICATIONS

    Directory of Open Access Journals (Sweden)

    Yu.L. Soldatskiy

    2007-01-01

    Full Text Available The researchers studied the results of the topical antibacterial therapy of acute pharyngitis among children by means of biclotymol contained medications. The treatment was carried on in two ways: the first group of patients (22 children was made of those, who received or dispersible pills, containing biclotymol, lysozyme and enoxolone; while in the therapy of children from the second group (24 children they additionally used biclotymol in the form of a dosing spray. The treatment efficiency proved to be comparable, yet in spite of somewhat subjectively worse to lerance of the combined therapy its application is statistically reliable to quickly improve the pharyngoscopical picture and remove the pain syndrome.Key words: acute pharyngitis, topical antibacterial therapy, childhood, biclotymol.

  10. Blood pressure kiosks for medication therapy management programs: business opportunity for pharmacists.

    Science.gov (United States)

    Houle, Sherilyn K D; Chuck, Anderson W; Tsuyuki, Ross T

    2012-01-01

    To develop an economic model based on the use of pharmacy-based blood pressure kiosks for case finding of remunerable medication therapy management (MTM) opportunities. Descriptive, exploratory, nonexperimental study. Ontario, Canada, between January 2010 and September 2011. More than 7.5 million blood pressure kiosk readings were taken from 341 pharmacies. A model was developed to estimate revenues achievable by using blood pressure kiosks for 1 month to identify a cohort of patients with blood pressure of 130/80 mm Hg or more and caring for those patients during 1 year. Revenue generated from MTM programs. Pharmacies could generate an average of $12,270 (range $4,523-24,420) annually in revenue from billing for MTM services. Blood pressure kiosks can be used to identify patients with elevated blood pressure who may benefit from reimbursable pharmacist cognitive services. Revenue can be reinvested to purchase automated dispensing technology or offset pharmacy technician costs to free pharmacists to provide pharmaceutical care. Improved patient outcomes, increased patient loyalty, and improved adherence are additional potential benefits.

  11. Medication and monitoring in palliative sedation therapy: a systematic review and quality assessment of published guidelines.

    Science.gov (United States)

    Schildmann, Eva Katharina; Schildmann, Jan; Kiesewetter, Isabel

    2015-04-01

    Palliative sedation therapy (PST) is increasingly used in patients at the end of life. However, consensus about medications and monitoring is lacking. To assess published PST guidelines with regard to quality and recommendations on drugs and monitoring. We searched CINAHL, the Cochrane Library, Embase, PsycINFO, PubMed, and references of included articles until July 2014. Search terms included "palliative sedation" or "sedation" and "guideline" or "policy" or "framework." Guideline selection was based on English or German publications that included a PST guideline. Two investigators independently assessed the quality of the guidelines according to the Appraisal of Guidelines for Research and Evaluation II instrument (AGREE II) and extracted information on drug selection and monitoring. Nine guidelines were eligible. Eight guidelines received high quality scores for the domain "scope and purpose" (median 69%, range 28-83%), whereas in the other domains the guidelines' quality differed considerably. The majority of guidelines suggest midazolam as drug of first choice. Recommendations on dosage and alternatives vary. The guidelines' recommendations regarding monitoring of PST show wide variation in the number and details of outcome parameters and methods of assessment. The published guidelines on PST vary considerably regarding their quality and content on drugs and monitoring. Given the need for clear guidance regarding PST in patients at the end of life, this comparative analysis may serve as a starting point for further improvement. Copyright © 2015 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  12. Comparison of two Medication Therapy Management Practice Models on Return on Investment.

    Science.gov (United States)

    Gazda, Nicholas P; Berenbrok, Lucas A; Ferreri, Stefanie P

    2017-06-01

    To compare the return on investment (ROI) of an integrated practice model versus a "hub and spoke" practice model of pharmacist provided medication therapy management (MTM). A cohort retrospective analysis of MTM claims billed in 76 pharmacies in North Carolina in the 2010 hub and spoke practice model and the 2012 "integrated" practice model were analyzed to calculate the ROI. In 2010, 4089 patients received an MTM resulting in 8757 claims in the hub and spoke model. In 2012, 4896 patients received an MTM resulting in 13 730 claims in the integrated model. In 2010, US$165 897.26 was invested in pharmacist salary and $173 498.00 was received in reimbursement, resulting in an ROI of +US$7600.74 (+4.6%). In 2012, US$280 890.09 was invested in pharmacist salary and US$302 963 was received in reimbursement, resulting in an ROI of +US$22 072.91 or (+7.9%). The integrated model of MTM showed an increase in number of claims submitted and in number of patients receiving MTM services, ultimately resulting in a higher ROI. While a higher ROI was evident in the integrated model, both models resulted in positive ROI (1:12-1:21), highlighting that MTM programs can be cost effective with different strategies of execution.

  13. Sulfur Mustard Research—Strategies for the Development of Improved Medical Therapy

    Science.gov (United States)

    Kehe, Kai; Balszuweit, Frank; Emmler, Judith; Kreppel, Helmut; Jochum, Marianne; Thiermann, Horst

    2008-01-01

    Objective: Sulfur mustard (SM) is a bifunctional alkylating substance being used as chemical warfare agent (vesicant). It is still regarded as a significant threat in chemical warfare and terrorism. Exposure to SM produces cutaneous blisters, respiratory and gastrointestinal tract injury, eye lesions, and bone marrow depression. Victims of World War I as well as those of the Iran-Iraq war have suffered from devastating chronic health impairment. Even decades after exposure, severe long-term effects like chronic obstructive lung disease, lung fibrosis, recurrent corneal ulcer disease, chronic conjunctivitis, abnormal pigmentation of the skin, and different forms of cancer have been diagnosed. Methods: This review briefly summarizes the scientific literature and own results concerning detection, organ toxicity of SM, its proposed toxicodynamic actions, and strategies for the development of improved medical therapy. Results: Despite extensive research efforts during the last century, efficient antidotes against SM have not yet been generated because its mechanism of action is not fully understood. However, deeper insights into these mechanisms gained in the last decade and promising developments of new drugs now offer new chances to minimize SM-induced organ damage and late effects. Conclusion: Polymerase inhibitors, anti-inflammatory drugs, antioxidants, matrix metalloproteinase inhibitors, and probably regulators of DNA damage repair are identified as promising approaches to improve treatment. PMID:18615149

  14. Distinct patterns in the gut microbiota after surgical or medical therapy in obese patients

    Directory of Open Access Journals (Sweden)

    Daniel A. Medina

    2017-06-01

    Full Text Available Bariatric surgery is highly successful in improving health compared to conventional dietary treatments. It has been suggested that the gut microbiota is a relevant factor in weight loss after bariatric surgery. Considering that bariatric procedures cause different rearrangements of the digestive tract, they probably have different effects on the gut microbiota. In this study, we compared the impact of medical treatment, sleeve gastrectomy and Roux-en-Y gastric bypass on the gut microbiota from obese subjects. Anthropometric and clinical parameters were registered before, 6 and 12 months after treatment. Fecal samples were collected and microbiota composition was studied before and six months post treatment using 16S rRNA gene sequencing and qPCR. In comparison to dietary treatment, changes in intestinal microbiota were more pronounced in patients subjected to surgery, observing a bloom in Proteobacteria. Interestingly, Bacteroidetes abundance was largely different after six months of each surgical procedure. Furthermore, changes in weight and BMI, or glucose metabolism, correlated positively with changes in these two phyla in these surgical procedures. These results indicate that distinct surgical procedures alter the gut microbiota differently, and changes in gut microbiota might contribute to health improvement. This study contributes to our understanding of the impact of weight loss surgery on the gut microbiota, and could be used to replicate this effect using targeted therapies.

  15. Integrative medical therapy: examination of meditation's therapeutic and global medicinal outcomes via nitric oxide (review).

    Science.gov (United States)

    Stefano, George B; Esch, Tobias

    2005-10-01

    Relaxation techniques are part of the integrative medicine movement that is of growing importance for mainstream medicine. Complementary medical therapies have the potential to affect many physiological systems. Repeatedly studies show the benefits of the placebo response and relaxation techniques in the treatment of hypertension, cardiac arrhythmias, chronic pain, insomnia, anxiety and mild and moderate depression, premenstrual syndrome, and infertility. In itself, relaxation is characterized by a decreased metabolism, heart rate, blood pressure, and rate of breathing as well as an increase in skin temperature. Relaxation approaches, such as progressive muscle relaxation, autogenic training, meditation and biofeedback, are effective in lowering systolic and diastolic blood pressure in hypertensive patients by a significant margin. Given this association with changes in vascular tone, we have hypothesized that nitric oxide, a demonstrated vasodilator substance, contribute to physiological activity of relaxation approaches. We examined the scientific literature concerning the disorders noted earlier for their nitric oxide involvement in an attempt to provide a molecular rationale for the positive effects of relaxation approaches, which are physiological and cognitive process. We conclude that constitutive nitric oxide may crucially contribute to potentially beneficial outcomes and effects in diverse pathologies, exerting a global healing effect.

  16. From the best results of medical research to therapy involving the context of an individual patient

    Directory of Open Access Journals (Sweden)

    Małgorzata K. Szerla

    2015-01-01

    Full Text Available Contextualisation is the process of identifying specific factors of a patient’s life situation, which is focused on individualised care. In the light of reference books, contextualisation is an integral part of therapy with an active participation of the patient and/or his/her carers. Among many factors that constitute the functioning of a person, family and socio-material situation, access to professional health care, and the ability to exercise self-care are major contextual factors of the patient’s health situation. The purpose of this article is to draw attention to the fact that the limiting oneself exclusively to algorithms as procedures based on the best evidence (best evidence medical research – BEMR may raise the specific danger of underestimating the variability of individual responses of the human body under the influence of factors forming a personal context. The phenomenon of contextualisation in the treatment of an individual patient is still not adequately disseminated, although it is an important element in the decision-making process, with proven impact on the efficiency and quality of care and satisfaction of a patient.

  17. Long-term Primary Medical Therapy with Somatostatin Analogs in Acromegaly

    Directory of Open Access Journals (Sweden)

    Deng-Huang Su

    2006-01-01

    Full Text Available To cure acromegalic patients, transsphenoidal surgery is considered first, especially for microadenoma. However, less than 50% of patients with macroadenoma achieve satisfactory biochemical control. Moreover, surgery may cause hypopituitarism. Medical therapy may offer the prospect of near normalization of growth hormone (GH/insulin-like growth factor-1 levels with substantial tumor shrinkage in a significant number of patients. Here, we report two cases of acromegaly under treatment with somato-statin analogs alone for more than 10 years. Case 1 was a 54-year-old man with a pituitary macro-adenoma. He received 4 years of octreotide treatment followed by 6 years of prolonged-release (PR lanreotide resulting in normal GH level. Case 2 was a 60-year-old woman with a 1.3 cm pituitary tumor. She received 8 years of octreotide treatment followed by 6 years of PR lanreotide resulting in subnormal GH level and gallbladder sludge. She had received bilateral total hip replacement for hip osteoarthritis at the age of 59 years. These cases illustrate that long-term treatment with somatostatin analogs offers an alternative choice in selected acromegalic patients, such as those with pituitary tumor who cannot be cured by surgery, those who have unacceptable anesthetic risk and those who refuse surgery.

  18. Retrospective financial analysis of medication therapy management services from the pharmacy's perspective.

    Science.gov (United States)

    McDonough, Randal P; Harthan, Aaron A; McLeese, Kelly E; Doucette, William R

    2010-01-01

    To determine the net financial gain or loss for medication therapy management (MTM) services provided to patients by an independent community pharmacy during 16 months of operation. Retrospective study. Independent community pharmacy in Iowa City, IA, from September 1, 2006, to December 31, 2007. Patients receiving MTM services during the specified period who had proper documentation of reimbursement for the services. MTM services were provided to the patient and documented by the pharmacist or student pharmacist. Net financial gains or losses for providing MTM services. Sensitivity analyses included costs that might be incurred under various conditions of operation. 103 initial and 88 follow-up MTM visits were conducted during a 16-month time period. The total cost for these services to the pharmacy was $11,191.72. Total revenue from these services was $11,195.00; therefore, the pharmacy experienced a net financial gain of $3.28. Sensitivity analyses were conducted, revealing the net gain/loss to the pharmacy if a student pharmacist was used and the net gain/loss if the pharmacist needed extra training to provide the services. Using a student pharmacist resulted in a net gain of $6,308.48, while extra training for the pharmacist resulted in a net loss of $1,602.72. The MTM service programs showed a positive financial gain after 16 months of operation, which should encourage pharmacists to incorporate these services into their practice.

  19. Measurement assurance studies of high-energy electron and photon dosimetry in radiation-therapy applications

    Energy Technology Data Exchange (ETDEWEB)

    Ehrlich, M; Soares, C G [National Bureau of Standards, Washington, DC (USA)

    1981-08-01

    This is a brief review of surveys on the dosimetry of radiation-therapy beams by the National Bureau of Standards (NBS). Covered are the NBS ferrous-sulfate (Fricke) dosimetry service, a recently completed survey carried out with thermoluminescence dosimeters (TLD) on the dosimetry in cobalt-60 teletherapy beams, and plans for a TLD survey of dosimetry in high-energy bremsstrahlung beams.

  20. Recent topical research on global, energy, health & medical, and tourism economics, and global software: An overview

    NARCIS (Netherlands)

    C-L. Chang (Chia-Lin); M.J. McAleer (Michael)

    2017-01-01

    textabstractThe paper presents an overview of recent topical research on global, energy, health & medical, and tourism economics, and global software. We have interpreted "global" in the title of the Journal of Reviews on Global Economics to cover contributions that have a global impact on

  1. Recent Topical Research on Global, Energy, Health & Medical, and Tourism Economics, and Global Software

    NARCIS (Netherlands)

    C-L. Chang (Chia-Lin); M.J. McAleer (Michael)

    2017-01-01

    textabstractThe paper presents an overview of recent topical research on global, energy, health & medical, and tourism economics, and global software. We have interpreted “global” in the title of the Journal of Reviews on Global Economics to cover contributions that have a global impact on

  2. Teaching Energy Metabolism Using Scientific Articles: Implementation of a Virtual Learning Environment for Medical Students

    Science.gov (United States)

    de Espindola, Marina Bazzo; El-Bacha, Tatiana; Giannella, Tais Rabetti; Struchiner, Miriam; da Silva, Wagner S.; Da Poian, Andrea T.

    2010-01-01

    This work describes the use of a virtual learning environment (VLE) applied to the biochemistry class for undergraduate, first-year medical students at the Federal University of Rio de Janeiro. The course focused on the integration of energy metabolism, exploring metabolic adaptations in different physiological or pathological states such as…

  3. Men Who Have Sex With Men in Peru: Acceptability of Medication-Assisted Therapy for Treating Alcohol Use Disorders.

    Science.gov (United States)

    Brown, Shan-Estelle; Vagenas, Panagiotis; Konda, Kelika A; Clark, Jesse L; Lama, Javier R; Gonzales, Pedro; Sanchez, Jorge; Duerr, Ann C; Altice, Frederick L

    2017-07-01

    In Peru, the HIV epidemic is concentrated in men who have sex with men (MSM) and transgender women (TGW). Multiple studies correlate alcohol use disorders (AUDs) with risky sexual behaviors among Peruvian MSM. Qualitative research was used to inform a clinical trial on the acceptability of medication-assisted therapies to assist management of AUDs and improve antiretroviral therapy (ART) adherence among MSM/TGW in Peru. Three focus groups involving HIV-infected or HIV-uninfected MSM/TGW ( n = 26) with AUDs (AUDIT ≥ 8) were transcribed, translated from Spanish into English, and analyzed using thematic content analysis. Despite having an AUD, participants considered themselves "social" drinkers, minimized their drinking behaviors, and differed about whether or not alcohol problems could be treated. Participants expressed skepticism about medication for treating AUDs. Three concepts emerged as necessary components of a treatment program for alcohol problems: cost, family support, and the potential to drink less alcohol without attaining total abstinence. This study reveals important areas of education to increase potential acceptability of a medication for treating AUDs among MSM/TGW. Given the social conditions and knowledge base of the participants, medication-assisted therapies using naltrexone may be a beneficial strategy for MSM with AUDs.

  4. Portal imaging improvement with a low energy un flattened beam in high energy medical accelerators

    Energy Technology Data Exchange (ETDEWEB)

    Krutman, Y; Faermann, S; Tsechanski, A [Ben-Gurion Univ. of the Negev, Beersheba (Israel)

    1996-12-01

    In this work we present a further improvement of the portal film option, for a Clinac 18 accelerator with a 10 MV therapeutic x-ray beam. This is done by lowering the nominal photon energy to 4 MV, therefore increasing the relative contribution of the low energy portion of the x-ray spectrum. Improvement of the image quality is demonstrated with a portal film scale tray, and with an anthropomorphic phantom, a graphical analysis demonstrates the improvement on image (authors).

  5. Long-term patterns of adherence to medication therapy among patients with type 2 diabetes mellitus in Denmark

    DEFF Research Database (Denmark)

    Jensen, Majken Linnemann; Jørgensen, Marit Eika; Hansen, Ebba Holme

    2017-01-01

    : Adherence to six medicine groups (metformin, sulfonylureas, acetylsalicylic acid, thiazide diuretics, renin angiotensin system inhibitors, and statins) were analysed among 5,232 patients with type 2 diabetes at a tertiary referral hospital during 1998-2009. Rate-ratios of initiation of treatment, recurrent......AIMS: Poor adherence to medication therapy among type 2 diabetes patients is a clinical challenge. We aimed to determine which factors are associated with the three phases of long-term adherence to medication: initiation, implementation and discontinuation in a register-based study. METHODS...... gaps in supply of medication, and discontinuation of treatment were analysed using Poisson regression. RESULTS: Poor initiation rather than poor implementation or discontinuation was the main contributor to medication nonadherence. Polypharmacy was a risk factor for slower initiation of treatment...

  6. Discussion of feasibility to carry out intensity modulated radiation therapy in conventional medical electron linear accelerator treatment rooms

    International Nuclear Information System (INIS)

    Yang Haiyou; Liu Liping; Liang Yueqin; Zhang Liang; Yu Shui

    2010-01-01

    Objective: To investigate the feasibility about the shielding effect of conventional medical electron linear accelerator treatment in the existing rooms to carry out intensity modulated radiation therapy (IMRT). Methods: The estimation model given in NCRP REPORT No. 151- S tructural Shielding Design and Evaluation for Megavoltage X-and Gamma-Ray Radiotherapy Facilities i s adopted by linking instances, which presents the calculation methods on radiation level at the ambience of megavoltage medical electron linear accelerator treatment room. Results: The radiation level, as well as the additional annual effect dose of occupational and public at the ambience of accelerator treatment room, in crease to a certain extent, when conventional medical electron linear accelerator treatment room; are used to carry out IMRT. Conclusion: It is necessary to make environmental impact assessment for conventional medical electron linear accelerator treatment rooms, which will be used to execute IMRT. (authors)

  7. Complementary and alternative medical therapies for chronic low back pain: What treatments are patients willing to try?

    Science.gov (United States)

    Sherman, Karen J; Cherkin, Daniel C; Connelly, Maureen T; Erro, Janet; Savetsky, Jacqueline B; Davis, Roger B; Eisenberg, David M

    2004-07-19

    Although back pain is the most common reason patients use complementary and alternative medical (CAM) therapies, little is known about the willingness of primary care back pain patients to try these therapies. As part of an effort to refine recruitment strategies for clinical trials, we sought to determine if back pain patients are willing to try acupuncture, chiropractic, massage, meditation, and t'ai chi and to learn about their knowledge of, experience with, and perceptions about each of these therapies. We identified English-speaking patients with diagnoses consistent with chronic low back pain using automated visit data from one health care organization in Boston and another in Seattle. We were able to confirm the eligibility status (i.e., current low back pain that had lasted at least 3 months) of 70% of the patients with such diagnoses and all eligible respondents were interviewed. Except for chiropractic, knowledge about these therapies was low. Chiropractic and massage had been used by the largest fractions of respondents (54% and 38%, respectively), mostly for back pain (45% and 24%, respectively). Among prior users of specific CAM therapies for back pain, massage was rated most helpful. Users of chiropractic reported treatment-related "significant discomfort, pain or harm" more often (23%) than users of other therapies (5-16%). Respondents expected massage would be most helpful (median of 7 on a 0 to 10 scale) and meditation least helpful (median of 3) in relieving their current pain. Most respondents indicated they would be "very likely" to try acupuncture, massage, or chiropractic for their back pain if they did not have to pay out of pocket and their physician thought it was a reasonable treatment option. Most patients with chronic back pain in our sample were interested in trying therapeutic options that lie outside the conventional medical spectrum. This highlights the need for additional studies evaluating their effectiveness and suggests that

  8. Patient perceptions of pharmacist roles in guiding self-medication of over-the-counter therapy in Qatar

    Directory of Open Access Journals (Sweden)

    Kerry Wilbur

    2010-04-01

    Full Text Available Kerry Wilbur1, Samah El Salam1, Ebrahim Mohammadi21Qatar University College of Pharmacy, Doha, Qatar; 2Qatar Petroleum Medical Services, Doha, QatarBackground: Self-care, including self-medication with over-the-counter (OTC drugs, facilitates the public’s increased willingness to assume greater responsibility for their own health. Direct consultation with pharmacists provides efficient professional guidance for safe and appropriate OTC use.Objective: The purpose of this study was to characterize patient perceptions of pharmacists and use of nonprescription therapy in an ambulatory care population in Qatar. Methods: Patients having prescriptions filled at one organization’s private medical clinics during two distinct two-week periods were invited to participate in a short verbal questionnaire. Awareness of pharmacist roles in guiding OTC drug selection was assessed, as were patient preferences for OTC indications. Attitudes towards pharmacist and nurse drug knowledge and comfort with direct dispensing were also evaluated.Results: Five hundred seventy patients participated representing 29 countries. Most respondents were men (92.1% with mean age of 38.3 years. Almost 1 in 7 did not know medical complaints could be assessed by a pharmacist (15.3% and 1 in 5 (21.9% were unaware pharmacists could directly supply OTC therapy. The majority (85.3% would be interested in this service. In general, respondents were more comfortable with medication and related advice supplied by pharmacists as opposed to nursing professionals.Conclusion: Patients were familiar with the roles of pharmacists as they pertain to selfmedication with OTC therapy and described the desire to use such a service within this Qatar ambulatory health care setting.Keywords: patient, self-medication, over-the-counter, pharmacist, Qatar

  9. Laser interstitial thermal therapy for medically intractable mesial temporal lobe epilepsy.

    Science.gov (United States)

    Kang, Joon Y; Wu, Chengyuan; Tracy, Joseph; Lorenzo, Matthew; Evans, James; Nei, Maromi; Skidmore, Christopher; Mintzer, Scott; Sharan, Ashwini D; Sperling, Michael R

    2016-02-01

    To describe mesial temporal lobe ablated volumes, verbal memory, and surgical outcomes in patients with medically intractable mesial temporal lobe epilepsy (mTLE) treated with magnetic resonance imaging (MRI)-guided stereotactic laser interstitial thermal therapy (LiTT). We prospectively tracked seizure outcome in 20 patients at Thomas Jefferson University Hospital with drug-resistant mTLE who underwent MRI-guided LiTT from December 2011 to December 2014. Surgical outcome was assessed at 6 months, 1 year, 2 years, and at the most recent visit. Volume-based analysis of ablated mesial temporal structures was conducted in 17 patients with mesial temporal sclerosis (MTS) and results were compared between the seizure-free and not seizure-free groups. Following LiTT, proportions of patients who were free of seizures impairing consciousness (including those with auras only) are as follows: 8 of 15 patients (53%, 95% confidence interval [CI] 30.1-75.2%) after 6 months, 4 of 11 patients (36.4%, 95% CI 14.9-64.8%) after 1 year, 3 of 5 patients (60%, 95% CI 22.9-88.4%) at 2-year follow-up. Median follow-up was 13.4 months after LiTT (range 1.3 months to 3.2 years). Seizure outcome after LiTT suggests an all or none response. Four patients had anterior temporal lobectomy (ATL) after LiTT; three are seizure-free. There were no differences in total ablated volume of the amygdalohippocampus complex or individual volumes of hippocampus, amygdala, entorhinal cortex, parahippocampal gyrus, and fusiform gyrus between seizure-free and non-seizure-free patients. Contextual verbal memory performance was preserved after LiTT, although decline in noncontextual memory task scores were noted. We conclude that MRI-guided stereotactic LiTT is a safe alternative to ATL in patients with medically intractable mTLE. Individualized assessment is warranted to determine whether the reduced odds of seizure freedom are worth the reduction in risk, discomfort, and recovery time. Larger prospective

  10. Implementation and Clinical Outcomes of an Employer-Sponsored, Pharmacist-Provided Medication Therapy Management Program.

    Science.gov (United States)

    Theising, Katie M; Fritschle, Traci L; Scholfield, Angelina M; Hicks, Emily L; Schymik, Michelle L

    2015-11-01

    Our objective was to describe the implementation and clinical outcomes of an employer-sponsored, pharmacist-provided medication therapy management (MTM) program for health plan beneficiaries with diabetes mellitus and/or hypertension. We conducted a single-center retrospective medical record review. The setting was a Pharmacy MTM Clinic at a self-insured health system consisting of six hospitals and several ancillary facilities. A total of 161 health plan beneficiaries with diabetes identified during annual wellness screenings for the health plan in 2012 and 225 health plan beneficiaries with diabetes and/or hypertension identified during annual wellness screenings for the health plan in 2013 were referred to the MTM clinic based on specific criteria. In 2012 the health system expanded its existing wellness program by implementing a voluntary diabetes care program for health plan beneficiaries with uncontrolled diabetes (hemoglobin A(1c) [A1C] 7% or higher); a similar program was added for hypertension for the 2013 plan year. All participants' A1C and blood pressure results were tracked from the date of their wellness screening through the end of the plan year. The pharmacists involved had the capability to directly implement drug regimen changes according to hospital protocol or provide recommendations to the physician, as specified by the referring physician. For the 2012-2013 plan year, the mean difference in A1C from baseline to program completion was -0.38% (95% confidence interval [CI] -0.58 to -0.18%, p<0.05). For beneficiaries with a baseline A1C of 7% or higher, the mean difference was -0.69% (95% CI -0.99 to -0.39%, p<0.05). For the 2013-2014 plan year, the mean difference in A1C from baseline to program completion was -0.62% (95% CI -0.81 to -0.44%, p<0.05). In that year, the mean difference in A1C for beneficiaries with A1C 7% or higher was -0.97% (95% CI -1.23 to -0.72%, p<0.05). For those referred for hypertension, a mean difference of -13 mm Hg (95

  11. Pharmacists' perceptions of advancing public health priorities through medication therapy management

    Directory of Open Access Journals (Sweden)

    Casserlie LM

    2016-09-01

    Full Text Available Background: Public health priorities can be addressed by pharmacists through channels such as medication therapy management (MTM to optimize patient and population outcomes. However, no studies have specifically assessed pharmacists’ perceptions of addressing public health priorities through MTM. Objective: The objective of this study was to assess pharmacists’ opinions regarding the feasibility and appropriateness of addressing seven areas of public health priority through MTM services to impact public health in direct patient care settings. Methods: An anonymous 37-question electronic survey was conducted to evaluate Ohio pharmacists’ opinions of advancing seven public health priorities identified from Healthy People 2020 (family planning, preconception care, smoking cessation, immunizations, nutrition/biometric wellness assessments, point-of-care testing, fall prevention through MTM activities; to identify potential barriers; and to collect demographic information. The cross-sectional survey was sent to a random sample of 500 pharmacists registered with the Ohio State Board of Pharmacy. Results: Seventy-six pharmacists responded to the survey, resulting in a 16% response rate. On average, it took respondents 5-10 minutes to complete the survey. The majority of respondents thought that each of the seven public health priorities were “important” or “very important” to patient health; the most commonly identified areas included smoking cessation, immunizations, and fall prevention (97.5%. When asked to indicate which of the seven areas they thought they could potentially have a role to provide services through MTM, on average pharmacists picked 4 of the priority areas. Only 6.6% indicated there was no role for pharmacists to provide MTM services for any of the listed categories. Staffing, time, and reimbursement represented the most commonly perceived barriers for pharmacists in providing MTM services. Fifty-seven percent indicated

  12. Experiential Education Builds Student Self-Confidence in Delivering Medication Therapy Management

    Directory of Open Access Journals (Sweden)

    Wendy M. Parker

    2017-07-01

    Full Text Available To determine the impact of advanced pharmacy practice experiences (APPE on student self-confidence related to medication therapy management (MTM, fourth-year pharmacy students were surveyed pre/post APPE to: identify exposure to MTM learning opportunities, assess knowledge of the MTM core components, and assess self-confidence performing MTM services. An anonymous electronic questionnaire administered pre/post APPE captured demographics, factors predicted to impact student self-confidence (Grade point average (GPA, work experience, exposure to MTM learning opportunities, MTM knowledge and self-confidence conducting MTM using a 5-point Likert scale (1 = Not at all Confident; 5 = Extremely Confident. Sixty-two students (26% response rate responded to the pre-APPE questionnaire and n = 44 (18% to the post-APPE. Over 90% demonstrated MTM knowledge and 68.2% completed MTM learning activities. APPE experiences significantly improved students’ overall self-confidence (pre-APPE = 3.27 (0.85 SD, post-APPE = 4.02 (0.88, p < 0.001. Students engaging in MTM learning opportunities had higher self-confidence post-APPE (4.20 (0.71 vs. those not reporting MTM learning opportunities (3.64 (1.08, p = 0.05. Post-APPE, fewer students reported MTM was patient-centric or anticipated engaging in MTM post-graduation. APPE learning opportunities increased student self-confidence to provide MTM services. However, the reduction in anticipated engagement in MTM post-graduation and reduction in sensing the patient-centric nature of MTM practice, may reveal a gap between practice expectations and reality.

