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  1. European AIDS Clinical Society Standard of Care meeting on HIV and related coinfections: The Rome Statements

    NARCIS (Netherlands)

    Mussini, C.; Antinori, A.; Bhagani, S.; Branco, T.; Brostrom, M.; Dedes, N.; Bereczky, T.; Girardi, E.; Gökengin, D.; Horban, A.; Lacombe, K.; Lundgren, J. D.; Mendao, L.; Mocroft, A.; Oprea, C.; Porter, K.; Podlekareva, D.; Battegay, M.; d'Arminio Monforte, A.; Mulcahy, Fiona; Geretti, Anna Maria; Clumeck, Nathan; Reiss, Peter; Arribas, Jose; Gatell, Jose; Katlama, Christine; Pozniak, Anton; Rockstroh, Jürgen; Youle, Mike; Friis-Møller, Nina; Rusconi, Stefano; Behrens, Georg; de Wit, Stéphane; Furrer, Hansjakob; Wensing, Annemarie; John Gill, M.; Letendre, Scott

    2016-01-01

    The objective of the 1st European AIDS Clinical Society meeting on Standard of Care in Europe was to raise awareness of the European scenario and come to an agreement on actions that could be taken in the future. Data-driven presentations were given on specific topics followed by interactive panel

  2. European AIDS Clinical Society Standard of Care meeting on HIV and related coinfections : The Rome Statements

    NARCIS (Netherlands)

    Mussini, C.; Antinori, A.; Bhagani, S.; Branco, T.; Brostrom, M.; Dedes, N.; Bereczky, T.; Girardi, E.; Gökengin, D.; Horban, A.; Lacombe, K.; Lundgren, J. D.; Mendao, L.; Mocroft, A.; Oprea, C.; Porter, K.; Podlekareva, D.; Battegay, M.; d'Arminio Monforte, A.; Mulcahy, Fiona; Geretti, Anna Maria; Clumeck, Nathan; Reiss, Peter; Arribas, Jose; Gatell, Jose; Katlama, Christine; Pozniak, Anton; Rockstroh, Jürgen; Youle, Mike; Friis-Møller, Nina; Rusconi, Stefano; Behrens, Georg; De Wit, Stéphane; Furrer, Hansjakob; Wensing, Annemarie|info:eu-repo/dai/nl/30817724X; John Gill, M.; Letendre, Scott

    2016-01-01

    Objectives: The objective of the 1st European AIDS Clinical Society meeting on Standard of Care in Europe was to raise awareness of the European scenario and come to an agreement on actions that could be taken in the future. Methods: Data-driven presentations were given on specific topics followed

  3. European AIDS Clinical Society Standard of Care meeting on HIV and related coinfections

    DEFF Research Database (Denmark)

    Mussini, C; Antinori, A; Bhagani, S

    2016-01-01

    diagnosed multi-drug-resistant cases. Hepatitis C is widespread in selected geographical areas and risk groups. CONCLUSIONS: The key conclusion from the meeting was that a high-priority group of actions could be identified, including: increasing HIV awareness and testing, improving training for health care......OBJECTIVES: The objective of the 1st European AIDS Clinical Society meeting on Standard of Care in Europe was to raise awareness of the European scenario and come to an agreement on actions that could be taken in the future. METHODS: Data-driven presentations were given on specific topics followed...... by interactive panel discussions. RESULTS: In Eastern European countries, the epidemic is largely driven by injecting drug use, in contrast with Western Europe where the infection mainly occurs through heterosexual contact. A high proportion of people living with HIV remain unaware of their infection...

  4. European AIDS Clinical Society Second Standard of Care Meeting, Brussels 16-17 November 2016

    DEFF Research Database (Denmark)

    De Wit, S; Battegay, M; D'Arminio Monforte, A

    2017-01-01

    The European AIDS Clinical Society (EACS) organized a second meeting on Standard of Care in Europe on November 16-17 th, 2016. The aims of the meeting were to discuss and propose actions on three topics, namely: Adherence to guidelines for treatment initiation, treatment monitoring and outcomes......, Retention in care and HIV and tuberculosis co-infection. Several actions need to be implemented in order to further improve quality of care and treatment of HIV in Europe. A common ground for standard of care, based on the EACS Guidelines should be established throughout Europe. EACS plans to interact....... Improving integration of services and accessibility to care play a major role. Integration is also key for optimizing care of HIV-tuberculosis co-infection, as well as diagnosis and prevention of tuberculosis in population at risk. The Standard of Care meeting organized every other year by EACS provides...

  5. Essentials from the 2015 European AIDS Clinical Society (EACS) guidelines for the treatment of adult HIV-positive persons

    NARCIS (Netherlands)

    Ryom, L.; Boesecke, C.; Gisler, V.; Manzardo, C.; Rockstroh, J. K.; Puoti, M.; Furrer, H.; Miro, J. M.; Gatell, J. M.; Pozniak, A.; Behrens, G.; Battegay, M.; Lundgren, J. D.; Lundgren, Jens D.; Ryom, Lene; Gatell, José M.; Pozniak, Anton; Manzardo, Christian; Monforte, Antonella d'Arminio; Arribas, José; Battegay, Manuel; Clumeck, Nathan; Dedes, Nikos; Geretti, Anna Maria; Horban, Andrzej; Katlama, Christina; McCormack, Sheena; Molina, Jean-Michel; Mussini, Cristina; Raffi, François; Reiss, Peter; Stellbrink, Hans-Jürgen; Behrens, Georg; Bower, Mark; Cinque, Paola; Collins, Simon; Compston, Juliet; Deray, Gilbert; de Wit, Stéphane; Fux, Christoph A.; Guraldi, Giovanni; Mallon, Patrick; Martinez, Esteban; Marzolini, Catia; Papapoulos, Socrates; Du Pasquier, Renaud; Poulter, Neil; Williams, Ian; Winston, Alan; Rockstroh, Jürgen K.; Puoti, Massimo; Boesecke, Christoph; Bhagani, Sanjay; Bruno, Raffaele; Konov, Svilen; Lacombe, Karine; Mauss, Stefan; Mendao, Luis; Peters, Lars; Rauch, Andri; Tural, Cristina; Furrer, Hansjakob; Miro, Jose M.; Gisler, Valentin; Fätkenkeuer, Gerd; Kirk, Ole; Mocroft, Amanda; Morlat, Philippe; Volny-Anne, Alain; Mulcahy, Fiona; Katlama, Christine; Oprea, Cristiana; Youle, Mike

    2016-01-01

    BackgroundThe European AIDS Clinical Society (EACS) guidelines are intended for all clinicians involved in the care of HIV-positive persons, and are available in print, online, and as a free App for download for iPhone and Android. Guideline highlightsThe 2015 version of the EACS guidelines contains

  6. Epidemiology of cryptosporidiosis among European AIDS patients

    DEFF Research Database (Denmark)

    Pedersen, C; Danner, S; Lazzarin, A

    1996-01-01

    OBJECTIVE: To study epidemiology and possible risk factors associated with the development of cryptosporidiosis among European patients with AIDS. METHODS: An inception cohort of 6548 patients with AIDS, consecutively diagnosed from 1979 to 1989, from 52 centres in 17 European countries was studied....... Data on all AIDS defining events were collected retrospectively from patients' clinical records. Kaplan-Meier estimates, log rank tests and Cox proportional hazard models were used to examine for possible risk factors associated with cryptosporidiosis. RESULTS: Cryptosporidiosis was diagnosed in 432 (6.......6%) patients, 216 at time of the AIDS diagnosis and 216 during follow-up. The probability of being diagnosed with cryptosporidiosis at AIDS diagnosis was significantly lower for intravenous drug users (1.3%) than for homosexual men (4.1%) and for patients belonging to other transmission categories (4.0%) (p...

  7. [AIDS prevention in European prisons].

    Science.gov (United States)

    Schaller, G; Harding, T W

    1995-01-01

    Informations on HIV/AIDS in prisons which include 32 prison-systems in 17 European countries have been collected. The principle of equivalence of preventive measures and health care between prisons and the outside community, prison authorities should strive to prevent HIV transmission in prisons. There have been major developments in effective prevention programmes in the community, there has been less progress within the prison-systems. Information on AIDS is provided to prisoners in almost all prison-systems. While condom distribution is practiced in a growing number of systems, no prison systems have adopted syringes/needle distribution or exchange during incarceration. A few system have accepted distribution of a disinfectant (diluted bleach) with instruction on cleaning injection materials. Despite clear recommendations made by international bodies in 1987/88, it must be concluded that discrimination and segregation (restriction from access to workshops, specially work in kitchens) remain widespread in 1992.

  8. HIV/AIDS Clinical Trials Fact Sheet

    Science.gov (United States)

    ... AIDS Drugs Clinical Trials Apps skip to content HIV Overview Home Understanding HIV/AIDS Fact Sheets HIV/ ... 4 p.m. ET) Send us an email HIV/AIDS Clinical Trials Last Reviewed: August 25, 2017 ...

  9. Epidemiology of cryptosporidiosis among European AIDS patients

    DEFF Research Database (Denmark)

    Pedersen, C; Danner, S; Lazzarin, A

    1996-01-01

    .6%) patients, 216 at time of the AIDS diagnosis and 216 during follow-up. The probability of being diagnosed with cryptosporidiosis at AIDS diagnosis was significantly lower for intravenous drug users (1.3%) than for homosexual men (4.1%) and for patients belonging to other transmission categories (4.0%) (p...... for intravenous drug users than for homosexual men (relative risk 0.34, 95% confidence limits 0.22-0.54) and for women compared with men (RR 0.43 (0.21-0.87)). The risk was higher in North Europe than in South and Central Europe. In a multivariate analysis only transmission category remained a significant...... predictor for the development of cryptosporidiosis. CONCLUSION: The development of cryptosporidiosis in AIDS patients may be associated with sexual risk behaviour....

  10. The European Prader-Willi Syndrome Clinical Research Database: An Aid in the Investigation of a Rare Genetically Determined Neurodevelopmental Disorder

    Science.gov (United States)

    Holland, A.; Whittington, J.; Cohen, O.; Curfs, L.; Delahaye, F.; Dudley, O.; Horsthemke, B.; Lindgren, A. -C.; Nourissier, C.; Sharma, N.; Vogels, A.

    2009-01-01

    Background: Prader-Willi Syndrome (PWS) is a rare genetically determined neurodevelopmental disorder with a complex phenotype that changes with age. The rarity of the syndrome and the need to control for different variables such as genetic sub-type, age and gender limits clinical studies of sufficient size in any one country. A clinical research…

  11. European Union and EDCTP strategy in the global context: recommendations for preventive HIV/AIDS vaccines research

    NARCIS (Netherlands)

    Lehner, Thomas; Hoelscher, Michael; Clerici, Mario; Gotch, Frances; Pedneault, Louise; Tartaglia, Jim; Gray, Clive; Mestecky, Jiri; Sattentau, Quentin; van de Wijgert, Janneke; Toure, Coumba; Osmanov, Saladin; Schmidt, Reinold E.; Debre, Patrice; Romaris, Manuel; Hoeveler, Arnd; Di Fabio, Simonetta

    2005-01-01

    The European Commission (EC) has strong commitments and recognises the need to continue to ensure that HIV/AIDS research efforts receive global attention. The EC is facing this challenge in a global context and has made substantial investments together with European Developing Countries Clinical

  12. Clinical reasons for returning hearing aids.

    Science.gov (United States)

    Hong, Ju Young; Oh, In-Hwan; Jung, Tae Suk; Kim, Tae Hyun; Kang, Ho Min; Yeo, Seung Geun

    2014-04-01

    Increases in older aged populations and exposure to complicated noise environments have increased the number of hearing-impaired patients, creating greater demands for hearing aids. We have assessed the reasons that individuals rejected wearing and returned properly prescribed hearing aids, as well as differences in individual factors between younger and elderly adults. Of 1138 patients for whom hearing aids were prescribed at Kyung Hee University Medical Center Hearing Aid Clinic, 81 (6.14%) returned their hearing aids, including 36 patients aged hearing-related, and hearing aid-related factors were assessed by retrospective chart analysis and phone survey and compared in the two groups. The primary symptoms reported by the 81 patients who returned their hearing aids were hearing disturbance, ringing, and fullness in the ear, in that order and in both groups. The rate of hearing aid return was similar in elderly females and males (p=0.288). The spondee recognition threshold was significantly higher in younger than in elderly adults (63.3±14.0 dB vs. 55.6±14.74 dB, p=0.019), but the hearing aid return rate was highest in patients with moderate hearing loss in both groups. In evaluating the reasons for return of hearing aids, we found that ineffectiveness of the device was the most frequent reason, accounting for 32.0% of returns, the highest percentage in both groups, with the most frequent patient problem caused by management difficulty in elderly and financial difficulty in younger adults. The reasons for hearing aid return were different in two groups. Financial considerations were cited more by younger adults, while difficulties in managing hearing aids were cited more frequently by elderly adults. Patients in both groups, however, reported that the most frequent reasons for return were inadequate hearing improvement and inconvenience wearing the hearing aid due to noise amplification.

  13. The normalization of AIDS in Western European countries.

    Science.gov (United States)

    Rosenbrock, R; Dubois-Arber, F; Moers, M; Pinell, P; Schaeffer, D; Setbon, M

    2000-06-01

    The occurrence of AIDS led in every Western European country to exceptional innovations in prevention, patient care, health policy and questions of civil rights. This exception can be explained above all by the fact that not only was a health catastrophe feared but also civilizational harm in the field of civil rights. Despite national differences, this brought about similar exceptionalist alliances consisting of health professionals, social movements and those affected. With the failure of a catastrophe to arise, signs of fatigue in the exceptionalist alliance and increasing possibilities of medical treatment, exceptionalism in Europe is drawing to a close. Four phases are distinguished between in this process, given nationally different patterns of development: Approx. 1981-1985: emergence of exceptionalism. The reasons underlying exceptionalism are investigated. Approx. 1986-1991: consolidation and performance of exceptionalism. The investigation centers on the exceptionalist policy model. Approx. 1991-1996: exceptionalism crumbling, steps toward normalization. The forces driving the process of normalization are investigated. Since 1996: normalization, normality. The forms and perspectives of the changes made in the management of HIV and AIDS are elucidated using examples from the fields of health care, primary prevention and drug policies. AIDS health-policy innovations, their risks and opportunities in the course of normalization are investigated. Three possible paths of development are identified: stabilization, generalization and retreat. The chances of utilizing innovations developed in connection with AIDS for the modernization of health policy in other fields of prevention and patient care vary from country to country with the degree to which AIDS exceptionalism has been institutionalized and the distance of these innovations from medical, therapeutic events.

  14. European and Developing Countries Clinical Trials Partnership (EDCTP): the path towards a true partnership

    OpenAIRE

    Ofori-Adjei David; Zijenah Lynn; Ndounga Mathieu; Ambene Herman PA; Kitua Andrew Y; Jaoko Walter G; Corrah Tumani; Ndumbe Peter M; Manyando Christine; Matee Mecky I; Agwale Simon; Shongwe Steven; Nyirenda Thomas; Makanga Michael

    2009-01-01

    Abstract Background European and Developing Countries Clinical Trials Partnership (EDCTP) was founded in 2003 by the European Parliament and Council. It is a partnership of 14 European Union (EU) member states, Norway, Switzerland, and Developing Countries, formed to fund acceleration of new clinical trial interventions to fight the human immunodeficiency virus and acquired immune deficiency syndrome (HIV/AIDS), malaria and tuberculosis (TB) in the sub-Saharan African region. EDCTP seeks to b...

  15. A European Approach to Clinical Investigator Training

    Directory of Open Access Journals (Sweden)

    Jean-Marie eBoeynaems

    2013-09-01

    Full Text Available A better education and training of clinical investigators and their teams is one of the factors that could foster the development of clinical research in Europe, a key objective of the Innovative Medicines Initiative (IMI. PharmaTrain (an IMI programme on training in medicines development and ECRIN (European Clinical Research Infrastructures Network have joined forces to address this issue. An advisory group composed of representatives of universities, pharmaceutical companies and other organisations met four times between June 2011 and July 2012. This resulted in a position paper proposing a strategy to improve and harmonize clinical investigator training in Europe, and including a detailed syllabus and list of learning outcomes. Major recommendations are the establishment of minimal and mutually recognized certification requirement for investigators throughout the EU and the creation of a European platform to provide a suitable course and examination infrastructure.

  16. STATE AID EVOLUTION OVERVIEW IN EUROPEAN UNION CONTEXT DURING THE PERIOD 2007-2012

    Directory of Open Access Journals (Sweden)

    Anca D.B., DODESCU

    2014-11-01

    Full Text Available According to the European Union point of view, the fundamental principle of state aid is to ensure that inside the single market, competition is not distorted. In this context, by exception state aid can be justified when they contribute to achieving EU's social and economic goals. This may take place when market forces obstruct the achieving of the proposed objectives or permit their achieving on unacceptable long terms and costs. This article is structured in four parts, focusing on European Union's vision regarding state aid measures. The first part of the article refers to the general context of state aid in EU. The second part of the article tries to define this concept according to European Commission point of view and also studies the state aid information provided by the EU, through its benchmarking instrument regarding state aid expenditure called State Aid Scoreboard. The third part of the article mainly presents the EU state aid evolution during the period 2007 - 2012 and establishes a methodological point of view in order to classify and divide state aid in two main categories: non-crisis state aid and crisis state aid, with the purpose of avoiding the distortion trends regarding state aid expenditure granted for the financial sector. This part of the article also presents different types of state aid at EU27 level and granted by the selected member states (Romania, Hungary, Bulgaria and Germany between 2007 and 2012 and also analysis horizontal aid, sectorial aid and state aid during the economic crisis 2008 - 2012, referring to recapitalization and asset relief measures and guarantees and liquidity measures. The last part of the article presents the conclusions and also states certain recommendations regarding EU state aid practices, based on the results obtained.

  17. Deprivation and AIDS in a southern European city: different patterns across transmission group.

    Science.gov (United States)

    Brugal, M Teresa; Borrell, Carme; Díaz-Quijano, Estela; Pasarín, M Isabel; García-Olalla, Patricia; Villalbí, Joan R

    2003-09-01

    To analyse deprivation and AIDS among three AIDS transmission groups (men who have sex with men--MSM, heterosexuals, and intravenous drug users--IDUs) in Barcelona, Spain, during the period 1990-95. This is an ecological study, the unit of analysis being the neighbourhoods. Included were AIDS cases residents in Barcelona. The association among AIDS rate and deprivation was studied using Spearman correlation coefficients and Poisson regression. For MSM, inner city neighbourhood residence meant a greater risk of AIDS; but lower educational level was inversely related with AIDS rates. For heterosexuals, variables related with AIDS rates were younger age, inner city areas and social unrest for women, and extreme poverty for men. Among UDIs variables related with AIDS were unemployment and social unrest for both sexes. The association between AIDS rates and deprivation differs across transmission groups in a southern European city.

  18. [European Union funds and clinical toxicology].

    Science.gov (United States)

    Wiszniewiecka, Monika; Cejrowski, Daniel; Sein Anand, Jacek

    2015-01-01

    Since 2014 we are heading the third programming period of help from European Union (EU). The new budget will run until 2020. From common resources of EU, 106 billion euro will reach Poland, of which about 82.3 billion to cohesion policy, levelling differences of regional development. Clinical toxicology centres will be able to apply for funding under the allocation for the health service. Polish health service very actively benefited from EU funds in previous programming periods, between 2004-2006, and 2007-2013. Thanks to grants from the EU, a large number of health centres were built or renovated. Unfortunately the needs of hospitals, which were underinvested for many years, exceeded available funds according to UE programmes. Except investment projects, also projects training of health professionals were executed. In the current programming period European Union will still support projects aimed at health service. Clinical toxicology centres should have a try of using this period to fulfil their plans.

  19. Foreign Aid, FDI and Economic Growth in East European Countries

    OpenAIRE

    Kamal Upadhyaya; Gyan Pradhan; Dharmendra Dhakal; Rabindra Bhandari

    2007-01-01

    This paper examines the effectiveness of foreign aid and foreign direct investment in the Czech Republic, Estonia, Hungary, Latvia, Lithuania and Poland. The model includes the labor force, capital stock, foreign aid and foreign direct investment, and is estimated using pooled annual time series data from 1993 to 2002. Before carrying out the estimation, the time series properties of the data are diagnosed and an error-correction model is developed and estimated using a fixed-effects estimato...

  20. Is HIV-2- induced AIDS different from HIV-1-associated AIDS? Data from a West African clinic

    NARCIS (Netherlands)

    Martinez-Steele, Euridice; Awasana, Akum Aveika; Corrah, Tumani; Sabally, Saihou; van der Sande, Marianne; Jaye, Assan; Togun, Toyin; Sarge-Njie, Ramu; McConkey, Samuel J.; Whittle, Hilton; Schim van der Loeff, Maarten F.

    2007-01-01

    Although AIDS is less frequent following HIV-2 than HIV-1 infection, it is unclear whether the clinical picture and clinical course of AIDS are similar in the two infections. To compare the pattern of AIDS-defining events, CD4 cell count at the time of AIDS diagnosis, survival from time of AIDS, and

  1. The acute AIDS abdomen – a prospective clinical and pathological ...

    African Journals Online (AJOL)

    Objectives: Patients with AIDS who present with an acute abdomen pose a new challenge to surgeons. The purpose of this study was to determine the nature and outcome of intra-abdominal catastrophes in AIDS patients. Methods: A prospective clinical study was conducted on HIV-positive patients who presented with an ...

  2. Paediatrics hiv/aids: Clinical presentation and practical ...

    African Journals Online (AJOL)

    Paediatrics hiv/aids: Clinical presentation and practical management Challenges in Sokoto, Nigeria. ... Abstract. Background: Implications of continuing HIV/AIDS pandemic in Nigeria is very grave for children. Lack of ... Thirty- six (87.8%) patients had protein – energy malnutrition (PEM), marasmus constituting 58%.

  3. [ECRIN (European clinical research infrastructures network), a pan-European infrastructure for clinical research].

    Science.gov (United States)

    Demotes-Mainard, Jacques

    2010-12-01

    Clinical research plays a key role both in the development of innovative health products and in the optimisation of medical strategies, leading to evidence-based practice and healthcare cost containment. ECRIN is a distributed ESFRI-roadmap pan-European infrastructure designed to support multinational clinical research, making Europe a single area for clinical studies, taking advantage of its population size to access patients, and unlocking latent scientific providing services to multinational. Servicing of multinational trials started during the preparatory phase, and ECRIN has applied for ERIC status in 2011. In parallel, ECRIN has also proposed an FP7 integrating activity project to further develop, upgrade and expand the ECRIN infrastructure built up during the past FP6 and FP7 projects, facilitating an efficient organization of clinical research in Europe, with ECRIN developing generic tools and providing generic services for multinational studies, and supporting the construction of pan-European disease-oriented networks that will in turn act as ECRIN users. This organization will improve Europe's attractiveness for industry trials, boost its scientific competitiveness, and result in better healthcare for European citizens. The three medical areas supported in this project (rare diseases, medical devices, and nutrition) will serve as pilots for other biomedical research fields. By creating a single area for clinical research in Europe, this structure will contribute to the implementation of the Europe flagship initiative 2020 'Innovation Union', whose objectives include defragmentation of research and educational capacities, tackling the major societal challenges (starting with healthy aging), and removing barriers to bringing ideas to the market.

  4. European clinical guidelines for hyperkinetic disorder -- first upgrade

    NARCIS (Netherlands)

    Taylor, E.; Dopfner, M.; Sergeant, J.A.; Asherson, P.; Banaschewski, T.; Coghill, D.; Danckaerts, M.; Rothenberger, A.; Sonuga-Barke, E.; Steinhausen, H.C.; Zuddas, A.

    2004-01-01

    BACKGROUND: The validity of clinical guidelines changes over time, because new evidence-based knowledge and experience develop. OBJECTIVE: Hence, the European clinical guidelines on hyperkinetic disorder from 1998 had to be evaluated and modified. METHOD: Discussions at the European Network for

  5. Clinical and epidemiological features of AIDS/tuberculosis comorbidity

    Directory of Open Access Journals (Sweden)

    Song Alice Tung Wan

    2003-01-01

    Full Text Available Considering the relevance of AIDS/tuberculosis comorbidity worldwide, especially in Brazil, this study was developed to describe the clinical and epidemiological features of the comorbid cases identified from 1989 to 1997 by the epidemiology service of the Hospital das Clínicas of the Universidade de São Paulo. METHODS: Databases containing information on all identified AIDS/tuberculosis cases cared for at the hospital were used to gather information on comorbid cases. RESULTS: During the period, 559 patients were identified as presenting with AIDS/tuberculosis comorbidity. Risk behavior for AIDS was primarily heterosexual contact (38.9%, followed by intravenous drug use (29.3% and homosexual/bisexual contact (23.2%. Regarding clinical features, there were higher rates of extrapulmonary tuberculosis when compared to tuberculosis without comorbidity. There was an increase in reporting of AIDS by ambulatory units during the period. Epidemiologically, there was a decrease in the male/female ratio, a predominance in the 20 to 39 year-old age group, and a majority of individuals who had less than 8 years of schooling and had low professional qualifications. CONCLUSIONS: High rates of AIDS/tuberculosis cases at our hospital indicate the need for better attention towards early detection of tuberculosis, especially in its extrapulmonary form. Since the population that attends this hospital tends to be of a lower socioeconomic status, better management of AIDS and tuberculosis is required to increase the rates of treatment adherence and thus lower the social costs.

  6. CLINICAL DESCRIPTION AND DIAGNOSIS OF HIV/AIDS

    Directory of Open Access Journals (Sweden)

    Suryono Suryono

    2014-01-01

    Full Text Available Infections ofHIV/AIDS currently has become very serious problems for the world health. In the country the first case ofHIV/AIDS was discovered in Bali in 1987, in its progress has not the meaning but after 1985 HIV transmission increased considerably. The complex problem that the living and the increasing number ofcases should indeed, medical practitioners understand more the clinical and how to diagnose infections ofHIV/AIDS. A snapshot ofthe clinical HIV infection/aids can be seen from grievances and a disease that often accompanies it, a complaint which is found at HIV/AIDS sufferers in the form of suds retroviral acute: fever, weight loss, diarrhea chronic, disphagi, limpadenopati, infections in the skin respiratory disorders and nervous breakdown center. While a disease that often been gained by those with HIV / AIDS as candidiasis, tuberculosis, pneumonia bakterialis, toksoplasmosis and pneumonia pneumocystic carinii. Diagnose HIV infection created based on clinical symptoms which includes major symptoms and symptoms of minor, and the result ofthe examination ofthe laboratory.

  7. The European Federation of Clinical Chemistry and Laboratory Medicine.

    Science.gov (United States)

    Hallworth, Mike

    2010-01-01

    Laboratory medicine is at the heart of modern health care and diagnosis and effective treatment of patients is impossible without high-quality bioanalytical services. The European Federation of Clinical Chemistry and Laboratory Medicine is a professional federation working to ensure high standards across the discipline in all European countries. This article describes our work in science, education and professional development.

  8. Constraints on Aid Conditionality: The case of the European Commission and the Palestinian Authority

    Directory of Open Access Journals (Sweden)

    Guy Burton

    2012-07-01

    Full Text Available Donors tend to be perceived as more powerful actors than the recipients in relation to foreign aid. However, this article presents a contrary example through the donor-recipient relationship between the European Commission (EC and the Palestinian Authority (PA during 2006-07. Drawing on previous scholarship and the EC-PA case, the article notes the roles played by recipients, third parties and donors in limiting conditionality. In addition to these actor-oriented explanations, the article draws attention to the constraining effect that structure (in the form of constant and changing local political contexts and actor preferences can play to limit aid conditionality. The article concludes with an observation on the continuing relevance of conditionality in general and a recommendation for further research on the role of structure in limiting conditions in relation to aid.

  9. AIDS--safety practices for clinical and research laboratories.

    Science.gov (United States)

    Federico, J V; Gershon, R R

    1984-04-01

    Acquired immunodeficiency syndrome, or AIDS, is currently a significant health problem receiving widespread interest as both cause and treatment are sought. Indications are that a transmissible agent is involved. Both clinical and research laboratories are receiving greater numbers of specimens from AIDS patients as both prevalence of the condition increases and research efforts intensify. Until such time as the causative agent is identified, prudent practice warrants that a high level of precaution be observed. The Division of Occupational and Environmental Health Services of the Yale University Health Services presents a set of safety procedures and guidelines for use by personnel of both clinical and research laboratory facilities. These exceed previously suggested containment recommendations.

  10. Mortality After Clinical Management of Aids-Associated Cryptococcal ...

    African Journals Online (AJOL)

    Mortality After Clinical Management of Aids-Associated Cryptococcal Meningitis in Kenya. ... Conversely, a minimum of two weeks of amphotericin B treatment (P < 0.001), initiation of ART (P = 0.007) and monitoring of creatinine and electrolyte levels (P = 0.02) were significantly associated with survival in the univariate ...

  11. mortality after clinical management of aids-associated cryptococcal ...

    African Journals Online (AJOL)

    2014-05-01

    May 1, 2014 ... MORTALITY AFTER CLINICAL MANAGEMENT OF AIDS-ASSOCIATED CRYPTOCOCCAL MENINGITIS IN KENYA. R.Baldassarre, MD ... Background: Cryptococcal meningitis (CM) is an increasingly prevalent infection ... two weeks of amphotericin B treatment (P < 0.001), initiation of ART (P = 0.007) and.

  12. Adjunctive corticosteroid therapy for Pneumocystis carinii pneumonia in AIDS: a randomized European multicenter open label study

    DEFF Research Database (Denmark)

    Nielsen, T L; Eeftinck Schattenkerk, J K; Jensen, B N

    1992-01-01

    Fifty-nine human immunodeficiency virus type-1-infected patients with a microscopically proven first episode of moderate to severe Pneumocystis carinii pneumonia (PCP) were enrolled into a randomized European multicenter study. The effect of adjunctive corticosteroid (CS) therapy was assessed on (a...... (10%) in the CS group; p = 0.01. The 90-day survival was 69% in controls versus 87% in CS patients; p = 0.07. Based on these data we conclude that adjunctive CS therapy for moderate to severe PCP in AIDS patients reduces the acute mortality and the need for mechanical ventilation....

  13. Economic impact of HIV/AIDS: a systematic review in five European countries.

    Science.gov (United States)

    Trapero-Bertran, Marta; Oliva-Moreno, Juan

    2014-12-01

    The HIV/AIDS disease represent a priority for all health authorities in all countries and it also represents serious added socioeconomic problems for societies over the world. The aim of this paper is to analize the economic impact associated to the HIV/AIDS in an European context. We conducted a systematic literature review for five different countries (France, Germany, Italy, Spain and United Kingdom) and searched five databases. Three types of analyses were undertaken: descriptive statistics; quantitative analysis to calculate mean costs; and comparison across countries. 26 papers were included in this study containing seventy-six cost estimates. Most of the studies analyzed the health care cost of treatment of HIV/AIDS. Only 50% of the cost estimates provided mean lymphocyte count describing the patients' disease stage. Approximately thirty percent of cost estimates did not indicate the developmental stage of the illness in the patients included. There is a high degree of variability in the estimated annual cost per patient of the treatments across countries. There is also a great disparity in total healh care costs for patients with lymphocyte counts between 200CD4+/mm3 and 500 CD4/mm3, although the reason of variation is unclear. In spite of the potential economic impact in terms of productivity losses and cost of formal and informal care, few studies have set out to estimate the non-medical costs of HIV/AIDS in the countries selected. Another important result is that, despite the low HIV/AIDS prevalence, its economic burden is very relevant in terms of the total health care costs in this five countries. This study also shows that there are relatively few studies of HIV costs in European countries compared to other diseases. Finally, we conclude that the methodology used in many of the studies carried out leaves ample room for improvement and that there is a need for these studies to reflect the economic impact of HIV/AIDS beyond health care including other

  14. European Aid to Foreign Countries in Emergencies - Are ECHO and the EU Large-Donor Countries on the Same Track?

    Directory of Open Access Journals (Sweden)

    Fulvio Attinà

    2014-09-01

    Full Text Available The paper analyses financial aid given by the richest countries of the European Union and by ECHO (European Commission’s Humanitarian Aid and Civil Protection Department to six geographical groups of countries. It aims at advancing existing knowledge about the relevance of enabling conditions and the importance of general interest and self-interest to emergency aid. In political science, explanation focuses on economic power and political interest as, respectively, the enabling condition and the contingent reason for aid. The paper analyses the ECHO/EDRIS dataset which weakly supports the enabling conditions explanation and disconfirms the geopolitical interest explanation. The large similarity of the data of the emergency aid policies of the most rich EU MSs requests further study about the EU countries’ preference for funding assistance directly to a larger extent than through the EU’s programs, and about keeping foreign assistance as shared competence in the EU system.

  15. Yeasts isolated from clinical samples of AIDS patients

    Directory of Open Access Journals (Sweden)

    Neves Rejane Pereira

    2002-01-01

    Full Text Available In order to investigate yeasts in oropharyngeal secretion, urine, sputum and inguinal scales from AIDS patients, clinical samples were collected from one hundred patients interned in the Infectious and Parasitic Diseases Sector of the Hospital das Clínicas of the Universidade Federal de Pernambuco and in Hospital Universitário Osvaldo Cruz of the Universidade de Pernambuco. Yeasts were isolated from seventy-two out of one hundred and eight clinical samples. The isolated yeasts were: Candida albicans (sixty-two isolates, Candida tropicalis (four isolates, Candida glabrata (two isolates, Candida parapsilosis (two isolates, Candida krusei (one isolate and Trichosporon pullulans (one isolate.

  16. Clinical features of HIV/AIDS patients with digestive diseases

    Directory of Open Access Journals (Sweden)

    YIN Fei

    2016-07-01

    Full Text Available ObjectiveTo analyze the clinical data of patients admitted with an initial diagnosis of digestive diseases who have human immunodeficiency virus (HIV/acquired immune deficiency syndrome (AIDS, and to guide clinical diagnosis. MethodsThe clinical data of HIV/AIDS patients who were hospitalized due to digestive system symptoms from January 1, 2013 to December 31, 2014 were collected, including epidemiological data, clinical symptoms and signs, auxiliary examinations, and complications. The features of each parameter were observed. The t-test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups. ResultsA total of 95 HIV/AIDS patients with digestive diseases were enrolled, and the male/female ratio was 1.4∶1. Among these patients, 57 (60% were aged 30-50 years, 85 (89.47% were Yi people, and 86 (90.53% were farmers. Of all patients, 46 (48.42% were infected via sexual transmission and 44 (46.32% were infected via intravenous drug use. In these patients, common clinical symptoms included abdominal pain (71.58%, pyrexia (43.16%, and diarrhea (17.89%, and common signs included ascites (28.42%, superficial lymphadenectasis (21.05%, and hepatosplenomegaly (16.84%. The auxiliary examination showed a significant increase in globulin. The proportion of patients with opportunistic infection reached 83.16%, mainly lung and digestive tract infections. Among the patients who underwent gastroscopy, 31.58% had mycotic esophagitis. Chronic non-atrophic gastritis, electrolyte disturbance, and intestinal obstruction were commonly seen in patients with noninfectious complications. Of all HIV/AIDS patients, 5474% (52/95 were complicated by HBV and/or HCV infection, and the liver function parameters globulin, total bilirubin, aspartate aminotransferase, alanine aminotransferase, and A/G showed significant differences between these patients and the patients with HIV infection

  17. Incorporating computer-aided language sample analysis into clinical practice.

    Science.gov (United States)

    Price, Lisa Hammett; Hendricks, Sean; Cook, Colleen

    2010-04-01

    During the evaluation of language abilities, the needs of the child are best served when multiple types and sources of data are included in the evaluation process. Current educational policies and practice guidelines further dictate the use of authentic assessment data to inform diagnosis and treatment planning. Language sampling and analysis (LSA) offers an important clinical tool for gathering such authentic assessment data, and computer-aided methods of LSA make it clinically feasible. The purpose of this tutorial is to provide step-by-step procedures for computer-aided LSA (CLSA). This tutorial includes instructions for a 4-step CLSA process: (a) eliciting a representative sample of the child's language and recording it directly onto the computer; (b) transcribing the language sample; (c) analyzing the language sample and interpreting the results using a readily available software program, Systematic Analysis of Language Transcripts (SALT; J. Miller & A. Iglesias, 2006); and (d) using the results to plan the child's treatment goals and activities. A case study is provided to illustrate this process. Digital technologies can dramatically improve the feasibility of LSA, potentially transforming clinical practice by providing a quantifiable but naturalistic measure of language. This tutorial will facilitate the integration of useful technologies into clinical practice and provide information regarding the application of CLSA data.

  18. Clinical risk factors for cytomegalovirus retinitis in patients with AIDS.

    Science.gov (United States)

    Hodge, William G; Boivin, Jean-François; Shapiro, Stanley H; Lalonde, Richard G; Shah, Kirtida C; Murphy, Bradley D; Dionne, Michel A; Goela, Aashish

    2004-07-01

    To determine the clinical risk factors for cytomegalovirus (CMV) retinitis in patients with AIDS. A case-control study. The study included 120 patients in whom CMV retinitis had been diagnosed from 1990 through 1999 (cases) and 159 patients without CMV retinitis from the same period (controls). All individuals had AIDS and CD4 counts less than 50 cells/microl at the time of diagnosis of retinitis in the cases or on the corresponding date for the controls. Clinical risk factors were determined by history or physical examination. Confounders controlled for included CD4 count, hospital center, and a series of variables to control for confounding by drug treatment. Statistical analysis was performed by multivariate logistic regression. A systematic model-building strategy was developed from assumption testing to model building to model checking. MAIN VARIABLES MEASURED: Presence of visual symptoms, retinal microinfarctions (cotton-wool spots), history of opportunistic infections, and risk factors for human immunodeficiency virus acquisition were determined and compared in both groups. The following clinical risk factors were significant predictors of CMV retinitis: flashing lights or floaters (odds ratio [OR], 11.42; 95% confidence interval [CI], 3.43 to 38.01), cotton-wool spots (OR, 2.90; 95% CI, 1.01 to 8.29), number of previous opportunistic infections (OR, 1.81; 95% CI, 1.24 to 2.64), previous nonocular CMV infection (OR, 82.99; 95% CI, 6.86 to 1004.58), previous Mycobacterium infection (OR, 3.41; 95% CI, 0.99 to 11.85), and homosexuality (OR, 2.83; 95% CI, 1.13 to 7.12). Based on this study, clinical variables have been identified that elevate the risk of CMV retinitis. These findings may be useful to clinicians and health policy experts in developing rational guidelines for screening, examination frequency, and targeted prophylaxis for CMV retinitis in patients with AIDS.

  19. [American and European legislation on bioethics evaluation of clinical experimentation].

    Science.gov (United States)

    Scuderi, G

    1998-01-01

    This paper describes the existing legislation for evaluating the bioethics of clinical trials (drug studies conducted on humans after completion of drug testing on animals). The legislation is presented in chronologic order; thus that of the United States is presented first, followed by a description of the European Union legislation, which includes a brief comment on Italian legislation. The rationale for informed consent and the specific requirements are addressed. Ethical committees are discussed in terms of their membership, responsibilities, and methods of revision. The paper concludes with a comparison between the USA and the European Union legislations.

  20. [Knowledge and attitudes of prison staff towards HIV/AIDS: a European study].

    Science.gov (United States)

    Rotily, M; Prudhomme, J; Pardal, M S; Hariga, F; Iandolo, E; Papadourakis, A; Moatti, J P

    2001-12-01

    The goal of this European pilot study was to evaluate the knowledge, attitudes and beliefs of prison staff from five countries towards HIV infection and to identify factors related to the potential discrimination of HIV-positive inmates. The survey revealed that the levels of knowledge with regard to HIV transmission and the degrees of tolerance varied significantly between prisons. A large proportion of staff overestimated the prevalence of HIV in their prison and feared being contaminated. The willingness of the staff to know the inmates' HIV seropositive status was negatively correlated to their level of tolerance; however, it was positively correlated to their knowledge of the modes of HIV transmission. This study underlines the necessity to improve HIV/AIDS prevention policy for prison staff in order to strengthen good practice in terms of managing the risk of contamination and hindering discrimination.

  1. Does the European Clinical Trials Directive really improve clinical trial approval time?

    NARCIS (Netherlands)

    Lambers Heerspink, Hiddo J.; Dobre, Daniela; Hillege, Hans L.; Grobbee, Diederick E.; de Zeeuw, Dick

    2008-01-01

    AIMS To facilitate and improve clinical research within Europe, the European Union (EU) adopted in 2001 the Clinical Trials Directive (EUCTD). The aim of this study was to compare duration between submission of a clinical drug trial application and approval by regulatory authorities in EU countries

  2. European registration process for Clinical Laboratory Geneticists in genetic healthcare.

    Science.gov (United States)

    Liehr, Thomas; Carreira, Isabel M; Aktas, Dilek; Bakker, Egbert; Rodríguez de Alba, Marta; Coviello, Domenico A; Florentin, Lina; Scheffer, Hans; Rincic, Martina

    2017-05-01

    Tremendous progress in genetics and genomics led to a wide range of healthcare providers, genetic tests, and more patients who can benefit from these developments. To guarantee and improve the quality of genetic testing, a unified European-based registration for individuals qualified in biomedicine was realized. Therefore a Europe-wide recognition of the profession 'European registered Clinical Laboratory Geneticist (ErCLG)' based on a syllabus of core competences was established which allows for harmonization in professional education. The 'European Board of Medical Genetics division - Clinical Laboratory Geneticist' provides now since 3 years the possibility to register as an ErCLG. Applicants may be from all European countries and since this year also from outside of Europe. Five subtitles reflect the exact specialty of each ErCLG, who can reregister every 5 years. A previously not possible statistics based on ~300 individuals from 19 countries as holders of an ErCLG title provides interesting insights into the professionals working in human genetics. It could be substantiated that there are around twice as many females than males and that a PhD title was achieved by 80% of registered ErCLGs. Also most ErCLGs are still trained as generalists (66%), followed by such ErCLGs with focus on molecular genetics (23%); the remaining are concentrated either on clinical (6%), tumor (4%) or biochemical genetics (1%). In conclusion, besides MDs and genetic counselors/nurses an EU-wide recognition system for Clinical Laboratory Geneticist has been established, which strengthens the status of specialists working in human genetic diagnostics in Europe and worldwide.

  3. Clinical highlights from the 2016 European Respiratory Society International Congress

    Directory of Open Access Journals (Sweden)

    Nicolas Kahn

    2017-04-01

    Full Text Available This article contains highlights and a selection of the scientific advances from the European Respiratory Society (ERS Clinical Assembly (Assembly 1 and its six respective groups (Groups 1.1–1.6 that were presented at the 2016 ERS International Congress in London, UK. The most relevant topics for clinicians will be discussed, covering a wide range of areas including clinical problems, rehabilitation and chronic care, thoracic imaging, interventional pulmonology, diffuse and parenchymal lung diseases, and general practice and primary care. In this comprehensive review, the newest research and actual data will be discussed and put into perspective.

  4. A European Spectrum of Pharmacogenomic Biomarkers: Implications for Clinical Pharmacogenomics.

    Directory of Open Access Journals (Sweden)

    Clint Mizzi

    Full Text Available Pharmacogenomics aims to correlate inter-individual differences of drug efficacy and/or toxicity with the underlying genetic composition, particularly in genes encoding for protein factors and enzymes involved in drug metabolism and transport. In several European populations, particularly in countries with lower income, information related to the prevalence of pharmacogenomic biomarkers is incomplete or lacking. Here, we have implemented the microattribution approach to assess the pharmacogenomic biomarkers allelic spectrum in 18 European populations, mostly from developing European countries, by analyzing 1,931 pharmacogenomics biomarkers in 231 genes. Our data show significant inter-population pharmacogenomic biomarker allele frequency differences, particularly in 7 clinically actionable pharmacogenomic biomarkers in 7 European populations, affecting drug efficacy and/or toxicity of 51 medication treatment modalities. These data also reflect on the differences observed in the prevalence of high-risk genotypes in these populations, as far as common markers in the CYP2C9, CYP2C19, CYP3A5, VKORC1, SLCO1B1 and TPMT pharmacogenes are concerned. Also, our data demonstrate notable differences in predicted genotype-based warfarin dosing among these populations. Our findings can be exploited not only to develop guidelines for medical prioritization, but most importantly to facilitate integration of pharmacogenomics and to support pre-emptive pharmacogenomic testing. This may subsequently contribute towards significant cost-savings in the overall healthcare expenditure in the participating countries, where pharmacogenomics implementation proves to be cost-effective.

  5. [Preliminary evaluation of clinical effect of computer aided design and computer aided manufacture zirconia crown].

    Science.gov (United States)

    Wang, Yu-guang; Xing, Yan-xi; Sun, Yu-chun; Zhao, Yi-jiao; Lü, Pei-jun; Wang, Yong

    2013-06-01

    To evaluate clinical effects of computer aided design and computer aided manufacturing (CAD/CAM) milled zirconia crown in three aspects: aesthetic, contact wear and fracture. Sixty patients were divided into two groups.In one group, 35 full contour CAD/CAM zirconia crown were made on molars of 30 patients. The manufacturing process of zirconia crown was as follow. First, the three dimensional(3-D) data of working models, antagonist impression and check records were acquired by 3-D laser scanning Dental wings S50. Then full contour zirconia crowns, which had functional occlusal contacts with antagonistic teeth, and appropriate contact with adjacent teeth were designed with Zeno-CAD(V4.2.5.5.12919) software. ZENOSTAR Zr pure zirconia material was milled in digital controlled machine WIELAND 4030 M1.In the end, the zirconia crown were completed with the method of second sintering and polishing. After clinical try-in, the crown was cemented.In the control group, thirty gold alloy full crown were made and cemented on molars of 30 patients. According to the modified U S Public Health Service Criteria(USPHS) evaluation standard, all crowns were evaluated on the same day, at three months, half a year, one year and two years following delivery. There were three aspects we were focusing on in the evaluation: aesthetic, contact wear(restoration and antagonist), and fracture. In all the prosthesis we evaluated during the 24 months, no fracture was found. Contact wear of crowns varies according to different antagonist teeth. The zirconia crowns show privilege in aesthesis, toughness and anti-wearing.However, there is contact wear on antagonistic natural teeth. Thus it is a good choice when full zirconia crowns are indicated on two antagonistic teeth in both jaws.

  6. Efficacy of 3 commonly used hearing aid circuits: A crossover trial. NIDCD/VA Hearing Aid Clinical Trial Group.

    Science.gov (United States)

    Larson, V D; Williams, D W; Henderson, W G; Luethke, L E; Beck, L B; Noffsinger, D; Wilson, R H; Dobie, R A; Haskell, G B; Bratt, G W; Shanks, J E; Stelmachowicz, P; Studebaker, G A; Boysen, A E; Donahue, A; Canalis, R; Fausti, S A; Rappaport, B Z

    2000-10-11

    Numerous studies have demonstrated that hearing aids provide significant benefit for a wide range of sensorineural hearing loss, but no carefully controlled, multicenter clinical trials comparing hearing aid efficacy have been conducted. To compare the benefits provided to patients with sensorineural hearing loss by 3 commonly used hearing aid circuits. Double-blind, 3-period, 3-treatment crossover trial conducted from May 1996 to February 1998. Eight audiology laboratories at Department of Veterans Affairs medical centers across the United States. A sample of 360 patients with bilateral sensorineural hearing loss (mean age, 67.2 years; 57% male; 78.6% white). Patients were randomly assigned to 1 of 6 sequences of linear peak clipper (PC), compression limiter (CL), and wide dynamic range compressor (WDRC) hearing aid circuits. All patients wore each of the 3 hearing aids, which were installed in identical casements, for 3 months. Results of tests of speech recognition, sound quality, and subjective hearing aid benefit, administered at baseline and after each 3-month intervention with and without a hearing aid. At the end of the experiment, patients ranked the 3 hearing aid circuits. Each circuit markedly improved speech recognition, with greater improvement observed for soft and conversationally loud speech (all 52-dB and 62-dB conditions, Phearing aid circuits more frequently (41.6%) than the WDRC (29.8%) and the PC (28.6%) (P =.001 for CL vs both WDRC and PC). Each circuit provided significant benefit in quiet and noisy listening situations. The CL and WDRC circuits appeared to provide superior benefits compared with the PC, although the differences between them were much less than the differences between the aided vs unaided conditions. JAMA. 2000;284:1806-1813.

  7. Computer-aided diagnosis and artificial intelligence in clinical imaging.

    Science.gov (United States)

    Shiraishi, Junji; Li, Qiang; Appelbaum, Daniel; Doi, Kunio

    2011-11-01

    Computer-aided diagnosis (CAD) is rapidly entering the radiology mainstream. It has already become a part of the routine clinical work for the detection of breast cancer with mammograms. The computer output is used as a "second opinion" in assisting radiologists' image interpretations. The computer algorithm generally consists of several steps that may include image processing, image feature analysis, and data classification via the use of tools such as artificial neural networks (ANN). In this article, we will explore these and other current processes that have come to be referred to as "artificial intelligence." One element of CAD, temporal subtraction, has been applied for enhancing interval changes and for suppressing unchanged structures (eg, normal structures) between 2 successive radiologic images. To reduce misregistration artifacts on the temporal subtraction images, a nonlinear image warping technique for matching the previous image to the current one has been developed. Development of the temporal subtraction method originated with chest radiographs, with the method subsequently being applied to chest computed tomography (CT) and nuclear medicine bone scans. The usefulness of the temporal subtraction method for bone scans was demonstrated by an observer study in which reading times and diagnostic accuracy improved significantly. An additional prospective clinical study verified that the temporal subtraction image could be used as a "second opinion" by radiologists with negligible detrimental effects. ANN was first used in 1990 for computerized differential diagnosis of interstitial lung diseases in CAD. Since then, ANN has been widely used in CAD schemes for the detection and diagnosis of various diseases in different imaging modalities, including the differential diagnosis of lung nodules and interstitial lung diseases in chest radiography, CT, and position emission tomography/CT. It is likely that CAD will be integrated into picture archiving and

  8. AIDS

    Science.gov (United States)

    ... smear to check for cancer of the anus Treatment HIV/AIDS is treated with medicines that stop the virus ... having a long-term illness. Outlook (Prognosis) With treatment, most people with HIV/AIDS can live a healthy and normal life. Current ...

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

    LENUS (Irish Health Repository)

    Keeling, Aoife N

    2009-05-01

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

  10. European and Developing Countries Clinical Trials Partnership (EDCTP: the path towards a true partnership

    Directory of Open Access Journals (Sweden)

    Ofori-Adjei David

    2009-07-01

    Full Text Available Abstract Background European and Developing Countries Clinical Trials Partnership (EDCTP was founded in 2003 by the European Parliament and Council. It is a partnership of 14 European Union (EU member states, Norway, Switzerland, and Developing Countries, formed to fund acceleration of new clinical trial interventions to fight the human immunodeficiency virus and acquired immune deficiency syndrome (HIV/AIDS, malaria and tuberculosis (TB in the sub-Saharan African region. EDCTP seeks to be synergistic with other funding bodies supporting research on these diseases. Methods EDCTP promotes collaborative research supported by multiple funding agencies and harnesses networking expertise across different African and European countries. EDCTP is different from other similar initiatives. The organisation of EDCTP blends important aspects of partnership that includes ownership, sustainability and responds to demand-driven research. The Developing Countries Coordinating Committee (DCCC; a team of independent scientists and representatives of regional health bodies from sub-Saharan Africa provides advice to the partnership. Thus EDCTP reflects a true partnership and the active involvement and contribution of these African scientists ensures joint ownership of the EDCTP programme with European counterparts. Results The following have been the major achievements of the EDCTP initiative since its formation in 2003; i increase in the number of participating African countries from two to 26 in 2008 ii the cumulative amount of funds spent on EDCTP projects has reached € 150 m, iii the cumulative number of clinical trials approved has reached 40 and iv there has been a significant increase number and diversity in capacity building activities. Conclusion While we recognise that EDCTP faced enormous challenges in its first few years of existence, the strong involvement of African scientists and its new initiatives such as unconditional funding to regional

  11. European and Developing Countries Clinical Trials Partnership (EDCTP): the path towards a true partnership.

    Science.gov (United States)

    Matee, Mecky I; Manyando, Christine; Ndumbe, Peter M; Corrah, Tumani; Jaoko, Walter G; Kitua, Andrew Y; Ambene, Herman Pa; Ndounga, Mathieu; Zijenah, Lynn; Ofori-Adjei, David; Agwale, Simon; Shongwe, Steven; Nyirenda, Thomas; Makanga, Michael

    2009-07-20

    European and Developing Countries Clinical Trials Partnership (EDCTP) was founded in 2003 by the European Parliament and Council. It is a partnership of 14 European Union (EU) member states, Norway, Switzerland, and Developing Countries, formed to fund acceleration of new clinical trial interventions to fight the human immunodeficiency virus and acquired immune deficiency syndrome (HIV/AIDS), malaria and tuberculosis (TB) in the sub-Saharan African region. EDCTP seeks to be synergistic with other funding bodies supporting research on these diseases. EDCTP promotes collaborative research supported by multiple funding agencies and harnesses networking expertise across different African and European countries. EDCTP is different from other similar initiatives. The organisation of EDCTP blends important aspects of partnership that includes ownership, sustainability and responds to demand-driven research. The Developing Countries Coordinating Committee (DCCC); a team of independent scientists and representatives of regional health bodies from sub-Saharan Africa provides advice to the partnership. Thus EDCTP reflects a true partnership and the active involvement and contribution of these African scientists ensures joint ownership of the EDCTP programme with European counterparts. The following have been the major achievements of the EDCTP initiative since its formation in 2003; i) increase in the number of participating African countries from two to 26 in 2008 ii) the cumulative amount of funds spent on EDCTP projects has reached 150 m euros, iii) the cumulative number of clinical trials approved has reached 40 and iv) there has been a significant increase number and diversity in capacity building activities. While we recognise that EDCTP faced enormous challenges in its first few years of existence, the strong involvement of African scientists and its new initiatives such as unconditional funding to regional networks of excellence in sub-Saharan Africa is envisaged to

  12. IMPLEMENTATION OF STATE AID POLICY FROM THE EUROPEAN UNION IN ROMANIA

    Directory of Open Access Journals (Sweden)

    Cristina BALDAN

    2012-12-01

    Full Text Available In 2009, the Competition Council's activity regarding the state aid field has considered Romania's obligations as a member state, and the fulfillment of some specific tasks by the competition authority acquired after January 1, 2007. In this regard, the Competition Council has encouraged the collaboration between institutions to develop projects of state aid schemes. In 2010 there were six major investment projects approved, four of them being in the photovoltaic sector in which three are in Germany, one is in Spain and the rest concern the mechanical industry in Germany and Italy. Also, there were approved five ad hoc aid measures in favor of individual enterprises, for investments in areas that are on the regional aid maps for the period 2007-2013, and ten aid schemes, of which five related to the outermost regions. In accordance with the guidelines on national regional aids for 2007-2013, the Commission developed a statistical evaluation of the situation of state aid and regional aid ceiling which received a transitional assisted area status under Article 107 paragraph 3 letters (a by the end of 2010. The Commission accepted the changes introduced by the three member states (France, Ireland and Italy in state aid maps for certain regions eligible for regional aid under Article 107 paragraph 3letter (c.

  13. Offering prenatal diagnostic tests: European guidelines for clinical practice [corrected].

    Science.gov (United States)

    Skirton, Heather; Goldsmith, Lesley; Jackson, Leigh; Lewis, Celine; Chitty, Lyn

    2014-05-01

    For over four decades, it has been possible to offer prenatal diagnostic testing for fetal abnormalities. Prenatal testing is now available for a wide range of monogenic disorders as well as chromosomal abnormalities and should be provided within the ethical framework of informed consent and autonomous choice. However, there are no published guidelines for health professionals from varied disciplines who offer prenatal diagnosis (PND) in a range of possible settings including departments of maternity, obstetrics and clinical genetics. We used an Expert Group technique to develop a set of guidelines for provision of prenatal diagnostic services. Thirteen European health professionals, all experts in PND, participated in a workshop to develop the guidelines, which were then subjected to a wide consultation process. The objective of PND was defined as providing prenatal diagnostic testing services (for genetic conditions) that enable families to make informed choices consistent with their individual needs and values and which support them in dealing with the outcome of such testing. General principles, logistical considerations, clinical care and counselling topics are all described and are equally applicable to invasive and non-invasive testing. These guidelines provide a framework for ethical clinical care; however, they are flexible enough to enable practitioners to adapt them to their particular setting. Ideally, an individualised approach to each family is required to ensure autonomous choice and informed consent regarding prenatal diagnostic testing within the local ethical and legal framework.

  14. Aid Donor Meets Strategic Partner? The European Union’s and China’s Relations with Ethiopia

    Directory of Open Access Journals (Sweden)

    Christine Hackenesch

    2013-01-01

    Full Text Available The motives, instruments and effects of China’s Africa policy have spurred a lively debate in European development policy circles. This paper assesses the “competitive pressure” that China’s growing presence in Africa exerts on the European development policy regime. Drawing on a large number of interviews conducted in China, Ethiopia and Europe between 2008 and 2011, the paper analyses Ethiopia as a case study. Ethiopia has emerged as one of the most important countries in Chinese as well as European cooperation with Africa. Yet, Chinese and European policies toward Ethiopia differ greatly. The EU mainly engages Ethiopia as an aid recipient, whereas China has developed a comprehensive political and economic partnership with the East African state. China has thereby become an alternative partner to the Ethiopian government, a development that both sheds light on the gap between European rhetoric and policy practice and puts pressure on the EU to make more efforts to reform its development policy system.

  15. The Scope of State Aid and Public Service Obligation for Airports and Air Carriers in the Light of European Law

    Directory of Open Access Journals (Sweden)

    Grzegorz Zajac

    2015-10-01

    Full Text Available Public aid is the kind of advantage granted directly or indirectly for private companies from State resources. The European Commission prerogative to control the transfer of public resources by the public authorities (national or local for the benefit of private undertakings, as a general rule, there is an obligation of notification, as provided for in article 108 (3 of the Treaty on the Functioning of the European Union (TFEU. It should be noted in the beginning that State aid given to undertakings conducting economic activity is, in principle, incompatible with the European Union’ law, as provided for in article. 107 (1 of the TFEU. There are certain situations that the granting of public funds will not constitute “public aid” within the meaning of article 107 of the TFEU and, therefore, will not violate European rules in this field. One of them are activities related to the exercise of the prerogatives of the public authority (security, safety, customs, air traffic control. The other is related to the exercise of services in general economic interest. This could be an example of public service obligation (PSO. This service can be applied in the light of the provisions of European law on two types of action on air routes, and on airport managing body. The imposition of a PSO to the specified route is the support given by the State to the outermost regions that due to their unfavourable geographical position cannot fully develop economically, and no carrier had not been interested in performing air services to that region due to the lack of cost effectiveness. Some activities at the airport may be considered as activities of general economic interest.

  16. Clinical experience of bone anchored hearing aid: a case report.

    Science.gov (United States)

    Miyasaka, Muneo; Akamatsu, Tadashi; Yamazaki, Akihisa; Tanaka, Rica

    2008-04-20

    To improve conventional bone conduction hearing aids, Tjellstrom, Branemark, developed an implant system consisting of a maxillofacial implant that derived from dental implants and a bone conduction hearing aid that was attached directly to the implant. This system has been commercially available as a bone anchored hearing aid (BAHA). More than 10,000 patients have benefited from BAHA in Scandinavia, North America, and many other regions. BAHA first became available in 1977 in Sweden but has not been used in Japan as widely as expected. This paper reports a case of a 8-year use of BAHA for hearing loss caused by microtia and external auditory canal atresia, with a review of literature. The patient has been followed up for 9 years after implant placement. Play audiometry with a loudspeaker showed a hearing loss of 25 dB. The patient says that BAHA is superior to conventional transcutaneous bone conduction hearing aids in easiness of attachment, esthetics, and speech recognition and music recognition. The skin and the bone around the implants remain in favorable condition. She has been free from the use of a headband for a conventional hearing aid.