  13. The effect of optimal medical therapy on 1-year mortality after acute myocardial infarction.

    Science.gov (United States)

    Bramlage, P; Messer, C; Bitterlich, N; Pohlmann, C; Cuneo, A; Stammwitz, E; Tebbenjohanns, J; Gohlke, H; Senges, J; Tebbe, U

    2010-04-01

    Five drug classes have been shown to improve the prognosis of acute myocardial infarction in clinical trials: aspirin, beta-blockers, statins, renin angiotensin system (RAS) blockers and thienopyridines. We aimed to assess whether the benefits of combining these drugs (termed optimal medical therapy, OMT), will result in a reduction of mortality in clinical practice. Nationwide registry Hospitals with a cardiology unit or internal medicine department. 5353 patients with acute myocardial infarction. At hospital discharge 89% received aspirin, 90% beta-blockers, 84% statins, 81% RAS blockers, 70% a thienopyridine and 46.2% OMT. Pharmacotherapy OR with 95% CI for mortality from myocardial infarction were calculated and adjusted for patient risk at baseline. Total mortality was reduced by 74% in patients receiving OMT (adj OR 0.26; 95% CI 0.18 to 0.38) versus patients receiving one or no drug. This was consistent in subgroups defined by STEMI/NSTEMI, diabetes and gender. Mortality was also reduced in patients receiving 2-4 drugs (adj OR 0.49; 95% CI 0.35 to 0.68), diabetic patients being the only subgroup with no significant effect. Analyses on the relative importance of either component revealed that withdrawal of beta-blockers (adj OR 0.63; 95% CI 0.34 to 1.16) and/or a combination of aspirin/clopidogrel (adj OR 0.59; 95% CI 0.20 to 1.17) abolished the risk reduction conferred by OMT. OMT over 1 year was associated with a significantly lower mortality of patients with acute myocardial infarction in clinical practice. However OMT is provided to less than half of eligible patients leaving room for substantial improvement.

  14. [Optimization of postoperative medical therapy of infective endocarditis in patients with congenital valvular heart disease].

    Science.gov (United States)

    Chistyakov, I S; Medvedev, A P; Pichugin, V V

    2016-01-01

    The purpose of this study was to evaluate the effectiveness of combined surgical and medical treatment of infective endocarditis in patients with congenital valvular heart disease when included in a regimen of the drug Reamberin. In this regard, the analysis of the effectiveness of a combination regimen of 74 patients with valvular congenital heart diseases complicated with infective endocarditis. Given the indications for surgical correction operative technique features and possible technical difficulties in carrying out such operations, due to the inflammatory changes and tissue destruction, and ways to overcome them. For the correction of metabolic disorders in the postoperative period, 47 patients (main group) was appointed Reamberin: once, intravenous drip 400 ml/day during the first 5 days after surgery. 27 patients (control group) was conducted infusion therapy depending on the severity of the condition according to the classical scheme. In addition to standard clinical and laboratory examination, to assess the effectiveness of Reamberin was investigated catalase activity of CPK in blood serum in the dynamics of observation (1, 3 and 5 days after surgery). It is revealed that surgical approach, used in complex treatment of patients with valvular congenital heart diseases, including reorganization of the cavities of the heart, increasing the frequency of joints and the use of reinforcing strips of synthetic material that prevents the cutting of sutures through the inflamed tissue has achieved good short-and long-term results. Infective endocarditis and destruction of the valvular annulus fibrosus the use of a frame of strips of polytetrafluoroethylene allows you to restore its integrity and to implant a mechanical prosthesis. The inclusion in the regimen of patients with infective endocarditis complicated by cardiac insufficiency in the early postoperative period the drug Reamberin improves the efficiency of treatment by a more rapid restoration of the normal

  15. Enhancing the Reach of Cognitive-Behavioral Therapy Targeting Posttraumatic Stress in Acute Care Medical Settings.

    Science.gov (United States)

    Darnell, Doyanne; O'Connor, Stephen; Wagner, Amy; Russo, Joan; Wang, Jin; Ingraham, Leah; Sandgren, Kirsten; Zatzick, Douglas

    2017-03-01

    Injured patients presenting to acute care medical settings have high rates of posttraumatic stress disorder (PTSD) and comorbidities, such as depression and substance use disorders. Integrating behavioral interventions that target symptoms of PTSD and comorbidities into the acute care setting can overcome common barriers to obtaining mental health care. This study examined the feasibility and acceptability of embedding elements of cognitive-behavioral therapy (CBT) in the delivery of routine postinjury care management. The investigation also explored the potential effectiveness of completion of CBT element homework that targeted PTSD symptom reduction. This study was a secondary analysis of data from a U.S. clinical trial of the effectiveness of a stepped collaborative care intervention versus usual care for injured inpatients. The investigation examined patients' willingness at baseline (prerandomization) to engage in CBT and pre- and postrandomization mental health service utilization among 115 patients enrolled in the clinical trial. Among intervention patients (N=56), the investigation examined acceptability of the intervention and used multiple linear regression to examine the association between homework completion as reported by the care manager and six-month PTSD symptom reduction as assessed by the PTSD Checklist-Civilian DSM-IV Version. Patients in the intervention condition reported obtaining significantly more psychotherapy or counseling than patients in the control group during the six-month follow-up, as well as a high degree of intervention acceptability. Completion of CBT element homework assignments was associated with improvement in PTSD symptoms. Integrating behavioral interventions into routine acute care service delivery may improve the reach of evidence-based mental health care targeting PTSD.

  16. A structured patient identification model for medication therapy management services in a community pharmacy.

    Science.gov (United States)

    Pagano, Gina M; Groves, Brigid K; Kuhn, Catherine H; Porter, Kyle; Mehta, Bella H

    To describe the development and implementation of a structured patient identification model for medication therapy management (MTM) services within traditional dispensing activities of a community pharmacy to facilitate pharmacist-provided completion of MTM services. A daily clinical opportunity report was developed as a structured model to identify MTM opportunities daily for all MTM-eligible patients expecting to pick up a prescription. Pharmacy staff was trained and the standardized model was implemented at study sites. One hundred nineteen grocery store-based community pharmacies throughout Ohio, West Virginia, and Michigan. A structured patient identification model in a community pharmacy consists of reviewing a clinical opportunity report, identifying interventions for MTM-eligible patients, and possibly collaborating with an interdisciplinary team. This model allows pharmacists to increase MTM cases performed by providing a structured process for identifying MTM-eligible patients and completing MTM services. The development and implementation of a structured patient identification model in the community pharmacy was completed and consists of pharmacists reviewing a clinical opportunity report to identify MTM opportunities and perform clinical interventions for patients. In a 3-month pre- and post-implementation comparison, there was a 49% increase in the number of MTM services provided by pharmacists (P < 0.001). A structured patient identification model in the community pharmacy was associated with an increase in the amount of MTM services provided by pharmacists. This method could be a useful tool at a variety of community pharmacies to solve challenges associated with MTM completion. Copyright © 2017 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.

  17. Tumours associated with medical X-ray therapy exposure in childhood

    International Nuclear Information System (INIS)

    Colman, M.; Kirsch, M.; Creditor, M.

    1978-01-01

    A total of 5166 persons who were exposed to limited field (80-100 cm 2 ) X-ray irradiation to the head, neck and upper chest region during childhood and adolescence have provided an outstanding opportunity for the study of tumour incidence following medical X-ray therapy. More than 3254 subjects have been traced, 3108 have completed questionnaires eliciting information on tumour incidence, and 1539 of these were subjected to a thorough clinical screening procedure that included a thyroid scintigram. The prevalence of thyroid tumours in the 1539 clinically screened subjects and the prevalence of all other tumours in the 3254 subjects traced can therefore be assumed to reflect the risks in the group of irradiated subjects as a whole. Median age at irradiation was 3.5 years, and median radiation dose 790 rads (7.9 Gy). Thyroid tumour was diagnosed in 413 subjects. Of those undergoing surgery (273) 30.3% were found to have thyroid cancer. A total of 366 surgical pathology specimens of the thyroid, including 93 from subjects who were diagnosed at other hospitals, were examined revealing 73 papillary carcinomas, 12 follicular carcinomas and 26 microscopic papillary carcinomas. One hundred and eighty-seven other (non-thyroid) neoplasmas identified included 27 benign and 10 malignant salivary gland tumours, 16 benign and seven malignant tumours of neural origin (brain, spinal cord, cranial and peripheral nerves), 37 skin tumours, 9 lymphomas, 8 gonadal tumours, 45 breast tumours and 28 tumours of miscellaneous sites. The incidence of thyroid tumours, salivary gland tumours and primary brain tumours was considerably in excess of the expected incidence (p values<0.0001), and a radiation dose-effect correlation was observed for thyroid and brain tumours. Gonadal tumours and lymphomas did not occur in excess of the expected incidence

  18. WE-A-BRF-01: Dual-Energy CT Imaging in Diagnostic Imaging and Radiation Therapy

    International Nuclear Information System (INIS)

    Molloi, S; Li, B; Yin, F; Chen, H

    2014-01-01

    classification based on calcium scores shows excellent agreement with classification on the basis of conventional coronary artery calcium scoring. These studies demonstrate dual-energy cardiovascular CT can potentially be a noninvasive and sensitive modality in high risk patients. On-board KV/MV Imaging. To enhance soft tissue contrast and reduce metal artifacts, we have developed a dual-energy CBCT technique and a novel on-board kV/MV imaging technique based on hardware available on modern linear accelerators. We have also evaluated the feasibility of these two techniques in various phantom studies. Optimal techniques (energy, beam filtration, # of overlapping projections, etc) have been investigated with unique calibration procedures, which leads to successful decomposition of imaged material into acrylic-aluminum basis material pair. This enables the synthesis of virtual monochromatic (VM) CBCT images that demonstrate much less beam hardening, significantly reduced metal artifacts, and/or higher soft tissue CNR compared to single-energy CBCT. Adaptive Radiation Therapy. DECT could actually contribute to the area of Dose-Guided Radiation Therapy (or Adaptive Therapy). The application of DECT imaging using 80kV and 140 kV combinations could potentially increase the image quality by reducing the bone or high density material artifacts and also increase the soft tissue contrast by a light contrast agent. The result of this higher contrast / quality images is beneficial for deformable image registration / segmentation algorithm to improve its accuracy hence to make adaptive therapy less time consuming in its recontouring process. The real time re-planning prior to per treatment fraction could become more realistic with this improvement especially in hypofractional SBRT cases. Learning Objectives: Learn recent developments of dual-energy imaging in diagnosis and radiation therapy; Understand the unique clinical problem and required quantification accuracy in each application

  19. Education and training in medical imaging for conventional and particle radiation therapy through the EC funded envision and entervision

    CERN Document Server

    Cirilli, M

    2014-01-01

    A key challenge in particle therapy today is quality assurance during treatment, which needs advanced medical imaging techniques. This issue is tackled by the EC funded project ENVISION, an R\\&D consortium of sixteen leading European research centres and one industrial partner, co-ordinated by CERN. ENVISION covers developments in Time Of Flight in-beam PET, in-beam single particle tomography, organ motion monitoring techniques, simulation, and treatment planning. Additionally, ENVISION serves as a training platform for the ENTERVISION project, a Marie-Curie Initial Training Network aimed at educating young researchers in online 3D digital imaging for hadron therapy. ENTERVISION brings together ten academic institutes and research centres of excellence and a leading European company in particle therapy, and is coordinated by CERN. Its multi-disciplinary training programme of ENTERVISION includes a diversified portfolio of scientific courses, complemented by specific courses aimed at developing soft skills...

  20. OBESITY: A GASTROENTEROLOGIST’S POINT OF VIEW AND VARIANTS OF MEDICAL THERAPY

    Directory of Open Access Journals (Sweden)

    V. B. Grinevich

    2015-01-01

    10.6 to 20.2% from baseline values. Patients with whom treatment was least effective, had higher insulin resistance index (r = 0.32, p < 0.05, higher leptin levels (r = 0.42, p < 0.05, higher degree of liver steatosis on ultrasound examination (r = 0.38, p < 0.05, higher proportion of patients with emotionally triggered eating behavior (r = 0.29, p < 0.05, as well as more advanced dysbiotic abnormalities of gut microflora (r = 0.27, p < 0.05. To decrease dysbiotic abnormalities of the gut, patients with previous lack of treatment efficacy were administered a prebiotic complex Eubicor®. 24-hour ambulatory blood pressure monitoring and electrocardiographic monitoring before the start of the treatment allowed to avoid significant side effects with daily sibutramine dose of 15 mg. During treatment with sibutramine, the following potentially related side effects were reported: dryness of mouth (6 cases in 15% of patients, episode of tachycardia at rest (2 cases, 5% patients, transient sleep disorder (3 cases, 7.5% patients.Conclusion: Sibutramine can be considered as an effective and safe agent for comprehensive treatment of patients with alimentary constitutional obesity grade II–III, resistant to previous medical therapy. Addition of the prebiotic complex (Eubicor® to diet allows for improvement of treatment efficacy in patients taking Reduxin®. 

  1. Religiously Integrated Cognitive Behavioral Therapy: A New Method of Treatment for Major Depression in Patients With Chronic Medical Illness

    Science.gov (United States)

    Pearce, Michelle J.; Koenig, Harold G.; Robins, Clive J.; Nelson, Bruce; Shaw, Sally F.; Cohen, Harvey J.; King, Michael B.

    2015-01-01

    Intervention studies have found that psychotherapeutic interventions that explicitly integrate clients’ spiritual and religious beliefs in therapy are as effective, if not more so, in reducing depression than those that do not for religious clients. However, few empirical studies have examined the effectiveness of religiously (vs. spiritually) integrated psychotherapy, and no manualized mental health intervention had been developed for the medically ill with religious beliefs. To address this gap, we developed and implemented a novel religiously integrated adaptation of cognitive–behavioral therapy (CBT) for the treatment of depression in individuals with chronic medical illness. This article describes the development and implementation of the intervention. First, we provide a brief overview of CBT. Next, we describe how religious beliefs and behaviors can be integrated into a CBT framework. Finally, we describe Religiously Integrated Cognitive Behavioral Therapy (RCBT), a manualized therapeutic approach designed to assist depressed individuals to develop depression-reducing thoughts and behaviors informed by their own religious beliefs, practices, and resources. This treatment approach has been developed for 5 major world religions (Christianity, Judaism, Islam, Buddhism, and Hinduism), increasing its potential to aid the depressed medically ill from a variety of religious backgrounds. PMID:25365155

  2. The impact of pharmacist face-to-face counseling to improve medication adherence among patients initiating statin therapy

    Directory of Open Access Journals (Sweden)

    Duncan I

    2012-04-01

    Full Text Available Michael Taitel1, Jenny Jiang1, Kristi Rudkin2, Susan Ewing2, Ian Duncan 1Clinical Outcomes and Analytics, Walgreens, 2Corporate Innovation Team, Walgreens, Deerfield, Illinois, USAPurpose: To evaluate the impact of a community-based pharmacist-led face-to-face counseling program on medication adherence for patients who were new to therapy (NTT for statin medications.Patients and methods: This retrospective cohort study evaluated a program that was implemented in 76 national community pharmacies located in the midwest USA. It consisted of two face-to-face patient counseling sessions with a pharmacist that addressed patient barriers to adherence. A group of 2056 NTT statin patients was identified between September 1, 2010 and October 31, 2010, and was followed for 12 months. The intervention group consisted of 586 patients, and the comparison group comprised 516 patients. Outcomes were measured using the continuous medication possession ratio (MPR, categorical MPR, and medication persistency.Results: After adjusting for covariates, the intervention group had statistically greater MPR than the comparison group at every month measured. For example, at 12 months the intervention group had a MPR of 61.8% (CI, 54.5%–69.2% and the comparison group had a MPR of 56.9% (CI, 49.5%–64.3%; this 4.9% difference is significant (P < 0.01. The 12 month categorical MPR also showed significant differences between groups (χ2 = 6.12, P < 0.05; 40.9% of the intervention group and 33.7% of comparison group had a MPR greater than or equal to 80%. Finally, the intervention group had significantly greater persistency with their medication therapy than the comparison group at 60, 90, 120, and 365 days.Conclusion: Patients who participated in brief face-to-face counseling sessions with a community pharmacist at the beginning of statin therapy demonstrated greater medication adherence and persistency than a comparison group. This brief targeted intervention at the

  3. Assessment of beam stability of high energy and low energy Varian medical linear accelerators

    International Nuclear Information System (INIS)

    Jayesh, K.; Mohan, R.; Joshi, R.C.; Ganesh, T.; Hegazy, M.; Oubaye, A.J.; AI Idrisi, Maha

    2008-01-01

    An accurate measurement of the dose delivered to the tumor in external beam radiotherapy is one of the primary responsibilities of a medical physicist. In general, such measurements have been based on the application of a dosimetry protocol and quality assurance procedures. Clinically one must be able to assess the beam quality, flatness and symmetry and variation in the output on daily basis. Flatness and symmetry are the main parameters for determining the pattern of a photon and electron beam produced by linear accelerators. The quality assurance in routine clinical practice of radiotherapy and consequently the treatment-outcome depends definitely on the physical parameters of treatment-delivery. Several recommendations from national and international associations are reported to define the limits for the beam parameters. The review of literature and various reports on quality assurance in radiotherapy show that for flatness, symmetry and output constancy the optimal level of deviation should be within ±3%

  4. Association of antidepressant medication therapy with inpatient rehabilitation outcomes for stroke, traumatic brain injury, or traumatic spinal cord injury.

    Science.gov (United States)

    Weeks, Douglas L; Greer, Christopher L; Bray, Brenda S; Schwartz, Catrina R; White, John R

    2011-05-01

    To study whether outcomes in patients who have undergone inpatient rehabilitation for stroke, traumatic brain injury (TBI), or traumatic spinal cord injury (TSCI) differ based on antidepressant medication (ADM) use. Retrospective cohort study of 867 electronic medical records of patients receiving inpatient rehabilitation for stroke, TBI, or TSCI. Four cohorts were formed within each rehabilitation condition: patients with no history of ADM use and no indication of history of depression; patients with no history of ADM use but with a secondary diagnostic code for a depressive illness; patients with a history of ADM use prior to and during inpatient rehabilitation; and patients who began ADM therapy in inpatient rehabilitation. Freestanding inpatient rehabilitation facility (IRF). Patients diagnosed with stroke (n=625), TBI (n=175), and TSCI (n=67). Not applicable. FIM, rehabilitation length of stay (LOS), deviation between actual LOS and expected LOS, and functional gain per day. In each impairment condition, patients initiating ADM therapy in inpatient rehabilitation had longer LOS than patients in the same impairment condition on ADM at IRF admission, and had significantly longer LOS than patients with no history of ADM use and no diagnosis of depression (Pstroke and TBI groups initiating ADM in IRF than their counterparts with no history of ADM use, illustrating that the group initiating ADM therapy in rehabilitation significantly exceeded expected LOS. Increased LOS did not translate into functional gains, and in fact, functional gain per day was lower in the group initiating ADM therapy in IRF. Explanations for unexpectedly long LOS in patients initiating ADM in inpatient rehabilitation focus on the potential for ADM to inhibit therapy-driven remodeling of the nervous system when initiated close in time to nervous system injury, or the possibility that untreated sequelae (eg, depressive symptoms or fatigue) were limiting progress in therapy, which triggered

  5. H_2-receptor Antagonist Therapy : With Special Reference to Ranitidine(Current Medical Therapy for Upper Gastrointestinal Ulcer Disease)

    OpenAIRE

    渡辺, 裕; 村山, 久夫; Watanabe, Yutaka; Murayama, Hisao

    1988-01-01

    The cure rate for endoscopic therapy was determined in 61 patients with a gastroduodenal ulcer who received Ranitidine at a dose of 150 mg twice daily, in the morning and evening. The ulcer patients were classified into initial-, recurrent-and intractable-ulcer groups, and the cumulative cure rate was compared among the three types of ulcers. The cure rate was 93% for the initial ulcer, 78% for recurrent and 50% for intractable. Uncured ulcers accounted for about 10% of the patients, and the ...

  6. A quality control method for detecting energy changes of medical accelerators

    International Nuclear Information System (INIS)

    McGinley, P.H.

    2000-01-01

    A description is presented of a simple and sensitive method for detecting a change in the energy of the electrons bombarding the target of medical accelerators. This technique is useful for x-ray beams with end point energy in the range of 15.7 to 25 MeV. The method is based on the photoactivation of 16 O and 14 N in a small sample of ammonium nitrate. It was found that the ratio of the activity induced in the oxygen divided by that produced in the nitrogen can be used as a quality control technique to detect a change in the energy of the electrons that bombard the target of the accelerator. An electron energy change of the order of 0.2 MeV can be determined using this method. (author)

  7. Long-term causes of death in patients with infective endocarditis who undergo medical therapy only or surgical treatment

    DEFF Research Database (Denmark)

    Østergaard, Lauge; Oestergaard, Louise Bruun; Lauridsen, Trine Kiilerich

    2018-01-01

    OBJECTIVES: It is known that patients surviving infective endocarditis have a poor long-term prognosis; however, few studies have addressed the long-term causes of death in patients surviving the initial hospitalization. METHODS: Using Danish administrative registries, we identified patients...... admitted to a hospital with 1st time infective endocarditis in the period from January 1996 to December 2014, who were alive at the time of discharge. The study population was categorized into (i) patients undergoing medical therapy only and (ii) patients undergoing surgical and medical treatment. We...... examined the cardiovascular and non-cardiovascular causes of death. Using the Cox analysis, we investigated the associated risk of dying from a specific prespecified cause of death (heart failure, infective endocarditis and stroke) within the surgery group when compared with the medically treated group...

  8. Utilizing Cognitive-Behavioral Therapy for Insomnia to Facilitate Discontinuation of Sleep Medication in Chronic Insomnia Patients

    Directory of Open Access Journals (Sweden)

    Jason Ong

    2012-04-01

    Full Text Available Many chronic insomnia patients use sleep medication well beyond the recommended duration, and patients who are hypnotic-dependent encounter several challenges when attempting to discontinue. The current article presents these challenges and reviews studies that have added cognitive-behavioral therapy for insomnia (CBTI to a gradual tapering program to facilitate discontinuation of hypnotic medication in chronic insomnia patients. The current literature provides substantial support for using CBTI to facilitate discontinuation of hypnotic medication in chronic insomnia patients. Across several randomized clinical trials, the majority of the findings indicate that using CBTI, delivered by a therapist or self-help, along with a supervised or gradual tapering program is superior to tapering only or CBTI only in terms of medication discontinuation. Although these results are promising, it should be noted that the long-term evidence is more equivocal, as over 40% of patients relapse in the need for sleep medication within 2 years, which may highlight the importance of adding follow-up booster sessions in hypnotic-dependent insomniacs. These findings indicate that rather than choosing between CBT and hypnotic medication, clinicians might be better served using both treatment modalities to optimize the relative strengths of each treatment. Such an approach represents a more modern view of treating chronic insomnia patients by using both pharmacological and non-pharmacological tools.

  9. Chronic pelvic pain syndrome: reduction of medication use after pelvic floor physical therapy with an internal myofascial trigger point wand.

    Science.gov (United States)

    Anderson, Rodney U; Harvey, Richard H; Wise, David; Nevin Smith, J; Nathanson, Brian H; Sawyer, Tim

    2015-03-01

    This study documents the voluntary reduction in medication use in patients with refractory chronic pelvic pain syndrome utilizing a protocol of pelvic floor myofascial trigger point release with an FDA approved internal trigger point wand and paradoxical relaxation therapy. Self-referred patients were enrolled in a 6-day training clinic from October, 2008 to May, 2011 and followed the protocol for 6 months. Medication usage and symptom scores on a 1-10 scale (10 = most severe) were collected at baseline, and 1 and 6 months. All changes in medication use were at the patient's discretion. Changes in medication use were assessed by McNemar's test in both complete case and modified intention to treat (mITT) analyses. 374 out of 396 patients met inclusion criteria; 79.7 % were male, median age of 43 years and median symptom duration of 5 years. In the complete case analysis, the percent of patients using medications at baseline was 63.6 %. After 6 months of treatment the percentage was 40.1 %, a 36.9 % reduction (p < 0.001). In the mITT analysis, there was a 22.7 % overall reduction from baseline (p < 0.001). Medication cessation at 6 months was significantly associated with a reduction in total symptoms (p = 0.03).

  10. An energy-subtraction Compton scatter camera design for in vivo medical imaging of radiopharmaceuticals

    International Nuclear Information System (INIS)

    Rohe, R.C.; Valentine, J.D.

    1996-01-01

    A Compton scatter camera (CSC) design is proposed for imaging radioisotopes used as biotracers. A clinical version may increase sensitivity by a factor of over 100, while maintaining or improving spatial resolution, as compared with existing Anger cameras that use lead collimators. This novel approach is based on using energy subtraction (ΔE = E 0 - E SC , where E 0 , ΔE, and E SC are the energy of the emitted gamma ray, the energy deposited by the initial Compton scatter, and the energy of the Compton scattered photon) to determine the amount of energy deposited in the primary system. The energy subtraction approach allows the requirement of high energy resolution to be placed on a secondary detector system instead of the primary detector system. Requiring primary system high energy resolution has significantly limited previous CSC designs for medical imaging applications. Furthermore, this approach is dependent on optimizing the camera design for data acquisition of gamma rays that undergo only one Compton scatter in a low-Z primary detector system followed by a total absorption of the Compton scattered photon in a high-Z secondary detector system. The proposed approach allows for a more compact primary detector system, a more simplified pulse processing interface, and a much less complicated detector cooling scheme as compared with previous CSC designs. Analytical calculations and Monte Carlo simulation results for some specific detector materials and geometries are presented

  11. Dissemination of medical applications of nuclear energy with virtual reality technology

    International Nuclear Information System (INIS)

    Botelho, Felipe M.; Oliveira, Beatriz A.R.

    2007-01-01

    This work makes use of Virtual Reality technology to disseminate medical applications of nuclear energy, with educational purposes. Virtual Reality is an effective learning tool, since navigation and interaction in virtual worlds can improve motivation in the learning process. With this technology, learning can be achieved in a clearer, joyful and more objective way. Among the existing medical applications of nuclear energy, this work focuses on the use of radiopharmaceuticals. The goal is to simulate this application in a virtual environment, for educational purposes, and to show the absorption of a radiopharmaceutical by the human body, during a diagnostics or treatment procedure. An example has been chosen, for Iodine radiopharmaceutical, which has affinity with the thyroid, and then concentrates in this organ. During the simulation, the concentration of the radioactive Iodine in the thyroid can be emphasized, and in the sequence, the virtual patient can be shown during the imaging procedure. (author)

  12. The experiences of persons living with HIV who participate in mind-body and energy therapies: a systematic review protocol of qualitative evidence.

    Science.gov (United States)

    Bremner, Marie; Blake, Barbara; Stiles, Cheryl

    2015-10-01

    The purpose of this systematic review is to explore the experiences and perceptions of persons living with HIV who participate in mind-body and energy therapies. The review will focus on the use of mind-body medicine and energy therapies that include meditation, prayer, mental healing, Tai Chi, yoga, art therapy, music therapy, dance therapy, Qigong, reiki, therapeutic touch, healing touch and electromagnetic therapy. These mind-body and energy therapies are selected categories because they do not involve options that might be contraindicated to an individual's current treatment regime. More specifically, the review questions are: Complementary and alternative medicine (CAM) is a popular adjunct to conventional medicine across global populations. Complementary generally refers to a non-mainstream approach together with conventional medicine whereas alternative refers to a non-mainstream approach in place of conventional medicine. Most people use non-mainstream approaches along with conventional treatments. The World Health Organization [WHO] defines CAM as distinct health-care practices that have not been assimilated into a country's mainstream health care system.The USA's National Center for Complementary and Integrative Health (NCCIH), formerly National Center for Complementary and Alternative Medicine (NCCAM), organizes CAM into five medical system categories: whole medical systems, mind-body medicine, biologically based practices, manipulative and body-based practices, and energy therapies. Whole medical systems include homeopathy, naturopathy, traditional Chinese medicine and Ayurveda. Mind-body medicine includes meditation, prayer, mental healing, Tai Chi, yoga, art therapy, music therapy and dance therapy. Biologically based practices include dietary supplements, herbal supplements and a few scientifically unproven therapies. Manipulative and body-based practices include massage and spinal manipulation such as chiropractic and osteopathic. Energy therapies

  13. Technical assistance for Meharry Medical College Energy Efficiency Project. Final project status and technical report

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1996-05-08

    This report presents the results of a program to provide technical assistance to Meharry Medical College. The purpose of the program is to facilitate Meharry`s effort to finance a campus-wide facility retrofit. The US Department of Energy (USDOE) funded the program through a grant to the Tennessee Department of Economic and Community Development (TECD). The University of Memphis-Technology and Energy Services (UM-TES), under contract to TECD, performed program services. The report has three sections: (1) introduction; (2) project definition, financing, and participants; and (3) opportunities for federal participation.

  14. Medical Cyclotrons

    Science.gov (United States)

    Friesel, D. L.; Antaya, T. A.

    Particle accelerators were initially developed to address specific scientific research goals, yet they were used for practical applications, particularly medical applications, within a few years of their invention. The cyclotron's potential for producing beams for cancer therapy and medical radioisotope production was realized with the early Lawrence cyclotrons and has continued with their more technically advanced successors — synchrocyclotrons, sector-focused cyclotrons and superconducting cyclotrons. While a variety of other accelerator technologies were developed to achieve today's high energy particles, this article will chronicle the development of one type of accelerator — the cyclotron, and its medical applications. These medical and industrial applications eventually led to the commercial manufacture of both small and large cyclotrons and facilities specifically designed for applications other than scientific research.

  15. Cellular Energy Pathways as Novel Targets for the Therapy of Autosomal Dominant Polycystic Kidney Disease

    Science.gov (United States)

    2016-09-01

    pathways that are involved in cyst development and expansion. These experiments will make use of cultured ADPKD cells and a mouse model of ADPKD to...AWARD NUMBER: W81XWH-15-1-0420 TITLE: Cellular Energy Pathways as Novel Targets for the Therapy of Autosomal Dominant Polycystic Kidney Disease...PRINCIPAL INVESTIGATOR: Kenneth R. Hallows, MD, PhD, FASN CONTRACTING ORGANIZATION: University of Southern California Los Angeles, CA 90089-0701

  16. Measurement assurance studies of high-energy electron and photon dosimetry in radiation-therapy applications

    International Nuclear Information System (INIS)

    Ehrlich, M.; Soares, C.G.

    1981-01-01

    This is a brief review of surveys on the dosimetry of radiation-therapy beams by the National Bureau of Standards (NBS). Covered are the NBS ferrous-sulfate (Fricke) dosimetry service, a recently completed survey carried out with thermoluminescence dosimeters (TLD) on the dosimetry in cobalt-60 teletherapy beams, and plans for a TLD survey of dosimetry in high-energy bremsstrahlung beams. (author)

  17. [Adherence to a medical nutrition therapy program in pregnant women with diabetes, measured by three methods, and its association with glycemic control].

    Science.gov (United States)

    Balas-Nakash, Margie; Rodríguez-Cano, Ameyalli; Muñoz-Manrique, Cinthya; Vásquez-Peña, Paulina; Perichart-Perera, Otilia

    2010-01-01

    The measurement of adherence to nutrition therapy is essential to evaluate if the outcomes are related to given recommendations. The aim of this study was to describe adherence to a Medical Nutrition Therapy Program in Mexican pregnant women with diabetes, using three different methods; and evaluate its association with glycemic control. Adherence was measured with a questionnaire (0-100%), women's self-perception (0-100%) and energy intake adequacy by multiple pass 24 hour recall (85-115% of recommendation). Women were randomly assigned to two different dietary strategies. Glycemic control was determined by capillary glucose self-monitoring. Women analyzed in this study (n=69) had an age range of 22-42 years; 47.8% had type 2 diabetes (DM2) and 52.2% had gestational diabetes (GDM). Energy intake adequacy was higher in women with GDM (41.9% vs. 37.7%, p = 0.001). Average adherence measured with the questionnaire was 55%; no differences were found by type of diabetes. Self-perception was higher in women with DM2 (84%) when compared to women with GDM (70%) (p = 0.039). No differences were found in the three methods by study group. Optimal glycemic control was observed in 50% of women; no association was found with adherence measured with any of the three methods studied. The observed differences in adherences suggest that it may be recommendable to combine different measurement methods and include social and psychological factors that affect behavioral change.

  18. Role of secondary low energy electrons in radiobiology and chemoradiation therapy of cancer

    Science.gov (United States)

    Sanche, Léon

    2009-05-01

    With the chemotherapeutic agent cisplatin bound to DNA, damage to the molecule by electrons of low and high energies increases by factors varying from 1.3 to 4.4. The enhancement in bond dissociation is triggered by modifications of the interaction of low energy electrons with DNA. From our understanding of the latter, the present Letter attempts to explain the basic radiation-damage mechanism responsible for the efficiency of the concomitant chemoradiation treatment of cancer. Such a basic comprehension of the direct effects of radiation may have implications in the design of new chemotherapeutic and radiosensitizing drugs, as well as in the development of more efficient protocols in chemoradiation therapy.

  19. Radiological and Medical Sciences Research Institute, Ghana Atomic Energy Commission: Annual Report 2014

    International Nuclear Information System (INIS)

    2014-01-01

    The Radiological and Medical Sciences Research Institute was established in 2009, as the forth research institute of the Ghana Atomic Energy Commission. This Annual Report provides an overview of the major activities of the Institutes in the year 2014. Major items covered in the report include: Strategic objectives; Collaborations; Personnel and Organisational Structure; Facilities and Technical Services; Summary of Research and Development Projects; Human Resource Development; Publications and Technical Reports.

  20. Efforts made for health and medical care by International Atomic Energy Agency

    International Nuclear Information System (INIS)

    Watanabe, Naoyuki

    2016-01-01

    The author, being a former senior medical officer and currently a consultant of the Nuclear Medicine Section, the Division of Human Health, the Department of Nuclear Sciences and Applications, the International Atomic Energy Agency (IAEA) to standardize the isotope and radiation technologies for health and medical care and transfer them to the IAEA member states to address their health issues, participated in an international cooperation project to survey the current situation of the health and medical care in Viet Nam and exchange opinions with the World Health Organization Western Pacific Regional Office Viet Nam Office and the Viet Nam Health Department coordinated by the Japan Public Health Association from 10th to 15th January 2016 and perceived efforts made and action plans for the health and medical care in Viet Nam by the international organizations of the IAEA and the World Health Organization (WHO). IAEA has verified various isotopes and radiation technologies up to now in the international field of health and medical care and has being offered them to the member states under the sustainable frame work of technical co-operation. However, the activity in the health and medical care field of IAEA is hardly recognized by the public health professionals in Japan. In order to attain the objective to improve and maintain human health under the umbrella of the United Nations system, the peaceful use of nuclear technology has been promoted in the field of non-electric applications of nuclear energy including human health and medical care by the IAEA. There are several discrepancies seen with the field and tactics of health and medical care between the IAEA and the WHO. In terms of measures to fight NCDs which should be an urgent issue in most of the member states, a comprehensive approach is often needed beyond the capability of IAEA as isotopes and radiation technologies. The IAEA should strive to solve issues on human health and medical care maintaining much

  1. Medical Music Therapy: A Model Program for Clinical Practice, Education, Training and Research

    Science.gov (United States)

    Standley, Jayne

    2005-01-01

    This monograph evolved from the unique, innovative partnership between the Florida State University Music Therapy Program and Tallahassee Memorial HealthCare. Its purpose is to serve as a model for music therapy educators, students, clinicians, and the hospital administrators who might employ them. This book should prove a valuable resource for…

  2. The Use of Medical Expulsive Therapy During Pregnancy: A Worldwide Perspective Among Experts.

    Science.gov (United States)

    Lloyd, Granville L; Lim, Amy; Hamoui, Nabeel; Nakada, Stephen Y; Kielb, Stephanie J

    2016-03-01

    Medical expulsive therapy (MET) is a pharmacologic approach thought to augment the spontaneous passage of ureteral calculi. The usage of MET pharmacologics for presumed ureteral calculi during pregnancy has not been studied and their safety and utility are unknown. We sought to characterize the worldwide usage of MET in the setting of pregnancy with presumed ureteral calculus (P-MET), as well as factors associated with physician use. Experts in stone management were specifically sought. A nine-question survey was delivered through society-administered e-mail. Questions gathered physician's worldwide region, degree of specialization in stone disease, practice type, interval since training, and willingness to use both MET and P-MET. We assessed drugs of choice in those using P-MET and reasons for avoidance in non-P-MET users. Finally, we assessed the impact of physician-perceived medicolegal risk on usage of P-MET. Five hundred sixty-five responses were recorded. Sixty-three percent were US-based practitioners and the remaining represented a worldwide distribution. Worldwide usage of MET was 97.6%, and tamsulosin was globally preferred by over 90% of urologists. P-MET was endorsed by only 44.3%. 23.6% of European practitioners used this strategy compared with 51.1% of US physicians. Time from training and practice type did not significantly interact with adoption of P-MET; experts were less likely to use P-MET. Physician nonuse of MET during pregnancy was adverse outcome related: 76.7% reported either the fear of legal risk (52.8%) or concerns about safety (23.9%). Respondents report impressive worldwide adoption of MET. P-MET is less trusted, and fears of legal risk and safety far outweigh questions about effectiveness. The effectiveness of drugs during pregnancy-induced ureteral dilation is unknown. Still, 44% of global respondents embrace usage of this drug strategy despite a paucity of evidence supporting either safety or effectiveness during pregnancy.

  3. Use of medical expulsive therapy in children: An assessment of nationwide practice patterns and outcomes

    Science.gov (United States)

    Ellison, Jonathan S.; Merguerian, Paul A.; Fu, Benjamin C.; Holt, Sarah K.; Lendvay, Thomas S.; Gore, John L.; Shnorhavorian, Margarett

    2018-01-01

    Summary Introduction Early data support the use of medical expulsive therapy (MET) in children. However, little is known regarding use or outcomes associated with MET outside of pediatric-specific practices. Using a national administrative dataset, we sought to characterize utilization patterns of MET as well as assess outcomes associated with MET exposure. Study design We interrogated the MarketScan Commercial Claims and Encounters database to identify children under the age of 18 presenting to the emergency department (ED) with any diagnosis of upper urinary tract calculi (UUTC, including renal and ureteral calculi). MET exposure was defined as having a prescription filled for a MET agent within 1 week of the ED encounter. Characteristics of children receiving MET were defined and outcomes compared between children with and without MET exposure. Results Of 1325 children included in the study, 13.2% received MET, including 15.4% of children with a diagnosis of “calculus of the ureter.” MET use increased significantly throughout the study period (p = 0.004), although only 30.4% of children considered potential MET candidates received MET in the final year of the study (2013). Among all patients, receipt of MET was associated with male gender, presence of comorbidity, provider-type (urologist), and year of diagnosis, although among those with a specific diagnosis of “calculus of the ureter,” only year of diagnosis remained a significant factor. Rates of unplanned physician visits and surgical interventions were similar between groups. Children receiving MET were more likely to receive follow-up imaging, although only 46% of children with ureteral calculi had appropriate follow-up imaging within 90 days, regardless of MET exposure. Odds ratios of factors and outcomes associated with MET exposure are shown in the Table. Discussion Although early data support safety and efficacy MET in children, nationwide use in children is low among potential candidates for

  4. Design of an achromatic and uncoupled medical gantry for radiation therapy

    International Nuclear Information System (INIS)

    Tsoupas, N.; Kayran, D.; Litvinenko, V.; MacKay, W.W.

    2011-01-01

    We are presenting the layout and the optics of a beam line to be used as a medical gantry in radiation therapy. The optical properties of the gantry's beam line are such as to make the beam line achromatic and uncoupled. These two properties make the beam spot size, which is delivered and focused by the gantry, on the tumor of the patient, independent of the angular orientation of the gantry. In this paper we present the layout of the magnetic elements of the gantry, and also present the theoretical basis for the optics design of such a gantry. A medical gantry, as it is used in the radiation treatment of cancer patients, is the last part of the beam optical system, of the accelerator complex, which delivers and focuses the beam on the tumor. The curved line shown in figure 1 is a schematic diagram of a gantry which can rotate about a horizontal axis. The particle beam (green arrow in fig. 1) enters the gantry, and is guided by the gantry on the tumor (red spot in fig. 1). As the gantry rotates about the axis shown in figure 1, the beam exiting the gantry always lies on a plane normal to the rotation axis at the point of the icocenter. Thus the gantry facilitates the ability of the beam delivery system, to deliver the beam at the tumor, which is placed at the icocenter, from any angle on this vertical plane, which is normal to the rotation angle of the gantry as stated earlier. The gantry consists of dipoles and quadrupoles elements whose median symmetry plane lies on a plane which contains the rotation axis of the gantry. In this paper we define this plane as the 'plane of the gantry'. As the beam is transported along the axis of rotation of the gantry and before it enters the gantry, it is focused by 'normal' quadrupoles and experiences no linear beam coupling. Subsequently the beam enters the gantry, and is transported by the gantry to the delivery point which is the tumor. The transported beam at the tumor is still linearly uncoupled as long as the plane of the

  5. Patent foramen ovale closure versus medical therapy after cryptogenic stroke: An updated meta-analysis of all randomized clinical trials.

    Science.gov (United States)

    Kheiri, Babikir; Abdalla, Ahmed; Osman, Mohammed; Ahmed, Sahar; Hassan, Mustafa; Bachuwa, Ghassan

    2018-03-07

    Cryptogenic strokes can be attributed to paradoxical emboli through patent foramen ovale (PFO). However, the effectiveness of PFO closure in preventing recurrent stroke is uncertain and the results of previous randomized clinical trials (RCTs) have been inconclusive. Hence, this study provides an updated meta-analysis of all RCTs comparing PFO closure with medical therapy for secondary prevention of cryptogenic stroke. All RCTs were identified by a comprehensive literature search of PubMed, Embase, the Cochrane Collaboration Central Register of Controlled Trials, Scopus, and Clinicaltrials.gov. The primary outcome was recurrent ischemic stroke and secondary outcomes were transient ischemic attack (TIA), all-cause mortality, new-onset atrial fibrillation (AF), serious adverse events, and major bleeding. 5 RCTs with 3440 participants were included in the present study (1829 patients underwent PFO closure and 1611 were treated medically). Pooled analysis showed a statistically significant reduction in the rate of recurrent stroke with PFO closure in comparison to medical therapy (OR 0.41; 95% CI 0.19-0.90; p = 0.03). However, there were no statistically significant reductions of recurrent TIAs (OR 0.77; 95% CI 0.51-1.14; p = 0.19) or all-cause mortality (OR 0.76; 95% CI 0.35-1.65; p = 0.48). The risk of developing new-onset AF was increased significantly with PFO closure (OR 4.74; 95% CI 2.33-9.61; p Patent foramen ovale closure in adults with recent cryptogenic stroke was associated with a lower rate of recurrent strokes in comparison with medical therapy alone.

  6. THE MUTIFACTORIAL PATTERN OF OSTEOPOROSIS: A REVIEW OF THE RESEARCHES OF THE DEPARTMENT OF THERAPY, INSTITUTE OF POSTGRADUATE EDUCATION, YAROSLAVL STATE MEDICAL UNIVERSITY

    Directory of Open Access Journals (Sweden)

    O. B. Ershova

    2016-01-01

    Full Text Available Osteoporosis (OP is one of the most common diseases and is characterized by serious clinical manifestations such as low-energy bone fractures that cause severe social consequences. In this connection, OP is now receiving much attention worldwide. In Yaroslavl, the Department of Therapy (Head, Professor N.I. Korshunov, MD, Institute of Postgraduate Education, Yaroslavl State Medical University (Chancellor, Prof. A.V. Pavlov, MD, has been intensively conducting researches into different aspects of OP for more than 20 years. The main areas of the investigations performed are the issues of the epidemiology and outcomes of osteoporotic fractures, the relationship of OP to different diseases (rheumatoid arthritis, cardiovascular diseases, as well as the specific features of the development of OP in fertile men and women and the problem of calcium and vitamin D deficiency in pregnant women. 

  7. Off-label use of medical products in radiation therapy: Summary of the Report of AAPM Task Group No. 121

    International Nuclear Information System (INIS)

    Thomadsen, Bruce R.; Thompson, Heaton H. II; Jani, Shirish K.

    2010-01-01

    approval process, along with manufacturers' responsibilities, labeling, marketing and promotion, and off-label use. This is an educational and descriptive report and does not contain prescriptive recommendations. This report addresses the role of the medical physicist in clinical situations involving off-label use. Case studies in radiation therapy are presented. Any mention of commercial products is for identification only; it does not imply recommendations or endorsements of any of the authors or the AAPM. The full report, containing extensive background on off-label use with several appendices, is available on the AAPM website (http://www.aapm.org/pubs/reports/).

  8. Off-label use of medical products in radiation therapy: Summary of the Report of AAPM Task Group No. 121

    Energy Technology Data Exchange (ETDEWEB)

    Thomadsen, Bruce R.; Thompson, Heaton H. II; Jani, Shirish K. [Department of Medical Physics, University of Wisconsin, Madison, Wisconsin 53705 (United States); Hagerstown, Maryland 21740 (United States); and others

    2010-05-15

    discussion of the approval process, along with manufacturers' responsibilities, labeling, marketing and promotion, and off-label use. This is an educational and descriptive report and does not contain prescriptive recommendations. This report addresses the role of the medical physicist in clinical situations involving off-label use. Case studies in radiation therapy are presented. Any mention of commercial products is for identification only; it does not imply recommendations or endorsements of any of the authors or the AAPM. The full report, containing extensive background on off-label use with several appendices, is available on the AAPM website (http://www.aapm.org/pubs/reports/).

  9. A urinary test procedure for identification of cannabidiol in patients undergoing medical therapy with marijuana

    OpenAIRE

    Wertlake, Paul T; Henson, Michael D

    2016-01-01

    Paul T Wertlake, Michael D Henson Pacific Toxicology Laboratories, Chatsworth, CA, USA Abstract: Marijuana is classified by the Drug Enforcement Agency (DEA) as Schedule I, drugs having no accepted medical value. Twenty-three states and the District of Columbia have legalized medical marijuana. This conflict inhibits physicians from prescribing marijuana and the systematic study of marijuana in medical care. This study concerns the use of the clinical laboratory as a resource for physicians ...

  10. Therapy with {sup 90}Y microspheres: radiation protection in new medical therapies; Terapia con microesferas de {sup 90}Y: proteccion radiologica en nuevas terapias medicas

    Energy Technology Data Exchange (ETDEWEB)

    Rojo, Ana; Puerta, Nancy, E-mail: arojo@arn.gob.ar [Autoridad Regulatoria Nuclear (ARN), Buenos Aires (Argentina)

    2013-07-01

    Primary liver cancer is one of the most frequent in the world and with a low cure rate. Radioembolization using 90y spheres is a promising treatment of this pathology and involves the percutaneous vascular application of radioisotope-labeled the order of Micron size particles. The advantages of this technique include the permit administered high doses of radiation to small volumes with low relative toxicity, offer the possibility of treating all the liver including microscopic tumors, and finally, the feasibility of combined with other therapies. Radiation protection in new medical therapies requires justification and optimization, as requirements for their implementation. The application of the principle of optimization in the context of the protection of the patient must be the minimum that it can be reasonably reached compatible with the required doses of treatment dose to healthy tissue. With {sup 90}Y microspheres therapy this optimization applies to the activity of 90y which is administered to the patient, and estimation methods are postulated. in this work are analyzed comparatively these methods, described the early physicists, equations and the limitations of each. Finally, it is concluded that the optimal method to be implemented for the evaluation of the activity of {sup 90}Y manage must be based in a voxel dosimetric model specific for each patient, however, the partitional method may be a good alternative if you don't have the tools to apply the method.

  11. Molecular mechanisms of the angiogenic effects of low-energy shock wave therapy: roles of mechanotransduction.

    Science.gov (United States)

    Hatanaka, Kazuaki; Ito, Kenta; Shindo, Tomohiko; Kagaya, Yuta; Ogata, Tsuyoshi; Eguchi, Kumiko; Kurosawa, Ryo; Shimokawa, Hiroaki

    2016-09-01

    We have previously demonstrated that low-energy extracorporeal cardiac shock wave (SW) therapy improves myocardial ischemia through enhanced myocardial angiogenesis in a porcine model of chronic myocardial ischemia and in patients with refractory angina pectoris. However, the detailed molecular mechanisms for the SW-induced angiogenesis remain unclear. In this study, we thus examined the effects of SW irradiation on intracellular signaling pathways in vitro. Cultured human umbilical vein endothelial cells (HUVECs) were treated with 800 shots of low-energy SW (1 Hz at an energy level of 0.03 mJ/mm(2)). The SW therapy significantly upregulated mRNA expression and protein levels of vascular endothelial growth factor (VEGF) and endothelial nitric oxide synthase (eNOS). The SW therapy also enhanced phosphorylation of extracellular signal-regulated kinase 1/2 (Erk1/2) and Akt. Furthermore, the SW therapy enhanced phosphorylation of caveolin-1 and the expression of HUTS-4 that represents β1-integrin activity. These results suggest that caveolin-1 and β1-integrin are involved in the SW-induced activation of angiogenic signaling pathways. To further examine the signaling pathways involved in the SW-induced angiogenesis, HUVECs were transfected with siRNA of either β1-integrin or caveolin-1. Knockdown of either caveolin-1 or β1-integrin suppressed the SW-induced phosphorylation of Erk1/2 and Akt and upregulation of VEGF and eNOS. Knockdown of either caveolin-1 or β1-integrin also suppressed SW-induced enhancement of HUVEC migration in scratch assay. These results suggest that activation of mechanosensors on cell membranes, such as caveolin-1 and β1-integrin, and subsequent phosphorylation of Erk and Akt may play pivotal roles in the SW-induced angiogenesis. Copyright © 2016 the American Physiological Society.

  12. Tamsulosin versus tamsulosin plus tadalafil as medical expulsive therapy for lower ureteric stones: a randomized controlled trial.

    Science.gov (United States)

    Jayant, Kumar; Agrawal, Rajendra; Agrawal, Swati

    2014-10-01

    To compare the efficacy of tamsulosin versus tamsulosin plus tadalafil as medical expulsive therapy for lower ureteric stones. Between January 2013 and December 2013, 244 patients presenting with distal ureteric stones (size 5-10 mm) were randomized equally to tamsulosin (group A) or tamsulosin plus tadalafil (group B). Therapy was given for a maximum of 4 weeks. Stone expulsion rate, time to stone expulsion, analgesic use, number of hospital visits for pain, follow up, endoscopic treatment and adverse effects of drugs were recorded. Statistical analyses were carried out using Student's t-test and the χ(2) -test. There was a statistically significant higher expulsion rate in group B compared with group A (83.6% vs 65.5%; P-value = 0.031) and a shorter time to expulsion (14.9 ± 4.4 days vs 16.7 ± 4.8 days; P-value = 0.003). Statistically significant differences were noted in terms of the number of hospital visits and analgesic requirement in favor of group B. There was no serious adverse event. An improvement in erectile function was noted in patients of group B compared with those of group A. Medical expulsive therapy for distal ureteric stones using tamsulosin plus tadalafil is safe, effective and well tolerated. Furthermore, tadalafil provides the additional advantage of improving erectile dysfunction when this condition coexists with a lower ureteric stone. © 2014 The Japanese Urological Association.

  13. Medications (for IBS)

    Medline Plus

    Full Text Available ... Agents Antidepressant Medications Newer IBS Medications Probiotics and Antibiotics Pharmacologic, or drug, therapy is best used in ... Agents Antidepressant Medications Newer IBS Medications Probiotics and ... Treatments Understanding Stress Cognitive Behavioral Therapy Relaxation ...

  14. Medications (for IBS)

    Medline Plus

    Full Text Available ... Agents Antidepressant Medications Newer IBS Medications Probiotics and Antibiotics Pharmacologic, or drug, therapy is best used in ... Agents Antidepressant Medications Newer IBS Medications Probiotics and Antibiotics Psychological Treatments Understanding Stress Cognitive Behavioral Therapy Relaxation ...

  15. EFFECT OF LOW ENERGY VERSUS MEDIUM ENERGY RADIAL SHOCK WAVE THERAPY IN THE TREATMENT OF CHRONIC PLANTER FASCIITIS

    Directory of Open Access Journals (Sweden)

    Khaled Z. Fouda

    2016-02-01

    Full Text Available Background: Plantar fasciitis (PF is the most common cause of heel pain and it can often be a challenge for clinicians to treat successfully. Radial shock wave therapy (RSWT has been introduced recently for treatment of musculoskeletal disorders. Different energy levels of shock wave therapy have been used in the literatures for treatment of PF with no clear settled parameters. Therefore, the purpose of this study was intended to investigate and compare the efficacy of two different energy levels of RSWT on PF patients. Methods: Forty patients having unilateral chronic PF were recruited for the study from orthopedic outpatient clinics of Cairo University hospitals and National Institute of Neuromotor System Cairo Egypt, with a mean age of (47.15±4.57 years. Patients were randomly assigned into two equal groups. Group (A treated with low intensity level of 1.6 bars (0.16 mJ/mm2 RSWT and group (B treated with medium intensity level of 4 bars (0.38 mJ/mm2 RSWT. Functional assessment of the foot based on Foot Function Index (FFI and Present pain intensity was measured during rest by Visual Analogue Scale (VAS. Results: There was as significant decreased in the total FFI scores from (118.42 ±6.51 to (81.37 ±3.46 for group (A and from (118.93 ±6.85 to (58.50 ±3.22 for group (B. Also regarding VAS Scores there was as significant decreased in the pain intensity from (5.11 ±0.41 to (2.85 ±0.31 for group (A and from (4.95 ±0.39 to (2.05 ±0.22 for group (B. Conclusion: Radial shock wave therapy is an effective modality that should be considered in the treatment of chronic PF, while the medium energy level RSWT is better than the low energy level RSWT in regarding to the measured treatment outcomes.

  16. Low medical morbidity and mortality after acute courses of electroconvulsive therapy in a population-based sample.

    Science.gov (United States)

    Blumberger, D M; Seitz, D P; Herrmann, N; Kirkham, J G; Ng, R; Reimer, C; Kurdyak, P; Gruneir, A; Rapoport, M J; Daskalakis, Z J; Mulsant, B H; Vigod, S N

    2017-12-01

    To determine event rates for specific medical events and mortality among individuals receiving electroconvulsive therapy (ECT). Population-based cohort study using health administrative data of acute ECT treatments delivered in Ontario, Canada, from 2003 to 2011. We measured the following medical event rates, per 10 000 ECT treatments, up to 7 and 30 days post-treatment: stroke, seizure, acute myocardial infarction, arrhythmia, pneumonia, pulmonary embolus, deep vein thrombosis, gastrointestinal bleeding, falls, hip fracture, and mortality. A total of 135 831 ECT treatments were delivered to 8810 unique patients. Overall medical event rates were 9.1 and 16.8 per 10 000 ECT treatments respectively. The most common medical events were falls (2.7 and 5.5 per 10 000 ECT treatments) and pneumonia (1.8 and 3.8 per 10 000 ECT treatments). Fewer than six deaths occurred on the day of an ECT treatment. This corresponded to a mortality rate of less than 0.4 per 10 000 treatments. Deaths within 7 and 30 days of an ECT treatment, excluding deaths due to external causes (e.g., accidental and intentional causes of death), were 1.0 and 2.4 per 10 000 ECT treatments respectively. Morbidity and mortality events after ECT treatments were relatively low, supporting ECT as a low-risk medical procedure. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  17. Therapy by electromagnetic wave of millimeter energy range (EFH-therapy, MRT, IWT). Scientific and practical materials on the use of physical factors in clinical and health resort practice

    International Nuclear Information System (INIS)

    Samosyuk, I.Z.; Chukhraev, N.V.; Shimkov, G.E.; Bitson, A.V.

    1999-01-01

    EHF-therapy method is a principally new method of treatment which is based on the peculiarities in perception by human organism the magnetic radiation of millimeter energy range. Practical use of this method has shown its high therapeutic efficiency at influencing on acupuncture points. This monography is completely devoted to description of EHF-therapy effects on acupuncture points with account of the Chinese reflexotherapy. Apparats of 'MIT' and 'Eleknronika-EHF' series do not provoke any damages in biological structures and refer to the safe class. The proposed scientific and practical materials on the use of physical factors in clinical and health resort practice are edited in addition to the previous monograph under the same title. These materials are of use for physicians of different specializations and listeners of medical advanced courses

  18. Chromatic energy filter and characterization of laser-accelerated proton beams for particle therapy

    Science.gov (United States)

    Hofmann, Ingo; Meyer-ter-Vehn, Jürgen; Yan, Xueqing; Al-Omari, Husam

    2012-07-01

    The application of laser accelerated protons or ions for particle therapy has to cope with relatively large energy and angular spreads as well as possibly significant random fluctuations. We suggest a method for combined focusing and energy selection, which is an effective alternative to the commonly considered dispersive energy selection by magnetic dipoles. Our method is based on the chromatic effect of a magnetic solenoid (or any other energy dependent focusing device) in combination with an aperture to select a certain energy width defined by the aperture radius. It is applied to an initial 6D phase space distribution of protons following the simulation output from a Radiation Pressure Acceleration model. Analytical formula for the selection aperture and chromatic emittance are confirmed by simulation results using the TRACEWIN code. The energy selection is supported by properly placed scattering targets to remove the imprint of the chromatic effect on the beam and to enable well-controlled and shot-to-shot reproducible energy and transverse density profiles.

  19. Chromatic energy filter and characterization of laser-accelerated proton beams for particle therapy

    Energy Technology Data Exchange (ETDEWEB)

    Hofmann, Ingo, E-mail: i.hofmann@gsi.de [Helmholtz-Institut Jena, Helmholtzweg 4, 07743 Jena (Germany); Gesellschaft fuer Schwerionenforschung (GSI), Planckstr. 1, 64291 Darmstadt (Germany); Meyer-ter-Vehn, Juergen [Max-Planck-Institut fuer Quantenoptik, Hans-Kopfermann-Str. 1, 85748 Garching (Germany); Yan, Xueqing [State Key Laboratory of Nuclear Physics and Technology, CAPT, Peking University, Beijing 100871 (China); Key Lab of High Energy Density Physics Simulation, CAPT, Peking University, Beijing 100871 (China); Max-Planck-Institut fuer Quantenoptik, Hans-Kopfermann-Str. 1, 85748 Garching (Germany); Al-Omari, Husam [Institute for Applied Physics, Goethe University Frankfurt, Max-von-Laue str. 1, 60438 Frankfurt (Germany); Gesellschaft fuer Schwerionenforschung (GSI), Planckstr. 1, 64291 Darmstadt (Germany)

    2012-07-21

    The application of laser accelerated protons or ions for particle therapy has to cope with relatively large energy and angular spreads as well as possibly significant random fluctuations. We suggest a method for combined focusing and energy selection, which is an effective alternative to the commonly considered dispersive energy selection by magnetic dipoles. Our method is based on the chromatic effect of a magnetic solenoid (or any other energy dependent focusing device) in combination with an aperture to select a certain energy width defined by the aperture radius. It is applied to an initial 6D phase space distribution of protons following the simulation output from a Radiation Pressure Acceleration model. Analytical formula for the selection aperture and chromatic emittance are confirmed by simulation results using the TRACEWIN code. The energy selection is supported by properly placed scattering targets to remove the imprint of the chromatic effect on the beam and to enable well-controlled and shot-to-shot reproducible energy and transverse density profiles.

  20. Baseline characteristics predict risk of progression and response to combined medical therapy for benign prostatic hyperplasia (BPH).

    Science.gov (United States)

    Kozminski, Michael A; Wei, John T; Nelson, Jason; Kent, David M

    2015-02-01

    To better risk stratify patients, using baseline characteristics, to help optimise decision-making for men with moderate-to-severe lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) through a secondary analysis of the Medical Therapy of Prostatic Symptoms (MTOPS) trial. After review of the literature, we identified potential baseline risk factors for BPH progression. Using bivariate tests in a secondary analysis of MTOPS data, we determined which variables retained prognostic significance. We then used these factors in Cox proportional hazard modelling to: i) more comprehensively risk stratify the study population based on pre-treatment parameters and ii) to determine which risk strata stood to benefit most from medical intervention. In all, 3047 men were followed in MTOPS for a mean of 4.5 years. We found varying risks of progression across quartiles. Baseline BPH Impact Index score, post-void residual urine volume, serum prostate-specific antigen (PSA) level, age, American Urological Association Symptom Index score, and maximum urinary flow rate were found to significantly correlate with overall BPH progression in multivariable analysis. Using baseline factors permits estimation of individual patient risk for clinical progression and the benefits of medical therapy. A novel clinical decision tool based on these analyses will allow clinicians to weigh patient-specific benefits against possible risks of adverse effects for a given patient. © 2014 The Authors. BJU International © 2014 BJU International.