  17. THE IMPLICATIONS OF STATE AID TO RnD ON ECONOMIC DEVELOPMENT IN THE EUROPEAN UNION

    Directory of Open Access Journals (Sweden)

    Bacila Nicolae

    2012-07-01

    Full Text Available In economic terms, the importance of state aid policy refers to the maintaining of an undistorted competition and the correction of inherent “market failures” which may occur in the economy, aiming at increasing economic efficiency, based on the traditional assumption that an effective competition will have a positive impact on economic development. The main objective of the present paper is to establish a possible correlation between state aid to research and development (RnD and GDP level in the EU. Our research hypothesis relates to considering state aid as a significant contribution to the economic development, measured by GDP level, which will be estimated as a function of state aid. Consequently, the main variables of this study are state aid to RnD and GDP level, considered in both relative and absolute terms. The relationship between technological change and economic development has been at the centre of the interest in both theoretical and empirical literature. The role of institutions and government policies in stimulating technological change has been provided mainly by the evolutionary theory, which considers economic development as a technological change driven process featured by a complex pattern which includes both uniformity and idiosyncrasy across time and countries. The relationship between these variables was estimated through a panel model which used seemly unrelated regression (SUR and ordinary least squares estimation (OLS. Taking into account that the economic value is likely to be realized after the innovation process took place we have interpreted this economic aspect in an econometric sense by using time lags. In analysing the relative importance of state aid to RnD, we have proposed an index which evaluates the relation between state aid and the relative size of the Member State’s economy. The relationship between state aid and GDP level was found to be positive and

  18. European consensus conference on faecal microbiota transplantation in clinical practice.

    Science.gov (United States)

    Cammarota, Giovanni; Ianiro, Gianluca; Tilg, Herbert; Rajilić-Stojanović, Mirjana; Kump, Patrizia; Satokari, Reetta; Sokol, Harry; Arkkila, Perttu; Pintus, Cristina; Hart, Ailsa; Segal, Jonathan; Aloi, Marina; Masucci, Luca; Molinaro, Antonio; Scaldaferri, Franco; Gasbarrini, Giovanni; Lopez-Sanroman, Antonio; Link, Alexander; de Groot, Pieter; de Vos, Willem M; Högenauer, Christoph; Malfertheiner, Peter; Mattila, Eero; Milosavljević, Tomica; Nieuwdorp, Max; Sanguinetti, Maurizio; Simren, Magnus; Gasbarrini, Antonio

    2017-04-01

    Faecal microbiota transplantation (FMT) is an important therapeutic option for Clostridium difficile infection. Promising findings suggest that FMT may play a role also in the management of other disorders associated with the alteration of gut microbiota. Although the health community is assessing FMT with renewed interest and patients are becoming more aware, there are technical and logistical issues in establishing such a non-standardised treatment into the clinical practice with safety and proper governance. In view of this, an evidence-based recommendation is needed to drive the practical implementation of FMT. In this European Consensus Conference, 28 experts from 10 countries collaborated, in separate working groups and through an evidence-based process, to provide statements on the following key issues: FMT indications; donor selection; preparation of faecal material; clinical management and faecal delivery and basic requirements for implementing an FMT centre. Statements developed by each working group were evaluated and voted by all members, first through an electronic Delphi process, and then in a plenary consensus conference. The recommendations were released according to best available evidence, in order to act as guidance for physicians who plan to implement FMT, aiming at supporting the broad availability of the procedure, discussing other issues relevant to FMT and promoting future clinical research in the area of gut microbiota manipulation. This consensus report strongly recommends the implementation of FMT centres for the treatment of C. difficile infection as well as traces the guidelines of technicality, regulatory, administrative and laboratory requirements. 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/.

  19. Computer-aided diagnosis: how to move from the laboratory to the clinic

    NARCIS (Netherlands)

    van Ginneken, Bram; Schaefer-Prokop, Cornelia M.; Prokop, Mathias

    2011-01-01

    Computer-aided diagnosis (CAD), encompassing computer-aided detection and quantification, is an established and rapidly growing field of research. In daily practice, however, most radiologists do not yet use CAD routinely. This article discusses how to move CAD from the laboratory to the clinic. The

  20. Clinical Outcomes of Snuggle up Position Using Positioning Aids for Preterm (27-32 Weeks Infants

    Directory of Open Access Journals (Sweden)

    Yashoda Sathish

    2017-03-01

    Full Text Available ABSTRACTBackground: Preterm birth, if not actively managed with developmental supportive care, can significantly contribute to neurodevelopmental compromise. Use of appropriate positioning aids helps with mimicking the intrauterine environment and facilitating neuromuscular development. Herein, we aimed to determine the effectiveness of snuggle up positioning aids on clinical outcomes of preterm (

  1. Computer-aided Diagnosis: How to Move from the Laboratory to the Clinic.

    NARCIS (Netherlands)

    Ginneken, B. van; Schaefer-Prokop, C.M.; Prokop, M.

    2011-01-01

    Computer-aided diagnosis (CAD), encompassing computer-aided detection and quantification, is an established and rapidly growing field of research. In daily practice, however, most radiologists do not yet use CAD routinely. This article discusses how to move CAD from the laboratory to the clinic. The

  2. Compassionate use of interventions: results of a European Clinical Research Infrastructures Network (ECRIN) survey of ten European countries

    LENUS (Irish Health Repository)

    Whitfield, Kate

    2010-11-12

    Abstract Background \\'Compassionate use\\' programmes allow medicinal products that are not authorised, but are in the development process, to be made available to patients with a severe disease who have no other satisfactory treatment available to them. We sought to understand how such programmes are regulated in ten European Union countries. Methods The European Clinical Research Infrastructures Network (ECRIN) conducted a comprehensive survey on clinical research regulatory requirements, including questions on regulations of \\'compassionate use\\' programmes. Ten European countries, covering approximately 70% of the EU population, were included in the survey (Austria, Denmark, France, Germany, Hungary, Ireland, Italy, Spain, Sweden, and the UK). Results European Regulation 726\\/2004\\/EC is clear on the intentions of \\'compassionate use\\' programmes and aimed to harmonise them in the European Union. The survey reveals that different countries have adopted different requirements and that \\'compassionate use\\' is not interpreted in the same way across Europe. Four of the ten countries surveyed have no formal regulatory system for the programmes. We discuss the need for \\'compassionate use\\' programmes and their regulation where protection of patients is paramount. Conclusions \\'Compassionate use\\' is a misleading term and should be replaced with \\'expanded access\\'. There is a need for expanded access programmes in order to serve the interests of seriously ill patients who have no other treatment options. To protect these patients, European legislation needs to be more explicit and informative with regard to the regulatory requirements, restrictions, and responsibilities in expanded access programmes.

  3. Book Review: A Clinical Atlas of Skin Conditions in HIV/AIDS: An ...

    African Journals Online (AJOL)

    Abstract. A Clinical Atlas of Skin Conditions in HIV/AIDS: An Illustrated Management Guide for Health Care Professionals. By Ncoza Dlova and Anisa Mosam. 2nd ed. Pretoria: HPMG, 2009. Pp. 100. ISBN 1-875098-40-2.

  4. [Clinical application of bone-anchored hearing aid implantation].

    Science.gov (United States)

    Xia, Yin; Zhang, Hua; Gong, Shu-sheng; Wang, Dan-ni; Zheng, Ya-li; Li, Yu-ling; Dong, Bo-ya; Han, De-min

    2013-08-01

    To discuss the indications, surgery methods and effects of the BAHA implantation by analyzing the patients' medical records of bone-anchored hearing aids(BAHA). Retrospective analyzed the records of 16 patients of BAHA implantation, including nine males and seven females. Their average age was 31 years old (8-53ys). Nine of them were congenital ear malformation, two were chronic suppurative otitis media, two were otosclerosis and three were unilateral severe sensorineural deafness. We evaluated their pure tone audiometry (PTA), speech audiometry and temporal CT before the surgery, and evaluated the aided PTA in soundfield and speech audiometry in sound field. These patients received BAHA implantation and installed the speech processor their months later. The average preoperative PTA measurements (PTA at 0.5, 1, 2, 4 kHz) was (63.2 ± 19.0) dB HL and postoperative aided PTA in sound field was (35.5 ± 10.9)dB HL. The average improvement in Hearing In Noise Test (HINT) was 37.0% ± 31.7%. The average improvement in Mandarin Speech Test was 76.0% ± 19.7%. After 4-16 months' follow-up, no significant complications were recorded. BAHA is a safe and effective bone implantable hearing device.

  5. The epidemiology of HIV and AIDS reports in migrants in the 27 European Union countries, Norway and Iceland: 1999-2006.

    Science.gov (United States)

    Del Amo, Julia; Likatavičius, Giedrius; Pérez-Cachafeiro, Santiago; Hernando, Victoria; González, Cristina; Jarrín, Inma; Noori, Teymur; Hamers, Françoise F; Bolúmar, Francisco

    2011-10-01

    To describe the epidemiology of HIV and AIDS by geographical origin in the EU, 1999-2006. AIDS and HIV cases from the EU 27, Norway and Iceland reported to European Centre for Epidemiological Monitoring of AIDS were analysed. Of 75,021 AIDS reports over 1999-2006, 35% were migrants. Of 2988 heterosexual AIDS reports in 2006, 50% were migrants, largely from Sub-Saharan Africa (SSA), 20% of 1404 AIDS cases in men who have sex with men (MSM) were migrants from Latin-America and Western Europe. Of 57 mother-to-child transmission (MTCT) AIDS cases, 23% were from SSA. AIDS cases decreased from 1999 to 2006 in natives (42%), Western Europeans (40%) and North Africa and Middle East (34%), but increased in people from SSA (by 89%), Eastern Europe (by 200%) and Latin-America (50%). Of 17,646 HIV infections in men and 9066 in females in 2006, 49 and 76% were migrants, largely from SSA. Of 169 MTCT infections, 41% were from SSA. Migrants, largely from SSA, represent a considerable proportion of AIDS and HIV reports in EU, especially among heterosexual and MTCT infections. Their contribution is higher among female reports. A substantial percentage of diagnoses in MSM are migrants, largely from Western Europe and Latin-America.

  6. The politics of civil society building: European private aid agencies and democratic transitions in Central America

    NARCIS (Netherlands)

    Biekart, C.H.

    1999-01-01

    Strengthening civil society may be all the rage in the international donor community, but what does it mean in practice? This seminal work critically examines the political aspects of civil society building and the role of non-governmental development aid agencies during recent democratic

  7. Clinical Marine Toxicology: A European Perspective for Clinical Toxicologists and Poison Centers

    Directory of Open Access Journals (Sweden)

    Luc De Haro

    2013-08-01

    Full Text Available Clinical marine toxicology is a rapidly changing area. Many of the new discoveries reported every year in Europe involve ecological disturbances—including global warming—that have induced modifications in the chorology, behavior, and toxicity of many species of venomous or poisonous aquatic life including algae, ascidians, fish and shellfish. These changes have raised a number of public issues associated, e.g., poisoning after ingestion of contaminated seafood, envenomation by fish stings, and exposure to harmful microorganism blooms. The purpose of this review of medical and scientific literature in marine toxicology is to highlight the growing challenges induced by ecological disturbances that confront clinical toxicologists during the everyday job in the European Poison Centers.

  8. European Good Laboratory and Clinical Practices: their relevance to clinical pathology laboratories.

    Science.gov (United States)

    Dent, N J

    1991-10-01

    The requirements for Good Laboratory (GLP) and Good Clinical Practices (CGP) were established as a matter of urgency by the United States in the early 1970s. These were in response to gross misconduct and, in many instances, fraud. Over the next 15 years, a plethora of regulatory principles, guidelines, and regulations was produced by many countries of the world, culminating in single standards for European, Japanese, and United States authorities. Although with regard to GLP this has basically become a worldwide recognized standard within the preclinical (toxicology) studies, in the veterinary, chemical, agrochemical, and pharmaceutical industries, the GCPs are now seeing a rebirth. Within a clinical trials environment, there is most certainly a requirement for compliance with GCP, especially with regard to the harmonization of data within the European Community. The goal of this article is to cover the following aspects: Why should we have good practices? Why should laboratory data be audited? Why is there a need for a QA unit or function? What is the QA operational approach? How does a laboratory audit take place within laboratories? In discussing the laboratories and their subsequent data audits, the pitfalls and benefits are addressed and an examination of the data from the sponsor's viewpoint is compared with that produced by the laboratory. The types of laboratories present in a clinical environment are examined. They obviously comprise clinical pathology, microbiology, and analytical as well as ancillary hospital areas such as X-ray and cardiology. These laboratories may also be in the private sector, the National Health Service, contract laboratories, universities, or the general practitioner population.(ABSTRACT TRUNCATED AT 250 WORDS)

  9. Radiology of HIV/AIDS in China: Current status and clinical application

    Directory of Open Access Journals (Sweden)

    Hongjun Li

    2015-06-01

    Full Text Available HIV infection targets at the human in the human body and targeting damage to immune system to compromise the result in hypoimmunity. HIV associated damages to tissues and organs as well as AIDS related infections caused by various pathogens and neoplasms are clinically common. AIDS related diseases are the main cause of death in patients with AIDS. Therefore, early prevention as well as appropriate and immediate treatment against AIDS related diseases play key role in prolonging the survival period and improving quality of life in patients with AIDS. In recent years, medical radiology has gained rapid development, which plays an important role in diagnosing and treating HIV/AIDS related diseases. The findings by medical radiology constitute an important chain of evidence for HIV/AIDS related diseases. Developed from traditional morphological radiology to current functional and molecular radiology, the modern medical radiology is providing a flood of diagnostic information to guide clinical practice. It is expected to provide accurate data for the location of lesions as well as quantitatively and qualitatively radiological diagnosis. Based on the radiological data, the goal of individualized treatment can be achieved.

  10. correlation of who clinical staging with cd4 counts in adult hiv/aids ...

    African Journals Online (AJOL)

    2011-02-02

    Feb 2, 2011 ... Cerebral toxoplasmosis. 2 (1.3%). Invasive cancer of the cervix. 1 (0.7%). CMV retinitis. 1 (0.7%). Majority of the patients presented with one or more HIV clinical events. The most prevalent HIV/. AIDS related clinical events were bacterial infections (34%), severe weight loss (28%) and Tuberculosis. (27%).

  11. [Congress of European society of cardiology (amsterdam, 2013): new recommendations and most important clinical studies].

    Science.gov (United States)

    Kanorskiĭ, S G; Mamedov, M N

    2014-01-01

    In this review we present short report on European Congress of Cardiology which took place in Amsterdam from August 3 to September 4, 2013. Four new European recommendations on the treatment of cardiovascular diseases are briefly characterized and reports of Hot Line and Clinical Trial Update scientific sessions are presented.

  12. Subjective measures of hearing aid benefit in the NIDCD/VA Clinical Trial.

    Science.gov (United States)

    Haskell, George B; Noffsinger, Douglas; Larson, Vernon D; Williams, David W; Dobie, Robert A; Rogers, Janette L

    2002-08-01

    Subjective measures of performance were assessed on three different hearing aid circuits as part of a large clinical trial. These measurements included the Profile of Hearing Aid Performance and a subjective ranking of individual preference. A multi-center, double-masked clinical trial of hearing aids was conducted at eight VA Medical Centers. Three hearing aid circuits, a linear peak-clipper, a linear compression limiter and a wide dynamic range compressor, were investigated. The experimental design was a three-period, three-treatment crossover design. Subjects (N = 360) were stratified by site and randomized to one of six sequences for the hearing aid circuits. All fittings were binaural and involved a 3-mo trial with each of the three circuits. All subjective measures were administered for unaided and aided conditions at the end of each trial period. While all of the circuits resulted in improved scores on the aided versus the unaided PHAP, there were few conditions in which one circuit outperformed the others. An exception was the aversiveness of sound subscale where the peak clipper frequently scored worse than either the compression limiter or the wide dynamic range compressor. In the subjective ranking scale the compression limiter received more first place rankings than the other two circuits, especially for one subgroup of patients with moderate flat hearing loss. All circuits were perceived as beneficial by these subjects in most situations. The peak clipper scored worse on aversiveness of sound than did the other two circuits for most subjects, while the compression limiter seemed to have a slight advantage in subjective rankings. Most subjects perceived considerable aided benefit in situations involving background noise and reverberation, situations where hearing aid benefit is often questioned.

  13. Clinical features of dysthyroid optic neuropathy: a European Group on Graves' Orbitopathy (EUGOGO) survey

    NARCIS (Netherlands)

    McKeag, David; Lane, Carol; Lazarus, John H.; Baldeschi, Lelio; Boboridis, Kostas; Dickinson, A. Jane; Hullo, A. Iain; Kahaly, George; Krassas, Gerry; Marcocci, Claudio; Marinò, Michele; Mourits, Maarten P.; Nardi, Marco; Neoh, Christopher; Orgiazzi, Jacques; Perros, Petros; Pinchera, Aldo; Pitz, Susanne; Prummel, Mark F.; Sartini, Maria S.; Wiersinga, Wilmar M.

    2007-01-01

    BACKGROUND: This study was performed to determine clinical features of dysthyroid optic neuropathy (DON) across Europe. METHODS: Forty seven patients with DON presented to seven European centres during one year. Local protocols for thyroid status, ophthalmic examination and further investigation

  14. Clinical Profile and HIV/AIDS Prevalence of Patients with ...

    African Journals Online (AJOL)

    Females made up 59%, with a male: female ratio 1:1.4. The common clinical features were weight loss (62.0%), glandular body swellings (28.0%) and prolonged fever (25.0%). Persistent fever >1month, weight loss >10% body weight and unexplained diarrhoea >1month were present in 66.7%, 83.3% and 16.7% HIV ...

  15. Indian Adolescent Living with HIV-AIDS: Current Clinical Scenario.

    Science.gov (United States)

    Joshi, Kavita S; Bhaware, Bhushan D; Pazare, Amar R

    2017-07-01

    Statistics suggest that, HIV has now largely become the disease of young patients. Hence, the adolescent HIV/AIDS needs to be handled and managed separately from adult HIV. Relatively fewer Indian data exist to characterize the associations in adolescents and young adults infected with HIV disease. The present study explores the current challenges in the management of HIV infected adolescents. The study was aimed at evaluating, relationship between CD4 count and duration of antiretroviral therapy (ART), effects of ART on body mass index and the adverse effects of antiretroviral drugs in adolescent HIV positive patients. This was a cross-sectional study involving 60 HIV positive adolescent patients attending tertiary care Institute KEM Hospital, Parel over duration of one year conducted at Mumbai. Patients on ART between age group 12 to 19 years. ART naïve patients were excluded from the study. 60 adolescent HIV positive patients attended our OPD including 37 males (61.67%) and 23 females (38.33%).The most common mode of transmission was vertical (80%). Education level was: school dropouts - 15%, primary education - 30%, Completed SSC - 31.7%, higher secondary - 23%. Among ADRs were 12 (63.15%) cases of anaemia due to Zidovudine, 4 (21.05%) hepatitis due to Nevirapine, 2 (10.52%) Tenofovir induced AKI and 1 (5.26%) Nevirapine rash. Wilcoxon matched pairs test showed a highly significant increase in the BMI (p ART under government programme has increased the duration of survival of the adolescent population with HIV. Treatment with HAART showed a favourable response with a statistical significant increase in CD4 count. Longer the duration of HAART, higher was the gain in CD4 count. Indian adolescent receiving long term ART, Lipodystrophy is not a troubling issue. Indian adolescent seems to be more tolerance of ART than the other parts of world.

  16. Clinical manifestations and survival of HIV/AIDS-infected patients, southern region of Thailand

    Directory of Open Access Journals (Sweden)

    B Chaimay

    2012-11-01

    Full Text Available Objective: The purpose of this study was to determine magnitude of clinical manifestations on survival of HIV/AIDS patients. Methods: The HIV/AIDS information system, a database containing demographic factors and clinical manifestations was used. A prospective, hospital-based cohort study was conducted in HIV/AIDS patients registered in both provincial and community hospitals from 14 provinces in southern region of Thailand, between January 1993 and April 2010. Totally, 52,459 of HIV/AIDS patients were routinely observed and followed up. One-fifth of the HIV/AIDS patients died (n=11,767, 22.43% during the follow-up period. The outcome was timed from diagnosis of HIV/AIDS infection to death. Cox's proportional hazard model was used to analyze the magnitude of clinical manifestations on survival of HIV/AIDS patients. Results: A statistically significant corresponding risk of clinical manifestation on death was found. HIV/AIDS patients who had clinical manifestations including: invasive cervical cancer (HR=0.14, 95% CI: 0.44 to 0.43, herpes simplex (0.81, 0.66 to 0.98, histoplasmosis (0.67, 0.46 to 0.97, Mycobacterium other species (0.78, 0.64 to 0.97 were more likely to have a longer life. However, patients expressed clinical manifestations including; candidiasis (1.45, 1.34 to 1.56, cryptococcosis (1.77, 1.64 to 1.91, cytomegalovirus retinitis (1.58, 1.26 to 1.98, HIV encephalopathy (2.17, 1.92 to 2.47, Mycobacterium avium complex (1.76, 1.32 to 2.33 Mycobacterium tuberculosis (1.25, 1.21 to 1.30, pneumonia recurrent (1.78, 1.61 to 1.96, Pneumocystis carinii (1.71, 1.63 to 1.78, salmonella septicemia (1.85, 1.43 to 2.39 toxoplasmosis (1.47, 1.30 to 1.66 and wasting syndrome (2.13, 2.04 to 2.21 were more likely to die faster. Conclusion: In conclusion, HIV/AIDS patients expressed clinical manifestations which were a risk of death must be monitored closely and intensively care to extend their life and increase their quality of life.

  17. Clinical and radiological deterioration in a patient with AIDS

    Energy Technology Data Exchange (ETDEWEB)

    Backer, A.I. de [General Hospital Sint-Lucas, Department of Radiology, Ghent (Belgium); Mortele, K.J. [Brigham and Women' s Hospital, Harvard Medical School, Department of Radiology, Division of Abdominal Imaging and Intervention, Boston, MA (United States); Bomans, P.; Vanschoubroeck, I.J. [Ziekenhuisnetwerk Antwerpen, Stuivenberg, Department of Internal Medicine, Antwerp (Belgium); Keulenaer, B.L. de [Royal Darwin Hospital, Intensive Care Unit, Tiwi, NT (Australia); Kockx, M.M. [Ziekenhuisnetwerk Antwerpen, Stuivenberg, Department of Pathology, Antwerp (Belgium)

    2005-11-01

    Paradoxical clinical deterioration of miliary tuberculosis, characterized by pulmonary and abdominal manifestations, is reported in a patient with the acquired immunodeficiency syndrome, after initiation of treatment with highly active antiretroviral therapy. Paradoxical reaction was attributed to partial restoration of cell-mediated immunity related to highly effective antiretroviral therapy. Because tuberculosis has a high prevalence in HIV patients and tuberculosis is often characterized by miliary spreading of disease in these patients, it is important to recognize this phenomenon. (orig.)

  18. Plagiocephaly Severity Scale to Aid in Clinical Treatment Recommendations.

    Science.gov (United States)

    Holowka, Mark A; Reisner, Andrew; Giavedoni, Brian; Lombardo, Janet R; Coulter, Colleen

    2017-05-01

    Studies have attempted to categorize infant cranial asymmetry in a variety of ways using both observational and quantitative techniques, but none have created a clinical tool that can serve as a treatment guide based on clinical outcomes. In 2006, a research team from Children's Healthcare of Atlanta published the results of a prospective analysis of 224 patients with cranial asymmetries and their treatment outcomes. As a continuation of the previous work, the researchers have identified a plagiocephaly severity scale based on those outcomes to assist medical professionals who treat patients with cranial abnormalities. Our hypothesis is to validate the proposed severity scale that categorizes the clinical presentation and severity of plagiocephaly.Of the 224 patients enrolled, 207 patients were placed in an experimental group and 17 patients who refused treatment were placed in a control group. Digital head shape data were collected. Cross-correlation matrices were computed across variables and regression models resulted in the identification of 5 meaningful variables. A 5-level clinical classification scale was created. Five 1 × 5 analyses of variance were computed to compare each classification level.Four of the 5 analyses of variance identified significant overall effects for classification. A model was developed from the empirical data and the model was tested for accuracy, resulting in 12.1% overall error. The model was validated for both experimental and control groups.The results show that the severity scale is a meaningful outcome-based scale that assists clinicians in developing a treatment plan for treating plagiocephaly. The scale has been validated across a large heterogeneous study sample.

  19. Partially implantable bone conduction hearing aids without a percutaneous abutment (Otomag): technique and preliminary clinical results.

    Science.gov (United States)

    Siegert, Ralf

    2011-01-01

    Patients with air-bone gaps who cannot be corrected successfully by tympanoplasty or with mixed hearing loss may be treated with bone conduction hearing aids. Their disadvantages are the obvious external fixation components or the biological and psychosocial problems of open implants. We have developed new partially implantable bone conduction hearing aid without a percutaneous abutment and have been using them clinically for 4 years. The principle of these bone conduction hearing aids is a magnetic coupling and acoustic transmission between implanted and external magnets. The goal of this study was to evaluate clinical and audiological results. Magnets are implanted into shallow bone beds in a one step procedure. The skin above the magnets is also reduced to a thickness of 4-5 mm, which reduces the attenuation to less than 10 dB compared to direct bone stimulation. Over 100 patients have been implanted in the last 5 years. Except for temporary pressure marks in 4%, which healed after careful shimming of the external base plate, there were no other complications. The holding strength of the external components is equivalent to partially implantable hearing aids and cochlea implants and the hearing improvement is similar to other bone conduction hearing aids. We have found the comfort and safety of this system is significantly improved compared to conventional or percutaneous bone conduction hearing aids. Copyright © 2011 S. Karger AG, Basel.

  20. Paediatric European Network for Treatment of AIDS (PENTA) guidelines for treatment of paediatric HIV-1 infection 2015: optimizing health in preparation for adult life

    NARCIS (Netherlands)

    Bamford, A.; Turkova, A.; Lyall, H.; Foster, C.; Klein, N.; Bastiaans, D.; Burger, D.; Bernadi, S.; Butler, K.; Chiappini, E.; Clayden, P.; della Negra, M.; Giacomet, V.; Giaquinto, C.; Gibb, D.; Galli, L.; Hainaut, M.; Koros, M.; Marques, L.; Nastouli, E.; Niehues, T.; Noguera-Julian, A.; Rojo, P.; Rudin, C.; Scherpbier, H. J.; Tudor-Williams, G.; Welch, S. B.

    2018-01-01

    The 2015 Paediatric European Network for Treatment of AIDS (PENTA) guidelines provide practical recommendations on the management of HIV-1 infection in children in Europe and are an update to those published in 2009. Aims of treatment have progressed significantly over the last decade, moving far

  1. Failures in clinical trials in the European Union: lessons from the Polish experience.

    Science.gov (United States)

    Waligora, Marcin

    2013-09-01

    When discussing the safety of research subjects, including their exploitation and vulnerability as well as failures in clinical research, recent commentators have focused mostly on countries with low or middle-income economies. High-income countries are seen as relatively safe and well-regulated. This article presents irregularities in clinical trials in an EU member state, Poland, which were revealed by the Supreme Audit Office of Poland (the NIK). Despite adopting many European Union regulations, including European Commission directives concerning Good Clinical Practice, these irregularities occurred. Causes as well as potential solutions to make clinical trials more ethical and safer are discussed.

  2. Hepatitis B vaccine antibody response and the risk of clinical AIDS or death.

    Directory of Open Access Journals (Sweden)

    Michael L Landrum

    Full Text Available Whether seroresponse to a vaccine such as hepatitis B virus (HBV vaccine can provide a measure of the functional immune status of HIV-infected persons is unknown.This study evaluated the relationship between HBV vaccine seroresponses and progression to clinical AIDS or death.From a large HIV cohort, we evaluated those who received HBV vaccine only after HIV diagnosis and had anti-HBs determination 1-12 months after the last vaccine dose. Non-response and positive response were defined as anti-HBs <10 and ≥ 10 IU/L, respectively. Participants were followed from date of last vaccination to clinical AIDS, death, or last visit. Univariate and multivariable risk of progression to clinical AIDS or death were evaluated with Cox regression models. A total of 795 participants vaccinated from 1986-2010 were included, of which 41% were responders. During 3,872 person-years of observation, 122 AIDS or death events occurred (53% after 1995. Twenty-two percent of non-responders experienced clinical AIDS or death compared with 5% of responders (p<0.001. Non-response to HBV vaccine was associated with a greater than 2-fold increased risk of clinical AIDS or death (HR 2.47; 95% CI, 1.38-4.43 compared with a positive response, after adjusting for CD4 count, HIV viral load, HAART use, and delayed type hypersensitivity skin test responses (an in vivo marker of cell-mediated immunity. This association remained evident among those with CD4 count ≥ 500 cells/mm³ (HR 3.40; 95% CI, 1.39-8.32.HBV vaccine responses may have utility in assessing functional immune status and risk stratificating HIV-infected individuals, including those with CD4 count ≥ 500 cells/mm³.

  3. Computer-aided diagnosis improves detection of small intracranial aneurysms on MRA in a clinical setting.

    Science.gov (United States)

    Štepán-Buksakowska, I L; Accurso, J M; Diehn, F E; Huston, J; Kaufmann, T J; Luetmer, P H; Wood, C P; Yang, X; Blezek, D J; Carter, R; Hagen, C; Hořínek, D; Hejčl, A; Roček, M; Erickson, B J

    2014-10-01

    MRA is widely accepted as a noninvasive diagnostic tool for the detection of intracranial aneurysms, but detection is still a challenging task with rather low detection rates. Our aim was to examine the performance of a computer-aided diagnosis algorithm for detecting intracranial aneurysms on MRA in a clinical setting. Aneurysm detectability was evaluated retrospectively in 48 subjects with and without computer-aided diagnosis by 6 readers using a clinical 3D viewing system. Aneurysms ranged from 1.1 to 6.0 mm (mean = 3.12 mm, median = 2.50 mm). We conducted a multireader, multicase, double-crossover design, free-response, observer-performance study on sets of images from different MRA scanners by using DSA as the reference standard. Jackknife alternative free-response operating characteristic curve analysis with the figure of merit was used. For all readers combined, the mean figure of merit improved from 0.655 to 0.759, indicating a change in the figure of merit attributable to computer-aided diagnosis of 0.10 (95% CI, 0.03-0.18), which was statistically significant (F(1,47) = 7.00, P = .011). Five of the 6 radiologists had improved performance with computer-aided diagnosis, primarily due to increased sensitivity. In conditions similar to clinical practice, using computer-aided diagnosis significantly improved radiologists' detection of intracranial DSA-confirmed aneurysms of ≤6 mm. © 2014 by American Journal of Neuroradiology.

  4. «Dallas Buyers Club (2013» clinical research with drugs for the AIDS epidemic 80

    Directory of Open Access Journals (Sweden)

    Marian de HAAN-BOSCH

    2015-07-01

    Full Text Available Dallas Buyers Club (2013, inspired by true events, tells the story of Ron Woodroof, a middle?aged elec? trician from Dallas (Texas, who is diagnosed with AIDS in 1985. With few treatment options, he estab? lishes the Dallas Buyers Club in order to provide unapproved drugs to the AIDS community. This results in constant business travels, disputes with the FDA and problems with the law and the IRS. The article analyzes the buyers’ clubs phenomenon in the US, the drugs cited in the film and the clinical trial with zidovudine shown in the movie. The film could be useful as a teaching tool providing an introduction to the AIDS epidemic, clinical research and drug development, bioethics of human research and the agen? cies that regulate drug approval and their availability. Finally, the article presents a possible guideline for the use of the film in a teaching environment.

  5. Predictors of Medication Adherence in an AIDS Clinical Trial: Patient and Clinician Perceptions

    Science.gov (United States)

    Cox, Lisa E.

    2009-01-01

    This article presents data from an AIDS clinical trial that evaluated 238 (60 percent nonwhite) patients infected with HIV and their clinician's perceptions of medication adherence and visit attendance in relationship to lifestyle, psychosocial, and health belief model (HBM) variables. Twelve sites collected data via a prospective, multisite…

  6. Anaphylaxis : Guidelines from the European Academy of Allergy and Clinical Immunology

    NARCIS (Netherlands)

    Muraro, A.; Roberts, G.; Worm, M.; Bilo, M. B.; Brockow, K.; Fernandez Rivas, M.; Santos, A. F.; Zolkipli, Z. Q.; Bellou, A.; Beyer, K.; Bindslev-Jensen, C.; Cardona, V.; Clark, A. T.; Demoly, P.; Dubois, A. E. J.; DunnGalvin, A.; Eigenmann, P.; Halken, S.; Harada, L.; Lack, G.; Jutel, M.; Niggemann, B.; Rueff, F.; Timmermans, F.; Vlieg-Boerstra, B. J.; Werfel, T.; Dhami, S.; Panesar, S.; Akdis, C. A.; Sheikh, A.

    Anaphylaxis is a clinical emergency, and all healthcare professionals should be familiar with its recognition and acute and ongoing management. These guidelines have been prepared by the European Academy of Allergy and Clinical Immunology (EAACI) Taskforce on Anaphylaxis. They aim to provide

  7. Anaphylaxis: guidelines from the European Academy of Allergy and Clinical Immunology

    NARCIS (Netherlands)

    Muraro, A.; Roberts, G.; Worm, M.; Bilò, M. B.; Brockow, K.; Fernández Rivas, M.; Santos, A. F.; Zolkipli, Z. Q.; Bellou, A.; Beyer, K.; Bindslev-Jensen, C.; Cardona, V.; Clark, A. T.; Demoly, P.; Dubois, A. E. J.; DunnGalvin, A.; Eigenmann, P.; Halken, S.; Harada, L.; Lack, G.; Jutel, M.; Niggemann, B.; Ruëff, F.; Timmermans, F.; Vlieg-Boerstra, B. J.; Werfel, T.; Dhami, S.; Panesar, S.; Akdis, C. A.; Sheikh, A.

    2014-01-01

    Anaphylaxis is a clinical emergency, and all healthcare professionals should be familiar with its recognition and acute and ongoing management. These guidelines have been prepared by the European Academy of Allergy and Clinical Immunology (EAACI) Taskforce on Anaphylaxis. They aim to provide

  8. Association of Systemic Lupus Erythematosus Clinical Features with European Population Genetic Substructure

    NARCIS (Netherlands)

    Alonso-Perez, Elisa; Suarez-Gestal, Marian; Calaza, Manuel; Witte, Torsten; Papasteriades, Chryssa; Marchini, Maurizio; Migliaresi, Sergio; Kovacs, Attila; Ordi-Ros, Josep; Bijl, Marc; Santos, Maria Jose; Ruzickova, Sarka; Pullmann, Rudolf; Carreira, Patricia; Skopouli, Fotini N.; D'Alfonso, Sandra; Sebastiani, Gian Domenico; Suarez, Ana; Blanco, Francisco J.; Gomez-Reino, Juan J.; Gonzalez, Antonio

    2011-01-01

    Systemic Lupus Erythematosus (SLE) is an autoimmune disease with a very varied spectrum of clinical manifestations that could be partly determined by genetic factors. We aimed to determine the relationship between prevalence of 11 clinical features and age of disease onset with European population

  9. The Cardiology Audit and Registration Data Standards (CARDS), European data standards for clinical cardiology practice

    NARCIS (Netherlands)

    M.R. Flynn (Rachel); C. Barrett (Conor); F.G. Cosio (Francisco); A.K. Gitt (Anselm); L.C. Wallentin (Lars); P. Kearney (Peter); M. Lonergan (Moira); E. Shelley (Emer); M.L. Simoons (Maarten)

    2005-01-01

    textabstractAIMS: Systematic registration of data from clinical practice is important for clinical care, local, national and international registries, and audit. Data to be collected for these different purposes should be harmonized. Therefore, during Ireland's Presidency of the European Union (EU)

  10. Hearing aid patients in private practice and public health (Veterans Affairs) clinics: are they different?

    Science.gov (United States)

    Cox, Robyn M; Alexander, Genevieve C; Gray, Ginger A

    2005-12-01

    In hearing aid research, it is commonplace to combine data across subjects whose hearing aids were provided in different service delivery models. There is reason to question whether these types of patients are always similar enough to justify this practice. To explore this matter, this investigation evaluated similarities and differences in self-report data obtained from hearing aid patients derived from public health (Veterans Affairs, VA) and private practice (PP) settings. The study was a multisite, cross-sectional survey in which 230 hearing aid patients from VA and PP audiology clinic settings provided self-report data on a collection of questionnaires both before and after the hearing aid fitting. Subjects were all older adults with mild to moderately severe hearing loss. About half of them had previous experience wearing hearing aids. All subjects were fitted with wide-dynamic-range-compression instruments and received similar treatment protocols. Numerous statistically significant differences were observed between the VA and PP subject groups. Before the fitting, VA patients reported higher expectations from the hearing aids and more severe unaided problems compared with PP patients with similar audiograms. Three wks after the fitting, VA patients reported more satisfaction with their hearing aids. On some measures VA patients reported more benefit, but different measures of benefit did not give completely consistent results. Both groups reported using the hearing aids an average of approximately 8 hrs per day. VA patients reported age-normal physical and mental health, but PP patients tended to report better than typical health for their age group. These data indicate that hearing aid patients seen in the VA public health hearing services are systematically different in self-report domains from those seen in private practice services. It is therefore risky to casually combine data from these two types of subjects or to generalize research results from one

  11. The clinical aspects of the acute facet syndrome: results from a structured discussion among European chiropractors

    Directory of Open Access Journals (Sweden)

    Jensen Tue

    2009-02-01

    Full Text Available Abstract Background The term 'acute facet syndrome' is widely used and accepted amongst chiropractors, but poorly described in the literature, as most of the present literature relates to chronic facet joint pain. Therefore, research into the degree of consensus on the subject amongst a large group of chiropractic practitioners was seen to be a useful contribution. Methods During the annual congress of The European Chiropractors Union (ECU in 2008, the authors conducted a workshop involving volunteer chiropractors. Topics were decided upon in advance, and the participants were asked to form into groups of four or five. The groups were asked to reach consensus on several topics relating to a basic case of a forty-year old man, where an assumption was made that his pain originated from the facet joints. First, the participants were asked to agree on a maximum of three keywords on each of four topics relating to the presentation of pain: 1. location, 2. severity, 3. aggravating factors, and 4. relieving factors. Second, the groups were asked to agree on three orthopaedic and three chiropractic tests that would aid in diagnosing pain from the facet joints. Finally, they were asked to agree on the number, frequency and duration of chiropractic treatment. Results Thirty-four chiropractors from nine European countries participated. They described the characteristics of an acute, uncomplicated facet syndrome as follows: local, ipsilateral pain, occasionally extending into the thigh with pain and decreased range of motion in extension and rotation both standing and sitting. They thought that the pain could be relieved by walking, lying with knees bent, using ice packs and taking non-steroidal anti-inflammatory drugs, and aggravated by prolonged standing or resting. They also stated that there would be no signs of neurologic involvement or antalgic posture and no aggravation of pain from sitting, flexion or coughing/sneezing. Conclusion The chiropractors

  12. [Clinical and therapy features of ocular toxoplasmosis in patients with HIV-AIDS infection].

    Science.gov (United States)

    Anghel, Gheorghe

    2002-01-01

    The paper presents clinical and therapy features of the ocular Toxoplasmosis in patients with HIV-AIDS infection. Four cases of AIDS have been observed in witch has been recognized the ocular toxoplasmosis (two at children and two at adults). It was watched the evolution under treatment of the lesions caused by the parasite and it was appreciated the efficiency of the therapy. The antitoxoplasmosis therapy is made in the same way as at the immunocompetents patients, but it must be followed by a maintenance treatment all the patience's life.

  13. Paediatric European Network for Treatment of AIDS (PENTA) guidelines for treatment of paediatric HIV‐1 infection 2015: optimizing health in preparation for adult life

    Science.gov (United States)

    Turkova, A; Lyall, H; Foster, C; Klein, N; Bastiaans, D; Burger, D; Bernadi, S; Butler, K; Chiappini, E; Clayden, P; Della Negra, M; Giacomet, V; Giaquinto, C; Gibb, D; Galli, L; Hainaut, M; Koros, M; Marques, L; Nastouli, E; Niehues, T; Noguera‐Julian, A; Rojo, P; Rudin, C; Scherpbier, HJ; Tudor‐Williams, G; Welch, SB

    2015-01-01

    The 2015 Paediatric European Network for Treatment of AIDS (PENTA) guidelines provide practical recommendations on the management of HIV‐1 infection in children in Europe and are an update to those published in 2009. Aims of treatment have progressed significantly over the last decade, moving far beyond limitation of short‐term morbidity and mortality to optimizing health status for adult life and minimizing the impact of chronic HIV infection on immune system development and health in general. Additionally, there is a greater need for increased awareness and minimization of long‐term drug toxicity. The main updates to the previous guidelines include: an increase in the number of indications for antiretroviral therapy (ART) at all ages (higher CD4 thresholds for consideration of ART initiation and additional clinical indications), revised guidance on first‐ and second‐line ART recommendations, including more recently available drug classes, expanded guidance on management of coinfections (including tuberculosis, hepatitis B and hepatitis C) and additional emphasis on the needs of adolescents as they approach transition to adult services. There is a new section on the current ART ‘pipeline’ of drug development, a comprehensive summary table of currently recommended ART with dosing recommendations. Differences between PENTA and current US and World Health Organization guidelines are highlighted and explained. PMID:25649230

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

    DEFF Research Database (Denmark)

    McMurray, Janet; Zérah, Simone; Hallworth, Michael

    2010-01-01

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

  15. Clinical decision aids for chest pain in the emergency department: identifying low-risk patients

    Directory of Open Access Journals (Sweden)

    Alley W

    2015-11-01

    Full Text Available William Alley, Simon A Mahler Department of Emergency Medicine, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA Abstract: Chest pain is one of the most common presenting complaints in the emergency department, though only a small minority of patients are subsequently diagnosed with acute coronary syndrome (ACS. However, missing the diagnosis has potential for significant morbidity and mortality. ACS presentations can be atypical, and their workups are often prolonged and costly. In order to risk-stratify patients and better direct the workup and care given, many decision aids have been developed. While each may have merit in certain clinical settings, the most useful aid in the emergency department is one that finds all cases of ACS while also identifying a substantial subset of patients at low risk who can be discharged without stress testing or coronary angiography. This review describes several of the chest pain decision aids developed and studied through the recent past, starting with the thrombolysis in myocardial infarction (TIMI risk score and Global Registry of Acute Coronary Events (GRACE scores, which were developed as prognostic aids for patients already diagnosed with ACS, then subsequently validated in the undifferentiated chest pain population. Asia-Pacific Evaluation of Chest Pain Trial (ASPECT; Accelerated Diagnostic Protocol to Assess Patients With Chest Pain Symptoms Using Contemporary Troponins (ADAPT; North American Chest Pain Rule (NACPR; and History, Electrocardiogram, Age, Risk factors, Troponin (HEART score have been developed exclusively for use in the undifferentiated chest pain population as well, with improved performance compared to their predecessors. This review describes the relative merits and limitations of these decision aids so that providers can determine which tool fits the needs of their clinical practice setting. Keywords: chest pain, decision aid, risk score, acute coronary syndrome

  16. A European multi-language initiative to make the general population aware of independent clinical research

    DEFF Research Database (Denmark)

    Mosconi, Paola; Antes, Gerd; Barbareschi, Giorgio

    2016-01-01

    BACKGROUND: The ECRAN (European Communication on Research Awareness Needs) project was initiated in 2012, with support from the European Commission, to improve public knowledge about the importance of independent, multinational, clinical trials in Europe. METHODS: Participants in the ECRAN...... consortium included clinicians and methodologists directly involved in clinical trials; researchers working in partnership with the public and patients; representatives of patients; and experts in science communication. We searched for, and evaluated, relevant existing materials and developed additional...... 2. An animated film about clinical trials, dubbed in the 23 official languages of the European Community, and an interactive tutorial 3. An inventory of resources, available in 23 languages, searchable by topic, author, and media type 4. Two educational games for young people, developed in six...

  17. Factors associated with the development of Pneumocystis carinii pneumonia in 5,025 European patients with AIDS. AIDS in Europe Study Group

    DEFF Research Database (Denmark)

    Lundgren, Jens Dilling; Barton, S E; Lazzarin, A

    1995-01-01

    of primary PCP prophylaxis, male homosexuality/bisexuality, diagnosis of AIDS in northern Europe, and CD4 cell count below 200 x 10(6)/L at the time of AIDS diagnosis. Patients with severe weight loss had a 60% higher risk of developing PCP during follow-up than those without such weight loss. Thus...

  18. Establishment of the European College of Veterinary Clinical Pathology (ECVCP) and the current status of veterinary clinical pathology in Europe

    DEFF Research Database (Denmark)

    O'Brien, P.J.; Fournel-Fleury, C.; Bolliger, Adrian Marc

    2007-01-01

    After 5 years of development, the European College of Veterinary Clinical Pathology (ECVCP)was formally recognized and approved on July 4, 2007 by the European Board of Veterinary Specialisation (EBVS), the European regulatory body that oversees specialization in veterinary medicine and which has...... approved 23 colleges. The objectives, committees, basis for membership, constitution, bylaws, information brochure and certifying examination of the ECVCP have remained unchanged during this time except as directed by EBVS. The ECVCP declared full functionality based on the following criteria: 1...... congresses and a joint journal (with the American Society for Veterinary Clinical Pathology) for communication of scientific research and information; the College also maintains a website, a joint listserv, and a newsletter; 6) collaboration in training and continuing education with relevant colleges...

  19. Clinical diagnosis of dental caries: a European perspective.

    Science.gov (United States)

    Pitts, N B

    2001-10-01

    The aim of this paper is to provide a broad international perspective on aspects of the RTI/UNC systematic review, to introduce relevant literature not cited, and to make recommendations for clinical practice education and research suggested by the evidence. Clinical caries diagnosis represents the foundation on which the answers to most of the consensus questions will be based. This paper highlights needs for being clear about definitions and nomenclature; understanding the importance of the concepts underlying the D1 and D3 diagnostic thresholds used widely within the RTI/UNC Review; and appreciating that the diagnostic challenge now faced by clinicians is significant and is becoming more complex as the presentation and distribution of the disease changes over time and the range of preventive and operative treatment options expands. A series of recommendations informed by the evidence are made, including a rather contentious issue for many clinicians concerning the lack of evidence supporting the continued use of a sharp explorer as a diagnostic tool for primary caries diagnosis. This practice should be discontinued as it may cause some harm to the patient and yet fails to provide a significant balancing diagnostic benefit. Finally, it is suggested that dentistry should learn from the developing evidence base in medicine on how best to disseminate the findings of reviews and promote appropriate changes in clinical practice.

  20. Factors associated with the development of Pneumocystis carinii pneumonia in 5,025 European patients with AIDS. AIDS in Europe Study Group

    DEFF Research Database (Denmark)

    Lundgren, Jens Dilling; Barton, S E; Lazzarin, A

    1995-01-01

    This study examined the factors associated with the development of a first episode of Pneumocystis carinii pneumonia (PCP) in 5,025 patients with AIDS, including 1,976 patients with primary PCP at the time of AIDS diagnosis and 635 with primary PCP occurring subsequently. Compared with untreated...... patients, patients treated with zidovudine were at similar risk of developing PCP during the first year of therapy but were at greater risk after longer intervals of treatment. The following factors were associated with an increased risk of PCP (either at the time of AIDS diagnosis or thereafter): lack...... of primary PCP prophylaxis, male homosexuality/bisexuality, diagnosis of AIDS in northern Europe, and CD4 cell count below 200 x 10(6)/L at the time of AIDS diagnosis. Patients with severe weight loss had a 60% higher risk of developing PCP during follow-up than those without such weight loss. Thus...

  1. Clinical indications for computed tomographic colonography: European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastrointestinal and Abdominal Radiology (ESGAR) Guideline

    NARCIS (Netherlands)

    Spada, Cristiano; Stoker, Jaap; Alarcon, Onofre; Barbaro, Federico; Bellini, Davide; Bretthauer, Michael; de Haan, Margriet C.; Dumonceau, Jean-Marc; Ferlitsch, Monika; Halligan, Steve; Helbren, Emma; Hellstrom, Mikael; Kuipers, Ernst J.; Lefere, Philippe; Mang, Thomas; Neri, Emanuele; Petruzziello, Lucio; Plumb, Andrew; Regge, Daniele; Taylor, Stuart A.; Hassan, Cesare; Laghi, Andrea

    2014-01-01

    This is an official guideline of the European Society of Gastrointestinal Endoscopy (ESGE) and the European Society of Gastrointestinal and Abdominal Radiology (ESGAR). It addresses the clinical indications for the use of computed tomographic colonography (CTC). A targeted literature search was

  2. Management of obesity in adults: European clinical practice guidelines.

    Science.gov (United States)

    Tsigos, Constantine; Hainer, Vojtech; Basdevant, Arnaud; Finer, Nick; Fried, Martin; Mathus-Vliegen, Elisabeth; Micic, Dragan; Maislos, Maximo; Roman, Gabriela; Schutz, Yves; Toplak, Hermann; Zahorska-Markiewicz, Barbara

    2008-01-01

    The development of consensus guidelines for obesity is complex. It involves recommending both treatment interventions and interventions related to screening and prevention. With so many publications and claims, and with the awareness that success for the individual is short-lived, many find it difficult to know what action is appropriate in the management of obesity. Furthermore, the significant variation in existing service provision both within countries as well as across the regions of Europe makes a standardised approach, even if evidence-based, difficult to implement. In formulating these guidelines, we have attempted to use an evidence-based approach while allowing flexibility for the practicing clinician in domains where evidence is currently lacking and ensuring that in treatment there is recognition of clinical judgment and of regional diversity as well as the necessity of an agreed approach by the individual and family. We conclude that i) physicians have a responsibility to recognise obesity as a disease and help obese patients with appropriate prevention and treatment, ii) treatment should be based on good clinical care and evidence-based interventions and iii) obesity treatment should focus on realistic goals and lifelong management. Copyright 2008 S. Karger AG, Basel.

  3. Early Clinical Signs and Symptoms of HIV Infection: Delaying progression to AIDS

    OpenAIRE

    Miedzinski, Lil J.

    1992-01-01

    Early clinical signs and symptoms of human immunodeficiency virus infection are protean and can reflect the effects of the virus or represent early manifestations of an illness associated with the acquired immunodeficiency syndrome. Knowledge of a patient's potential risk for HIV infection and of the natural history of the illness allow early signs and symptoms to be recognized. Early intervention can delay progression to AIDS.

  4. Fractography of clinically fractured, implant-supported dental computer-aided design and computer-aided manufacturing crowns

    NARCIS (Netherlands)

    Lohbauer, Ulrich; Belli, Renan; Cune, Marco S; Schepke, Ulf

    2017-01-01

    Today, a substantial part of the dental crown production uses computer-aided design and computer-aided manufacturing (CAD/CAM) technology. A recent step in restorative dentistry is the replacement of natural tooth structure with pre-polymerized and machined resin-based methacrylic polymers.

  5. Clinical decision aids for chest pain in the emergency department: identifying low-risk patients

    Science.gov (United States)

    Alley, William; Mahler, Simon A

    2015-01-01

    Chest pain is one of the most common presenting complaints in the emergency department, though only a small minority of patients are subsequently diagnosed with acute coronary syndrome (ACS). However, missing the diagnosis has potential for significant morbidity and mortality. ACS presentations can be atypical, and their workups are often prolonged and costly. In order to risk-stratify patients and better direct the workup and care given, many decision aids have been developed. While each may have merit in certain clinical settings, the most useful aid in the emergency department is one that finds all cases of ACS while also identifying a substantial subset of patients at low risk who can be discharged without stress testing or coronary angiography. This review describes several of the chest pain decision aids developed and studied through the recent past, starting with the thrombolysis in myocardial infarction (TIMI) risk score and Global Registry of Acute Coronary Events (GRACE) scores, which were developed as prognostic aids for patients already diagnosed with ACS, then subsequently validated in the undifferentiated chest pain population. Asia-Pacific Evaluation of Chest Pain Trial (ASPECT); Accelerated Diagnostic Protocol to Assess Patients With Chest Pain Symptoms Using Contemporary Troponins (ADAPT); North American Chest Pain Rule (NACPR); and History, Electrocardiogram, Age, Risk factors, Troponin (HEART) score have been developed exclusively for use in the undifferentiated chest pain population as well, with improved performance compared to their predecessors. This review describes the relative merits and limitations of these decision aids so that providers can determine which tool fits the needs of their clinical practice setting. PMID:27147894

  6. Prevalence and clinical management of cytomegalovirus retinitis in AIDS patients in shanghai, china

    Directory of Open Access Journals (Sweden)

    Shi Ying

    2011-11-01

    Full Text Available Abstract Background Cytomegalovirus retinitis is a common AIDS-associated illness, leading to blindness in up to 30% of patients. This study was to investigate the prevalence and clinical management of the cytomegalovirus retinitis associated with AIDS in a large municipality of China. Methods Clinical and laboratory data from 23 cytomegalovirus retinitis patients (35 eyes out of 303 hospitalized AIDS individuals in a single medical center were analyzed retrospectively. Two of 23 patients were diagnosed cytomegalovirus retinitis just before hospitalization without anti-CMV therapy. Ganciclovir combined with the high active anti-retroviral therapy was installed for treatment of cytomegalovirus retinitis after diagnosis was confirmed. The data were analyzed by specialists and statistics was also applied. Results The prevalence of cytomegalovirus retinitis in hospitalized AIDS patients was 7.6% in this study. The level of CD4+ T lymphocytes was correlated well with the occurrence of cytomegalovirus retinitis, showing 16.8% (19/113 (95% confidence interval: 10.4,25.0, 5.4% (3/56 (95% confidence interval: 1.1,14.9, and 1.4% (1/69 (95% confidence interval: 0.0,7.8 occurrence in the patients with CD4+ T lymphocyte counts 4+ T lymphocyte counts was 31.7 ± 38.6 cells/μl in 23 AIDS patients with cytomegalovirus retinitis. Median CD4+ T lymphocyte count is 20 cells/μl with inter-quartile range as (5, 36. Seven patients died (11 eyes and 16 patients (24 eyes survived. The proportion of blindness and low vision in eyes infected with cytomegalovirus retinitis respectively was 20.8% (5/24 and 29.2% (7/24 when they were diagnosed in survivors. The ganciclovir therapy was effective in 16 patients (24 eyes. Clinical recovery of cytomegalovirus retinitis was 41.7% (10/24 and clinical improvement 58.3% (14/24. After anti-CMV treatment, the proportion of blindness or low vision was 16.7% (4/24. Conclusions The AIDS patients with CD4+ T lymphocyte 4+ T lymphocyte

  7. Evidence-based clinical management and utilization of new technology in European neurosurgery.

    Science.gov (United States)

    Weber, Clemens; Jakola, Asgeir S; Gulati, Sasha; Nygaard, Oystein P; Solheim, Ole

    2013-04-01

    Evidence-based medicine (EBM) has become one of the pillars of modern patient care. However, neurosurgery has always been an experience-based and technology-driven discipline, and it remains unknown to which extent European neurosurgeons follow high-level evidence-based recommendations. We conducted a Web-based survey with a 15-item questionnaire about evidence-based clinical management and utilization of new technology among European neurosurgeons. Two different sum scores were calculated from the questions concerning clinical practice; evidence-based treatment score and new technology score. A high evidence-based treatment score means that more clinical conditions (i.e., study questions) were managed in compliance with the available highest levels of evidence from published clinical trials. A high new technology score reflects the use of a high number of modern tools in neurosurgical practice. A total of 239 neurosurgeons from 30 different European countries answered the questionnaire. There were large variations among European neurosurgeons in providing evidence-based care and in utilization of various modern tools. There were significant regional differences in evidence-based treatment scores and modern technology scores with higher scores in northern and western Europe. High-volume institutions were not associated with better evidence-based treatment scores, but had significantly higher new technology scores. There were significantly higher new technology scores at university hospitals and a trend towards higher evidence-based treatment scores compared to other hospitals. Clinical management in neurosurgery does not always comply with the best available evidence and there are large regional differences in clinical management and in utilization of various modern tools. The position of evidence-based medicine in European neurosurgery seems weak and this may be a threat to the quality of care.

  8. A multi-center, double blind clinical trial comparing benefit from three commonly used hearing aid circuits.

    Science.gov (United States)

    Larson, Vernon D; Williams, David W; Henderson, William G; Luethke, Lynn E; Beck, Lucille B; Noffsinger, Douglas; Bratt, Gene W; Dobie, Robert A; Fausti, Stephen A; Haskell, George B; Rappaport, Bruce Z; Shanks, Janet E; Wilson, Richard H

    2002-08-01

    Although numerous studies have demonstrated that hearing aids provide significant benefit, carefully controlled, multi-center clinical trials have not been conducted. A multi-center clinical trial was conducted to compare the efficacy of three commonly used hearing aid circuits: peak clipping, compression limiting, and wide dynamic range compression. Patients (N = 360) with bilateral, sensorineural hearing loss were studied using a double blind, three-period, three-treatment crossover design. The patients were fit with each of three programmable hearing aid circuits. Outcome tests were administered in the unaided condition at baseline and then after 3 mo usage of each circuit, the tests were administered in both aided and unaided conditions. The outcome test battery included tests of speech recognition, sound quality and subjective scales of hearing aid benefit, including patients' overall rank-order rating of the three circuits. Each hearing aid circuit improved speech recognition markedly, with greater improvement observed for soft and conversationally loud speech in both quiet and noisy listening conditions. In addition, a significant reduction in the problems encountered in communication was observed. Some tests suggested that the two compression hearing aids provided a better listening experience than the peak clipping hearing aid. In the rank-order ratings, patients preferred the compression limiting hearing aid more frequently than the other two hearing aids. The three hearing aid circuits studied provide significant benefit both in quiet and in noisy listening situations. The two compression hearing aids appear to provide superior benefits compared to the linear circuit, although the differences between the hearing aids were smaller than the differences between unaided and aided conditions.

  9. The EU-AIMS Longitudinal European Autism Project (LEAP) : Clinical characterisation

    NARCIS (Netherlands)

    Charman, Tony; Loth, Eva; Tillmann, Julian; Crawley, Daisy; Wooldridge, Caroline; Goyard, David; Ahmad, Jumana; Auyeung, Bonnie; Ambrosino, Sara|info:eu-repo/dai/nl/413586561; Banaschewski, Tobias; Baron-Cohen, Simon; Baumeister, Sarah; Beckmann, Christian; Bölte, Sven; Bourgeron, Thomas; Bours, Carsten; Brammer, Michael; Brandeis, Daniel; Brogna, Claudia; De Bruijn, Yvette; Chakrabarti, Bhismadev; Cornelissen, Ineke; Acqua, Flavio Dell; Dumas, Guillaume; Durston, Sarah|info:eu-repo/dai/nl/243083912; Ecker, Christine; Faulkner, Jessica; Frouin, Vincent; Garcés, Pilar; Ham, Lindsay; Hayward, Hannah; Hipp, Joerg; Holt, Rosemary J.; Isaksson, Johan; Johnson, Mark H.; Jones, Emily J.H.; Kundu, Prantik; Lai, Meng Chuan; D'Ardhuy, Xavier Liogier; Lombardo, Michael V.; Lythgoe, David J; Mandl, René|info:eu-repo/dai/nl/304814172; Mason, Luke; Meyer-Lindenberg, Andreas; Moessnang, Carolin; Mueller, Nico; O'Dwyer, Laurence; Oldehinkel, Marianne; Oranje, Bob|info:eu-repo/dai/nl/217177409; Pandina, Gahan; Persico, Antonio M.; Ruggeri, Barbara; Ruigrok, Amber N V; Sabet, Jessica; Sacco, Roberto; Cáceres, Antonia San Jóse; Simonoff, Emily; Toro, Roberto; Tost, Heike; Waldman, Jack; Williams, Steve C.R.; Zwiers, Marcel P.; Spooren, Will; Murphy, Declan G M; Buitelaar, Jan K.

    2017-01-01

    Background: The EU-AIMS Longitudinal European Autism Project (LEAP) is to date the largest multi-centre, multi-disciplinary observational study on biomarkers for autism spectrum disorder (ASD). The current paper describes the clinical characteristics of the LEAP cohort and examines age, sex and IQ

  10. Quality of life, clinical characteristics and treatment adherence of people living with HIV/AIDS

    OpenAIRE

    Ana Cristina de Oliveira e Silva; Renata Karina Reis; Jordana de Almeida Nogueira; Elucir Gir

    2014-01-01

    OBJECTIVES: to assess the quality of life of people living with HIV/AIDS and verify its association with clinical characteristics and treatment adherence.METHOD: cross-sectional study conducted in a hospital in the state of Paraíba, Brazil. A questionnaire was used to collect socio-demographic and clinical data. The quality of life scale proposed by the World Health Organization and a questionnaire to measure treatment adherence were used.RESULTS: of the 314 interviewees, 190 (60.5%) were mal...

  11. Clinical manifestation of HIV/AIDS patients: differences between public and private hospitals in Jakarta

    Directory of Open Access Journals (Sweden)

    Herdiman T. Pohan

    2004-12-01

    Full Text Available The aims of this study is to determine the demographic data, risk factors, clinical presentations, opportunistic/co-infections and its difference between public and private hospitals. A retrospective -descriptive study was conducted in Dr. Cipto Mangunkusumo National General Hospital (public hospital and Medistra Hospital (private hospital, Jakarta. The inclusion criteria were new HIV/AIDS cases admitted in year 2002-2003 and positive HIV serology (Elisa method. Secondary data were collected form medical record. Sixty-six subjects were enrolled in this study (public hospital 30 subjects and private hospital 36 subjects, consist of 59 male (89.4% and 7 female (10.6%. Thirty-seven percent subjects were defined as HIV and 62% AIDS. Risk factors obtained include drug user (59.1%, homosexual (13.6%, heterosexual (21.1%, transfusion (1.5% and maternal-child (perinatal (1.5%. The clinical symptoms mainly present as acute fever (56.2%, weight loss (39.4%, cough (38.8%, shortness of breath (27.2%, chronic diarrhea (22.8%, prolong fever (19.7%, loss of conciousness (15.3%, anorexia (15.3%. Significant differences between public and private hospitals were seen in fever and cough symptoms. Clinical presentation of HIV/AIDS patients during admission were : pneumonia (56%, oral trush (22.6%, anemia (56.5%, leucopenia (32.3%, lymphopenia (55.9%, elevated AST/ALT (66.1%, hypoalbuminemia (46.9%, limphadenopathy (10.6%, brain space occuping lesion (7.6%, encephalopathy (6.0%, pulmonary tb and pleural effusion (10.6%. The opportunistic and co-infections present were candidiasis (25.8%, chronic hepatitis C (24.2%, chronic hepatitis B and C (4.5%, pulmonary tb, lymphadenitis and miliary tb. Candidiasis and pulmonary tb were frequently found in public hospital. In conclusion from this study that clinical manifestation of HIV/AIDS were young man or woman, with one or more possible risk factor, had fever, respiratory complain, loss of body weight, chronic diarrhea

  12. Science without meritocracy. Discrimination among European specialists in infectious diseases and clinical microbiology: a questionnaire survey

    Science.gov (United States)

    Tacconelli, Evelina; Poljak, Mario; Cacace, Marina; Caiati, Giovanni; Benzonana, Nur; Nagy, Elisabeth; Kortbeek, Titia

    2012-01-01

    Objective In 2009, in a European survey, around a quarter of Europeans reported witnessing discrimination or harassment at their workplace. The parity committee from the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) designed a questionnaire survey to investigate forms of discrimination with respect to country, gender and ethnicity among medical professionals in hospitals and universities carrying out activities in the clinical microbiology (CM) and infectious diseases (ID) fields. Design The survey consisted of 61 questions divided into five areas (sociodemographic, professional census and environment, leadership and generic) and ran anonymously for nearly 3 months on the ESCMID website. Subjects European specialists in CM/ID. Results Overall, we included 1274 professionals. The majority of respondents (68%) stated that discrimination is present in medical science. A quarter of them reported personal experience with discrimination, mainly associated with gender and geographic region. Specialists from South-Western Europe experienced events at a much higher rate (37%) than other European regions. The proportion of women among full professor was on average 46% in CM and 26% in ID. Participation in high-level decision-making committees was significantly (>10 percentage points) different by gender and geographic origin. Yearly gross salary among CM/ID professionals was significantly different among European countries and by gender, within the same country. More than one-third of respondents (38%) stated that international societies in CM/ID have an imbalance as for committee member distribution and speakers at international conferences. Conclusions A quarter of CM/ID specialists experienced career and research discrimination in European hospitals and universities, mainly related to gender and geographic origin. Implementing proactive policies to tackle discrimination and improve representativeness and balance in career among CM

  13. Science without meritocracy. Discrimination among European specialists in infectious diseases and clinical microbiology: a questionnaire survey.

    Science.gov (United States)

    Tacconelli, Evelina; Poljak, Mario; Cacace, Marina; Caiati, Giovanni; Benzonana, Nur; Nagy, Elisabeth; Kortbeek, Titia

    2012-01-01

    In 2009, in a European survey, around a quarter of Europeans reported witnessing discrimination or harassment at their workplace. The parity committee from the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) designed a questionnaire survey to investigate forms of discrimination with respect to country, gender and ethnicity among medical professionals in hospitals and universities carrying out activities in the clinical microbiology (CM) and infectious diseases (ID) fields. The survey consisted of 61 questions divided into five areas (sociodemographic, professional census and environment, leadership and generic) and ran anonymously for nearly 3 months on the ESCMID website. European specialists in CM/ID. Overall, we included 1274 professionals. The majority of respondents (68%) stated that discrimination is present in medical science. A quarter of them reported personal experience with discrimination, mainly associated with gender and geographic region. Specialists from South-Western Europe experienced events at a much higher rate (37%) than other European regions. The proportion of women among full professor was on average 46% in CM and 26% in ID. Participation in high-level decision-making committees was significantly (>10 percentage points) different by gender and geographic origin. Yearly gross salary among CM/ID professionals was significantly different among European countries and by gender, within the same country. More than one-third of respondents (38%) stated that international societies in CM/ID have an imbalance as for committee member distribution and speakers at international conferences. A quarter of CM/ID specialists experienced career and research discrimination in European hospitals and universities, mainly related to gender and geographic origin. Implementing proactive policies to tackle discrimination and improve representativeness and balance in career among CM/ID professionals in Europe is urgently needed.

  14. The management of HIV- and AIDS-related pain in a primary health clinic in Tshwane, South Africa.

    Science.gov (United States)

    Maree, Johanna Elizabeth; Dreyer Wright, Susanna Catharina; Makua, Mogalagadi Rachel

    2013-06-01

    Pain has been recognized as an important, highly prevalent, and debilitating symptom of HIV and AIDS. In South Africa, many people living with HIV and AIDS utilize primary health clinics for pain management. Primary health clinics are nurse led and face a variety of challenges pertaining to pain management. The purpose of this study was to explore if HIV and AIDS pain is effectively managed in a primary health clinic in Tshwane, South Africa. The study aimed to explore the level and characteristics of HIV- and AIDS-related pain, the pain-related experiences of patients and if pain was managed according to the applicable guidelines of the Department of Health. A quantitative survey was conducted. The target population was HIV and AIDS patients who had been using the primary health clinic for chronic pain management. The sampling method was convenience (n = 500). Data were gathered by means of structured interviews and structured observation. The data were analyzed using the SSPS 15 program and open coding. The study provided evidence that HIV- and AIDS-related pain is not managed effectively. Despite repeated visits to the primary health clinic, the overwhelming majority of patients still experienced pain. Nurses added to the suffering, because they lacked knowledge of pain and pain management. It is recommended that nurses practicing in primary health clinics should be trained and supervised to effectively manage the pain of people living with HIV and AIDS. Copyright © 2013 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

  15. Certified Nurse Aides and Scope of Practice: Clinical Outcomes and Patient Safety.

    Science.gov (United States)

    McMullen, Tara L; Resnick, Barbara; Hansen, Jennie Chin; Miller, Nancy; Rubinstein, Robert

    2015-12-01

    To understand the impact of scope of practice and allowable certified nurse aide (CNA) tasks across states, the current study compared clinical outcomes in states with a basic scope of practice versus those that allowed for an expanded scope. The current study used data from the Minimum Data Set as well as staffing data from the Centers for Medicare and Medicaid Services. Clinical outcomes included: (a) percent of residents whose need for help with daily activities has increased, (b) percent of high-risk residents with pressure ulcers, (c) percent of residents who self-report moderate to severe pain, (d) percent of residents experiencing one or more falls with major injury, and (e) CNA staffing hours. There was no difference in clinical outcomes between states with expanded or basic scopes. Many factors influence clinical outcomes among residents and additional staffing and facility characteristics should be considered in future studies. Copyright 2015, SLACK Incorporated.

  16. Transcutaneous Bone-anchored Hearing Aids Versus Percutaneous Ones: Multicenter Comparative Clinical Study.

    Science.gov (United States)

    Iseri, Mete; Orhan, Kadir Serkan; Tuncer, Ulku; Kara, Ahmet; Durgut, Merve; Guldiken, Yahya; Surmelioglu, Ozgur

    2015-06-01

    The aim of this study is to compare the clinical audiological outcomes as well as patient satisfaction of bone-anchored, hearing aid surgery between the percutaneous Dermalock and the transcutaneous Attract systems. This is a multicenter, retrospective clinical study. The patients who underwent Baha Dermalock and Baha Attract surgery were analyzed for hearing results, surgical complications, and postoperative follow-up specifications for both systems. Speech reception thresholds and bone conduction thresholds with and without aided conditions were evaluated. Patient satisfactions were also determined for both groups by Glasgow Benefit Inventory questionnaire. Both of the groups had some minor complications such as skin irritations around the abutment and skin erythema over the magnet. Both of the groups benefit from the devices audiologically; however, when the groups were compared, better results were observed in the percutaneous, bone-conduction group. We can confirm that both transcutaneous and percutaneous techniques are effective in the rehabilitation of conductive hearing loss when conventional hearing aids cannot be used. However, both of the systems have some advantages and limitations in terms of audiological and surgical perspectives.

  17. European regulations for the introduction of novel radiopharmaceuticals in the clinical setting.

    Science.gov (United States)

    Decristoforo, Clemens; Penuelas, Ivan; Patt, Marianne; Todde, Sergio

    2017-06-01

    The development of novel radiopharmaceuticals is very rapid and highly innovative both for diagnostic and therapeutic applications. The translation into the clinic, however, is hampered by the high regulatory demands in Europe. This article describes the main rules, guidelines and guidance documents in the European Union in relation to the pharmaceutical regulatory framework. Until today a great number of radiopharmaceuticals are introduced clinically using specific national pathways outside the clinical trial regulation and examples are provided. In this context, the European Pharmacopoeia with a legal status plays an important role in defining quality standards. For clinical trials the application system and regulatory framework in Europe is currently considerably changing. Whereas the current clinical trial directive requires a lengthy and complicated national application process, the new regulation 536/2014 will introduce a streamlined and unified European application process. This new regulation also takes into account the specific properties of radioactive investigational medicinal products and has introduced exceptions for good manufacturing practices (GMP) and labelling for radiopharmaceuticals. Besides the main regulatory texts, several guidelines have been published, e.g. related to toxicity testing or first in man studies. In relation to radiopharmaceuticals professional organization, in particular the EANM, have published a number of documents in relation to GMP, documentation and toxicity studies, that support professionals in the application process. All these documents are summarized and discussed.

  18. A critique of emerging European legislation in the pharmaceutical industry: a clinical trials analysis.

    Science.gov (United States)

    Murray, Elizabeth; McAdam, Rodney; Burke, Moira T

    2004-01-01

    The objective of this paper is to critique emerging legislation in the pharmaceutical industry, focusing on the clinical trials sector. Possible changes are identified and discussed inrelation to their impact on phase I clinical trials conducted in the UK. It is concluded that smaller contract research organisations, which have benefited in the past from European Union legislative variation, may have resource problems in trying to cope with the changing business environment created through legislative harmonization. These SMEs must use this opportunity to seek clinical trials research partnerships in a new harmonized EU market.

  19. Relating working memory to compression parameters in clinically fit hearing AIDS.

    Science.gov (United States)

    Souza, Pamela E; Sirow, Lynn

    2014-12-01

    Several laboratory studies have demonstrated that working memory may influence response to compression speed in controlled (i.e., laboratory) comparisons of compression. In this study, the authors explored whether the same relationship would occur under less controlled conditions, as might occur in a typical audiology clinic. Participants included 27 older adults who sought hearing care in a private practice audiology clinic. Working memory was measured for each participant using a reading span test. The authors examined the relationship between working memory and aided speech recognition in noise, using clinically fit hearing aids with a range of compression speeds. Working memory, amount of hearing loss, and age each contributed to speech recognition, but the contribution depended on the speed of the compression processor. For fast-acting compression, the best performance was obtained by patients with high working memory. For slow-acting compression, speech recognition was affected by age and amount of hearing loss but was not affected by working memory. Despite the expectation of greater variability from differences in compression implementation, number of compression channels, or attendant signal processing, the relationship between working memory and compression speed showed a similar pattern as results from more controlled, laboratory-based studies.

  20. STD Clinic Patients' Awareness of Non-AIDS Complications of HIV Infection.

    Science.gov (United States)

    Castro, José Guillermo; Granovsky, Inna; Jones, Deborah; Weiss, Stephen M

    2015-01-01

    Participants were recruited from a sexually transmitted disease (STD) clinic in Florida and were assessed regarding the knowledge and awareness of non-AIDS conditions associated with HIV infection. Questionnaires were administered before and after a brief information session on non-AIDS conditions associated with HIV infection. Participants included men (n = 46) and women (n = 51). Prior to the information session, at baseline, only 34% of the participants were worried about HIV infection. Most participants (82%) agreed that HIV could be treated with antiretroviral therapy (ART), while only 38% were aware that HIV-associated conditions cannot be easily treated with ART. After the information session, almost all participants reported they were concerned regarding the risk of HIV infection. High-risk patients may have limited knowledge about the consequences of HIV infection beyond the traditional AIDS-associated conditions. Increased awareness of these less known consequences of HIV infection may decrease the potential for complacency regarding acquiring HIV infection. © The Author(s) 2014.

  1. European AIDS Clinical Society (EACS) guidelines on the prevention and management of metabolic diseases in HIV

    DEFF Research Database (Denmark)

    Lundgren, J D; Battegay, M; Behrens, G

    2008-01-01

    BACKGROUND: Metabolic diseases are frequently observed in HIV-infected persons and, as the risk of contracting these diseases is age-related, their prevalence will increase in the future as a consequence of the benefits of antiretroviral therapy (ART). SUMMARY OF GUIDELINES: All HIV-infected pers......BACKGROUND: Metabolic diseases are frequently observed in HIV-infected persons and, as the risk of contracting these diseases is age-related, their prevalence will increase in the future as a consequence of the benefits of antiretroviral therapy (ART). SUMMARY OF GUIDELINES: All HIV......-infected persons should be screened at regular intervals for a history of metabolic disease, dyslipidaemia, diabetes mellitus, hypertension and alteration of body composition; cardiovascular risk and renal function should also be assessed. Efforts to prevent cardiovascular disease will vary in intensity depending...... on an individual's absolute risk of ischaemic heart disease and should be comprehensive in nature. Lifestyle interventions should focus on counselling to stop smoking, modify diet and take regular exercise. A healthy diet, exercise and maintaining normal body weight tend to reduce dyslipidaemia; if not effective...

  2. European AIDS Clinical Society (EACS) guidelines on the prevention and management of metabolic diseases in HIV

    NARCIS (Netherlands)

    Lundgren, J. D.; Battegay, M.; Behrens, G.; de Wit, S.; Guaraldi, G.; Katlama, C.; Martinez, E.; Nair, D.; Powderly, W. G.; Reiss, P.; Sutinen, J.; Vigano, A.

    2008-01-01

    BACKGROUND: Metabolic diseases are frequently observed in HIV-infected persons and, as the risk of contracting these diseases is age-related, their prevalence will increase in the future as a consequence of the benefits of antiretroviral therapy (ART). SUMMARY OF GUIDELINES: All HIV-infected persons

  3. Clinical research with children: the European legal framework and its implementation in French and Italian law.

    Science.gov (United States)

    Altavilla, Annagrazia

    2008-07-01

    According to the International Convention of the Rights of the Child, an improvement of the protection of the rights of children in Europe should be accomplished by inserting the principle of best interests and evolving capacities in the legal framework related to paediatric clinical research. In this article, an overview is given of the European legal framework governing clinical research on minors in a comparative approach. The lack of coordination between different International and European ethical/ legal statements and its impact on national legislations is evaluated by analyzing provisions that have been foreseen in Italy and in France as a result of the ratification/implementation process. A presentation of the perspectives of paediatric research in Europe is provided.

  4. The EU-AIMS Longitudinal European Autism Project (LEAP): clinical characterisation.

    OpenAIRE

    Charman, Tony; Loth, Eva; Tillmann, Julian; Crawley, Daisy; Wooldridge, Caroline; Goyard, David; Ahmad, Jumana; Auyeung, Bonnie; Ambrosino, Sara; Banaschewski, Tobias; Baron-Cohen, Simon; Baumeister, Sarah; Beckmann, Christian; Bölte, Sven; Bourgeron, Thomas

    2017-01-01

    Abstract Background The EU-AIMS Longitudinal European Autism Project (LEAP) is to date the largest multi-centre, multi-disciplinary observational study on biomarkers for autism spectrum disorder (ASD). The current paper describes the clinical characteristics of the LEAP cohort and examines age, sex and IQ differences in ASD core symptoms and common co-occurring psychiatric symptoms. A companion paper describes the overall design and expe...

  5. Association of Systemic Lupus Erythematosus Clinical Features with European Population Genetic Substructure

    Science.gov (United States)

    Calaza, Manuel; Witte, Torsten; Papasteriades, Chryssa; Marchini, Maurizio; Migliaresi, Sergio; Kovacs, Attila; Ordi-Ros, Josep; Bijl, Marc; Santos, Maria Jose; Ruzickova, Sarka; Pullmann, Rudolf; Carreira, Patricia; Skopouli, Fotini N.; D'Alfonso, Sandra; Sebastiani, Gian Domenico; Suarez, Ana; Blanco, Francisco J.; Gomez-Reino, Juan J.; Gonzalez, Antonio

    2011-01-01

    Systemic Lupus Erythematosus (SLE) is an autoimmune disease with a very varied spectrum of clinical manifestations that could be partly determined by genetic factors. We aimed to determine the relationship between prevalence of 11 clinical features and age of disease onset with European population genetic substructure. Data from 1413 patients of European ancestry recruited in nine countries was tested for association with genotypes of top ancestry informative markers. This analysis was done with logistic regression between phenotypes and genotypes or principal components extracted from them. We used a genetic additive model and adjusted for gender and disease duration. Three clinical features showed association with ancestry informative markers: autoantibody production defined as immunologic disorder (P = 6.8×10−4), oral ulcers (P = 6.9×10−4) and photosensitivity (P = 0.002). Immunologic disorder was associated with genotypes more common in Southern European ancestries, whereas the opposite trend was observed for photosensitivity. Oral ulcers were specifically more common in patients of Spanish and Portuguese self-reported ancestry. These results should be taken into account in future research and suggest new hypotheses and possible underlying mechanisms to be investigated. A first hypothesis linking photosensitivity with variation in skin pigmentation is suggested. PMID:22194982

  6. Association of systemic lupus erythematosus clinical features with European population genetic substructure.

    Directory of Open Access Journals (Sweden)

    Elisa Alonso-Perez

    Full Text Available Systemic Lupus Erythematosus (SLE is an autoimmune disease with a very varied spectrum of clinical manifestations that could be partly determined by genetic factors. We aimed to determine the relationship between prevalence of 11 clinical features and age of disease onset with European population genetic substructure. Data from 1413 patients of European ancestry recruited in nine countries was tested for association with genotypes of top ancestry informative markers. This analysis was done with logistic regression between phenotypes and genotypes or principal components extracted from them. We used a genetic additive model and adjusted for gender and disease duration. Three clinical features showed association with ancestry informative markers: autoantibody production defined as immunologic disorder (P = 6.8×10(-4, oral ulcers (P = 6.9×10(-4 and photosensitivity (P = 0.002. Immunologic disorder was associated with genotypes more common in Southern European ancestries, whereas the opposite trend was observed for photosensitivity. Oral ulcers were specifically more common in patients of Spanish and Portuguese self-reported ancestry. These results should be taken into account in future research and suggest new hypotheses and possible underlying mechanisms to be investigated. A first hypothesis linking photosensitivity with variation in skin pigmentation is suggested.

  7. Association of systemic lupus erythematosus clinical features with European population genetic substructure.

    Science.gov (United States)

    Alonso-Perez, Elisa; Suarez-Gestal, Marian; Calaza, Manuel; Witte, Torsten; Papasteriades, Chryssa; Marchini, Maurizio; Migliaresi, Sergio; Kovacs, Attila; Ordi-Ros, Josep; Bijl, Marc; Santos, Maria Jose; Ruzickova, Sarka; Pullmann, Rudolf; Carreira, Patricia; Skopouli, Fotini N; D'Alfonso, Sandra; Sebastiani, Gian Domenico; Suarez, Ana; Blanco, Francisco J; Gomez-Reino, Juan J; Gonzalez, Antonio

    2011-01-01

    Systemic Lupus Erythematosus (SLE) is an autoimmune disease with a very varied spectrum of clinical manifestations that could be partly determined by genetic factors. We aimed to determine the relationship between prevalence of 11 clinical features and age of disease onset with European population genetic substructure. Data from 1413 patients of European ancestry recruited in nine countries was tested for association with genotypes of top ancestry informative markers. This analysis was done with logistic regression between phenotypes and genotypes or principal components extracted from them. We used a genetic additive model and adjusted for gender and disease duration. Three clinical features showed association with ancestry informative markers: autoantibody production defined as immunologic disorder (P = 6.8×10(-4)), oral ulcers (P = 6.9×10(-4)) and photosensitivity (P = 0.002). Immunologic disorder was associated with genotypes more common in Southern European ancestries, whereas the opposite trend was observed for photosensitivity. Oral ulcers were specifically more common in patients of Spanish and Portuguese self-reported ancestry. These results should be taken into account in future research and suggest new hypotheses and possible underlying mechanisms to be investigated. A first hypothesis linking photosensitivity with variation in skin pigmentation is suggested.

  8. [Sexual behavior characteristics of clients attending the Israel AIDS Task Force anonymous clinic in Tel Aviv].

    Science.gov (United States)

    Bar-On, Yaeli; Perry, Zvi H; Nof, Einav; Shiber, Asher; Risenberg, Klaris; Ben Zion, Itzhak

    2014-09-01

    Until now, research on sexual behavior and HIV in Israel has been carried out mainly on the general population, and focused primarily on defining populations at risk, without adequate consideration given to the reasons bringing these populations to be tested, and their specific sexual behaviors. In Israel, one can choose whether to take an HIV test in confidential centers (giving one's name under medical confidentiality) or in anonymous centers (Israel AIDS Task Force in Tel Aviv and Beer Sheva, Levinsky Clinic in Tel Aviv and Haparsim Clinic in Haifa]. At least 21% of the clients of the anonymous testing centers in Israel belong to a high risk population in contrast to 2.6% in confidential clinics, and so, in this study, we hypothesize that characterization of sexual behavior patterns in anonymous testing centers might enable us to better characterize sexual behavior patterns in high risk populations. In this cross-sectional study, we used questionnaires distributed in the clinics by the Israel AIDS Task Force in order to characterize their clinic's clients. The questionnaires were completed by the Israel AIDS Task Force consultants during the consultation period at which the anonymous test was performed. Data collected included: gender, age, testing history, specific sexual behaviors and reasons for applying for the current test. A total of 926 questionnaires were collected; 29.9% of them were of female patients. The average age was 29.47 years (1±8.66]; 21.3% of the clients were men who have sex with men [MSM]; only 2.3% of the clients belonged to other high risk populations. In all groups, the majority of the patients reported high risk sexual behavior (any sexual contact without a condom) and the average age for the first test was much higher than the average age of first sexual intercourse common in Israel. Women reported more participation in unprotected vaginal intercourse than heterosexual men, and a substantial part of MSM reported performing unprotected

  9. Successful applications of computer aided drug discovery: moving drugs from concept to the clinic.

    Science.gov (United States)

    Talele, Tanaji T; Khedkar, Santosh A; Rigby, Alan C

    2010-01-01

    Drug discovery and development is an interdisciplinary, expensive and time-consuming process. Scientific advancements during the past two decades have changed the way pharmaceutical research generate novel bioactive molecules. Advances in computational techniques and in parallel hardware support have enabled in silico methods, and in particular structure-based drug design method, to speed up new target selection through the identification of hits to the optimization of lead compounds in the drug discovery process. This review is focused on the clinical status of experimental drugs that were discovered and/or optimized using computer-aided drug design. We have provided a historical account detailing the development of 12 small molecules (Captopril, Dorzolamide, Saquinavir, Zanamivir, Oseltamivir, Aliskiren, Boceprevir, Nolatrexed, TMI-005, LY-517717, Rupintrivir and NVP-AUY922) that are in clinical trial or have become approved for therapeutic use.

  10. Decision Aids Can Support Cancer Clinical Trials Decisions: Results of a Randomized Trial.

    Science.gov (United States)

    Politi, Mary C; Kuzemchak, Marie D; Kaphingst, Kimberly A; Perkins, Hannah; Liu, Jingxia; Byrne, Margaret M

    2016-12-01

    Cancer patients often do not make informed decisions regarding clinical trial participation. This study evaluated whether a web-based decision aid (DA) could support trial decisions compared with our cancer center's website. Adults diagnosed with cancer in the past 6 months who had not previously participated in a cancer clinical trial were eligible. Participants were randomized to view the DA or our cancer center's website (enhanced usual care [UC]). Controlling for whether participants had heard of cancer clinical trials and educational attainment, multivariable linear regression examined group on knowledge, self-efficacy for finding trial information, decisional conflict (values clarity and uncertainty), intent to participate, decision readiness, and trial perceptions. Two hundred patients (86%) consented between May 2014 and April 2015. One hundred were randomized to each group. Surveys were completed by 87 in the DA group and 90 in the UC group. DA group participants reported clearer values regarding trial participation than UC group participants reported (least squares [LS] mean = 15.8 vs. 32, p trial participation among cancer patients facing this preference-sensitive choice. Although better informing patients before trial participation could improve retention, more work is needed to examine DA impact on enrollment and retention. This paper describes evidence regarding a decision tool to support patients' decisions about trial participation. By improving knowledge, helping patients clarify preferences for participation, and facilitating conversations about trials, decision aids could lead to decisions about participation that better match patients' preferences, promoting patient-centered care and the ethical conduct of clinical research. ©AlphaMed Press.

  11. Genome-wide association study implicates PARD3B-based AIDS restriction

    NARCIS (Netherlands)

    Troyer, Jennifer L.; Nelson, George W.; Lautenberger, James A.; Chinn, Leslie; McIntosh, Carl; Johnson, Randall C.; Sezgin, Efe; Kessing, Bailey; Malasky, Michael; Hendrickson, Sher L.; Li, Guan; Pontius, Joan; Tang, Minzhong; An, Ping; Winkler, Cheryl A.; Limou, Sophie; Le Clerc, Sigrid; Delaneau, Olivier; Zagury, Jean-François; Schuitemaker, Hanneke; van Manen, Daniëlle; Bream, Jay H.; Gomperts, Edward D.; Buchbinder, Susan; Goedert, James J.; Kirk, Gregory D.; O'Brien, Stephen J.

    2011-01-01

    Host genetic variation influences human immunodeficiency virus (HIV) infection and progression to AIDS. Here we used clinically well-characterized subjects from 5 pretreatment HIV/AIDS cohorts for a genome-wide association study to identify gene associations with rate of AIDS progression. European

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

    DEFF Research Database (Denmark)

    McMurray, Janet; Zérah, Simone; Hallworth, Michael

    2010-01-01

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

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

    LENUS (Irish Health Repository)

    McMurray, Janet

    2010-07-01

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

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

    LENUS (Irish Health Repository)

    McMurray, Janet

    2009-01-01

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

  15. Multi-morbidities of allergic rhinitis in adults: European Academy of Allergy and Clinical Immunology Task Force Report

    NARCIS (Netherlands)

    Cingi, C.; Gevaert, P.; Mösges, R.; Rondon, C.; Hox, V.; Rudenko, M.; Muluk, N. B.; Scadding, G.; Manole, F.; Hupin, C.; Fokkens, W. J.; Akdis, C.; Bachert, C.; Demoly, P.; Mullol, J.; Muraro, A.; Papadopoulos, N.; Pawankar, R.; Rombaux, P.; Toskala, E.; Kalogjera, L.; Prokopakis, E.; Hellings, P. W.; Bousquet, J.

    2017-01-01

    This report has been prepared by the European Academy of Allergy and Clinical Immunology Task Force on Allergic Rhinitis (AR) comorbidities. The aim of this multidisciplinary European consensus document is to highlight the role of multimorbidities in the definition, classification, mechanisms,

  16. 'PICO-D Management'; a decision-aid for evidence-based chiropractic education and clinical practice.

    Science.gov (United States)

    Amorin-Woods, Lyndon G; Losco, Barrett E

    2016-01-01

    Various models and decision-making aids exist for chiropractic clinical practice. "PICO-D Man" (Patient-Intervention-Comparator-Outcome-Duration Management) is a decision-aid developed in an educational setting which field practitioners may also find useful for applying defensible evidence-based practice. Clinical decision-making involves understanding and evaluating both the proposed clinicalintervention(s) and the relevant and available management options with respect to describing the patient and their problem, clinical and cost effectiveness, safety, feasibility and time-frame. For people consulting chiropractors this decision-aid usually requires the practitioner to consider a comparison of usual chiropractic care, (clinical management including a combination of active care and passive manual interventions), to usual medical care usually including medications, or other allied healthmanagement options while being mindful of the natural history of the persons' condition.

  17. Test Sensitivity in the Computer-Aided Detection of Breast Cancer from Clinical Mammographic Screening: a Meta-analysis

    CERN Document Server

    Levman, Jacob

    2013-01-01

    Objectives: To assess evaluative methodologies for comparative measurements of test sensitivity in clinical mammographic screening trials of computer-aided detection (CAD) technologies. Materials and Methods: This meta-analysis was performed by analytically reviewing the relevant literature on the clinical application of computer-aided detection (CAD) technologies as part of a breast cancer screening program based on x-ray mammography. Each clinical study's method for measuring the CAD system's improvement in test sensitivity is examined in this meta-analysis. The impact of the chosen sensitivity measurement on the study's conclusions are analyzed. Results: This meta-analysis demonstrates that some studies have inappropriately compared sensitivity measurements between control groups and CAD enabled groups. The inappropriate comparison of control groups and CAD enabled groups can lead to an underestimation of the benefits of the clinical application of computer-aided detection technologies. Conclusions: The po...

  18. Firstly diagnosed HIV/AIDS-associated tuberculosis: clinical peculiarities and causes of patients` deaths

    Directory of Open Access Journals (Sweden)

    A. S. Shalmin

    2013-06-01

    Full Text Available Introduction. According to the literature, HIV infection increases the risk of tuberculosis, and tuberculosis causes an adverse effect on the course of HIV infection. Tuberculosis is the direct cause of death of patients up to 30.0% with HIV infection and in 90.0% of cases at AIDS. That’s why studying the clinical course of HIV/AIDS-associated tuberculosis and analysis of causes of death in these patients is highly actual today. The aim of the study. To determine the clinical course and causes of death in patients with primarily diagnosed HIV/AIDS-associated tuberculosis. Materials and methods. 22 patients cards who died of primarily diagnosed HIV/AIDS-associated tuberculosis were analyzed in this article. The results of research. Among patients with primarily diagnosed HIV/AIDS-associated tuberculosis there were 12 men (54.6%, and 10 (45.4% women. The average age was 39.5 ± 1.5 years. There were 90.9% of unemployed patients (20 patients, 4 patients (18.2% were former prisoners, 1(4.5% – shelterless person, 5 patients (22.7% suffered from drug addiction and alcoholism. 9 (40.9% patients lived antisocial life. HIV-infection had started after tuberculosis in 1 patient (4.5%, before tuberculosis - in 15 (68.2%, the simultaneous detection of co-infection was found in 6 cases (27.3%. Prevailed disseminated (60 % and infiltrative forms of lung tuberculosis (33,3 % were significantly (P <0.05 more often registered among patients with co-infection of primarily diagnosed HIV/AIDS-associated tuberculosis. 5 (33.3% patients had pulmonary tuberculosis combined with extrapulmonary, that significantly complicated the course of co-infection. There were 3 patients (13.6%, who interrupted treatment, 1 patient refused treatment completely. 6 patients had received antiretroviral therapy (27.3%, 5 patients (22.7% renounced, in 11 (50.0% - antiretroviral therapy was not intended. The autopsy determined that 14 (63.6% patients died from progressive worsening of

  19. Plasma HIV-1 Tropism and the Risk of Short-Term Clinical Progression to AIDS or Death

    DEFF Research Database (Denmark)

    Casadellà, Maria; Cozzi-Lepri, Alessandro; Phillips, Andrew

    2017-01-01

    OBJECTIVE: To investigate if plasma HIV-1 tropism testing could identify subjects at higher risk for clinical progression and death in routine clinical management. DESIGN: Nested case-control study within the EuroSIDA cohort. METHODS: Cases were subjects with AIDS or who died from any cause, with...

  20. A clinical decision aid for the selection of antithrombotic therapy for the prevention of stroke due to atrial fibrillation

    DEFF Research Database (Denmark)

    LaHaye, Stephen Andrew; Gibbens, Sabra Lynn; Ball, David Gerald Andrew

    2012-01-01

    The availability of new antithrombotic agents, each with a unique efficacy and bleeding profile, has introduced a considerable amount of clinical uncertainty with physicians. We have developed a clinical decision aid in order to assist clinicians in determining an optimal antithrombotic regime...

  1. Clinical and Microbiological Profile of HIV/AIDS Cases with Diarrhea in North India

    Directory of Open Access Journals (Sweden)

    Arun Kumar Jha

    2012-01-01

    Full Text Available Intestinal infections are a significant cause of morbidity and mortality in people living with HIV/AIDS (PLWHA especially in developing countries. The present study was conducted to assess the clinical and microbiological spectrum in HIV/AIDS cases with diarrhea and to correlate the occurrence of such pathogens with stool characters, HIV seropositivity status, and CD4 counts. Stools from 154 HIV seropositive subjects and 50 HIV negative controls were examined by direct microscopy, fecal cultures, and serological tests (Clostridium difficile Toxin A, Cryptosporidium antigen, and Entamoeba histolytica antigen ELISA. CD4 T cell enumeration was done using FACS count (Becton Dickinson. The study showed a male preponderance (112 males and 42 females. Weakness, abdominal pain, and anorexia were the most common symptoms. Coccidian parasites were the most common cause of diarrhea in HIV seropositive cases. C. parvum was seen in 60.42% while Isospora belli in 9.03%. Amongst the bacterial pathogens C. difficile was detected in 18.06%, diarrheagenic Escherichia coli in 11.11%, and Shigella spp. in 2.78%. Pathogen isolation rates were more in HIV seropositive cases and subjects with low CD4 T lymphocyte counts. Regular monitoring of CD4 T lymphocyte counts and screening for enteric pathogens will help improve the quality of life for PLWHA.

  2. Effects of Computer-Aided Manufacturing Technology on Precision of Clinical Metal-Free Restorations

    Directory of Open Access Journals (Sweden)

    Ki-Hong Lee

    2015-01-01

    Full Text Available Purpose. The purpose of this study was to investigate the marginal fit of metal-free crowns made by three different computer-aided design/computer-aided manufacturing (CAD/CAM systems. Materials and Methods. The maxillary left first premolar of a dentiform was prepared for all-ceramic crown restoration. Thirty all-ceramic premolar crowns were made, ten each manufactured by the Lava system, Cercon, and Cerec. Ten metal ceramic gold (MCG crowns served as control. The marginal gap of each sample was measured under a stereoscopic microscope at 75x magnification after cementation. One-way ANOVA and the Duncan’s post hoc test were used for data analysis at the significance level of 0.05. Results. The mean (standard deviation marginal gaps were 70.5 (34.4 μm for the MCG crowns, 87.2 (22.8 μm for Lava, 58.5 (17.6 μm for Cercon, and 72.3 (30.8 μm for Cerec. There were no significant differences in the marginal fit among the groups except that the Cercon crowns had significantly smaller marginal gaps than the Lava crowns (P<0.001.  Conclusions. Within the limitation of this study, all the metal-free restorations made by the digital CAD/CAM systems had clinically acceptable marginal accuracy.

  3. Plasma HIV-1 tropism and risk of short-term clinical progression to AIDS or death

    DEFF Research Database (Denmark)

    Fontdevila, Maria Casadellà; Cozzi-Lepri, Alessandro; Phillips, Andrew

    2014-01-01

    INTRODUCTION: It is uncertain if plasma HIV-1 tropism is an independent predictor of short-term risk of clinical progression / death, in addition to the CD4 count and HIV RNA level. We conducted a nested case-control study within EuroSIDA to assess this question amongst people with current HIV RNA...... was observed between tropism and ART status. There were no significant differences in the CD4+ slope within or between tropism groups. CONCLUSIONS: Plasma HIV-1 tropism does not appear to add to the ability of CD4 count and viral load to predict the short term risk of AIDS and death outcomes, even with 454...... level >1000 copies/mL, including both people on ART and those ART naïve. METHODS: People with an AIDS diagnosis or who died from any causes for whom there was a stored plasma sample with HIV-1 RNA (VL)≥1,000 copies/mL available in the time window of 3-12 months prior to the event were identified...

  4. Effects of Computer-Aided Manufacturing Technology on Precision of Clinical Metal-Free Restorations.

    Science.gov (United States)

    Lee, Ki-Hong; Yeo, In-Sung; Wu, Benjamin M; Yang, Jae-Ho; Han, Jung-Suk; Kim, Sung-Hun; Yi, Yang-Jin; Kwon, Taek-Ka

    2015-01-01

    The purpose of this study was to investigate the marginal fit of metal-free crowns made by three different computer-aided design/computer-aided manufacturing (CAD/CAM) systems. The maxillary left first premolar of a dentiform was prepared for all-ceramic crown restoration. Thirty all-ceramic premolar crowns were made, ten each manufactured by the Lava system, Cercon, and Cerec. Ten metal ceramic gold (MCG) crowns served as control. The marginal gap of each sample was measured under a stereoscopic microscope at 75x magnification after cementation. One-way ANOVA and the Duncan's post hoc test were used for data analysis at the significance level of 0.05. The mean (standard deviation) marginal gaps were 70.5 (34.4) μm for the MCG crowns, 87.2 (22.8) μm for Lava, 58.5 (17.6) μm for Cercon, and 72.3 (30.8) μm for Cerec. There were no significant differences in the marginal fit among the groups except that the Cercon crowns had significantly smaller marginal gaps than the Lava crowns (P < 0.001). Within the limitation of this study, all the metal-free restorations made by the digital CAD/CAM systems had clinically acceptable marginal accuracy.

  5. [The etiological, clinical and prognosis of diarrhea occurs during AIDS in to hospital in Bamako].

    Science.gov (United States)

    Dao, S; Oumar, A A; Doumbia, S; Goita, D; Boushab, M; Maiga, I I; Bougoudogo, F

    2007-01-01

    Its was a descriptive survey achieved in the service of the infectious and tropical illnesses of the teaching hospital of the "Point G" from 31 December 2002 to 30 June 2004 was about the analysis of 76 files. Its goal was to determine the clinical, etiological and prognostic aspects, of the diarrhea during the AIDS. The oral-pharyngeal candidiasis (50%), the deshydratation (60,5%), the fever (67,5%) and the thinning (77,6%) were associated to the diarrhoea frequently. Cholera syndrome was (52.6%), dysenteric syndrome was (36.8%) and the diarrhea syndrome was (10.5%). According to the etiological aspect, the parasites were founded in 51,3 % of cases, bacteria 9,2 % of cases, and fungus 5,3%. Any pathogen hasn't been founded in 34,2% of cases. Cyptosporidium parvum (15,8 %), and Isospora Belli (11,8%) was the most common parasites founded, but some unusual pathogens as: Entamoeba hystolitica, Trichomonas intestinalis , Giardia intestinalis , Shistosoma mansoni , Dicrococelium dendriticum, Trichostrongylus were present . The most common bacteria were Escherichia coli 5,3%. The fungus family was represented by Candida albicans . The lethality rate was 46,1%. The etiology of diarrhea occurs during aids is variable and include opportunistic and non opportunistic. The fatality rate remains incised because the delay of care and the poverty of the patients.

  6. Clinical, polysomnographic and genome-wide association analyses of narcolepsy with cataplexy: a European Narcolepsy Network study

    National Research Council Canada - National Science Library

    Luca, G. De; Haba-Rubio, J; Dauvilliers, Y; Lammers, G.J; Overeem, S; Donjacour, C.E; Mayer, G; Javidi, S; Iranzo, A; Santamaria, J; Peraita-Aados, R; Hor, H; Kutalik, Z; Plazzi, G; Poli, F; Pizza, F; Arnulf, I; Leceneux, M; Bassetti, C; Mathis, J; Heinzer, R; Jennum, P; Knudsen, S; Geisler, P; Wierzbicka, A; Feketeova, E; Pfister, C; Khatami, R; Baumann, C; Tafti, M

    2013-01-01

    The aim of this study was to describe the clinical and PSG characteristics of narcolepsy with cataplexy and their genetic predisposition by using the retrospective patient database of the European Narcolepsy Network (EU-NN...

  7. Quality rating test of hearing aid benefit in the NIDCD/VA Clinical Trial.

    Science.gov (United States)

    Noffsinger, Douglas; Haskell, George B; Larson, Vernon D; Williams, David W; Wilson, Eleanor; Plunkett, Sheril; Kenworthy, Diane

    2002-08-01

    As part of a large clinical trial that compared three hearing aid circuits using several evaluation methods, judgments about quality of listening experiences were sought from all subjects. Three dimensions were examined: loudness, noise interference and overall liking (quality). Eight Audiology units in VA Medical Centers participated. Three hearing aid circuits were compared: linear peak clipper, compression limiter, and wide dynamic range compressor. The experimental design was a three-period, three-treatment crossover design. Baseline measures were made using a battery of tests in unaided conditions. Subjects (N = 360) were then stratified by participating site and randomized to one of six sequences of the three hearing aid circuits. Each circuit was fit binaurally and all subjects used each of the three circuits for 3 mo. All outcome measures were administered in unaided and aided conditions after each 3-mo period. The study used a double-blind strategy, i.e., neither the audiologist giving the tests nor the subject knew which circuit was being used. A different audiologist programmed the devices. For loudness judgments, soft and loud presentations of speech in quiet and in babble competition were judged more comfortable via the wide dynamic range circuit. The noise interference tasks and overall liking of the listening experience showed few significant differences across circuits. All circuits made the listening experience more comfortably loud for soft and conversation-level speech. Differences across circuits in terms of the overall quality of the listening experience and how noise interference was rated were small. Only isolated conditions, usually favoring the WDRC circuit, reached significance levels. The loudness dimension results were clearer. The WDRC circuit made sounds at either the loud or soft extreme more comfortable. When subjects were grouped by amount and configuration of hearing loss, the advantages for the WDRC and to a lesser extent the

  8. Evaluating Protocol Lifecycle Time Intervals in HIV/AIDS Clinical Trials

    Science.gov (United States)

    Schouten, Jeffrey T.; Dixon, Dennis; Varghese, Suresh; Cope, Marie T.; Marci, Joe; Kagan, Jonathan M.

    2014-01-01

    Background Identifying efficacious interventions for the prevention and treatment of human diseases depends on the efficient development and implementation of controlled clinical trials. Essential to reducing the time and burden of completing the clinical trial lifecycle is determining which aspects take the longest, delay other stages, and may lead to better resource utilization without diminishing scientific quality, safety, or the protection of human subjects. Purpose In this study we modeled time-to-event data to explore relationships between clinical trial protocol development and implementation times, as well as identify potential correlates of prolonged development and implementation. Methods We obtained time interval and participant accrual data from 111 interventional clinical trials initiated between 2006 and 2011 by NIH’s HIV/AIDS Clinical Trials Networks. We determined the time (in days) required to complete defined phases of clinical trial protocol development and implementation. Kaplan-Meier estimates were used to assess the rates at which protocols reached specified terminal events, stratified by study purpose (therapeutic, prevention) and phase group (pilot/phase I, phase II, and phase III/ IV). We also examined several potential correlates to prolonged development and implementation intervals. Results Even though phase grouping did not determine development or implementation times of either therapeutic or prevention studies, overall we observed wide variation in protocol development times. Moreover, we detected a trend toward phase III/IV therapeutic protocols exhibiting longer developmental (median 2 ½ years) and implementation times (>3years). We also found that protocols exceeding the median number of days for completing the development interval had significantly longer implementation. Limitations The use of a relatively small set of protocols may have limited our ability to detect differences across phase groupings. Some timing effects

  9. Working Memory and Hearing Aid Processing: Literature Findings, Future Directions, and Clinical Applications.

    Science.gov (United States)

    Souza, Pamela; Arehart, Kathryn; Neher, Tobias

    2015-01-01

    Working memory-the ability to process and store information-has been identified as an important aspect of speech perception in difficult listening environments. Working memory can be envisioned as a limited-capacity system which is engaged when an input signal cannot be readily matched to a stored representation or template. This "mismatch" is expected to occur more frequently when the signal is degraded. Because working memory capacity varies among individuals, those with smaller capacity are expected to demonstrate poorer speech understanding when speech is degraded, such as in background noise. However, it is less clear whether (and how) working memory should influence practical decisions, such as hearing treatment. Here, we consider the relationship between working memory capacity and response to specific hearing aid processing strategies. Three types of signal processing are considered, each of which will alter the acoustic signal: fast-acting wide-dynamic range compression, which smooths the amplitude envelope of the input signal; digital noise reduction, which may inadvertently remove speech signal components as it suppresses noise; and frequency compression, which alters the relationship between spectral peaks. For fast-acting wide-dynamic range compression, a growing body of data suggests that individuals with smaller working memory capacity may be more susceptible to such signal alterations, and may receive greater amplification benefit with "low alteration" processing. While the evidence for a relationship between wide-dynamic range compression and working memory appears robust, the effects of working memory on perceptual response to other forms of hearing aid signal processing are less clear cut. We conclude our review with a discussion of the opportunities (and challenges) in translating information on individual working memory into clinical treatment, including clinically feasible measures of working memory.

  10. Working memory and hearing aid processing: Literature findings, future directions, and clinical applications

    Directory of Open Access Journals (Sweden)

    Pamela eSouza

    2015-12-01

    Full Text Available Working memory—the ability to process and store information—has been identified as an important aspect of speech perception in difficult listening environments. Working memory can be envisioned as a limited-capacity system which is engaged when an input signal cannot be readily matched to a stored representation or template. This mismatch is expected to occur more frequently when the signal is degraded. Because working memory capacity varies among individuals, those with smaller capacity are expected to demonstrate poorer speech understanding when speech is degraded, such as in background noise. However, it is less clear whether (and how working memory should influence practical decisions, such as hearing treatment. Here, we consider the relationship between working memory capacity and response to specific hearing aid processing strategies. Three types of signal processing are considered, each of which will alter the acoustic signal: fast-acting wide-dynamic range compression, which smooths the amplitude envelope of the input signal; digital noise reduction, which may inadvertently remove speech signal components as it suppresses noise; and frequency compression, which alters the relationship between spectral peaks. For fast-acting wide-dynamic range compression, a growing body of data suggests that individuals with smaller working memory capacity may be more susceptible to such signal alterations, and may receive greater amplification benefit with low alteration processing. While the evidence for a relationship between wide-dynamic range compression and working memory appears robust, the effects of working memory on perceptual response to other forms of hearing aid signal processing are less clear cut. We conclude our review with a discussion of the opportunities (and challenges in translating information on individual working memory into clinical treatment, including clinically-feasible measures of working memory.

  11. European Communities Confederation of Clinical Chemistry Working Group on Accreditation: past, present and future.

    Science.gov (United States)

    Huisman, W

    2001-07-20

    During the past 10 years, many activities have taken place in the field of quality systems and accreditation in medical laboratories. Each country in Europe has a slightly different approach. The Working Group on Accreditation of the European Communities Confederation of Clinical Chemistry (EC4) tries to support harmonisation of these efforts. For this purpose, they edited the Essential Criteria for quality systems of medical laboratories and supported the forthcoming International ISO standard "Quality management for the medical laboratory". At this moment, a Model Quality Manual is nearly ready for publication. The next items are setting up criteria for auditing the quality system and criteria for the accreditation process.

  12. Definition of a core set of quality indicators for the assessment of HIV/AIDS clinical care: a systematic review.

    Science.gov (United States)

    Catumbela, Emanuel; Certal, Victor; Freitas, Alberto; Costa, Carlos; Sarmento, António; da Costa Pereira, Altamiro

    2013-06-28

    Several organizations and individual authors have been proposing quality indicators for the assessment of clinical care in HIV/AIDS patients. Nevertheless, the definition of a consensual core set of indicators remains controversial and its practical use is largely limited. This study aims not only to identify and characterize these indicators through a systematic literature review but also to propose a parsimonious model based on those most used. MEDLINE, SCOPUS, Cochrane databases and ISI Web of Knowledge, as well as official websites of organizations dealing with HIV/AIDS care, were searched for articles and information proposing HIV/AIDS clinical care quality indicators. The ones that are on patient's perspective and based on services set were excluded. Data extraction, using a predefined data sheet based on Cochrane recommendations, was done by one of the authors while a second author rechecked the extracted data for any inconsistency. A total of 360 articles were identified in our search query but only 12 of them met the inclusion criteria. We also identified one relevant site. Overall, we identified 65 quality indicators for HIV/AIDS clinical care distributed as following: outcome (n=15) and process-related (n=50) indicators; generic (n=36) and HIV/AIDS disease-specific (n=29) indicators; baseline examinations (n=19), screening (n=9), immunization (n=4), prophylaxis (n=5), HIV monitoring (n=16), and therapy (=12) indicators. There are several studies that set up HIV clinical care indicators, with only a part of them useful to assess the HIV clinical care. More importantly, HIV/AIDS clinical care indicators need to be valid, reliable and most of all feasible.

  13. Cortical Auditory Evoked Potentials Reveal Changes in Audibility with Nonlinear Frequency Compression in Hearing Aids for Children: Clinical Implications.

    Science.gov (United States)

    Ching, Teresa Y C; Zhang, Vicky W; Hou, Sanna; Van Buynder, Patricia

    2016-02-01

    Hearing loss in children is detected soon after birth via newborn hearing screening. Procedures for early hearing assessment and hearing aid fitting are well established, but methods for evaluating the effectiveness of amplification for young children are limited. One promising approach to validating hearing aid fittings is to measure cortical auditory evoked potentials (CAEPs). This article provides first a brief overview of reports on the use of CAEPs for evaluation of hearing aids. Second, a study that measured CAEPs to evaluate nonlinear frequency compression (NLFC) in hearing aids for 27 children (between 6.1 and 16.8 years old) who have mild to severe hearing loss is reported. There was no significant difference in aided sensation level or the detection of CAEPs for /g/ between NLFC on and off conditions. The activation of NLFC was associated with a significant increase in aided sensation levels for /t/ and /s/. It also was associated with an increase in detection of CAEPs for /t/ and /s/. The findings support the use of CAEPs for checking audibility provided by hearing aids. Based on the current data, a clinical protocol for using CAEPs to validate audibility with amplification is presented.

  14. Clinical Use of Tolerogenic Dendritic Cells-Harmonization Approach in European Collaborative Effort

    Directory of Open Access Journals (Sweden)

    Anja Ten Brinke

    2015-01-01

    Full Text Available The number of patients with autoimmune diseases and severe allergies and recipients of transplants increases worldwide. Currently, these patients require lifelong administration of immunomodulatory drugs. Often, these drugs are expensive and show immediate or late-occurring severe side effects. Treatment would be greatly improved by targeting the cause of autoimmunity, that is, loss of tolerance to self-antigens. Accumulating knowledge on immune mechanisms has led to the development of tolerogenic dendritic cells (tolDC, with the specific objective to restrain unwanted immune reactions in the long term. The first clinical trials with tolDC have recently been conducted and more tolDC trials are underway. Although the safety trials have been encouraging, many questions relating to tolDC, for example, cell-manufacturing protocols, administration route, amount and frequency, or mechanism of action, remain to be answered. Aiming to join efforts in translating tolDC and other tolerogenic cellular products (e.g., Tregs and macrophages to the clinic, a European COST (European Cooperation in Science and Technology network has been initiated—A FACTT (action to focus and accelerate cell-based tolerance-inducing therapies. A FACTT aims to minimize overlap and maximize comparison of tolDC approaches through establishment of minimum information models and consensus monitoring parameters, ensuring that progress will be in an efficient, safe, and cost-effective way.

  15. Co-infection by Cryptococcus neoformans and Mycobacterium avium intracellulare in AIDS. Clinical and epidemiological aspects.

    Science.gov (United States)

    Arastéh, K; Cordes, C; Futh, U; Grosse, G; Dietz, E; Staib, F

    In the observation of various opportunistic pathogens in HIV-positive persons, co-infection by Cryptococcus neoformans together with Mycobacterium avium intracellulare was found if there was a CD4 lymphocyte count as low as 3-20/microliters. In 1540 HIV-positive patients under treatment at a Berlin hospital (Auguste-Viktoria-Krankenhaus) during 1985-1994, all AIDS-relevant diseases were examined in a multivariate analysis as variables of influence on the manifestation of a systemic Mycobacterium avium complex (MAC) infection. The analysis involved data on 36 cases of cryptococcosis and 202 cases with a typical clinical course in whom MAC had been detected at sterile body sites. As significant and independent factors of influence, the following were identified: C. neoformans infection, wasting syndrome, lower age, low CD4 lymphocyte count and preceding Pneumocystis carinii pneumonia (PcP) prophylaxis. Cryptococcosis ranged first with an ods ratio of 2.75. The concomitant manifestation of cryptococcosis and systemic MAC infection in six patients is shown. Because both opportunists, C. neoformans and avian mycobacteria, may have their common habitat in droppings of defined species of pet birds, a common source of infection deserves further clinical and epidemiological attention.

  16. Parkinsonism and AIDS: a clinical comparative study before and after HAART

    Directory of Open Access Journals (Sweden)

    Ana Lucia Zuma de Rosso

    2009-09-01

    Full Text Available In 2002, after analyzing 28 HIV-positive patients with movement disorders we emphasized the decreasing not only of Parkinsonism but also of other involuntary movements in HIV patients in the last few years. The objective of this study is to compare the clinical results between HIV-positive patients with Parkinsonism before and after HAART. In 14 years (1986-1999 2,460 HIV-positive patients were seen in our Hospital 14 (0.6% of which presented with Parkinsonism. Eight years after (2000-2007 970 HIV positive patients were seen and only two (0.2% had Parkinsonism. We conclude that after the introduction of HAART there was an evident decrease in AIDS-related Parkinsonism.No ano de 2002, após analisarmos 28 pacientes HIV-positivos que apresentavam distúrbios do movimento, enfatizamos o declínio, não só do parkinsonismo, como também de outros movimentos involuntários em pacientes infectados pelo HIV nos últimos anos. O objetivo deste estudo é comparar os resultados clínicos entre pacientes HIV-positivos com parkinsonismo antes e depois da introdução do esquema HAART. Em 14 anos (1986-1999, 2.460 pacientes HIV-positivos foram avaliados em nosso Hospital dos quais 14 (0,6% apresentaram parkinsonismo. Nos oito anos seguintes (2000-2007, 970 pacientes HIV-positivos foram avaliados e somente dois (0,2% tinham parkinsonismo. Concluímos que após a introdução do esquema HAART houve evidente declínio do parkinsonismo secundário à AIDS.

  17. Clinical outcomes and immune benefits of anti-epileptic drug therapy in HIV/AIDS

    Directory of Open Access Journals (Sweden)

    Krentz Hartmut B

    2010-06-01

    Full Text Available Abstract Background Anti-epileptic drugs (AEDs are frequently prescribed to persons with HIV/AIDS receiving combination antiretroviral therapy (cART although the extent of AED use and their interactions with cART are uncertain. Herein, AED usage, associated toxicities and immune consequences were investigated. Methods HIV replication was analysed in proliferating human T cells during AED exposure. Patients receiving AEDs in a geographically-based HIV care program were assessed using clinical and laboratory variables in addition to assessing AED indication, type, and cumulative exposures. Results Valproate suppressed proliferation in vitro of both HIV-infected and uninfected T cells (p 0.05 but AED exposures did not affect HIV production in vitro. Among 1345 HIV/AIDS persons in active care between 2001 and 2007, 169 individuals were exposed to AEDs for the following indications: peripheral neuropathy/neuropathic pain (60%, seizure/epilepsy (24%, mood disorder (13% and movement disorder (2%. The most frequently prescribed AEDs were calcium channel blockers (gabapentin/pregabalin, followed by sodium channel blockers (phenytoin, carbamazepine, lamotrigine and valproate. In a nested cohort of 55 AED-treated patients receiving cART and aviremic, chronic exposure to sodium and calcium channel blocking AEDs was associated with increased CD4+ T cell levels (p 0.05 with no change in CD8+ T cell levels over 12 months from the beginning of AED therapy. Conclusions AEDs were prescribed for multiple indications without major adverse effects in this population but immune status in patients receiving sodium or calcium channel blocking drugs was improved.

  18. European AIDS Clinical Society (EACS) guidelines for the clinical management and treatment of HIV-infected adults

    DEFF Research Database (Denmark)

    Clumeck, N; Pozniak, A; Raffi, F

    2008-01-01

    visits as well as post-exposure prophylaxis. A revision of the 2005 guidelines based on current data includes changes in the sections on primary HIV infection, when to initiate therapy, which drug combinations are preferred as initial combination regimens for antiretroviral-naïve patients, how to manage...... and physicians or patient group organizations to negotiate with their national health authorities with a view to implementing what should be the standard of care for HIV-infected patients all over Europe....

  19. EVOLUTION OF PATIENTS WITH AIDS AFTER cART: CLINICAL AND LABORATORY EVOLUTION OF PATIENTS WITH AIDS AFTER 48 WEEKS OF ANTIRETROVIRAL TREATMENT

    Directory of Open Access Journals (Sweden)

    Ana Esther Carvalho Gomes Fukumoto

    2013-07-01

    Full Text Available SUMMARY Combination Antiretroviral Therapy (cART aims to inhibit viral replication, delay immunodeficiency progression and improve survival in AIDS patients. The objective of this study was to compare two different schemes of cART, based on plasma viral load (VL and CD4+ T lymphocyte count, during 48 weeks of treatment. For this purpose, 472 medical charts of a Specialized Outpatient Service were reviewed from 1998 to 2005. Out of these, 58 AIDS patients who had received a triple drug scheme as the initial treatment were included in the study and two groups were formed: Group 1 (G1: 47 individuals treated with two nucleoside reverse-transcriptase inhibitors (NRTI and one non-nucleoside reverse-transcriptase inhibitor; Group 2 (G2: 11 patients treated with two NRTI and one protease inhibitor. In G1 and G2, 53.2% and 81.8% respectively were patients with an AIDS-defining disease. The T CD4+ lymphocyte count increased progressively up until the 24th week of treatment in all patients, while VL became undetectable in 68.1% of G1 and in 63.6% of G2. The study concluded that the evolutions of laboratory tests were similar in the two treatment groups and that both presented a favorable clinical evolution.

  20. Hereditary colorectal cancer syndromes: American Society of Clinical Oncology Clinical Practice Guideline endorsement of the familial risk-colorectal cancer: European Society for Medical Oncology Clinical Practice Guidelines.

    Science.gov (United States)

    Stoffel, Elena M; Mangu, Pamela B; Gruber, Stephen B; Hamilton, Stanley R; Kalady, Matthew F; Lau, Michelle Wan Yee; Lu, Karen H; Roach, Nancy; Limburg, Paul J

    2015-01-10

    To provide recommendations on prevention, screening, genetics, treatment, and management for people at risk for hereditary colorectal cancer (CRC) syndromes. The American Society of Clinical Oncology (ASCO) has a policy and set of procedures for endorsing clinical practice guidelines that have been developed by other professional organizations. The Familial Risk-Colorectal Cancer: European Society for Medical Oncology Clinical Practice Guideline published in 2013 on behalf of the European Society for Medical Oncology (ESMO) Guidelines Working Group in Annals of Oncology was reviewed for developmental rigor by methodologists, with content and recommendations reviewed by an ASCO endorsement panel. The ASCO endorsement panel determined that the recommendations of the ESMO guidelines are clear, thorough, and based on the most relevant scientific evidence. The ASCO panel endorsed the ESMO guidelines and added a few qualifying statements. Approximately 5% to 6% of patient cases of CRC are associated with germline mutations that confer an inherited predisposition for cancer. The possibility of a hereditary cancer syndrome should be assessed for every patient at the time of CRC diagnosis. A diagnosis of Lynch syndrome, familial adenomatous polyposis, or another genetic syndrome can influence clinical management for patients with CRC and their family members. Screening for hereditary cancer syndromes in patients with CRC should include review of personal and family histories and testing of tumors for DNA mismatch repair deficiency and/or microsatellite instability. Formal genetic evaluation is recommended for individuals who meet defined criteria. © 2014 by American Society of Clinical Oncology.

  1. Examination of skin lesions for cancer : Which clinical decision aids and tools are available in general practice?

    NARCIS (Netherlands)

    Koelink, Cecile J. L.; Jonkman, Marcel F.; Van der Meer, Klaas; Van der Heide, Wouter K.

    2014-01-01

    Background While skin cancer incidence is rising throughout Europe, general practitioners (GP) feel unsure about their ability to diagnose skin malignancies. Objectives To evaluate whether the GP has sufficient validated clinical decision aids and tools for the examination of potentially malignant

  2. Associating Drugs, Targets and Clinical Outcomes into an Integrated Network Affords a New Platform for Computer-Aided Drug Repurposing

    DEFF Research Database (Denmark)

    Oprea, Tudor; Nielsen, Sonny Kim; Ursu, Oleg

    2011-01-01

    benefit from an integrated, semantic-web compliant computer-aided drug repurposing (CADR) effort, one that would enable deep data mining of associations between approved drugs (D), targets (T), clinical outcomes (CO) and SE. We report preliminary results from text mining and multivariate statistics, based...

  3. European Society of Clinical Microbiology and Infectious Diseases: update of the treatment guidance document for Clostridium difficile infection

    NARCIS (Netherlands)

    Debast, S.B.; Bauer, M.P.; Kuijper, E.J.