  1. A parameter study to determine the optimal source neutron energy in boron neutron capture therapy of brain tumours

    Energy Technology Data Exchange (ETDEWEB)

    Nievaart, V A [Reactor Physics Department, Delft University of Technology, Mekelweg 15, 2629JB Delft (Netherlands); Moss, R L [Joint Research Centre of the European Commission, Postbus 2, 1755ZG Petten (Netherlands); Kloosterman, J L [Reactor Physics Department, Delft University of Technology, Mekelweg 15, 2629JB Delft (Netherlands); Hagen, T H J J van der [Reactor Physics Department, Delft University of Technology, Mekelweg 15, 2629JB Delft (Netherlands); Dam, H van [Reactor Physics Department, Delft University of Technology, Mekelweg 15, 2629JB Delft (Netherlands)

    2004-09-21

    The values of the parameters used in boron neutron capture therapy (BNCT) to calculate a given dose to human tissue vary with patients due to different physical, biological and/or medical circumstances. Parameters include the tissue dimensions, the {sup 10}B concentration and the relative biological effectiveness (RBE) factors for the different dose components associated with BNCT. Because there is still no worldwide agreement on RBE values, more often than not, average values for these parameters are used. It turns out that the RBE-problem can be circumvented by taking into account all imaginable parameter values. Approaching this quest from another angle: the outcome will also provide the parameters (and values) which influence the optimal source neutron energy. For brain tumours it turns out that the {sup 10}B concentration, the RBE factors for {sup 10}B as well as fast neutrons, together with the dose limit set for healthy tissue, affect the optimal BNCT source neutron energy. By using source neutrons of a few keV together with neutrons of a few eV, it ensures that, under all imaginable circumstances, a maximum of alpha (and lithium) particles can be delivered in the tumour.

  2. Complementary and alternative medical therapies for chronic low back pain: What treatments are patients willing to try?

    Directory of Open Access Journals (Sweden)

    Erro Janet

    2004-07-01

    Full Text Available Abstract Background Although back pain is the most common reason patients use complementary and alternative medical (CAM therapies, little is known about the willingness of primary care back pain patients to try these therapies. As part of an effort to refine recruitment strategies for clinical trials, we sought to determine if back pain patients are willing to try acupuncture, chiropractic, massage, meditation, and t'ai chi and to learn about their knowledge of, experience with, and perceptions about each of these therapies. Methods We identified English-speaking patients with diagnoses consistent with chronic low back pain using automated visit data from one health care organization in Boston and another in Seattle. We were able to confirm the eligibility status (i.e., current low back pain that had lasted at least 3 months of 70% of the patients with such diagnoses and all eligible respondents were interviewed. Results Except for chiropractic, knowledge about these therapies was low. Chiropractic and massage had been used by the largest fractions of respondents (54% and 38%, respectively, mostly for back pain (45% and 24%, respectively. Among prior users of specific CAM therapies for back pain, massage was rated most helpful. Users of chiropractic reported treatment-related "significant discomfort, pain or harm" more often (23% than users of other therapies (5–16%. Respondents expected massage would be most helpful (median of 7 on a 0 to 10 scale and meditation least helpful (median of 3 in relieving their current pain. Most respondents indicated they would be "very likely" to try acupuncture, massage, or chiropractic for their back pain if they did not have to pay out of pocket and their physician thought it was a reasonable treatment option. Conclusions Most patients with chronic back pain in our sample were interested in trying therapeutic options that lie outside the conventional medical spectrum. This highlights the need for additional

  3. Cooperation project: medical physics in cancer diagnosis and therapy in Bangladesh

    International Nuclear Information System (INIS)

    Quast, Ulrich; Zakaria, Golam Abu; Hoever, Karl-Heinz; Ahmad, Gias uddin; Akhter, Shaheen

    1999-01-01

    Bangladesh requires 200 radiotherapy facilities, 4 are in use; 400 medical physicists are needed, 3 are employed. On a private basis, a DGMP working group started in 1996, annual workshops on medical physics in cancer diagnosis and treatment, joined by many working physicists interested to become medical physicists. Basic topics were the principles, applications, acceptance, dosimetry and planning of 60 Co radiotherapy. In 1998, the Bangladesh association of physicists in medicine (BMPA) was founded, a young scientific society requiring international co-operation. The long experience in Medical Physics in India, its neighbouring country, could be very helpful in providing excellent medical physics courses. To absorb new technology and science, it is necessary to change the education policy; creativity and innovativeness must be valued more than the old knowledge, being replaced quickly by new knowledge and new technologies. (author)

  4. Medical approaches to suffering are limited, so why critique Improving Access to Psychological Therapies from the same ideology.

    Science.gov (United States)

    Binnie, James

    2018-04-01

    Although the article by Scott rightly questions the dynamics of the Improving Access to Psychological Therapies system and re-examines the recovery rates, finding quite shocking results, his recommendations are ultimately flawed. There is a strong critique of the diagnostic procedures in Improving Access to Psychological Therapies services, but the answer is not to diagnose more rigorously and to adhere more strictly to a manualised approach to psychotherapy. The opposite may be required. Alternatives to the medical model of distress offer a less stigmatising and more human approach to helping people with their problems. Perhaps psychological therapists and the people they work alongside would be better served by a psychological approach rather than a psychiatric one.

  5. X-ray evidence of low-energy photon therapy for cervical lordosis restoration and radial head spur healing

    Science.gov (United States)

    Fitz-Ritson, Donald; Filonenko, Natalia; Salansky, Norman M.

    1994-09-01

    X rays were used for low energy photon therapy (LEPT) efficacy assessment for cervical lordosis restoration and radial head spur healing. Two cases, their evaluation, and treatment are discussed along with the follow-up results.

  6. Student personality and learning styles: A comparison between radiation therapy and medical imaging undergraduate students in New Zealand

    International Nuclear Information System (INIS)

    Dungey, G.; Yielder, J.

    2017-01-01

    This study investigated the learning styles and personality type of undergraduate radiation therapy students at the University of Otago, Wellington (UOW) in New Zealand (NZ) to ascertain whether there is a pattern evidenced for this group and how that might compare with NZ medical imaging students. All students enrolled in the first year of the Bachelor of Radiation Therapy degree from 2014 to 2016 at the UOW were invited to participate in this research. The test tool was the Paragon Learning Style Inventory (PLSI), which is a standardised questionnaire adapted from the Myers-Briggs Type Indicator (MBTI). All students who participated in the workshops consented for their data to be used for this project. The current study is longitudinal, and will continue for five years in total. The initial findings indicate that the cohorts of RT students exhibit personality and learning style preferences similar in Introversion/Extraversion and Thinking/Feeling to the proportion expected in the normal population. However, the Sensing/Intuition and Judging/Perceiving dichotomies show some similarities to the medical imaging students studied, who fell considerably outside that expected in the normal population. Overall, the dominant preference combinations identified, although different in degree, were similar to those of medical imaging students. The continuation of the radiation therapy study is important to ascertain more fully whether the results are particular to these cohorts of students or are trending towards showing a pattern of personality and learning style within the profession. - Highlights: • RT students are likely to have personality types that enable them to be caring, dependable, and good team-players. • When under stress, RT students may catastrophise, blame others, and exhibit a decrease in efficiency. • Low job satisfaction and burnout is possible without a balanced team that includes the vision from intuitive leaders. • Educators need to encourage

  7. Student personality and learning styles: A comparison between radiation therapy and medical imaging undergraduate students in New Zealand.

    Science.gov (United States)

    Dungey, G; Yielder, J

    2017-05-01

    This study investigated the learning styles and personality type of undergraduate radiation therapy students at the University of Otago, Wellington (UOW) in New Zealand (NZ) to ascertain whether there is a pattern evidenced for this group and how that might compare with NZ medical imaging students. All students enrolled in the first year of the Bachelor of Radiation Therapy degree from 2014 to 2016 at the UOW were invited to participate in this research. The test tool was the Paragon Learning Style Inventory (PLSI), which is a standardised questionnaire adapted from the Myers-Briggs Type Indicator (MBTI). All students who participated in the workshops consented for their data to be used for this project. The current study is longitudinal, and will continue for five years in total. The initial findings indicate that the cohorts of RT students exhibit personality and learning style preferences similar in Introversion/Extraversion and Thinking/Feeling to the proportion expected in the normal population. However, the Sensing/Intuition and Judging/Perceiving dichotomies show some similarities to the medical imaging students studied, who fell considerably outside that expected in the normal population. Overall, the dominant preference combinations identified, although different in degree, were similar to those of medical imaging students. The continuation of the radiation therapy study is important to ascertain more fully whether the results are particular to these cohorts of students or are trending towards showing a pattern of personality and learning style within the profession. Copyright © 2016 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.

  8. Log-Gabor Energy Based Multimodal Medical Image Fusion in NSCT Domain

    Directory of Open Access Journals (Sweden)

    Yong Yang

    2014-01-01

    Full Text Available Multimodal medical image fusion is a powerful tool in clinical applications such as noninvasive diagnosis, image-guided radiotherapy, and treatment planning. In this paper, a novel nonsubsampled Contourlet transform (NSCT based method for multimodal medical image fusion is presented, which is approximately shift invariant and can effectively suppress the pseudo-Gibbs phenomena. The source medical images are initially transformed by NSCT followed by fusing low- and high-frequency components. The phase congruency that can provide a contrast and brightness-invariant representation is applied to fuse low-frequency coefficients, whereas the Log-Gabor energy that can efficiently determine the frequency coefficients from the clear and detail parts is employed to fuse the high-frequency coefficients. The proposed fusion method has been compared with the discrete wavelet transform (DWT, the fast discrete curvelet transform (FDCT, and the dual tree complex wavelet transform (DTCWT based image fusion methods and other NSCT-based methods. Visually and quantitatively experimental results indicate that the proposed fusion method can obtain more effective and accurate fusion results of multimodal medical images than other algorithms. Further, the applicability of the proposed method has been testified by carrying out a clinical example on a woman affected with recurrent tumor images.

  9. Optimization of dual-energy CT acquisitions for proton therapy using projection-based decomposition.

    Science.gov (United States)

    Vilches-Freixas, Gloria; Létang, Jean Michel; Ducros, Nicolas; Rit, Simon

    2017-09-01

    Dual-energy computed tomography (DECT) has been presented as a valid alternative to single-energy CT to reduce the uncertainty of the conversion of patient CT numbers to proton stopping power ratio (SPR) of tissues relative to water. The aim of this work was to optimize DECT acquisition protocols from simulations of X-ray images for the treatment planning of proton therapy using a projection-based dual-energy decomposition algorithm. We have investigated the effect of various voltages and tin filtration combinations on the SPR map accuracy and precision, and the influence of the dose allocation between the low-energy (LE) and the high-energy (HE) acquisitions. For all spectra combinations, virtual CT projections of the Gammex phantom were simulated with a realistic energy-integrating detector response model. Two situations were simulated: an ideal case without noise (infinite dose) and a realistic situation with Poisson noise corresponding to a 20 mGy total central dose. To determine the optimal dose balance, the proportion of LE-dose with respect to the total dose was varied from 10% to 90% while keeping the central dose constant, for four dual-energy spectra. SPR images were derived using a two-step projection-based decomposition approach. The ranges of 70 MeV, 90 MeV, and 100 MeV proton beams onto the adult female (AF) reference computational phantom of the ICRP were analytically determined from the reconstructed SPR maps. The energy separation between the incident spectra had a strong impact on the SPR precision. Maximizing the incident energy gap reduced image noise. However, the energy gap was not a good metric to evaluate the accuracy of the SPR. In terms of SPR accuracy, a large variability of the optimal spectra was observed when studying each phantom material separately. The SPR accuracy was almost flat in the 30-70% LE-dose range, while the precision showed a minimum slightly shifted in favor of lower LE-dose. Photon noise in the SPR images (20 mGy dose

  10. A silicon strip detector array for energy verification and quality assurance in heavy ion therapy.

    Science.gov (United States)

    Debrot, Emily; Newall, Matthew; Guatelli, Susanna; Petasecca, Marco; Matsufuji, Naruhiro; Rosenfeld, Anatoly B

    2018-02-01

    The measurement of depth dose profiles for range and energy verification of heavy ion beams is an important aspect of quality assurance procedures for heavy ion therapy facilities. The steep dose gradients in the Bragg peak region of these profiles require the use of detectors with high spatial resolution. The aim of this work is to characterize a one dimensional monolithic silicon detector array called the "serial Dose Magnifying Glass" (sDMG) as an independent ion beam energy and range verification system used for quality assurance conducted for ion beams used in heavy ion therapy. The sDMG detector consists of two linear arrays of 128 silicon sensitive volumes each with an effective size of 2mm × 50μm × 100μm fabricated on a p-type substrate at a pitch of 200 μm along a single axis of detection. The detector was characterized for beam energy and range verification by measuring the response of the detector when irradiated with a 290 MeV/u 12 C ion broad beam incident along the single axis of the detector embedded in a PMMA phantom. The energy of the 12 C ion beam incident on the detector and the residual energy of an ion beam incident on the phantom was determined from the measured Bragg peak position in the sDMG. Ad hoc Monte Carlo simulations of the experimental setup were also performed to give further insight into the detector response. The relative response profiles along the single axis measured with the sDMG detector were found to have good agreement between experiment and simulation with the position of the Bragg peak determined to fall within 0.2 mm or 1.1% of the range in the detector for the two cases. The energy of the beam incident on the detector was found to vary less than 1% between experiment and simulation. The beam energy incident on the phantom was determined to be (280.9 ± 0.8) MeV/u from the experimental and (280.9 ± 0.2) MeV/u from the simulated profiles. These values coincide with the expected energy of 281 MeV/u. The sDMG detector

  11. Beam neutron energy optimization for boron neutron capture therapy using monte Carlo method

    International Nuclear Information System (INIS)

    Pazirandeh, A.; Shekarian, E.

    2006-01-01

    In last two decades the optimal neutron energy for the treatment of deep seated tumors in boron neutron capture therapy in view of neutron physics and chemical compounds of boron carrier has been under thorough study. Although neutron absorption cross section of boron is high (3836b), the treatment of deep seated tumors such as glioblastoma multiform requires beam of neutrons of higher energy that can penetrate deeply into the brain and thermalized in the proximity of the tumor. Dosage from recoil proton associated with fast neutrons however poses some constraints on maximum neutron energy that can be used in the treatment. For this reason neutrons in the epithermal energy range of 10eV-10keV are generally to be the most appropriate. The simulation carried out by Monte Carlo methods using MCBNCT and MCNP4C codes along with the cross section library in 290 groups extracted from ENDF/B6 main library. The ptimal neutron energy for deep seated tumors depends on the sue and depth of tumor. Our estimated optimized energy for the tumor of 5cm wide and 1-2cm thick stands at 5cm depth is in the range of 3-5keV

  12. Clinical trials of boron neutron capture therapy [in humans] [at Beth Israel Deaconess Medical Center][at Brookhaven National Laboratory

    International Nuclear Information System (INIS)

    Wallace, Christine

    2001-01-01

    Assessment of research records of Boron Neutron Capture Therapy was conducted at Brookhaven National Laboratory and Beth Israel Deaconess Medical Center using the Code of Federal Regulations, FDA Regulations and Good Clinical Practice Guidelines. Clinical data were collected FR-om subjects' research charts, and differences in conduct of studies at both centers were examined. Records maintained at Brookhaven National Laboratory were not in compliance with regulatory standards. Beth Israel's records followed federal regulations. Deficiencies discovered at both sites are discussed in the reports

  13. QALMA: A computational toolkit for the analysis of quality protocols for medical linear accelerators in radiation therapy

    Science.gov (United States)

    Rahman, Md Mushfiqur; Lei, Yu; Kalantzis, Georgios

    2018-01-01

    Quality Assurance (QA) for medical linear accelerator (linac) is one of the primary concerns in external beam radiation Therapy. Continued advancements in clinical accelerators and computer control technology make the QA procedures more complex and time consuming which often, adequate software accompanied with specific phantoms is required. To ameliorate that matter, we introduce QALMA (Quality Assurance for Linac with MATLAB), a MALAB toolkit which aims to simplify the quantitative analysis of QA for linac which includes Star-Shot analysis, Picket Fence test, Winston-Lutz test, Multileaf Collimator (MLC) log file analysis and verification of light & radiation field coincidence test.

  14. Medical ozone therapy as a potential treatment modality for regeneration of damaged articular cartilage in osteoarthritis

    Directory of Open Access Journals (Sweden)

    Sello Lebohang Manoto

    2018-05-01

    Full Text Available Osteoarthritis (OA is the most common degenerative joint disease and a growing health problem affecting more than half of the population over the age of 65. It is characterized by inflammation in the cartilage and synovium, resulting in the loss of joint structure and progressive damage to the cartilage. Many pro-inflammatory mediators are elevated in OA, including reactive oxygen species (ROS such as nitric oxide (NO and hydrogen peroxide (H2O2. Damaged articular cartilage remains a challenge to treat due to the limited self-healing capacity of the tissue and unsuccessful biological interventions. This highlights the need for better therapeutic strategies to heal damaged articular cartilage. Ozone (O3 therapy has been shown to have positive results in the treatment of OA; however the use of O3 therapy as a therapeutic agent is controversial. There is a perception that O3 is always toxic, whereas evidence indicates that when it is applied following a specified method, O3 can be effective in the treatment of degenerative diseases. The mechanism of action of O3 therapy in OA is not fully understood and this review summarizes the use of O3 therapy in the treatment of damaged articular cartilage in OA. Keywords: Osteoarthritis (OA, Articular cartilage, Ozone (O3 therapy, Reactive oxygen species (ROS

  15. Adherence therapy improves medication adherence and quality of life in people with Parkinson's disease: a randomised controlled trial.

    Science.gov (United States)

    Daley, D J; Deane, K H O; Gray, R J; Clark, A B; Pfeil, M; Sabanathan, K; Worth, P F; Myint, P K

    2014-08-01

    Many factors are associated with medication non-adherence in Parkinson's disease (PD), including complex treatment regimens, mood disorders and impaired cognition. However, interventions to improve adherence which acknowledge such factors are lacking. A phase II randomised controlled trial was conducted investigating whether Adherence Therapy (AT) improves medication adherence and quality of life (QoL) compared with routine care (RC) in PD. Eligible PD patients and their spouse/carers were randomised to intervention (RC plus AT) or control (RC alone). Primary outcomes were change in adherence (Morisky Medication Adherence Scale) and QoL (Parkinson's Disease Questionnaire-39) from baseline to week-12 follow up. Secondary outcomes were MDS-UPDRS (part I, II, IV), Beliefs about Medication Questionnaire (BMQ), EuroQol (EQ-5D) and the Caregiving Distress Scale. Blinded data were analysed using logistic and linear regression models based on the intention-to-treat principle. Seventy-six patients and 46 spouse/carers completed the study (intervention: n = 38 patients, n = 24 spouse/carers). At week-12 AT significantly improved adherence compared with RC (OR 8.2; 95% CI: 2.8, 24.3). Numbers needed to treat (NNT) were 2.2 (CI: 1.6, 3.9). Compared with RC, AT significantly improved PDQ-39 (-9.0 CI: -12.2, -5.8), BMQ general harm (-1.0 CI: -1.9, -0.2) and MDS-UPDRS part II (-4.8 CI: -8.1, -1.4). No significant interaction was observed between the presence of a spouse/carer and the effect of AT. Adherence Therapy improved self-reported adherence and QoL in a PD sample. The small NNT suggests AT may be cost-effective. A larger pragmatic trial to test the efficacy and cost-effectiveness of AT by multiple therapists is required. © 2014 John Wiley & Sons Ltd.

  16. Radiation protection in medical equipment therapy and diagnosis in (RICK) and (MC)

    International Nuclear Information System (INIS)

    Mohammed, M.I.

    2006-04-01

    In the present research work we are trying to study the status of the radiation protection applications around some medical facilities in Khartoum. The rules and principles of radiation protection in Radiation and Isotope Center (Khartoum), and at Medical Corporation (MC) were investigated. It is found that the rules are applied in accordance with international recommendations. Results of the investigations, measurements and some concluding remarks to improve the situation are reported.(Author)

  17. Safe Disposal of Medical and Plastic Waste and Energy Recovery Possibilities using Plasma Pyrolysis Technology

    International Nuclear Information System (INIS)

    Nema, S.K.; Mukherjee, S.

    2010-01-01

    Plasma pyrolysis and plasma gasification are emerging technologies that can provide complete solution to organic solid waste disposal. In these technologies plasma torch is used as a workhorse to convert electrical energy into heat energy. These technologies dispose the organic waste in an environment friendly manner. Thermal plasma provides extremely high temperature in oxygen free or controlled air environment which is required for pyrolysis or gasification reactions. Plasma based medical waste treatment is an extremely complex technology since it has to contend with extreme temperatures and corrosion-prone environment, complex pyro-chemistry resulting in toxic and dangerous products, if not controlled. In addition, one has to take care of complete combustion of pyrolyzed gases followed by efficient scrubbing to meet the emission standards set by US EPA and Central Pollution Control Board, India. In medical waste, high volume and low packing density waste with nonstandard composition consisting of a variety of plastics, organic material and liquids used to be present. The present paper describes the work carried out at Institute for Plasma Research, India, on plasma pyrolysis of (i) medical waste disposal and the results of emission measurement done at various locations in the system and (ii) energy recovery from cotton and plastic waste. The process and system development has been done in multiple steps. Different plasma pyrolysis models were made and each subsequent model was improved upon to meet stringent emission norms and to make the system energy efficient and user friendly. FCIPT, has successfully demonstrated up to 50 kg/ hr plasma pyrolysis systems and have installed plasma pyrolysis facilities at various locations in India . Plastic Waste disposal along with energy recovery in 15 kg/ hr model has also been developed and demonstrated at FCIPT. In future, this technology has great potential to dispose safely different waste streams such as biomass

  18. Cupping therapy: A prudent remedy for a plethora of medical ailments.

    Science.gov (United States)

    Mehta, Piyush; Dhapte, Vividha

    2015-07-01

    Since ancient times, complementary and alternative medicine (CAM; bǔ chōng yǔ tì dài yī xué) have played an important role in human health and welfare. Many therapeutic approaches in healthcare outside the realm of conventional medicine persist in various parts of the world. There is considerable scientific and commercial potential in CAM, which needs to be explored precisely. Cupping therapy ( bá guàn liáo fǎ), one of the CAM, is practiced across the world. This therapy is believed to act by correcting imbalances in the internal bio field, such as by restoring the flow of "Qi (qì)". Cupping involves applying a heated cup to generate a partial vacuum that mobilizes the blood flow and promotes effective healing. This review outlines various tools and techniques of cupping therapy.

  19. Improving outcomes for patients with medication-resistant anxiety: effects of collaborative care with cognitive behavioral therapy.

    Science.gov (United States)

    Campbell-Sills, Laura; Roy-Byrne, Peter P; Craske, Michelle G; Bystritsky, Alexander; Sullivan, Greer; Stein, Murray B

    2016-12-01

    Many patients with anxiety disorders remain symptomatic after receiving evidence-based treatment, yet research on treatment-resistant anxiety is limited. We evaluated effects of cognitive behavioral therapy (CBT) on outcomes of patients with medication-resistant anxiety disorders using data from the Coordinated Anxiety Learning and Management (CALM) trial. Primary care patients who met study entry criteria (including DSM-IV diagnosis of generalized anxiety disorder, panic disorder, posttraumatic stress disorder, or social anxiety disorder) despite ongoing pharmacotherapy of appropriate type, dose, and duration were classified as medication resistant (n = 227). Logistic regression was used to estimate effects of CALM's CBT program (CALM-CBT; chosen by 104 of 117 medication-resistant patients randomized to CALM) versus usual care (UC; n = 110) on response [≥ 50% reduction of 12-item Brief Symptom Inventory (BSI-12) anxiety and somatic symptom score] and remission (BSI-12 < 6) at 6, 12, and 18 months. Within-group analyses examined outcomes by treatment choice (CBT vs. CBT plus medication management) and CBT dose. Approximately 58% of medication-resistant CALM-CBT patients responded and 46% remitted during the study. Relative to UC, CALM-CBT was associated with greater response at 6 months (AOR = 3.78, 95% CI 2.02-7.07) and 12 months (AOR = 2.49, 95% CI 1.36-4.58) and remission at 6, 12, and 18 months (AORs = 2.44 to 3.18). Patients in CBT plus medication management fared no better than those in CBT only. Some evidence suggested higher CBT dose produced better outcomes. CBT can improve outcomes for patients whose anxiety symptoms are resistant to standard pharmacotherapy. © 2016 Wiley Periodicals, Inc.

  20. Ethnic differences in the effectiveness of cognitive behavioral therapy combined with medication: Comparing Asian American and white psychiatric patients.

    Science.gov (United States)

    Tang, Jennifer Y; Li, Chieh; Rodgers, Rachel F; Ballou, Mary

    2016-12-01

    Several meta-analyses have demonstrated the effectiveness of treatment utilizing cognitive behavioral therapy (CBT) combined with medication. There is, however, a paucity of research comparing the effectiveness of this combined treatment with psychiatric patients from different ethnic backgrounds. This study is the first of its kind to compare the effectiveness of CBT combined with medication for Asian American and White patients' psychiatric symptom severity levels of depression, anxiety, psychological well-being, and quality of life. The study examined the effects of CBT combined with medication for 43 Asian American and 43 White Non-Hispanic patients at an acute psychiatric partial hospital. A 2×2 between-within repeated measures analysis of variance was used. Results indicated significant improvement after treatment in all symptom categories assessed for the Asian American and White patients. The findings displayed trends over the course of treatment toward a greater decrease in anxiety symptoms among Asian patients but a larger increase in functioning level among White patients. In conclusion, the findings from this study provide preliminary cross-cultural support for CBT combined with medication as a treatment in partial hospital settings and suggest that the effectiveness of such treatments is similar across cultural groups. Copyright © 2016. Published by Elsevier B.V.

  1. Obesity therapy: altering the energy intake-and-expenditure balance sheet.

    Science.gov (United States)

    Crowley, Vivion E F; Yeo, Giles S H; O'Rahilly, Stephen

    2002-04-01

    Obesity is associated with numerous health complications, which range from non-fatal debilitating conditions such as osteoarthritis, to life-threatening chronic diseases such as coronary heart disease, diabetes and certain cancers. The psychological consequences of obesity can range from lowered self-esteem to clinical depression. Despite the high prevalence of obesity and the many advances in our understanding of how it develops, current therapies have persistently failed to achieve long-term success. This review focuses on how fat mass can be reduced by altering the balance between energy intake and expenditure.

  2. Effect of Low-Energy Linear Shockwave Therapy on Erectile Dysfunction

    DEFF Research Database (Denmark)

    Fojecki, Grzegorz L; Thiessen, Stefan; Osther, Palle Jørn Sloth

    2017-01-01

    INTRODUCTION: Previous studies have shown that focal low-energy extracorporeal shockwave therapy (Li-ESWT) can have a positive effect in men with erectile dysfunction (ED). Linear Li-ESWT (LLi-ESWT) for ED has not been previously assessed in a randomized trial. AIM: To evaluate the treatment...... MEASURES: The primary outcome measurement was an increase of at least five points on the IIEF-EF score. The secondary outcome measurement was an increased EHS score to at least 3 in men with a score no higher than 2 at baseline. Data were analyzed by linear and logistic regression. RESULTS: Mean IIEF...

  3. Neutron therapy

    International Nuclear Information System (INIS)

    Riesler, Rudi

    1995-01-01

    Standard radiotherapy uses Xrays or electrons which have low LET (linear energy transfer); in contrast, particles such as neutrons with high LET have different radiobiological responses. In the late 1960s, clinical trials by Mary Catterall at the Hammersmith Hospital in London indicated that fast neutron radiation had clinical advantages for certain malignant tumours. Following these early clinical trials, several cyclotron facilities were built in the 1980s for fast neutron therapy, for example at the University of Washington, Seattle, and at UCLA. Most of these newer machines use extracted cyclotron proton beams in the range 42 to 66 MeV with beam intensities of 15 to 60 microamps. The proton beams are transported to dedicated therapy rooms, where neutrons are produced from beryllium targets. Second-generation clinical trials showed that accurate neutron beam delivery to the tumour site is more critical than for photon therapy. In order to achieve precise beam geometries, the extracted proton beams have to be transported through a gantry which can rotate around the patient and deliver beams from any angle; also the neutron beam outline (''field shape'') must be adjusted to extremely irregular shapes using a flexible collimation system. A therapy procedure has to be appropriately organized, with physicians, radiotherapists, nurses, medical physicists and other staff in attendance; other specialized equipment, such as CT or MRI scanners and radiation simulators must be made available. Neutron therapy is usually performed only in radiation oncology departments of major medical centres

  4. Dosimetric comparison of stopping power calibration with dual-energy CT and single-energy CT in proton therapy treatment planning

    Energy Technology Data Exchange (ETDEWEB)

    Zhu, Jiahua [Department of Physics, University of Adelaide, Adelaide, SA 5005 (Australia); Penfold, Scott N., E-mail: scott.penfold@adelaide.edu.au [Department of Physics, University of Adelaide, Adelaide, SA 5005, Australia and Department of Medical Physics, Royal Adelaide Hospital, Adelaide, SA 5000 (Australia)

    2016-06-15

    Purpose: The accuracy of proton dose calculation is dependent on the ability to correctly characterize patient tissues with medical imaging. The most common method is to correlate computed tomography (CT) numbers obtained via single-energy CT (SECT) with proton stopping power ratio (SPR). CT numbers, however, cannot discriminate between a change in mass density and change in chemical composition of patient tissues. This limitation can have consequences on SPR calibration accuracy. Dual-energy CT (DECT) is receiving increasing interest as an alternative imaging modality for proton therapy treatment planning due to its ability to discriminate between changes in patient density and chemical composition. In the current work we use a phantom of known composition to demonstrate the dosimetric advantages of proton therapy treatment planning with DECT over SECT. Methods: A phantom of known composition was scanned with a clinical SECT radiotherapy CT-simulator. The phantom was rescanned at a lower X-ray tube potential to generate a complimentary DECT image set. A set of reference materials similar in composition to the phantom was used to perform a stoichiometric calibration of SECT CT number to proton SPRs. The same set of reference materials was used to perform a DECT stoichiometric calibration based on effective atomic number. The known composition of the phantom was used to assess the accuracy of SPR calibration with SECT and DECT. Intensity modulated proton therapy (IMPT) treatment plans were generated with the SECT and DECT image sets to assess the dosimetric effect of the imaging modality. Isodose difference maps and root mean square (RMS) error calculations were used to assess dose calculation accuracy. Results: SPR calculation accuracy was found to be superior, on average, with DECT relative to SECT. Maximum errors of 12.8% and 2.2% were found for SECT and DECT, respectively. Qualitative examination of dose difference maps clearly showed the dosimetric advantages

  5. Successful Elimination of Ascaris lumbricoides from the Gallbladder by Conservative Medical Therapy

    OpenAIRE

    Misra, Manish Kumar; Singh, Sarabjeet; Bhagat, Tripta Sethi

    2012-01-01

    Migration of Ascaris lumbricoides into the gallbladder is rare, unlike ascariasis of the bile duct and when it does occur, treatment is generally by endoscopic or surgical extraction. We describe a case of the successful treatment of gallbladder ascariasis with conservative therapy.