    2014-01-01

    In 2009 the first European Society of Clinical Microbiology and Infection (ESCMID) treatment guidance document for Clostridium difficile infection (CDI) was published. The guideline has been applied widely in clinical practice. In this document an update and review on the comparative effectiveness

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

    Science.gov (United States)

    Plochg, Thomas; Arah, Onyebuchi A.; Botje, Daan; Thompson, Caroline A.; Klazinga, Niek S.; Wagner, Cordula; Mannion, Russell; Lombarts, Kiki; Klazinga, NS; Kringos, DS; Lombarts, MJMH; Plochg, T; Lopez, MA; Secanell, M; Sunol, R; Vallejo, P; Bartels, P; Kristensen, S; Michel, P; Saillour-Glenisson, F; Vlcek, F; Car, M; Jones, S; Klaus, E; Bottaro, S; Garel, P; Saluvan, M; Bruneau, C; Depaigne-Loth, A; Shaw, C; Hammer, A; Ommen, O; Pfaff, H; Groene, O; Botje, D; Wagner, C; Kutaj-Wasikowska, H; Kutryba, B; Escoval, A; Lívio, A; Eiras, M; Franca, M; Leite, I; Almeman, F; Kus, H; Ozturk, K; Mannion, R; Arah, OA; DerSarkissian, M; Thompson, CA; Wang, A; Thompson, A

    2014-01-01

    Objective Clinical management is hypothesized to be critical for hospital management and hospital performance. The aims of this study were to develop and validate professional involvement scales for measuring the level of clinical management by physicians and nurses in European hospitals. Design Testing of validity and reliability of scales derived from a questionnaire of 21 items was developed on the basis of a previous study and expert opinion and administered in a cross-sectional seven-country research project ‘Deepening our Understanding of Quality improvement in Europe’ (DUQuE). Setting and Participants A sample of 3386 leading physicians and nurses working in 188 hospitals located in Czech Republic, France, Germany, Poland, Portugal, Spain and Turkey. Main Outcome Measures Validity and reliability of professional involvement scales and subscales. Results Psychometric analysis yielded four subscales for leading physicians: (i) Administration and budgeting, (ii) Managing medical practice, (iii) Strategic management and (iv) Managing nursing practice. Only the first three factors applied well to the nurses. Cronbach's alpha for internal consistency ranged from 0.74 to 0.86 for the physicians, and from 0.61 to 0.81 for the nurses. Except for the 0.74 correlation between ‘Administration and budgeting’ and ‘Managing medical practice’ among physicians, all inter-scale correlations were management roles’ of physicians and nurses. Conclusions The professional involvement scales appear to yield reliable and valid data in European hospital settings, but the scale ‘Managing medical practice’ for nurses needs further exploration. The measurement instrument can be used for international research on clinical management. PMID:24615595

  5. Investigating clinical predictors of arteriovenous fistula functional patency in a European cohort.

    Science.gov (United States)

    Masengu, Agnes; Maxwell, Alexander P; Hanko, Jennifer B

    2016-02-01

    Arteriovenous fistula (AVF) failure to mature (FTM) rates contribute to excessive dependence on central venous catheters for haemodialysis. Choosing the most appropriate vascular access site for an individual patient is guided largely by their age, co-morbidities and clinical examination. We investigated the clinical predictors of AVF FTM in a European cohort of patients and applied an existing clinical risk prediction model for AVF FTM to this population. A prospective cohort study was designed that included all patients undergoing AVF creation between January 2009 and December 2014 in a single centre (Belfast City Hospital) who had a functional AVF outcome observed by March 2015. A total of 525 patients had a functional AVF outcome recorded and were included in the FTM analysis. In this cohort, 309 (59%) patients achieved functional AVF patency and 216 (41%) patients had FTM. Female gender [P functional patency and ultimately survival in dialysis patients. Clinical predictors of AVF FTM may not be sufficient on their own to improve vascular access functional patency rates.

  6. Environmental occurrence and clinical impact of Vibrio vulnificus and Vibrio parahaemolyticus: a European perspective.

    Science.gov (United States)

    Baker-Austin, Craig; Stockley, Louise; Rangdale, Rachel; Martinez-Urtaza, Jaime

    2010-02-01

    Vibrio vulnificus and Vibrio parahaemolyticus are ubiquitous Gram-negative bacterial pathogens found naturally in marine and estuarine waters, and are a leading cause of seafood-associated bacterial illness. These pathogens are commonly reported in the USA and in many Asian countries, including China, Japan and Taiwan; however, there is growing concern that V. vulnificus and V. parahaemolyticus may represent an important and increasing clinical problem in Europe. Several factors underlie the need for a greater understanding of these non-cholera vibrios within a European context. First, there is a growing body of evidence to suggest that V. vulnificus and V. parahaemolyticus infections are increasing, and tend to follow regional climatic trends, with outbreaks typically following episodes of unusually warm weather. Such findings are especially alarming given current predictions regarding warming of marine waters as a result of global climatic change. Second, a myriad of epidemiological factors may greatly increase the incidence as well as clinical burden of these pathogens - including increasing global consumption and trade of seafood produce coupled to an increase in the number of susceptible individuals consuming seafood produce. Finally, there is currently a lack of detailed surveillance information regarding non-cholerae Vibrio infections in Europe, as these pathogens are not notifiable in many countries, which probably masks the true clinical burden of many human infections. This review will present a pertinent overview of both the environmental occurrence and clinical impact of V. vulnificus and V. parahaemolyticus in Europe. © 2010 Crown copyright.

  7. Hereditary Colorectal Cancer Syndromes: American Society of Clinical Oncology Clinical Practice Guideline Endorsement of the Familial Risk–Colorectal Cancer: European Society for Medical Oncology Clinical Practice Guidelines

    Science.gov (United States)

    Stoffel, Elena M.; Mangu, Pamela B.; Gruber, Stephen B.; Hamilton, Stanley R.; Kalady, Matthew F.; Lau, Michelle Wan Yee; Lu, Karen H.; Roach, Nancy; Limburg, Paul J.

    2015-01-01

    Purpose To provide recommendations on prevention, screening, genetics, treatment, and management for people at risk for hereditary colorectal cancer (CRC) syndromes. The American Society of Clinical Oncology (ASCO) has a policy and set of procedures for endorsing clinical practice guidelines that have been developed by other professional organizations. Methods The Familial Risk–Colorectal Cancer: European Society for Medical Oncology Clinical Practice Guideline published in 2013 on behalf of the European Society for Medical Oncology (ESMO) Guidelines Working Group in Annals of Oncology was reviewed for developmental rigor by methodologists, with content and recommendations reviewed by an ASCO endorsement panel. Results The ASCO endorsement panel determined that the recommendations of the ESMO guidelines are clear, thorough, and based on the most relevant scientific evidence. The ASCO panel endorsed the ESMO guidelines and added a few qualifying statements. Recommendations Approximately 5% to 6% of patient cases of CRC are associated with germline mutations that confer an inherited predisposition for cancer. The possibility of a hereditary cancer syndrome should be assessed for every patient at the time of CRC diagnosis. A diagnosis of Lynch syndrome, familial adenomatous polyposis, or another genetic syndrome can influence clinical management for patients with CRC and their family members. Screening for hereditary cancer syndromes in patients with CRC should include review of personal and family histories and testing of tumors for DNA mismatch repair deficiency and/or microsatellite instability. Formal genetic evaluation is recommended for individuals who meet defined criteria. PMID:25452455

  8. European aid control policy and environmental protection - an evaluation of the new Community guidelines; Die europaeische Beihilfenaufsicht im Umweltschutz - Darstellung und Kritik des neuen Gemeinschaftsrahmens

    Energy Technology Data Exchange (ETDEWEB)

    Ewringmann, D.; Thoene, M. [Koeln Univ. (Germany). Finanzwissenschaftliches Forschungsinstitut; Fischer, H.G.

    2002-01-01

    On 3 February 2001 the European Commission adopted the new Community guidelines on state aid for environmental protection. These guidelines outline the methods and criteria used by the Commission when controlling environmental state aid according to Art. 87 and 88 of the EC-Treaty. The study analyses the development of the new guidelines and their potential effects on environmental protection and environmental policy in the Member States of the European Union. In essence, the guidelines display three harmful tendencies: - they hamper progressive and innovative environmental policy that improves on 'least common denominator'-Community standards; - they do not respect the limits of the Commissions's authority, and interfere with the Member States' exclusive authority to decide on strategies and instruments of their respective environmental policies, and they especially affect Member States' choices between different energy sources and the general structure of its energy supply; - finally, they do not improve the protection of air competition on the common market. Based on these findings, the report delineates perspectives for an aid control policy that protects fair competition, and that gives incentives for voluntary national and regional environmental protection, allows for the equal treatment of clean techniques, and provides a consistent framework for exemptions from ecological taxes and environmental levies at the same time. (orig.) [German] Die Europaeische Kommission hat mit Wirkung vom 3. Februar 2001 einen neuen Gemeinschaftsrahmen fuer staatliche Umweltschutzbeihilfen erlassen. Dieser skizziert die Verfahren und Kriterien, welche die Kommission in ihrer Ueberpruefung staatlicher Umweltschutzbeihilfen auf Vereinbarkeit mit dem gemeinsamen Markt nach Art. 87 u. 88 EGV nutzen will. Die vorliegende Untersuchung schildert die Entstehung des Beihilferahmens und analysiert dessen potenzielle Wirkungen auf den Umweltschutz und die

  9. Reflectance imaging spectroscopy: possible aid in the clinical diagnosis of melanoma

    Science.gov (United States)

    Tomatis, Stefano; Marchesini, Renato; Bartoli, Cesare; Bono, Aldo; Clemente, Claudio; Cupeta, Carmela; Pignoli, Emanuele; Sichirollo, Adele E.; Cascinelli, Natale

    1995-04-01

    Reflectance spectrophotometry allows an objective evaluation of surface colors and it has been proposed as a tool to discriminate cutaneous melanoma from other pigmented cutaneous lesions. In order to improve reflectance spectral analysis of moles, a novel spectrophotometric system has been developed, based on the use of a CCD camera provided with a set of interference filters. For each filter the system acquires an image of the lesion. The images are digitized and stored in a PC for off-line data handling. Reflectance images from visible to near IR were acquired of 51 cutaneous pigmented lesions including melanoma and dysplastic, compound and junctional nevus. Four reflectance standards were used to convert the image raw numbers into absolute reflectance values. From each spectral image, corresponding to a selected wavelength, four parameters were derived to quantify color, pigment distribution, dimension and boundary of each lesion. A statistical analysis performed on the selected parameters shows that the mean effective reflectance, pigment distribution and lesion area are significantly different when melanoma is compared to the other lesions. This result suggests that telespectrophotometry could be used as an aid in performing clinical diagnosis of melanoma.

  10. Two Different Percutaneous Bone-Anchored Hearing Aid Abutment Systems: Comparative Clinical Study.

    Science.gov (United States)

    Polat, Beldan; İşeri, Mete; Orhan, Kadir Serkan; Yılmazer, Ayça Başkadem; Enver, Necati; Ceylan, Didem; Kara, Ahmet; Güldiken, Yahya; Çomoğlu, Şenol

    2016-04-01

    To compare two different percutaneous bone-anchored hearing aid (BAHA) abutment systems regarding operation time, scar healing, quality of life, implant stability, audiologic results, and complications. The study involves a prospective multi-center clinical evaluation. Thirty-two consecutive patients who had undergone BAHA surgery from January 2011 to January 2013 in two tertiary centers were included in the study. The Glasgow Inventory Benefit Score was used to assess the patients at least 6 months after surgery. The operation time and complications were recorded. Implant stability quotient (ISQ) values were recorded using resonance frequency analysis. Holger's classification was used to evaluate skin reactions. The mean length of the operation was 39.2±4 min for standard abutment and 18.3±5.7 min for hydroxyapatite-coated abutment. ISQ scores were significantly better for standard abutment in all tests. The mean total Glasgow Inventory Benefit Score was 39.3±19 for the standard abutment and 46.3±24.5 for the hydroxyapatite-coated abutment groups, but there was no statistical significance between the two groups. There was no difference in audiological improvement between the two groups after surgery. Hydroxyapatite-coated abutment provided a shorter operation time that was significantly different from standard abutment. There were no significant differences between standard abutment and hydroxyapatite-coated abutment regarding audiologic improvement, quality of life, loading time, and complications.

  11. Computer-aided proximal caries diagnosis: correlation with clinical examination and histology

    Energy Technology Data Exchange (ETDEWEB)

    Kang, Byung Cheol [Chonnam University, School of Dentistry, Gwangju (Korea, Republic of); Scheetz, James P.; Aarman, Allan G. [University of Louisville, School of Dentistry, Louisville (United States)

    2002-09-15

    To evaluate the performance of the LOGICON Caries Detector using RVG-4 and RVG-ui sensors, by comparing results of each detector to the results of clinical and histological examinations. Pairs of extracted teeth were radiographed, and a total of 57 proximal surfaces, which included both carious and non-carious situations, were analyzed. The RVG-4 produced 8-bit images, while the RVG-ui unit produced 12-bit images, which were taken in the high sensitivity mode. The images produced by the LOGICON were evaluated by a trained observer using both automated and manual caries detection software modes. Ground sections of the teeth established the actual absence or existence of caries. LOGICON-aided caries detection and depth discrimination of the RVG-4 and RVG-ui sensors were equally inconsistent irrespective of whether the LOGICON software was set to the automated or manual mode. Sensitivity ranged from 50% to 57% for caries penetration of the enamel-dentin junction. Care needs to be taken when using LOGICON in conjunction with RVG images as an adjunct for treatment planning dental caries. Even when applied by a trained observer, substantial discrepancies exist between the results of the LOGICON software-guided evalutation using RVG images and histologic examination.

  12. Gastroenteritis: First Aid

    Science.gov (United States)

    First aid Gastroenteritis: First aid Gastroenteritis: First aid By Mayo Clinic Staff Gastroenteritis is an inflammation of your stomach and intestines. Common causes are: Viruses. Food or water contaminated by ...

  13. Prevalence of clinical oral manifestations and symptoms of HIV/AIDS ...

    African Journals Online (AJOL)

    Background: The oral cavity is one of the sites where HIV infection and AIDS manifests through development of an unspecified number of oral lesions. Objective: To determine the prevalence of oral manifestation of HIV/AIDS in an essentially rural population at Sikonge district. Type of study: Cross-sectional study.

  14. A Computed Tomography-Aided Clinical Report on Anatomical Variations of the Paranasal Sinuses

    Directory of Open Access Journals (Sweden)

    Salah ELdeen Dafalla

    2017-02-01

    remaining 67% were normal. A bilateral hypoplastic maxillary sinus was seen in 23%, a unilateral hypoplastic maxillary sinus in 3%, extensive pneumatization in 17%, bilateral septation in 17%, unilateral septation in 19%, Haller cells in 33%, and normal anatomy in 67% of patients. Conclusion: A CT-aided study gives good results describing anatomical variations of the PNS in the Sudanese population and to the best of our knowledge, this is the first detailed clinical report on PNS in Sudan.

  15. Description of an efficacious behavioral peer-driven intervention to reduce racial/ethnic disparities in AIDS clinical trials.

    Science.gov (United States)

    Leonard, N R; Banfield, A; Riedel, M; Ritchie, A S; Mildvan, D; Arredondo, G; Cleland, C M; Gwadz, M V

    2013-08-01

    AIDS clinical trials (ACTs) are critical to the development of new treatments for HIV infection. However, people of color living with HIV/AIDS are involved in ACTs at disproportionally low rates, with African-Americans experiencing the greatest under-representation. In this article, we describe the core elements and key characteristics of a highly efficacious multi-component peer-driven intervention (PDI) designed to increase rates of screening for and enrollment into ACTs among African-American and Latino/Hispanic individuals, by addressing the main complex, multi-level barriers they experience to ACTs. We discuss the process of developing the intervention, the theoretical models guiding its delivery format and content, and provide an overview of the intervention's components. We then use brief case studies to illustrate a number of key issues that may arise during intervention implementation. Finally, we describe lessons learned and provide recommendations for the PDI's uptake in clinical and clinical trials settings.

  16. Clinical features of dysthyroid optic neuropathy: a European Group on Graves' Orbitopathy (EUGOGO) survey

    Science.gov (United States)

    McKeag, David; Lane, Carol; Lazarus, John H; Baldeschi, Lelio; Boboridis, Kostas; Dickinson, A Jane; Hullo, A Iain; Kahaly, George; Krassas, Gerry; Marcocci, Claudio; Marinò, Michele; Mourits, Maarten P; Nardi, Marco; Neoh, Christopher; Orgiazzi, Jacques; Perros, Petros; Pinchera, Aldo; Pitz, Susanne; Prummel, Mark F; Sartini, Maria S; Wiersinga, Wilmar M

    2007-01-01

    Background This study was performed to determine clinical features of dysthyroid optic neuropathy (DON) across Europe. Methods Forty seven patients with DON presented to seven European centres during one year. Local protocols for thyroid status, ophthalmic examination and further investigation were used. Each eye was classified as having definite, equivocal, or no DON. Results Graves' hyperthyroidism occurred in the majority; 20% had received radioiodine. Of 94 eyes, 55 had definite and 17 equivocal DON. Median Clinical Activity Score was 4/7 but 25% scored 3 or less, indicating severe inflammation was not essential. Best corrected visual acuity was 6/9 (Snellen) or worse in 75% of DON eyes. Colour vision was reduced in 33 eyes, of which all but one had DON. Half of the DON eyes had normal optic disc appearance. In DON eyes proptosis was > 21 mm (significant) in 66% and visual fields abnormal in 71%. Orbital imaging showed apical muscle crowding in 88% of DON patients. Optic nerve stretch and fat prolapse were infrequently reported. Conclusion Patients with DON may not have severe proptosis and orbital inflammation. Optic disc swelling, impaired colour vision and radiological evidence of apical optic nerve compression are the most useful clinical features in this series. PMID:17035276

  17. Plasma HIV-1 tropism and risk of short-term clinical progression to AIDS or death

    Directory of Open Access Journals (Sweden)

    Maria Casadellà Fontdevila

    2014-11-01

    Full Text Available Introduction: It is uncertain if plasma HIV-1 tropism is an independent predictor of short-term risk of clinical progression / death, in addition to the CD4 count and HIV RNA level. We conducted a nested case-control study within EuroSIDA to assess this question amongst people with current HIV RNA level >1000 copies/mL, including both people on ART and those ART naïve. Methods: People with an AIDS diagnosis or who died from any causes for whom there was a stored plasma sample with HIV-1 RNA (VL≥1,000 copies/mL available in the time window of 3–12 months prior to the event were identified. At least one control was selected for each case matched for age, VL and HCV status at the time of sampling. Controls were event-free after a matched duration of time from the date of sampling. Plasma HIV tropism was estimated using 454 and population sequencing (PS. Non-R5 HIV was defined as: (a ≥2% of sequences with a Geno2Pheno (G2P FPR≤3.75% by 454, and (b a G2P FPR≤10% by PS. We also compared CD4 slopes over the 12 months following the date of sampling using a linear mixed model with random intercept according to HIV tropism and ART status. Results: The study included 266 subjects, 100 cases and 166 controls, with sample taken on average in 2006; 23% and 24% had non-R5 HIV by 454 and PS respectively. There were 19% women, 25% MSM, 92% Caucasians, 22% HCV+. At the time of sampling, 26% were ART-naïve, 25% had started but were off ART and 49% were receiving ART. The median age, CD4 and viral load was 41 years, 350 cells/mm3 and 4.81 log c/mL, respectively. Baseline characteristics were well balanced by tropism. Factors independently associated with clinical progression or death were female gender (OR=2.12; 95% CI=1.04, 4.36; p=0.038, CD4+ count (OR=0.90 per 100 cells/mm3 higher; 95% CI 0.80, 1.00; p=0.058, being on ART (OR=2.72; 95% CI 1.15, 6.41; p=0.022 and calendar year of sample (OR=0.84 per more recent year; 95% CI=0.77, 0.91; p<0

  18. [Evaluation of production and clinical working time of computer-aided design/computer-aided manufacturing (CAD/CAM) custom trays for complete denture].

    Science.gov (United States)

    Wei, L; Chen, H; Zhou, Y S; Sun, Y C; Pan, S X

    2017-02-18

    To compare the technician fabrication time and clinical working time of custom trays fabricated using two different methods, the three-dimensional printing custom trays and the conventional custom trays, and to prove the feasibility of the computer-aided design/computer-aided manufacturing (CAD/CAM) custom trays in clinical use from the perspective of clinical time cost. Twenty edentulous patients were recruited into this study, which was prospective, single blind, randomized self-control clinical trials. Two custom trays were fabricated for each participant. One of the custom trays was fabricated using functional suitable denture (FSD) system through CAD/CAM process, and the other was manually fabricated using conventional methods. Then the final impressions were taken using both the custom trays, followed by utilizing the final impression to fabricate complete dentures respectively. The technician production time of the custom trays and the clinical working time of taking the final impression was recorded. The average time spent on fabricating the three-dimensional printing custom trays using FSD system and fabricating the conventional custom trays manually were (28.6±2.9) min and (31.1±5.7) min, respectively. The average time spent on making the final impression with the three-dimensional printing custom trays using FSD system and the conventional custom trays fabricated manually were (23.4±11.5) min and (25.4±13.0) min, respectively. There was significant difference in the technician fabrication time and the clinical working time between the three-dimensional printing custom trays using FSD system and the conventional custom trays fabricated manually (Ptime spent on fabricating three-dimensional printing custom trays using FSD system and making the final impression with the trays are less than those of the conventional custom trays fabricated manually, which reveals that the FSD three-dimensional printing custom trays is less time-consuming both in the

  19. Animal Bites: First Aid

    Science.gov (United States)

    First aid Animal bites: First aid Animal bites: First aid By Mayo Clinic Staff These guidelines can help you care for a minor animal bite, such ... 26, 2017 Original article: http://www.mayoclinic.org/first-aid/first-aid-animal-bites/basics/ART-20056591 . Mayo ...

  20. Genetics in clinical practice: general practitioners' educational priorities in European countries.

    NARCIS (Netherlands)

    Julian-Reynier, C.; Nippert, I.; Calefato, J.M.; Harris, H.J.; Kristoffersson, U.; Schmidtke, J.; Kate, L. ten; Anionwu, E.; Benjamin, C.; Challen, K.; Plass, A.M.; Harris, R.

    2008-01-01

    Purpose: To assess how general practitioners (GPs) from European countries prioritized their genetic educational needs according to their geographic, sociodemographic, and educational characteristics. Methods: Cross-sectional survey, random and total samples of GPs in five European countries

  1. Common definition for categories of clinical research: a prerequisite for a survey on regulatory requirements by the European Clinical Research Infrastructures Network (ECRIN)

    DEFF Research Database (Denmark)

    Kubiak, Christine; de Andres-Trelles, Fernando; Kuchinke, Wolfgang

    2009-01-01

    with cell therapy, etc.); diagnostic studies; clinical research on nutrition; other interventional clinical research (including trials in complementary and alternative medicine, trials with collection of blood or tissue samples, physiology studies, etc.); and epidemiology studies. Our classification......BACKGROUND: Thorough knowledge of the regulatory requirements is a challenging prerequisite for conducting multinational clinical studies in Europe given their complexity and heterogeneity in regulation and perception across the EU member states. METHODS: In order to summarise the current situation...... in relation to the wide spectrum of clinical research, the European Clinical Research Infrastructures Network (ECRIN) developed a multinational survey in ten European countries. However a lack of common classification framework for major categories of clinical research was identified, and therefore reaching...

  2. Clinical indications for computed tomographic colonography: European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastrointestinal and Abdominal Radiology (ESGAR) Guideline

    Energy Technology Data Exchange (ETDEWEB)

    Spada, Cristiano; Barbaro, Federico; Petruzziello, Lucio [Catholic University, Digestive Endoscopy Unit, Rome (Italy); Stoker, Jaap; Haan, Margriet C. de [University of Amsterdam, Department of Radiology, Academic Medical Center, Amsterdam (Netherlands); Alarcon, Onofre [Universidad de La Laguna, Department of Gastroenterology, Hospital Universitario de Canarias, Facultad de Medicina, La Laguna, Tenerife (Spain); Bellini, Davide; Laghi, Andrea [Sapienza University of Rome, I.C.O.T. Hospital, Department of Radiological Sciences, Oncology and Pathology, Latina (Italy); Bretthauer, Michael [Oslo University Hospital, Department of Health Economy and Health Management, University of Oslo, and Department of Transplantation Medicine, Gastroenterology Unit, Oslo (Norway); Dumonceau, Jean-Marc [Gedyt Endoscopy Center, Buenos Aires (Argentina); Ferlitsch, Monika [Medical University of Vienna, Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Vienna (Austria); Halligan, Steve; Helbren, Emma; Plumb, Andrew; Taylor, Stuart A. [University College London, Centre for Medical Imaging, London (United Kingdom); Hellstrom, Mikael [Sahlgrenska University Hospital and Sahlgrenska Academy at University of Gothenburg, Department of Radiology, Gothenburg (Sweden); Kuipers, Ernst J. [Erasmus MC University Medical Center, Department of Gastroenterology and Hepatology, Rotterdam (Netherlands); Lefere, Philippe [Virtual Colonoscopy Teaching Centre, Hooglede (Belgium); AZ Delta, Roeselare (Belgium); Mang, Thomas [Medical University of Vienna, Department of Biomedical Imaging and Image-guided Therapy, Vienna (Austria); Neri, Emanuele [University of Pisa, Diagnostic and Interventional Radiology, Pisa (Italy); Regge, Daniele [Institute for Cancer Research and Treatment, Candiolo-Torino (Italy); Hassan, Cesare [Catholic University, Digestive Endoscopy Unit, Rome (Italy); Ospedale Nuovo Regina Margherita, Department of Gastroenterology, Rome (Italy)

    2014-10-03

    Colorectal cancer (CRC) is a major cause of morbidity and mortality [1, 2]. CRC screening by fecal occult blood testing (FOBT) has been shown to reduce CRC mortality [3, 4], and is currently used in several European countries. Colonoscopy is highly effective for detecting advanced neoplasia, and endoscopic polypectomy reduces subsequent CRCspecific incidence and mortality [5]. In Europe, colonoscopy is mainly used to investigate FOBT-positive or symptomatic patients, or as a preventive strategy in those with increased CRC risk [6]. Computed tomographic colonography (CTC) is a minimally invasive imaging technique that is highly accurate for detecting colorectal cancer (CRC) and adenomatous polyps. The technique is standardized [7], and CTC is more easily performed than barium enema. Evidence-based data suggest that CTC is the natural replacement for barium enema and a complementary rather than an alternative examination to colonoscopy. However, the clinical scenarios for which CTC is indicated remain unclear. To address this uncertainty - 20 years after the first presentation of CTC at a radiological meeting [8] - the European Society of Gastrointestinal Endoscopy (ESGE) and the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) decided to produce a common guideline regarding indications for CTC in clinical practice. Technical and quality issues of CTC have been deliberately excluded from this work as these have already been discussed separately [7].

  3. American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association medical guidelines for clinical practice for the diagnosis and management of thyroid nodules

    DEFF Research Database (Denmark)

    Gharib, H; Papini, E; Paschke, R

    2010-01-01

    American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association medical guidelines for clinical practice for the diagnosis and management of thyroid nodules are systematically developed statements to assist health care professionals in medical...... decision making for specific clinical conditions. Most of the content herein is based on literature reviews. In areas of uncertainty, professional judgment was applied. These guidelines are a working document that reflects the state of the field at the time of publication. Because rapid changes...

  4. A scalable computer-aided detection system for microcalcification cluster identification in a pan-European distributed database of mammograms

    Energy Technology Data Exchange (ETDEWEB)

    Retico, A. [Istituto Nazionale di Fisica Nucleare, Largo Pontecorvo 3, 56127 Pisa (Italy)]. E-mail: alessandra.retico@df.unipi.it; Delogu, P. [Istituto Nazionale di Fisica Nucleare, Largo Pontecorvo 3, 56127 Pisa (Italy): Dipartimento di Fisica dell' Universita di Pisa, Largo Pontecorvo 3, 56127 Pisa (Italy); Fantacci, M.E. [Istituto Nazionale di Fisica Nucleare, Largo Pontecorvo 3, 56127 Pisa (Italy): Dipartimento di Fisica dell' Universita di Pisa, Largo Pontecorvo 3, 56127 Pisa (Italy); Preite Martinez, A. [Dipartimento di Fisica dell' Universita di Pisa, Largo Pontecorvo 3, 56127 Pisa (Italy); Stefanini, A. [Istituto Nazionale di Fisica Nucleare, Largo Pontecorvo 3, 56127 Pisa (Italy): Dipartimento di Fisica dell' Universita di Pisa, Largo Pontecorvo 3, 56127 Pisa (Italy); Tata, A. [Istituto Nazionale di Fisica Nucleare, Largo Pontecorvo 3, 56127 Pisa (Italy)

    2006-12-20

    A computer-aided detection (CADe) system for microcalcification cluster identification in mammograms has been developed in the framework of the EU-founded MammoGrid project. The CADe software is mainly based on wavelet transforms and artificial neural networks. It is able to identify microcalcifications in different kinds of mammograms (i.e. acquired with different machines and settings, digitized with different pitch and bit depth or direct digital ones). The CADe can be remotely run from GRID-connected acquisition and annotation stations, supporting clinicians from geographically distant locations in the interpretation of mammographic data. We report the FROC analyses of the CADe system performances on three different dataset of mammograms, i.e. images of the CALMA INFN-founded database collected in the Italian National screening program, the MIAS database and the so-far collected MammoGrid images. The sensitivity values of 88% at a rate of 2.15 false positive findings per image (FP/im), 88% with 2.18 FP/im and 87% with 5.7 FP/im have been obtained on the CALMA, MIAS and MammoGrid database, respectively.

  5. Manifestasi klinis tipe kandidiasis oral pada penderita AIDS di Rumah Sakit Dr Wahidin Sudirohusodo, Makassar (Clinical manifestations of oral candidiasis types in AIDS patients at Dr Wahidin Sudirohusodo Hospital, Makassar)

    OpenAIRE

    Sumintarti Sumintarti; Andi Rasdiana S

    2014-01-01

    Oral candidiasis is one of clinical manifestations in aquired immune deficiency syndrome (AIDS) patients. This condition is a common opportunistic infection of the oral cavity caused by an overgrowth of Candida spesies . The clinical types of oral candidiasis are erythematous or atropic , pseudomembranous, hyperplastic or chronic, and angular cheilitis. AIDS is group of symptoms that resulting from infection of human immunodeficiency virus (HIV). This case is associated with th...

  6. A review of technological and clinical aspects of robot-aided rehabilitation of upper-extremity after stroke.

    Science.gov (United States)

    Babaiasl, Mahdieh; Mahdioun, Seyyed Hamed; Jaryani, Poorya; Yazdani, Mojtaba

    2016-01-01

    Cerebrovascular accident (CVA) or stroke is one of the leading causes of disability and loss of motor function. Millions of people around the world are effected by it each year. Stroke results in disabled arm function. Restoration of arm function is essential to regaining activities of daily living (ADL). Along with traditional rehabilitation methods, robot-aided therapy has emerged in recent years. Robot-aided rehabilitation is more intensive, of longer duration and more repetitive. Using robots, repetitive dull exercises can turn into a more challenging and motivating tasks such as games. Besides, robots can provide a quantitative measure of the rehabilitation progress. This article overviews the terms used in robot-aided upper-limb rehabilitation. It continues by investigating the requirements for rehabilitation robots. Then the most outstanding works in robot-aided upper-limb rehabilitation and their control schemes have been investigated. The clinical outcomes of the built robots are also given that demonstrates the usability of these robots in real-life applications and their acceptance. This article summarizes a review done along with a research on the design, simulation and control of a robot for use in upper-limb rehabilitation after stroke. Implications for Rehabilitation Reviewing common terms in rehabilitation of upper limb using robots Reviewing rehabilitation robots built up to date Reviewing clinical outcomes of the mentioned rehabilitation robots.

  7. Can patient decision aids help people make good decisions about participating in clinical trials? A study protocol

    Directory of Open Access Journals (Sweden)

    Fergusson Dean A

    2008-07-01

    Full Text Available Abstract Background Evidence shows that the standard process for obtaining informed consent in clinical trials can be inadequate, with study participants frequently not understanding even basic information fundamental to giving informed consent. Patient decision aids are effective decision support tools originally designed to help patients make difficult treatment or screening decisions. We propose that incorporating decision aids into the informed consent process will improve the extent to which participants make decisions that are informed and consistent with their preferences. A mixed methods study will test this proposal. Methods Phase one of this project will involve assessment of a stratified random sample of 50 consent documents from recently completed investigator-initiated clinical trials, according to existing standards for supporting good decision making. Phase two will involve interviews of a purposive sample of 50 trial participants (10 participants from each of five different clinical areas about their experience of the informed consent process, and how it could be improved. In phase three, we will convert consent forms for two completed clinical trials into decision aids and pilot test these new tools using a user-centered design approach, an iterative development process commonly employed in computer usability literature. In phase four, we will conduct a pilot observational study comparing the new tools to standard consent forms, with potential recruits to two hypothetical clinical trials. Outcomes will include knowledge of key aspects of the decision, knowledge of the probabilities of different outcomes, decisional conflict, the hypothetical participation decision, and qualitative impressions of the experience. Discussion This work will provide initial evidence about whether a patient decision aid can improve the informed consent process. The larger goal of this work is to examine whether study recruitment can be improved from

  8. Anaphylaxis: guidelines from the European Academy of Allergy and Clinical Immunology.

    Science.gov (United States)

    Muraro, A; Roberts, G; Worm, M; Bilò, M B; Brockow, K; Fernández Rivas, M; Santos, A F; Zolkipli, Z Q; Bellou, A; Beyer, K; Bindslev-Jensen, C; Cardona, V; Clark, A T; Demoly, P; Dubois, A E J; DunnGalvin, A; Eigenmann, P; Halken, S; Harada, L; Lack, G; Jutel, M; Niggemann, B; Ruëff, F; Timmermans, F; Vlieg-Boerstra, B J; Werfel, T; Dhami, S; Panesar, S; Akdis, C A; Sheikh, A

    2014-08-01

    Anaphylaxis is a clinical emergency, and all healthcare professionals should be familiar with its recognition and acute and ongoing management. These guidelines have been prepared by the European Academy of Allergy and Clinical Immunology (EAACI) Taskforce on Anaphylaxis. They aim to provide evidence-based recommendations for the recognition, risk factor assessment, and the management of patients who are at risk of, are experiencing, or have experienced anaphylaxis. While the primary audience is allergists, these guidelines are also relevant to all other healthcare professionals. The development of these guidelines has been underpinned by two systematic reviews of the literature, both on the epidemiology and on clinical management of anaphylaxis. Anaphylaxis is a potentially life-threatening condition whose clinical diagnosis is based on recognition of a constellation of presenting features. First-line treatment for anaphylaxis is intramuscular adrenaline. Useful second-line interventions may include removing the trigger where possible, calling for help, correct positioning of the patient, high-flow oxygen, intravenous fluids, inhaled short-acting bronchodilators, and nebulized adrenaline. Discharge arrangements should involve an assessment of the risk of further reactions, a management plan with an anaphylaxis emergency action plan, and, where appropriate, prescribing an adrenaline auto-injector. If an adrenaline auto-injector is prescribed, education on when and how to use the device should be provided. Specialist follow-up is essential to investigate possible triggers, to perform a comprehensive risk assessment, and to prevent future episodes by developing personalized risk reduction strategies including, where possible, commencing allergen immunotherapy. Training for the patient and all caregivers is essential. There are still many gaps in the evidence base for anaphylaxis. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  9. The European Multicentre Bronchiectasis Audit and Research Collaboration (EMBARC): experiences from a successful ERS Clinical Research Collaboration.

    Science.gov (United States)

    Chalmers, James D; Crichton, Megan; Goeminne, Pieter C; Loebinger, Michael R; Haworth, Charles; Almagro, Marta; Vendrell, Montse; De Soyza, Anthony; Dhar, Raja; Morgan, Lucy; Blasi, Francesco; Aliberti, Stefano; Boyd, Jeanette; Polverino, Eva

    2017-09-01

    In contrast to airway diseases like chronic obstructive pulmonary disease or asthma, and rare diseases such as cystic fibrosis, there has been little research and few clinical trials in bronchiectasis. Guidelines are primarily based on expert opinion and treatment is challenging because of the heterogeneous nature of the disease. In an effort to address decades of underinvestment in bronchiectasis research, education and clinical care, the European Multicentre Bronchiectasis Audit and Research Collaboration (EMBARC) was established in 2012 as a collaborative pan-European network to bring together bronchiectasis researchers. The European Respiratory Society officially funded EMBARC in 2013 as a Clinical Research Collaboration, providing support and infrastructure to allow the project to grow. EMBARC has now established an international bronchiectasis registry that is active in more than 30 countries both within and outside Europe. Beyond the registry, the network participates in designing and facilitating clinical trials, has set international research priorities, promotes education and has participated in producing the first international bronchiectasis guidelines. This manuscript article the development, structure and achievements of EMBARC from 2012 to 2017. To understand the role of Clinical Research Collaborations as the major way in which the European Respiratory Society can stimulate clinical research in different disease areasTo understand some of the key features of successful disease registriesTo review key epidemiological, clinical and translational studies of bronchiectasis contributed by the European Multicentre Bronchiectasis Audit and Research Collaboration (EMBARC) project in the past 5 yearsTo understand the key research priorities identified by EMBARC for the next 5 years.

  10. An epidemic model for the transmission dynamics of HIV/AIDS with different clinical stages

    Directory of Open Access Journals (Sweden)

    Sandip Omar

    2010-06-01

    Full Text Available In this paper, a five–dimensional mathematical model is proposed for the transmission dynamics of HIV/AIDS within a population of varying size. In writing the model, we have divided the population under consideration into five sub classes of susceptible, infective, pre-AIDS, AIDS related complex and that of AIDS patients. The model has two non- negative equilibria namely, a disease free and the endemic equilibrium. The model has been studied using stability theory. It is shown that the positive non-trivial equilibrium is always locally stable but it may become globally stable under certain condition showing that the disease becomes endemic due to constant migration of the population into the habitat. The effect of various parameters on the spread of the disease has also been discussed.

  11. Computer-Aided Diagnosis Sensor and System of Breast Sonography: A Clinical Study

    National Research Council Canada - National Science Library

    Jong-Ha Lee; Eun-Jin Lee

    2014-01-01

    .... This paper discusses novel Fourier-based shape feature extraction techniques that provide enhanced classification accuracy for breast tumors in the computer-aided B-mode ultrasound diagnosis system...

  12. Development of diagnostic criteria for serious non-AIDS events in HIV clinical trials

    DEFF Research Database (Denmark)

    Lifson, Alan R; Belloso, Waldo H; Davey, Richard T

    2010-01-01

    (ESPRIT). RESULTS: Final criteria are presented for acute myocardial infarction, congestive heart failure, coronary artery disease requiring drug treatment, coronary revascularization, decompensated liver disease, deep vein thrombosis, diabetes mellitus, end-stage renal disease, non-AIDS cancer...

  13. The methodological quality of clinical guidelines of the European Society of Human Reproduction and Embryology (ESHRE).

    Science.gov (United States)

    Nelen, W L D M; van der Pluijm, R W; Hermens, R P M G; Bergh, C; de Sutter, P; Nygren, K G; Wetzels, A M M; Grol, R P T M; Kremer, J A M

    2008-08-01

    Clinical practice guidelines bridge the gap between the evidence from literature and clinical practice, and they may provide guidance in ethical, legal and societal dilemmas. To explore the potentials for future international guideline development within the field of human reproduction and embryology, we assessed the quality of existing guidelines produced by the European Society of Human Reproduction and Embryology (ESHRE). We systematically searched for the ESHRE guidelines produced after 1996 in electronic databases and on the Internet. Subsequently, we assessed the methodological quality of these guidelines using the validated Appraisal of Guidelines for Research and Evaluation (AGREE) Instrument. The overall methodological quality of most of the 11 selected ESHRE guidelines was poor. Most of the guidelines scored development', 'applicability' and 'editorial independence'. Only one guideline was rated 'strongly recommended'. The methodological quality of the guidelines produced under the auspices of ESHRE can be improved. We suggest a systematic, up-to-date methodology, investment in guideline development specialists, systematic quality control and the incorporation of indicator development. Furthermore, attention should be paid to the document nomenclature, and an ESHRE guidelines' summary on a special part of the ESHRE website would be a good initiative.

  14. Resource use and costs of exenatide bid or insulin in clinical practice: the European CHOICE study.

    Science.gov (United States)

    Kiiskinen, Urpo; Matthaei, Stephan; Reaney, Matthew; Mathieu, Chantal; Ostenson, Claes-Göran; Krarup, Thure; Theodorakis, Michael; Kiljański, Jacek; Salaun-Martin, Carole; Sapin, Hélène; Guerci, Bruno

    2013-01-01

    CHOICE (CHanges to treatment and Outcomes in patients with type 2 diabetes initiating InjeCtablE therapy) assessed patterns of exenatide bid and initial insulin therapy usage in clinical practice in six European countries and evaluated outcomes during the study. CHOICE was a 24-month, prospective, noninterventional observational study. Clinical and resource use data were collected at initiation of first injectable therapy (exenatide bid or insulin) and at regular intervals for 24 months. Costs were evaluated from the national health care system perspective at 2009 prices. A total of 2515 patients were recruited. At the 24-month analysis, significant treatment change had occurred during the study in 42.2% of 1114 eligible patients in the exenatide bid cohort and 36.0% of 1274 eligible patients in the insulin cohort. Improvements in glycemic control were observed over the course of the study in both cohorts (P bid cohort (P bid cohort and €3265.5 in the insulin cohort (€1791.9 versus €2465.5 due to costs other than those of injectable therapy). When baseline direct cost and patients' and disease characteristics were controlled for, mean direct costs differed by country (P bid, compared with insulin, therapy was compensated for by lower mean costs of other health service utilization. Costs associated with exenatide bid or insulin initiation varied across countries, highlighting the need to avoid generalization of resource use and cost implications of a particular therapy when estimated in specific country settings.

  15. An Integrated Intervention for Increasing Clinical Nurses? Knowledge of HIV/AIDS-Related Occupational Safety

    OpenAIRE

    Liping He; Zhiyan Lu; Jing Huang; Yiping Zhou; Jian Huang; Yongyi Bi; Jun Li

    2016-01-01

    Background: Approximately 35 new HIV (Human Immunodeficiency Virus, HIV) cases and at least 1000 serious infections are transmitted annually to health care workers. In China, HIV prevalence is increasing and nursing personnel are encountering these individuals more than in the past. Contaminated needle-stick injuries represent a significant occupational burden for nurses. Evidence suggests that nurses in China may not fully understand HIV/AIDS (Acquired immunodeficiency syndrome, AIDS) and HI...

  16. HIV/AIDS and lipodystrophy: Implications for clinical management in resource-limited settings

    Directory of Open Access Journals (Sweden)

    Julia L Finkelstein

    2015-01-01

    Full Text Available Introduction: Lipodystrophy is a term used to describe a metabolic complication of fat loss, fat gain, or a combination of fat loss and gain, which is associated with some antiretroviral (ARV therapies given to HIV-infected individuals. There is limited research on lipodystrophy in low- and middle-income countries, despite accounting for more than 95% of the burden of HIV/AIDS. The objective of this review was to evaluate the prevalence, pathogenesis and prognosis of HIV-related lipoatrophy, lipohypertrophy and mixed syndrome, to inform clinical management in resource-limited settings. Methods: We conducted a structured literature search using MEDLINE electronic databases. Relevant MeSH terms were used to identify published human studies on HIV and lipoatrophy, lipohypertrophy, or mixed syndrome in low-, low-middle- and upper-middle-income countries through 31 March 2014. The search resulted in 5296 articles; after 1599 studies were excluded (958 reviews, 641 non-human, 3697 studies were extracted for further review. After excluding studies conducted in high-income settings (n=2808, and studies that did not meet inclusion criteria (n=799, 90 studies were included in this review. Results and Discussion: Of the 90 studies included in this review, only six were from low-income countries and eight were from lower middle-income economies. These studies focused on lipodystrophy prevalence, risk factors and side effects of antiretroviral therapy (ART. In most studies, lipodystrophy developed after the first six months of therapy, particularly with the use of stavudine. Lipodystrophy is associated with increased risk of cardiometabolic complications. This is disconcerting and anticipated to increase, given the rapid scale-up of ART worldwide, the increasing number and lifespan of HIV-infected patients on long-term therapy, and the emergence of obesity and non-communicable diseases in settings with extensive HIV burden. Conclusions: Lipodystrophy is

  17. HIV/AIDS and lipodystrophy: implications for clinical management in resource-limited settings.

    Science.gov (United States)

    Finkelstein, Julia L; Gala, Pooja; Rochford, Rosemary; Glesby, Marshall J; Mehta, Saurabh

    2015-01-01

    Lipodystrophy is a term used to describe a metabolic complication of fat loss, fat gain, or a combination of fat loss and gain, which is associated with some antiretroviral (ARV) therapies given to HIV-infected individuals. There is limited research on lipodystrophy in low- and middle-income countries, despite accounting for more than 95% of the burden of HIV/AIDS. The objective of this review was to evaluate the prevalence, pathogenesis and prognosis of HIV-related lipoatrophy, lipohypertrophy and mixed syndrome, to inform clinical management in resource-limited settings. We conducted a structured literature search using MEDLINE electronic databases. Relevant MeSH terms were used to identify published human studies on HIV and lipoatrophy, lipohypertrophy, or mixed syndrome in low-, low-middle- and upper-middle-income countries through 31 March 2014. The search resulted in 5296 articles; after 1599 studies were excluded (958 reviews, 641 non-human), 3697 studies were extracted for further review. After excluding studies conducted in high-income settings (n=2808), and studies that did not meet inclusion criteria (n = 799), 90 studies were included in this review. Of the 90 studies included in this review, only six were from low-income countries and eight were from lower middle-income economies. These studies focused on lipodystrophy prevalence, risk factors and side effects of antiretroviral therapy (ART). In most studies, lipodystrophy developed after the first six months of therapy, particularly with the use of stavudine. Lipodystrophy is associated with increased risk of cardiometabolic complications. This is disconcerting and anticipated to increase, given the rapid scale-up of ART worldwide, the increasing number and lifespan of HIV-infected patients on long-term therapy, and the emergence of obesity and non-communicable diseases in settings with extensive HIV burden. Lipodystrophy is common in resource-limited settings, and has considerable implications for

  18. Clinical characteristics of Pulmonary Tuberculosis in patients with HIV/AIDS: a Case-Control Study

    Directory of Open Access Journals (Sweden)

    "A. Hadadi

    2006-07-01

    Full Text Available Background: Pulmonary TB is still the most common form of the tuberculosis in HIV infected patients with different presentations according to the degree of immunosuppression. The aim of this study was to investigate the impact of HIV infection on the clinical, laboratory and radiological presentation of tuberculosis. Methods: We compared 80 HIV negative pulmonary TB patients with 40 HIV positive pulmonary TB patients during 1999-2005 in a teaching hospital of Tehran University of Medical Sciences, Iran. Results: Tuberculosis was more common in men in both groups. The mean age of HIV positive patients was lower than HIV negatives (35.95+/-10.4 versus 46.95+/-20.39, P =0.002. Weight loss and chronic cough were significantly more frequent in HIV negative patients (76.3% vs. 45% p<0.001 and 93.8% vs. 80%, P<0.05 respectively, whereas fatigue were more prominent in HIV positives (45% vs. 21.3%, P< 0.001. Cavitations and infiltrations were reported in the CXR of HIV/TB patients less than HIV negative patients (OR=0.21, 95% CI: 0.05-0.97, P= 0.01 and OR=0.27%, 95% CI: 0.09-0.75%, P =0.02 respectively. Primary involvement pattern was observed more than secondary involvement in HIV/TB group (OR=3.95, 95% CI: 1.73-9.03, P =0.001. The laboratory findings in HIV/TB patients were as follows: more negative PPD skin (75% vs. 50% tests, higher ESR (86.5% vs. 63.7%, lower mean Hb (10.6 vs. 12.4 and lower mean leukocyte (6545 vs. 9195 and lymphocyte count (1281 vs. 1838. In all of the above mentioned findings the differences between two groups were significant. Fourthy Seven% of patients had Lymphocyte count less than 1200 which means they were in AIDS stage. Conclusion: Immune system suppression in HIV can alter the clinical, laboratory and radiological features of tuberculosis. It is crucial to consider tuberculosis in differential diagnosis of every HIV patients with respiratory symptoms.

  19. Low vision AIDS provision for visually impaired egyptian patients - a clinical outcome.

    Science.gov (United States)

    Shaaban, Sherin; El-Lakkany, Ahmad Rashid; Swelam, Ashraf; Anwar, Ghada

    2009-01-01

    To evaluate a low vision rehabilitation service implemented for heterogeneously diverse group of Egyptianpatients with vision loss in terms of improving their visual performance and fulfilling their visual needs. Fifty patients with low vision were included in a prospective study. History taking, ophthalmic examinationand evaluation of the visual functions were performed for all patients. The required magnification was calculated, andsubsequently a low vision aid was chosen after counseling with patients. Low vision aids were tried in office, followedby a period of training before patients received their own low vision aids. Follow up was done for 6 months. All patients who were referred to the low vision unit were not satisfied with their current spectacles or lowvision aids. After training and prescription of suitable LVAs, the improvement in distance and near visual acuity wasstatistically significant (p<0.001). Fifty-six per cent of the patients (n=28) showed improvement in distance visualacuity of 5 lines or more, and 57% of the patients (n=27) could discern N8 print size or better. The most commonlyused aids were high powered near adds. Despite the complaints about the appearance and use of LVAs, 76% of thepatients reported being moderately to highly-satisfied with their aids. The significant improvement in the visual performance of patients with low vision after the prescriptionand training on the use of LVAs, associated with patients' satisfaction, confirms the importance of expanding lowvision rehabilitative services and increasing the public awareness of its existence and benefits.

  20. Assessment of the knowledge and attitudes regarding HIV/AIDS among pre-clinical medical students in Israel

    Science.gov (United States)

    2014-01-01

    Background Today’s medical students are the future physicians of people living with HIV/AIDS (PLWHA). It is therefore essential that medical students possess the appropriate knowledge and attitudes regarding PLWHA. This study aims to evaluate knowledge and attitudes of pre-clinical Israeli medical students and to assess whether their knowledge and attitudes change throughout their pre-clinical studies. Methods A cross-sectional study was conducted among all pre-clinical medical students from the four medical schools in Israel during the academic year of 2010/2011 (a total of 1,470 students). A self-administered questionnaire was distributed. The questionnaire sought student responses pertaining to knowledge of HIV transmission and non-transmission routes, basic knowledge of HIV/AIDS treatment and attitudes towards HIV/AIDS. Results The study’s response rate was 62.24 percent. Knowledge among pre-clinical medical students was generally high and showed a statistically significant improvement as students progressed through their pre-clinical studies. However, there were some misconceptions, mostly regarding HIV transmission via breastfeeding and knowledge of HIV prevention after exposure to the virus. Students’ attitudes were found to include stigmatizing notions. Furthermore, the majority of medical students correlated HIV with shame and fear. In addition, students’ attitudes toward HIV testing and providing confidential medical information were contradictory to health laws, protocols and guidelines. Overall, no positive changes in students’ attitudes were observed during the pre-clinical years of medical school. Conclusion The knowledge of pre-clinical medical students in Israel is generally high, although there are some knowledge inadequacies that require more emphasis in the curricula of the medical schools. Contrary to HIV-related knowledge, medical students’ attitudes are unaffected by their progression through medical school. Therefore, medical

  1. Challenges of audit of care on clinical quality indicators for hypertension and type 2 diabetes across four European countries.

    Science.gov (United States)

    Suija, Kadri; Kivisto, Katrin; Sarria-Santamera, Antonio; Kokko, Simo; Liseckiene, Ida; Bredehorst, Maren; Jaruseviciene, Lina; Papp, Renata; Oona, Marje; Kalda, Ruth

    2015-02-01

    The purpose of the study was to measure clinical quality by doing an audit of clinical records and to compare the performance based on clinical quality indicators (CQI) for hypertension and type 2 diabetes across seven European countries: Estonia, Finland, Germany, Hungary, Italy, Lithuania and Spain. Two common chronic conditions in primary care (PC), hypertension and type 2 diabetes, were selected for audit. The assessment of CQI started with a literature review of different databases: Organization for Economic Co-operation and Development, World Health Organization, European Commission European Community Health Indicators, US National Library of Medicine. Data were collected from clinical records. Although it was agreed to obtain the clinical indicators in a similar way from each country, the specific data collection process in every country varied greatly, due to different traditions in collecting and keeping the patients' data, as well as differences in regulation regarding access to clinical information. Also, there was a huge variability across countries in the level of compliance with the indicators. Measurement of clinical performance in PC by audit is methodologically challenging: different databases provide different information, indicators of quality of care have insufficient scientific proof and there are country-specific regulations. There are large differences not only in quality of health care across Europe but also in how it is measured. © The Author 2014. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  2. First clinical experiences with a direct acoustic cochlear stimulator in comparison to preoperative fitted conventional hearing aids.

    Science.gov (United States)

    Busch, Susan; Kruck, Stefanie; Spickers, Dirk; Leuwer, Rudolf; Hoth, Sebastian; Praetorius, Mark; Plinkert, Peter K; Mojallal, Hamidreza; Schwab, Burkard; Maier, Hannes; Lenarz, Thomas

    2013-12-01

    Patients with moderate-to-severe mixed hearing losses (MHLs) are hard to provide sufficient benefit with currently available conventional hearing aids. Here, the long-term safety of a direct acoustic cochlear stimulator (DACS) and the effectiveness compared with conventional "high-performance" hearing aids were investigated. Prospective, within patient reference, nonrandomized, interventional multicenter clinical study performed at these 3 centers: Medical University Hannover, University of Heidelberg, and Helios Hospital Krefeld. Ten otosclerosis patients with severe-to-profound MHL were preoperatively fitted with state-of-the-art conventional hearing aids (HA). After 2 months of testing conventional HA, 9 of the patients decided to be implanted with a DACS. Air conduction (AC) and bone conduction (BC) aided and unaided thresholds, speech discrimination before and after implantation and at 3, 6, and 12 months after activation. The subjective benefit was assessed by the Abbreviated Profile of Hearing Aid Benefit (APHAB). Preoperative hearing thresholds were preserved over the 12 month observation time after activation. Average functional gain (0.5-4 kHz) achieved with conventional HA was 47 dB compared with 56 dB with the DACS. Speech-in-noise tests revealed a lower SNR for DACS (3.1 dB) than for the HA (6.6 dB) and patients were more satisfied with the DACS. The DACS significantly improved hearing, speech intelligibility, and satisfaction in patients with a severe-to-profound mixed hearing loss and can be considered a safe and useful alternative to conventional hearing aids.

  3. Clinical and laboratory characteristics, staging, and outcomes of individuals with AIDS-associated Kaposi's sarcoma at an university hospital

    OpenAIRE

    de Lima, Catarina Ten?rio; de Ara?jo, Paulo S?rgio Ramos; TEIXEIRA,Heberton Medeiros; dos Santos, Josemir Belo; da Silveira, Vera Magalh?es

    2017-01-01

    Abstract: Background: Kaposi's sarcoma continues to be the most common human immunodeficiency virus - associated neoplasm with considerable morbidity and mortality. Objective: To describe the clinical and laboratory characteristics, initial staging, and outcomes of aids patients with Kaposi's sarcoma at an university hospital of Recife, Pernambuco. Methods: This is a descriptive study with analytic character, retrospective, of a case series between 2004 and 2014. Results: Of the 22 patien...

  4. European recommendations for the clinical use of HIV drug resistance testing: 2011 update.

    Science.gov (United States)

    Vandamme, Anne-Mieke; Camacho, Ricardo J; Ceccherini-Silberstein, Francesca; de Luca, Andreu; Palmisano, Lucia; Paraskevis, Dimitrios; Paredes, Roger; Poljak, Mario; Schmit, Jean-Claude; Soriano, Vincent; Walter, Hauke; Sönnerborg, Anders

    2011-01-01

    The European HIV Drug Resistance Guidelines Panel, established to make recommendations to clinicians and virologists, felt that sufficient new information has become available to warrant an update of its recommendations, explained in both pocket guidelines and this full paper. The Panel makes the following recommendations concerning the indications for resistance testing: for HIV-1 (i) test earliest sample for protease and reverse transcriptase drug resistance in drug-naive patients with acute or chronic infection; (ii) test protease and reverse transcriptase drug resistance at virologic failure, and other drug targets (integrase and envelope) if such drugs were part of the failing regimen; (iii) consider testing for CCR5 tropism at virologic failure or when a change of therapy has to be made in absence of detectable viral load, and in the latter case test DNA or last detectable plasma RNA; (iv) consider testing earliest detectable plasma RNA when a successful nonnucleoside reverse transcriptase inhibitor-containing therapy was inappropriately interrupted; (v) genotype source patient when postexposure prophylaxis is considered; for HIV-2, (vi) consider resistance testing where treatment change is needed after treatment failure. The Panel recommends genotyping in most situations, using updated and clinically evaluated interpretation systems. It is mandatory that laboratories performing HIV resistance tests take part regularly in external quality assurance programs, and that they consider storing samples in situations where resistance testing cannot be performed as recommended. Similarly, it is necessary that HIV clinicians and virologists take part in continuous education and discuss problematic clinical cases. Indeed, resistance test results should be used in the context of all other clinically relevant information for predicting therapy response.

  5. Syphilis and HIV co-infection in patients who attend an AIDS outpatient clinic in Vitoria, Brazil.

    Science.gov (United States)

    Callegari, Fabiola Mesquita; Pinto-Neto, Lauro Ferreira; Medeiros, Charlla Jezus; Scopel, Camila Binsi; Page, Kimberly; Miranda, Angélica Espinosa

    2014-01-01

    Our goal was to determine the prevalence of, and risk factors associated with, syphilis in HIV-infected patients who attend an AIDS outpatient clinic in Vitoria, Brazil. We conducted a cross-sectional study-including interviews for demographic, behavioral, and clinical characteristics-and blood collection (venipuncture and fingerstick) for VDRL and treponemal tests (rapid test) in a total of 438 patients. The mean age was 43.0 years (SD = 11), and mean years of school was 8.1 (SD = 4.2). The prevalence of syphilis was 5.3 % (95 % CI 3.3-7.3). The treponemal test was positive in 18.9 % of participants. In multivariate analysis, prevalent syphilis infection was independently associated with male gender (AOR 4.6, 95 % CI 1.1-20.0), a history of male-male sex (AOR 1.8, 95 % CI 1.6-4.1), current use of antiretroviral therapy (AOR 5.5, 95 % CI 1.7-16.7), and history of treated syphilis infection (AOR 5.5, 95 % CI 2.0-15.8). Syphilis prevalence was high in patients living with HIV/AIDS who attend an AIDS clinic; therefore, routine sexually transmitted infections counseling and screening should be included in their care.

  6. Clinical, polysomnographic and genome-wide association analyses of narcolepsy with cataplexy: a European Narcolepsy Network study

    NARCIS (Netherlands)

    Luca, G. De; Haba-Rubio, J.; Dauvilliers, Y.; Lammers, G.J.; Overeem, S.; Donjacour, C.E.; Mayer, G.; Javidi, S.; Iranzo, A.; Santamaria, J.; Peraita-Adrados, R.; Hor, H.; Kutalik, Z.; Plazzi, G.; Poli, F.; Pizza, F.; Arnulf, I.; Lecendreux, M.; Bassetti, C.; Mathis, J.; Heinzer, R.; Jennum, P.; Knudsen, S.; Geisler, P.; Wierzbicka, A.; Feketeova, E.; Pfister, C.; Khatami, R.; Baumann, C.; Tafti, M.

    2013-01-01

    The aim of this study was to describe the clinical and PSG characteristics of narcolepsy with cataplexy and their genetic predisposition by using the retrospective patient database of the European Narcolepsy Network (EU-NN). We have analysed retrospective data of 1099 patients with narcolepsy

  7. The effect of certification and accreditation on quality management in 4 clinical services in 73 European hospitals.

    NARCIS (Netherlands)

    Shaw, C.D.; Groene, O.; Botje, D.; Suñol, R.; Kutryba, B.; Klazinga, N.; Bruneau, C.; Hammer, A.; Wang, A.; Arah, O.A.; Wagner, C.

    2014-01-01

    Objective: To investigate the relationship between ISO 9001 certification, healthcare accreditation and quality management in European hospitals. Design: A mixed method multi-level cross-sectional design in seven countries. External teams assessed clinical services on the use of quality management

  8. [A pilot clinical study of immediate provisionalization with a chairside computer aided design and computer aided manufacture monolithic crown for single tooth immediate implant placement].

    Science.gov (United States)

    Tian, J H; Di, P; Lin, Y; Zhang, Y; Wei, D H; Cui, H Y

    2017-01-09

    Objective: To evaluate the primary clinical outcomes of immediate provisionalization with a monolithic crown utilizing a novel chairside computer aided design and computer aided manufacture (CAD/CAM) workflow for single tooth immediate implant placement. Methods: This pilot study was a prospective within-subjects design. Thirteen consecutive patients were included and diagnosed with untreatable single incisor or premolar with fine general and local anatomical conditions. The trial was conducted at Department of Implantology, Peking University School and Hospital of Stomatology, Beijing, between January 2016 and June 2016. The teeth were extracted atraumatically and implants were immediately placed in the fresh sockets. Two screw-retained interim crowns were fabricated for the same site utilizing different workflows, a monolithic lithium disilicate (LS2) crown produced by CEREC (Sirona, Germany) chairside CAD/CAM system (CER group) and a manually fabricated resin crown utilizing conventional workflow (CONV group) respectively. The patients were blinded to the group allocation of the two interim crowns. After the clinical try-in for both crowns in a randomized sequence, the patients' level of satisfaction was assessed with a virtual analogue scale (VAS) questionnaire. The restorations chosen by patients themselves were seated in the implants by one experienced prosthodontist. The accuracy, aesthetic effect and clinical time consumption of both groups were compared. Statistical analyses were performed with the Wilcoxon signed rank test. Results: All patients were treated with atraumatic tooth extraction, immediate implant placement using flapless surgery and immediate provisionalization in a single visit. The interim crowns of both groups could be fitted with or without slight adjustments. For each patient, the interim crown of CER group was chosen to be seated with a relatively higher VAS result. The white esthetic score (WES) results demonstrated no statistically

  9. Validation of the "United Registries for Clinical Assessment and Research" (UR-CARE), a European online registry for clinical care and research in Inflammatory Bowel Disease

    DEFF Research Database (Denmark)

    Burisch, Johan; Gisbert, Javier P; Siegmund, Britta

    2018-01-01

    Background: The "United Registries for Clinical Assessment and Research" (UR-CARE) database is an initiative of the European Crohn's and Colitis Organisation (ECCO) to facilitate daily patient care and research studies in inflammatory bowel disease (IBD). Herein, we sought to validate the databas...

  10. Common definition for categories of clinical research: a prerequisite for a survey on regulatory requirements by the European Clinical Research Infrastructures Network (ECRIN

    Directory of Open Access Journals (Sweden)

    Sanz Nuria

    2009-10-01

    Full Text Available Abstract Background Thorough knowledge of the regulatory requirements is a challenging prerequisite for conducting multinational clinical studies in Europe given their complexity and heterogeneity in regulation and perception across the EU member states. Methods In order to summarise the current situation in relation to the wide spectrum of clinical research, the European Clinical Research Infrastructures Network (ECRIN developed a multinational survey in ten European countries. However a lack of common classification framework for major categories of clinical research was identified, and therefore reaching an agreement on a common classification was the initial step in the development of the survey. Results The ECRIN transnational working group on regulation, composed of experts in the field of clinical research from ten European countries, defined seven major categories of clinical research that seem relevant from both the regulatory and the scientific points of view, and correspond to congruent definitions in all countries: clinical trials on medicinal products; clinical trials on medical devices; other therapeutic trials (including surgery trials, transplantation trials, transfusion trials, trials with cell therapy, etc.; diagnostic studies; clinical research on nutrition; other interventional clinical research (including trials in complementary and alternative medicine, trials with collection of blood or tissue samples, physiology studies, etc.; and epidemiology studies. Our classification was essential to develop a survey focused on protocol submission to ethics committees and competent authorities, procedures for amendments, requirements for sponsor and insurance, and adverse event reporting following five main phases: drafting, consensus, data collection, validation, and finalising. Conclusion The list of clinical research categories as used for the survey could serve as a contribution to the, much needed, task of harmonisation and

  11. Common definition for categories of clinical research: a prerequisite for a survey on regulatory requirements by the European Clinical Research Infrastructures Network (ECRIN).

    Science.gov (United States)

    Kubiak, Christine; de Andres-Trelles, Fernando; Kuchinke, Wolfgang; Huemer, Karl-Heinz; Thirstrup, Steffen; Whitfield, Kate; Libersa, Christian; Barraud, Béatrice; Grählert, Xina; Dreier, Gabriele; Grychtol, Ruth; Temesvari, Zsuzsa; Blasko, Gyorgy; Kardos, Gabriella; O'Brien, Timothy; Cooney, Margaret; Gaynor, Siobhan; Schieppati, Arrigo; Sanz, Nuria; Hernandez, Raquel; Asker-Hagelberg, Charlotte; Johansson, Hanna; Bourne, Sue; Byrne, Jane; Asghar, Adeeba; Husson, Jean-Marc; Gluud, Christian; Demotes-Mainard, Jacques

    2009-10-16

    Thorough knowledge of the regulatory requirements is a challenging prerequisite for conducting multinational clinical studies in Europe given their complexity and heterogeneity in regulation and perception across the EU member states. In order to summarise the current situation in relation to the wide spectrum of clinical research, the European Clinical Research Infrastructures Network (ECRIN) developed a multinational survey in ten European countries. However a lack of common classification framework for major categories of clinical research was identified, and therefore reaching an agreement on a common classification was the initial step in the development of the survey. The ECRIN transnational working group on regulation, composed of experts in the field of clinical research from ten European countries, defined seven major categories of clinical research that seem relevant from both the regulatory and the scientific points of view, and correspond to congruent definitions in all countries: clinical trials on medicinal products; clinical trials on medical devices; other therapeutic trials (including surgery trials, transplantation trials, transfusion trials, trials with cell therapy, etc.); diagnostic studies; clinical research on nutrition; other interventional clinical research (including trials in complementary and alternative medicine, trials with collection of blood or tissue samples, physiology studies, etc.); and epidemiology studies. Our classification was essential to develop a survey focused on protocol submission to ethics committees and competent authorities, procedures for amendments, requirements for sponsor and insurance, and adverse event reporting following five main phases: drafting, consensus, data collection, validation, and finalising. The list of clinical research categories as used for the survey could serve as a contribution to the, much needed, task of harmonisation and simplification of the regulatory requirements for clinical research

  12. Common definition for categories of clinical research: a prerequisite for a survey on regulatory requirements by the European Clinical Research Infrastructures Network (ECRIN)

    LENUS (Irish Health Repository)

    Kubiak, Christine

    2009-10-16

    Abstract Background Thorough knowledge of the regulatory requirements is a challenging prerequisite for conducting multinational clinical studies in Europe given their complexity and heterogeneity in regulation and perception across the EU member states. Methods In order to summarise the current situation in relation to the wide spectrum of clinical research, the European Clinical Research Infrastructures Network (ECRIN) developed a multinational survey in ten European countries. However a lack of common classification framework for major categories of clinical research was identified, and therefore reaching an agreement on a common classification was the initial step in the development of the survey. Results The ECRIN transnational working group on regulation, composed of experts in the field of clinical research from ten European countries, defined seven major categories of clinical research that seem relevant from both the regulatory and the scientific points of view, and correspond to congruent definitions in all countries: clinical trials on medicinal products; clinical trials on medical devices; other therapeutic trials (including surgery trials, transplantation trials, transfusion trials, trials with cell therapy, etc.); diagnostic studies; clinical research on nutrition; other interventional clinical research (including trials in complementary and alternative medicine, trials with collection of blood or tissue samples, physiology studies, etc.); and epidemiology studies. Our classification was essential to develop a survey focused on protocol submission to ethics committees and competent authorities, procedures for amendments, requirements for sponsor and insurance, and adverse event reporting following five main phases: drafting, consensus, data collection, validation, and finalising. Conclusion The list of clinical research categories as used for the survey could serve as a contribution to the, much needed, task of harmonisation and simplification of the

  13. Patients' satisfaction with sexual and reproductive health services delivered in HIV clinics across European regions.

    Science.gov (United States)

    Platteau, Tom; Müller, Matthias C; Nideröst, Sibylle; Csepe, Peter; Dedes, Nikos; Apers, Ludwig; Schrooten, Ward; Nöstlinger, Christiana

    2013-09-01

    Throughout Europe, differences in satisfaction with HIV-care of people living with HIV (PLHIV) persist, despite a tendency towards harmonisation of policy and management. A European sample of 1,549 PLHIV responded to an anonymous questionnaire assessing demographic background, general health, mental health, sexual health, and HIV-service provision. We compared the results across 3 regions: Western, Southern and Central/Eastern Europe. PLHIV differed in several socio-demographic variables (gender, migrant status, sexual orientation, and financial situation) as well as specific psychosocial aspects (HIV-related discrimination, satisfaction with sexual and reproductive health (SRH) services in HIV-care settings, and complaints about service provision). Using multivariate analysis, a predictive model for satisfaction with SRH services in HIV clinics was developed, resulting into region of residence, and participants' satisfaction with their own health status as significant predictors. Better integration of SRH services in HIV-care should be encouraged. Service providers should be trained and encouraged to discuss SRH issues with their patients to create a supportive environment, free of discrimination. More time should be allocated to discuss SRH issues with individual patients.

  14. Plasma HIV-1 Tropism and the Risk of Short-Term Clinical Progression to AIDS or Death.

    Science.gov (United States)

    Casadellà, Maria; Cozzi-Lepri, Alessandro; Phillips, Andrew; Noguera-Julian, Marc; Bickel, Markus; Sedlacek, Dalibor; Zilmer, Kai; Clotet, Bonaventura; Lundgren, Jens D; Paredes, Roger

    2017-01-01

    To investigate if plasma HIV-1 tropism testing could identify subjects at higher risk for clinical progression and death in routine clinical management. Nested case-control study within the EuroSIDA cohort. Cases were subjects with AIDS or who died from any cause, with a plasma sample with HIV-1 RNA >1000 copies/mL available for tropism testing 3 to 12 months prior to the event. At least 1 control matched for age, HIV-1 RNA and HCV status at the time of sampling were selected per each case. Conditional logistic regression was used to investigate exposures associated with clinical progression to AIDS or death. A linear mixed model with random intercept was used to compare CD4+T-cell slopes by HIV tropism over the 12 months following the date of sampling. The study included 266 subjects, 100 cases and 166 controls; one quarter had X4 HIV; 26% were ART-naïve. Baseline factors independently associated with clinical progression or death were female gender (OR = 2.13 vs. male, 95CI = 1.04, 4.36), p = 0.038), CD4+T-cell count (OR = 0.90 (95CI = 0.80, 1.00) per 100 cells/mm3 higher, p = 0.058), being on ART (OR = 2.72 vs. being off-ART (95CI = 1.15, 6.41), p = 0.022) and calendar year of sample [OR = 0.84 (95CI = 0.77, 0.91) per more recent year, pdeath. CD4+T-cell slopes did not differ within or between tropism groups. The predictive role of plasma tropism determined using 454 sequencing in the context of people receiving cART with detectable VL is not helpful to identify subjects at higher risk for clinical progression to AIDS or death.

  15. Previously Unidentified Single Nucleotide Polymorphisms in HIV/AIDS Cases Associate with Clinical Parameters and Disease Progression

    Directory of Open Access Journals (Sweden)

    Vladimir V. Anokhin

    2016-01-01

    Full Text Available The genetic background of an individual plays an important role in the progression of HIV infection to AIDS. Identifying previously unknown or uncharacterized single nucleotide polymorphisms (SNPs that associate with disease progression may reveal important therapeutic targets and provide a greater understanding of disease pathogenesis. In the present study, we employed ultra-high multiplex PCR on an Ion Torrent next-generation sequencing platform to sequence 23 innate immune genes from 94 individuals with HIV/AIDS. This data was used to identify potential associations of SNPs with clinical parameters and disease progression. SNPs that associated with an increased viral load were identified in the genes for the interleukin 15 receptor (IL15RA, toll-like receptor 7 (TLR7, tripartite motif-containing protein 5 (TRIM5, and two killer-cell immunoglobulin-like receptors (KIR2DL1 and KIR2DL3. Additionally, SNPs that associated with progression from HIV infection to AIDS were identified in two 2′-5′-oligoadenylate synthetase genes (OAS2 and OAS3. In contrast, other SNPs identified in OAS2 and OAS3 genes, as well as in the TRIM5 and KIR2DS4 genes, were associated with a slower progression of disease. Taken together, our data demonstrates the utility of ultra-high multiplex PCR in identifying polymorphisms of potential clinical significance and further,identifies SNPs that may play a role in HIV pathogenesis.

  16. European clinical guidelines for Tourette Syndrome and other tic disorders. Part I : assessment

    NARCIS (Netherlands)

    Cath, Danielle C.; Hedderly, Tammy; Ludolph, Andrea G.; Stern, Jeremy S.; Murphy, Tara; Hartmann, Andreas; Czernecki, Virginie; Robertson, Mary May; Martino, Davide; Munchau, A.; Rizzo, R.

    A working group of the European Society for the Study of Tourette Syndrome (ESSTS) has developed the first European assessment guidelines of Tourette Syndrome (TS). The available literature including national guidelines was thoroughly screened and extensively discussed in the expert group of ESSTS

  17. First clinical experiences with an implantable bone conduction hearing aid at the University of Amsterdam

    NARCIS (Netherlands)

    van der Hulst, R. J.; Dreschler, W. A.; Tange, R. A.

    1993-01-01

    A transcutaneous bone-conduction hearing aid was implanted in 11 patients who were not suitable for transcranial sound amplification. Audiological and surgical selection criteria were followed strictly. One device had to be explanted and minor revision surgery was needed in two cases for skin

  18. Graphical and Normative Analysis of Binocular Vision by Mini Computer: A Teaching Aid and Clinical Tool.

    Science.gov (United States)

    Kees, Martin; Schor, Clifton

    1981-01-01

    An inexpensive computer graphics systems (Commodore PET), used as a video aid for teaching students advanced case analysis, is described. The course provides students with the analytical tools for evaluating with graphical and statistical techniques and treating with lenses, prisms, and orthoptics various anomalies of binocular vision. (MLW)

  19. Socio-demographic and clinical profile of AIDS patients in

    African Journals Online (AJOL)

    Other previously rare presentations were also noted. Conclusion: The change observed in the distribution of HIV/AIDS cases in Jimma indicates the maturation of the HIV epidemic. The heterosexual nature of the transmission indicates the need for intervention aimed at reducing risky sexual behaviours. [Ethiop.J.Health Dev ...

  20. Clinical evaluation of a computer-aided diagnosis system for determining cancer aggressiveness in prostate MRI

    NARCIS (Netherlands)

    Litjens, G.J.; Barentsz, J.O.; Karssemeijer, N.; Huisman, H.J.

    2015-01-01

    To investigate the added value of computer-aided diagnosis (CAD) on the diagnostic accuracy of PIRADS reporting and the assessment of cancer aggressiveness.Multi-parametric MRI and histopathological outcome of MR-guided biopsies of a consecutive set of 130 patients were included. All cases were

  1. Clinical evaluation of a computer-aided diagnosis system for determining cancer aggressiveness in prostate MRI.

    Science.gov (United States)

    Litjens, Geert J S; Barentsz, Jelle O; Karssemeijer, Nico; Huisman, Henkjan J

    2015-11-01

    To investigate the added value of computer-aided diagnosis (CAD) on the diagnostic accuracy of PIRADS reporting and the assessment of cancer aggressiveness. Multi-parametric MRI and histopathological outcome of MR-guided biopsies of a consecutive set of 130 patients were included. All cases were prospectively PIRADS reported and the reported lesions underwent CAD analysis. Logistic regression combined the CAD prediction and radiologist PIRADS score into a combination score. Receiver-operating characteristic (ROC) analysis and Spearman's correlation coefficient were used to assess the diagnostic accuracy and correlation to cancer grade. Evaluation was performed for discriminating benign lesions from cancer and for discriminating indolent from aggressive lesions. In total 141 lesions (107 patients) were included for final analysis. The area-under-the-ROC-curve of the combination score was higher than for the PIRADS score of the radiologist (benign vs. cancer, 0.88 vs. 0.81, p = 0.013 and indolent vs. aggressive, 0.88 vs. 0.78, p Computer-aided diagnosis helps radiologists discriminate benign findings from cancer in prostate MRI. • Combining PIRADS and computer-aided diagnosis improves differentiation between indolent and aggressive cancer. • Adding computer-aided diagnosis to PIRADS increases the correlation coefficient with respect to cancer grade.

  2. spectrum and outcome of clinical diseases in adults living with aids

    African Journals Online (AJOL)

    hi-tech

    2003-10-01

    Oct 1, 2003 ... HIV/AIDS is a leading cause of public health crises and the increasing incidence and prevalence .... Neither homosexuality nor intravenous drug use was reported in any of the subjects. Figure 1 .... but higher than tetanus and meningitis as causes of medical admission amongst adults in sagamu (6). This.

  3. A generic tool for development of decision aids based on clinical practice guidelines.

    NARCIS (Netherlands)

    Raats, C.J.; Veenendaal, H van; Versluijs, M.M.; Burgers, J.S.

    2008-01-01

    OBJECTIVE: Patient involvement in medical decision making has been suggested to contribute to patients' satisfaction and better patient outcomes. Decision aids are particularly useful for preference-sensitive decisions. Ideally, these should be based on up-to-date evidence-based guidelines. The

  4. Do the American Society of Clinical Oncology Value Framework and the European Society of Medical Oncology Magnitude of Clinical Benefit Scale Measure the Same Construct of Clinical Benefit?

    Science.gov (United States)

    Cheng, Sierra; McDonald, Erica J; Cheung, Matthew C; Arciero, Vanessa S; Qureshi, Mahin; Jiang, Di; Ezeife, Doreen; Sabharwal, Mona; Chambers, Alexandra; Han, Dolly; Leighl, Natasha; Sabarre, Kelley-Anne; Chan, Kelvin K W

    2017-08-20

    Purpose Whether the ASCO Value Framework and the European Society for Medical Oncology (ESMO) Magnitude of Clinical Benefit Scale (MCBS) measure similar constructs of clinical benefit is unclear. It is also unclear how they relate to quality-adjusted life-years (QALYs) and funding recommendations in the United Kingdom and Canada. Methods Randomized clinical trials of oncology drug approvals by the US Food and Drug Administration, European Medicines Agency, and Health Canada between 2006 and August 2015 were identified and scored using the ASCO version 1 (v1) framework, ASCO version 2 (v2) framework, and ESMO-MCBS by at least two independent reviewers. Spearman correlation coefficients were calculated to assess construct (between frameworks) and criterion validity (against QALYs from the National Institute for Health and Care Excellence [NICE] and the pan-Canadian Oncology Drug Review [pCODR]). Associations between scores and NICE/pCODR recommendations were examined. Inter-rater reliability was assessed using intraclass correlation coefficients. Results From 109 included randomized clinical trials, 108 ASCOv1, 111 ASCOv2, and 83 ESMO scores were determined. Correlation coefficients for ASCOv1 versus ESMO, ASCOv2 versus ESMO, and ASCOv1 versus ASCOv2 were 0.36 (95% CI, 0.15 to 0.54), 0.17 (95% CI, -0.06 to 0.37), and 0.50 (95% CI, 0.35 to 0.63), respectively. Compared with NICE QALYs, correlation coefficients were 0.45 (ASCOv1), 0.53 (ASCOv2), and 0.46 (ESMO); with pCODR QALYs, coefficients were 0.19 (ASCOv1), 0.20 (ASCOv2), and 0.36 (ESMO). None of the frameworks were significantly associated with NICE/pCODR recommendations. Inter-rater reliability was good for all frameworks. Conclusion The weak-to-moderate correlations of the ASCO frameworks with the ESMO-MCBS, as well as their correlations with QALYs and with NICE/pCODR funding recommendations, suggest different constructs of clinical benefit measured. Construct convergent validity with the ESMO-MCBS did not

  5. Prosthetic rehabilitation with an implant-supported fixed prosthesis using computer-aided design and computer-aided manufacturing dental technology for a patient with a mandibulectomy: A clinical report.

    Science.gov (United States)

    Yoon, Hyung-In; Han, Jung-Suk

    2016-02-01

    The fabrication of dental prostheses with computer-aided design and computer-aided manufacturing shows acceptable marginal fits and favorable treatment outcomes. This clinical report describes the management of a patient who had undergone a mandibulectomy and received an implant-supported fixed prosthesis by using additive manufacturing for the framework and subtractive manufacturing for the monolithic zirconia restorations. Copyright © 2016 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.

  6. Clinical application of a novel computer-aided detection system based on three-dimensional CT images on pulmonary nodule.

    Science.gov (United States)

    Zeng, Jian-Ye; Ye, Hai-Hong; Yang, Shi-Xiong; Jin, Ren-Chao; Huang, Qi-Liang; Wei, Yong-Chu; Huang, Si-Guang; Wang, Bin-Qiang; Ye, Jia-Zhou; Qin, Jian-Ying

    2015-01-01

    The aim of this study was to investigate the clinical application effects of a novel computer-aided detection (CAD) system based on three-dimensional computed tomography (CT) images on pulmonary nodule. 98 cases with pulmonary nodule (PN) in our hospital from Jun, 2009 to Jun, 2013 were analysed in this study. All cases underwent PN detection both by the simple spiral CT scan and by the computer-aided system based on 3D CT images, respectively. Postoperative pathological results were considered as the "gold standard", for both two checking methods, the diagnostic accuracies for determining benign and malignant PN were calculated. Under simple spiral CT scan method, 63 cases is malignant, including 50 true positive cases and 13 false positive cases from the "gold standard"; 35 cases is benign, 16 true negative case and 19 false negative cases, the Sensitivity 1 (Se1)=0.725, Specificity1 (Sp1)=0.448, Agreement rate1 (Kappa 1)=0.673, J1 (Youden's index 1)=0.173, LR(+)1=1.616, LR(-)1=0.499. Kappa 1=0.673 between the 0.4 and 0.75, has a moderate consistency. Underwent computer-aided detection (CAD) based on 3D CT method, 67cases is malignant, including 62 true positive cases and 7 false positive cases; 31 cases is benign, 24 true negative case and 7 false negative cases, Sensitivity 2 (Se2)=0.899, Specificity2 (Sp2)=0.828, Agreement rate (Kappa 2)=0.877, J2 (Youden's index 2)=0.727, LR(+)2=5.212, LR(-)2=0.123. Kappa 2=0.877 >0.75, has a good consistency. Computer-aided PN detecting system based on 3D CT images has better clinical application value, and can help doctor carry out early diagnosis of lung disease (such as cancer, etc.) through CT images.

  7. Quality of life, socioeconomic and clinical factors, and physical exercise in persons living with HIV/AIDS

    Directory of Open Access Journals (Sweden)

    Rafaela Catherine da Silva Cunha de Medeiros

    Full Text Available ABSTRACT OBJECTIVE To analyze whether socioeconomic and clinical aspects and the aspects of healthy life habits are associated with the quality of life of persons living with HIV/AIDS. METHODS This is a cross-sectional exploratory quantitative research, with 227 persons living with HIV/AIDS, treated at two hospitals of reference between April 2012 and June 2014. We used structured questionnaires to assess socioeconomic aspects (gender, age, education level, marital status, race, socioeconomic status, dependents on family income, employment relationship, clinical parameters (time of disease diagnosis, use and time of medication, CD4 T-cell count, and viral load, and practice of physical exercise. To assess quality of life, we used the Quality of Life questionnaire (HAT-QoL. For characterization of the socioeconomic and clinical data and domains of quality of life, we conducted a descriptive analysis (simple frequency, averages, and standard deviations. We applied linear regression, following a hierarchical model for each domain of quality of life. RESULTS The domains that presented lower averages for quality of life were financial concern, concern with confidentiality, general function, and satisfaction with life. We found associations with the variables of socioeconomic status and physical exercise, therapy, and physical exercise for the last two domains, consecutively. CONCLUSIONS The quality of life of persons living with HIV/AIDS shows losses, especially in the financial and confidentiality areas, followed by general function of the body and satisfaction with life, in which socioeconomic and clinical aspects and healthy living habits, such as the practice of physical exercise, are determining factors for this reality.

  8. The knowledge and attitude about HIV/AIDS among Jordanian dental students: (Clinical versus pre clinical students at the University of Jordan

    Directory of Open Access Journals (Sweden)

    Shayyab Mohammad H

    2011-06-01

    Full Text Available Abstract Background The present study aimed to address the suspected deficiency in the level of understanding of HIV/AIDS among clinical and pre clinical dental students at the University of Jordan. In this cross-sectional study, structured questionnaires were distributed to fifth year dental students (n = 121 and to third year dental students (n = 144 in the academic year 2008/2009. Findings Significantly higher percentage of fifth-year students compared to third-year students felt that the teaching they received on cross-infection precautions and barrier dentistry was adequate (P Significantly higher proportion of third-year students compared to fifth-year (39.2% vs. 26.3% thought that HIV patients should be referred to other centers or support groups for treatment (P = 0.04. Conclusions The level of knowledge of Jordanian dental students about HIV and AIDS was generally acceptable; there were inadequacies, however, in their understanding regarding some aspects of AIDS epidemic which demands that dental school curriculum needs some improvement.

  9. Clinical results of hearing aid with noise-level-controlled selective amplification.

    Science.gov (United States)

    Ono, H; Kanzaki, J; Mizoi, K

    1983-01-01

    We have developed a hearing aid which reduces the low-frequency energy of the input sound according to the input noise level and the spectrum of the environmental noise. The results of speech discrimination tests using speech in noise in 70 hearing-impaired subjects showed improvement in word discrimination scores in noise of over 15% for 50 of 53 subjects with sensorineural hearing loss. This group of hearing-impaired patients was subdivided into categories according to (a) audiogram type [flat, sloping (i.e. gradual high-frequency loss) and abruptly falling (steep high-frequency slope)]; (b) degree of hearing loss (less than or more than 50 dB average loss) and (c) etiology (familial deafness, presbyacusis). Results on 17 subjects with conductive or mixed hearing impairments showed no improvement, but expressed a preference for this system. The subject reported that the sound was more natural and quiet compared with the conventional AGC hearing aids.

  10. Evaluation of a clinical auditory profile in hearing-aid candidates

    DEFF Research Database (Denmark)

    Thorup, Nicoline; Santurette, Sébastien; Jørgensen, Søren

    2015-01-01

    and temporal resolution, binaural hearing, speech intelligibility in stationary and fluctuating noise, and a working-memory test. Six weeks after HA fitting they answered the International Outcome Inventory – Hearing Aid evaluation. The HI group was homogeneous based on the audiogram, but only one test......Hearing-impaired (HI) listeners often complain about communicating in the presence of background noise, although audibility may be restored by a hearing-aid (HA). The audiogram typically forms the basis for HA fitting, such that people with similar audiograms are given the same prescription...... was correlated to pure-tone hearing thresholds. Moreover, HI listeners who took the least advantage from fluctuations in background noise in terms of speech intelligibility experienced greater HA benefit. Further analysis of whether specific outcomes are directly related to speech intelligibility in fluctuating...

  11. American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association Medical guidelines for clinical practice for the diagnosis and management of thyroid nodules

    DEFF Research Database (Denmark)

    Gharib, Hossein; Papini, Enrico; Paschke, Ralf

    2010-01-01

    American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association Medical Guidelines for Clinical Practice for the Diagnosis and Management of Thyroid Nodules are systematically developed statements to assist health care professionals in medical...... decision making for specific clinical conditions. Most of the content herein is based on literature reviews. In areas of uncertainty, professional judgment was applied.These guidelines are a working document that reflects the state of the field at the time of publication. Because rapid changes in this area...

  12. American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association Medical Guidelines for Clinical Practice for the Diagnosis and Management of thyroid Nodules

    DEFF Research Database (Denmark)

    Gharib, Hossein; Papini, Enrico; Paschke, Ralf

    2010-01-01

    American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association Medical Guidelines for Clinical Practice for the Diagnosis and Management of Thyroid Nodules are systematically developed statements to assist health care professionals in medical...... decision making for specific clinical conditions. Most of the content herein is based on literature reviews. In areas of uncertainty, professional judgment was applied.These guidelines are a working document that reflects the state of the field at the time of publication. Because rapid changes in this area...

  13. Accuracy of computer-aided template-guided oral implant placement: a prospective clinical study

    Science.gov (United States)

    2014-01-01

    Purpose The aim of the present study was to evaluate the in vivo accuracy of flapless, computer-aided implant placement by comparing the three-dimensional (3D) position of planned and placed implants through an analysis of linear and angular deviations. Methods Implant position was virtually planned using 3D planning software based on the functional and aesthetic requirements of the final restorations. Computer-aided design/computer-assisted manufacture technology was used to transfer the virtual plan to the surgical environment. The 3D position of the planned and placed implants, in terms of the linear deviations of the implant head and apex and the angular deviations of the implant axis, was compared by overlapping the pre- and postoperative computed tomography scans using dedicated software. Results The comparison of 14 implants showed a mean linear deviation of the implant head of 0.56 mm (standard deviation [SD], 0.23), a mean linear deviation of the implant apex of 0.64 mm (SD, 0.29), and a mean angular deviation of the long axis of 2.42° (SD, 1.02). Conclusions In the present study, computer-aided flapless implant surgery seemed to provide several advantages to the clinicians as compared to the standard procedure; however, linear and angular deviations are to be expected. Therefore, accurate presurgical planning taking into account anatomical limitations and prosthetic demands is mandatory to ensure a predictable treatment, without incurring possible intra- and postoperative complications. Graphical Abstract PMID:25177520

  14. Papillary cannulation and sphincterotomy techniques at ERCP: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline

    NARCIS (Netherlands)

    Testoni, Pier Alberto; Mariani, Alberto; Aabakken, Lars; Arvanitakis, Marianna; Bories, Erwan; Costamagna, Guido; Devière, Jacques; Dinis-Ribeiro, Mario; Dumonceau, Jean-Marc; Giovannini, Marc; Gyokeres, Tibor; Hafner, Michael; Halttunen, Jorma; Hassan, Cesare; Lopes, Luis; Papanikolaou, Ioannis S.; Tham, Tony C.; Tringali, Andrea; van Hooft, Jeanin; Williams, Earl J.

    2016-01-01

    This Guideline is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE). It provides practical advice on how to achieve successful cannulation and sphincterotomy at minimum risk to the patient. The Grading of Recommendations Assessment, Development, and Evaluation

  15. The European Respiratory Society and European Society of Thoracic Surgeons clinical guidelines for evaluating fitness for radical treatment (surgery and chemoradiotherapy) in patients with lung cancer.

    Science.gov (United States)

    Brunelli, Alessandro; Charloux, Anne; Bolliger, Chris T; Rocco, Gaetano; Sculier, Jean-Paul; Varela, Gonzalo; Licker, Marc; Ferguson, Mark K; Faivre-Finn, Corinne; Huber, Rudolf Maria; Clini, Enrico M; Win, Thida; De Ruysscher, Dirk; Goldman, Lee

    2009-07-01

    The European Respiratory Society (ERS) and the European Society of Thoracic Surgeons (ESTS) established a joint task force with the purpose to develop clinical evidence-based guidelines on evaluation of fitness for radical therapy in patients with lung cancer. The following topics were discussed, and are summarized in the final report along with graded recommendations: Cardiologic evaluation before lung resection; lung function tests and exercise tests (limitations of ppoFEV1; DLCO: systematic or selective?; split function studies; exercise tests: systematic; low-tech exercise tests; cardiopulmonary (high tech) exercise tests); future trends in preoperative work-up; physiotherapy/rehabilitation and smoking cessation; scoring systems; advanced care management (ICU/HDU); quality of life in patients submitted to radical treatment; combined cancer surgery and lung volume reduction surgery; compromised parenchymal sparing resections and minimally invasive techniques: the balance between oncological radicality and functional reserve; neoadjuvant chemotherapy and complications; definitive chemo and radiotherapy: functional selection criteria and definition of risk; should surgical criteria be re-calibrated for radiotherapy?; the patient at prohibitive surgical risk: alternatives to surgery; who should treat thoracic patients and where these patients should be treated?

  16. Contextual factors and anxiety in minority and European American youth presenting for treatment across two urban university clinics.

    Science.gov (United States)

    Beidas, Rinad S; Suarez, Liza; Simpson, David; Read, Kendra; Wei, Chiaying; Connolly, Sucheta; Kendall, Philip

    2012-05-01

    The current study compared ethnic minority and European American clinically-referred anxious youth (N=686; 2-19 years) on internalizing symptoms (i.e., primary anxiety and comorbid depression) and neighborhood context. Data were provided from multiple informants including youth, parents, and teachers. Internalizing symptoms were measured by the Multidimensional Anxiety Scale for Children, Child Depression Inventory, Child Behavior Checklist and Teacher Report Form. Diagnoses were based on the Anxiety Disorders Interview Schedule for Children. Neighborhood context was measured using Census tract data (i.e., owner-occupied housing, education level, poverty level, and median home value). Ethnic minority and European American youth showed differential patterns of diagnosis and severity of anxiety disorders. Further, ethnic minority youth lived in more disadvantaged neighborhoods. Ethnicity and neighborhood context appear to have an additive influence on internalizing symptoms in clinically-referred anxious youth. Implications for evidence-based treatments are discussed. Copyright © 2012 Elsevier Ltd. All rights reserved.

  17. EC4 European Syllabus for Post-Graduate Training in Clinical Chemistry and Laboratory Medicine: version 3 - 2005.

    Science.gov (United States)

    Zerah, Simone; McMurray, Janet; Bousquet, Bernard; Baum, Hannsjorg; Beastall, Graham H; Blaton, Vic; Cals, Marie-Josèphe; Duchassaing, Danielle; Gaudeau-Toussaint, Marie-Françoise; Harmoinen, Aimo; Hoffmann, Hans; Jansen, Rob T; Kenny, Desmond; Kohse, Klaus P; Köller, Ursula; Gobert, Jean-Gérard; Linget, Christine; Lund, Erik; Nubile, Giuseppe; Opp, Matthias; Pazzagli, Mario; Pinon, Georges; Queralto, José M; Reguengo, Henrique; Rizos, Demetrios; Szekeres, Thomas; Vidaud, Michel; Wallinder, Hans

    2006-01-01

    The EC4 Syllabus for Postgraduate Training is the basis for the European Register of Specialists in Clinical Chemistry and Laboratory Medicine. The syllabus: Indicates the level of requirements in postgraduate training to harmonise the postgraduate education in the European Union (EU); Indicates the level of content of national training programmes to obtain adequate knowledge and experience; Is approved by all EU societies for clinical chemistry and laboratory medicine. The syllabus is not primarily meant to be a training guide, but on the basis of the overview given (common minimal programme), national societies should formulate programmes that indicate where knowledge and experience is needed. The main points of this programme are: Indicates the level of requirements in postgraduate training to harmonise the postgraduate education in the European Union (EU); Indicates the level of content of national training programmes to obtain adequate knowledge and experience; Is approved by all EU societies for clinical chemistry and laboratory medicine. Knowledge in biochemistry, haematology, immunology, etc.; Pre-analytical conditions; Evaluation of results; Interpretations (post-analytical phase); Laboratory management; and Quality insurance management. The aim of this version of the syllabus is to be in accordance with the Directive of Professional Qualifications published on 30 September 2005. To prepare the common platforms planned in this directive, the disciplines are divided into four categories: Indicates the level of requirements in postgraduate training to harmonise the postgraduate education in the European Union (EU); Indicates the level of content of national training programmes to obtain adequate knowledge and experience; Is approved by all EU societies for clinical chemistry and laboratory medicine. Knowledge in biochemistry, haematology, immunology, etc.; Pre-analytical conditions; Evaluation of results; Interpretations (post-analytical phase); Laboratory

  18. [Regulations of the ethical evaluation system of scientific and clinical research in connection with Poland joining the European Union].

    Science.gov (United States)

    Raszeja, Stefan

    2004-01-01

    The author has discussed the procedures of the Bioethical Commission of a biomedical research assessment and clinical trials based on analysis of the directives of the European Commission. Particularly criticized was the omission of the role of local committees in the case of the multi-center studies. Also underlined was a necessity to inform the examined persons, in a wider and more understandable fashion, about an essence of the examination and the expected level of risk.

  19. The management of clinical laboratories in Europe: a FESCC survey. Forum of the European Societies of Clinical Chemistry and Laboratory Medicine.

    Science.gov (United States)

    de Kieviet, Wim; Blaton, Victor; Kovacs, Gabor L; Palicka, Vladimir; Pulkki, Kari

    2002-03-01

    The professional duties of the specialists in clinical chemistry differ from country to country in Europe. One of the main goals of the Strategic Plan of the Forum of the European Societies of Clinical Chemistry and Laboratory Medicine (FESCC; IFCC-Europe) is to promote a high scientific and professional standard in the field of clinical chemistry and laboratory medicine in Europe. This can be stimulated by the knowledge of the local conditions in each country and by striving towards a strong and harmonised position in all the European countries. In order to enhance the knowledge of the managerial situation of the specialists in clinical chemistry in Europe, FESCC launched a survey in September 2000. This survey provides information about the position of the specialists in clinical chemistry in the various disciplines in the medical laboratories and in hospitals, and about the advisory tasks and the managerial education during the post-graduate training in clinical chemistry. Of the 35 FESCC member countries 33 have participated in the survey (94%). The results show a rather heterogeneous situation in Europe caused by the local historical developments, the differences in academic background and the relative numbers of private and physicians' office laboratories. Large differences exist between the European countries in the disciplines of laboratory medicine that are headed by a specialist in clinical chemistry. In the different countries the clinical chemistry laboratories are headed by specialists in clinical chemistry in between 20% and 100% of the laboratories. The haematology, immunology, microbiology, therapeutic drug monitoring, molecular biology and haemostasis laboratories and departments of blood banking are headed by specialists in clinical chemistry in between 0% and 100% of the laboratories. The responsibilities for the various managerial tasks of the specialists in clinical chemistry show no uniformity in Europe. In the majority of the countries the

  20. An Integrated Intervention for Increasing Clinical Nurses' Knowledge of HIV/AIDS-Related Occupational Safety.

    Science.gov (United States)

    He, Liping; Lu, Zhiyan; Huang, Jing; Zhou, Yiping; Huang, Jian; Bi, Yongyi; Li, Jun

    2016-11-07

    Background: Approximately 35 new HIV (Human Immunodeficiency Virus, HIV) cases and at least 1000 serious infections are transmitted annually to health care workers. In China, HIV prevalence is increasing and nursing personnel are encountering these individuals more than in the past. Contaminated needle-stick injuries represent a significant occupational burden for nurses. Evidence suggests that nurses in China may not fully understand HIV/AIDS (Acquired immunodeficiency syndrome, AIDS) and HIV-related occupational safety. At this time, universal protection precautions are not strictly implemented in Chinese hospitals. Lack of training may place nurses at risk for occupational exposure to blood-borne pathogens. Objectives: To assess the effectiveness of integrated interventions on nurses' knowledge improvement about reducing the risk of occupationally acquired HIV infection. Methods: We audited integrated interventions using 300 questionnaires collected from nurses at the Affiliated Hospital of Xiangnan University, a public polyclinic in Hunan Province. The intervention studied was multifaceted and included appropriate and targeted training content for hospital, department and individual levels. After three months of occupational safety integrated interventions, 234 participants who completed the program were assessed. Results: Of the subjects studied, 94.3% (283/300) were injured one or more times by medical sharp instruments or splashed by body fluids in the last year and 95.3% considered their risk of occupational exposure high or very high. After the intervention, awareness of HIV/AIDS-related knowledge improved significantly (χ² = 86.34, p = 0.00), and correct answers increased from 67.9% to 82.34%. Correct answers regarding risk perception were significantly different between pre-test (54.4%) and post-test (66.6%) (χ² = 73.2, p = 0.00). When coming into contact with patient body fluids and blood only 24.0% of subjects used gloves regularly. The pre

  1. An Integrated Intervention for Increasing Clinical Nurses’ Knowledge of HIV/AIDS-Related Occupational Safety

    Science.gov (United States)

    He, Liping; Lu, Zhiyan; Huang, Jing; Zhou, Yiping; Huang, Jian; Bi, Yongyi; Li, Jun

    2016-01-01

    Background: Approximately 35 new HIV (Human Immunodeficiency Virus, HIV) cases and at least 1000 serious infections are transmitted annually to health care workers. In China, HIV prevalence is increasing and nursing personnel are encountering these individuals more than in the past. Contaminated needle-stick injuries represent a significant occupational burden for nurses. Evidence suggests that nurses in China may not fully understand HIV/AIDS (Acquired immunodeficiency syndrome, AIDS) and HIV-related occupational safety. At this time, universal protection precautions are not strictly implemented in Chinese hospitals. Lack of training may place nurses at risk for occupational exposure to blood-borne pathogens. Objectives: To assess the effectiveness of integrated interventions on nurses’ knowledge improvement about reducing the risk of occupationally acquired HIV infection. Methods: We audited integrated interventions using 300 questionnaires collected from nurses at the Affiliated Hospital of Xiangnan University, a public polyclinic in Hunan Province. The intervention studied was multifaceted and included appropriate and targeted training content for hospital, department and individual levels. After three months of occupational safety integrated interventions, 234 participants who completed the program were assessed. Results: Of the subjects studied, 94.3% (283/300) were injured one or more times by medical sharp instruments or splashed by body fluids in the last year and 95.3% considered their risk of occupational exposure high or very high. After the intervention, awareness of HIV/AIDS-related knowledge improved significantly (χ2 = 86.34, p = 0.00), and correct answers increased from 67.9% to 82.34%. Correct answers regarding risk perception were significantly different between pre-test (54.4%) and post-test (66.6%) (χ2 = 73.2, p = 0.00). When coming into contact with patient body fluids and blood only 24.0% of subjects used gloves regularly. The pre

  2. An Integrated Intervention for Increasing Clinical Nurses’ Knowledge of HIV/AIDS-Related Occupational Safety

    Directory of Open Access Journals (Sweden)

    Liping He

    2016-11-01

    Full Text Available Background: Approximately 35 new HIV (Human Immunodeficiency Virus, HIV cases and at least 1000 serious infections are transmitted annually to health care workers. In China, HIV prevalence is increasing and nursing personnel are encountering these individuals more than in the past. Contaminated needle-stick injuries represent a significant occupational burden for nurses. Evidence suggests that nurses in China may not fully understand HIV/AIDS (Acquired immunodeficiency syndrome, AIDS and HIV-related occupational safety. At this time, universal protection precautions are not strictly implemented in Chinese hospitals. Lack of training may place nurses at risk for occupational exposure to blood-borne pathogens. Objectives: To assess the effectiveness of integrated interventions on nurses’ knowledge improvement about reducing the risk of occupationally acquired HIV infection. Methods: We audited integrated interventions using 300 questionnaires collected from nurses at the Affiliated Hospital of Xiangnan University, a public polyclinic in Hunan Province. The intervention studied was multifaceted and included appropriate and targeted training content for hospital, department and individual levels. After three months of occupational safety integrated interventions, 234 participants who completed the program were assessed. Results: Of the subjects studied, 94.3% (283/300 were injured one or more times by medical sharp instruments or splashed by body fluids in the last year and 95.3% considered their risk of occupational exposure high or very high. After the intervention, awareness of HIV/AIDS-related knowledge improved significantly (χ2 = 86.34, p = 0.00, and correct answers increased from 67.9% to 82.34%. Correct answers regarding risk perception were significantly different between pre-test (54.4% and post-test (66.6% (χ2 = 73.2, p = 0.00. When coming into contact with patient body fluids and blood only 24.0% of subjects used gloves regularly

  3. American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association medical guidelines for clinical practice for the diagnosis and management of thyroid nodules: Executive Summary of recommendations

    DEFF Research Database (Denmark)

    Gharib, H; Papini, E; Paschke, R

    2010-01-01

    American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association medical guidelines for clinical practice for the diagnosis and management of thyroid nodules are systematically developed statements to assist health care professionals in medical...

  4. Estimating Cardiovascular Risk in Spain by the European Guidelines on Cardiovascular Disease Prevention in Clinical Practice.

    Science.gov (United States)

    Amor, Antonio Jesús; Masana, Luis; Soriguer, Federico; Goday, Albert; Calle-Pascual, Alfonso; Gaztambide, Sonia; Rojo-Martínez, Gemma; Valdés, Sergio; Gomis, Ramón; Ortega, Emilio

    2015-05-01

    There are no nationwide, population-based studies in Spain assessing overall cardiovascular risk. We aimed to describe cardiovascular risk and achievement of treatment goals following the 2012 European Guidelines on cardiovascular disease prevention strategy. We also investigated clinical characteristics (non-classical risk factors) associated with moderate risk. Participants (n=2310, 58% women) aged 40 to 65 years from a national population-based study (Di@bet.es Study) were identified. First, a priori high/very-high risk individuals were identified. Next, total cardiovascular risk (Systematic Coronary Risk Evaluation equation including high-density lipoprotein cholesterol) was used to assess risk of a priori non-high risk individuals. Variables independently associated with moderate versus low-risk were investigated by multiple logistic regression analysis. Age-and-sex standardized (direct method) percentages of high/very-high, moderate, and low-risk were 22.8%, 43.5%, and 33.7%, respectively. Most men were at moderate (56.2%), while 55.4% of women were at low risk. Low-density lipoprotein cholesterol (< 70,<100, < 115 mg/dL) and blood pressure (<140/90 mmHg) goals for very-high, high and moderate risk were met in 15%, 26% and 46%, and 77%, 68% and 85% of the individuals, respectively. Body mass index, high triglycerides concentrations, diastolic blood pressure, and low Mediterranean diet adherence (in women) were independently associated with moderate (versus low) risk. Cardiovascular risk in Spain is mainly moderate in men and low in women. Achievement of treatment goals in high-risk individuals should be improved. The prevalence of non-classical cardiovascular risk factors is elevated in subjects at moderate risk, an important aspect to consider in a population-based strategy to decrease cardiovascular disease in the most prevalent group. Copyright © 2014 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  5. Evolution of the European guidelines for the clinical development of factor VIII products: little progress towards improved patient management.

    Science.gov (United States)

    Mannucci, P M

    2013-05-01

    In the process of clinical development and licensing of factor VIII (FVIII) products for treatment of haemophilia A, the safety concerns generated in the 1980s by the risk of pathogen transmission were tremendously reduced by the implementation of an array of methods for inactivation/removal of blood borne pathogens. The current focus on the risk of FVIII inhibitors does not stem from a new awareness, because this multifactorial complication has long been recognized. With this background, I believe that the current European regulatory guidelines for the clinical development and licensing of FVIII products fail to reflect the tremendous progress made in terms of clinical efficacy and safety, because they are witnessing a continuous increase in the demands from health agencies to the point that clinical studies have become more and more difficult to carry out. This article reviews the evolution of the European regulations on new FVIII products, lists a number of regulatory requirements whose scientific and/or clinical rationale is perhaps questionable and recommends keeping such requirements in reasonable limits of feasibility, without jeopardizing current high standards of efficacy and safety. © 2012 Blackwell Publishing Ltd.

  6. [Clinical and bacteriological profiles of the urinary infections associated the VIH/AIDS in hospital area of Bamako, Mali].

    Science.gov (United States)

    Dao, S; Oumar, A A; Dembele, J P; Noutache, J L; Fongoro, S; Maiga, I; Bougoudogo, F

    2007-01-01

    The syndrome of immunodepression is the bed of multiple infections of which urinary infections. The goal of this study was to determine the aspects clinical and bacteriological urinary infections during the AIDS with the service of the infectious diseases of the hospital of the Point G of February 1, 2003 to June 30 2005. The diagnosis of the urinary infection was retained on the basis of bacteria number > or =10(4) bacteriury and or leucocytes count > or =10(5)/mm3. The prevalence of the urinary infection was estimated at 8.85%. The principal clinical aspects were a symptomatic pyelonephritis 73.5%, the leucocytiury 11.8%, the cystitis 8.8%, and acute prostatitis 5.9%. Escherichia coli was the most frequent bacterium (46.7%). The sensitivity of the germs was 91.7% with the aminosides, 90.9% with the fluoroquinolones, from 63.6 to 80% respectively with the cephalosporines of first and second generation. Resistance to ampicilline, chloramphenicol and sulfamides was about 72 and 80%. The systematic research of the urinary infection is necessary during the AIDS and the antibiotherapy of choice in first intention in absence of etiologic possibility of diagnosis should be the aminosides and or the fluoroquinolones.

  7. Improving diagnostic capability for HPV disease internationally within the NIH-NIAID-Division of AIDS Clinical Trial Networks

    Science.gov (United States)

    Godfrey, Catherine C.; Michelow, Pamela M.; Godard, Mandana; Sahasrabuddhe, Vikrant V.; Darden, Janice; Firnhaber, Cynthia S.; Wetherall, Neal T.; Bremer, James; Coombs, Robert W.; Wilkin, Timothy

    2014-01-01

    Objectives To evaluate an external quality assurance (EQA) program for the laboratory diagnosis of human papillomavirus (HPV) disease that was established to improve international research capability within the Division of AIDS at the National Institute of Allergy and Infectious Disease–supported Adult AIDS Clinical Trials Group network. Methods A three-component EQA scheme was devised comprising assessments of diagnostic accuracy of cytotechnologists and pathologists using available EQA packages, review of quality and accuracy of clinical slides from local sites by an outside expert, and HPV DNA detection using the commercially available HPV test kit. Results Seven laboratories and 17 pathologists in Africa, India, and South America participated. EQA scores were suboptimal for standard packages in three of seven laboratories. There was good agreement between the local laboratory and the central reader 70% of the time (90% confidence interval, 42%-98%). Performance on the College of American Pathologists’ HPV DNA testing panel was successful in all laboratories tested. Conclusions The prequalifying EQA round identified correctable issues that will improve the laboratory diagnosis of HPV related cervical disease at the international sites and will provide a mechanism for ongoing education and continuous quality improvement. PMID:24225757

  8. Ethical approval for multicentre clinical trials in children. Contrasting systems in three European countries.

    Science.gov (United States)

    Pinkerton, C R; Ablett, S; Boos, J; Philip, T

    2002-05-01

    Pan-European collaboration in studies of novel therapies and treatment strategies in childhood cancer is playing an increasing role in the attempt to improve cure rates. Differences in the systems of various countries with regard to drug control and ethical issues may lead to problems and delays. This applies in particular to phase I/II studies in children where the ethical considerations may be complex. In this review, the systems in three large countries-UK, France and Germany-are reviewed and current moves within the European Community towards a more standard approach are discussed.

  9. The EC4 European syllabus for post-graduate training in clinical chemistry and laboratory medicine: version 4--2012.

    Science.gov (United States)

    Wieringa, Gijsbert; Zerah, Simone; Jansen, Rob; Simundic, Ana-Maria; Queralto, José; Solnica, Bogdan; Gruson, Damien; Tomberg, Karel; Riittinen, Leena; Baum, Hannsjörg; Brochet, Jean-Philippe; Buhagiar, Gerald; Charilaou, Charis; Grigore, Camelia; Johnsen, Anders H; Kappelmayer, Janos; Majkic-Singh, Nada; Nubile, Giuseppe; O'Mullane, John; Opp, Matthias; Pupure, Silvija; Racek, Jaroslav; Reguengo, Henrique; Rizos, Demetrios; Rogic, Dunja; Špaňár, Július; Štrakl, Greta; Szekeres, Thomas; Tzatchev, Kamen; Vitkus, Dalius; Wallemacq, Pierre; Wallinder, Hans

    2012-08-01

    Laboratory medicine's practitioners across the European community include medical, scientific and pharmacy trained specialists whose contributions to health and healthcare is in the application of diagnostic tests for screening and early detection of disease, differential diagnosis, monitoring, management and treatment of patients, and their prognostic assessment. In submitting a revised common syllabus for post-graduate education and training across the 27 member states an expectation is set for harmonised, high quality, safe practice. In this regard an extended 'Core knowledge, skills and competencies' division embracing all laboratory medicine disciplines is described. For the first time the syllabus identifies the competencies required to meet clinical leadership demands for defining, directing and assuring the efficiency and effectiveness of laboratory services as well as expectations in translating knowledge and skills into ability to practice. In a 'Specialist knowledge' division, the expectations from the individual disciplines of Clinical Chemistry/Immunology, Haematology/Blood Transfusion, Microbiology/ Virology, Genetics and In Vitro Fertilisation are described. Beyond providing a common platform of knowledge, skills and competency, the syllabus supports the aims of the European Commission in providing safeguards to increasing professional mobility across European borders at a time when demand for highly qualified professionals is increasing and the labour force is declining. It continues to act as a guide for the formulation of national programmes supplemented by the needs of individual country priorities.

  10. Evaluation of clinical and immunological markers for predicting virological failure in a HIV/AIDS treatment cohort in Busia, Kenya.

    Directory of Open Access Journals (Sweden)

    Cecilia Ferreyra

    Full Text Available BACKGROUND: In resource-limited settings where viral load (VL monitoring is scarce or unavailable, clinicians must use immunological and clinical criteria to define HIV virological treatment failure. This study examined the performance of World Health Organization (WHO clinical and immunological failure criteria in predicting virological failure in HIV patients receiving antiretroviral therapy (ART. METHODS: In a HIV/AIDS program in Busia District Hospital, Kenya, a retrospective, cross-sectional cohort analysis was performed in April 2008 for all adult patients (>18 years old on ART for ≥12 months, treatment-naive at ART start, attending the clinic at least once in last 6 months, and who had given informed consent. Treatment failure was assessed per WHO clinical (disease stage 3 or 4 and immunological (CD4 cell count criteria, and compared with virological failure (VL >5,000 copies/mL. RESULTS: Of 926 patients, 123 (13.3% had clinically defined treatment failure, 53 (5.7% immunologically defined failure, and 55 (6.0% virological failure. Sensitivity, specificity, positive predictive value, and negative predictive value of both clinical and immunological criteria (combined in predicting virological failure were 36.4%, 83.5%, 12.3%, and 95.4%, respectively. CONCLUSIONS: In this analysis, clinical and immunological criteria were found to perform relatively poorly in predicting virological failure of ART. VL monitoring and new algorithms for assessing clinical or immunological treatment failure, as well as improved adherence strategies, are required in ART programs in resource-limited settings.

  11. Electrical nerve stimulation as an aid to the placement of a brachial plexus block : clinical communication

    Directory of Open Access Journals (Sweden)

    K.E. Joubert

    2002-07-01

    Full Text Available Most local anaesthetic blocks are placed blindly, based on a sound knowledge of anatomy. Very often the relationship between the site of deposition of local anaesthetic and the nerve to be blocked is unknown. Large motor neurons may be stimulated with the aid of an electrical current. By observing for muscle twitches, through electrical stimulation of the nerve, a needle can be positioned extremely close to the nerve. The accuracy of local anaesthetic blocks can be improved by this technique. By using the lowest possible current a needle could be positioned within 2-5mm of a nerve. The correct duration of stimulation ensures that stimulation of sensory nerves does not occur. The use of electrical nerve stimulation in veterinary medicine is a novel technique that requires further evaluation.

  12. Clinical and experimental studies on inflammatory mediators during AIDS-associated Pneumocystis carinii pneumonia

    DEFF Research Database (Denmark)

    Benfield, Thomas

    2003-01-01

    , National Institutes of Health, Bethesda, Maryland, USA. Pneumocystis carinii pneumonia (PCP) is the most frequent AIDS defining illness over the past 20 years. PCP is associated with considerable morbidity and mortality. An inflammatory reaction to P. carinii is believed to cause respiratory failure...... markers. Bronchoalveolar lavage (BAL) neutrophilia has been associated with disease severity, and an increased risk of death from PCP. Through competitive inhibitory studies, we showed that BAL fluid neutrophil chemotactic activity largely was explained by the presence of interleukin-8 (IL-8). Further, we......This thesis is based on studies carried out during my appointment as a research fellow at the Department of Infectious Diseases, Hvidovre Hospital, University of Copenhagen, Denmark from 1993 to 1997. Part of this period was spent as a guest researcher at the Critical Care Medicine Department...

  13. Comparison between National Institute for Health and Care Excellence (NICE) and European Society of Cardiology (ESC) guidelines for the diagnosis and management of stable angina: implications for clinical practice.

    Science.gov (United States)

    Archbold, R Andrew

    2016-01-01

    Cardiologists in the UK use clinical practice guidelines from the National Institute for Health and Care Excellence (NICE) and from the European Society of Cardiology (ESC) to aid clinical decision-making. This review compares their recommendations regarding stable angina. NICE's diagnostic algorithm changed clinical practice in the UK, with most cardiologists moving from the exercise ECG towards newer, more accurate imaging modalities such as CT and MRI for diagnostic testing in patients with a low or medium probability of coronary artery disease (CAD), and directly to invasive coronary angiography in patients with a high probability of CAD. ESC guidelines are based around stress imaging for most patient groups. Both guidelines stress the importance of optimal medical therapy for patients with stable angina. NICE recommends coronary artery bypass graft surgery to improve prognosis for patients with left main stem and/or proximal 3-vessel disease, whereas the ESC also includes proximal left anterior descending artery disease among its indications for revascularisation to improve prognosis, particularly if there is evidence of myocardial ischaemia. The relation between disease complexity and 5-year clinical outcomes after revascularisation in patients with left main stem and/or 3-vessel CAD has been integrated into ESC guidance through the use of the SYNTAX score to aid treatment selection in this group of patients. Patients with stable angina who have disease involving the proximal left anterior descending artery are less likely to undergo myocardial revascularisation if they are managed according to NICE's guidance compared with the ESC's guidance.

  14. [Congress of European Society of Cardiology (London, 2015): Results of Most Important Clinical Trials].

    Science.gov (United States)

    Kanorsky, S G; Mamedov, M N

    2016-03-01

    Report on all six Hot Line sessions of the European Society of Cardiology Congress, 2015, is presented. These sessions were doted to studies in acute myocardial infarction, atrial fibrillation/cardiac electrical pacing, diabetes/pharmacotherapy, arterial hypertension, heart failure, and coronary artery disease.

  15. Clinical and inflammatory characteristics of the European U-BIOPRED adult severe asthma cohort

    DEFF Research Database (Denmark)

    Shaw, Dominick E; Sousa, Ana R; Fowler, Stephen J

    2015-01-01

    U-BIOPRED is a European Union consortium of 20 academic institutions, 11 pharmaceutical companies and six patient organisations with the objective of improving the understanding of asthma disease mechanisms using a systems biology approach.This cross-sectional assessment of adults with severe ast...

  16. Laparoscopic surgery for pancreatic neoplasms: the European association for endoscopic surgery clinical consensus conference

    NARCIS (Netherlands)

    Edwin, Bjørn; Sahakyan, Mushegh A.; Abu Hilal, Mohammad; Besselink, Marc G.; Braga, Marco; Fabre, Jean-Michel; Fernández-Cruz, Laureano; Gayet, Brice; Kim, Song Cheol; Khatkov, Igor E.; Baichorov, Magomet E.; de Rooij, Thijs; Genç, Cansu G.; Haugvik, Sven-Petter; Izrailov, Roman E.; Khisamov, Arthur A.; Sánchez-Cabús, Santiago; Souche, Régis; van Hilst, Jony

    2017-01-01

    Introduced more than 20 years ago, laparoscopic pancreatic surgery (LAPS) has not reached a uniform acceptance among HPB surgeons. As a result, there is no consensus regarding its use in patients with pancreatic neoplasms. This study, organized by the European Association for Endoscopic Surgery

  17. Multi-morbidities of allergic rhinitis in adults: European Academy of Allergy and Clinical Immunology Task Force Report.

    Science.gov (United States)

    Cingi, C; Gevaert, P; Mösges, R; Rondon, C; Hox, V; Rudenko, M; Muluk, N B; Scadding, G; Manole, F; Hupin, C; Fokkens, W J; Akdis, C; Bachert, C; Demoly, P; Mullol, J; Muraro, A; Papadopoulos, N; Pawankar, R; Rombaux, P; Toskala, E; Kalogjera, L; Prokopakis, E; Hellings, P W; Bousquet, J

    2017-01-01

    This report has been prepared by the European Academy of Allergy and Clinical Immunology Task Force on Allergic Rhinitis (AR) comorbidities. The aim of this multidisciplinary European consensus document is to highlight the role of multimorbidities in the definition, classification, mechanisms, recommendations for diagnosis and treatment of AR, and to define the needs in this neglected area by a literature review. AR is a systemic allergic disease and is generally associated with numerous multi-morbid disorders, including asthma, eczema, food allergies, eosinophilic oesophagitis (EoE), conjunctivitis, chronic middle ear effusions, rhinosinusitis, adenoid hypertrophy, olfaction disorders, obstructive sleep apnea, disordered sleep and consequent behavioural and educational effects. This report provides up-to-date usable information to: (1) improve the knowledge and skills of allergists, so as to ultimately improve the overall quality of patient care; (2) to increase interest in this area; and (3) to present a unique contribution to the field of upper inflammatory disease.

  18. Students' experiences of cooperation with nurse teacher during their clinical placements: an empirical study in a Western European context.

    Science.gov (United States)

    Saarikoski, Mikko; Kaila, Päivi; Lambrinou, Ekaterini; Pérez Cañaveras, Rosa Maria; Tichelaar, Erna; Tomietto, Marco; Warne, Tony

    2013-03-01

    In many European countries during the last decade, the clinical role of the nurse teacher has changed from a clinical skilled practitioner to a liaison person working between educational and health care provider organisations. This study explored pre-registration nursing students' perceptions of cooperation with nurse teachers during their clinical placements in nine Western European countries. The study also assessed the type and range of e-communication between students and nurse teachers and whom the students' perceived as their most important professional role model. The study is a descriptive survey. Quantitative data were collected from 17 higher education institutes of nursing located in the northern, middle and southern parts of Europe. The purposive sample (N = 1903) comprised students who had participated in courses which included clinical placements. The data were analysed using descriptive statistics. Comparisons between the groups were made using cross-tabulation. The majority (57%) of students met their nurse teacher 1-3 times during their placement while 13% of the students did not meet their nurse teacher at all. Additionally, 66% of respondents used some form of e-communication (e-mail, mobile text messages etc.) to communicate with their nurse teacher. It is important to clarify the division of labour between nurse teachers and Mentors. There are both opportunities and challenges in how to utilise information technology to more effectively promote cooperation between students and nurse teachers. Copyright © 2012 Elsevier Ltd. All rights reserved.

  19. Cardiopulmonary Resuscitation (CPR): First Aid

    Science.gov (United States)

    First aid Cardiopulmonary resuscitation (CPR): First aid Cardiopulmonary resuscitation (CPR): First aid By Mayo Clinic Staff Cardiopulmonary resuscitation (CPR) is a lifesaving technique useful in many emergencies, including heart attack or near ...