  6. Successful Elimination of Ascaris lumbricoides from the Gallbladder by Conservative Medical Therapy.

    Science.gov (United States)

    Misra, Manish Kumar; Singh, Sarabjeet; Bhagat, Tripta Sethi

    2013-06-01

    Migration of Ascaris lumbricoides into the gallbladder is rare, unlike ascariasis of the bile duct and when it does occur, treatment is generally by endoscopic or surgical extraction. We describe a case of the successful treatment of gallbladder ascariasis with conservative therapy.

  7. No speed limits in medical imaging and high-energy physics

    CERN Multimedia

    Rita Giuffredi & Tom Meyer

    2015-01-01

    Speed, or high time resolution, is becoming increasingly important, if not crucial, in the high-energy physics domain, both for particle acceleration and detection systems. Medical-imaging technology also vitally depends on high time resolution detection techniques, often the offspring of today’s large particle physics experiments. The four-year FP7 Marie Curie Training Project “PicoSEC-MCNet”, which draws to a close at the end of November, was designed to develop ultra-fast photon detectors for applications in both domains. The project has achieved important results that promise to trigger further developments in the years to come.   The PicoSEC-MCNet project participants. “New requirements in high-energy physics force us to push the limits of photon detection speed, as future high-luminosity accelerators will force us to cope with the unprecedentedly short bunch crossing intervals needed to produce sufficient luminosity,” explains Tom M...

  8. Radiation protection metrology at a high-energy neutron therapy facility

    International Nuclear Information System (INIS)

    Bonnett, D.E.; Sherwin, A.G.; More, B.R.

    1991-01-01

    A radiation protection survey has been carried out at a high-energy neutron therapy facility using a combination of different detectors and counters. Included in the survey were measurements with a tissue equivalent proportional counter (TEPC), a rem meter, a large volume ionisation chamber (LVI) and a Geiger counter. Dose equivalent rates, normalised to a proton beam current of 25 μA, of between 1 μSv.h -1 and 0.7 Sv.h -1 were recorded depending on the location. In general the results confirm the tendency of the rem meter to over-read in fields consisting mainly of low energy neutrons and illustrate the advantages of the diagnostic and gamma discriminating properties of the TEPC. The LVI-Geiger system was found to be the least favourable combination of dosemeters, substantially under-reading and being unable to estimate the neutron dose rate at levels below about 32 μGy.h -1 . (author)

  9. Catheter ablation versus medical therapy for patients with persistent atrial fibrillation: a systematic review and meta-analysis of evidence from randomized controlled trials.

    Science.gov (United States)

    Chen, Chen; Zhou, Xinbin; Zhu, Min; Chen, Shenjie; Chen, Jie; Cai, Hongwen; Dai, Jin; Xu, Xiaoming; Mao, Wei

    2018-06-01

    The superiority of catheter ablation (CA) for persistent (and long-standing persistent) atrial fibrillation (AF) is currently not well defined. We performed a meta-analysis of randomized controlled trials (RCTs) to assess the clinical outcomes of CA compared with medical therapy in persistent AF patients. We systematically searched PubMed, EMBASE, the Cochrane Library, and clinicaltrials.gov for RCTs comparing CA with medical therapy in patients with persistent AF. For CA vs medical rhythm control, the primary outcome was freedom from atrial arrhythmia. For CA vs medical rate control, the primary outcome was the change in the left ventricular ejection fraction (LVEF). Eight studies with a total of 809 patients were included in the final analysis. Compared with medical rhythm control, CA was superior in achieving freedom from atrial arrhythmia (RR 2.08, 95% CI [1.67, 2.58]; P medical rate control in persistent AF patients with heart failure (HF), CA significantly improved the LVEF (MD 7.72, 95%CI [4.78, 10.67]; P medical therapy in persistent AF patients and might be considered as a first-line therapy for some persistent AF patients especially for those with HF.

  10. An Energy-Efficient ASIC for Wireless Body Sensor Networks in Medical Applications.

    Science.gov (United States)

    Xiaoyu Zhang; Hanjun Jiang; Lingwei Zhang; Chun Zhang; Zhihua Wang; Xinkai Chen

    2010-02-01

    An energy-efficient application-specific integrated circuit (ASIC) featured with a work-on-demand protocol is designed for wireless body sensor networks (WBSNs) in medical applications. Dedicated for ultra-low-power wireless sensor nodes, the ASIC consists of a low-power microcontroller unit (MCU), a power-management unit (PMU), reconfigurable sensor interfaces, communication ports controlling a wireless transceiver, and an integrated passive radio-frequency (RF) receiver with energy harvesting ability. The MCU, together with the PMU, provides quite flexible communication and power-control modes for energy-efficient operations. The always-on passive RF receiver with an RF energy harvesting block offers the sensor nodes the capability of work-on-demand with zero standby power. Fabricated in standard 0.18-¿m complementary metal-oxide semiconductor technology, the ASIC occupies a die area of 2 mm × 2.5 mm. A wireless body sensor network sensor-node prototype using this ASIC only consumes < 10-nA current under the passive standby mode, and < 10 ¿A under the active standby mode, when supplied by a 3-V battery.

  11. 'Heart-talk:' considering the role of the heart in therapy as evidenced in the Quran and medical research.

    Science.gov (United States)

    Hussain, Feryad

    2013-12-01

    The emphasis on scientific approaches and evidence-based therapy has been a key force in developing and refining existing models of therapy. While this has been unquestioningly invaluable, it has similarly restricted the development and so implementation of those models that do not lend themselves easily to current research methodology, since the lack of evidence-practice research means they are not considered as 'legitimate' therapeutic practice. That the mind and body have an inter-dependent relationship is readily evidenced in numerous religious texts, but the lack of acknowledgement of that relationship in contemporary therapeutic approaches means that patients are not able to benefit from its use in sessions. Ironically, it is current developments in medical research that have discovered the reality around this relationship that have enabled such models to be further explore within an accepted context of evidence-based practice. This paper highlights the relationship between the heart and brain function as evidenced with brief reference to Quranic verses and medical (namely, neurocardiological) research. Further, it raises questions around the implications of this information for therapists working in both physical and mental health. The concept of 'heart talk' is an extension of the term 'heart brain' coined by Dr Armour (Professor of Pharmacology) in 1991 and is suggestive of its use in the world of psychological therapy. It relates to those cognitions which patients suggest come 'from the heart' which though previously dismissed are now suggestive of having some scientific basis and are potentially a legitimate source of information in understanding patients experiences.

  12. Design criteria for a high energy Compton Camera and possible application to targeted cancer therapy

    Science.gov (United States)

    Conka Nurdan, T.; Nurdan, K.; Brill, A. B.; Walenta, A. H.

    2015-07-01

    The proposed research focuses on the design criteria for a Compton Camera with high spatial resolution and sensitivity, operating at high gamma energies and its possible application for molecular imaging. This application is mainly on the detection and visualization of the pharmacokinetics of tumor targeting substances specific for particular cancer sites. Expected high resolution (animals with a human tumor xenograft which is one of the first steps in evaluating the potential utility of a candidate gene. The additional benefit of high sensitivity detection will be improved cancer treatment strategies in patients based on the use of specific molecules binding to cancer sites for early detection of tumors and identifying metastasis, monitoring drug delivery and radionuclide therapy for optimum cell killing at the tumor site. This new technology can provide high resolution, high sensitivity imaging of a wide range of gamma energies and will significantly extend the range of radiotracers that can be investigated and used clinically. The small and compact construction of the proposed camera system allows flexible application which will be particularly useful for monitoring residual tumor around the resection site during surgery. It is also envisaged as able to test the performance of new drug/gene-based therapies in vitro and in vivo for tumor targeting efficacy using automatic large scale screening methods.

  13. SU-F-J-140: Using Handheld Stereo Depth Cameras to Extend Medical Imaging for Radiation Therapy Planning

    Energy Technology Data Exchange (ETDEWEB)

    Jenkins, C; Xing, L; Yu, S [Stanford University, Stanford, CA (United States)

    2016-06-15

    Purpose: A correct body contour is essential for the accuracy of dose calculation in radiation therapy. While modern medical imaging technologies provide highly accurate representations of body contours, there are times when a patient’s anatomy cannot be fully captured or there is a lack of easy access to CT/MRI scanning. Recently, handheld cameras have emerged that are capable of performing three dimensional (3D) scans of patient surface anatomy. By combining 3D camera and medical imaging data, the patient’s surface contour can be fully captured. Methods: A proof-of-concept system matches a patient surface model, created using a handheld stereo depth camera (DC), to the available areas of a body contour segmented from a CT scan. The matched surface contour is then converted to a DICOM structure and added to the CT dataset to provide additional contour information. In order to evaluate the system, a 3D model of a patient was created by segmenting the body contour with a treatment planning system (TPS) and fabricated with a 3D printer. A DC and associated software were used to create a 3D scan of the printed phantom. The surface created by the camera was then registered to a CT model that had been cropped to simulate missing scan data. The aligned surface was then imported into the TPS and compared with the originally segmented contour. Results: The RMS error for the alignment between the camera and cropped CT models was 2.26 mm. Mean distance between the aligned camera surface and ground truth model was −1.23 +/−2.47 mm. Maximum deviations were < 1 cm and occurred in areas of high concavity or where anatomy was close to the couch. Conclusion: The proof-of-concept study shows an accurate, easy and affordable method to extend medical imaging for radiation therapy planning using 3D cameras without additional radiation. Intel provided the camera hardware used in this study.

  14. Improvement of adipose tissue-derived cells by low-energy extracorporeal shock wave therapy.

    Science.gov (United States)

    Priglinger, Eleni; Schuh, Christina M A P; Steffenhagen, Carolin; Wurzer, Christoph; Maier, Julia; Nuernberger, Sylvia; Holnthoner, Wolfgang; Fuchs, Christiane; Suessner, Susanne; Rünzler, Dominik; Redl, Heinz; Wolbank, Susanne

    2017-09-01

    Cell-based therapies with autologous adipose tissue-derived cells have shown great potential in several clinical studies in the last decades. The majority of these studies have been using the stromal vascular fraction (SVF), a heterogeneous mixture of fibroblasts, lymphocytes, monocytes/macrophages, endothelial cells, endothelial progenitor cells, pericytes and adipose-derived stromal/stem cells (ASC) among others. Although possible clinical applications of autologous adipose tissue-derived cells are manifold, they are limited by insufficient uniformity in cell identity and regenerative potency. In our experimental set-up, low-energy extracorporeal shock wave therapy (ESWT) was performed on freshly obtained human adipose tissue and isolated adipose tissue SVF cells aiming to equalize and enhance stem cell properties and functionality. After ESWT on adipose tissue we could achieve higher cellular adenosine triphosphate (ATP) levels compared with ESWT on the isolated SVF as well as the control. ESWT on adipose tissue resulted in a significantly higher expression of single mesenchymal and vascular marker compared with untreated control. Analysis of SVF protein secretome revealed a significant enhancement in insulin-like growth factor (IGF)-1 and placental growth factor (PLGF) after ESWT on adipose tissue. Summarizing we could show that ESWT on adipose tissue enhanced the cellular ATP content and modified the expression of single mesenchymal and vascular marker, and thus potentially provides a more regenerative cell population. Because the effectiveness of autologous cell therapy is dependent on the therapeutic potency of the patient's cells, this technology might raise the number of patients eligible for autologous cell transplantation. Copyright © 2017 International Society for Cellular Therapy. Published by Elsevier Inc. All rights reserved.

  15. Energy Therapies in Advanced Practice Oncology: An Evidence-Informed Practice Approach

    Science.gov (United States)

    Potter, Pamela J.

    2013-01-01

    Advanced practitioners in oncology want patients to receive state-of-the-art care and support for their healing process. Evidence-informed practice (EIP), an approach to evaluating evidence for clinical practice, considers the varieties of evidence in the context of patient preference and condition as well as practitioner knowledge and experience. This article offers an EIP approach to energy therapies, namely, Therapeutic Touch (TT), Healing Touch (HT), and Reiki, as supportive interventions in cancer care; a description of the author’s professional experience with TT, HT, and Reiki in practice and research; an overview of the three energy healing modalities; a review of nine clinical studies related to oncology; and recommendations for EIP. These studies demonstrate a response to previous research design critiques. Findings indicate a positive benefit for oncology patients in the realms of pain, quality of life, fatigue, health function, and mood. Directionality of healing in immune response and cell line studies affirms the usual explanation that these therapies bring harmony and balance to the system in the direction of health. Foremost, the research literature demonstrates the safety of these therapies. In order to consider the varieties of evidence for TT, HT, and Reiki, EIP requires a qualitative examination of patient experiences with these modalities, exploration of where these modalities have been integrated into cancer care and how the practice works in the oncology setting, and discovery of the impact of implementation on provider practice and self-care. Next steps toward EIP require fleshing out the experience of these modalities by patients and health-care providers in the oncology care setting. PMID:25031994

  16. Emergency Victim Care. A Training Manual for Emergency Medical Technicians. Module 5. CPR, Oxygen Therapy. Revised.

    Science.gov (United States)

    Ohio State Dept. of Education, Columbus. Div. of Vocational Education.

    This student manual, the fifth in a set of 14 modules, is designed to train emergency medical technicians (EMTs) in Ohio. The module contains two sections covering the following course content; cardiopulmonary resuscitation (CPR) (including artificial ventilation, foreign body obstructions, adjunctive equipment and special techniques, artificial…

  17. Mesenchymal Stem Cell Therapy for Acute Radiation Syndrome: Innovative Medical Approaches in Military Medicine

    Science.gov (United States)

    2015-01-30

    Eaton and Varney Military Medical Research (2015) 2:2 Page 8 of 97. Meirelles Lda S, Fontes AM, Covas DT, Caplan AI. Mechanisms involved in the...2007;110:2764–7. 26. Koc ON, Gerson SL, Cooper BW, Dyhouse SM, Haynesworth SE, Caplan AI, et al. Rapid hematopoietic recovery after coinfusion of

  18. Attitudes towards Older Adults: A Comparison of Physical Therapy and Medical Students.

    Science.gov (United States)

    Schmidt, Ron; And Others

    Since attitudes of medical professionals may influence the health care delivered to elderly people and there is an increasing proportion of older people in society, it would seem appropriate to assess the attitudes toward older adults held by health care providers. This study examined attitudes toward older adults held by physical therapy…

  19. Medical evaluations of ionizing radiation effects during I131 therapy in patients after thyroid carcinoma surgery

    International Nuclear Information System (INIS)

    Hermida, J.C.

    1996-01-01

    This study shows the para-clinical studies on a 39 years old patient who was operated on of a thyroid carcinoma and who, under the beirwaltes medical record (in use in our country), received in the post surgical stage, a Iodine-131 dose of about 2960 MBq (80 mCi) for ablation, having been noted subsequently her pregnancy condition. (author). 6 refs

  20. Is Timing of Medical Therapy Related to Outcome in Painful Chronic Pancreatitis?

    NARCIS (Netherlands)

    Olesen, S.S.; Graversen, C.; Bouwense, S.A.; Wilder-Smith, O.H.G.; Goor, H. van; Drewes, A.M.

    2016-01-01

    OBJECTIVES: The authors investigated if timing of medical treatment is associated with the analgesic effect of pregabalin or placebo in patients with chronic pancreatitis (CP). METHODS: Sixty-four patients received pregabalin (150-300 mg twice a day) or matching placebo for 3 consecutive weeks.

  1. David Grant Medical Center energy use baseline and integrated resource assessment

    Energy Technology Data Exchange (ETDEWEB)

    Richman, E.E.; Hoshide, R.K.; Dittmer, A.L.

    1993-04-01

    The US Air Mobility Command (AMC) has tasked Pacific Northwest Laboratory (PNL) with supporting the US Department of Energy (DOE) Federal Energy Management Program`s (FEMP) mission to identify, evaluate, and assist in acquiring all cost-effective energy resource opportunities (EROs) at the David Grant Medical Center (DGMC). This report describes the methodology used to identify and evaluate the EROs at DGMC, provides a life-cycle cost (LCC) analysis for each ERO, and prioritizes any life-cycle cost-effective EROs based on their net present value (NPV), value index (VI), and savings to investment ratio (SIR or ROI). Analysis results are presented for 17 EROs that involve energy use in the areas of lighting, fan and pump motors, boiler operation, infiltration, electric load peak reduction and cogeneration, electric rate structures, and natural gas supply. Typical current energy consumption is approximately 22,900 MWh of electricity (78,300 MBtu), 87,600 kcf of natural gas (90,300 MBtu), and 8,300 gal of fuel oil (1,200 MBtu). A summary of the savings potential by energy-use category of all independent cost-effective EROs is shown in a table. This table includes the first cost, yearly energy consumption savings, and NPV for each energy-use category. The net dollar savings and NPV values as derived by the life-cycle cost analysis are based on the 1992 federal discount rate of 4.6%. The implementation of all EROs could result in a yearly electricity savings of more than 6,000 MWh or 26% of current yearly electricity consumption. More than 15 MW of billable load (total billed by the utility for a 12-month period) or more than 34% of current billed demand could also be saved. Corresponding natural gas savings would be 1,050 kcf (just over 1% of current consumption). Total yearly net energy cost savings for all options would be greater than $343,340. This value does not include any operations and maintenance (O&M) savings.

  2. David Grant Medical Center energy use baseline and integrated resource assessment

    Energy Technology Data Exchange (ETDEWEB)

    Richman, E.E.; Hoshide, R.K.; Dittmer, A.L.

    1993-04-01

    The US Air Mobility Command (AMC) has tasked Pacific Northwest Laboratory (PNL) with supporting the US Department of Energy (DOE) Federal Energy Management Program's (FEMP) mission to identify, evaluate, and assist in acquiring all cost-effective energy resource opportunities (EROs) at the David Grant Medical Center (DGMC). This report describes the methodology used to identify and evaluate the EROs at DGMC, provides a life-cycle cost (LCC) analysis for each ERO, and prioritizes any life-cycle cost-effective EROs based on their net present value (NPV), value index (VI), and savings to investment ratio (SIR or ROI). Analysis results are presented for 17 EROs that involve energy use in the areas of lighting, fan and pump motors, boiler operation, infiltration, electric load peak reduction and cogeneration, electric rate structures, and natural gas supply. Typical current energy consumption is approximately 22,900 MWh of electricity (78,300 MBtu), 87,600 kcf of natural gas (90,300 MBtu), and 8,300 gal of fuel oil (1,200 MBtu). A summary of the savings potential by energy-use category of all independent cost-effective EROs is shown in a table. This table includes the first cost, yearly energy consumption savings, and NPV for each energy-use category. The net dollar savings and NPV values as derived by the life-cycle cost analysis are based on the 1992 federal discount rate of 4.6%. The implementation of all EROs could result in a yearly electricity savings of more than 6,000 MWh or 26% of current yearly electricity consumption. More than 15 MW of billable load (total billed by the utility for a 12-month period) or more than 34% of current billed demand could also be saved. Corresponding natural gas savings would be 1,050 kcf (just over 1% of current consumption). Total yearly net energy cost savings for all options would be greater than $343,340. This value does not include any operations and maintenance (O M) savings.

  3. Cupping therapy: A prudent remedy for a plethora of medical ailments

    Directory of Open Access Journals (Sweden)

    Piyush Mehta

    2015-07-01

    Full Text Available Since ancient times, complementary and alternative medicine (CAM; 補充與替代醫學 bǔ chōng yǔ tì dài yī xué have played an important role in human health and welfare. Many therapeutic approaches in healthcare outside the realm of conventional medicine persist in various parts of the world. There is considerable scientific and commercial potential in CAM, which needs to be explored precisely. Cupping therapy (拔罐療法 bá guàn liáo fǎ, one of the CAM, is practiced across the world. This therapy is believed to act by correcting imbalances in the internal bio field, such as by restoring the flow of “Qi (氣qì”. Cupping involves applying a heated cup to generate a partial vacuum that mobilizes the blood flow and promotes effective healing. This review outlines various tools and techniques of cupping therapy.

  4. Effectiveness of Combination Therapy with Honey in H.Pylori Eradication in Pediatrics Medical Centre

    Directory of Open Access Journals (Sweden)

    Z.N. Hatmi

    2006-07-01

    Full Text Available Background: There are several million new cases of peptic disease annually. The disease has a various range of presentations. Gram negative helicobacter pylori bacilli is considered as an etiologic factor in this disease. Goal of treatment in peptic disease is eradication of the helicobacter pylori (HP. Combination therapy has been implemented in the treatment of this disease. Different modalities have been recommended up to now. In order to lower adverse effects, cost and drug resistance, researchers have introduced a new combination therapy in which honey is substituted for metronidazole. Methods: A step II of clinical trial was designed. The sample size was 15 children. Diagnosis of HP infection was confirmed with histopathology. Treatment regimen consisted of omeprazole, amoxicillin, bismuth and honey. After a 3-4 week follow- up, eradication was evaluated. Results: 15 children completed the follow- up period. Mean age of patients was 9.4 years. Treatment effectiveness was 80 percent. Conclusion: Combination therapy with 3 drugs along with honey has significant effectiveness on HP eradication.

  5. A Novel Integrated Cognitive-Behavioral Therapy for Anxiety and Medication Adherence Among Persons Living With HIV/AIDS.

    Science.gov (United States)

    Brandt, Charles P; Paulus, Daniel J; Garza, Monica; Lemaire, Chad; Norton, Peter J; Zvolensky, Michael J

    2018-02-01

    Persons living with HIV/AIDS (PLHIV) are able to live full lifespans after infection, however, rates of anxiety disorders among this population are elevated compared to national samples. Importantly, these anxiety symptoms and disorders have a negative effect on medication adherence, quality of life and other psychological disorders, such as depression. In order to reduce the impact of anxiety among PLHIV, a six-session transdiagnostic CBT-based treatment manual for anxiety among PLHIV named the HIV/Anxiety Management-Reduction Treatment (HAMRT) was developed and implemented. The current manuscript discusses the content of this manual as well as results from three cases examining the impact of HAMRT. Results indicated that HAMRT was effective in reducing symptoms of anxiety, anxiety sensitivity, depression, and negative affect among our sample. Additionally, results indicated that HAMRT was effective in increasing HIV medication adherence as well as quality of life. Results are discussed in terms of the potential utility of an anxiety-reduction therapy program aimed at increasing medication adherence among PLHIV.

  6. Receipt of Medication and Behavioral Therapy Among a National Sample of School-Age Children Diagnosed With Attention-Deficit/Hyperactivity Disorder.

    Science.gov (United States)

    Walls, Morgan; Allen, Caitlin G; Cabral, Howard; Kazis, Lewis E; Bair-Merritt, Megan

    2018-04-01

    In 2011, the American Academy of Pediatrics published practice guidelines for attention-deficit/hyperactivity disorder (ADHD), recommending both medication and behavioral therapy for school-age children. The current study examines associations between child/family characteristics and ADHD medication, behavioral, and combined therapy. This study used data from the 2014 National Survey of the Diagnosis and Treatment of ADHD and Tourette syndrome, a nationally representative follow-up survey to the 2011-2012 National Survey of Children's Health. Descriptive statistics were used to estimate frequencies of ADHD treatments and multivariable logistic regression to examine child/family characteristics associated with parent-reported medication use, classroom management, and parent training for children aged 8 to 17 diagnosed with ADHD (n = 2401). Black and Hispanic children were less likely than white children to have ever received ADHD medication. Hispanic children were less likely than white children to be currently receiving medications (adjusted odds ratio, 0.49; 95% confidence interval, 0.30-0.80). No differences were found in current medication use for black children compared to white children. Thirty-percent of parents reported that their child was currently receiving classroom management, and 31% reported having ever received parent training for ADHD. Children whose ADHD medication was managed by a primary care physician were less likely to receive combined medication and behavioral therapy compared to children managed by specialty physicians (adjusted odds ratio, 2.58; 95% confidence interval, 1.75-3.79). Most school-age children reported receiving medication for ADHD; however, medication disparities persist. Parent-reported use of behavioral therapies are low. Future research should examine reasons for observed variation in treatment and interventions to optimize ADHD care. Copyright © 2018 Academic Pediatric Association. Published by Elsevier Inc. All

  7. Clinical and cost-effectiveness of cognitive behaviour therapy for health anxiety in medical patients: a multicentre randomised controlled trial.

    Science.gov (United States)

    Tyrer, Peter; Cooper, Sylvia; Salkovskis, Paul; Tyrer, Helen; Crawford, Michael; Byford, Sarah; Dupont, Simon; Finnis, Sarah; Green, John; McLaren, Elenor; Murphy, David; Reid, Steven; Smith, Georgina; Wang, Duolao; Warwick, Hilary; Petkova, Hristina; Barrett, Barbara

    2014-01-18

    Health anxiety has been treated by therapists expert in cognitive behaviour therapy with some specific benefit in some patients referred to psychological services. Those in hospital care have been less often investigated. Following a pilot trial suggesting efficacy we carried out a randomised study in hospital medical clinics. We undertook a multicentre, randomised trial on health anxious patients attending cardiac, endocrine, gastroenterological, neurological, and respiratory medicine clinics in secondary care. We included those aged 16-75 years, who satisfied the criteria for excessive health anxiety, and were resident in the area covered by the hospital, were not under investigation for new pathology or too medically unwell to take part. We used a computer-generated random scheme to allocate eligible medical patients to an active treatment group of five-to-ten sessions of adapted cognitive behaviour therapy (CBT-HA group) delivered by hospital-based therapists or to standard care in the clinics. The primary outcome was change in health anxiety symptoms measured by the Health Anxiety Inventory at 1 year and the main secondary hypothesis was equivalence of total health and social care costs over 2 years, with an equivalence margin of £150. Analysis was by intention to treat. The study is registered with controlled-trials.com, ISRCTN14565822. Of 28,991 patients screened, 444 were randomly assigned to receive either adapted cognitive behaviour therapy (CBT-HA group, 219 participants) or standard care (standard care group, 225), with 205 participants in the CBT-HA group and 212 in the standard care group included in the analyses of the primary endpoints. At 1 year, improvement in health anxiety in the patients in the CBT-HA group was 2·98 points greater than in those in the standard care group (95% CI 1·64-4·33, pbehaviour therapy achieved normal levels of health anxiety compared with those in the control group (13·9% vs 7·3%; odds ratio 2·15, 95% CI 1·09-4

  8. Doctors’ Support – An important part of medical therapy and quality of life

    Directory of Open Access Journals (Sweden)

    Mariusz Jaworski

    2015-07-01

    Full Text Available Introduction: The correct patient – doctor relationship is important in shaping the whole process of treatment. The scientific studies highlight the various irregularities in this relationship and its negative impact on the effectiveness of medical treatment. The purpose of this study was to assess the relationship between levels of doctors’ support and attitude to certain aspects of the treatment process and quality of life among patients with psoriasis. Material and Methods: The study was conducted on 50 patients with psoriasis aged from 21 to 78 who are treated in dermatological clinics. The Psoriasis Area and Severity Index (PASI was used to assess the severity of psoriatic skin changes. The patients completed a questionnaire for the assessment of receive doctors’ support, and its relationship with the attitude towards the disease. The research tool was developed based on literature review. Results: The level of doctors’ support had a direct impact on the patients’ attitude the disease, including attitudes towards the treatment and medical personnel, as well as adherence to medical recommendations; and indirectly on satisfaction with the treatment and the quality of life. Conclusions: Results of this study have shown clear evidence the importance of the level of doctors’ support in psoriasis which could help to improve the overall functioning of these patients. The level of doctors’ support indirectly affects the quality of life in patients with psoriasis.

  9. Review article: Medical decision models of Helicobacter pylori therapy to prevent gastric cancer.

    Science.gov (United States)

    Sonnenberg, A; Inadomi, J M

    1998-02-01

    The aim of the present article is to study the utility of Helicobacter pylori eradication programmes in decreasing the incidence of gastric cancer. Three types of decision models are employed to pursue this aim, i.e. decision tree, present value, and declining exponential approximation of life expectancy (DEALE). 1) A decision tree allows one to model the interaction of multiple variables in great detail and to calculate the marginal cost, as well as the marginal cost-benefit ratio, of a preventive strategy. The cost of gastric cancer, the efficacy of H. pylori therapy in preventing cancer, and the cumulative probability of developing gastric cancer exert the largest influence on the marginal cost of cancer prevention. The high cost of future gastric cancer and a high efficacy of therapy make screening for H. pylori and its eradication the preferred strategy. 2) The present value is an economic method to adjust future costs or benefits to their current value using a discount rate and the length of time between now and a given time point in the future. It accounts for the depreciation of money and all material values over time. During childhood, the present value of future gastric cancer is very low. Vaccination of children to prevent gastric cancer would need to be very inexpensive to be practicable. Cancer prevention becomes a feasible option, only if the time period between the preventive measures and the occurrence of gastric cancer can be made relatively short. 3) The DEALE provides a means to calculate the increase in life expectancy that would occur, if death from a particular disease became preventable. Life expectancy of the general population is hardly affected by gastric cancer. For life expectancy to increase appreciably by vaccination or antibiotic therapy directed against H. pylori infection, these interventions would need to be focused towards a sub-population with an a priori high risk for gastric cancer.