  20. Modelling the relationship of clinical governance and informatics: matching competencies to aid development

    Directory of Open Access Journals (Sweden)

    Christopher Mimnagh

    2004-11-01

    Full Text Available The authors outline an a priori model relating clinical and informatics competencies. They discuss the implications for both informatics training and governance, suggesting areas for research, and recommend a joined-up approach to assessment and delivery.

  1. The current practice trends in pediatric bone-anchored hearing aids in Canada: a national clinical and surgical practice survey

    Science.gov (United States)

    2013-01-01

    Background Since the introduction of bone-anchored hearing aids (BAHAs) in the 1980s, the practices of surgeons who implant these hearing aids have become varied; different indications and surgical techniques are utilized depending on the surgeon and institution. The objective of the current study is to describe the clinical and surgical practices of otolaryngologists in Canada who perform pediatric BAHA operations. Methods A detailed practice questionnaire was devised and sent to all members of the Canadian Society of Otolaryngology-Head and Neck Surgery. Those who performed pediatric BAHA surgeries were asked to participate. Results Twelve responses were received (response rate of 80%). All of the respondents identified congenital aural atresia to be an indication for pediatric BAHAs. Other indications were chronic otitis externa or media with hearing loss (92%), allergic reactions to conventional hearing aids (75%), congenital fixation or anomaly of ossicular chain (67%), and unilateral deafness (25%). Minor complications, such as skin reactions, were reported in 25% of cases, while major complications were very rare. There was great variability with regards to surgical techinque and post-operative management. The extent of financial support for the BAHA hardware and device also varied between provinces, and even within the same province. Conclusion There is a lack of general consensus regarding pediatric BAHA surgeries in Canada. With such a small community of otolaryngologists performing this procedure, we are hopeful that this survey can serve as an impetus for a national collaboration to establish a set of general management principles and inspire multi-site research ventures. PMID:23815797

  2. Preliminary Clinical Application of Removable Partial Denture Frameworks Fabricated Using Computer-Aided Design and Rapid Prototyping Techniques.

    Science.gov (United States)

    Ye, Hongqiang; Ning, Jing; Li, Man; Niu, Li; Yang, Jian; Sun, Yuchun; Zhou, Yongsheng

    The aim of this study was to explore the application of computer-aided design and rapid prototyping (CAD/RP) for removable partial denture (RPD) frameworks and evaluate the fitness of the technique for clinical application. Three-dimensional (3D) images of dentition defects were obtained using a lab scanner. The RPD frameworks were designed using commercial dental software and manufactured using selective laser melting (SLM). A total of 15 cases of RPD prostheses were selected, wherein each patient received two types of RPD frameworks, prepared by CAD/RP and investment casting. Primary evaluation of the CAD/RP framework was performed by visual inspection. The gap between the occlusal rest and the relevant rest seat was then replaced using silicone, and the specimens were observed and measured. Paired t test was used to compare the average thickness and distributed thickness between the CAD/RP and investment casting frameworks. Analysis of variance test was used to compare the difference in thickness among different zones. The RPD framework was designed and directly manufactured using the SLM technique. CAD/RP frameworks may meet the clinical requirements with satisfactory retention and stability and no undesired rotation. Although the average gap between the occlusal rest and the corresponding rest seat of the CAD/RP frameworks was slightly larger than that of the investment casting frameworks (P < .05), it was acceptable for clinical application. RPD frameworks can be designed and fabricated directly using digital techniques with acceptable results in clinical application.

  3. Essentials from the 2015 European AIDS Clinical Society (EACS) guidelines for the treatment of adult HIV-positive persons

    DEFF Research Database (Denmark)

    Nielsen, Lene Ryom; Boesecke, C; Gisler, V

    2016-01-01

    ) study results. The recommendations for the preferred and the alternative ART options have also been revised, and a new section on the use of pre-exposure prophylaxis (PrEP) has been added. A number of new antiretroviral drugs/drug combinations have been added to the updated tables on drug......-drug interactions, adverse drug effects, dose adjustment for renal/liver insufficiency and for ART administration in persons with swallowing difficulties. The revisions of the coinfection section reflect the major advances in anti-hepatitis C virus (HCV) treatment with direct-acting antivirals with earlier start...... of treatment in individuals at increased risk of liver disease progression, and a phasing out of interferon-containing treatment regimens. The section on opportunistic diseases has been restructured according to individual pathogens/diseases and a new overview table has been added on CD4 count thresholds...

  4. Pneumonia and Pleural Effusion due to Cryptococcus Laurentii in a Clinically Proven Case of AIDS

    Directory of Open Access Journals (Sweden)

    Esaki Muthu Shankar

    2006-01-01

    Full Text Available Non-neoformans cryptococci were previously considered to be saprophytes and nonpathogenic to humans. Cryptococcus laurentii is frequently used as a biological means to control fruit rot. Interestingly, C laurentii has recently been reported to be a rare cause of infection in humans. The authors report a case of pulmonary cryptococcosis caused by C laurentii in a diabetic AIDS patient who was on antituberculosis and antiretroviral treatments. The sputum smear revealed capsulated yeast cells that were identified as C laurentii. Repeated pleural fluid culture revealed growth of C laurentii. Both respiratory samples were negative for acid-fast bacilli. Moraxella catarrhalis and Klebsiella pneumoniae were also found in the sputum, but not in the pleural fluid. The patient had a good response to oral fluconazole therapy at 600 mg/day for five weeks and was then discharged. The present article is the first to report on the rare pulmonary involvement of C laurentii in the Indian HIV population. These unusual forms of cryptococci create a diagnostic predicament in the rapid diagnosis of pulmonary cryptococcosis. A high degree of suspicion and improvement of techniques for culture and identification will contribute to the early diagnosis and treatment of unusual fungal infections.

  5. Clinical evaluation of a computer-aided diagnosis system for determining cancer aggressiveness in prostate MRI

    Energy Technology Data Exchange (ETDEWEB)

    Litjens, Geert J.S.; Barentsz, Jelle O.; Karssemeijer, Nico; Huisman, Henkjan J. [Radboud University Medical Center, Department of Radiology, Nijmegen (Netherlands)

    2015-11-15

    To investigate the added value of computer-aided diagnosis (CAD) on the diagnostic accuracy of PIRADS reporting and the assessment of cancer aggressiveness. Multi-parametric MRI and histopathological outcome of MR-guided biopsies of a consecutive set of 130 patients were included. All cases were prospectively PIRADS reported and the reported lesions underwent CAD analysis. Logistic regression combined the CAD prediction and radiologist PIRADS score into a combination score. Receiver-operating characteristic (ROC) analysis and Spearman's correlation coefficient were used to assess the diagnostic accuracy and correlation to cancer grade. Evaluation was performed for discriminating benign lesions from cancer and for discriminating indolent from aggressive lesions. In total 141 lesions (107 patients) were included for final analysis. The area-under-the-ROC-curve of the combination score was higher than for the PIRADS score of the radiologist (benign vs. cancer, 0.88 vs. 0.81, p = 0.013 and indolent vs. aggressive, 0.88 vs. 0.78, p < 0.01). The combination score correlated significantly stronger with cancer grade (0.69, p = 0.0014) than the individual CAD system or radiologist (0.54 and 0.58). Combining CAD prediction and PIRADS into a combination score has the potential to improve diagnostic accuracy. Furthermore, such a combination score has a strong correlation with cancer grade. (orig.)

  6. European Viscum album: a potent phytotherapeutic agent with multifarious phytochemicals, pharmacological properties and clinical evidence

    OpenAIRE

    Singh, Brahma N.; Saha, Chaitrali; Galun, Danijel; Upreti, Dalip K.; Bayry, Jagadeesh; Kaveri, Srini V.

    2016-01-01

    International audience; Viscum album L. or European mistletoe (Loranthaceae), a semi-parasitic shrub, has been used as a traditional medicine in Europe for centuries to treat various diseases like cancer, cardiovascular disorder, epilepsy, infertility, hypertension and arthritis. V. album contains diverse phytochemicals, which exert a large number of biological and pharmacological activities. The aim of this review is to compile the developments in the domain of V. album and research trends, ...

  7. Hotline update of clinical trials and registries presented at the at the European Society of Cardiology Congress in Paris 2011.

    Science.gov (United States)

    Walenta, K; Sinning, J M; Werner, C; Böhm, M

    2011-11-01

    This article provides information and commentaries on trials which were presented at the Hotline and Clinical Trial Update Sessions during the Late Breaking Clinical Trial Sessions European Society of Cardiology Congress, held in Paris, France, from 27th to 31st August 2011. This article gives an overview on a number of novel clinical trials in the field of cardiovascular medicine, which were presented. The data have been presented by leading experts in the accordant field with relevant positions in the trials. Unpublished reports should be considered as preliminary data as the analysis may change in the final publications. The comprehensive summaries have been generated from the oral presentation and the webcasts of the European Society of Cardiology, similar as previously reported (Lenski et al. in Clin Res Cardiol Off J Ger Card Soc 99: 679-692, 2010) and should provide the readers with the most comprehensive information of relevant publications. The data were presented by leading experts in the field with relevant positions in the trials.

  8. Computer-Aided Clinical Trial Recruitment Based on Domain-Specific Language Translation: A Case Study of Retinopathy of Prematurity

    Science.gov (United States)

    2017-01-01

    Reusing the data from healthcare information systems can effectively facilitate clinical trials (CTs). How to select candidate patients eligible for CT recruitment criteria is a central task. Related work either depends on DBA (database administrator) to convert the recruitment criteria to native SQL queries or involves the data mapping between a standard ontology/information model and individual data source schema. This paper proposes an alternative computer-aided CT recruitment paradigm, based on syntax translation between different DSLs (domain-specific languages). In this paradigm, the CT recruitment criteria are first formally represented as production rules. The referenced rule variables are all from the underlying database schema. Then the production rule is translated to an intermediate query-oriented DSL (e.g., LINQ). Finally, the intermediate DSL is directly mapped to native database queries (e.g., SQL) automated by ORM (object-relational mapping).

  9. Usability evaluation of pharmacogenomics clinical decision support aids and clinical knowledge resources in a computerized provider order entry system: a mixed methods approach.

    Science.gov (United States)

    Devine, Emily Beth; Lee, Chia-Ju; Overby, Casey L; Abernethy, Neil; McCune, Jeannine; Smith, Joe W; Tarczy-Hornoch, Peter

    2014-07-01

    Pharmacogenomics (PGx) is positioned to have a widespread impact on the practice of medicine, yet physician acceptance is low. The presentation of context-specific PGx information, in the form of clinical decision support (CDS) alerts embedded in a computerized provider order entry (CPOE) system, can aid uptake. Usability evaluations can inform optimal design, which, in turn, can spur adoption. The study objectives were to: (1) evaluate an early prototype, commercial CPOE system with PGx-CDS alerts in a simulated environment, (2) identify potential improvements to the system user interface, and (3) understand the contexts under which PGx knowledge embedded in an electronic health record is useful to prescribers. Using a mixed methods approach, we presented seven cardiologists and three oncologists with five hypothetical clinical case scenarios. Each scenario featured a drug for which a gene encoding drug metabolizing enzyme required consideration of dosage adjustment. We used Morae(®) to capture comments and on-screen movements as participants prescribed each drug. In addition to PGx-CDS alerts, 'Infobutton(®)' and 'Evidence' icons provided participants with clinical knowledge resources to aid decision-making. Nine themes emerged. Five suggested minor improvements to the CPOE user interface; two suggested presenting PGx information through PGx-CDS alerts using an 'Infobutton' or 'Evidence' icon. The remaining themes were strong recommendations to provide succinct, relevant guidelines and dosing recommendations of phenotypic information from credible and trustworthy sources; any more information was overwhelming. Participants' median rating of PGx-CDS system usability was 2 on a Likert scale ranging from 1 (strongly agree) to 7 (strongly disagree). Usability evaluation results suggest that participants considered PGx information important for improving prescribing decisions; and that they would incorporate PGx-CDS when information is presented in relevant and

  10. [Natriuretic peptides and their use in clinical practice according to the guidelines of the European Society of Cardiology].

    Science.gov (United States)

    Stryjewski, Piotr J; Nessler, Bohdan; Paweł, Matusik; Badacz, Leszek; Nowak, Jacek; Nessler, Jadwiga

    2014-01-01

    In recent years, assay levels of natriuretic peptides are used in everyday clinical practice. The most commonly used is the assay the concentration of NT-proBNP in conjunction with the longest half-life (120 minutes) and its stability. According to the guidelines of the European Society of Cardiology determination of NT-proBNP were used in the diagnosis of acute and chronic heart failure, risk stratification in acute coronary syndromes, pulmonary embolism and in assessing the overall risk of cardiovascular patients prior to surgery. In addition, there are works whose authors have demonstrated the usefulness of NT-proBNP determination in valvular, atrial fibrillation, and syncope.

  11. The clinical feature of HIV/AIDS at presentation at the Jos University ...

    African Journals Online (AJOL)

    This study was therefore conducted to determine the commonest symptoms and signs at presentation in HIV-infected individuals at the Jos University Teaching Hospital. Method: This descriptive study was conducted at the antiretroviral clinic of the Jos University Teaching Hospital, Jos, between May and October 2004.

  12. ASSESSMENT OF CLINICAL CASE-DEFINITION FOR HIV/AIDS IN ...

    African Journals Online (AJOL)

    hi-tech

    2004-05-05

    May 5, 2004 ... lesions and the rarity of pneumocystis carinii pneumonia in this study are important findings. Seven clinical characteristics predicted HIV infection. These included pulmonary tuberculosis (p=0.009), lymphadenopathy (p=0.007), diarrhoea (p=0.000), chronic cough (p=0.001), dermatitis (p=0.003), herpes ...

  13. Computer-based clinical decision aids. A review of methods and assessment of systems

    NARCIS (Netherlands)

    Reisman, Y

    1996-01-01

    During the last three decades a great deal of research has been devoted to the development of integrated clinical decision support systems. This report aims to give a basic understanding of what is required for such a system. By means of a large literature study a survey is given of the major

  14. Detection of cytomegalovirus DNA in serum correlates with clinical cytomegalovirus retinitis in AIDS

    DEFF Research Database (Denmark)

    Hansen, K K; Ricksten, A; Hofmann, B

    1994-01-01

    The high sensitivity of nested polymerase chain reaction (PCR) offers the possibility of rapid detection of cytomegalovirus (CMV) DNA in serum. Five consecutive serum samples were examined from 52 human immunodeficiency virus (HIV)-seropositive patients (19 of whom had clinically presumed diagnosis...

  15. Computer-aided assessment of the generalizability of clinical trial results.

    Science.gov (United States)

    Cahan, Amos; Cahan, Sorel; Cimino, James J

    2017-03-01

    The effects of an intervention on patients from populations other than that included in a trial may vary as a result of differences in population features, treatment administration, or general setting. Determining the generalizability of a trial to a target population is important in clinical decision making at both the individual practitioner and policy-making levels. However, awareness to the challenges associated with the assessment of generalizability of trials is low and tools to facilitate such assessment are lacking. We review the main factors affecting the generalizability of a clinical trial results beyond the trial population. We then propose a framework for a standardized evaluation of parameters relevant to determining the external validity of clinical trials to produce a "generalizability score". We then apply this framework to populations of patients with heart failure included in trials, cohorts and registries to demonstrate the use of the generalizability score and its graphic representation along three dimensions: participants' demographics, their clinical profile and intervention setting. We use the generalizability score to compare a single trial to multiple "target" clinical scenarios. Additionally, we present the generalizability score of several studies with regard to a single "target" population. Similarity indices vary considerably between trials and target population, but inconsistent reporting of participant characteristics limit head-to-head comparisons. We discuss the challenges involved in performing automatic assessment of trial generalizability at scale and propose the adoption of a standard format for reporting the characteristics of trial participants to enable better interpretation of their results. Copyright © 2017 Elsevier B.V. All rights reserved.

  16. Adherence to antiretroviral therapy among HIV and AIDS patients at the Kwa-Thema clinic in Gauteng Province, South Africa

    Directory of Open Access Journals (Sweden)

    Melaku A. Eyassu

    2016-03-01

    Full Text Available Background: Introduction of antiretroviral therapy (ART has shown reduction in HIV-related mortality and morbidity in people living with HIV and AIDS. Since high levels of adherence of more than 95.0% is required to achieve effective suppression of viral load, researchers found it important to establish whether people are pursuing what is expected of them.Aim and setting: The study was aimed at determining adherence to ART among HIV and AIDS patients at the Kwa-Thema clinic in Gauteng Province.Methods: Quantitative cross-sectional descriptive design was used. Ethical clearance was sort from MEDUNSA Research Ethics Committee. Validity and reliability were maintained throughout the study. A non-probability systematic sampling was used. Data were collected using administered structured questionnaire, and a total of 290 respondents were involved. Data were analysed using SPSS software version 22.Results: The findings indicated that the adherence to ART was 77.0%. Factors that were significantly associated with adherence were gender ( χ2 = 3.78, df = 1, p < 0.05, level of education ( χ2 = 3.52, df = 3, p = 0.032, co-treatment of HIV and other infections ( χ2 = 5.46, df = 4, p = 0.019, ability to follow ART ( χ2 = 12.82, df = 1, p = 0.000 < 0.05, and types of antiretroviral drugs.Recommendation: The study recommends intensification of health education campaign against stigma and gender discrimination. Providing feedback to patients regarding benefits of ART is important.Conclusion: The study concluded that adherence to ART at the Kwa-Thema clinic was suboptimal (less than 95% at 77%, but comparable with the adherence levels in other developing countries.

  17. Access to Justice – Rights or Rations? Comparing European Legal Aid Systems in the Context of a Shrinking Budgetary Environment 

    OpenAIRE

    Follett, Lynne

    2008-01-01

    The inspiration for this thesis was derived from a week spent in the family law department of a local solicitor's practice. The UK government's reforms to the legal aid system were about to be implemented and appeared to be affecting the work undertaken as well as the morale of the solicitors working there. The discussion reviews the recent and proposed reforms to legal aid in England and Wales and their effect on access to justice. A comparison is made with other legal aid systems within the...

  18. A Computer-Aided Analysis Method of SPECT Brain Images for Quantitative Treatment Monitoring: Performance Evaluations and Clinical Applications.

    Science.gov (United States)

    Zheng, Xiujuan; Wei, Wentao; Huang, Qiu; Song, Shaoli; Wan, Jieqing; Huang, Gang

    2017-01-01

    The objective and quantitative analysis of longitudinal single photon emission computed tomography (SPECT) images are significant for the treatment monitoring of brain disorders. Therefore, a computer aided analysis (CAA) method is introduced to extract a change-rate map (CRM) as a parametric image for quantifying the changes of regional cerebral blood flow (rCBF) in longitudinal SPECT brain images. The performances of the CAA-CRM approach in treatment monitoring are evaluated by the computer simulations and clinical applications. The results of computer simulations show that the derived CRMs have high similarities with their ground truths when the lesion size is larger than system spatial resolution and the change rate is higher than 20%. In clinical applications, the CAA-CRM approach is used to assess the treatment of 50 patients with brain ischemia. The results demonstrate that CAA-CRM approach has a 93.4% accuracy of recovered region's localization. Moreover, the quantitative indexes of recovered regions derived from CRM are all significantly different among the groups and highly correlated with the experienced clinical diagnosis. In conclusion, the proposed CAA-CRM approach provides a convenient solution to generate a parametric image and derive the quantitative indexes from the longitudinal SPECT brain images for treatment monitoring.

  19. The nutritional status of clinic attendees living with HIV/AIDS in St Vincent and the Grenadines.

    Science.gov (United States)

    Burgin, J; Nichols, S; Dalrymple, N

    2008-11-01

    The purpose of this study was to assess nutritional status and dietary practices in persons living with HIV/AIDS (PLWHA). A case-control design was used. Cases consisted of 36 PLWHA. Controls consisted of 37 persons within the same age range from the general population. Participants filled out a questionnaire consisting of sociodemographic, dietary and health history items. In addition, they had weight, height, upper mid-arm circumference and triceps skinfold measured using standard procedure. Biochemical and clinical data for cases were extracted from their clinic file. HIV-positive persons had significantly lower mean weight, BMI, upper mid-arm circumferences, arm muscle area and arm fat area than persons in the control group. They were also less likely to use multivitamins, dietary supplements, fruit and vegetables than persons in the control group. Correlation coefficients between corrected arm muscle area (CAMA) and BMI and weight ranged from 0.67 to 0.74 in cases and 0.41 to 0.68 for the control group, respectively. Screening for depleted CD4 counts using gender specific CAMA cut-offs indicative of depleted arm muscle reserves resulted in 48% sensitivity and 100% specificity in identifying PLWHA with CD4 counts < 200 cells/microL. The findings suggest that PLWHA are at increased risk for poor intakes of fruits and vegetables and depleted lean body mass. In addition, CAMA along with other clinic measures might be useful in the identification of PLWHA who might be responding adequately to treatment.

  20. Computer-Aided Detection of Colorectal Polyps at CT Colonography: Prospective Clinical Performance and Third-Party Reimbursement.

    Science.gov (United States)

    Ziemlewicz, Timothy J; Kim, David H; Hinshaw, J Louis; Lubner, Meghan G; Robbins, Jessica B; Pickhardt, Perry J

    2017-06-01

    We assessed the initial clinical performance and third-party reimbursement rates of supplementary computer-aided detection (CAD) at CT colonography (CTC) for detecting colorectal polyps 6 mm or larger in routine clinical practice. We retrospectively assessed the prospective clinical performance of a U.S. Food and Drug Administration-approved CAD system in second-reader mode in 347 consecutive adults (mean age, 57.6 years; 205 women, 142 men) undergoing CTC evaluation over a 5-month period. The reference standard consisted of the prospective interpretation by experienced CTC radiologists combined with subsequent optical colonoscopy (OC), if performed. We also assessed third-party reimbursement for CAD for studies performed over an 18-month period. In all, 69 patients (mean [± SD] age, 59.0 ± 7.7 years; 32 men, 37 women) had 129 polyps ≥ 6 mm. Per-patient CAD sensitivity was 91.3% (63 of 69). Per-polyp CAD-alone sensitivity was 88.4% (114 of 129), including 88.3% (83 of 94) for 6- to 9-mm polyps and 88.6% (31 of 35) for polyps 10 mm or larger. On retrospective review, three additional polyps 6 mm or larger were seen at OC and marked by CAD but dismissed as CAD false-positives at CTC. The mean number of false-positive CAD marks was 4.4 ± 3.1 per series. Of 1225 CTC cases reviewed for reimbursement, 31.0% of the total charges for CAD interpretation had been recovered from a variety of third-party payers. In our routine clinical practice, CAD showed good sensitivity for detecting colorectal polyps 6 mm or larger, with an acceptable number of false-positive marks. Importantly, CAD is already being reimbursed by some third-party payers in our clinical CTC practice.

  1. A Comparative Study of Computer-Aided Clinical Diagnosis of Birth Defects.

    Science.gov (United States)

    1981-01-21

    Disease Frame in PIP FRAME NAME: ACHONDROPLASIA TYPE: SYNDROME FINDING: STATURE WITH LEVEL SHORT, TYPE DISPROPORTIONATE. AND ONSET AT-BIRTH FINDING...ready for use by the medical community. ---- _ ------ - M -1 n . .i -97. H.B. Sherman Appendix I - List of Syndromes ACHONDROPLASIA ACROFACIAL...Appendix 11 - List of Clinical Cases Case Number Case Name 1 SPONDYLOEPIPHYSEAL DYSPLASIA CONGENITA 2 ACHONDROPLASIA 3 SPONDYLOEPIPHYSEAL DYSPLASIA

  2. Reference markers in computer aided orthopaedic surgery: rotational stability testings and clinical implications.

    Science.gov (United States)

    Kendoff, Daniel; Gardner, Michael J; Krettek, Christian; Hüfner, Tobias; Citak, Musa

    2008-06-01

    Navigation procedures rely on the stability of the reference arrays (RA) fixed to the bony anatomy. The risk of inadvertent collision and unnoticed movements of the RA may occur, and limb movements might also provocate collisions. Consequently, relevant measurements failures during the navigated procedure might occur and reduce the overall precision of the system. The magnitude of torque to destabilize an RA from its bony-fixation is unknown. The purpose of this study was to determine the ability of standard RA's to resist applied torque. A digital torque application device was developed to allow for precise torque application to the RA system at four cadavers. Clockwise, gradually increasing rotational force was applied to the RA in 1, 2, or 3 Nm, held for 1 s and released, repeated in 10 cycles. One pin fixation systems with 4.0 Schanz pins were used. A second RA was fixed 20 cm proximal to the tested RA. A navigation system was used to measure the relative positions of both RA's during torque application. The rotational differences at torque application were calculated and statistically evaluated. Results revealed averaged 1.0 degrees rotation [range (r), 1.0-1.1 degrees ] with first cycle of 1 Nm torque, the last cycle averaged 1.0 degrees (r, 1.0-1.1 degrees ) with no significant differences in rotation between any of the cycles (p > 0.5). Torque of 2 Nm resulted in 1.8 degrees rotation (r, 1.5-1.8 degrees ) with no significant increases between first and second cycle (p = 0.56), second and third trials (p = 0.35) while fourth cycle averaged 2.0 degrees , with significant increase (p = 0.011). All subsequent cycles resulted in significant increases. Torque of 3 Nm produced 2.9 degrees of rotation for initial cycle (r,2.5-3.3 degrees ), with significant increases with each cycle (p or =2 Nm may cause loosening of the RA, thus may lose its original position relative to the bone. Surgeons using computer aided surgery systems should be aware of possible

  3. Stroke: First Aid

    Science.gov (United States)

    First aid Stroke: First aid Stroke: First aid By Mayo Clinic Staff A stroke occurs when there's bleeding into your brain or when blood flow to your ... cells start dying. Seek immediate medical assistance. A stroke is a true emergency. The sooner treatment is ...

  4. Dislocation: First Aid

    Science.gov (United States)

    First aid Dislocation: First aid Dislocation: First aid By Mayo Clinic Staff A dislocation is an injury in which the ends of your bones are forced from ... a collision during contact or high-speed sports. Dislocation usually involves the body's larger joints. In adults, ...

  5. European specialist porphyria laboratories: diagnostic strategies, analytical quality, clinical interpretation, and reporting as assessed by an external quality assurance program.

    Science.gov (United States)

    Aarsand, Aasne K; Villanger, Jørild H; Støle, Egil; Deybach, Jean-Charles; Marsden, Joanne; To-Figueras, Jordi; Badminton, Mike; Elder, George H; Sandberg, Sverre

    2011-11-01

    The porphyrias are a group of rare metabolic disorders whose diagnosis depends on identification of specific patterns of porphyrin precursor and porphyrin accumulation in urine, blood, and feces. Diagnostic tests for porphyria are performed by specialized laboratories in many countries. Data regarding the analytical and diagnostic performance of these laboratories are scarce. We distributed 5 sets of multispecimen samples from different porphyria patients accompanied by clinical case histories to 18-21 European specialist porphyria laboratories/centers as part of a European Porphyria Network organized external analytical and postanalytical quality assessment (EQA) program. The laboratories stated which analyses they would normally have performed given the case histories and reported results of all porphyria-related analyses available, interpretative comments, and diagnoses. Reported diagnostic strategies initially showed considerable diversity, but the number of laboratories applying adequate diagnostic strategies increased during the study period. We found an average interlaboratory CV of 50% (range 12%-152%) for analytes in absolute concentrations. Result normalization by forming ratios to the upper reference limits did not reduce this variation. Sixty-five percent of reported results were within biological variation-based analytical quality specifications. Clinical interpretation of the obtained analytical results was accurate, and most laboratories established the correct diagnosis in all distributions. Based on a case-based EQA scheme, variations were apparent in analytical and diagnostic performance between European specialist porphyria laboratories. Our findings reinforce the use of EQA schemes as an essential tool to assess both analytical and diagnostic processes and thereby to improve patient care in rare diseases.

  6. A standards-based clinical information system for HIV/AIDS.

    Science.gov (United States)

    Stitt, F W

    1995-01-01

    To create a clinical data repository to interface the Veteran's Administration (VA) Decentralized Hospital Computer Program (DHCP) and a departmental clinical information system for the management of HIV patients. This system supports record-keeping, decision-making, reporting, and analysis. The database development was designed to overcome two impediments to successful implementations of clinical databases: (i) lack of a standard reference data model, and; (ii) lack of a universal standard for medical concept representation. Health Level Seven (HL7) is a standard protocol that specifies the implementation of interfaces between two computer applications (sender and receiver) from different vendors or sources of electronic data exchange in the health care environment. This eliminates or substantially reduces the custom interface programming and program maintenance that would otherwise be required. HL7 defines the data to be exchanged, the timing of the interchange, and the communication of errors to the application. The formats are generic in nature and must be configured to meet the needs of the two applications involved. The standard conceptually operates at the seventh level of the ISO model for Open Systems Interconnection (OSI). The OSI simply defines the data elements that are exchanged as abstract messages, and does not prescribe the exact bit stream of the messages that flow over the network. Lower level network software developed according to the OSI model may be used to encode and decode the actual bit stream. The OSI protocols are not universally implemented and, therefore, a set of encoding rules for defining the exact representation of a message must be specified. The VA has created an HL7 module to assist DHCP applications in exchanging health care information with other applications using the HL7 protocol. The DHCP HL7 module consists of a set of utility routines and files that provide a generic interface to the HL7 protocol for all DHCP applications

  7. The Vision Van, a mobile eye clinic, aids relief efforts in tsunami-stricken areas.

    Science.gov (United States)

    Oshima, Catherine Ross; Yuki, Kenya; Uchida, Atsuro; Dogru, Murat; Koto, Takashi; Ozawa, Yoko; Tsubota, Kazuo

    2012-01-01

    In the wake of the devastating earthquake and tsunami of March 11, our group at Keio University worked diligently to bring the Vision Van, a mobile eye clinic, from Miami, Florida, to disaster areas where medicines, eyeglasses, and indeed all other ophthalmological supplies and services, were nonexistent, thereby assisting many tsunami survivors suffering from eye problems. This act was encouraging not only to the patients and those working in the disaster-hit areas but also to ophthalmologists who wanted to use their medical specialty to assist those in need.

  8. Hotline sessions and clinical trial updates presented at the European Society of Cardiology Congress in Stockholm 2010.

    Science.gov (United States)

    Lenski, Matthias; Mahfoud, Felix; Werner, Christian; Bauer, Axel; Böhm, Michael

    2010-11-01

    This article gives an overview on several novel clinical trials in the field of cardiovascular (CV) medicine which were presented during the hotline sessions and clinical trial updates at the European Society of Cardiology Congress, held in Stockholm, Sweden, from 28th August to 1st September 2010. The data have been presented by leading experts in the accordant field with relevant positions in the trials. Unpublished reports should be considered as preliminary data as the analysis may change in the final publications. The summaries presented in the manuscript were generated from the oral presentations and should provide the readers with the most comprehensive information on diagnostic and therapeutic development in CV medicine similar as previously reported Schirmer SH et al.

  9. Clinical implications of JUPITER in a contemporary European population: the EPIC-Norfolk prospective population study.

    Science.gov (United States)

    Sondermeijer, Brigitte M; Boekholdt, S Matthijs; Rana, Jamal S; Kastelein, John J P; Wareham, Nicholas J; Khaw, Kay-Tee

    2013-05-01

    Justification for the Use of statins in Prevention: an Intervention Trial Evaluating Rosuvastatin (JUPITER) has raised several points of debate. We quantified the proportion of individuals meeting the JUPITER criteria, determined their risk profile, and their risk of coronary heart disease (CHD) events during a long-term follow-up in a contemporary European cohort. A total of 25 639 participants aged between 45 and 79 years were followed for 11.4 ± 2.8 years in EPIC-Norfolk population cohort. A total of 8397 individuals with complete data available were considered potentially eligible for primary prevention. A total of 846 (10.1%) individuals fulfilled the JUPITER criteria [low-density lipoprotein cholesterol-C (LDL-C) JUPITER criteria had significantly higher CHD risk compared with those with LDL-C ≥ 3.4 mmol/L and C-reactive protein JUPITER criteria. In this European cohort, JUPITER-eligible individuals had significantly higher event rates compared with those with LDL-C JUPITER criteria qualified almost one-fifth of the population for statin therapy that otherwise would not have qualified based on SCORE or ATP III criteria.

  10. Quality of life, socioeconomic and clinical factors, and physical exercise in persons living with HIV/AIDS.

    Science.gov (United States)

    Medeiros, Rafaela Catherine da Silva Cunha de; Medeiros, Jason Azevedo de; Silva, Tatiane Andreza Lima da; Andrade, Ricardo Dias de; Medeiros, Danielle Coutinho de; Araújo, Juliany de Souza; Oliveira, Antônio Manuel Gouveia de; Costa, Marcos Aurélio de Albuquerque; Dantas, Paulo Moreira Silva

    2017-07-20

    To analyze whether socioeconomic and clinical aspects and the aspects of healthy life habits are associated with the quality of life of persons living with HIV/AIDS. This is a cross-sectional exploratory quantitative research, with 227 persons living with HIV/AIDS, treated at two hospitals of reference between April 2012 and June 2014. We used structured questionnaires to assess socioeconomic aspects (gender, age, education level, marital status, race, socioeconomic status, dependents on family income, employment relationship), clinical parameters (time of disease diagnosis, use and time of medication, CD4 T-cell count, and viral load), and practice of physical exercise. To assess quality of life, we used the Quality of Life questionnaire (HAT-QoL). For characterization of the socioeconomic and clinical data and domains of quality of life, we conducted a descriptive analysis (simple frequency, averages, and standard deviations). We applied linear regression, following a hierarchical model for each domain of quality of life. The domains that presented lower averages for quality of life were financial concern, concern with confidentiality, general function, and satisfaction with life. We found associations with the variables of socioeconomic status and physical exercise, therapy, and physical exercise for the last two domains, consecutively. The quality of life of persons living with HIV/AIDS shows losses, especially in the financial and confidentiality areas, followed by general function of the body and satisfaction with life, in which socioeconomic and clinical aspects and healthy living habits, such as the practice of physical exercise, are determining factors for this reality. Analisar se aspectos socioeconômicos, clínicos e de hábitos de vida saudável estão associados à qualidade de vida em pessoas vivendo com HIV/aids. Pesquisa quantitativa exploratória de corte transversal, com 227 pessoas vivendo com HIV/aids, atendidos em dois hospitais de refer

  11. A clinical study of temporomandibular disorder. The value of bone scintigraphy as an aid to diagnosis

    Energy Technology Data Exchange (ETDEWEB)

    Sugiura, Masashi [Nippon Dental Univ. (Japan). School of Dentistry at Niigata

    2000-07-01

    Temporomandibular disorder (TMD) is still not defined with respect to the point of an entity, terminological problems, and clinical classification and gradings. Moreover, diagnostic problems of internal deranegement and osteodeformity at the temporomandibular joint such as type IV and mechanism of bone remodeling at condylar head are also still not clear. In this investigation, we tried to classify the severity and progressive grading according to the symptoms and objective laboratory data taken from soft tissues such as muscles related to mastication, discs and ligaments, and hard tissues such as condylar head and temporal bone changes around the temporomandibular joint. Preliminary diagnostic clinical tool of the assessment of temporomandibular joint by maens of bone scintigraphy was attributed to the additional diagnostic procedure and research for the bone remodeling for the temporomandibular disorder because this can be defined between subjective and objective symptoms in this disorder. Bone scintigraphy will solve many problems concerning undefined degenerative bone changes in TMD, enable more accurate diagnosis, and the selection of treatment and prognosis in future investigation. Also, it is believed single photon emission computed tomography (SPECT) nuclear bone imaging is a highly accurate diagnostic method for craniomandibular disorders. (author)

  12. Typical investigational medicinal products follow relatively uniform regulations in 10 European Clinical Research Infrastructures Network (ECRIN countries

    Directory of Open Access Journals (Sweden)

    Gluud Christian

    2012-03-01

    Full Text Available Abstract Background In order to facilitate multinational clinical research, regulatory requirements need to become international and harmonised. The EU introduced the Directive 2001/20/EC in 2004, regulating investigational medicinal products in Europe. Methods We conducted a survey in order to identify the national regulatory requirements for major categories of clinical research in ten European Clinical Research Infrastructures Network (ECRIN countries-Austria, Denmark, France, Germany, Hungary, Ireland, Italy, Spain, Sweden, and United Kingdom-covering approximately 70% of the EU population. Here we describe the results for regulatory requirements for typical investigational medicinal products, in the ten countries. Results Our results show that the ten countries have fairly harmonised definitions of typical investigational medicinal products. Clinical trials assessing typical investigational medicinal products require authorisation from a national competent authority in each of the countries surveyed. The opinion of the competent authorities is communicated to the trial sponsor within the same timelines, i.e., no more than 60 days, in all ten countries. The authority to which the application has to be sent to in the different countries is not fully harmonised. Conclusion The Directive 2001/20/EC defined the term 'investigational medicinal product' and all regulatory requirements described therein are applicable to investigational medicinal products. Our survey showed, however, that those requirements had been adopted in ten European countries, not for investigational medicinal products overall, but rather a narrower category which we term 'typical' investigational medicinal products. The result is partial EU harmonisation of requirements and a relatively navigable landscape for the sponsor regarding typical investigational medicinal products.

  13. A review of the organization, regulation, and financing practices of postgraduate education in clinical nursing in 12 European countries.

    Science.gov (United States)

    Rautiainen, Elina; Vallimies-Patomäki, Marjukka

    2016-01-01

    The aim of this study was to generate information of postgraduate education in clinical nursing in the EU member states. Data were collected via a structured electronic questionnaire and the questionnaire was sent to the government chief nurses in 26 EU countries in May 2013. Response rate was 46% (n=12). In total, 42 domains of specialization were identified. The most common domains were intensive care, mental health, operating room, emergency care, and pediatrics. Specialization programs were organized by university in two of the respondent countries, as residency program in one country, and as a mix of them in four countries. Regulation practices varied remarkably between the countries: scope of practice, subjects, entry requirements, length of education, description of the minimum competence requirements, and education standards related to the specialization programs were most often regulated by act, decree or other regulation. In some of the countries, no registration was required beyond the initial registration, whereas in some others, registration practices varied depending on the specialization program. New information was gathered on the regulation practices of postgraduate education in clinical nursing in the European Region concerning title provision, entry requirements, and financing practices. The awarded title on specialization programs depended on the level of postgraduate education, and the title might vary between the domains. General clinical experience was included in the entry requirements in seven countries. The government was mainly responsible for financing the postgraduate education in four countries, employer in three countries, and in the rest of the countries, there was a combination of different financiers. The importance of knowledge exchange on postgraduate education across the European countries needs to be acknowledged. Information provided by this study on international regulation practices provides useful information for the policy

  14. The methodological quality of clinical guidelines of the European Society of Human Reproduction and Embryology (ESHRE).

    NARCIS (Netherlands)

    Nelen, W.L.D.M.; Pluijm, RW van der; Hermens, R.P.; Bergh, C.; Sutter, P de; Nygren, K.G.; Wetzels, A.M.M.; Grol, R.P.T.M.; Kremer, J.A.M.

    2008-01-01

    BACKGROUND: Clinical practice guidelines bridge the gap between the evidence from literature and clinical practice, and they may provide guidance in ethical, legal and societal dilemmas. To explore the potentials for future international guideline development within the field of human reproduction

  15. SeDeLo: using semantics and description logics to support aided clinical diagnosis.

    Science.gov (United States)

    Rodríguez-González, Alejandro; Labra-Gayo, Jose Emilio; Colomo-Palacios, Ricardo; Mayer, Miguel A; Gómez-Berbís, Juan Miguel; García-Crespo, Angel

    2012-08-01

    Automated medical diagnosis systems based on knowledge-oriented descriptions have gained momentum with the emergence of semantic descriptions. The objective of this paper is to propose a normalized design that solves some of the problems which have been detected by authors in previous tools. The authors bring together two different technologies to develop a new clinical decision support system: description logics aimed at developing inference systems to improve decision support for the prevention, treatment and management of illness and semantic technologies. Because of its new design, the system is capable of obtaining improved diagnostics compared with previous efforts. However, this evaluation is more focused in the computational performance, giving as result that description logics is a good solution with small data sets. In this paper, we provide a well-structured ontology for automated diagnosis in the medical field and a three-fold formalization based on Description Logics with the use of Semantic Web technologies.

  16. Chlamydia trachomatis infection among HIV-infected women attending an AIDS clinic in the city of Manaus, Brazil.

    Science.gov (United States)

    Silva, Leila Cristina Ferreira; Miranda, Angélica Espinosa; Batalha, Rosieny Santos; Sabino, Carolina Cristina Dantas; Dib, Elizabeth; Costa, Carolina Marinho da; Ramasawmy, Rajendranath; Talhari, Sinésio

    2012-01-01

    This was a cross-sectional study aimed to determine the prevalence of and to identify risk factors for Chlamydia trachomatis (CT) among human immunodeficiency virus (HIV)-infected women attending the acquired immunodeficiency syndrome (AIDS) clinic in the city of Manaus, Brazil, in 2009-2010. Participants answered a questionnaire containing demographic, epidemiological, and clinical data. A genital specimen was collected during examination to detect CT-DNA by hybrid capture, and blood samples were taken to determine CD4(+)T and HIV viral load. There were 329 women included in the study. Median age was 32 years (IQR=27-38) and median schooling was nine years (IQR=4-11). The prevalence of CT was 4.3% (95%CI: 2.1-6.5). Logistic regression analysis showed that age between 18-29 years [OR=4.1(95%CI: 1.2-13.4)] and complaint of pelvic pain [OR=3.7 (95%CI: 1.2-12.8)] were independently associated with CT. The use of condom was inversely associated with CT [OR=0.39 (95%CI: 0.1-0.9)]. The results showed that younger women who did not use condoms are at a higher risk for CT. Screening for sexually transmitted infections must be done routinely and safe sexual practices should be promoted among this population. Copyright © 2012 Elsevier Editora Ltda. All rights reserved.

  17. Chlamydia trachomatis infection among HIV-infected women attending an AIDS clinic in the city of Manaus, Brazil

    Directory of Open Access Journals (Sweden)

    Leila Cristina Ferreira Silva

    Full Text Available This was a cross-sectional study aimed to determine the prevalence of and to identify risk factors for Chlamydia trachomatis (CT among human immunodeficiency virus (HIV-infected women attending the acquired immunodeficiency syndrome (AIDS clinic in the city of Manaus, Brazil, in 2009-2010. Participants answered a questionnaire containing demographic, epidemiological, and clinical data. A genital specimen was collected during examination to detect CT-DNA by hybrid capture, and blood samples were taken to determine CD4+T and HIV viral load. There were 329 women included in the study. Median age was 32 years (IQR = 27-38 and median schooling was nine years (IQR = 4-11. The prevalence of CT was 4.3% (95%CI: 2.1-6.5. Logistic regression analysis showed that age between 18-29 years [OR = 4.1(95%CI: 1.2-13.4] and complaint of pelvic pain [OR = 3.7 (95%CI: 1.2-12.8] were independently associated with CT. The use of condom was inversely associated with CT [OR = 0.39 (95%CI: 0.1-0.9]. The results showed that younger women who did not use condoms are at a higher risk for CT. Screening for sexually transmitted infections must be done routinely and safe sexual practices should be promoted among this population.

  18. Clinical effectiveness of dolutegravir in the treatment of HIV/AIDS

    Directory of Open Access Journals (Sweden)

    Taha H

    2015-10-01

    Full Text Available Huda Taha,1 Archik Das,2 Satyajit Das1,3 1Integrated Sexual Health Service Coventry and Warwickshire Partnership NHS Trust, Coventry, 2School of Medicine, Birmingham University, Birmingham, 3Coventry University, Coventry, UK Abstract: Dolutegravir (DTG is a second-generation integrase strand transfer inhibitor (INSTI, which has now been licensed to be used in different countries including the UK. Earlier studies have demonstrated that DTG when used with nucleoside backbone in treatment-naïve and -experienced patients has been well tolerated and demonstrated virological suppression comparable to other INSTIs and superiority against other first-line agents, including efavirenz and boosted protease inhibitors. Like other INSTIs, DTG uses separate metabolic pathways compared to other antiretrovirals and is a minor substrate for CYP-450. It does not appear to have a significant interaction with drugs, which uses the CYP-450 system. Nonetheless, it uses renal solute transporters that may potentially inhibit the transport of other drugs and can have an effect on the elimination of other drugs. However, the impact of this mechanism appears to be very minimal and insignificant clinically. The side effect profiles of DTG are similar to raltegravir and have been found to be well tolerated. DTG has a long plasma half-life and is suitable for once daily use without the need for a boosting agent. DTG has all the potential to be used as a first-line drug in combination with other nucleoside backbones, especially in the form of a single tablet in combination with abacavir and lamivudine. The purpose of this review article is to present the summary of the available key information about the clinical usefulness of DTG in the treatment of HIV infection. Keywords: dolutegravir, integrase inhibitors, HIV, antiretroviral, treatment

  19. European recommendations for the clinical use of HIV drug resistance testing: 2011 update

    DEFF Research Database (Denmark)

    Vandamme, Anne-Mieke; Camacho, Ricardo J; Ceccherini-Silberstein, Francesca

    2011-01-01

    the following recommendations concerning the indications for resistance testing: for HIV-1 (i) test earliest sample for protease and reverse transcriptase drug resistance in drug-naive patients with acute or chronic infection; (ii) test protease and reverse transcriptase drug resistance at virologic failure......The European HIV Drug Resistance Guidelines Panel, established to make recommendations to clinicians and virologists, felt that sufficient new information has become available to warrant an update of its recommendations, explained in both pocket guidelines and this full paper. The Panel makes......) consider testing earliest detectable plasma RNA when a successful nonnucleoside reverse transcriptase inhibitor-containing therapy was inappropriately interrupted; (v) genotype source patient when postexposure prophylaxis is considered; for HIV-2, (vi) consider resistance testing where treatment change...

  20. Guideline on Muscle-Invasive and Metastatic Bladder Cancer (European Association of Urology Guideline): American Society of Clinical Oncology Clinical Practice Guideline Endorsement.

    Science.gov (United States)

    Milowsky, Matthew I; Rumble, R Bryan; Booth, Christopher M; Gilligan, Timothy; Eapen, Libni J; Hauke, Ralph J; Boumansour, Pat; Lee, Cheryl T

    2016-06-01

    To endorse the European Association of Urology guideline on muscle-invasive (MIBC) and metastatic bladder cancer. The American Society of Clinical Oncology (ASCO) has a policy and set of procedures for endorsing clinical practice guidelines that have been developed by other professional organizations. The guideline on MIBC and metastatic bladder cancer was reviewed for developmental rigor by methodologists. The ASCO Endorsement Panel then reviewed the content and recommendations. The ASCO Endorsement Panel determined that the recommendations from the European Association of Urology guideline on MIBC and metastatic bladder cancer, published online in March 2015, are clear, thorough, and based on the most relevant scientific evidence. ASCO endorses the guideline on MIBC and metastatic bladder cancer and has added qualifying statements, including highlighting the use of chemoradiotherapy for select patients with MIBC and recommending a preference for clinical trials in the treatment of metastatic disease in the second-line setting. Multidisciplinary care for patients with MIBC and metastatic bladder cancer is critical. The standard treatment of MIBC (cT2-T4a N0M0) is neoadjuvant cisplatin-based combination chemotherapy followed by radical cystectomy. In cisplatin-ineligible patients, radical cystectomy alone is recommended. Adjuvant cisplatin-based chemotherapy may be offered to high-risk patients who have not received neoadjuvant therapy. Chemoradiotherapy may be offered as an alternative to cystectomy in appropriately selected patients with MIBC and in some patients for whom cystectomy is not an option. Metastatic disease should be treated with cisplatin-containing combination chemotherapy or with carboplatin combination chemotherapy or single agents in patients ineligible for cisplatin.Additional information is available at http://www.asco.org/endorsements/MIBC and www.asco.org/guidelineswiki. © 2016 by American Society of Clinical Oncology.

  1. Clinical features of migraine aura: Results from a prospective diary-aided study.

    Science.gov (United States)

    Viana, Michele; Sances, Grazia; Linde, Mattias; Ghiotto, Natascia; Guaschino, Elena; Allena, Marta; Terrazzino, Salvatore; Nappi, Giuseppe; Goadsby, Peter J; Tassorelli, Cristina

    2017-09-01

    Background A detailed evaluation of migraine aura symptoms is crucial for classification issues and pathophysiological discussion. Few studies have focused on the detailed clinical aspects of migraine aura. Methods We conducted a prospective diary-based study of migraine aura features including presence, quality, laterality, duration of each aura symptom, their temporal succession; presence of headache and its temporal succession with aura. Results Seventy-two patients completed the study recording the characteristics of three consecutive auras ( n = 216 auras). Visual symptoms occurred in 212 (98%), sensory symptoms in 77 (36%) and dysphasic symptoms in 22 (10%). Most auras had more than one visual symptom (median 2, IQR 1-3, range 1-4). The majority of patients (56%) did not report a stereotyped aura on the three attacks with respect to visual features, the combination and/or temporal succession of the three aura symptoms. Fifty-seven percent of patients also reported a different scenario of temporal succession between aura and headache in the three attacks. Five per cent of aura symptoms were longer than four hours. Conclusion These findings show a high inter- and intravariability of migraine with aura attacks. Furthermore, they provide reliable data to enrich and clarify the spectrum of the aura phenotype.

  2. [Decision aids in complex polypharmacy : Medication data bases and counselling by clinical pharmacists].

    Science.gov (United States)

    Weinrebe, W; Preda, R; Bischoff, S; Nussbickel, D; Humm, M; Jeckelmann, K; Goetz, S

    2017-07-18

    The number of older people with polypharmacy (more than six drugs taken simultaneously) is increasing. The greatest proportion consists of guideline drugs, analgesics and psychopharmaceuticals because in many cases of geriatric multimorbidity several underlying main diseases are present which must be treated according to the guidelines. Polypharmacy is a complex and difficult situation for all treating physicians because substantial side effects and intoxication can be induced but it can also be very difficult to recognize which drug was at fault and how a reduction can be safely made. This article describes the exemplary case of a 77-year-old patient with drug-induced delirium and demonstrates the procedure followed. The question of rapid assistance by the utilization of medication data bases is described and the importance of clinical pharmacists is demonstrated. In the future working with medication data bases will possibly become increasingly more important for physicians and hopefully simpler. The case presented here also shows that the effective and justified reduction of drugs can show a very good effect and is possible.

  3. Clinical trials update from the European Society of Cardiology Congress in Vienna, 2007 : PROSPECT, EVEREST, ARISE, ALOFT, FINESSE, Prague-8, CARESS in MI and ACUITY

    NARCIS (Netherlands)

    Recio-Mayoral, A.; Kaski, J. -C.; McMurray, J. J. V.; Horowitz, J.; van Veldhuisen, D. J.; Remme, W. J.

    2007-01-01

    The Clinical Trials described in this article were presented at the Hotline and Clinical Trial Update Sessions of the European Society of Cardiology Congress held in September 2007 in Vienna, Austria. The sessions chosen for this article represent the scope of interest of Cardiovascular Drugs and

  4. European clinical guidelines for Tourette syndrome and other tic disorders. Part I: assessment

    DEFF Research Database (Denmark)

    Cath, Danielle C; Hedderly, Tammy; Ludolph, Andrea G

    2011-01-01

    members. Detailed clinical assessment guidelines of tic disorders and their comorbidities in both children and adults are presented. Screening methods that might be helpful and necessary for specialists' differential diagnosis process are suggested in order to further analyse cognitive abilities...

  5. En Route towards European Clinical breakpoints for veterinary antimicrobial susceptibility testing

    DEFF Research Database (Denmark)

    Toutain, Pierre Louis; Bousquet-Mélou, Alain; Damborg, Peter

    2017-01-01

    VetCAST is the EUCAST sub-committee for Veterinary Antimicrobial Susceptibility Testing. Its remit is to define clinical breakpoints (CBPs) for antimicrobial drugs (AMDs) used in veterinary medicine in Europe. This position paper outlines the procedures and reviews scientific options to solve...... challenges for the determination of specific CBPs for animal species, drug substances and disease conditions. VetCAST will adopt EUCAST approaches: the initial step will be data assessment; then procedures for decisions on the CBP; and finally the release of recommendations for CBP implementation......-clinical pharmacokinetic data [this PK/PD break-point is the highest possible MIC for which a given percentage of animals in the target population achieves a critical value for the selected PK/PD index (fAUC/MIC or fT > MIC)] and (iii) when possible, a clinical cut-off, that is the relationship between MIC and clinical...

  6. Image-aided Suicide Gene Therapy Utilizing Multifunctional hTERT-targeting Adenovirus for Clinical Translation in Hepatocellular Carcinoma

    Science.gov (United States)

    Kim, Yun-Hee; Kim, Kyung Tae; Lee, Sang-Jin; Hong, Seung-Hee; Moon, Ju Young; Yoon, Eun Kyung; Kim, Sukyoung; Kim, Eun Ok; Kang, Se Hun; Kim, Seok Ki; Choi, Sun Il; Goh, Sung Ho; Kim, Daehong; Lee, Seong-Wook; Ju, Mi Ha; Jeong, Jin Sook; Kim, In-Hoo

    2016-01-01

    Trans-splicing ribozyme enables to sense and reprogram target RNA into therapeutic transgene and thereby becomes a good sensing device for detection of cancer cells, judging from transgene expression. Previously we proposed PEPCK-Rz-HSVtk (PRT), hTERT targeting trans-splicing ribozyme (Rz) driven by liver-specific promoter phosphoenolpyruvate carboxykinase (PEPCK) with downstream suicide gene, herpes simplex virus thymidine kinase (HSVtk) for hepatocellular carcinoma (HCC) gene therapy. Here, we describe success of a re-engineered adenoviral vector harboring PRT in obtaining greater antitumor activity with less off-target effect for clinical application as a theranostics. We introduced liver-selective apolipoprotein E (ApoE) enhancer to the distal region of PRT unit to augment activity and liver selectivity of PEPCK promoter, and achieved better transduction into liver cancer cells by replacement of serotype 35 fiber knob on additional E4orf1-4 deletion of E1&E3-deleted serotype 5 back bone. We demonstrated that our refined adenovirus harboring PEPCK/ApoE-Rz-HSVtk (Ad-PRT-E) achieved great anti-tumor efficacy and improved ability to specifically target HCC without damaging normal hepatocytes. We also showed noninvasive imaging modalities were successfully employed to monitor both how well a therapeutic gene (HSVtk) was expressed inside tumor and how effectively a gene therapy took an action in terms of tumor growth. Collectively, this study suggests that the advanced therapeutic adenoviruses Ad-PRT-E and its image-aided evaluation system may lead to the powerful strategy for successful clinical translation and the development of clinical protocols for HCC therapy. PMID:26909111

  7. Design, development and clinical validation of computer-aided surgical simulation system for streamlined orthognathic surgical planning.

    Science.gov (United States)

    Yuan, Peng; Mai, Huaming; Li, Jianfu; Ho, Dennis Chun-Yu; Lai, Yingying; Liu, Siting; Kim, Daeseung; Xiong, Zixiang; Alfi, David M; Teichgraeber, John F; Gateno, Jaime; Xia, James J

    2017-12-01

    There are many proven problems associated with traditional surgical planning methods for orthognathic surgery. To address these problems, we developed a computer-aided surgical simulation (CASS) system, the AnatomicAligner, to plan orthognathic surgery following our streamlined clinical protocol. The system includes six modules: image segmentation and three-dimensional (3D) reconstruction, registration and reorientation of models to neutral head posture, 3D cephalometric analysis, virtual osteotomy, surgical simulation, and surgical splint generation. The accuracy of the system was validated in a stepwise fashion: first to evaluate the accuracy of AnatomicAligner using 30 sets of patient data, then to evaluate the fitting of splints generated by AnatomicAligner using 10 sets of patient data. The industrial gold standard system, Mimics, was used as the reference. When comparing the results of segmentation, virtual osteotomy and transformation achieved with AnatomicAligner to the ones achieved with Mimics, the absolute deviation between the two systems was clinically insignificant. The average surface deviation between the two models after 3D model reconstruction in AnatomicAligner and Mimics was 0.3 mm with a standard deviation (SD) of 0.03 mm. All the average surface deviations between the two models after virtual osteotomy and transformations were smaller than 0.01 mm with a SD of 0.01 mm. In addition, the fitting of splints generated by AnatomicAligner was at least as good as the ones generated by Mimics. We successfully developed a CASS system, the AnatomicAligner, for planning orthognathic surgery following the streamlined planning protocol. The system has been proven accurate. AnatomicAligner will soon be available freely to the boarder clinical and research communities.

  8. Epidemiology, clinical, immune, and molecular profiles of microsporidiosis and cryptosporidiosis among HIV/AIDS patients

    Directory of Open Access Journals (Sweden)

    Wumba R

    2012-07-01

    Full Text Available Roger Wumba,1 Benjamin Longo-Mbenza,2 Jean Menotti,3,4 Madone Mandina,5 Fabien Kintoki,5 Nani Hippolyte Situakibanza,1,5 Marie Kapepela Kakicha,6 Josue Zanga,1 Kennedy Mbanzulu-Makola,1 Tommy Nseka,1 Jean Pierre Mukendi,1 Eric Kendjo,7 Jean Sala,1 Marc Thellier7,81Department of Tropical Medicine, Infectious and Parasitic Diseases, Department of Parasitology, University Clinic of Kinshasa, Faculty of Medicine, University of Kinshasa, Kinshasa, Congo; 2Faculty of Health Sciences, Walter Sisulu University, Eastern Cape, South Africa; 3Laboratory of Parasitology and Mycology, Saint-Louis Hospital, Public Assistance-Hospitals of Paris, Paris, France; 4Faculty of Medicine, Lariboisière-Saint-Louis, University of Paris VII, Paris, France; 5Department of Internal Medicine, University Clinic of Kinshasa, Faculty of Medicine, University of Kinshasa, Kinshasa, Congo; 6Department of Pediatrics, University Clinic of Kinshasa, Faculty of Medicine, University of Kinshasa, Kinshasa, Congo; 7National Center for Malaria Research, AP-HP, CHU Pitie Salpêtrière, Paris, France; 8Laboratory of Parasitology and Mycology, Pitié Salpêtrière Hospital, Public Assistance-Hospitals of Paris, Pierre and Marie Curie University, Paris, FranceBackground: The objective of this study was to determine the prevalence of intestinal parasites, with special emphasis on microsporidia and Cryptosporidium, as well as their association with human immunodeficiency virus (HIV symptoms, risk factors, and other digestive parasites. We also wish to determine the molecular biology definitions of the species and genotypes of microsporidia and Cryptosporidium in HIV patients.Methods: In this cross-sectional study, carried out in Kinshasa, Democratic Republic of the Congo, stool samples were collected from 242 HIV patients (87 men and 155 women with referred symptoms and risk factors for opportunistic intestinal parasites. The analysis of feces specimen were performed using Ziehl

  9. The Clinical Impact of Continuing to Prescribe Antiretroviral Therapy in Patients with Advanced AIDS Who Manifest No Virologic or Immunologic Benefit

    NARCIS (Netherlands)

    Wohl, David A.; Kendall, Michelle A.; Feinberg, Judith; Alston-Smith, Beverly; Owens, Susan; Chafey, Suzette; Marco, Michael; Maxwell, Sharon; Benson, Constance; Keiser, Philip; van der Horst, Charles; Jacobson, Mark A.; Hoffman, J.; Cahill, S.; Petersen, T.; Keiser, P.; Putnam, B.; Levinson, R.; Feinberg, J.; Baer, J.; Zelasky, C.; Pedersen, S.; Nicotera, J.; Bailey, V.; Nichols, C.; Quinn, J.; Norris, J.; Valle, S.; Moe, A.; Johiro, A.; Jacobson, M.; Volinski, J.; Storey, S.; Schouten, J. [=Judith; Mildvan, D.; Revuelta, M.; Hutt, R.; Vasquez, M.; Greisberger, C.; Reichman, R.; Riddler, S.; Rutecki, B.; Koletar, S. L.; Gochnour, D.; Salata, R. A.; Walton, P.; Rodriguez, M.; Kessels, L.; Coleman, K.; Lyons, A.; Tashima, K. T.; Sousa, H.; O'Brien, W. A.; Mogridge, C.; Connor, J. Noel; Crawford, M.; Palmore, M.; Patrick, E. R.; Bolivar, H. H.; Fischl, M. A.; Jacobson, Mark; Alston-Smith, Beverly L.; Foutes, Marilyn; Andersen, Janet; Jabs, Douglas; Walker, David; Ferguson, Elaine; Crumpacker, Clyde S.; Griffiths, Paul; Spector, Stephen A.; Kerkau, Melissa; Webb, Nancy

    2013-01-01

    Introduction: Despite the efficacy and tolerability of modern antiretroviral therapy (ART), many patients with advanced AIDS prescribed these regimens do not achieve viral suppression or immune reconstitution as a result of poor adherence, drug resistance, or both. The clinical outcomes of continued

  10. Student′s preference of various audiovisual aids used in teaching pre- and para-clinical areas of medicine

    OpenAIRE

    Navatha Vangala

    2015-01-01

    Introduction: The formal lecture is among the oldest teaching methods that have been widely used in medical education. Delivering a lecture is made easy and better by use of audiovisual aids (AV aids) such as blackboard or whiteboard, an overhead projector, and PowerPoint presentation (PPT). Objective: To know the students preference of various AV aids and their use in medical education with an aim to improve their use in didactic lectures. Materials and Methods: The study was carried out amo...