  10. A Wireless Magnetic Resonance Energy Transfer System for Micro Implantable Medical Sensors

    Directory of Open Access Journals (Sweden)

    Tianyang Yang

    2012-07-01

    Full Text Available Based on the magnetic resonance coupling principle, in this paper a wireless energy transfer system is designed and implemented for the power supply of micro-implantable medical sensors. The entire system is composed of the in vitro part, including the energy transmitting circuit and resonant transmitter coils, and in vivo part, including the micro resonant receiver coils and signal shaping chip which includes the rectifier module and LDO voltage regulator module. Transmitter and receiver coils are wound by Litz wire, and the diameter of the receiver coils is just 1.9 cm. The energy transfer efficiency of the four-coil system is greatly improved compared to the conventional two-coil system. When the distance between the transmitter coils and the receiver coils is 1.5 cm, the transfer efficiency is 85% at the frequency of 742 kHz. The power transfer efficiency can be optimized by adding magnetic enhanced resonators. The receiving voltage signal is converted to a stable output voltage of 3.3 V and a current of 10 mA at the distance of 2 cm. In addition, the output current varies with changes in the distance. The whole implanted part is packaged with PDMS of excellent biocompatibility and the volume of it is about 1 cm3.

  11. A dual energy CT study on vascular effects of gold nanoparticles in radiation therapy

    Science.gov (United States)

    Ashton, Jeffrey R.; Hoye, Jocelyn; Deland, Katherine; Whitley, Melodi; Qi, Yi; Moding, Everett; Kirsch, David G.; West, Jennifer; Badea, Cristian T.

    2016-03-01

    Gold nanoparticles (AuNPs) are emerging as promising agents for both cancer therapy and CT imaging. AuNPs are delivered to tumors via the enhanced permeability and retention effect and they preferentially accumulate in close proximity to the tumor blood vessels. AuNPs produce low-energy, short-range photoelectrons during external beam radiation therapy (RT), boosting dose. This work is focused on understanding how tumor vascular permeability is influenced by AuNP-augmented radiation therapy (RT), and how this knowledge can potentially improve the delivery of additional nanoparticle-based chemotherapeutics. We use dual energy (DE) CT to detect accumulation of AuNPs and increased vascular permeability to liposomal iodine (i.e. a surrogate for chemotherapeutics with liposome encapsulation) following RT. We used sarcoma tumors generated in LSL-KrasG12D; p53FL/FL conditional mutant mice. A total of n=37 mice were used in this study. The treated mice were injected with 20 mg AuNP (0.1 ml/25 g mouse) 24 hours before delivery of 5 Gy RT (n=5), 10 Gy RT (n=3) or 20 Gy RT (n=6). The control mice received no AuNP injection and either no RT (n=6), 5 Gy RT (n=3), 10 Gy RT (n=3), 20 Gy RT (n=11). Twenty four hours post-RT, the mice were injected with liposomal iodine (0.3 ml/25 mouse) and imaged with DE-CT three days later. The results suggest that independent of any AuNP usage, RT levels of 10 Gy and 20 Gy increase the permeability of tumor vasculature to liposomal iodine and that the increase in permeability is dose-dependent. We found that the effect of RT on vasculature may already be at its maximum response i.e. saturated at 20 Gy, and therefore the addition of AuNPs had almost no added benefit. Similarly, at 5 Gy RT, our data suggests that there was no effect of AuNP augmentation on tumor vascular permeability. However, by using AuNPs with 10 Gy RT, we observed an increase in the vascular permeability, however this is not yet statistically significant due to the small

  12. Patient and family perceptions of physical therapy in the medical intensive care unit.

    Science.gov (United States)

    Sottile, Peter D; Nordon-Craft, Amy; Malone, Daniel; Schenkman, Margaret; Moss, Marc

    2015-10-01

    Patient and family member perceptions of physical therapy (PT) in the intensive care unit and the factors that influence their degree of satisfaction have not been described. A panel of experts developed a questionnaire that assessed patient and family perceptions of PT. Critically ill patients and their family members were asked to complete the survey. Patient and family member scores were compared and stratified by age, sex, and mechanical ventilation for greater than 14 days compared to 14 days or less. A total of 55 patients and 49 family members completed the survey. Patients and family members reported that PT was necessary and beneficial to recovery, despite associating PT with difficulty, exertion, and discomfort. Patient perceptions were similar regardless of age or sex. Family members underestimated a patient's enjoyment of PT (P = .03). For individuals who required prolonged mechanical ventilation (>14 days), patients reported that PT was more difficult (P = .03) and less enjoyable (P = .049), and family members reported PT as causing greater discomfort (P = .005). In addition, family members of patients who required prolonged mechanical ventilation felt that PT was less beneficial (P = .01). Physical therapy is perceived as necessary and beneficial to recovery by critically ill patients and family members. Copyright © 2015 Elsevier Inc. All rights reserved.

  13. A medicated polycarboxylate cement to prevent complications in composite resin therapy

    International Nuclear Information System (INIS)

    Okamoto, Y.; Shintani, H.; Yamaki, M.

    1990-01-01

    Preparative treatment is the preferred method to protect the dentin and pulp from complications in composite resin therapy. This study investigated the in vivo effects of the polycarboxylate cement containing zinc fluoride and tannic acid in composite resin restorations. Scanning electron micrographs established that the composite resin failed to contact the axial wall. The gaps varied from 10 to 60 microns. However, this polycarboxylate cement was shown to provide excellent adaptation to dentin when used as a base and its chemical adhesion allowed it to make close contact with the unetched dentin. The newly developed electron probe x-ray microanalyzer revealed that the in vivo penetration of fluoride and zinc occurred through the dentinal tubules. When this polycarboxylate cement was used, the orifices of dentinal tubules were partially occluded, possibly with the smear layer fixed by tannic acid. In addition, by releasing the components, this polycarboxylate cement adds acid resistance to dentin and increases the resistance of dentin collagen to proteolytic enzymes. As such this polycarboxylate cement offers advantages as a base to composite resin therapy

  14. Medical and Interventional Therapy for Spontaneous Vertebral Artery Dissection in the Craniocervical Segment

    Directory of Open Access Journals (Sweden)

    Guiyun Zhang

    2017-01-01

    Full Text Available Background and Purpose. Spontaneous vertebral artery dissection (SVAD is an important reason for posterior-circulation-ischemic stroke in the young and middle-aged population. Although some previous reports reveal a favorable outcome with conservative therapy, it is still controversial in the treatment of SVAD in some specific patients. Herein, we present our 10 years of clinical experience for SVAD at this location. Material and Methods. 20 patients with 20 SVADs in V2 and V3 segments were retrospectively studied. Clinical manifestations and imageology materials were collected and analyzed. All the patients underwent anticoagulation except for one patient because of contraindication. 14 patients underwent Wingspan stents implantation with general anesthesia. Results. In our sample, ischemia (infarction or transient ischemic attack, TIA was found in all the patients. Angiographic stenosis and dissection aneurysm were the most common findings in the segments mentioned above. 19 of the patients (95% got the excellent imageological and clinical outcomes. Conclusions. According to our experience in this group, although anticoagulation is effective in vertebral artery dissection, interventional therapy for SVADs in V2 and/or V3 segments is preferred in some specific patients. Stent with higher radial supporting and flexibility, such as Wingspan stent, is suggested.

  15. Low-energy extracorporeal shockwave therapy (ESWT improves metaphyseal fracture healing in an osteoporotic rat model.

    Directory of Open Access Journals (Sweden)

    Gina A Mackert

    Full Text Available As result of the current demographic changes, osteoporosis and osteoporotic fractures are becoming an increasing social and economic burden. In this experimental study, extracorporeal shock wave therapy (ESWT, was evaluated as a treatment option for the improvement of osteoporotic fracture healing.A well-established fracture model in the metaphyseal tibia in the osteoporotic rat was used. 132 animals were divided into 11 groups, with 12 animals each, consisting of one sham-operated group and 10 ovariectomized (osteoporotic groups, of which 9 received ESWT treatment. Different energy flux intensities (0.15 mJ/mm2, 0.35 mJ/mm2, or 0.55 mJ/mm2 as well as different numbers of ESWT applications (once, three times, or five times throughout the 35-day healing period were applied to the osteoporotic fractures. Fracture healing was investigated quantitatively and qualitatively using micro-CT imaging, quantitative real-time polymerase chain reaction (qRT-PCR analysis, histomorphometric analysis and biomechanical analysis.The results of this study show a qualitative and quantitative improvement in the osteoporotic fracture healing under low-energy (energy flux intensity: 0,15 mJ/mm2 ESWT and with fewer treatment applications per healing period.In conclusion, low-energy ESWT seems to exhibit a beneficial effect on the healing of osteoporotic fractures, leading to improved biomechanical properties, enhanced callus-quantity and -quality, and an increase in the expression of bone specific transcription factors. The results suggest that low-energy ESWT, as main treatment or as adjunctive treatment in addition to a surgical intervention, may prove to be an effective, simple to use, and cost-efficient option for the qualitative and quantitative improvement of osteoporotic fracture healing.

  16. Dose calculation methods in photon beam therapy using energy deposition kernels

    International Nuclear Information System (INIS)

    Ahnesjoe, A.

    1991-01-01

    The problem of calculating accurate dose distributions in treatment planning of megavoltage photon radiation therapy has been studied. New dose calculation algorithms using energy deposition kernels have been developed. The kernels describe the transfer of energy by secondary particles from a primary photon interaction site to its surroundings. Monte Carlo simulations of particle transport have been used for derivation of kernels for primary photon energies form 0.1 MeV to 50 MeV. The trade off between accuracy and calculational speed has been addressed by the development of two algorithms; one point oriented with low computional overhead for interactive use and one for fast and accurate calculation of dose distributions in a 3-dimensional lattice. The latter algorithm models secondary particle transport in heterogeneous tissue by scaling energy deposition kernels with the electron density of the tissue. The accuracy of the methods has been tested using full Monte Carlo simulations for different geometries, and found to be superior to conventional algorithms based on scaling of broad beam dose distributions. Methods have also been developed for characterization of clinical photon beams in entities appropriate for kernel based calculation models. By approximating the spectrum as laterally invariant, an effective spectrum and dose distribution for contaminating charge particles are derived form depth dose distributions measured in water, using analytical constraints. The spectrum is used to calculate kernels by superposition of monoenergetic kernels. The lateral energy fluence distribution is determined by deconvolving measured lateral dose distributions by a corresponding pencil beam kernel. Dose distributions for contaminating photons are described using two different methods, one for estimation of the dose outside of the collimated beam, and the other for calibration of output factors derived from kernel based dose calculations. (au)

  17. Medical Management

    Science.gov (United States)

    ... org Close Charcot-Marie-Tooth Disease (CMT) Medical Management Although there’s no cure for CMT, there are ... individualized physical therapy program. For more on medical management of CMT, see Surgery Sometimes, Bracing Often, Caution ...

  18. Dose levels due to neutrons in the vicinity of high energy medical accelerators

    International Nuclear Information System (INIS)

    McGinley, P.H.; Wood, M.; Sohrabi, M.; Mills, M.; Rodriguez, R.

    1976-01-01

    High energy photons are generated for use in radiation therapy by the decelleration of electrons in metal targets. Fast neutrons are also generated as a result of (γ, n) and (e, e'n) interactions in the target, beam compensator filter, and collimator material. In this work the adsorbed dose to neutrons was measured at the center of a 10 x 10 cm photon beam and 5 cm outside of the beam edge for a number of treatment units. Dose levels due to slow and fast neutrons were also established outside of the treatment rooms and a Bonner sphere neutron spectrometer system was employed to determine the neutron energy spectrum due to stray neutron radiation at each accelerator. For the linac it was found that the neutron dose at the beam center was 0.0039% of the photon dose and values of 0.049% and 0.053% were observed for the Allis Chalmers betatron and the Brown Boveri Betatron. Dose equivalent rates in the range of 0.3 to 22.5 mrem/hr were measured for points outside the treatment rooms when the accelerators were operated at a photon dose rate of 100 rad/min at the treatment position

  19. Attitudes of Israeli Rheumatologists to the Use of Medical Cannabis as Therapy for Rheumatic Disorders

    Directory of Open Access Journals (Sweden)

    Jacob N. Ablin

    2016-04-01

    Full Text Available Background While medical cannabis has been used for thousands of years in the treatment of pain and other symptoms, evidence-based use is limited and practitioners face multiple areas of uncertainty regarding the rational use of these compounds. Nonetheless, an increasing public interest and advocacy in favor of medical cannabis is causing the issue to be encountered ever more frequently by physicians in different fields of medicine and particularly in rheumatology. In view of this situation, we have surveyed the attitudes of Israeli rheumatologists to the use of medical cannabis. Objectives As rheumatologists are specialized in caring for patients presenting with musculoskeletal complaints, the confidence of rheumatologists’ knowledge of cannabinoids was surveyed. Methods All members of the Israeli Society of Rheumatology were surveyed by e-mail for their confidence and knowledge of cannabinoids and their perceived competence to prescribe herbal cannabis. Results A total of 23 out of 119 (19.3% Israeli rheumatologists approached returned the questionnaire. Three-quarters of responders were not confident about their knowledge of cannabinoid molecules or ability to write a prescription for herbal cannabis, and 78% were not confident to write a prescription for herbal cannabis; 74% of responders held the opinion that there was some role for cannabinoids in the management of rheumatic disease. Conclusion Israeli rheumatologists lack confidence in their knowledge of cannabinoids in general, yet are open to the possibility of introducing this treatment. Additional data and guidance are necessary in order to allow rational utilization of cannabinoids for management of rheumatic pain.

  20. Neutron dose to patients treated with high-energy medical accelerators

    International Nuclear Information System (INIS)

    McGinley, P.H.

    2001-01-01

    The neutron dose equivalent received by patients treated with high energy x-ray beams was measured in this research. A total of 13 different medical accelerators were evaluated in terms of the neutron dose equivalent in the patient plane and at the beam center. The neutron dose equivalent at the beam center was found to ranged from 0.02 to 9.4 mSv per Sv of x-ray dose and values from 0.029 to 2.58 mSv per Sv of x-ray were measured in the patient plane. It was concluded that the neutron levels meet the International Electrotechnical Commission standard for the patient plane. It was also concluded that when intensity modulated radiation treatment is conducted the neutron dose equivalent received by the patient will increase by a factor of 2 to 10. (author)

  1. OPTIMIZATION OF THE EPITHERMAL NEUTRON BEAM FOR BORON NEUTRON CAPTURE THERAPY AT THE BROOKHAVEN MEDICAL RESEARCH REACTOR.

    Energy Technology Data Exchange (ETDEWEB)

    HU,J.P.; RORER,D.C.; RECINIELLO,R.N.; HOLDEN,N.E.

    2002-08-18

    Clinical trials of Boron Neutron Capture Therapy for patients with malignant brain tumor had been carried out for half a decade, using an epithermal neutron beam at the Brookhaven's Medical Reactor. The decision to permanently close this reactor in 2000 cut short the efforts to implement a new conceptual design to optimize this beam in preparation for use with possible new protocols. Details of the conceptual design to produce a higher intensity, more forward-directed neutron beam with less contamination from gamma rays, fast and thermal neutrons are presented here for their potential applicability to other reactor facilities. Monte Carlo calculations were used to predict the flux and absorbed dose produced by the proposed design. The results were benchmarked by the dose rate and flux measurements taken at the facility then in use.

  2. A comparison of nifedipine and tamsulosin as medical expulsive therapy for the management of lower ureteral stones without ESWL

    Science.gov (United States)

    Cao, Dehong; Yang, Lu; Liu, Liangren; Yuan, Haichao; Qian, Shenqiang; Lv, Xiao; Han, Pin; Wei, Qiang

    2014-01-01

    Administration of nifedipine or tamsulosin has been suggested to augment stone expulsion rates. We aimed to compare the stone expulsion rates and adverse effects associated with the use of nifedipine or tamsulosin as medical expulsive therapy (MET) for the management of lower ureteral stones (LUS) without extracorporeal shock wave lithotripsy (ESWL) via a literature review and meta-analysis. Relevant randomized controlled trials (RCTs) were identified from the Medline, EMBASE, Cochrane CENTRAL, and Google Scholar databases. Finally, a total of 7 RCTs with 3897 patients were included. Our meta-analysis showed that tamsulosin could significantly increase the stone expulsion rate relative to nifedipine in patients with LUS (random-effects model; risk ratio [RR] = 0.81; 95% confidence interval [CI] = 0.75–0.88; P tamsulosin was more effective than nifedipine in patients with LUS, as evidenced by the higher stone expulsion rate. Tamsulosin treatment should therefore be considered for patients with LUS. PMID:24919112

  3. Rotation therapy for maniacs, melancholics and idiots: theory, practice and perception in European medical and literary case histories.

    Science.gov (United States)

    Dickson, Sheila

    2018-03-01

    This article examines the development and use of rotation therapy in the emerging field of psychiatry at the beginning of the 19th century, and the cross-fertilization between British, Irish, German, French and other European proponents of 'Cox's Swing'. Its short-lived popularity is linked to prevalent Enlightenment thought, to the development of an industrial and technological society, to the modern medical theories of irritability, and to the new practice of 'moral management' of the mentally ill. Case studies documenting the use of the Swing are considered from these perspectives, and are compared with contemporary public reactions in the form of publications in newspapers and of a literary text by German Romantic author Ludwig Achim von Arnim.

  4. Long-term pain relief with optimized medical treatment including antioxidants and step-up interventional therapy in patients with chronic pancreatitis.

    Science.gov (United States)

    Shalimar; Midha, Shallu; Hasan, Ajmal; Dhingra, Rajan; Garg, Pramod Kumar

    2017-01-01

    Abdominal pain is difficult to treat in patients with chronic pancreatitis (CP). Medical therapy including antioxidants has been shown to relieve pain of CP in the short-term. Our aim was to study the long-term results of optimized medical and interventional therapy for pain relief in patients with CP with a step-up approach. All consecutive patients with CP were included prospectively in the study. They were treated medically with a well-balanced diet, pancreatic enzymes, and antioxidants (9000 IU beta-carotene, 0.54 g vitamin C, 270 IU vitamin E, 600 µg organic selenium, and 2 g methionine). Endoscopic therapy and/or surgery were offered if medical therapy failed. Pain relief was the primary outcome measure. A total of 313 patients (mean age 26.16 ± 12.17; 244 males) with CP were included; 288 (92%) patients had abdominal pain. The etiology of CP was idiopathic in 224 (71.6%) and alcohol in 82 (26.2%). At 1-year follow-up, significant pain relief was achieved in 84.7% of patients: 52.1% with medical therapy, 16.7% with endoscopic therapy, 7.6% with surgery, and 8.3% spontaneously. The mean pain score decreased from 6.36 ± 1.92 to 1.62 ± 2.10 (P pain free at those follow-up periods. Significant pain relief is achieved in the majority of patients with optimized medical and interventional treatment. © 2016 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.

  5. No hypothyroidism after I-131 therapy in pts with toxic nodular goiter, treated under combined thyreostatic, thyreomimetic medication

    International Nuclear Information System (INIS)

    Giubbini, R.; Panarotto, M.B.; Paghera, B.; Pagliaini, R.; Pajoro, U.; Pizzocaro, C.; Rossini, P.L.; Terzi, A.; Maira, G.

    2002-01-01

    Background. Treatment of toxic nodular goiter with 131-I is generally satisfactory and will cause a reversion of hyperthyroidism. To avoid the risk of thyrotoxic storm I-131 therapy is usually performed after pre-treatment with antithyroid drugs, which causes a TSH increase and functional recruitment of previously inhibited normal thyroid tissue. In this functional state both autonomous nodule(s) and normal tissue are irradiated after I-131 administration. This may be the reason of late hypothyroidism occurring in 15-25% of Pts. Aim of the study was the evaluation of a different pre-treatment modality with combined methimazole (10-20 mg) and Triiodo-thyronine (T3 - 60 μg) in order to treat pts in euthyroid state with suppressed TSH. Study protocol. After diagnosis of hyperthyroidism with autonomous functioning tissue the pts were put under thyreostatic medication. Two months later TSH was checked and if >0.5% U.I the T3 treatment was associated. After two more months, the TSH level was checked again and, if suppressed, the pt received I-131 therapy. Study population. 93 pts (74f, 19m - age 75±10) were consecutively enrolled. 24 pts had a toxic nodular goiter and 69 a multi nodular one, respectively; they were evaluated at diagnosis, at pre-treatment, two months after therapy and at late follow-up (3.1 ± 3.5 yrs). Methods: 557±225 MBq of I-131 (according to uptake determinations and gland weight) were administered. Methymazole was discontinued 3 days before treatment whereas T3 was maintained during I-131 therapy. Results: Euthyroidism was achieved after the first treatment in 71% of pts. At late follow-up TSH values over the normal range were observed in only 4 pts (4.3% - however all 4 pts had TSH level below 6 I.U.). Summaries of FT3 and FT4 values are presented. Conclusions: The treatment of toxic nodular goiter under combined thyreostatic-thyreomimetic treatment is a safe, well tolerated and effective procedure allowing a 71% success at the first treatment

  6. Inter and Intratumour Heterogeneity: A Barrier to Individualized Medical Therapy in Renal Cell Carcinoma?

    International Nuclear Information System (INIS)

    Fisher, Rosalie; Larkin, James; Swanton, Charles

    2012-01-01

    There are nearly 9000 new diagnoses of renal cell carcinoma (RCC) each year in the United Kingdom, and nearly 60,000 in the United States (Jemal et al., 2010; UK, 2011; Jemal et al., 2010; Cancer Research UK, 2011). Nephrectomy for localized disease may be curative, but ∼50% of patients present with or subsequently develop metastatic disease (Motzer et al., 1996; Leibovich et al., 2003), which is inevitably fatal. In general, these patients require palliative systemic therapy, but metastatic RCC (mRCC) has historically been refractory to cytotoxic and hormonal therapy (Harris, 1983; Yagoda and Bander, 1989). Prior to 2007, immunotherapy with interferon-alpha or interleukin-2 was the mainstay of treatment, with modest benefits at best (Motzer et al., 2002b; Coppin et al., 2005). Since then, seven molecularly targeted agents have been approved for use in mRCC, all of which have been shown in phase III randomized clinical trials to improve disease control and which now represent the standards of care (Escudier et al., 2007a,b; Hudes et al., 2007; Motzer et al., 2007, 2010; Rini et al., 2008, 2011; Sternberg et al., 2010). Sunitinib, sorafenib, pazopanib, and axitinib are orally administered inhibitors of multiple tyrosine kinase receptors, with variable affinity for the vascular endothelial growth factor receptor (VEGF-R), and provide tumor control through suppression of angiogenesis, as does the monoclonal antibody to VEGF, bevacizumab. Temsirolimus and everolimus are mammalian target of rapamycin (mTOR) inhibitors; the mTOR pathway is a key component of the PI3K/Akt pathway which mediates tumor cell proliferation and survival via cell cycle regulatory proteins (Schmelzle and Hall, 2000; Fingar et al., 2004) and is also thought to influence angiogenesis (Del Bufalo et al., 2006; Thomas et al.,). A therapeutic approach which targets critical biological signaling pathways has clearly been the most successful strategy to treat mRCC to date, however, anti-VEGF and anti

  7. Localized Energy-Based Normalization of Medical Images: Application to Chest Radiography.

    Science.gov (United States)

    Philipsen, R H H M; Maduskar, P; Hogeweg, L; Melendez, J; Sánchez, C I; van Ginneken, B

    2015-09-01

    Automated quantitative analysis systems for medical images often lack the capability to successfully process images from multiple sources. Normalization of such images prior to further analysis is a possible solution to this limitation. This work presents a general method to normalize medical images and thoroughly investigates its effectiveness for chest radiography (CXR). The method starts with an energy decomposition of the image in different bands. Next, each band's localized energy is scaled to a reference value and the image is reconstructed. We investigate iterative and local application of this technique. The normalization is applied iteratively to the lung fields on six datasets from different sources, each comprising 50 normal CXRs and 50 abnormal CXRs. The method is evaluated in three supervised computer-aided detection tasks related to CXR analysis and compared to two reference normalization methods. In the first task, automatic lung segmentation, the average Jaccard overlap significantly increased from 0.72±0.30 and 0.87±0.11 for both reference methods to with normalization. The second experiment was aimed at segmentation of the clavicles. The reference methods had an average Jaccard index of 0.57±0.26 and 0.53±0.26; with normalization this significantly increased to . The third experiment was detection of tuberculosis related abnormalities in the lung fields. The average area under the Receiver Operating Curve increased significantly from 0.72±0.14 and 0.79±0.06 using the reference methods to with normalization. We conclude that the normalization can be successfully applied in chest radiography and makes supervised systems more generally applicable to data from different sources.

  8. LIBO - boosting medical cyclotron facilities for cancer therapy Exhibition LEPFest 2000

    CERN Multimedia

    2000-01-01

    Length : Energy boost : From 62 to 200 MeVAccelerating gradient : 10 MeV/metreAccelerating frequency : 3 GHz Collaboration : CERN, INFN and University of Milan, INFN and University of Naples and TERA foundation Prototype test in 2001 : SC cyclotron Catania

  9. Preliminary investigation of stereotactic body radiation therapy for medically inoperable stage I/II non-small cell lung cancer

    International Nuclear Information System (INIS)

    Guo Jindong; Lu Changxing; Wang Jiaming; Liu Jun; Li Hongxuan; Wang Changlu; Gao Lanting; Zhao Lei

    2011-01-01

    Objective: To evaluate the therapeutic efficacy and treatment-related toxicity of stereotactic body radiation therapy (SBRT) in patients with medically inoperable stage I/II non-small cell lung cancer (NSCLC). Methods: SBRT was applied to 30 patients, including clinically staged T 1 , T 2 (≤5 cm) or T 3 (chest wall primary tumors only), N 0 , M 0 ,biopsy-confirmed NSCLC. All patients were precluded from lobotomy because of physical condition or comorbidity. No patients developed tumors of any T-stage in the proximal zone. SBRT was performed with the total dose of 50 Gy to 70 Gy in 10 - 11 fractions during 12 - 15 days. prescription line was set onthe edge of the PTV. Results: The follow-up rate was 100%. The number of patients who completed the 1-, and 2-year follow-up were 15, and 10, respectively. All 30 patients completed therapy as planned. The complete response (CR), partial response (PR) and stable disease (SD) rates were 37%, 53% and 3%, respectively. With a median follow-up of 16 months (range, 4-36 months), Kaplan-Meier local control at 2 years was 94%. The 2-year overall survival was 84% and the 2-year cancer specific survival was 90%. Seven patients(23%) developed Grade 2 pneumonitis, no grade > 2 acute or late lung toxicity was observed. No one developed chest wall pain. Conclusions: It is feasible to deliver 50 Gy to 70 Gy of SBRT in 10 - 11 fractions for medically inoperable patients with stage I / II NSCLC. It was associated with low incidence of toxicities and provided sustained local tumor control.The preliminary investigation indicated the cancer specific survival probability of SBRT was high. It is necessary to perform similar investigation in a larger number of patients with long-term follow-up. (authors)

  10. Undergraduate medical textbooks do not provide adequate information on intravenous fluid therapy: a systematic survey and suggestions for improvement.

    Science.gov (United States)

    Powell, Arfon G M T; Paterson-Brown, Simon; Drummond, Gordon B

    2014-02-20

    Inappropriate prescribing of intravenous (IV) fluid, particularly 0.9% sodium chloride, causes post-operative complications. Fluid prescription is often left to junior medical staff and is frequently poorly managed. One reason for poor intravenous fluid prescribing practices could be inadequate coverage of this topic in the textbooks that are used. We formulated a comprehensive set of topics, related to important common clinical situations involving IV fluid therapy, (routine fluid replacement, fluid loss, fluids overload) to assess the adequacy of textbooks in common use. We assessed 29 medical textbooks widely available to students in the UK, scoring the presence of information provided by each book on each of the topics. The scores indicated how fully the topics were considered: not at all, partly, and adequately. No attempt was made to judge the quality of the information, because there is no consensus on these topics. The maximum score that a book could achieve was 52. Three of the topics we chose were not considered by any of the books. Discounting these topics as "too esoteric", the maximum possible score became 46. One textbook gained a score of 45, but the general score was poor (median 11, quartiles 4, 21). In particular, coverage of routine postoperative management was inadequate. Textbooks for undergraduates cover the topic of intravenous therapy badly, which may partly explain the poor knowledge and performance of junior doctors in this important field. Systematic revision of current textbooks might improve knowledge and practice by junior doctors. Careful definition of the remit and content of textbooks should be applied more widely to ensure quality and "fitness for purpose", and avoid omission of vital knowledge.

  11. The Clatterbridge high-energy neutron therapy facility: specification and performance

    International Nuclear Information System (INIS)

    Bonnett, D.E.; Blake, S.W.; Shaw, J.E.; Bewley, D.K.

    1988-01-01

    A high energy neutron therapy facility has been installed at the Douglas Cyclotron Centre, Clatterbridge Hospital Merseyside, to extend M.R.C. clinical trials of fast neutrons. The neutron beam is produced by bombarding a beryllium target with 62 MeV protons. The target is isocentrically mounted with potential for 360 0 rotation, with a fully variable collimator, giving a range of rectilinear field sizes from 5 cm x 5 cm to 30 cm x 30 cm. Basic neutron beam data including output, field flatness, penumbra and depth-dose data have been measured. For a 10 cm x 10 cm field, 50% depth dose occurs at 16.2 cm in water and output is 1.63 cGy μ A -1 min -1 at maximum dose depth. Effectiveness of the target shielding and neutron-induced radioactivity in the treatment head were also measured. It is concluded that the equipment meets design specifications and fully satisfies criticisms of earlier neutron therapy equipment. A full radiation survey showed that radiation levels present no significant staff hazard. (UK)

  12. Results of high energy x-ray therapy of gastric carcinoma, 2. Recurrent gastric carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Asakawa, H; Otawa, H; Yamada, S [Miyagi Prefectural Adult Disease Center, Natori (Japan)

    1979-01-01

    Thirty cases with recurrent gastric carcinoma were treated with a combination of high energy x-ray and some anti-cancer drugs at Miyagi Seijinbyo Center between 1967 and 1977. Twenty three cases of them tolerated well such treatment; the irradiated dose was more than 4000 rad without any serious complication. The response of recurrent tumor to irradiation was marked in 11 lesions of 21 local recurrences and 4 metastases of the lymph node. The survival rates of those irradiated more than 4000 rad were 22% at one year, 15% at two years and 5% at three years. The median survival month was 6,9 months. These rates obtained in a combined radiation therapy seemed to be well matched for those reported by other authors in a surgical management of recurrent gastric carcinoma. As a conclusion, it was suggested that a combined radiation therapy with some anticancer drugs should be an effective procedure to prolong the life of a patient of recurrent gastric carcinoma.

  13. Tibial nerve stimulation for overactive bladder syndrome unresponsive to medical therapy.

    Science.gov (United States)

    Ridout, A E; Yoong, W

    2010-02-01

    Overactive bladder syndrome is defined as a symptom syndrome which includes urinary urgency, with or without urge incontinence, usually accompanied by frequency (>8 micturitions/24 h) and nocturia. Conservative treatment usually comprises behavioural techniques, bladder retraining, pelvic floor re-education and pharmacotherapy but up to 30% of patients will remain refractory to treatment. Although second-line treatment options such as sacral nerve stimulation and intravesical botulinum A injections are valuable additions to the therapeutic arsenal, they are relatively invasive and can have serious side-effects. Inhibition of detrusor activity by peripheral neuromodulation of the posterior tibial nerve was first described in 1983, with recent authors further confirming a 60-80% positive response rate. This review was undertaken to examine published literature on percutaneous tibial nerve stimulation and to discuss outcome measures, maintenance therapy and prognostic factors of this technique.

  14. Budesonide/formoterol combination therapy as both maintenance and reliever medication in asthma

    DEFF Research Database (Denmark)

    O'Byrne, Paul M; Bisgaard, Hans; Godard, Philippe P

    2005-01-01

    with as-needed bud/form would provide rapid symptom relief and simultaneous adjustment in antiinflammatory therapy, thereby reducing exacerbations. In this double-blind, randomized, parallel-group study, 2,760 patients with asthma aged 4-80 years (FEV1 60-100% predicted) received either terbutaline 0.4 mg...... as SABA with bud/form 80/4.5 microg twice a day (bud/form + SABA) or bud 320 microg twice a day (bud + SABA) or bud/form 80/4.5 microg twice a day with 80/4.5 microg as-needed (bud/form maintenance + relief). Children used a once-nocte maintenance dose. Bud/form maintenance + relief prolonged time...... to first severe exacerbation (p relief also prolonged...

  15. Outcomes from peptic ulcer surgery have not benefited from advances in medical therapy.

    Science.gov (United States)

    Towfigh, Shirin; Chandler, Charles; Hines, Oscar J; McFadden, David W

    2002-04-01

    Given the advancements in medical treatment of peptic ulcer disease such as Helicobacter pylori eradication and proton-pump inhibitors, we sought to assess their impact on the need for surgical intervention. Patients who underwent peptic ulcer surgery between 1981 and 1998 were evaluated in a retrospective chart review from a tertiary-care hospital (n = 222). The number of operations performed for peptic ulcers decreased annually (24 vs 11.3). Seventy-seven per cent of all cases were done urgently; most were performed for acute perforated ulcers. The overall 30-day mortality rate was 13 per cent, which remained unchanged over the past two decades. The highest mortality rate (82%) was in the transplanted population (n = 11). Our institutional experience demonstrates that despite the lower volume of patients requiring operative management a greater percentage of these patients are presenting with urgent need for surgery. Also despite the aggressive endoscopic management of acutely bleeding ulcers there was no change in the percentage of patients taken to the operating room for uncontrollable hemorrhage. Improvements in medical management of peptic ulcer disease have decreased the surgical volume; nevertheless we show a rising proportion of urgent operations performed annually, and mortality remains high.

  16. Arterial homograft and medical therapy in pseudoaneurysm of infrarenal aorta concomitant with recurrent right ventricular thrombus in Behcet's disease

    International Nuclear Information System (INIS)

    Vahedian, Jalal; Sadeghapour, Ali

    2006-01-01

    Pseudoaneurysm of the infrarenal aorta due to Behcet s disease is very rare. We report a case of pseudoaneurysm associated with Behcet s disease in a 17-year-old boy with a recurrent right ventricular thrombus successfully treated with revascularization using arterial homograft patch. Echocardiography examination revealed a right ventricular mass, thought to be a thrombus in an unusual location. Postoperatively, the findings of the pathologic examination confirmed the mass as a thrombus. When the patient was subsequently re-admitted to the emergency unit with complaints of severe abdominal pain, fever, fatigue, sinus tachycardia, and a pulsating and tender abdominal mass, a right ventricular thrombus and a large pseudoaneurysm of the abdominal aorta were found on echocardiography and angiography. The patient underwent resection of the aortic aneurysm and aortoplasty, using arterial homograft patch, and received immunosuppressive and anticoagulation therapy. The thrombus of the right ventricle disappeared 4 months later. This case indicates that a right ventricular thrombosis in Behcet s disease may be managed by medical therapy. (author)

  17. SU-F-P-08: Medical Physics Perspective On Radiation Therapy Quality and Safety Considerations in Low Income Settings

    Energy Technology Data Exchange (ETDEWEB)

    Van Dyk, J [Western University London, ON (Canada); Meghzifene, A [International Atomic Energy Agency, Vienna (Austria)

    2016-06-15

    Purpose: The last few years have seen a significant growth of interest in the global radiation therapy crisis. Various organizations are quantifying the need and providing aid in support of addressing the shortfall existing in many low-to-middle income countries (LMICs). The Lancet Oncology Commission report (Lancet Oncol. Sep;16(10):1153-86, 2015) projects a need of 22,000 new medical physicists in LMICs by 2035 if there is to be equal access globally. With the tremendous demand for new facilities, equipment and personnel, it is very important to recognize quality and safety considerations and to address them directly. Methods: A detailed examination of quality and safety publications was undertaken. A paper by Dunscombe (Front. Oncol. 2: 129, 2012) reviewed the recommendations of 7 authoritative reports on safety in radiation therapy and found the 12 most cited recommendations, summarized in order of most to least cited: training, staffing, documentation/standard operating procedures, incident learning, communication/questioning, check lists, QC/PM, dosimetric audit, accreditation, minimizing interruptions, prospective risk assessment, and safety culture. However, these authoritative reports were generally based on input from high income contexts. In this work, the recommendations were analyzed with a special emphasis on issues that are significant in LMICs. Results: The review indicated that there are significant challenges in LMICs with training and staffing ranking at the top in terms quality and safety. Conclusion: With the recognized need for expanding global access to radiation therapy, especially in LMICs, and the backing by multiple support organizations, quality and safety considerations must be overtly addressed. While multidimensional, training and staffing are top priorities. The use of outdated systems with poor interconnectivity, coupled with a lack of systematic QA in high patient load settings are additional concerns. Any support provided to lower

  18. SU-F-P-08: Medical Physics Perspective On Radiation Therapy Quality and Safety Considerations in Low Income Settings

    International Nuclear Information System (INIS)

    Van Dyk, J; Meghzifene, A

    2016-01-01

    Purpose: The last few years have seen a significant growth of interest in the global radiation therapy crisis. Various organizations are quantifying the need and providing aid in support of addressing the shortfall existing in many low-to-middle income countries (LMICs). The Lancet Oncology Commission report (Lancet Oncol. Sep;16(10):1153-86, 2015) projects a need of 22,000 new medical physicists in LMICs by 2035 if there is to be equal access globally. With the tremendous demand for new facilities, equipment and personnel, it is very important to recognize quality and safety considerations and to address them directly. Methods: A detailed examination of quality and safety publications was undertaken. A paper by Dunscombe (Front. Oncol. 2: 129, 2012) reviewed the recommendations of 7 authoritative reports on safety in radiation therapy and found the 12 most cited recommendations, summarized in order of most to least cited: training, staffing, documentation/standard operating procedures, incident learning, communication/questioning, check lists, QC/PM, dosimetric audit, accreditation, minimizing interruptions, prospective risk assessment, and safety culture. However, these authoritative reports were generally based on input from high income contexts. In this work, the recommendations were analyzed with a special emphasis on issues that are significant in LMICs. Results: The review indicated that there are significant challenges in LMICs with training and staffing ranking at the top in terms quality and safety. Conclusion: With the recognized need for expanding global access to radiation therapy, especially in LMICs, and the backing by multiple support organizations, quality and safety considerations must be overtly addressed. While multidimensional, training and staffing are top priorities. The use of outdated systems with poor interconnectivity, coupled with a lack of systematic QA in high patient load settings are additional concerns. Any support provided to lower

  19. Long-term survival benefit of revascularization compared with medical therapy in patients with coronary chronic total occlusion and well-developed collateral circulation.

    Science.gov (United States)

    Jang, Woo Jin; Yang, Jeong Hoon; Choi, Seung-Hyuk; Song, Young Bin; Hahn, Joo-Yong; Choi, Jin-Ho; Kim, Wook Sung; Lee, Young Tak; Gwon, Hyeon-Cheol

    2015-02-01

    The purpose of this study was to compare the long-term clinical outcomes of patients with chronic total occlusion (CTO) and well-developed collateral circulation treated with revascularization versus medical therapy. Little is known about the clinical outcomes and optimal treatment strategies of CTO with well-developed collateral circulation. We screened 2,024 consecutive patients with at least 1 CTO detected on coronary angiogram. Of these, we analyzed data from 738 patients with Rentrop 3 grade collateral circulation who were treated with medical therapy alone (n = 236), coronary artery bypass grafting (n = 170) or percutaneous coronary intervention (n = 332; 80.1% successful). Patients who underwent revascularization and medical therapy (revascularization group, n = 502) were compared with those who underwent medical therapy alone (medication group, n = 236) in terms of cardiac death and major adverse cardiac events (MACE), defined as the composite of cardiac death, myocardial infarction, and repeat revascularization. During a median follow-up duration of 42 months, multivariate analysis revealed a significantly lower incidence of cardiac death (hazard ratio [HR]: 0.29; 95% confidence interval [CI]: 0.15 to 0.58; p collateral circulation, aggressive revascularization may reduce the risk of cardiac mortality and MACE. Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  20. Evaluation of a Pilot Medication-Assisted Therapy Program in Kazakhstan: Successes, Challenges, and Opportunities for Scaleup

    Directory of Open Access Journals (Sweden)

    Azizbek A. Boltaev

    2012-01-01

    Full Text Available Study Aims. Evaluate the quality and effectiveness of the medication-assisted therapy (MAT pilot in Kazakhstan and review implementation context and related challenges. Methods. We performed a desk review of MAT policy and program documents and reviewed medical records at three MAT sites in Kazakhstan. MAT patients (n=93 were interviewed to assess their perceptions of the program and its impact on their health, criminal, drug use, and HIV risk related behaviors as well as expenditures on nonprescribed psychoactive drugs. Persons injecting drugs who are not in treatment, MAT program staff, and other stakeholders were interviewed to obtain their perspectives on MAT. Results. Legislation supports introducing MAT as a standard of care for treatment of opioid dependence; however, its progress has been hampered by active opposition. Inadequate access and coverage, insufficient supply management, scarce infrastructure of narcological facilities, limited opportunities for staff development, and restrictive methadone dispensing policies compromise the quality of the intervention and limit its potential benefits. There were significant reductions in criminal, drug use, and HIV risk related behaviors in patients receiving MAT. Conclusions. The MAT pilot in Kazakhstan demonstrated its feasibility and effectiveness in the local context and is recommended for scaleup throughout the country.

  1. Enhancing human-animal relationships through veterinary medical instruction in animal-assisted therapy and animal-assisted activities.

    Science.gov (United States)

    Schaffer, Caroline Brunsman

    2008-01-01

    Instruction in animal-assisted therapy (AAT) and animal-assisted activities (AAAs) teaches veterinary medical students to confidently and assertively maximize the benefits and minimize the risks of this union of animals and people. Instruction in AAT/AAA also addresses requirements by the American Veterinary Medical Association Council on Education that accredited schools/colleges of veterinary medicine include in their standard curriculum the topics of the human-animal bond, behavior, and the contributions of the veterinarian to the overall public and professional health care teams. Entry-level veterinarians should be prepared to: (1) assure that animals who provide AAT/AAA are healthy enough to visit nursing homes, hospitals, or other institutions; (2) promote behavior testing that selects animals who will feel safe, comfortable, and connected; (3) advise facilities regarding infection control and ways to provide a safe environment where the animals, their handlers, and the people being visited will not be injured or become ill; and (4) advocate for their patients and show compassion for their clients when animals are determined to be inappropriate participants in AAT/AAA programs. This article presents AAT/AAA terminology, ways in which veterinarians can advocate for AAT/AAA, the advantages of being involved in AAT/AAA, a model AAT/AAA practicum from Tuskegee University's School of Veterinary Medicine (TUSVM), and examples of co-curricular activities in AAT/AAA by TUSVM's student volunteers.

  2. Integrating Medication Therapy Management (MTM Services Provided by Community Pharmacists into a Community-Based Accountable Care Organization (ACO

    Directory of Open Access Journals (Sweden)

    Brian Isetts

    2017-10-01

    Full Text Available (1 Background: As the U.S. healthcare system evolves from fee-for-service financing to global population-based payments designed to be accountable for both quality and total cost of care, the effective and safe use of medications is gaining increased importance. The purpose of this project was to determine the feasibility of integrating medication therapy management (MTM services provided by community pharmacists into the clinical care teams and the health information technology (HIT infrastructure for Minnesota Medicaid recipients of a 12-county community-based accountable care organization (ACO. (2 Methods: The continuous quality improvement evaluation methodology employed in this project was the context + mechanism = outcome (CMO model to account for the fact that programs only work insofar as they introduce promising ideas, solutions and opportunities in the appropriate social and cultural contexts. Collaborations between a 12-county ACO and 15 community pharmacies in Southwest Minnesota served as the social context for this feasibility study of MTM referrals to community pharmacists. (3 Results: All 15 community pharmacy sites were integrated into the HIT infrastructure through Direct Secure Messaging, and there were 32 recipients who received MTM services subsequent to referrals from the ACO at 5 of the 15 community pharmacies over a 1-year implementation phase. (4 Conclusion: At the conclusion of this project, an effective electronic communication and MTM referral system was activated, and consideration was given to community pharmacists providing MTM in future ACO shared savings agreements.

  3. EFFECTS OF RELIGIOUS VERSUS STANDARD COGNITIVE-BEHAVIORAL THERAPY ON OPTIMISM IN PERSONS WITH MAJOR DEPRESSION AND CHRONIC MEDICAL ILLNESS.

    Science.gov (United States)

    Koenig, Harold G; Pearce, Michelle J; Nelson, Bruce; Daher, Noha

    2015-11-01

    We compared the effectiveness of religiously integrated cognitive behavioral therapy (RCBT) versus standard CBT (SCBT) on increasing optimism in persons with major depressive disorder (MDD) and chronic medical illness. Participants aged 18-85 were randomized to either RCBT (n = 65) or SCBT (n = 67) to receive ten 50-min sessions remotely (94% by telephone) over 12 weeks. Optimism was assessed at baseline, 12 and 24 weeks by the Life Orientation Test-Revised. Religiosity was assessed at baseline using a 29-item scale composed of religious importance, individual religious practices, intrinsic religiosity, and daily spiritual experiences. Mixed effects growth curve models were used to compare the effects of treatment group on trajectory of change in optimism. In the intention-to-treat analysis, both RCBT and SCBT increased optimism over time, although there was no significant difference between treatment groups (B = -0.75, SE = 0.57, t = -1.33, P = .185). Analyses in the highly religious and in the per protocol analysis indicated similar results. Higher baseline religiosity predicted an increase in optimism over time (B = 0.07, SE = 0.02, t = 4.12, P optimism predicted a faster decline in depressive symptoms over time (B = -0.61, SE = 0.10, t = -6.30, P optimism in persons with MDD and chronic medical illness. While baseline religiosity does not moderate this effect, religiosity predicts increases in optimism over time independent of treatment group. © 2015 Wiley Periodicals, Inc.

  4. The neutron dose equivalent around high energy medical electron linear accelerators

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    Poje Marina

    2014-01-01

    Full Text Available The measurement of neutron dose equivalent was made in four dual energy linear accelerator rooms. Two of the rooms were reconstructed after decommissioning of 60Co units, so the main limitation was the space. The measurements were performed by a nuclear track etched detectors LR-115 associated with the converter (radiator that consist of 10B and with the active neutron detector Thermo BIOREM FHT 742. The detectors were set at several locations to evaluate the neutron ambient dose equivalent and/or neutron dose rate to which medical personnel could be exposed. Also, the neutron dose dependence on collimator aperture was analyzed. The obtained neutron dose rates outside the accelerator rooms were several times smaller than the neutron dose rates inside the accelerator rooms. Nevertheless, the measured neutron dose equivalent was not negligible from the aspect of the personal dosimetry with almost 2 mSv a year per person in the areas occupied by staff (conservative estimation. In rooms with 15 MV accelerators, the neutron exposure to the personnel was significantly lower than in the rooms having 18 MV accelerators installed. It was even more pronounced in the room reconstructed after the 60Co decommissioning. This study confirms that shielding from the neutron radiation should be considered when building vaults for high energy linear accelerators, especially when the space constraints exist.

  5. Music therapy for reducing agitation and psychotropic medication in nursing home residents with dementia

    DEFF Research Database (Denmark)

    Ridder, Hanne Mette Ochsner

    2015-01-01

    Dementia is a neurocognitive disease with a high risk of social isolation and agitation due to loss of cognitive functions. In nursing home residents with dementia, agitation is the most significant symptom causing patient distress and care- giver burden. Agitation is described as abuse or aggres......Dementia is a neurocognitive disease with a high risk of social isolation and agitation due to loss of cognitive functions. In nursing home residents with dementia, agitation is the most significant symptom causing patient distress and care- giver burden. Agitation is described as abuse...... or aggressive or inappropriate behaviour. According to a psychosocial model of care, agitation is understood as attempts to communicate psychosocial needs. The prevalence of agitation is predicted by the psychosocial culture of care, and too often symptoms of agitation are treated with psychotropic medication...

  6. Percutaneous Coronary Intervention Is More Beneficial Than Optimal Medical Therapy in Elderly Patients with Angina Pectoris.

    Science.gov (United States)

    Won, Hoyoun; Her, Ae Young; Kim, Byeong Keuk; Kim, Yong Hoon; Shin, Dong Ho; Kim, Jung Sun; Ko, Young Guk; Choi, Donghoon; Kwon, Hyuck Moon; Jang, Yangsoo; Hong, Myeong Ki

    2016-03-01

    Data comparing the clinical benefits of medical treatment with those of percutaneous coronary intervention (PCI) in an elderly population with angina pectoris are limited. Therefore, we evaluated the efficacy of elective PCI versus optimal medical treatment (OMT) in elderly patients (between 75 and 84 years old) with angina pectoris. One hundred seventy-seven patients with significant coronary artery stenosis were randomly assigned to either the PCI group (n=90) or the OMT group (n=87). The primary outcome was a composite of major adverse events in the 1-year follow-up period that included cardiovascular death, non-fatal myocardial infarction, coronary revascularization, and stroke. Major adverse events occurred in 5 patients (5.6%) of the PCI group and in 17 patents (19.5%) of the OMT group (p=0.015). There were no significant differences between the PCI group and the OMT group in cardiac death [hazard ratio (HR) for the PCI group 0.454; 95% confidence interval (CI) 0.041-5.019, p=0.520], myocardial infarction (HR 0.399; 95% CI 0.039-4.050, p=0.437), or stroke (HR 0.919; 95% CI 0.057-14.709, p=0.952). However, the PCI group showed a significant preventive effect of the composite of major adverse events (HR 0.288; 95% CI 0.106-0.785, p=0.015) and against the need for coronary revascularization (HR 0.157; 95% CI 0.035-0.703, p=0.016). Elective PCI reduced major adverse events and was found to be an effective treatment modality in elderly patients with angina pectoris and significant coronary artery stenosis, compared to OMT.

  7. Impact of pharmacy technician-centered medication reconciliation on optimization of antiretroviral therapy and opportunistic infection prophylaxis in hospitalized patients with HIV/AIDS.

    Science.gov (United States)

    Siemianowski, Laura A; Sen, Sanchita; George, Jomy M

    2013-08-01

    This study aimed to examine the role of a pharmacy technician-centered medication reconciliation (PTMR) program in optimization of medication therapy in hospitalized patients with HIV/AIDS. A chart review was conducted for all inpatients that had a medication reconciliation performed by the PTMR program. Adult patients with HIV and antiretroviral therapy (ART) and/or the opportunistic infection (OI) prophylaxis listed on the medication reconciliation form were included. The primary objective is to describe the (1) number and types of medication errors and (2) the percentage of patients who received appropriate ART. The secondary objective is a comparison of the number of medication errors between standard mediation reconciliation and a pharmacy-led program. In the PTMR period, 55 admissions were evaluated. In all, 50% of the patients received appropriate ART. In 27of the 55 admissions, there were 49 combined ART and OI-related errors. The most common ART-related errors were drug-drug interactions. The incidence of ART-related medication errors that included drug-drug interactions and renal dosing adjustments were similar between the pre-PTMR and PTMR groups (P = .0868). Of the 49 errors in the PTMR group, 18 were intervened by a medication reconciliation pharmacist. A PTMR program has a positive impact on optimizing ART and OI prophylaxis in patients with HIV/AIDS.

  8. Prevalence and Side Effects of Energy Drink Consumption among Medical Students at Umm Al-Qura University, Saudi Arabia

    Directory of Open Access Journals (Sweden)

    Naif A. Bawazeer

    2013-12-01

    Full Text Available Background: Energy drinks are freely available at markets and shops on the university campus without regulation or proper education regarding its side effects. The caffeine amount within energy drinks is high and could become an addictive substance or cause intoxication. Therefore, this study aims to assess the prevalence of energy drink consumption and its reported side effects among medical students. Methods:A total number of 257 medical students from Umm Al-Qura University completed a questionnaire about energy drinks that was administrated electronically from September through November, 2012. Results:Out of the 257 participants, 27.2% (n=70 reported consuming at least one energy drink per month, with 61.5% (n=48 being males. Males consume significantly more energy drinks than females (p=0.0001. The students consumed energy drinks to get energy in general (32.8% and while studying for exams or finishing a project (31.4%. Other reasons given include, lack of sleep (12.8%, just to be like friends (11.4%, or driving (8.5%. Heart palpitations are the most common side effect in our sample (20%, followed by insomnia (10%, headache and tremors (5.7%, nausea and vomiting (4.2% and nervousness (2.8%. Conclusion: Energy drinks consumption is common practice among medical students and the main reason cited for consumption is the need for energy during general activities. Approximately one-third of the consumers manifested some side effect after consumption. We recommend the need to create public awareness about energy drinks. Further studies are recommended to assess the educational level of students consuming energy drinks, about the dangerous side effects.

  9. Contemporary concepts of the medical therapy of portal hypertension under liver cirrhosis.

    Science.gov (United States)

    Garbuzenko, Dmitry Victorovich

    2015-05-28

    Severe complications of liver cirrhosis are mostly related to portal hypertension. At the base of the pathogenesis of portal hypertension is the increase in hepatic vascular resistance to portal blood flow with subsequent development of hyperdynamic circulation, which, despite of the formation of collateral circulation, promotes progression of portal hypertension. An important role in its pathogenesis is played by the rearrangement of vascular bed and angiogenesis. As a result, strategic directions of the therapy of portal hypertension under liver cirrhosis include selectively decreasing hepatic vascular resistance with preserving or increasing portal blood flow, and correcting hyperdynamic circulation and pathological angiogenesis, while striving to reduce the hepatic venous pressure gradient to less than 12 mmHg or 20% of the baseline. Over the last years, substantial progress in understanding the pathophysiological mechanisms of hemodynamic disorders under liver cirrhosis has resulted in the development of new drugs for their correction. Although the majority of them have so far been investigated only in animal experiments, as well as at the molecular and cellular level, it might be expected that the introduction of the new methods in clinical practice will increase the efficacy of the conservative approach to the prophylaxis and treatment of portal hypertension complications. The purpose of the review is to describe the known methods of portal hypertension pharmacotherapy and discuss the drugs that may affect the basic pathogenetic mechanisms of its development.

  10. Design and development of new collimator cones for fractionated stereotactic radiation therapy in Samsung Medical Center.

    Science.gov (United States)

    Ahn, Y C; Ju, S G; Kim, D Y; Choi, D R; Huh, S J; Park, Y H; Lim, D H; Kim, M K

    1999-05-01

    In stereotactic radiotherapy using X-Knife system, the commercially supplied collimator cone system had a few mechanical limitations. The authors have developed new collimator cones to overcome these limitations and named them "SMC type" collimator cones. We made use of cadmium-free cerrobend alloy within the stainless steel cylinder housing. We made nine cones of relatively larger sizes (3.0 cm to 7.0 cm in diameter) and of shorter length with bigger clearance from the isocenter than the commercial cones. The cone housing and the collimator cones were designed to insert into the wedge mount of the gantry head to enable double-exposure linac-gram taking. The mechanical accuracy of pointing to the isocenter was tested by ball test and cone rotation test, and the dosimetric measurements were performed, all of which were with satisfactory results. A new innovative quality assurance procedure using linac-grams on the patients at the actual treatment setup was attempted after taking 10 sets of AP and lateral linac-grams and the overall mechanical isocenter accuracy was excellent (average error = 0.4 +/- 0.2 mm). We have developed the SMC type collimator cone system mainly for fractionated stereotactic radiation therapy use with our innovative ideas. The new cones' mechanical accuracy and physical properties were satisfactory for clinical use, and the verification of the isocenter accuracy on the actual treatment setup has become possible.

  11. Graves' disease and radioiodine therapy. Is success of ablation dependent on the choice of thyreostatic medication?

    International Nuclear Information System (INIS)

    Kobe, C.; Weber, I.; Eschner, W.; Sudbrock, F.; Schmidt, M.; Dietlein, M.; Schicha, H.

    2008-01-01

    Aim: this study was performed to analyse the impact of the choice of antithyroid drugs (ATD) on the outcome of ablative radioiodine therapy (RIT) in patients with Graves' disease. Patients, material, methods: a total of 571 consecutive patients were observed for 12 months after RIT between July 2001 and June 2004. Inclusion criteria were the confirmed diagnosis of Graves' disease, compensation of hyperthyroidism and withdrawal of ATD two days before preliminary radioiodine-testing and RIT. The intended dose of 250 Gy was calculated from the results of the radioiodine test and the therapeutically achieved dose was measured by serial uptake measurements. The end-point measure was thyroid function 12 months offer RIT; success was defined as elimination of hyperthyroidism. The pretreatment ATD was retrospectively correlated with the results achieved. Results: relief from hyperthyroidism was achieved in 96% of patients. 472 patients were treated with carbimazole or methimazole (CMI) and 61 with propylthiouracil (PTU). 38 patients had no thyrostatic drugs (ND) prior to RIT. The success rate was equal in all groups (CMI 451/472; PTU 61/61; ND 37/38; p = 0.22). Conclusion: thyrostatic treatment with PTU achieves excellent results in ablative RIT, using an accurate dosimetric approach with an achieved post-therapeutic dose of more than 200 Gy. (orig.)

  12. Prognosis of medical and economic efficiency of a patient-oriented program implementation aimed at formation of adherenceto drug therapy among rural population

    Directory of Open Access Journals (Sweden)

    E A Kitaeva

    2018-02-01

    Full Text Available Aim. Development and implementation of novel organizational management technologies of medical care aimed at formation of adherence to drug therapy in patients from rural areas and calculation of medical and economic efficiency of implementation of this project. Methods. The study subject was the population of Rybnaya Sloboda district of the Republic of Tatarstan. Patient recruitment into the groups was conducted in the polyclinic of Rybnaya Sloboda central regional hospital. The duration of the study was 6 months for each of two groups with further follow-up and evaluation of adherence to therapy for 2 months. Results. Annually stroke affects 5.6 to 6.6 million of people around the world, 35% of whom die in the acute period. Recently, serious rejuvenation of cardiovascular disorders has been observed. The main reason for such trend is low patients’ compliance to drug therapy. And patients’ compliance itself allows significantly decreasing the risk of cardiovascular complications. The article discussed the issues of low compliance to drug therapy, presents the methods of its formation in patients from rural area. The examples of foreign and Russian experience of increasing patients’ compliance to drug therapy are described and the key intervention points for patients are determined. On the basis of conducted analysis, implementation was developed and suggested for patient-oriented program aimed at formation of adherence to drug therapy of rural population. Also, the authors performed evaluation of medical and economic efficiency of implementation of a patient-oriented program aimed at formation of adherence to drug therapy of rural population (assessment of expenditures for medications, hospital stay, incapacity related to the main disease; evaluation of expenditures for prevention of complications and disability. Conclusion. Effective organization of prophylactic activity is of great importance for prevention of cardiovascular disease

  13. The heart field effect: Synchronization of healer-subject heart rates in energy therapy.

    Science.gov (United States)

    Bair, Christine Caldwell

    2008-01-01

    Recent health research has focused on subtle energy and vibrational frequency as key components of health and healing. In particular, intentional direction of bioenergy is receiving increasing scientific attention. This study investigates the effect of the healer's electromagnetic (EM) heart field upon subjects during energy healing as measured by synchronization of heart rates and scores on a Subjective Units of Distress (SUD) scale and a Profile of Mood States (POMS) inventory. A nonequivalent pretest-posttest design was used based on heart rate comparisons between healer and subject and correlated with pre-and posttest SUD and POMS scores. Subjects included those who sat within the 3- to 4-foot "strong" range of the independent variable, the healer's heart field, while performing self-application of WHEE (the wholistic hybrid derived from EMDR [eye movement desensitization and reprocessing], and EFT [emotional freedom technique]), a meridian-based tapping technique (n=50); and those who performed the same process beyond the 15- to 18-foot range of the healer's EM heart field (n=41). The dependent variables were heart rate, SUD, and POMS inventory. All subjects completed these measures within 1 hour. Study results showed statistically significant heart-rate synchronization with the intervention population. In addition, SUD and POMS scores demonstrated considerably more improvement than in the control population, indicating additional benefit beyond the meridian-based therapies, such as WHEE, alone. Additional findings and future research recommendations are presented in this article.

  14. High-energy versus low-energy extracorporeal shock wave therapy for calcifying tendinitis of the shoulder: which is superior? A meta-analysis.