  11. [Spanish adaptation of the 2016 European Guidelines on cardiovascular disease prevention in clinical practice].

    Science.gov (United States)

    Royo-Bordonada, M Á; Armario, P; Lobos Bejarano, J M; Pedro-Botet, J; Villar Alvarez, F; Elosua, R; Brotons Cuixart, C; Cortés, O; Serrano, B; Cammafort Babkowski, M; Gil Núñez, A; Pérez, A; Maiques, A; de Santiago Nocito, A; Castro, A; Alegría, E; Baeza, C; Herranz, M; Sans, S; Campos, P

    The VI European Guidelines for Cardiovascular Prevention recommend combining population and high-risk strategies with lifestyle changes as a cornerstone of prevention, and propose the SCORE function to quantify cardiovascular risk. The guidelines highlight disease specific interventions, and conditions as women, young people and ethnic minorities. Screening for subclinical atherosclerosis with noninvasive imaging techniques is not recommended. The guidelines distinguish four risk levels (very high, high, moderate and low) with therapeutic objectives for lipid control according to risk. Diabetes mellitus confers a high risk, except for subjects with type 2 diabetes with less than arterial hypertension will depend on the blood pressure level and the cardiovascular risk, taking into account the lesion of target organs. The guidelines don't recommend antiplatelet drugs in primary prevention because of the increased bleeding risk. The low adherence to the medication requires simplified therapeutic regimes and to identify and combat its causes. The guidelines highlight the responsibility of health professionals to take an active role in advocating evidence-based interventions at the population level, and propose effective interventions, at individual and population level, to promote a healthy diet, the practice of physical activity, the cessation of smoking and the protection against alcohol abuse. Copyright © 2016. Publicado por Elsevier España, S.L.U.

  12. Spanish adaptation of the 2016 European Guidelines on cardiovascular disease prevention in clinical practice.

    Science.gov (United States)

    Royo-Bordonada, M Á; Armario, P; Lobos Bejarano, J M; Pedro-Botet, J; Villar Alvarez, F; Elosua, R; Brotons Cuixart, C; Cortés, O; Serrano, B; Camafort Babkowski, M; Gil Núñez, A; Pérez, A; Maiques, A; de Santiago Nocito, A; Castro, A; Alegría, E; Baeza, C; Herranz, M; Sans, S; Campos, P

    The VI European Guidelines for Cardiovascular Prevention recommend combining population and high-risk strategies with lifestyle changes as a cornerstone of prevention, and propose the SCORE function to quantify cardiovascular risk. The guidelines highlight disease specific interventions, and conditions as women, young people and ethnic minorities. Screening for subclinical atherosclerosis with noninvasive imaging techniques is not recommended. The guidelines distinguish four risk levels (very high, high, moderate and low) with therapeutic objectives for lipid control according to risk. Diabetes mellitus confers a high risk, except for subjects with type 2 diabetes with less than <10 years of evolution, without other risk factors or complications, or type 1 diabetes of short evolution without complications. The decision to start pharmacological treatment of arterial hypertension will depend on the blood pressure level and the cardiovascular risk, taking into account the lesion of target organs. The guidelines don't recommend antiplatelet drugs in primary prevention because of the increased bleeding risk. The low adherence to the medication requires simplified therapeutic regimes and to identify and combat its causes. The guidelines highlight the responsibility of health professionals to take an active role in advocating evidence-based interventions at the population level, and propose effective interventions, at individual and population level, to promote a healthy diet, the practice of physical activity, the cessation of smoking and the protection against alcohol abuse. Copyright © 2017. Publicado por Elsevier España, S.L.U.

  13. [Spanish adaptation of the 2016 European Guidelines on cardiovascular disease prevention in clinical practice].

    Science.gov (United States)

    Royo-Bordonada, Miguel Ángel; Armario, Pedro; Lobos Bejarano, José María; Pedro-Botet, Juan; Villar Álvarez, Fernando; Elosua, Roberto; Brotons Cuixart, Carlos; Cortés, Olga; Serrano, Benilde; Camafort Babkowski, Miguel; Gil Núñez, Antonio; Pérez, Antonio; Maiques, Antonio; de Santiago Nocito, Ana; de Castro, Almudena; Alegría, Eduardo; Baeza, Ciro; Herranz, María; Sans, Susana; Campos, Pilar

    The VI European Guidelines for Cardiovascular Prevention recommend combining population and high-risk strategies with lifestyle changes as a cornerstone of prevention, and propose the SCORE function to quantify cardiovascular risk. The guidelines highlight disease specific interventions, and conditions as women, young people and ethnic minorities. Screening for subclinical atherosclerosis with noninvasive imaging techniques is not recommended. The guidelines distinguish four risk levels (very high, high, moderate and low) with therapeutic objectives for lipid control according to risk. Diabetes mellitus confers a high risk, except for subjects with type 2 diabetes with less than <10 years of evolution, without other risk factors or complications, or type 1 diabetes of short evolution without complications. The decision to start pharmacological treatment of arterial hypertension will depend on the blood pressure level and the cardiovascular risk, taking into account the lesion of target organs. The guidelines don't recommend antiplatelet drugs in primary prevention because of the increased bleeding risk. The low adherence to the medication requires simplified therapeutic regimes and to identify and combat its causes. The guidelines highlight the responsibility of health professionals to take an active role in advocating evidence-based interventions at the population level, and propose effective interventions, at individual and population level, to promote a healthy diet, the practice of physical activity, the cessation of smoking and the protection against alcohol abuse. Copyright © 2017. Publicado por Elsevier España, S.L.U.

  14. Key Steps in Conducting Systematic Reviews for Underpinning Clinical Practice Guidelines: Methodology of the European Association of Urology.

    Science.gov (United States)

    Knoll, Thomas; Omar, Muhammad Imran; Maclennan, Steven; Hernández, Virginia; Canfield, Steven; Yuan, Yuhong; Bruins, Max; Marconi, Lorenzo; Van Poppel, Hein; N'Dow, James; Sylvester, Richard

    2017-09-13

    The findings of systematic reviews (SRs) and meta-analyses (MAs) are used for clinical decision making. The European Association of Urology has committed increasing resources into the development of high quality clinical guidelines based on such SRs and MAs. In this paper, we have summarised the process of conducting SRs for underpinning clinical practice guidelines under the auspices of the European Association of Urology Guidelines Office. The process involves explicit methods and the findings should be reproducible. When conducting a SR, the essential first step is to formulate a clear and answerable research question. An extensive literature search lays the foundation for evidence synthesis. Data are extracted independently by two reviewers and any disagreements are resolved by discussion or arbitration by a third reviewer. In SRs, data for particular outcomes in individual randomised controlled trials may be combined statistically in a meta-analysis to increase power when the studies are similar enough. Biases in studies included in a SR/MA can lead to either an over estimation or an under estimation of true intervention effect size, resulting in heterogeneity in outcome between studies. A number of different tools are available such as Cochrane Risk of Bias assessment tool for randomised controlled trials. In circumstances where there is too much heterogeneity, or when a review has included nonrandomised comparative studies, it is more appropriate to conduct a narrative synthesis. The GRADE tool for assessing quality of evidence strives to be a structured and transparent system, which can be applied to all evidence, regardless of quality. A SR not only identifies, evaluates, and summarises the best available evidence, but also the gaps to be targeted by future studies. SRs and MAs are integral in developing sound clinical practice guidelines and recommendations. Clinical practice guidelines should be evidence based, and systematic reviews and meta

  15. Spinal spondylosis and acute intervertebral disc prolapse in a European brown bear (Ursus arctos arctos : clinical communication

    Directory of Open Access Journals (Sweden)

    W.M. Wagner

    2005-06-01

    Full Text Available A 22-year-old male European brown bear (Ursus arctos arctos was presented to the Onderstepoort Veterinary Academic Hospital after an acute onset of hind limb paralysis 4 days earlier. Previous radiographs revealed marked degenerative joint disease of the stifles, tarsi and digits. The clinical findings were consistent with acute disc prolapse. Lateral radiographs of the entire vertebral column were made as well as ventrodorsal pelvic radiographs. The latter were within normal limits. The vertebral column revealed multiple lesions consistent with chronic and acute disc herniations. Lateral compression of the caudal lumbar nerve roots could not be ruled out. Owing to multiple significant findings of the vertebral column and the poor prognosis for full recovery after surgery, the bear was euthanased. The diagnosis of an acute disc prolapse and multiple chronic disc herniations was confirmed on necropsy.

  16. Violence in Clinical Psychiatry. Proceedings of the 6th European congress

    NARCIS (Netherlands)

    Needham, I.; Callaghan, P.; Palmstierna, T.; Nijman, H.L.I.; Oud, N.E.

    2009-01-01

    This book of conference proceedings offers an overview of the work of many clinicians, researchers, and others on topics pertinent to the field of clinical violence such as legal and ethical perspectives on violence, the impact of violence on patients and staff, coercive measures, the

  17. En Route towards European Clinical breakpoints for veterinary antimicrobial susceptibility testing

    NARCIS (Netherlands)

    Toutain, Pierre Louis; Bousquet-Mélou, Alain; Damborg, Peter; Ferran, Aude A.; Mevius, Dik; Pelligand, Ludovic; Veldman, Kees T.; Lees, Peter

    2017-01-01

    VetCAST is the EUCAST sub-committee for Veterinary Antimicrobial Susceptibility Testing. Its remit is to define clinical breakpoints (CBPs) for antimicrobial drugs (AMDs) used in veterinary medicine in Europe. This position paper outlines the procedures and reviews scientific options to solve

  18. Spectrum of clinical features associated with interstitial chromosome 22q11 deletions : a European collaborative study

    NARCIS (Netherlands)

    Ryan, AK; Goodship, JA; Wilson, DI; Philip, N; Levy, A; Seidel, H; Schuffenhauer, S; Oechsler, H; Belohradsky, B; Prieur, M; Aurias, A; Raymond, FL; ClaytonSmith, J; Hatchwell, E; McKeown, C; Beemer, FA; Dallapiccola, B; Novelli, G; Hurst, JA; Ignatius, J; Green, AJ; Brueton, L; BrondumNielsen, K; Stewart, F; VanEssen, T; Patton, M; Paterson, J; Scambler, PJ

    1997-01-01

    We present clinical data on 558 patients with deletions within the DiGeorge syndrome critical region of chromosome 22q11. Twenty-eight percent of the cases where parents had been tested had inherited deletions, with a marked excess of maternally inherited deletions (maternal 61, paternal 18). Eight

  19. The ENDOCARE questionnaire guides European endometriosis clinics to improve the patient-centeredness of their care

    NARCIS (Netherlands)

    Dancet, E.A.; Apers, S.; Kluivers, K.B.; Kremer, J.A.M.; Sermeus, W.; Devriendt, C.; Nelen, W.L.D.M.; D'Hooghe, T.M.

    2012-01-01

    STUDY QUESTION: How patient-centered are two included specialized endometriosis clinics relative to each other and how can they improve the patient-centeredness of their care? SUMMARY ANSWER: The validated ENDOCARE questionnaire (ECQ) reliably concluded that the adjusted overall patient-centeredness

  20. Associating Drugs, Targets and Clinical Outcomes into an Integrated Network Affords a New Platform for Computer-Aided Drug Repurposing.

    Science.gov (United States)

    Oprea, Tudor I; Nielsen, Sonny Kim; Ursu, Oleg; Yang, Jeremy J; Taboureau, Olivier; Mathias, Stephen L; Kouskoumvekaki, Lrene; Sklar, Larry A; Bologa, Cristian G

    2011-03-14

    Finding new uses for old drugs is a strategy embraced by the pharmaceutical industry, with increasing participation from the academic sector. Drug repurposing efforts focus on identifying novel modes of action, but not in a systematic manner. With intensive data mining and curation, we aim to apply bio- and cheminformatics tools using the DRUGS database, containing 3,837 unique small molecules annotated on 1,750 proteins. These are likely to serve as drug targets and antitargets (i.e., associated with side effects, SE). The academic community, the pharmaceutical sector and clinicians alike could benefit from an integrated, semantic-web compliant computer-aided drug repurposing (CADR) effort, one that would enable deep data mining of associations between approved drugs (D), targets (T), clinical outcomes (CO) and SE. We report preliminary results from text mining and multivariate statistics, based on 7,684 approved drug labels, ADL (Dailymed) via text mining. From the ADL corresponding to 988 unique drugs, the "adverse reactions" section was mapped onto 174 SE, then clustered via principal component analysis into a 5x5 self-organizing map that was integrated into a Cytoscape network of SE-D-T-CO. This type of data can be used to streamline drug repurposing and may result in novel insights that can lead to the identification of novel drug actions.

  1. Evaluating research and impact: a bibliometric analysis of research by the NIH/NIAID HIV/AIDS clinical trials networks.

    Directory of Open Access Journals (Sweden)

    Scott R Rosas

    2011-03-01

    Full Text Available Evaluative bibliometrics uses advanced techniques to assess the impact of scholarly work in the context of other scientific work and usually compares the relative scientific contributions of research groups or institutions. Using publications from the National Institute of Allergy and Infectious Diseases (NIAID HIV/AIDS extramural clinical trials networks, we assessed the presence, performance, and impact of papers published in 2006-2008. Through this approach, we sought to expand traditional bibliometric analyses beyond citation counts to include normative comparisons across journals and fields, visualization of co-authorship across the networks, and assess the inclusion of publications in reviews and syntheses. Specifically, we examined the research output of the networks in terms of the a presence of papers in the scientific journal hierarchy ranked on the basis of journal influence measures, b performance of publications on traditional bibliometric measures, and c impact of publications in comparisons with similar publications worldwide, adjusted for journals and fields. We also examined collaboration and interdisciplinarity across the initiative, through network analysis and modeling of co-authorship patterns. Finally, we explored the uptake of network produced publications in research reviews and syntheses. Overall, the results suggest the networks are producing highly recognized work, engaging in extensive interdisciplinary collaborations, and having an impact across several areas of HIV-related science. The strengths and limitations of the approach for evaluation and monitoring research initiatives are discussed.

  2. Evaluating Research and Impact: A Bibliometric Analysis of Research by the NIH/NIAID HIV/AIDS Clinical Trials Networks

    Science.gov (United States)

    Rosas, Scott R.; Kagan, Jonathan M.; Schouten, Jeffrey T.; Slack, Perry A.; Trochim, William M. K.

    2011-01-01

    Evaluative bibliometrics uses advanced techniques to assess the impact of scholarly work in the context of other scientific work and usually compares the relative scientific contributions of research groups or institutions. Using publications from the National Institute of Allergy and Infectious Diseases (NIAID) HIV/AIDS extramural clinical trials networks, we assessed the presence, performance, and impact of papers published in 2006–2008. Through this approach, we sought to expand traditional bibliometric analyses beyond citation counts to include normative comparisons across journals and fields, visualization of co-authorship across the networks, and assess the inclusion of publications in reviews and syntheses. Specifically, we examined the research output of the networks in terms of the a) presence of papers in the scientific journal hierarchy ranked on the basis of journal influence measures, b) performance of publications on traditional bibliometric measures, and c) impact of publications in comparisons with similar publications worldwide, adjusted for journals and fields. We also examined collaboration and interdisciplinarity across the initiative, through network analysis and modeling of co-authorship patterns. Finally, we explored the uptake of network produced publications in research reviews and syntheses. Overall, the results suggest the networks are producing highly recognized work, engaging in extensive interdisciplinary collaborations, and having an impact across several areas of HIV-related science. The strengths and limitations of the approach for evaluation and monitoring research initiatives are discussed. PMID:21394198

  3. HIV/AIDS

    Science.gov (United States)

    ... pain Fatigue HIV/AIDS Symptoms & causes Diagnosis & treatment Advertisement Mayo Clinic does not endorse companies or products. ... a Job Site Map About This Site Twitter Facebook Google YouTube Pinterest Mayo Clinic is a not- ...

  4. Effects of computer-aided clinical decision support systems in improving antibiotic prescribing by primary care providers: a systematic review.

    Science.gov (United States)

    Holstiege, Jakob; Mathes, Tim; Pieper, Dawid

    2015-01-01

    To assess the effectiveness of computer-aided clinical decision support systems (CDSS) in improving antibiotic prescribing in primary care. A literature search utilizing Medline (via PubMed) and Embase (via Embase) was conducted up to November 2013. Randomized controlled trials (RCTs) and cluster randomized trials (CRTs) that evaluated the effects of CDSS aiming at improving antibiotic prescribing practice in an ambulatory primary care setting were included for review. Two investigators independently extracted data about study design and quality, participant characteristics, interventions, and outcomes. Seven studies (4 CRTs, 3 RCTs) met our inclusion criteria. All studies were performed in the USA. Proportions of eligible patient visits that triggered CDSS use varied substantially between intervention arms of studies (range 2.8-62.8%). Five out of seven trials showed marginal to moderate statistically significant effects of CDSS in improving antibiotic prescribing behavior. CDSS that automatically provided decision support were more likely to improve prescribing practice in contrast to systems that had to be actively initiated by healthcare providers. CDSS show promising effectiveness in improving antibiotic prescribing behavior in primary care. Magnitude of effects compared to no intervention, appeared to be similar to other moderately effective single interventions directed at primary care providers. Additional research is warranted to determine CDSS characteristics crucial to triggering high adoption by providers as a perquisite of clinically relevant improvement of antibiotic prescribing. © The Author 2014. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.comFor numbered affiliations see end of article.

  5. The convergence process in European Higher Education and its historical cultural impact on Spanish clinical nursing training.

    Science.gov (United States)

    Siles González, J; Ruiz, Ma C Solano

    2012-11-01

    The objective of this study was to promote student reflection on the historical and cultural impact of the implementation of the European Higher Education Area (EHEA) on the nursing practicum course in Spain. The objective was to demonstrate the relevance of a clinical practice diary as a facilitative tool for reflection, metacognition and self-evaluation during the practicum. The theoretical framework for this study was based on the socio-critical and critical thinking and comparative education paradigms. Methodologically, we used reflection and educational, ethnography-based resources. Theoretical and methodological competencies were perceived as requiring more time and effort (records, nursing process: 29%/35% respectively), whereas the technical skills that related to community work are perceived as involving the least amount of time and effort requiring (13%/10% respectively). The conclusion we have reached is that the primary difficulties in implementing the EHEA are in the cultural transformations that result from the new system of student-centred learning. A clinical practice diary is an effective tool with which to contextualise the nursing practicum and its impact on cultural characteristics, ways of thinking and the reflections of the students. This clinical practice diary facilitates the achievement of competences through the processes of reflection and metacognition. Copyright © 2011 Elsevier Ltd. All rights reserved.

  6. The EC4 European syllabus for post-graduate training in clinical chemistry and laboratory medicine

    DEFF Research Database (Denmark)

    Wieringa, Gijsbert; Zerah, Simone; Jansen, Rob

    2012-01-01

    , management and treatment of patients, and their prognostic assessment. In submitting a revised common syllabus for post-graduate education and training across the 27 member states an expectation is set for harmonised, high quality, safe practice. In this regard an extended 'Core knowledge, skills...... and competencies' division embracing all laboratory medicine disciplines is described. For the first time the syllabus identifies the competencies required to meet clinical leadership demands for defining, directing and assuring the efficiency and effectiveness of laboratory services as well as expectations...... in translating knowledge and skills into ability to practice. In a 'Specialist knowledge' division, the expectations from the individual disciplines of Clinical Chemistry/Immunology, Haematology/Blood Transfusion, Microbiology/ Virology, Genetics and In Vitro Fertilisation are described. Beyond providing...

  7. Robot-aided therapy for upper limbs in patients with stroke-related lesions. Brief report of a clinical experience

    Directory of Open Access Journals (Sweden)

    Dall'Armi Valentina

    2011-04-01

    Full Text Available Abstract This study was aimed at verifying the improvement on the motor impairment and functionality in 19 patients with chronic hemiparesis after stroke treated with a robot-aided rehabilitation protocol using the ReoGo™ system (Motorika Medical Ltd, Israel, and at evaluating the persistence of the effects after 1 month. The study also focused on the actual possibility of administering the robot-aided therapy with the ReoGo™ for the upper limbs and on the patients' degree of acceptance and compliance with the treatment. Subjects underwent an assessment prior to the start of the rehabilitation project (T-1, one at the start (T0, one at the end of the treatment (T1 and one after one month from the end of the treatment (T2. The following tests were administered: (i Fugl-Meyer (FM upper limb; Ashworth scale (AS; Functional Independence Measure (FIM™ (T-1 - T2; (ii strength evaluation; Visual Analogue Scale (VAS for pain; Frenchay Arm test (FAT; Box and Block test (BBT; Timed Up and Go (TUG test (T0 - T2. Additionally, the Euro-QoL questionnaire and a VAS for the treatment satisfaction were administered to the subjects. Non-statistical difference of scores at T-1 and T0 on almost the entire battery of tasks suggested a stable patients' performance prior to the start of the rehabilitation. With the exception of the Medical Research Council (MRC and the AS sub-scales measuring -as appropriate- strength and spasticity of the shoulder, triceps and wrist, all scores showed a significant increase between T0 and T1. The improvement on the pain could not be proved significant (p = 0.10. A significant increase between T0 and T2 was found for all assessment scores, with the exception of the MRC for external shoulder rotators (p = 0.05 and of the AS for shoulder (p = 0.32 and wrist (p = 0.08. Substantial stability was observed between T1 and T2. Patients were capable of completing the treatment and showed good participant satisfaction. This pilot study

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

    DEFF Research Database (Denmark)

    Lippi, G.; Banfi, G.; Church, S.

    2015-01-01

    , is aimed to provide further contributions for pursuing quality and harmony in the preanalytical phase, and is a synopsis of lectures of the third European Federation of Clinical Chemistry and Laboratory Medicine (EFLM)-Becton Dickinson (BD) European Conference on Preanalytical Phase meeting entitled......). Although laboratory medicine seems less vulnerable than other clinical and diagnostic areas, the chance of errors is not negligible and may adversely impact on quality of testing and patient safety. This article, which continues a biennial tradition of collective papers on preanalytical quality improvement...

  9. The Effects of Service-Delivery Model and Purchase Price on Hearing-Aid Outcomes in Older Adults: A Randomized Double-Blind Placebo-Controlled Clinical Trial

    Science.gov (United States)

    Rogers, Sara E.; Quigley, Tera M.; Main, Anna K.; Kinney, Dana L.; Herring, Christine

    2017-01-01

    Objectives The objectives of this study were to determine efficacy of hearing aids in older adults using audiology best practices, to evaluate the efficacy of an alternative over-the-counter (OTC) intervention, and to examine the influence of purchase price on outcomes for both service-delivery models. Design The design of this study was a single-site, prospective, double-blind placebo-controlled randomized trial with three parallel branches: (a) audiology best practices (AB), (b) consumer decides OTC model (CD), and (c) placebo devices (P). Outcome measures were obtained after a typical 6-week trial period with follow-up 4-week AB-based trial for those initially assigned to CD and P groups. Setting Older adults from the general community were recruited via newspaper and community flyers to participate at a university research clinic. Participants Participants were adults, ages 55–79 years, with mild-to-moderate hearing loss. There were 188 eligible participants: 163 enrolled as a volunteer sample, and 154 completed the intervention. Intervention(s) All participants received the same high-end digital mini-behind-the-ear hearing aids fitted bilaterally. AB and P groups received best-practice services from audiologists; differing mainly in use of appropriate (AB) or placebo (P) hearing aid settings. CD participants self-selected their own pre-programmed hearing aids via an OTC model. Primary and Secondary Outcome Measures Primary outcome measure was a 66-item self-report, Profile of Hearing Aid Benefit (Cox & Gilmore, 1990). Secondary outcome measure was the Connected Speech Test (Cox, Alexander, & Gilmore, 1987) benefit. Additional measures of hearing-aid benefit, satisfaction, and usage were also obtained. Results Per-protocol analyses were performed. AB service-delivery model was found to be efficacious for most of the outcome measures, with moderate or large effect sizes (Cohen's d). CD service-delivery model was efficacious, with similar effect sizes. However

  10. Knowledge and attitude of Indian clinical dental students towards the dental treatment of patients with human immunodeficiency virus (HIV)/acquired immune-deficiency syndrome (AIDS).

    Science.gov (United States)

    Oberoi, Sukhvinder Singh; Marya, Charu Mohan; Sharma, Nilima; Mohanty, Vikrant; Marwah, Mohita; Oberoi, Avneet

    2014-12-01

    Oral health care of patients with human immunodeficiency virus (HIV)/acquired immune-deficiency syndrome (AIDS) is a growing area of concern. Information on HIV- and AIDS-related knowledge among dental students provides a crucial foundation for efforts aimed at developing an appropriate dental curriculum on HIV and AIDS. The purpose of this study was to assess the knowledge and attitude of Indian clinical dental students towards the treatment of patients with HIV/AIDS and perceived sources of information regarding HIV-related issues. Data were collected from clinical dental students (third year, fourth year and internship) from three dental institutions in Delhi National Capital Region (NCR). The questions assessed the knowledge and attitude towards treatment of patients with HIV and the perceived source of information related to HIV. The willingness to treat HIV-positive patients among dental students was 67.0%, and 74.20% were confident of treating a patient with HIV/AIDS. The potential problems in rendering treatment to these patients were effect on the attitude of other patients (49.90%) and staff fears (52.50%). The correct knowledge regarding the infection-control practice (barrier technique) was found among only 15.50% of respondents. The respondents had sufficient knowledge regarding the oral manifestations of HIV/AIDS. There was no correlation between the knowledge and attitude score, demonstrating a gap between knowledge and attitude among dental students regarding treatment of HIV-infected patients. Appropriate knowledge has to be delivered through the dental education curriculum, which can instil confidence in students about their ability to manage HIV-positive patients. © 2014 FDI World Dental Federation.

  11. Examining the effectiveness of home-based parent aide services to reduce risk for physical child abuse and neglect: six-month findings from a randomized clinical trial.

    Science.gov (United States)

    Guterman, Neil B; Tabone, Jiyoung K; Bryan, George M; Taylor, Catherine A; Napoleon-Hanger, Cynthia; Banman, Aaron

    2013-08-01

    This study set out to carry out a feasible, real-world, randomized clinical trial to examine the benefits of home-based paraprofessional parent aide services in reducing physical abuse and neglect risk in high-risk parents. Families were randomly assigned to receive either parent aide plus case management services (n = 73) or case management services only (n = 65), collecting in-home data on physical child abuse and neglect and proximal risk and protective factors, just prior to service initiation, and again after six months of services. Mothers receiving parent aide and case management services reported significant improvements from baseline to six-month follow-up in self-reported indicators of physical child abuse risk, as well as improvements on parental stress, mastery, depression, and anxiety, whereas mothers receiving only case management services did not. The slopes of such observed changes across groups, however, were not found to be statistically significantly different. No discernable improvements were found with regard to indicators of risk for child neglect. As the first randomized clinical trial examining the effectiveness of parent aide services, this study provides the first controlled evidence examining the potential benefits of this service modality. This study suggests promising trends regarding the benefit of parent aide services with respect to physical child abuse risk reduction and related predictors, but evidence does not appear to suggest that such services, as they are presently delivered, reduce child neglect. These findings support the continued use of parent aide services in cases of physical child abuse and also suggest careful consideration of the ways such services may be better configured to extend their impact, particularly with respect to child neglect risk. Copyright © 2013 Elsevier Ltd. All rights reserved.

  12. Clinical and biochemical changes in 53 Swedish dogs bitten by the European adder - Vipera berus

    Directory of Open Access Journals (Sweden)

    Frendin Jan HM

    2010-04-01

    Full Text Available Abstract Background Every year many dogs in Sweden are bitten by Vipera berus, the only venomous viper in Sweden. This prospective study investigated clinical signs, some biochemical parameters, treatment, and progress of disease after snakebite in 53 dogs. Effects of treatment with and without glucocorticoids were evaluated. Methods All fifty-three dogs bitten by Vipera berus were examined the same day the dog was bitten and the next day. Two more examinations during 23 days post snake bite were included. Creatinine, creatine kinase (CK, alanine aminotransferase (ALT, glutamate dehydrogenase (GLDH, alkaline phosphatase (ALP and bile acid results were followed through 3 to 4 samplings from 34 of the dogs. Results All dogs had variable severity of local swelling in the bite area and 73 per cent had affected mental status. Initial cardiac auscultation examination was normal in all dogs, but six dogs had cardiac abnormalities at their second examination, including cardiac arrhythmias and cardiac murmurs. All dogs received fluid therapy, 36 dogs were given analgesics, 22 dogs were treated with glucocorticoids, and ten dogs were treated with antibiotics. Evidence of transient muscle damage (increased CK was seen one day after the snake bite in 15 (54% of 28 sampled dogs. Moderate changes in hepatic test results occurred in 1 dog and several dogs (22 of 34 had transient, minor increases in one or more hepatic test result. No dog died during the observation period as a consequence of the snake bite. Conclusions Snake bite caused local swelling in all dogs and mental depression of short duration in most dogs. Some dogs had transient clinical signs that could be indicative of cardiac injury and some other had transient biochemical signs of liver injury. Treatment with glucocorticoids did not have any clear positive or negative effect on clinical signs and mortality.

  13. Clinical and biochemical changes in 53 Swedish dogs bitten by the European adder--Vipera berus.

    Science.gov (United States)

    Lervik, Jessica Berger; Lilliehöök, Inger; Frendin, Jan H M

    2010-04-23

    Every year many dogs in Sweden are bitten by Vipera berus, the only venomous viper in Sweden. This prospective study investigated clinical signs, some biochemical parameters, treatment, and progress of disease after snakebite in 53 dogs. Effects of treatment with and without glucocorticoids were evaluated. All fifty-three dogs bitten by Vipera berus were examined the same day the dog was bitten and the next day. Two more examinations during 23 days post snake bite were included. Creatinine, creatine kinase (CK), alanine aminotransferase (ALT), glutamate dehydrogenase (GLDH), alkaline phosphatase (ALP) and bile acid results were followed through 3 to 4 samplings from 34 of the dogs. All dogs had variable severity of local swelling in the bite area and 73 per cent had affected mental status. Initial cardiac auscultation examination was normal in all dogs, but six dogs had cardiac abnormalities at their second examination, including cardiac arrhythmias and cardiac murmurs. All dogs received fluid therapy, 36 dogs were given analgesics, 22 dogs were treated with glucocorticoids, and ten dogs were treated with antibiotics. Evidence of transient muscle damage (increased CK) was seen one day after the snake bite in 15 (54%) of 28 sampled dogs. Moderate changes in hepatic test results occurred in 1 dog and several dogs (22 of 34) had transient, minor increases in one or more hepatic test result. No dog died during the observation period as a consequence of the snake bite. Snake bite caused local swelling in all dogs and mental depression of short duration in most dogs. Some dogs had transient clinical signs that could be indicative of cardiac injury and some other had transient biochemical signs of liver injury. Treatment with glucocorticoids did not have any clear positive or negative effect on clinical signs and mortality.

  14. Oral erythema multiforme: trends and clinical findings of a large retrospective European case series.

    Science.gov (United States)

    Celentano, Antonio; Tovaru, Serban; Yap, Tami; Adamo, Daniela; Aria, Massimo; Mignogna, Michele Davide

    2015-12-01

    Erythema multiforme (EM) continues to be an underestimated disease with a lack of strict classification and diagnostic criteria. We present the analysis of a case series of 60 oral EM patients from 2 centers and illustrate the range of oral clinical presentations. Clinical data from 60 EM patients with oral involvement, diagnosed and treated between 1982 and 2014, were retrospectively collected from the archives of 2 independent hospitals. Statistical analyses of the data were performed using the Pearson χ-squared test and the Mann-Whitney U test. Thirty-one patients (51.7%) were male and 29 (48.3%) were female, with a mean (±SD) age of 37.9 years (±18.1). The frequency of previous occurrences ranged from 0 to 10 (mean ± SD: 1.4 ± 2.0). Twenty-nine patients (48%) had no previous occurrence. Medications (particularly antipyretics, food additives, and antibiotics) were the suspected precipitants in 28 patients (46.7%), whereas herpes simplex virus infection was suspected in 18 (30.0%). All but 1 patient had involvement of multiple oral sites, with the buccal mucosa being the most commonly involved oral site (75%), followed by the vermillion border (71.7%). Patients with EM may present initially to oral health care workers. Medications and herpes simplex virus continue to be the most typically involved precipitating factors. Our data highlight the additional role of food-derived antigens. Although laboratory tests can provide support diagnostically, EM diagnosis continues to be based on clinical features. A medication and food diary should be encouraged particularly in patients with recurrent forms. Copyright © 2015 Elsevier Inc. All rights reserved.

  15. Free software to analyse the clinical relevance of drug interactions with antiretroviral agents (SIMARV(®)) in patients with HIV/AIDS.

    Science.gov (United States)

    Giraldo, N A; Amariles, P; Monsalve, M; Faus, M J

    Highly active antiretroviral therapy has extended the expected lifespan of patients with HIV/AIDS. However, the therapeutic benefits of some drugs used simultaneously with highly active antiretroviral therapy may be adversely affected by drug interactions. The goal was to design and develop a free software to facilitate analysis, assessment, and clinical decision making according to the clinical relevance of drug interactions in patients with HIV/AIDS. A comprehensive Medline/PubMed database search of drug interactions was performed. Articles that recognized any drug interactions in HIV disease were selected. The publications accessed were limited to human studies in English or Spanish, with full texts retrieved. Drug interactions were analyzed, assessed, and grouped into four levels of clinical relevance according to gravity and probability. Software to systematize the information regarding drug interactions and their clinical relevance was designed and developed. Overall, 952 different references were retrieved and 446 selected; in addition, 67 articles were selected from the citation lists of identified articles. A total of 2119 pairs of drug interactions were identified; of this group, 2006 (94.7%) were drug-drug interactions, 1982 (93.5%) had an identified pharmacokinetic mechanism, and 1409 (66.5%) were mediated by enzyme inhibition. In terms of clinical relevance, 1285 (60.6%) drug interactions were clinically significant in patients with HIV (levels 1 and 2). With this information, a software program that facilitates identification and assessment of the clinical relevance of antiretroviral drug interactions (SIMARV(®)) was developed. A free software package with information on 2119 pairs of antiretroviral drug interactions was designed and developed that could facilitate analysis, assessment, and clinical decision making according to the clinical relevance of drug interactions in patients with HIV/AIDS. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. The Frequency of Hearing Loss and Hearing Aid Prescription in the Clients of the Avesina Education and Health Center, Audiometry Clinic, 1377

    Directory of Open Access Journals (Sweden)

    Abbas Bastani

    2003-08-01

    Full Text Available Objective: Determining the frequency of hearing disorders and hearing aid using in the clients referring to the Avesina education and health center, audiometry clinic, 1377. Method and Material: This is an assesive-descriptive survey that conducted on more than 2053 (1234 males and 819 females who referred for audiometry after examination by a physician. Case history, otoscopy, PTA, speech and immittance audiometry were conducted for all the clients. The findings were expressed in tables and diagrams of frequency. The age and sex relationship. All types of hearing losses and the number of the hearing-impaired clients need a hearing aid were assessed. Findings: 56% of this population were hearing-impaired and 44% had normal hearing were hearing. 60% were males and 40% females. Of the hearing-impaired, 44% had SNHL, 35.6% CHL and 8.2% mixed hearing loss. The hearing aid was prescribed for 204 (83 females and121 males if they need that only 20 females and 32 males wear it. Conclusion: It this sample, SNHL is of higher frequency. According to this survey, the more the age, the more the hearing aid is accepted (85% of wearer are more than 49 the prevalence of the hearing impaired males are more than females (60% versus 40%. Only 25% of the hearing-impaired wear hearing aids.

  17. Clinical features and outcomes of AIDS-related cytomegalovirus retinitis in the era of highly active antiretroviral therapy.

    Science.gov (United States)

    Arantes, Tiago Eugênio Faria e; Garcia, Claudio Renato; Saraceno, Janaína Jamile Ferreira; Muccioli, Cristina

    2010-01-01

    To describe the features and outcomes of patients with AIDS-related cytomegalovirus retinitis after highly active antiretroviral therapy availability. Retrospective chart review of 30 consecutive patients (44 eyes) with AIDS and newly diagnosed, active AIDS-related cytomegalovirus retinitis, examined from January 2005 to December 2007. The mean age was 34.8 years, 18 patients (60.0%) were male and median duration of AIDS was 90 months. Nineteen patients (63.3%) had evidence of highly active antiretroviral therapy failure and median CD4+ lymphocyte count was 12.5 cells/microl. Visual acuity at presentation was 20/40 or better in 27 eyes (61.4%). Retinitis involved Zone 1 in 13 eyes (39.5%). Despite specific anti-AIDS-related cytomegalovirus therapy, 16 eyes (36.4%) presented relapse of retinitis and 10 eyes (22.7%) lost at least three lines of vision. When compared to highly active antiretroviral therapy responsive patients, eyes of highly active antiretroviral therapy failure patients were more likely to develop relapse of retinitis (p=0.03) and loss of at least three lines of vision (p=0.03). The patients in this series are essentially young men with longstanding AIDS, non-responsive to highly active antiretroviral therapy and with a similar immunological profile as noted before highly active antiretroviral therapy era. These findings have implications for the management of the disease and confirm the magnitude of rational periodic screening after diagnosis of AIDS.

  18. Non-allergic rhinitis: Position paper of the European Academy of Allergy and Clinical Immunology.

    Science.gov (United States)

    Hellings, P W; Klimek, L; Cingi, C; Agache, I; Akdis, C; Bachert, C; Bousquet, J; Demoly, P; Gevaert, P; Hox, V; Hupin, C; Kalogjera, L; Manole, F; Mösges, R; Mullol, J; Muluk, N B; Muraro, A; Papadopoulos, N; Pawankar, R; Rondon, C; Rundenko, M; Seys, S F; Toskala, E; Van Gerven, L; Zhang, L; Zhang, N; Fokkens, W J

    2017-11-01

    This EAACI position paper aims at providing a state-of-the-art overview on nonallergic rhinitis (NAR). A significant number of patients suffering from persistent rhinitis are defined as nonallergic noninfectious rhinitis (NANIR) patients, often denominated in short as having NAR. NAR is defined as a symptomatic inflammation of the nasal mucosa with the presence of a minimum of two nasal symptoms such as nasal obstruction, rhinorrhea, sneezing, and/or itchy nose, without clinical evidence of endonasal infection and without systemic signs of sensitization to inhalant allergens. Symptoms of NAR may have a wide range of severity and be either continuously present and/or induced by exposure to unspecific triggers, also called nasal hyperresponsiveness (NHR). NHR represents a clinical feature of both AR and NAR patients. NAR involves different subgroups: drug-induced rhinitis, (nonallergic) occupational rhinitis, hormonal rhinitis (including pregnancy rhinitis), gustatory rhinitis, senile rhinitis, and idiopathic rhinitis (IR). NAR should be distinguished from those rhinitis patients with an allergic reaction confined to the nasal mucosa, also called "entopy" or local allergic rhinitis (LAR). We here provide an overview of the current consensus on phenotypes of NAR, recommendations for diagnosis, a treatment algorithm, and defining the unmet needs in this neglected area of research. © 2017 EAACI and John Wiley and Sons A/S. Published by John Wiley and Sons Ltd.

  19. Rare Cancers Europe (RCE) methodological recommendations for clinical studies in rare cancers: a European consensus position paper.

    Science.gov (United States)

    Casali, P G; Bruzzi, P; Bogaerts, J; Blay, J-Y

    2015-02-01

    While they account for one-fifth of new cancer cases, rare cancers are difficult to study. A higher than average degree of uncertainty should be accommodated for clinical as well as for population-based decision making. Rules of rational decision making in conditions of uncertainty should be rigorously followed and would need widely informative clinical trials. In principle, any piece of new evidence would need to be exploited in rare cancers. Methodologies to explicitly weigh and combine all the available evidence should be refined, and the Bayesian logic can be instrumental to this end. Likewise, Bayesian-design trials may help optimize the low number of patients liable to be enrolled in clinical studies on rare cancers, as well as adaptive trials in general, with their inherent potential of flexibility when properly applied. While clinical studies are the mainstay to test hypotheses, the potential of electronic patient records should be exploited to generate new hypotheses, to create external controls for future studies (when internal controls are unpractical), to study effectiveness of new treatments in real conditions. Framework study protocols in specific rare cancers to sequentially test sets of new agents, as from the early post-phase I development stage, should be encouraged. Also the compassionate and the off-label settings should be exploited to generate new evidence, and flexible regulatory innovations such as adaptive licensing could convey new agents early to rare cancer patients, while generating evidence. Though validation of surrogate end points is problematic in rare cancers, the use of an updated notion of tumor response may be of great value in the single patient to optimize the use of therapies, all the more the new ones. Disease-based communities, involving clinicians and patients, should be regularly consulted by regulatory bodies when setting their policies on drug approval and reimbursement in specific rare cancers. © The Author 2014

  20. Revised guidelines for the clinical management of Lynch syndrome (HNPCC): recommendations by a group of European experts.

    Science.gov (United States)

    Vasen, Hans F A; Blanco, Ignacio; Aktan-Collan, Katja; Gopie, Jessica P; Alonso, Angel; Aretz, Stefan; Bernstein, Inge; Bertario, Lucio; Burn, John; Capella, Gabriel; Colas, Chrystelle; Engel, Christoph; Frayling, Ian M; Genuardi, Maurizio; Heinimann, Karl; Hes, Frederik J; Hodgson, Shirley V; Karagiannis, John A; Lalloo, Fiona; Lindblom, Annika; Mecklin, Jukka-Pekka; Møller, Pal; Myrhoj, Torben; Nagengast, Fokko M; Parc, Yann; Ponz de Leon, Maurizio; Renkonen-Sinisalo, Laura; Sampson, Julian R; Stormorken, Astrid; Sijmons, Rolf H; Tejpar, Sabine; Thomas, Huw J W; Rahner, Nils; Wijnen, Juul T; Järvinen, Heikki Juhani; Möslein, Gabriela

    2013-06-01

    Lynch syndrome (LS) is characterised by the development of colorectal cancer, endometrial cancer and various other cancers, and is caused by a mutation in one of the mismatch repair genes: MLH1, MSH2, MSH6 or PMS2. In 2007, a group of European experts (the Mallorca group) published guidelines for the clinical management of LS. Since then substantial new information has become available necessitating an update of the guidelines. In 2011 and 2012 workshops were organised in Palma de Mallorca. A total of 35 specialists from 13 countries participated in the meetings. The first step was to formulate important clinical questions. Then a systematic literature search was performed using the Pubmed database and manual searches of relevant articles. During the workshops the outcome of the literature search was discussed in detail. The guidelines described in this paper may be helpful for the appropriate management of families with LS. Prospective controlled studies should be undertaken to improve further the care of these families.

  1. Revised guidelines for the clinical management of Lynch syndrome (HNPCC): recommendations by a group of European experts

    Science.gov (United States)

    Vasen, Hans F A; Blanco, Ignacio; Aktan-Collan, Katja; Gopie, Jessica P; Alonso, Angel; Aretz, Stefan; Bernstein, Inge; Bertario, Lucio; Burn, John; Capella, Gabriel; Colas, Chrystelle; Engel, Christoph; Frayling, Ian M; Genuardi, Maurizio; Heinimann, Karl; Hes, Frederik J; Hodgson, Shirley V; Karagiannis, John A; Lalloo, Fiona; Lindblom, Annika; Mecklin, Jukka-Pekka; Møller, Pal; Myrhoj, Torben; Nagengast, Fokko M; Parc, Yann; Ponz de Leon, Maurizio; Renkonen-Sinisalo, Laura; Sampson, Julian R; Stormorken, Astrid; Sijmons, Rolf H; Tejpar, Sabine; Thomas, Huw J W; Rahner, Nils; Wijnen, Juul T; Järvinen, Heikki Juhani; Möslein, Gabriela

    2013-01-01

    Lynch syndrome (LS) is characterised by the development of colorectal cancer, endometrial cancer and various other cancers, and is caused by a mutation in one of the mismatch repair genes: MLH1, MSH2, MSH6 or PMS2. In 2007, a group of European experts (the Mallorca group) published guidelines for the clinical management of LS. Since then substantial new information has become available necessitating an update of the guidelines. In 2011 and 2012 workshops were organised in Palma de Mallorca. A total of 35 specialists from 13 countries participated in the meetings. The first step was to formulate important clinical questions. Then a systematic literature search was performed using the Pubmed database and manual searches of relevant articles. During the workshops the outcome of the literature search was discussed in detail. The guidelines described in this paper may be helpful for the appropriate management of families with LS. Prospective controlled studies should be undertaken to improve further the care of these families. PMID:23408351

  2. European recommendations for the clinical use of HIV drug resistance testing: 2011 update

    DEFF Research Database (Denmark)

    Vandamme, Anne-Mieke; Camacho, Ricardo J; Ceccherini-Silberstein, Francesca

    2011-01-01

    the following recommendations concerning the indications for resistance testing: for HIV-1 (i) test earliest sample for protease and reverse transcriptase drug resistance in drug-naive patients with acute or chronic infection; (ii) test protease and reverse transcriptase drug resistance at virologic failure......) consider testing earliest detectable plasma RNA when a successful nonnucleoside reverse transcriptase inhibitor-containing therapy was inappropriately interrupted; (v) genotype source patient when postexposure prophylaxis is considered; for HIV-2, (vi) consider resistance testing where treatment change...... is needed after treatment failure. The Panel recommends genotyping in most situations, using updated and clinically evaluated interpretation systems. It is mandatory that laboratories performing HIV resistance tests take part regularly in external quality assurance programs, and that they consider storing...

  3. Introduction to a Special Issue of the Journal of Immunological Methods: Building global resource programs to support HIV/AIDS clinical trial studies.

    Science.gov (United States)

    Sanchez, Ana M; Denny, Thomas N; O'Gorman, Maurice

    2014-07-01

    This Special Issue of the Journal of Immunological Methods includes 16 manuscripts describing quality assurance activities related to virologic and immunologic monitoring of six global laboratory resource programs that support international HIV/AIDS clinical trial studies: Collaboration for AIDS Vaccine Discovery (CAVD); Center for HIV/AIDS Vaccine Immunology (CHAVI); External Quality Assurance Program Oversight Laboratory (EQAPOL); HIV Vaccine Trial Network (HVTN); International AIDS Vaccine Initiative (IAVI); and Immunology Quality Assessment (IQA). The reports from these programs address the many components required to develop comprehensive quality control activities and subsequent quality assurance programs for immune monitoring in global clinical trials including: all aspects of processing, storing, and quality assessment of PBMC preparations used ubiquitously in HIV clinical trials, the development and optimization of assays for CD8 HIV responses and HIV neutralization, a comprehensive global HIV virus repository, and reports on the development and execution of novel external proficiency testing programs for immunophenotyping, intracellular cytokine staining, ELISPOT and luminex based cytokine measurements. In addition, there are articles describing the implementation of Good Clinical Laboratory Practices (GCLP) in a large quality assurance laboratory, the development of statistical methods specific for external proficiency testing assessment, a discussion on the ability to set objective thresholds for measuring rare events by flow cytometry, and finally, a manuscript which addresses a framework for the structured reporting of T cell immune function based assays. It is anticipated that this series of manuscripts covering a wide range of quality assurance activities associated with the conduct of global clinical trials will provide a resource for individuals and programs involved in improving the harmonization, standardization, accuracy, and sensitivity of

  4. Utility of clinical assessment, imaging, and cryptococcal antigen titer to predict AIDS-related complicated forms of cryptococcal meningitis

    Directory of Open Access Journals (Sweden)

    Kandel Sean

    2010-08-01

    Full Text Available Abstract Background This study aimed to evaluate the prevalence and predictors of AIDS-related complicated cryptococcal meningitis. The outcome was complicated cryptococcal meningitis: prolonged (≥ 14 days altered mental status, persistent (≥ 14 days focal neurologic findings, cerebrospinal fluid (CSF shunt placement or death. Predictor variable operating characteristics were estimated using receiver operating characteristic curve (ROC analysis. Multivariate analysis identified independent predictors of the outcome. Results From 1990-2009, 82 patients with first episode of cryptococcal meningitis were identified. Of these, 14 (17% met criteria for complicated forms of cryptococcal meningitis (prolonged altered mental status 6, persistent focal neurologic findings 7, CSF surgical shunt placement 8, and death 5. Patients with complicated cryptococcal meningitis had higher frequency of baseline focal neurological findings, head computed tomography (CT abnormalities, mean CSF opening pressure, and cryptococcal antigen (CRAG titers in serum and CSF. ROC area of log2 serum and CSF CRAG titers to predict complicated forms of cryptococcal meningitis were comparable, 0.78 (95%CI: 0.66 to 0.90 vs. 0.78 (95% CI: 0.67 to 0.89, respectively (χ2, p = 0.95. The ROC areas to predict the outcomes were similar for CSF pressure and CSF CRAG titers. In a multiple logistic regression model, the following were significant predictors of the outcome: baseline focal neurologic findings, head CT abnormalities and log2 CSF CRAG titer. Conclusions During initial clinical evaluation, a focal neurologic exam, abnormal head CT and large cryptococcal burden measured by CRAG titer are associated with the outcome of complicated cryptococcal meningitis following 2 weeks from antifungal therapy initiation.

  5. ‘PICO-D Management’; a decision-aid for evidence-based chiropractic education and clinical practice

    National Research Council Canada - National Science Library

    Amorin-Woods, Lyndon G; Losco, Barrett E

    2016-01-01

    .... Results "PICO-D Man" (Patient-Intervention-Comparator-Outcome-Duration Management) is a decision-aid developed in an educational setting which field practitioners may also find useful for applying defensible evidence-based practice...

  6. [The common position of the Czech professional associations on the consensus of the European Atherosclerosis Society and the European Federation of Clinical Chemistry and Laboratory Medicine regarding investigation on blood lipids and interpretation of their levels].

    Science.gov (United States)

    Soška, Vladimír; Franeková, Janka; Friedecký, Bedřich; Jabor, Antonín; Kraml, Pavel; Rosolová, Hana; Vrablík, Michal

    The aim of this opinion is to summarize and to comment the consensus of the European Atherosclerosis Society and European Federation of Clinical Chemistry and Laboratory Medicine, which covers two main areas: 1) whether it is necessary / required to be fasting or non-fasting before blood sampling for lipids measurement, and what are the changes in the concentration of blood lipids during the day; 2) What decision limits (cut off value) of lipids and lipoproteins should be reported from laboratories and what is the recommended procedure for people with extreme / critical blood lipid values. Following parameters are discused: total cholesterol, LDL cholesterol, HDL cholesterol, non-HDL cholesterol, triglycerides, apolipoprotein A1, apolipoprotein B, lipoprotein(a). This opinion should be the object of interest both for professionals in clinical laboratories and for physicians in hospitals and out-patients departments.Key words: apolipoproteins - blood collection - cholesterol - laboratory testing - lipoprotein(a) - cut off limits - triglycerides.

  7. Clinical microbiology and infectious diseases - 11th European Congress. 1-4 April 2001, Istanbul, Turkey.

    Science.gov (United States)

    Akova, M

    2001-07-01

    This report covers the four different sessions of the congress. All sessions included the presentation of papers about treatment of respiratory tract infections (RTIs). RTIs account for 25% of all the community-acquired infections and are the second most frequent among nosocomial infections after urinary tract infections. Recent years have witnessed a great increase in resistance to antibiotics among pathogens causing RTIs. These changes have rendered several 'classical' antibiotics less effective in this indication. The drug industry has collectively made a great effort to develop new antibiotics to overcome this resistance. In the sessions described below, four different antibiotics were reviewed for their efficacy in RTIs. A relatively 'older' group comprising a beta-lactam and beta-lactamase-inhibitor combination was presented for use both in community and hospital settings. Two different quinolone antibiotics, levofloxacin (Daiichi Seiyaku) and moxifloxacin (Bayer), were the focus of another two sessions. In an era of penicillin resistance in Streptococcus pneumoniae and increasing importance of atypical organisms causing RTIs, the new fluoroquinolone derivatives have become critical agents. These new compounds are proving capable not only of eradicating troublesome pathogens, but also achieving this faster than any other drug. Finally, a new class of antibiotics, namely ketolides, was presented as a novel addition to the macrolide-lincosamide-streptogramin group. In vitro experiments and clinical experiments with telithromycin (Aventis Pharma), the first ketolide antimicrobial, were reported. All these presentations demonstrated telithromycin's potent activity against key respiratory pathogens, including resistant strains.

  8. Preventive health care among HIV positive women in a Utah HIV/AIDS clinic: a retrospective cohort study

    Science.gov (United States)

    2014-01-01

    Background Despite evidence that HIV positive women may suffer higher rates of heart disease, diabetes, human papillomavirus infection, and some types of cancer, the provision of preventive health services to HIV positive women is unknown. Preventive health services recommended for such women include breast, colorectal and cervical cancer screening, sexually transmitted infection (STI) testing, vaccinations, and patient counseling on a number of issues including sexual behaviors. Methods This retrospective cohort study utilized medical record reviews of 192 HIV positive women who were patients at the University of Utah Infectious Diseases Clinic in 2009. Medical records were reviewed for all encounters during 2009 using a standardized data collection form; data were collected on patient demographics and a variety of preventive health services. Chi squared tests were used to assess receipt of preventive health services by demographic factors, and multivariable logistic regression was used to determine predictors of receiving select services. Results The most commonly recorded preventive services included blood pressure screening, screening for Hepatitis A and B, Tetanus-Diphtheria-Pertussis vaccination, Pneumococcal pneumonia vaccination, substance abuse screening, and mental health screening. STI testing and safe sex counseling were documented in the medical records of only 37% and 33.9% of women, respectively. Documentation of cancer screening was also low, with cervical cancer screening documented for 56.8% of women, mammography for 65% (N = 26/40) of women, and colorectal cancer screening for 10% (N = 4/40) of women, where indicated. In multivariable models, women with private health insurance were less likely to have documented STI testing (OR 0.20; 95% CI 0.08 - 0.52), and, Hispanic women were less likely to have documented safe-sex counseling (OR 0.26; 95% CI 0.07 - 0.94). Conclusions HIV/AIDS providers should focus on the needs of all women for

  9. The Clinical Usefulness of Ultrasound-Aided Fixation Using an Absorbable Plate System in Patients with Zygomatico-Maxillary Fracture

    Directory of Open Access Journals (Sweden)

    Jong Hun Lee

    2013-07-01

    Full Text Available Background  Ultrasound-aided fixation is a recently developed alternative method of treatment of zygomatico-maxillary (ZM fracture, and it can resolve the problems of excessivetorsion force and subsequent fractures of screws. We conducted this study to evaluate theclinical usefulness of ultrasound-aided fixation as compared with the conventional fixationmethod using a drill and an expanderin patientswith ZMfracture.Methods  We conducted a retrospective study in 35 patientswith ZMfracturewho had beentreated at our hospital during a period ranging fromMarch of 2008 toDecember of 2010. Wedivided them into two groups: an ultrasound-aided fixation group, comprising 13 patientswho underwent ultrasound-aided fixation (SonicWeld Rx, KLS Martin, and a conventionalgroup, comprising 22 patients who underwent conventional fixation (Biosorb FX, LinvatecBiomaterials Ltd.. We compared such variables as sex, direction, age at operation, follow-upperiod, operation duration, number of fixed holes, and time to discharge between the twogroups.Results  The ultrasound-aided fixation reduced the operation duration by about 30 minutesas comparedwith that of conventional fixation. Therewas no significant difference in followup period, number of fixed holes, ortime to discharge between the two groups. Furthermore,therewere no complicationsin either group.Conclusions  The ultrasound-aided fixation offractured ZMbone using an absorbable implantsystemissafe and effective in promptly reducing the bone fracture and providing satisfactorycosmetic outcomes overtime.

  10. Student′s preference of various audiovisual aids used in teaching pre- and para-clinical areas of medicine

    Directory of Open Access Journals (Sweden)

    Navatha Vangala

    2015-01-01

    Full Text Available Introduction: The formal lecture is among the oldest teaching methods that have been widely used in medical education. Delivering a lecture is made easy and better by use of audiovisual aids (AV aids such as blackboard or whiteboard, an overhead projector, and PowerPoint presentation (PPT. Objective: To know the students preference of various AV aids and their use in medical education with an aim to improve their use in didactic lectures. Materials and Methods: The study was carried out among 230 undergraduate medical students of first and second M.B.B.S studying at Malla Reddy Medical College for Women, Hyderabad, Telangana, India during the month of November 2014. Students were asked to answer a questionnaire on the use of AV aids for various aspects of learning. Results: This study indicates that students preferred PPT, the most for a didactic lecture, for better perception of diagrams and flowcharts. Ninety-five percent of the students (first and second M.B.B.S were stimulated for further reading if they attended a lecture augmented by the use of visual aids. Teacher with good teaching skills and AV aids (58% was preferred most than a teacher with only good teaching skills (42%. Conclusion: Our study demonstrates that lecture delivered using PPT was more appreciated and preferred by the students. Furthermore, teachers with a proper lesson plan, good interactive and communicating skills are needed for an effective presentation of lecture.

  11. Daptomycin for the treatment of osteomyelitis and orthopaedic device infections: real-world clinical experience from a European registry.

    Science.gov (United States)

    Malizos, K; Sarma, J; Seaton, R A; Militz, M; Menichetti, F; Riccio, G; Gaudias, J; Trostmann, U; Pathan, R; Hamed, K

    2016-01-01

    Osteomyelitis is a serious infection predominantly caused by Gram-positive bacteria, including methicillin-resistant Staphylococcus aureus (MRSA). Orthopaedic device-related infections are complex and require a careful combination of surgical intervention and antimicrobial therapy. Daptomycin, a cyclic lipopeptide, effectively penetrates soft tissue and bone and demonstrates rapid concentration-dependent bactericidal activity against Gram-positive pathogens. This retrospective, non-interventional study evaluated clinical outcomes in patients with osteomyelitis or orthopaedic device infections treated with daptomycin from the European Cubicin® Outcomes Registry and Experience (EU-CORE(SM)) study. Patients were treated between January 2006 and April 2012, with follow-up to 2014. Clinical outcomes were assessed as success (cured or improved), failure or non-evaluable. Of 6,075 patients enrolled, 638 (median age, 63.5 years) had primary infections of osteomyelitis or orthopaedic device infections, 224 had non-prosthetic osteomyelitis, 208 had osteomyelitis related to a permanent or temporary prosthetic device, and 206 had orthopaedic device infections. The most commonly isolated pathogen was S. aureus (214 [49.1 %]; 24.8 % were MRSA). Overall, 455 (71.3 %) patients had received previous antibiotic therapy. Patients underwent surgical interventions, including tissue (225 [35.3 %]) and bone (196 [30.7 %]) debridement, as part of their treatment. Clinical success rates were 82.7 % and 81.7 % in S. aureus and coagulase-negative staphylococcal infections. Adverse events (AEs) and serious AEs assessed as possibly related to daptomycin were observed in 6.7 % and 1.9 % of patients, respectively. Daptomycin was discontinued by 5.5 % of patients due to AEs and 10 (1.6 %) deaths were reported. In conclusion, daptomycin was effective and safe in patients with osteomyelitis or orthopaedic device infections.

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

    DEFF Research Database (Denmark)

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

    2016-01-01

    Patient safety is a leading challenge in healthcare and from the laboratory perspective it is now well established that preanalytical errors are the major contributor to the overall rate of diagnostic and therapeutic errors. To address this, the European Federation of Clinical Chemistry...

  13. Determinants of first- and second-generation antipsychotic drug use in clinically unstable patients with schizophrenia treated in four European countries

    NARCIS (Netherlands)

    Barbui, Corrado; Nosè, Michela; Mazzi, Maria Angela; Bindman, Jonathan; Leese, Morven; Schene, Aart; Becker, Thomas; Angermeyer, Matthias C.; Koeter, Maarten; Gray, Richard; Tansella, Michele

    2006-01-01

    The present study investigated the use of antipsychotics in a sample of clinically unstable patients with schizophrenia who were recruited in four European sites. The study aimed: (i) to test whether the length of previous antipsychotic exposure was associated with the choice of antipsychotic

  14. Hotlines and clinical trial updates presented at the European Society of Cardiology Meeting 2009: data from RE-LY, PLATO, MADIT-CRT, PROTECT, SYNTAX, TRITON and more

    NARCIS (Netherlands)

    Schirmer, S. H.; van der Laan, A. M.; Böhm, M.; Mahfoud, F.

    2009-01-01

    This summary article provides an update on novel clinical trials in the field of cardiovascular (CV) medicine which were presented at the annual meeting of the European Cardiac Society, held in Barcelona, Spain, in August-September 2009. The data were presented by leading experts in the field with

  15. Five-year results of a prospective randomised controlled clinical trial of posterior computer-aided design-computer-aided manufacturing ZrSiO4 -ceramic crowns.