    Science.gov (United States)

    Verstraelen, F U; In den Kleef, N J H M; Jansen, L; Morrenhof, J W

    2014-09-01

    There are several treatment options for calcifying tendinitis of the shoulder. The next step treatment after conservative treatment fails is still a matter of dispute. Extracorporeal shock wave therapy (ESWT) has been shown to be a good alternative to surgery, but the best treatment intensity remains unknown. High-energy ESWT is much more painful, more expensive, and usually is done in an inpatient setting, whereas low-energy ESWT can be performed in an outpatient setting by a physical therapist. A systematic review and meta-analysis of randomized trials was performed to answer two clear research questions: (1) Is there a greater increase in the Constant-Murley score in patients treated with high-energy ESWT compared with those treated with low-energy ESWT by 3 months and by 6 months? (2) Is there a greater chance of complete resorption of the calcifications in patients treated with high-energy ESWT compared with those treated with low-energy ESWT by 3 months and by 6 months? Five relevant electronic online databases, Medline (through PubMed), EMBASE (through OVID), Cinahl (through EBSCO), Web of Science, and the Cochrane Central Register of Controlled Trials, were systematically searched. We also crosschecked the reference lists of articles and reviews for possible relevant studies. Eligible for inclusion were all randomized controlled trials (RCTs) that compared high-energy ESWT (> 0.28 mJ/mm(2)) with low-energy ESWT (energy ESWT compared with patients treated with low-energy ESWT at 3 and 6 months. The 3-month mean difference was 9.88 (95% CI, 9.04-10.72, p energy ESWT more often resulted in complete resorption of the deposits at 3 months. The corresponding odds ratio was 3.40 (95% CI, 1.35-8.58) and p = 0.009 (6-month data could not be pooled). When shock wave therapy is chosen, high-energy shock wave therapy is more likely to result in improved Constant-Murley score and resorption of the deposits compared with low-energy therapy. Level I, therapeutic study

  15. Adaptive pacing, cognitive behaviour therapy, graded exercise, and specialist medical care for chronic fatigue syndrome: a cost-effectiveness analysis.

    Directory of Open Access Journals (Sweden)

    Paul McCrone

    Full Text Available The PACE trial compared the effectiveness of adding adaptive pacing therapy (APT, cognitive behaviour therapy (CBT, or graded exercise therapy (GET, to specialist medical care (SMC for patients with chronic fatigue syndrome. This paper reports the relative cost-effectiveness of these treatments in terms of quality adjusted life years (QALYs and improvements in fatigue and physical function.Resource use was measured and costs calculated. Healthcare and societal costs (healthcare plus lost production and unpaid informal care were combined with QALYs gained, and changes in fatigue and disability; incremental cost-effectiveness ratios (ICERs were computed.SMC patients had significantly lower healthcare costs than those receiving APT, CBT and GET. If society is willing to value a QALY at £30,000 there is a 62.7% likelihood that CBT is the most cost-effective therapy, a 26.8% likelihood that GET is most cost effective, 2.6% that APT is most cost-effective and 7.9% that SMC alone is most cost-effective. Compared to SMC alone, the incremental healthcare cost per QALY was £18,374 for CBT, £23,615 for GET and £55,235 for APT. From a societal perspective CBT has a 59.5% likelihood of being the most cost-effective, GET 34.8%, APT 0.2% and SMC alone 5.5%. CBT and GET dominated SMC, while APT had a cost per QALY of £127,047. ICERs using reductions in fatigue and disability as outcomes largely mirrored these findings.Comparing the four treatments using a health care perspective, CBT had the greatest probability of being the most cost-effective followed by GET. APT had a lower probability of being the most cost-effective option than SMC alone. The relative cost-effectiveness was even greater from a societal perspective as additional cost savings due to reduced need for informal care were likely.

  16. Age of Onset, Duration, and Type of Medication Therapy for Attention-Deficit/Hyperactivity Disorder (ADHD) and Substance Use During Adolescence: A Multi-Cohort National Study

    Science.gov (United States)

    McCabe, Sean Esteban; Dickinson, Kara; West, Brady T.; Wilens, Timothy E.

    2016-01-01

    Objective To examine whether age of onset, duration, or type of medication therapy for attention-deficit/hyperactivity disorder (ADHD) is associated with substance use during adolescence. Method Nationally representative samples of high school seniors were surveyed via self-administered questionnaires. The sample consisted of 40,358 individuals from ten independent cohorts (2005-2014) and represented a population that was 52% female, 62% White, 10% African-American, 14% Hispanic, and 14% other. Design-based logistic regression analyses were used to test the associations between age of onset, duration, and type of ADHD medication therapy and recent substance use, controlling for potential confounding factors. Results Individuals who initiated stimulant medication therapy for ADHD later (ages 10-14 and 15 years and older) and for shorter duration (2 years or less and 3-5 years) as well as those who reported only non-stimulant medication therapy for ADHD had significantly greater odds of substance use in adolescence relative to individuals who initiated stimulant medication therapy for ADHD earlier (aged 9 or less) and for longer duration (6 or more years). The odds of substance use generally did not differ between population controls (youth without ADHD and unmedicated youth with ADHD) and individuals who initiated stimulant medication for ADHD early (aged 9 or less) and for longer duration (6 or more years). Conclusion Relative to later onset and shorter duration of stimulant treatment for ADHD, early onset and longer duration of stimulant treatment for ADHD was associated with a risk of substance use during adolescence that is lower and similar to that in the general population. PMID:27238066

  17. Environmental Determinants of Chronic Disease and Medical Approaches: Recognition, Avoidance, Supportive Therapy, and Detoxification

    International Nuclear Information System (INIS)

    Sears, M.E.; Sears, M.E.; Genuis, S.J.

    2012-01-01

    The World Health Organization warns that chronic, non communicable diseases are rapidly becoming epidemic worldwide. Escalating rates of neuro cognitive, metabolic, autoimmune and cardiovascular diseases cannot be ascribed only to genetics, lifestyle, and nutrition; early life and ongoing exposures, and bio accumulated toxicants may also cause chronic disease. Contributors to ill health are summarized from multiple perspectives biological effects of classes of toxicants, mechanisms of toxicity, and a synthesis of toxic contributors to major diseases. Health care practitioners have wide-ranging roles in addressing environmental factors in policy and public health and clinical practice. Public health initiatives include risk recognition and chemical assessment then exposure reduction, remediation, monitoring, and avoidance. The complex web of disease and environmental contributors is amenable to some straightforward clinical approaches addressing multiple toxicants. Widely applicable strategies include nutrition and supplements to counter toxic effects and to support metabolism; as well as exercise and sweating, and possibly medication to enhance excretion. Addressing environmental health and contributors to chronic disease has broad implications for society, with large potential benefits from improved health and productivity.

  18. Eosinophilic esophagitis: dilate or medicate? A cost analysis model of the choice of initial therapy.

    Science.gov (United States)

    Kavitt, R T; Penson, D F; Vaezi, M F

    2014-07-01

    Eosinophilic esophagitis (EoE) is an increasingly recognized clinical entity. The optimal initial treatment strategy in adults with EoE remains controversial. The aim of this study was to employ a decision analysis model to determine the less costly option between the two most commonly employed treatment strategies in EoE. We constructed a model for an index case of a patient with biopsy-proven EoE who continues to be symptomatic despite proton-pump inhibitor therapy. The following treatment strategies were included: (i) swallowed fluticasone inhaler (followed by esophagogastroduodenoscopy [EGD] with dilation if ineffective); and (ii) EGD with dilation (followed by swallowed fluticasone inhaler if ineffective). The time horizon was 1 year. The model focused on cost analysis of initial treatment strategies. The perspective of the healthcare payer was used. Sensitivity analyses were performed to assess the robustness of the model. For every patient whose symptoms improved or resolved with the strategy of fluticasone first followed by EGD, if necessary, it cost an average of $1078. Similarly, it cost an average of $1171 per patient if EGD with dilation was employed first. Sensitivity analyses indicated that initial treatment with fluticasone was the less costly strategy to improve dysphagia symptoms as long as the effectiveness of fluticasone remains at or above 0.62. Swallowed fluticasone inhaler (followed by EGD with dilation if necessary) is the more economical initial strategy when compared with EGD with dilation first. © 2012 Copyright the Authors. Journal compilation © 2012, Wiley Periodicals, Inc. and the International Society for Diseases of the Esophagus.

  19. Design and dosimetry of a few leaf electron collimator for energy modulated electron therapy

    International Nuclear Information System (INIS)

    Al-Yahya, Khalid; Verhaegen, Frank; Seuntjens, Jan

    2007-01-01

    Despite the capability of energy modulated electron therapy (EMET) to achieve highly conformal dose distributions in superficial targets it has not been widely implemented due to problems inherent in electron beam radiotherapy such as planning dosimetry accuracy, and verification as well as a lack of systems for automated delivery. In previous work we proposed a novel technique to deliver EMET using an automated 'few leaf electron collimator' (FLEC) that consists of four motor-driven leaves fit in a standard clinical electron beam applicator. Integrated with a Monte Carlo based optimization algorithm that utilizes patient-specific dose kernels, a treatment delivery was incorporated within the linear accelerator operation. The FLEC was envisioned to work as an accessory tool added to the clinical accelerator. In this article the design and construction of the FLEC prototype that match our compact design goals are presented. It is controlled using an in-house developed EMET controller. The structure of the software and the hardware characteristics of the EMET controller are demonstrated. Using a parallel plate ionization chamber, output measurements were obtained to validate the Monte Carlo calculations for a range of fields with different energies and sizes. Further verifications were also performed for comparing 1-D and 2-D dose distributions using energy independent radiochromic films. Comparisons between Monte Carlo calculations and measurements of complex intensity map deliveries show an overall agreement to within ±3%. This work confirms our design objectives of the FLEC that allow for automated delivery of EMET. Furthermore, the Monte Carlo dose calculation engine required for EMET planning was validated. The result supports the potential of the prototype FLEC for the planning and delivery of EMET

  20. Low-energy Shock Wave Therapy Ameliorates Erectile Dysfunction in a Pelvic Neurovascular Injuries Rat Model.

    Science.gov (United States)

    Li, Huixi; Matheu, Melanie P; Sun, Fionna; Wang, Lin; Sanford, Melissa T; Ning, Hongxiu; Banie, Lia; Lee, Yung-Chin; Xin, Zhongcheng; Guo, Yinglu; Lin, Guiting; Lue, Tom F

    2016-01-01

    Erectile dysfunction (ED) caused by pelvic injuries is a common complication of civil and battlefield trauma with multiple neurovascular factors involved, and no effective therapeutic approach is available. To test the effect and mechanisms of low-energy shock wave (LESW) therapy in a rat ED model induced by pelvic neurovascular injuries. Thirty-two male Sprague-Dawley rats injected with 5-ethynyl-2'-deoxyuridine (EdU) at newborn were divided into 4 groups: sham surgery (Sham), pelvic neurovascular injury by bilateral cavernous nerve injury and internal pudendal bundle injury (PVNI), PVNI treated with LESW at low energy (Low), and PVNI treated with LESW at high energy (High). After LESW treatment, rats underwent erectile function measurement and the tissues were harvested for histologic and molecular study. To examine the effect of LESW on Schwann cells, in vitro studies were conducted. The intracavernous pressure (ICP) measurement, histological examination, and Western blot (WB) were conducted. Cell cycle, Schwann cell activation-related markers were examined in in vitro experiments. LESW treatment improves erectile function in a rat model of pelvic neurovascular injury by leading to angiogenesis, tissue restoration, and nerve generation with more endogenous EdU(+) progenitor cells recruited to the damaged area and activation of Schwann cells. LESW facilitates more complete re-innervation of penile tissue with regeneration of neuronal nitric oxide synthase (nNOS)-positive nerves from the MPG to the penis. In vitro experiments demonstrated that LESW has a direct effect on Schwann cell proliferation. Schwann cell activation-related markers including p-Erk1/2 and p75 were upregulated after LESW treatment. LESW-induced endogenous progenitor cell recruitment and Schwann cell activation coincides with angiogenesis, tissue, and nerve generation in a rat model of pelvic neurovascular injuries. Copyright © 2016 International Society for Sexual Medicine. Published by

  1. A STUDY OF ANTIRETROVIRAL THERAPY OUTCOMES IN A TERTIARY CARE CENTER IN THANJAVUR MEDICAL COLLEGE HOSPITAL, SOUTHERN INDIA

    Directory of Open Access Journals (Sweden)

    Kannan V. P

    2017-05-01

    Full Text Available BACKGROUND The number of people infected with the Human Immunodeficiency Virus (HIV worldwide was estimated to be 33.2 million at the end of 2007. The introduction of Anti-Retroviral Therapy (ART has significantly reduced morbidity and mortality in HIVinfected patients in various developed and developing countries. However, the outcome of ART in India’s National ART Programme has not been reported in detail. The aim of the study is to- 1. Evaluate the immunological response of HIV infected adults starting Highly Active Antiretroviral Therapy (HAART. 2. Evaluate the clinical response of highly active antiretroviral therapy in HIV infected adults. 3. Assess the functional status improvement following highly active antiretroviral therapy. MATERIALS AND METHODS To evaluate the effectiveness of the National ART Programme at Thanjavur Medical College Hospital, we undertook a prospective observational study involving ART naive patients who were started on ART between May 2015 and October 2016. ART was offered to these patients in accordance with NACO guidelines. The regimen consisted of two nucleoside reverse transcriptase inhibitors and one non-nucleoside reverse transcriptase inhibitor. The available drugs included efavirenz, lamivudine, nevirapine and zidovudine. The CD4+ lymphocyte (CD4 count (cells/µL was estimated at baseline and at six months intervals during follow-up. Prophylaxis and treatment of opportunistic infections were in accordance with NACO guidelines. Anti-tuberculosis treatment was administered according to the Revised National Tuberculosis Control Programme guidelines. RESULTS Among 203 patients started on ART in this study, 3 died after completing 6 months of therapy and 17 died within 6 months of therapy. Out of the remaining 183 patients, 104 were males and 79 were females. The predominant route of HIV transmission is through unsafe sexual practice, which accounts for 84% of cases. Incidence of HIV is less common in literate

  2. Development of a time-of-flight Compton camera prototype for online control of ion therapy and medical imaging

    International Nuclear Information System (INIS)

    Ley, Jean-Luc

    2015-01-01

    Hadron-therapy is one of the modalities available for treating cancer. This modality uses light ions (protons, carbon ions) to destroy cancer cells. Such particles have a ballistic accuracy thanks to their quasi-rectilinear trajectory, their path and the finished profile maximum dose in the end. Compared to conventional radiotherapy, this allows to spare the healthy tissue located adjacent downstream and upstream of the tumor. One of this modality's quality assurance challenges is to control the positioning of the dose deposited by ions in the patient. One possibility to perform this control is to detect the prompt gammas emitted during nuclear reactions induced along the ion path in the patient. A Compton camera prototype, theoretically allowing to maximize the detection efficiency of the prompt gammas, is being developed under a regional collaboration. This camera was the main focus of my thesis, and particularly the following points: i) studying, throughout Monte Carlo simulations, the operation of the prototype in construction, particularly with respect to the expected counting rates on the different types of accelerators in hadron-therapy ii) conducting simulation studies on the use of this camera in clinical imaging, iii) characterising the silicon detectors (scatterer) iv) confronting Geant4 simulations on the camera's response with measurements on the beam with the help of a demonstrator. As a result, the Compton camera prototype developed makes a control of the localization of the dose deposition in proton therapy to the scale of a spot possible, provided that the intensity of the clinical proton beam is reduced by a factor 200 (intensity of 10 8 protons/s). An application of the Compton camera in nuclear medicine seems to be attainable with the use of radioisotopes of an energy greater than 300 keV. These initial results must be confirmed by more realistic simulations (homogeneous and heterogeneous PMMA targets). Tests with the progressive

  3. Electronic medical record systems are associated with appropriate placement of HIV patients on antiretroviral therapy in rural health facilities in Kenya: a retrospective pre-post study

    NARCIS (Netherlands)

    Oluoch, Tom; Katana, Abraham; Ssempijja, Victor; Kwaro, Daniel; Langat, Patrick; Kimanga, Davies; Okeyo, Nicky; Abu-Hanna, Ameen; de Keizer, Nicolette

    2014-01-01

    There is little evidence that electronic medical record (EMR) use is associated with better compliance with clinical guidelines on initiation of antiretroviral therapy (ART) among ART-eligible HIV patients. We assessed the effect of transitioning from paper-based to an EMR-based system on

  4. Quality of life assessed with the medical outcomes study short form 36-item health survey of patients on renal replacement therapy: A systematic review and meta-analysis

    NARCIS (Netherlands)

    Y.S. Liem (Ylian Serina); J.L. Bosch (Johanna); L.R. Arends (Lidia); M.H. Heijenbrok-Kal (Majanka); M.G.M. Hunink (Myriam)

    2007-01-01

    textabstractObjectives: The Medical Outcomes Study Short Form 36-Item Health Survey (SF-36) is the most widely used generic instrument to estimate quality of life of patients on renal replacement therapy. Purpose of this study was to summarize and compare the published literature on quality of

  5. Effect of cognitive therapy with antidepressant medications vs antidepressants alone on the rate of recovery in major depressive disorder a randomized clinical trial

    NARCIS (Netherlands)

    Hollon, S.D.; DeRubeis, R.J.; Fawcett, J.; Amsterdam, J.D.; Shelton, R.C.; Zajecka, J.; Young, P.R.; Gallop, R.

    2014-01-01

    IMPORTANCE Antidepressant medication (ADM) is efficacious in the treatment of depression, but not all patients achieve remission and fewer still achieve recovery with ADM alone. OBJECTIVE To determine the effects of combining cognitive therapy (CT) with ADM vs ADM alone on remission and recovery in

  6. Electronic medication monitoring-informed counseling to improve adherence to combination anti-retroviral therapy and virologic treatment outcomes: a meta-analysis

    NARCIS (Netherlands)

    Langebeek, Nienke; Nieuwkerk, Pythia

    2015-01-01

    Adherence to combination anti-retroviral therapy for HIV infection is a primary determinant of treatment success, but is often suboptimal. Previous studies have suggested that electronic medication monitoring-informed counseling is among the most effective adherence intervention components. Our

  7. [Practice evolution of hypofractionation in breast radiation therapy and medical impact].

    Science.gov (United States)

    Dupin, C; Vilotte, F; Lagarde, P; Petit, A; Breton-Callu, C

    2016-06-01

    Whole breast irradiation after conservative surgery is the standard treatment for invasive breast cancer. Randomized studies indicate that hypofractionation can be equivalent for selected patients. This study focuses on fractionation practice evolution in a single centre, and analyses the economic impact of practice modification. All prescriptions for invasive breast cancer between January 2010 and June 2014 were analyzed. Female patients 60 years or older, pN0 were considered for the economic study. Patients included in clinical trials or patient with high-grade tumours were excluded from the hypofractionation practice study, because physician could not choose fractionation. We used data from the Medical public health system to calculate cost per fraction and transportation cost. Two thousand thirty one patients were treated; 399 were eligible for the economic study (20%) and 282 for the practice study (14%). Treatment with 25 fractions decreased from 90% to 16% in the first half of 2014. Meanwhile, treatment with 15 or 16 fractions increased from 6% in 2010 to 68% in the first half of 2014. Hypofractionated treatment proportion was 100% with 42.5Gy in 16 fractions in 2010 and 100% 40Gy in 15 fractions in 2014, according to long-term follow-up publication of START trials. Treatment with five fractions remained stable around 7% (4 to 16%), reserved for patients over 80 years (PPractice change led to an increase of hypofractionation in recent years. Hypofractionation may be currently prescribed and may concern 20% of patients. This practice evolution is beneficial for patients and the public health system. Copyright © 2016 Société française de radiothérapie oncologique (SFRO). Published by Elsevier SAS. All rights reserved.

  8. Multiscale registration of medical images based on edge preserving scale space with application in image-guided radiation therapy

    Science.gov (United States)

    Li, Dengwang; Li, Hongsheng; Wan, Honglin; Chen, Jinhu; Gong, Guanzhong; Wang, Hongjun; Wang, Liming; Yin, Yong

    2012-08-01

    Mutual information (MI) is a well-accepted similarity measure for image registration in medical systems. However, MI-based registration faces the challenges of high computational complexity and a high likelihood of being trapped into local optima due to an absence of spatial information. In order to solve these problems, multi-scale frameworks can be used to accelerate registration and improve robustness. Traditional Gaussian pyramid representation is one such technique but it suffers from contour diffusion at coarse levels which may lead to unsatisfactory registration results. In this work, a new multi-scale registration framework called edge preserving multiscale registration (EPMR) was proposed based upon an edge preserving total variation L1 norm (TV-L1) scale space representation. TV-L1 scale space is constructed by selecting edges and contours of images according to their size rather than the intensity values of the image features. This ensures more meaningful spatial information with an EPMR framework for MI-based registration. Furthermore, we design an optimal estimation of the TV-L1 parameter in the EPMR framework by training and minimizing the transformation offset between the registered pairs for automated registration in medical systems. We validated our EPMR method on both simulated mono- and multi-modal medical datasets with ground truth and clinical studies from a combined positron emission tomography/computed tomography (PET/CT) scanner. We compared our registration framework with other traditional registration approaches. Our experimental results demonstrated that our method outperformed other methods in terms of the accuracy and robustness for medical images. EPMR can always achieve a small offset value, which is closer to the ground truth both for mono-modality and multi-modality, and the speed can be increased 5-8% for mono-modality and 10-14% for multi-modality registration under the same condition. Furthermore, clinical application by adaptive

  9. Multiscale registration of medical images based on edge preserving scale space with application in image-guided radiation therapy

    International Nuclear Information System (INIS)

    Li Dengwang; Wan Honglin; Li Hongsheng; Chen Jinhu; Gong Guanzhong; Yin Yong; Wang Hongjun; Wang Liming

    2012-01-01

    Mutual information (MI) is a well-accepted similarity measure for image registration in medical systems. However, MI-based registration faces the challenges of high computational complexity and a high likelihood of being trapped into local optima due to an absence of spatial information. In order to solve these problems, multi-scale frameworks can be used to accelerate registration and improve robustness. Traditional Gaussian pyramid representation is one such technique but it suffers from contour diffusion at coarse levels which may lead to unsatisfactory registration results. In this work, a new multi-scale registration framework called edge preserving multiscale registration (EPMR) was proposed based upon an edge preserving total variation L1 norm (TV-L1) scale space representation. TV-L1 scale space is constructed by selecting edges and contours of images according to their size rather than the intensity values of the image features. This ensures more meaningful spatial information with an EPMR framework for MI-based registration. Furthermore, we design an optimal estimation of the TV-L1 parameter in the EPMR framework by training and minimizing the transformation offset between the registered pairs for automated registration in medical systems. We validated our EPMR method on both simulated mono- and multi-modal medical datasets with ground truth and clinical studies from a combined positron emission tomography/computed tomography (PET/CT) scanner. We compared our registration framework with other traditional registration approaches. Our experimental results demonstrated that our method outperformed other methods in terms of the accuracy and robustness for medical images. EPMR can always achieve a small offset value, which is closer to the ground truth both for mono-modality and multi-modality, and the speed can be increased 5–8% for mono-modality and 10–14% for multi-modality registration under the same condition. Furthermore, clinical application by

  10. Linear Energy Transfer-Guided Optimization in Intensity Modulated Proton Therapy: Feasibility Study and Clinical Potential

    Energy Technology Data Exchange (ETDEWEB)

    Giantsoudi, Drosoula, E-mail: dgiantsoudi@partners.org [Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (United States); Grassberger, Clemens; Craft, David; Niemierko, Andrzej; Trofimov, Alexei; Paganetti, Harald [Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (United States)

    2013-09-01

    Purpose: To investigate the feasibility and potential clinical benefit of linear energy transfer (LET) guided plan optimization in intensity modulated proton therapy (IMPT). Methods and Materials: A multicriteria optimization (MCO) module was used to generate a series of Pareto-optimal IMPT base plans (BPs), corresponding to defined objectives, for 5 patients with head-and-neck cancer and 2 with pancreatic cancer. A Monte Carlo platform was used to calculate dose and LET distributions for each BP. A custom-designed MCO navigation module allowed the user to interpolate between BPs to produce deliverable Pareto-optimal solutions. Differences among the BPs were evaluated for each patient, based on dose–volume and LET–volume histograms and 3-dimensional distributions. An LET-based relative biological effectiveness (RBE) model was used to evaluate the potential clinical benefit when navigating the space of Pareto-optimal BPs. Results: The mean LET values for the target varied up to 30% among the BPs for the head-and-neck patients and up to 14% for the pancreatic cancer patients. Variations were more prominent in organs at risk (OARs), where mean LET values differed by a factor of up to 2 among the BPs for the same patient. An inverse relation between dose and LET distributions for the OARs was typically observed. Accounting for LET-dependent variable RBE values, a potential improvement on RBE-weighted dose of up to 40%, averaged over several structures under study, was noticed during MCO navigation. Conclusions: We present a novel strategy for optimizing proton therapy to maximize dose-averaged LET in tumor targets while simultaneously minimizing dose-averaged LET in normal tissue structures. MCO BPs show substantial LET variations, leading to potentially significant differences in RBE-weighted doses. Pareto-surface navigation, using both dose and LET distributions for guidance, provides the means for evaluating a large variety of deliverable plans and aids in

  11. Photon and electron collimator effects on electron output and abutting segments in energy modulated electron therapy

    International Nuclear Information System (INIS)

    Olofsson, Lennart; Karlsson, Magnus G.; Karlsson, Mikael

    2005-01-01

    In energy modulated electron therapy a large fraction of the segments will be arranged as abutting segments where inhomogeneities in segment matching regions must be kept as small as possible. Furthermore, the output variation between different segments should be minimized and must in all cases be well predicted. For electron therapy with add-on collimators, both the electron MLC (eMLC) and the photon MLC (xMLC) contribute to these effects when an xMLC tracking technique is utilized to reduce the x-ray induced leakage. Two add-on electron collimator geometries have been analyzed using Monte Carlo simulations: One isocentric eMLC geometry with an isocentric clearance of 35 cm and air or helium in the treatment head, and one conventional proximity geometry with a clearance of 5 cm and air in the treatment head. The electron fluence output for 22.5 MeV electrons is not significantly affected by the xMLC if the shielding margins are larger than 2-3 cm. For small field sizes and 9.6 MeV electrons, the isocentric design with helium in the treatment head or shielding margins larger than 3 cm is needed to avoid a reduced electron output. Dose inhomogeneity in the matching region of electron segments is, in general, small when collimator positions are adjusted to account for divergence in the field. The effect of xMLC tracking on the electron output can be made negligible while still obtaining a substantially reduced x-ray leakage contribution. Collimator scattering effects do not interfere significantly when abutting beam techniques are properly applied

  12. Linear Energy Transfer-Guided Optimization in Intensity Modulated Proton Therapy: Feasibility Study and Clinical Potential

    International Nuclear Information System (INIS)

    Giantsoudi, Drosoula; Grassberger, Clemens; Craft, David; Niemierko, Andrzej; Trofimov, Alexei; Paganetti, Harald

    2013-01-01

    Purpose: To investigate the feasibility and potential clinical benefit of linear energy transfer (LET) guided plan optimization in intensity modulated proton therapy (IMPT). Methods and Materials: A multicriteria optimization (MCO) module was used to generate a series of Pareto-optimal IMPT base plans (BPs), corresponding to defined objectives, for 5 patients with head-and-neck cancer and 2 with pancreatic cancer. A Monte Carlo platform was used to calculate dose and LET distributions for each BP. A custom-designed MCO navigation module allowed the user to interpolate between BPs to produce deliverable Pareto-optimal solutions. Differences among the BPs were evaluated for each patient, based on dose–volume and LET–volume histograms and 3-dimensional distributions. An LET-based relative biological effectiveness (RBE) model was used to evaluate the potential clinical benefit when navigating the space of Pareto-optimal BPs. Results: The mean LET values for the target varied up to 30% among the BPs for the head-and-neck patients and up to 14% for the pancreatic cancer patients. Variations were more prominent in organs at risk (OARs), where mean LET values differed by a factor of up to 2 among the BPs for the same patient. An inverse relation between dose and LET distributions for the OARs was typically observed. Accounting for LET-dependent variable RBE values, a potential improvement on RBE-weighted dose of up to 40%, averaged over several structures under study, was noticed during MCO navigation. Conclusions: We present a novel strategy for optimizing proton therapy to maximize dose-averaged LET in tumor targets while simultaneously minimizing dose-averaged LET in normal tissue structures. MCO BPs show substantial LET variations, leading to potentially significant differences in RBE-weighted doses. Pareto-surface navigation, using both dose and LET distributions for guidance, provides the means for evaluating a large variety of deliverable plans and aids in

  13. Preliminary investigations of Monte Carlo Simulations of neutron energy and LET spectra for fast neutron therapy facilities

    International Nuclear Information System (INIS)

    Kroc, T.K.

    2009-01-01

    No fast neutron therapy facility has been built with optimized beam quality based on a thorough understanding of the neutron spectrum and its resulting biological effectiveness. A study has been initiated to provide the information necessary for such an optimization. Monte Carlo studies will be used to simulate neutron energy spectra and LET spectra. These studies will be bench-marked with data taken at existing fast neutron therapy facilities. Results will also be compared with radiobiological studies to further support beam quality ptimization. These simulations, anchored by this data, will then be used to determine what parameters might be optimized to take full advantage of the unique LET properties of fast neutron beams. This paper will present preliminary work in generating energy and LET spectra for the Fermilab fast neutron therapy facility.

  14. Risk of low-energy hip, wrist, and upper arm fractures among current and previous users of hormone replacement therapy

    DEFF Research Database (Denmark)

    Hundrup, Yrsa Andersen; Høidrup, Susanne; Ekholm, Ola

    2004-01-01

    To examine the effect of oestrogen alone and in combination with progestin on the risk of low-energy, hip, wrist, and upper arm fractures. Additionally, to examine to what extent previous use, duration of use as well as recency of discontinuation of hormone replacement therapy (HRT) influences...

  15. Data Decision and Drug Therapy Based on Non-Small Cell Lung Cancer in a Big Data Medical System in Developing Countries

    Directory of Open Access Journals (Sweden)

    Jia Wu

    2018-05-01

    Full Text Available In many developing or underdeveloped countries, limited medical resources and large populations may affect the survival of mankind. The research for the medical information system and recommendation of effective treatment methods may improve diagnosis and drug therapy for patients in developing or underdeveloped countries. In this study, we built a system model for the drug therapy, relevance parameter analysis, and data decision making in non-small cell lung cancer. Based on the probability analysis and status decision, the optimized therapeutic schedule can be calculated and selected, and then effective drug therapy met