    Science.gov (United States)

    Passia, N; Stampf, S; Strub, J R

    2013-08-01

    The aim of this prospective randomised controlled clinical trial was to evaluate the clinical outcome of shrinkage-free ZrSiO4 -ceramic full-coverage crowns on premolars and molars in comparison with conventional gold crowns over a 5-year period. Two hundred and twenty-three patients were included and randomly divided into two treatment groups. One hundred and twenty-three patients were restored with 123 ZrSiO4 -ceramic crowns, and 100 patients received 100 gold crowns, which served as the control. All crowns were conventionally cemented with glass-ionomer cement. After an observation period of 6, 12, 24, 36, 48 and 60 months, the survival probability (Kaplan-Meier) for the shrinkage-free ZrSiO4 -ceramic crowns was 98·3%, 92·0%, 84·7%, 79% and 73·2% and for the gold crowns, 99%, 97·9%, 95·7%, 94·6% and 92·3%, respectively. The difference between the test and control group was statistically significant (P = 0·0027). The gold crowns showed a better marginal integrity with less marginal discoloration than the ceramic crowns. The most common failure in the ceramic crown group was fracture of the crown. The 60-month results of this prospective randomised controlled clinical trial suggest that the use of these shrinkage-free ZrSiO4 -ceramic crowns in posterior tooth restorations cannot be recommended. © 2013 John Wiley & Sons Ltd.

  16. Computer-aided diagnosis system for bone scintigrams from Japanese patients: importance of training database

    DEFF Research Database (Denmark)

    Horikoshi, Hiroyuki; Kikuchi, Akihiro; Onoguchi, Masahisa

    2012-01-01

    Computer-aided diagnosis (CAD) software for bone scintigrams have recently been introduced as a clinical quality assurance tool. The purpose of this study was to compare the diagnostic accuracy of two CAD systems, one based on a European and one on a Japanese training database, in a group of bone...

  17. The effect of treatment with zidovudine with or without acyclovir on HIV p24 antigenaemia in patients with AIDS or AIDS-related complex

    DEFF Research Database (Denmark)

    Pedersen, C; Cooper, D A; Brun-Vézinet, F

    1992-01-01

    . SUBJECTS: One hundred and ninety-seven HIV-infected patients (60 with AIDS and 137 with ARC or KS). MAIN OUTCOME MEASURES: Serum HIV p24-antigen levels measured using the Abbott HIV solid-phase enzyme immunoassay. RESULTS: Of 76 ARC/KS patients who were initially HIV p24-antigen-positive, one out of 25......OBJECTIVE: To evaluate changes in serum HIV p24-antigen levels in a subset of patients who participated in a European/Australian double-blind, placebo-controlled trial evaluating the efficacy of zidovudine (250 mg every 6 h) alone or in combination with acyclovir (800 mg every 6 h) in patients...... with AIDS, AIDS-related complex (ARC) or Kaposi's sarcoma (KS). DESIGN: Double-blind, placebo-controlled randomized clinical trial of less than or equal to 6 months' therapy. SETTING: Samples were obtained from patients attending teaching hospital outpatient clinics in seven European countries and Australia...

  18. Immunity against HIV/AIDS, malaria, and tuberculosis during co-infections with neglected infectious diseases: recommendations for the European Union research priorities.

    Directory of Open Access Journals (Sweden)

    Diana Boraschi

    2008-06-01

    Full Text Available Infectious diseases remain a major health and socioeconomic problem in many low-income countries, particularly in sub-Saharan Africa. For many years, the three most devastating diseases, HIV/AIDS, malaria, and tuberculosis (TB have received most of the world's attention. However, in rural and impoverished urban areas, a number of infectious diseases remain neglected and cause massive suffering. It has been calculated that a group of 13 neglected infectious diseases affects over one billion people, corresponding to a sixth of the world's population. These diseases include infections with different types of worms and parasites, cholera, and sleeping sickness, and can cause significant mortality and severe disabilities in low-income countries. For most of these diseases, vaccines are either not available, poorly effective, or too expensive. Moreover, these neglected diseases often occur in individuals who are also affected by HIV/AIDS, malaria, or TB, making the problem even more serious and indicating that co-infections are the rule rather than the exception in many geographical areas. To address the importance of combating co-infections, scientists from 14 different countries in Africa and Europe met in Addis Ababa, Ethiopia, on September 9-11, 2007. The message coming from these scientists is that the only possibility for winning the fight against infections in low-income countries is by studying, in the most global way possible, the complex interaction between different infections and conditions of malnourishment. The new scientific and technical tools of the post-genomic era can allow us to reach this goal. However, a concomitant effort in improving education and social conditions will be needed to make the scientific findings effective.

  19. One hundred years of allergen immunotherapy European Academy of Allergy and Clinical Immunology celebration: review of unanswered questions.

    Science.gov (United States)

    Calderón, M; Cardona, V; Demoly, P

    2012-04-01

    Allergen immunotherapy was introduced by Leonard Noon 100 years ago and is the only disease-modifying treatment for allergic individuals. Improved understanding of immunology has taught us a great deal about the underlying mechanisms involved in allergen immunotherapy; however, despite these developments, a number of important questions remain unanswered. Several of these questions relate to the practice of allergen immunotherapy in the clinic, such as: Is it possible to unify units of allergen potency? Which treatment schedules are best? Is allergen immunotherapy effective in all patient groups? Is there a dose-response relationship for efficacy and safety?, and Is there evidence for long-term effects following allergen immunotherapy? Others are related to new developments, such as new indications, or developments in the production of allergens. On the centenary of Noon's discovery, European experts in the field of immunotherapy met in Geneva under the aegis of the EAACI to discuss these controversial issues. This study presents outcomes and conclusions from these discussions. © 2012 John Wiley & Sons A/S.

  20. Trends in clinical hemapheresis 1986. Progress report on the 4th annual meeting of the European Society for Hemapheresis.

    Science.gov (United States)

    Nydegger, U E; Vaudaux, P; Castelli, D

    1987-09-01

    After a rather long initial period fraught with difficulties, plasma exchange has become an adjunct to the treatment of numerous diseases, such as hyperviscosity syndrome, where it alleviates disease symptoms, hemophilia due to inhibitors to clotting factor VIII, thrombotic thrombocytopenic purpura, rapidly progressing and Goodpasture glomerulonephritis, myasthenia gravis and Guillain Barré syndrome. In addition, plateletpheresis has also grown from being a procedure of experimental clinical application to one of practical routine importance; at the Berne University Hospital, approximately 25% of all transfused platelets in 1986 were apheresis platelets, a proportion that elsewhere may reach 40%. Despite the successes so far obtained with apheresis, many aspects of this therapy remain to be reconsidered. Improvement of donor-recipient matching and of yield in plateletpheresis, better selection of replacement fluids, and increased donor and patient safety and comfort may further strengthen the value of apheresis in therapeutic protocols. This was the major background for the scientific program of the 4th Annual Meeting of the European Society for Hemapheresis that was assembled to shed light on those aspects of the apheresis field which are still unclear. A total of 31 lectures and 76 individual contributions were debated by 280 participants from Europe and overseas. The present essay is a review of the highlights of this meeting, the main lectures of which were published in Plasma Therapy and Transfusion Technology, vol. 7, 1986.

  1. The 10th anniversary of the Junior Members and Affiliates of the European Academy of Allergy and Clinical Immunology.

    Science.gov (United States)

    Skevaki, Chrysanthi L; Maggina, Paraskevi; Santos, Alexandra F; Rodrigues-Alves, Rodrigo; Antolin-Amerigo, Dario; Borrego, Luis Miguel; Bretschneider, Isabell; Butiene, Indre; Couto, Mariana; Fassio, Filippo; Gardner, James; Xatzipsalti, Maria; Hovhannisyan, Lilit; Hox, Valerie; Makrinioti, Heidi; O Neil, Serena E; Pala, Gianni; Rudenko, Michael; Santucci, Annalisa; Seys, Sven; Sokolowska, Milena; Whitaker, Paul; Heffler, Enrico

    2011-12-01

    This year is the 10th anniversary of the European Academy of Allergy and Clinical Immunology (EAACI) Junior Members and Affiliates (JMAs). The aim of this review is to highlight the work and activities of EAACI JMAs. To this end, we have summarized all the initiatives taken by JMAs during the last 10 yr. EAACI JMAs are currently a group of over 2380 clinicians and scientists under the age of 35 yr, who support the continuous education of the Academy's younger members. For the past decade, JMAs enjoy a steadily increasing number of benefits such as free online access to the Academy's journals, the possibility to apply for Fellowships and the Mentorship Program, travel grants to attend scientific meetings, and many more. In addition, JMAs have been involved in task forces, cooperation schemes with other scientific bodies, organization of JMA focused sessions during EAACI meetings, and participation in the activities of EAACI communication platforms. EAACI JMA activities represent an ideal example of recruiting, training, and educating young scientists in order for them to thrive as future experts in their field. This model may serve as a prototype for other scientific communities, several of which have already adapted similar policies. © 2011 John Wiley & Sons A/S.

  2. On the acquisition of liquids in European Portuguese: empirical contributions for the identification of clinical markers in phonological disorders

    Directory of Open Access Journals (Sweden)

    Ana Margarida Ramalho

    2017-08-01

    Full Text Available Little is known on the phonological constituents in the grammar of children with phonological disorders. The few results available in the literature come from studies implementing nonword repetition tasks. In this paper, we used an assessment test built on the basis of the non-linear phonological approach (the CLCP – PE to analyse the impact of the variables syllable constituency, word stress, word position and word length in the production of two of the most problematic root nodes in the phonological development of Portuguese children: /l/ and /ɾ/. Production data from Portuguese children with typical and atypical phonological development (SLI and SSD will be compared, in order to contribute for the discussion on the use of /l/ and /ɾ/ in different prosodic positions as potential clinical markers in European Portuguese. The results reported in this paper show robust effects for all tested phonological variables in the typically developing children and the effect of syllable constituency, word position and word length in the atypically developing children, with no effect of word stress in the later. ---DOI: http://dx.doi.org/10.12957/matraga.2017.28714

  3. Clinical trials and systematic reviews addressing similar interventions for the same condition do not consider similar outcomes to be important: a case study in HIV/AIDS.

    Science.gov (United States)

    Saldanha, Ian J; Li, Tianjing; Yang, Cui; Owczarzak, Jill; Williamson, Paula R; Dickersin, Kay

    2017-04-01

    The usefulness of clinical trials and systematic reviews is compromised when they report different outcomes. We compared outcomes in reviews of HIV/AIDS and the trials included in the reviews. We examined all Cochrane reviews of HIV/AIDS (as of June 2013) that included ≥1 trial and the trials that the reviews included. We compared outcomes within subgroups defined by type of intervention: clinical management, biomedical prevention, behavioral prevention, and health services. We included 84 reviews that encompassed 524 trials. Although the median number of outcomes per trial (8) and per review (7.5) was similar, the trials reported a considerably greater number of unique outcomes than the reviews (779 vs. 218), ranging from 2.3 times greater (clinical management) to 5.4 times greater (behavioral prevention). High proportions of trial outcomes were not in any review: 68% (clinical management) to 83% (behavioral prevention). Lower proportions of review outcomes were not in any trial: 11% (clinical management) to 39% (health services). Outcomes in trials and reviews are not well aligned for appropriate inclusion of trial results in reviews and meta-analyses. Differences in perspectives, goals, and constraints between trialists and reviewers may explain differences in outcomes they consider important. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

  4. A European multicenter randomized double-blind placebo-controlled monotherapy clinical trial of milnacipran in treatment of fibromyalgia

    DEFF Research Database (Denmark)

    Branco, Jaime C; Zachrisson, Olof; Perrot, Serge

    2010-01-01

    This randomized, double-blind, placebo-controlled, multicenter study investigated the efficacy and safety of milnacipran in the treatment of fibromyalgia (FM) in a European population.......This randomized, double-blind, placebo-controlled, multicenter study investigated the efficacy and safety of milnacipran in the treatment of fibromyalgia (FM) in a European population....

  5. A Randomized Controlled Trial of a Mobile Clinical Decision Aid to Improve Access to Kidney Transplantation: iChoose Kidney

    Directory of Open Access Journals (Sweden)

    Rachel E. Patzer

    2016-05-01

    Discussion: Engaging patients in health care choices can increase patient empowerment and improve knowledge and understanding of treatment choices. If the effectiveness of iChoose Kidney has a greater impact on patients with low health literacy, lower socioeconomic status, and minority race, this decision aid could help reduce disparities in access to kidney transplantation.

  6. American College of Rheumatology/European League against Rheumatism Preliminary Definition of Remission in Rheumatoid Arthritis for Clinical Trials

    Science.gov (United States)

    Felson, David T.; Smolen, Josef S.; Wells, George; Zhang, Bin; van Tuyl, Lilian H. D.; Funovits, Julia; Aletaha, Daniel; Allaart, Renée; Bathon, Joan; Bombardieri, Stefano; Brooks, Peter; Brown, Andrew; Matucci-Cerinic, Marco; Choi, Hyon; Combe, Bernard; de Wit, Maarten; Dougados, Maxime; Emery, Paul; Furst, Dan; Gomez-Reino, Juan; Hawker , Gillian; Keystone, Edward; Khanna, Dinesh; Kirwan, John; Kvien, Tore; Landewé, Robert; Listing, Joachim; Michaud, Kaleb; Mola, Emilio Martin; Montie, Pam; Pincus, Ted; Richards, Pam; Siegel, Jeff; Simon, Lee; Sokka, Tuulikki; Strand, Vibeke; Tugwell, Peter; Tyndall, Alan; van der Heijde, Desirée; Verstappen, Suzan; White, Barbara; Wolfe, Fred; Zink, Angela; Boers, Maarten

    2010-01-01

    Background With remission in rheumatoid arthritis (RA) an increasingly attainable goal, there is no widely used definition of remission that is stringent but achievable and could be applied uniformly as an outcome in clinical trials. Methods A committee consisting of members of the American College of Rheumatology, the European League Against Rheumatism and the Outcome Measures in Rheumatology Initiative (OMERACT) met to guide the process and review prespecified analyses from clinical trials of patients with RA. The committee requested a stringent definition (little, if any, active disease) and decided to use core set measures to define remission including at least joint counts and an acute phase reactant. Members were surveyed to select the level of each core set measure consistent with remission. Candidate definitions of remission were tested including those that constituted a number of individual measures in remission (Boolean approach) as well as definitions using disease activity indexes. To select a definition of remission, trial data were analyzed to examine the added contribution of patient reported outcomes and the ability of candidate measures to predict later good x-ray and functional outcomes. Results Survey results for the definition of remission pointed to indexes at published thresholds and to a count of core set measures with each measure scored as 1 or less (e.g. tender and swollen joint counts, CRP and global assessments on 0-10 scale). Analyses suggested the need to include a patient reported measure. Examination of 2 year follow-up data suggested that many candidate definitions performed comparably in terms of predicting later good x-ray and functional outcomes, although DAS28 based measures of remission did not predict good radiographic outcomes as well as did the other candidate definitions. Given these and other considerations, we propose that a patient be defined as in remission based on one of two definitions : 1: When their scores on the

  7. Social factors and lifestyle attributes associated with nutritional status of people living with HIV/AIDS attending care and treatment clinics in Ilala District, Dar Es Salaam.

    Science.gov (United States)

    Ritte, S A; Kessy, A T

    2012-03-01

    Tanzania is one of the countries that suffer huge burden of malnutrition and food poverty with over two million people living with HIV/AIDS. Despite ongoing nutritional interventions in care and treatment clinics for people living with HIV/AIDS (PLWHA), a high proportion of them still face nutritional problems, with about 29% being underweight. This study therefore aimed assessing social factors and lifestyle attributes associated with nutritional status among adults living with HIV/AIDS and attending care and treatment clinics (CTCs) in an urban district in Tanzania. An interview schedule was administered to 412 randomly selected adult male and female clients attending different CTCs in Ilala district. Their anthropometric measurements i.e. body weights and heights were also taken. Findings revealed that 18.4% of males and females were underweight according to their body mass indices. The risk of being underweight was higher among respondents who were young; who had never married; had no formal education as well as those who reported to be living with their families or friends, although these associations were not statistically significant. On the other hand, factors which had statistically significant association with nutritional status included the type of persons the client was living with and the habit of drinking alcohol. From the findings we conclude that PLWHA attending Care and Treatment Clinics in Ilala district, Dar es Salaam have problems with their nutrition with underweight being common among them. This suggests that the existing care and treatment clinics that provide nutritional support to PLWHA do not appear to address these issues in their totality. There is therefore, need to ensure that more efforts are geared towards providing nutritional counseling, support and encouragement of these clients within social contexts of their lives so in order for the current efforts to give best results.

  8. Ethical principles and legal requirements for pediatric research in the EU: an analysis of the European normative and legal framework surrounding pediatric clinical trials.

    Science.gov (United States)

    Pinxten, Wim; Dierickx, Kris; Nys, Herman

    2009-10-01

    The involvement of minors in clinical research is inevitable to catch up with the lack of drugs labeled for pediatric use. To encourage the responsible conduct of pediatric clinical trials in the EU, an extensive legal framework has been developed over the past decade in which the practical, ethical, legal, social, and commercial issues in pediatric research are addressed. In this article, the European legal framework surrounding pediatric clinical trials is analyzed from the perspective of the major ethical concerns in pediatric research. The four principles of biomedical ethics will be used as a conceptual framework (1) to map the ethical issues addressed in the European legal framework, (2) to study how these issues are commonly handled in competent adults, (3) to detect workability problems of these paradigmatic approaches in the specific setting of pediatric research, and (4) to illustrate the strong urge to differentiate, specify, or adjust these paradigmatic approaches to guarantee their successful operation in pediatric research. In addition, a concise comparative analysis of the European regulation will be made. To conclude our analysis, we integrate our findings in the existing ethical discussions on issues specific to pediatric clinical research.

  9. Evaluation of oncology drugs at the European Medicines Agency and US Food and Drug Administration: when differences have an impact on clinical practice.

    Science.gov (United States)

    Trotta, Francesco; Leufkens, Hubert G M; Schellens, Jan H M; Laing, Richard; Tafuri, Giovanni

    2011-06-01

    The aims of this study were to compare the approaches of the European Medicines Agency (EMA) and the US Food and Drug Administration (FDA) in the evaluation and approval of new anticancer indications and to identify possible clinical implications associated with these differences. Information on the European Union therapeutic indications for the cohort of anticancer drugs was extracted from the European Public Assessment Reports and from the FDA review reports. Overall, 42 anticancer drugs were approved by EMA between 1995 and 2008, corresponding to a total of 100 indications. In 47 of 100 indications, a difference was found. For 19 of these 47 indications, the difference was that one agency approved an indication, whereas the other agency did not. For the remaining 28 indications, the same indication was approved by both of the agencies and differences were evaluated through an algorithm; in 10 cases, discrepancies in therapeutic indications between EMA and FDA were considered clinically relevant. We found an overall trend that the agency that was second to give a positive approval was usually more restrictive in terms of wording of the indication compared with the agency that provided approval first. Regarding the use and robustness of available clinical data for evaluation, no clear associations could be found. Clinically relevant differences in the outcome of the EMA and FDA approval process of oncology products were found. Neither of the agencies seems to have a prevailing restrictive behavior over the other. Further efforts on harmonizing decision making between regulatory systems are needed.

  10. Amyloid PET in European and North American cohorts; and exploring age as a limit to clinical use of amyloid imaging

    Energy Technology Data Exchange (ETDEWEB)

    Chiotis, Konstantinos [Karolinska Institutet, Department of NVS, Center for Alzheimer Research, Translational Alzheimer Neurobiology, Stockholm (Sweden); Carter, Stephen F. [Karolinska Institutet, Department of NVS, Center for Alzheimer Research, Translational Alzheimer Neurobiology, Stockholm (Sweden); University of Manchester, Wolfson Molecular Imaging Centre, Institute of Brain, Behaviour and Mental Health, Manchester (United Kingdom); Farid, Karim [Karolinska Institutet, Department of NVS, Center for Alzheimer Research, Translational Alzheimer Neurobiology, Stockholm (Sweden); APHP, Hotel-Dieu Hospital, Department of Nuclear Medicine, Paris (France); Savitcheva, Irina [Karolinska University Hospital Huddinge, Department of Radiology, Stockholm (Sweden); Nordberg, Agneta [Karolinska Institutet, Department of NVS, Center for Alzheimer Research, Translational Alzheimer Neurobiology, Stockholm (Sweden); Karolinska University Hospital Huddinge, Department of Geriatric Medicine, Stockholm (Sweden); Collaboration: for the Diagnostic Molecular Imaging (DiMI) network and the Alzheimer' s Disease Neuroimaging Initiative

    2015-09-15

    Several radiotracers that bind to fibrillar amyloid-beta in the brain have been developed and used in various patient cohorts. This study aimed to investigate the comparability of two amyloid positron emission tomography (PET) tracers as well as examine how age affects the discriminative properties of amyloid PET imaging. Fifty-one healthy controls (HCs), 72 patients with mild cognitive impairment (MCI) and 90 patients with Alzheimer's disease (AD) from a European cohort were scanned with [11C]Pittsburgh compound-B (PIB) and compared with an age-, sex- and disease severity-matched population of 51 HC, 72 MCI and 84 AD patients from a North American cohort who were scanned with [18F]Florbetapir. An additional North American population of 246 HC, 342 MCI and 138 AD patients with a Florbetapir scan was split by age (55-75 vs 76-93 y) into groups matched for gender and disease severity. PET template-based analyses were used to quantify regional tracer uptake. The mean regional uptake patterns were similar and strong correlations were found between the two tracers across the regions of interest in HC (ρ = 0.671, p = 0.02), amyloid-positive MCI (ρ = 0.902, p < 0.001) and AD patients (ρ = 0.853, p < 0.001). The application of the Florbetapir cut-off point resulted in a higher proportion of amyloid-positive HC and a lower proportion of amyloid-positive AD patients in the older group (28 and 30 %, respectively) than in the younger group (19 and 20 %, respectively). These results illustrate the comparability of Florbetapir and PIB in unrelated but matched patient populations. The role of amyloid PET imaging becomes increasingly important with increasing age in the diagnostic assessment of clinically impaired patients. (orig.)

  11. [Consensus statement of the National AIDS Plan Secretariat, Spanish Society of Emergency Medicine and AIDS Study Group of the Spanish Society of Infectious Diseases and Clinical Microbiology on Emergency and Human Immunodeficiency Virus Infection].

    Science.gov (United States)

    2013-01-01

    Supporting non-HIV specialist professionals in the treatment of patients with urgent diseases resulting from HIV infection. These recommendations have been agreed by an expert panel from the National AIDS Plan Secretariat, the Spanish Society of Emergency Medicine, and the AIDS Study Group. A review has been made of the safety and efficacy results of clinical trials and cohort studies published in biomedical journals (PubMed and Embase) or presented at conferences. The strength of each recommendation (A, B, C) and the level of supporting evidence (I, II, III) are based on a modification of the criteria of the Infectious Diseases Society of America. The data to be collected from the emergency medical history in order to recognize the patient at risk of HIV infection were specified. It stressed the basic knowledge of ART principles and its importance in terms of decline in morbidity and mortality of HIV+ patients and referring to the HIV specialist for follow-up, where appropriate, including drug interactions. Management of different emergency situations that may occur in patients with HIV infection is also mentioned. The non-HIV specialist professional, will find the necessary tools to approach HIV patients with an emergency disease. Copyright © 2012 Elsevier España, S.L. All rights reserved.

  12. Clinical presentation and outcome of non-AIDS defining cancers, in HIV-infected patients in the ART-era: the Italian Cooperative Group on AIDS and tumors activity.

    Science.gov (United States)

    Berretta, M; Martellotta, F; Di Francia, R; Spina, M; Vaccher, E; Balestreri, L; Borsatti, E; Bearz, A; De Paoli, P; Tirelli, U

    2015-10-01

    The advent of antiretroviral therapy (ART) has markedly extended the survival rates of patients with human immunodeficiency virus (HIV), leading to suppression even though not eradication of HIV. In HIV infected patients, cancer has become a growing problem, representing the first cause of death. A large number of worldwide studies have shown that HIV infection raises the risk of many non-AIDS defining cancers (NADCs), including squamous cell carcinoma of the anus (SCCA), testis cancer, lung cancer, cancer of the colon and rectum (CRC), skin (basal cell skin carcinoma and melanoma), Hodgkin disease (HD) and hepatocellular carcinoma (HCC). Generally in HIV positive patients NADCs are more aggressive and in advanced stage disease than in the general population. In the ART era, however, the outcome of HIV positive patients is more similar as in the general population. Only about lung cancer the outcome seems different between HIV positive and HIV negative patients. The aim of this article is to provide an up-date on NADCs within the activity of the Italian Cooperative Group on AIDS and Tumors (GICAT) to identify clinical prognostic and predicting factors in patients with HIV infection included in the GICAT.

  13. AIDS, ativismo e regulação de ensaios clínicos no Brasil: o Protocolo 028 AIDS, activism, and the regulation of clinical trials in Brazil: Protocol 028

    Directory of Open Access Journals (Sweden)

    Maria Auxiliadora Oliveira

    2001-08-01

    Full Text Available Este artigo examina a política e a prática da avaliação de medicamentos no Brasil, buscando identificar a influência que a sociedade civil organizada, no caso, os ativistas da AIDS, exerce na construção da racionalidade científica de ensaios clínicos modernos. Baseando-se na experiência do ensaio clínico do Indinavir/Merck (Protocolo 028, como estudo de caso, discute-se de que maneira grupos sociais organizados desenvolvem estratégias para interferir na condução de estudos de avaliação de medicamentos, adequando-os aos seus próprios interesses. Tendo como referência teórica a sociologia da tradução, este artigo descreve e analisa as estratégias utilizadas pelos ativistas do grupo PelaVidda/SP (ONG/AIDS no processo de construção do consenso sobre ineficácia da monoterapia com o Indinavir junto aos diversos fóruns regulatórios envolvidos na solução da controvérsia gerada durante o período de execução do referido estudo.This paper examines the politics and practices of drug evaluation in Brazil. It traces the history of AIDS activists' influence on the organization of modern clinical trials and their scientific rationale. Using the Merck indinavir trial as a case study, the authors discuss how organized civil society has developed strategies to intervene in the course of drug evaluation trials, shaping them according to its own interests. Adopting translation sociology as the theoretical framework, the paper describes and analyzes the strategies used by activists from "Grupo PelaVidda/SP" (an AIDS NGO to build a consensus concerning indinavir monotherapy's lack of efficacy. The study considers the several regulatory forums involved in dealing with the controversy during the trial period.

  14. [Update of the Clinical Guidelines of the European Association of Urology on muscle-invasive and metastatic bladder carcinoma].

    Science.gov (United States)

    Stenzl, A; Cowan, N C; De Santis, M; Jakse, G; Kuczyk, M A; Merseburger, A S; Ribal, M J; Sherif, A; Witjes, J A

    2010-01-01

    New data regarding diagnosis and treatment of muscle-invasive and metastatic bladder cancer (MiM-BC) has emerged and led to an update of the European Association of Urology (EAU) guidelines for MiM-BC. To review the new EAU guidelines for MiM-BC. A comprehensive workup of the literature obtained from Medline, the Cochrane central register of systematic reviews, and reference lists in publications and review articles was developed and screened by a group of urologists, oncologists, and radiologist appointed by the EAU Guideline Committee. Previous recommendations based on the older literature on this subject were taken into account. Levels of evidence and grade of guideline recommendations were added, modified from the Oxford Centre for Evidence-based Medicine Levels of Evidence. The diagnosis of muscle-invasive bladder cancer (BCa) is made by transurethral resection (TUR) and following histopathologic evaluation. Patients with confirmed muscle-invasive BCa should be staged by computed tomography (CT) scans of the chest, abdomen, and pelvis, if available. Adjuvant chemotherapy is currently only advised within clinical trials. Radical cystectomy (RC) is the treatment of choice for both sexes, and lymph node dissection should be an integral part of cystectomy. An orthotopic bladder substitute should be offered to both male and female patients lacking any contraindications, such as no tumour at the level of urethral dissection. Multimodality bladder-preserving treatment in localised disease is currently regarded only as an alternative in selected, well-informed, and compliant patients for whom cystectomy is not considered for clinical or personal reasons. An appropriate schedule for disease monitoring should be based on: a) natural timing of recurrence; b) probability of disease recurrence; c) functional deterioration at particular sites; and d) consideration of treatment of a recurrence. In metastatic disease, the first-line treatment for patients fit enough to

  15. Joint model-based clustering of nonlinear longitudinal trajectories and associated time-to-event data analysis, linked by latent class membership: with application to AIDS clinical studies.

    Science.gov (United States)

    Huang, Yangxin; Lu, Xiaosun; Chen, Jiaqing; Liang, Juan; Zangmeister, Miriam

    2017-10-27

    Longitudinal and time-to-event data are often observed together. Finite mixture models are currently used to analyze nonlinear heterogeneous longitudinal data, which, by releasing the homogeneity restriction of nonlinear mixed-effects (NLME) models, can cluster individuals into one of the pre-specified classes with class membership probabilities. This clustering may have clinical significance, and be associated with clinically important time-to-event data. This article develops a joint modeling approach to a finite mixture of NLME models for longitudinal data and proportional hazard Cox model for time-to-event data, linked by individual latent class indicators, under a Bayesian framework. The proposed joint models and method are applied to a real AIDS clinical trial data set, followed by simulation studies to assess the performance of the proposed joint model and a naive two-step model, in which finite mixture model and Cox model are fitted separately.

  16. Clinical education and training of student nurses in four moderately new European Union countries: Assessment of students' satisfaction with the learning environment.

    Science.gov (United States)

    Antohe, Ileana; Riklikiene, Olga; Tichelaar, Erna; Saarikoski, Mikko

    2016-03-01

    Nurses underwent different models of education during various historical periods. The recent decade in Europe has been marked with educational transitions for the nursing profession related to Bologna Declaration and enlargement of the European Union. This paper aims to explore the situation of clinical placements for student nurses and assess students' satisfaction with the learning environment in four relatively new member states of European Union: the Czech Republic, Hungary, Lithuania and Romania. The data for cross-sectional quantitative study were collected during the exploratory phase of EmpNURS Project via a web based questionnaire which utilized a part of Clinical Learning Environment scale (CLES + T). The students evaluated their clinical learning environment mainly positively. The students' utter satisfaction with their clinical placements reached a high level and strongly correlated with the supervisory model. Although the commonest model for supervision was traditional group supervision, the most satisfied students had the experience of individualised supervision. The study gives a picture of the satisfaction of students with the learning environment and, moreover, with clinical placement education of student nurses in four EU countries. The results highlight the individualized supervision model as a crucial factor of students' total satisfaction during their clinical training periods. Copyright © 2015 Elsevier Ltd. All rights reserved.

  17. Correlation between baseline CD4 + T-Lymphocyte count and plasma viral load in AIDS patients and their early clinical and immunological response to HAART: A preliminary study

    Directory of Open Access Journals (Sweden)

    Gautam H

    2008-01-01

    Full Text Available The aim of this study was to determine the clinical, immunological and virological status of newly diagnosed AIDS cases and to monitor their clinical and immunological response to HAART after a minimum period of three months. Forty three drug naive AIDS patients were enrolled. The most common presenting complaints were weight loss (74.4%, cough (72.1% and diarrhoea (67.4%. Mean baseline CD4 cell count was 112 ± 60 cells/μL and mean baseline plasma viral load of 31 patients studied was 192,686 copies/mL. Baseline plasma viral load was higher among patients with lower baseline CD4 cell count. During follow-up, 80.8% patients showed clinical improvement, while a CD4 cell count increased by ≥50 cells/μL in 84.6% cases. Mean CD4 cell count increased from 126 ± 16.6 cells/μL at baseline to 278 ± 196.7 cells/μL.

  18. Prevalence and clinical implications of interactive toxicity beliefs regarding mixing alcohol and antiretroviral therapies among people living with HIV/AIDS.

    Science.gov (United States)

    Kalichman, Seth C; Amaral, Christina M; White, Denise; Swetsze, Connie; Pope, Howard; Kalichman, Moira O; Cherry, Chauncey; Eaton, Lisa

    2009-06-01

    Alcohol use is a barrier to medication adherence. Beyond the cognitive effects of intoxication, people living with HIV/AIDS who believe that alcohol should not be mixed with their medications may temporarily stop taking medications when drinking. To examine the effects of alcohol-treatment beliefs on HIV treatment adherence. People living with HIV/AIDS who were receiving treatment (n = 145) were recruited from community and clinical services during the period between January 2006 and May 2008 to complete measures of substance use and alcohol-antiretroviral (ARV) interactive toxicity beliefs (e.g., alcohol breaks down HIV medications so they will not work). Medication adherence was monitored using unannounced telephone-based pill counts. Forty percent of participants were currently using alcohol and nearly one in four drinkers reported stopping their medications when drinking. Beliefs that mixing alcohol and medications is toxic were common among drinkers and nondrinkers, with most beliefs endorsed more frequently by non-drinkers. Hierarchical regression analysis showed that stopping ARVs when drinking was associated with treatment nonadherence over and above quantity/frequency of alcohol use and problem drinking. Beliefs that alcohol and ARVs should not be mixed and that treatments should be interrupted when drinking are common among people living with HIV/AIDS. Clinicians should educate patients about the necessity of continuing to take ARV medications without interruption even if they are drinking alcohol.

  19. [CLINICAL APPLICATION OF INDIVIDUALIZED REFERENCE MODEL OF SAGITTAL CURVES BY THREE-DIMENSIONAL PRINTING TECHNIQUE AND COMPUTER-AIDED NAVIGATION SYSTEM FOR LUMBAR SPONDYLOLISTHESIS].

    Science.gov (United States)

    Wu, Chao; Tan, Lun; Lin, Xu; Hu, Haigang

    2015-06-01

    To evaluate the clinical significance of individualized reference model of sagittal curves by three-dimensional (3D) printing technique and computer-aided navigation system for lumbar spondylolisthesis. METHODS Between February 2011 and October 2012, 66 patients with lumbar spondylolisthesis underwent posterior lumbar interbody fusion (PLIF) by traditional operation in 36 cases (control group) and by individualized reference model of sagittal curves by 3D printing technique and computer-aided navigation system in 30 cases (trial group). There was no significant difference in gender, age, disease duration, segment, type of disease, degree of spondylolisthesis, and preoperative the visual analogue scale (VAS) of low back pain and leg pain between 2 groups (P>0.05). The operation time, blood loss, fluoroscopy times, VAS score of low back pain and leg pain were compared between 2 groups; the sagittal screw angle (SSA), accuracy rate of pedicle screw, Taillard index, disc height recovery rate, and sagittal angle recovery rate were compared between 2 groups. There was no significant difference in operation time and blood loss between 2 groups (P > 0.05). But fluoroscopy times of control group were significantly higher than those of trial group (P reference model of sagittal curves by 3D printing technique and computer-aided navigation system can effectively correct spondylolisthesis, recover the lumbar sagittal angle and improve the VAS score of low back pain though it has similar operation time and blood loss to traditional PLIF.

  20. AIDS (image)

    Science.gov (United States)

    AIDS (acquired immune deficiency syndrome) is caused by HIV (human immunodeficiency virus), and is a syndrome that ... life-threatening illnesses. There is no cure for AIDS, but treatment with antiviral medicine can suppress symptoms. ...

  1. Foreign aid

    DEFF Research Database (Denmark)

    Tarp, Finn

    2008-01-01

    Foreign aid has evolved significantly since the Second World War in response to a dramatically changing global political and economic context. This article (a) reviews this process and associated trends in the volume and distribution of foreign aid; (b) reviews the goals, principles and instituti......Foreign aid has evolved significantly since the Second World War in response to a dramatically changing global political and economic context. This article (a) reviews this process and associated trends in the volume and distribution of foreign aid; (b) reviews the goals, principles...... and institutions of the aid system; and (c) discusses whether aid has been effective. While much of the original optimism about the impact of foreign aid needed modification, there is solid evidence that aid has indeed helped further growth and poverty reduction...

  2. Plaque and gingivitis reduction in patients undergoing orthodontic treatment with fixed appliances-comparison of toothbrushes and interdental cleaning aids. A 6-month clinical single-blind trial.

    Science.gov (United States)

    Kossack, Christoph; Jost-Brinkmann, Paul-Georg

    2005-01-01

    Comparison of the efficacy of different oral cleaning devices to improve dental hygiene in patients with multibracket appliances. In a single-blind four-way crossover clinical trial, the following toothbrushes and cleaning aids were tested over 6 months to determine their efficacy in removing plaque and preventing gingivitis: the (A) manual interX short brush-head toothbrush (elmex), the (B) Sonic Speed SR-100E sonic toothbrush (Water Pik), the (C) Sonic Speed toothbrush in conjunction with the electric interdental cleaning device Flosser FL-110 (Water Pik), and (D) the Sonic Speed sonic toothbrush in conjunction with multi-floss 3-phase dental floss (elmex). Forty patients were randomly split up into four groups. Each group brushed their teeth for 4 weeks using cleaning aids/combinations A, B, C or D in different orders. The trial organization was controlled by a computer system that also assisted in recording the modified Quigley Hein Index (mQHI) and Papillary Bleeding Index (PBI) every two weeks using voice control. Initial improvement was observed with all cleaning aids/combinations, but after 4 weeks of application, conditions deteriorated again--except one. After 4 weeks of application, only cleaning involving the combined use of the sonic toothbrush and the Flosser FL-110 (C) was found to be significantly more effective than cleaning with the manual toothbrush (A), and that was mainly attributed to the flosser. In patients with good oral hygiene (mQHI(initial) or = 1.5)-by using an interdental cleaning aid. In the long run, the Flosser FL-110 is more effective than multi-floss 3-phase dental floss.

  3. Current issues in medically assisted reproduction and genetics in Europe: research, clinical practice, ethics, legal issues and policy. European Society of Human Genetics and European Society of Human Reproduction and Embryology.

    Science.gov (United States)

    Harper, Joyce C; Geraedts, Joep; Borry, Pascal; Cornel, Martina C; Dondorp, Wybo; Gianaroli, Luca; Harton, Gary; Milachich, Tanya; Kääriäinen, Helena; Liebaers, Inge; Morris, Michael; Sequeiros, Jorge; Sermon, Karen; Shenfield, Françoise; Skirton, Heather; Soini, Sirpa; Spits, Claudia; Veiga, Anna; Vermeesch, Joris Robert; Viville, Stéphane; de Wert, Guido; Macek, Milan

    2013-11-01

    In March 2005, a group of experts from the European Society of Human Genetics and European Society of Human Reproduction and Embryology met to discuss the interface between genetics and assisted reproductive technology (ART), and published an extended background paper, recommendations and two Editorials. Seven years later, in March 2012, a follow-up interdisciplinary workshop was held, involving representatives of both professional societies, including experts from the European Union Eurogentest2 Coordination Action Project. The main goal of this meeting was to discuss developments at the interface between clinical genetics and ARTs. As more genetic causes of reproductive failure are now recognised and an increasing number of patients undergo testing of their genome before conception, either in regular health care or in the context of direct-to-consumer testing, the need for genetic counselling and preimplantation genetic diagnosis (PGD) may increase. Preimplantation genetic screening (PGS) thus far does not have evidence from randomised clinical trials to substantiate that the technique is both effective and efficient. Whole-genome sequencing may create greater challenges both in the technological and interpretational domains, and requires further reflection about the ethics of genetic testing in ART and PGD/PGS. Diagnostic laboratories should be reporting their results according to internationally accepted accreditation standards (International Standards Organisation - ISO 15189). Further studies are needed in order to address issues related to the impact of ART on epigenetic reprogramming of the early embryo. The legal landscape regarding assisted reproduction is evolving but still remains very heterogeneous and often contradictory. The lack of legal harmonisation and uneven access to infertility treatment and PGD/PGS fosters considerable cross-border reproductive care in Europe and beyond. The aim of this paper is to complement previous publications and provide

  4. The clinical characteristics and prognostic significance of AID, miR-181b, and miR-155 expression in adult patients with de novo B-cell acute lymphoblastic leukemia.

    Science.gov (United States)

    Zhou, Guangquan; Cao, Yang; Dong, Weimin; Lin, Yan; Wang, Qi; Wu, Wei; Hua, Xiaoying; Ling, Yun; Xie, Xiaobao; Hu, Shaoyan; Cen, Jiannong; Gu, Weiying

    2017-09-01

    This study aimed to investigate clinical characteristics and prognostic significance of activation-induced cytidine deaminase (AID) gene, miR-181b and miR-155 expression in de novo adult B-cell acute lymphoblastic leukemia (B-ALL) patients. Results showed that AID and miR-155 expression were higher in B-ALL patients than healthy controls, while miR-181b expression was lower in B-ALL patients. In addition, Ph(+) B-ALLs had higher AID expression than Ph(-) B-ALLs, and its high expression was associated with BCR-ABL. Moreover, B-ALL patients with AID(high) or miR-181b(low) expression had a shorter overall survival (OS). AID(high) with miR-181b(low), AID(high) with miR-155(low), miR-181b(low), miR-155(low), AID(high) with miR-181b(low) and miR-155(low) expression were associated with shorter OS. Combination of the three molecules are more accurate predictors for unfavorable OS compared with univariate group. Therefore, AID, miR-181b and miR-155 provide clinical prognosis of adult de novo B-ALL patients and may refine their molecular risk classification.

  5. Sociodemographic, Epidemiological and Clinical Profile of the Cases of Hiv/Aids Among Adolescents in Pernambuco State (BRAZIL

    Directory of Open Access Journals (Sweden)

    João Victor Batista Cabral

    2015-06-01

    (67.45%, mulatto and black color (58.91%, resident in urban area (95.35%, concentrated according to residence, notification and treatment cities in Recife and Jaboatão dos Guararapes, infected through sexual intercourse (74.42%, considering among men (40.63% through homosexual relations and among women (93.75% through heterosexual intercourse. Most cases were defined by CDC criteria Modified (93,80% and (12.40% died due to AIDS.

  6. Clinical deterioration during antitubercular treatment at a district hospital in South Africa: the importance of drug resistance and AIDS defining illnesses.

    Directory of Open Access Journals (Sweden)

    Dominique J Pepper

    Full Text Available Clinical deterioration on drug therapy for tuberculosis is a common cause of hospital admission in Africa. Potential causes for clinical deterioration in settings of high HIV-1 prevalence include drug resistant Mycobacterium tuberculosis (M.tb, co-morbid illnesses, poor adherence to therapy, tuberculosis associated-immune reconstitution inflammatory syndrome (TB-IRIS and subtherapeutic antitubercular drug levels. It is important to derive a rapid diagnostic work-up to determine the cause of clinical deterioration as well as specific management to prevent further clinical deterioration and death. We undertook this study among tuberculosis (TB patients referred to an adult district level hospital situated in a high HIV-1 prevalence setting to determine the frequency, reasons and outcome for such clinical deterioration.A prospective observational study conducted during the first quarter of 2007. We defined clinical deterioration as clinical worsening or failure to stabilise after 14 or more days of antitubercular treatment, resulting in hospital referral. We collected data on tuberculosis diagnosis and treatment, HIV-1 status and antiretroviral treatment, and investigated reasons for clinical deterioration as well as outcome.During this period, 352 TB patients met inclusion criteria; 296 were admitted to hospital accounting for 17% of total medical admissions (n = 1755. Eighty three percent of TB patients (291/352 were known to be HIV-1 co-infected with a median CD4 count of 89cells/mm(3 (IQR 38-157. Mortality among TB patients admitted to hospital was 16% (n = 48. The median duration of hospital admission was 9.5 days (IQR 4-18, longer than routine in this setting (4 days. Among patients in whom HIV-1 status was known (n = 324, 72% of TB patients (n = 232 had an additional illness to tuberculosis; new AIDS defining illnesses (n = 80 were the most frequent additional illnesses (n = 208 in HIV-1 co-infected patients (n = 291. Rifampin-resistant M

  7. Perfil clínico da Enterocolite por Citomegalovírus (CMV na síndrome da imunodeficiência adquirida (Aids Clinical profile of Cytomegalovirus Colitis in AIDS

    Directory of Open Access Journals (Sweden)

    D.B. de Lima

    2000-03-01

    Full Text Available Múltiplos agentes estão envolvidos na etiopatogenia da diarréia em Aids. O exame de fezes e a colonoscopia são elementos decisivos para o diagnóstico específico. A enterocolite por CMV pode cursar com febre, emagrecimento, diarréia intermitente e hematoquesia. Outros agentes causadores de diarréia podem ter o mesmo espectro de apresentação. OBJETIVO: Definir o perfil clínico da enterocolite por CMV em pacientes com Aids, comparando os parâmetros clínicos, endoscópicos e de tempo de sobrevida entre dois grupos com diarréia crônica, grupo A com CMV e grupo B sem CMV. MÉTODOS: Foram acompanhados 48 pacientes com Aids e diarréia de duração maior que 30 dias, sendo 27 do grupo A e 21 do grupo B. Os parâmetros analisados foram idade, situação de risco, duração da diarréia, hematoquesia, intervalo de tempo entre diagnóstico da infecção por HIV e início de diarréia, achados endoscópicos e sobrevida. Foram realizados exames parasitológicos, culturas e colonoscopia com biópsias. Foi utilizado o teste "t-student" para amostras não pareadas e o teste Qui-Quadrado com correção de Yates para variáveis não paramétricas. Foram construídas curvas de sobrevida pelo método descrito por Kaplan-Meier e aplicado o teste de Mantel - Haenszel. Foi assumido como nível de significância estatística o valor de P menor que 0.05. RESULTADOS: O padrão endoscópico da infecção por CMV correspondeu a ulcerações associadas a hemorragia de submucosa 14 (51.8% P P > 0.001. Os outros parâmetros estudados não mostraram significância estatística. CONCLUSÕES: A presença de enterocolite por CMV em Aids é marcador de mau prognóstico e menor sobrevida. Existe um padrão endoscópico sugestivo da infecção por CMV.OBJECTIVE: To determine the clinical profile of CMV colitis in AIDS patients, comparing clinical, endoscopic parameters and survival time between 2 groups of AIDS patients having chronic diarrhea. Group A being CMV

  8. Benefit from non-linear frequency compression hearing aids in a clinical setting: the effects of duration of experience and severity of high-frequency hearing loss.

    Science.gov (United States)

    Hopkins, Kathryn; Khanom, Mumtaz; Dickinson, Ann-Marie; Munro, Kevin J

    2014-04-01

    To determine whether non-linear frequency compression (NLFC) is effective for hearing-impaired adults in a clinical setting. To determine whether benefit from NLFC is related to duration of NLFC experience or severity of high-frequency hearing loss. Participants were fitted with Phonak frequency compression hearing aids as part of their standard clinical care, using the manufacturer's default fitting settings. Participants had been using NLFC for between 1 and 121 weeks at the time of testing. Speech recognition thresholds in noise and consonant recognition in quiet were measured with and without NLFC enabled. Forty-six experienced adult hearing-aid users. Consonant recognition in quiet, but not speech recognition in noise was significantly better with NLFC enabled. There was no significant correlation between duration of frequency compression experience and benefit. Benefit for consonant recognition was negatively correlated with mean audiometric thresholds from 2-6 kHz. NLFC was beneficial for consonant recognition but not speech recognition in noise. There was no evidence to support the idea that a long period of acclimatization is necessary to gain full benefit. The relation between benefit and high-frequency thresholds might be explained by the poor audibility of compressed information for some listeners with severe loss.

  9. Clinical profile of HIV/AIDS-infected patients admitted to a new specialist unit in Dhaka, Bangladesh--a low-prevalence country for HIV.

    Science.gov (United States)

    Matin, Nashaba; Shahrin, Lubaba; Pervez, Mohammed Moshtaq; Banu, Sayera; Ahmed, Dilruba; Khatun, Mahmuda; Pietroni, Mark

    2011-02-01

    This paper describes the clinical features of a series of patients admitted to the specialist HIV/AIDS unit (Jagori) of the Dhaka Hospital, ICDDR,B (International Centre for Diarrhoeal Disease Research, Bangladesh) during May 2008-February 2010. Data were collected from a review of documents and electronic case-records and collation of laboratory results with respect to CD4 counts. One hundred and nine patients were admitted during this period. Their mean age was 33.4 years, and 62% were male. On admission, the mean CD4 count +/- standard deviation (SD) was 244 +/- 245 (range 2-1,549). The death rate was 12%. The patients were classified as World Health Organization clinical stage 1: 23%, stage 2: 30%, stage 3: 23%, and stage 4: 24% during the admission. The commonest diagnosis recorded was tuberculosis (TB) (23%), which was also the commonest cause of death (38%). Even for those clinicians with limited experience of managing AIDS cases, the commonest problem encountered in this patient group was TB, reflecting the continued high burden of TB on health services in Bangladesh. Additional challenges to managing TB/HIV co-infection include atypical presentations in HIV-infected persons and the complex drug interaction with antiretroviral therapy.

  10. Tumor response assessment: comparison between unstructured free text reporting in routine clinical workflow and computer-aided evaluation based on RECIST 1.1 criteria.

    Science.gov (United States)

    Goebel, Juliane; Hoischen, Julia; Gramsch, Carolin; Schemuth, Haemi P; Hoffmann, Andreas-Claudius; Umutlu, Lale; Nassenstein, Kai

    2017-12-01

    Standardized computer-aided tumor response assessment is common in clinical trials. In contrast, unstructured free text reporting (UFTR) is common in daily routine. Therefore, this study aimed to discern and quantify differences between UFTR and computer-aided standardized tumor response evaluation based on RECIST 1.1 criteria (RECIST), serving as gold standard, in clinical workflow. One-hundred consecutive patients with cancer eligible for RECIST 1.1 evaluation, who received five follow-up CTs of the trunk, were retrospectively included. All UFTRs were assigned to RECIST response categories [complete response, partial response (PR), stable disease (SD), progressive disease (PD)]. All CTs were re-evaluated using dedicated software (mint lesion™) applying RECIST 1.1. The accordance in tumor response ratings was analyzed using Cohen's kappa. At the first follow-up, 47 cases were rated differently with an SD underrepresentation and a PR and PD overrepresentation in UFTR. In the subsequent follow-ups, categorical differences were seen in 38, 44, 37, and 44%. Accordance between UFTR and RECIST was fair to moderate (Cohen's kappa: 0.356, 0.477, 0.390, 0.475, 0.376; always p evaluation based on RECIST 1.1. Thus, standardized reporting should be implemented in daily routine workflow.

  11. Detection of HIV drug resistance during antiretroviral treatment and clinical progression in a large European cohort study

    DEFF Research Database (Denmark)

    Cozzi-Lepri, Alessandro; Phillips, Andrew N; Clotet, Bonaventura

    2008-01-01

    OBJECTIVE(S): To investigate the relationship between detection of HIV drug resistance by 2 years from starting antiretroviral therapy and the subsequent risk of progression to AIDS and death. DESIGN: Virological failure was defined as experiencing two consecutive viral loads of more than 400...

  12. Compliance of blood sampling procedures with the CLSI H3-A6 guidelines: An observational study by the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) working group for the preanalytical phase (WG-PRE)

    NARCIS (Netherlands)

    Simundic, Ana-Maria; Church, Stephen; Cornes, Michael P.; Grankvist, Kjell; Lippi, Giuseppe; Nybo, Mads; Nikolac, Nora; van Dongen-Lases, Edmee; Eker, Pinar; Kovalevskaya, Svjetlana; Kristensen, Gunn B. B.; Sprongl, Ludek; Sumarac, Zorica

    2015-01-01

    Abstract Background: An observational study was conducted in 12 European countries by the European Federation of Clinical Chemistry and Laboratory Medicine Working Group for the Preanalytical Phase (EFLM WG-PRE) to assess the level of compliance with the CLSI H3-A6 guidelines. Methods: A structured

  13. [Update of the Clinical Guidelines of the European Association of Urology on muscle-invasive and metastatic bladder carcinoma

    NARCIS (Netherlands)

    Stenzl, A.; Cowan, N.C.; Santis, M. de; Jakse, G.; Kuczyk, M.A.; Merseburger, A.S.; Ribal, M.J.; Sherif, A.; Witjes, J.A.

    2010-01-01

    CONTEXT: New data regarding diagnosis and treatment of muscle-invasive and metastatic bladder cancer (MiM-BC) has emerged and led to an update of the European Association of Urology (EAU) guidelines for MiM-BC. OBJECTIVE: To review the new EAU guidelines for MiM-BC. EVIDENCE ACQUISITION: A

  14. Diversity in clinical management and protocols for the treatment of major bleeding trauma patients across European level I Trauma Centres

    NARCIS (Netherlands)

    Schäfer, Nadine; Driessen, Arne; Fröhlich, Matthias; Stürmer, Ewa K.; Maegele, Marc; Johansson, Pär I.; Ostrowski, Sisse R.; Stensballe, Jakob; Goslings, J. Carel; Juffermans, Nicole; Balvers, Kirsten; Neble, Sylvie; van Dieren, Susan; Gaarder, Christine; Naess, Pål A.; Kolstadbraten, Knut Magne; Brohi, Karim; Eaglestone, Simon; Rourke, Claire; Campbell, Helen; Curry, Nicola; Stanworth, Simon; Harrison, Michael; Buchanan, James; Soyel, Hamit; Gall, Lewis; Orr, Adrian; Char, Ahmed; Görlinger, Klaus; Schubert, Axel

    2015-01-01

    Background: Uncontrolled haemorrhage is still the leading cause of preventable death after trauma and the primary focus of any treatment strategy should be related to early detection and control of blood loss including haemostasis. Methods: For assessing management practices across six European

  15. Revised guidelines for the clinical management of Lynch syndrome (HNPCC) : Recommendations by a group of European experts

    NARCIS (Netherlands)

    Vasen, Hans F. A.; Blanco, Ignacio; Aktan-Collan, Katja; Gopie, Jessica P.; Alonso, Angel; Aretz, Stefan; Bernstein, Inge; Bertario, Lucio; Burn, John; Capella, Gabriel; Colas, Chrystelle; Engel, Christoph; Frayling, Ian M.; Genuardi, Maurizio; Heinimann, Karl; Hes, Frederik J.; Hodgson, Shirley V.; Karagiannis, John A.; Lalloo, Fiona; Lindblom, Annika; Mecklin, Jukka-Pekka; Moller, Pal; Myrhoj, Torben; Nagengast, Fokko M.; Parc, Yann; de Leon, Maurizio Ponz; Renkonen-Sinisalo, Laura; Sampson, Julian R.; Stormorken, Astrid; Sijmons, Rolf H.; Tejpar, Sabine; Thomas, Huw J. W.; Rahner, Nils; Wijnen, Juul T.; Jaervinen, Heikki Juhani; Moeslein, Gabriela; Jarvinen, H.J.; Moslein, G.

    Lynch syndrome (LS) is characterised by the development of colorectal cancer, endometrial cancer and various other cancers, and is caused by a mutation in one of the mismatch repair genes: MLH1, MSH2, MSH6 or PMS2. In 2007, a group of European experts (the Mallorca group) published guidelines for

  16. Religiosity, Meaning in Life, and Clinical Symptomology: A Comparison of African-American and European-American College Students

    Science.gov (United States)

    Holmes, Jeffrey D.; Hardin, Susan I.

    2009-01-01

    This study examined whether religiosity is subsumed under the broader construct of meaning in life as a predictor of psychological symptomology in college students from two ethnic groups. Data from 299 undergraduates indicated that among European-American students, religiosity predicted little variance in psychological symptomology and was…

  17. An evaluation of the suitability of the European suspension test to reflect in vitro activity of antiseptics against clinically significant organisms.

    Science.gov (United States)

    Payne, D N; Babb, J R; Bradley, C R

    1999-01-01

    The effectiveness of four antiseptics representing soluble phenolics (Dettol), Quaternary Ammonium Compounds (QAC) (Dettol Hospital Concentrate: DHC), mixed QAC/chlorhexidine (Hibicet Hospital Concentrate: HHC) and povidone iodine (Betadine) was assessed using the proposed phase 2 step 1 European Suspension test. The in vitro activity of the antiseptics against two of the proposed challenge strains, i.e. Staphylococcus aureus and Pseudomonas aeruginosa, was compared with that of 14 problematic clinical isolates of bacteria from a range of genera, including some multiple antibiotic resistant strains, and a clinical isolate of Candida albicans. In addition to the 5 min contact time recommended in the European test, a 1 min time was included. All four products, at their recommended use dilutions and a contact time of 5 min, achieved a Microbicidal Effect (ME) log reduction of at least 5 against the majority of organisms. Differences in activity between products were more pronounced and therefore the tests more discriminatory, when the contact time was reduced to 1 min. The clinical strains were not overtly more resistant to antiseptics than the standard test strains, suggesting that the CEN test strains mimic the antiseptic susceptibility of clinical isolates.

  18. Computer-aided system for diagnosing thyroid nodules on ultrasound: A comparison with radiologist-based clinical assessments.

    Science.gov (United States)

    Gao, Luying; Liu, Ruyu; Jiang, Yuxin; Song, Wenfeng; Wang, Ying; Liu, Jia; Wang, Juanjuan; Wu, Dongqian; Li, Shuai; Hao, Aimin; Zhang, Bo

    2017-12-29

    The purpose of this study was to compare the diagnostic efficiency of a thyroid ultrasound computer-aided diagnosis (CAD) system with that of 1 radiologist. This study retrospectively reviewed 342 surgically resected thyroid nodules from July 2013 to December 2013 at our center. The nodules were assessed on typical ultrasound images using the CAD system and reviewed by 1 experienced radiologist. The radiologist stratified the risk of malignancy using the Thyroid Imaging Reporting and Data Systems (TIRADS) and the American Thyroid Association (ATA) guidelines. The radiologist, using TI-RADS and ATA guidelines, performed better than the CAD system (P system was similar to that of an experienced radiologist (P > .05; P .05). However, we found that the CAD system had lower specificity (P system in differentiating nodules was similar to that of an experienced radiologist. However, the CAD system had lower specificity. © 2017 Wiley Periodicals, Inc.

  19. Reproducible diagnosis of Chronic Lymphocytic Leukemia by flow cytometry: an European Research Initiative on CLL (ERIC) & European Society for Clinical Cell Analysis (ESCCA) harmonisation project.

    Science.gov (United States)

    Rawstron, Andy C; Kreuzer, Karl-Anton; Soosapilla, Asha; Spacek, Martin; Stehlikova, Olga; Gambell, Peter; McIver-Brown, Neil; Villamor, Neus; Psarra, Katherina; Arroz, Maria; Milani, Raffaella; de la Serna, Javier; Cedena, M Teresa; Jaksic, Ozren; Nomdedeu, Josep; Moreno, Carol; Rigolin, Gian Matteo; Cuneo, Antonio; Johansen, Preben; Johnsen, Hans E; Rosenquist, Richard; Niemann, Carsten Utoft; Kern, Wolfgang; Westerman, David; Trneny, Marek; Mulligan, Stephen; Doubek, Michael; Pospisilova, Sarka; Hillmen, Peter; Oscier, David; Hallek, Michael; Ghia, Paolo; Montserrat, Emili

    2017-10-10

    The diagnostic criteria for CLL rely on morphology and immunophenotype. Current approaches have limitations affecting reproducibility and there is no consensus on the role of new markers. The aim of this project was to identify reproducible criteria and consensus on markers recommended for the diagnosis of CLL. ERIC/ESCCA members classified 14 of 35 potential markers as "required" or "recommended" for CLL diagnosis, consensus being defined as >75% and >50% agreement, respectively. An approach to validate "required" markers using normal peripheral blood was developed. Responses were received from 150 participants with a diagnostic workload >20 CLL cases per week in 23/150 (15%), 5-20 in 82/150 (55%) and 97% concordance with current approaches. A pilot study to validate staining quality was completed in eleven centres. Markers considered as "required" for the diagnosis of CLL by the participants in this study (CD19, CD5, CD20, CD23, Kappa and Lambda) are consistent with current diagnostic criteria and practice. Importantly, a reproducible approach to validate and apply these markers in individual laboratories has been identified. Finally, a consensus "recommended" panel of markers to refine diagnosis in borderline cases (CD43, CD79b, CD81, CD200, CD10, ROR1) has been defined and will be prospectively evaluated. This article is protected by copyright. All rights reserved. © 2017 International Clinical Cytometry Society.

  20. European Association for the Study of the Liver (EASL), European Association for the Study of Diabetes (EASD) and European Association for the Study of Obesity (EASO) clinical practice recommendations for the management of non-alcoholic fatty liver disease: evaluation of their application in people with Type 2 diabetes.

    Science.gov (United States)

    Sberna, A L; Bouillet, B; Rouland, A; Brindisi, M C; Nguyen, A; Mouillot, T; Duvillard, L; Denimal, D; Loffroy, R; Vergès, B; Hillon, P; Petit, J M

    2017-12-16

    To evaluate the application of the recently proposed recommendations by the European Association for the Study of the Liver, European Association for the Study of Diabetes and European Association for the Study of Obesity for the diagnosis, treatment and follow-up of non-alcoholic fatty liver disease in people with Type 2 diabetes. A total of 179 people with Type 2 diabetes were included in this study. Liver fat content (assessed using proton magnetic resonance spectroscopy), fatty liver index score, non-alcoholic fatty liver disease fibrosis score, and SteatoTest and FibroTest scores were determined. According to proton magnetic resonance spectroscopy, 68.7% of participants had steatosis (liver fat content >5.5%). The application of the guidelines using several combinations (fatty liver index + non-alcoholic fatty liver disease fibrosis scores, Steatotest + FibroTest scores, proton magnetic resonance spectroscopy + non-alcoholic fatty liver disease fibrosis score, proton magnetic resonance spectroscopy + FibroTest) resulted in a referral to a liver clinic for 33.5-84.9% people with Type 2 diabetes. The application of these new algorithms for the diagnosis, and follow-up of non-alcoholic fatty liver disease would lead to an excessive number of people with Type 2 diabetes being referred to a liver clinic. We suggest that new clinical and/or biological biomarkers of steatosis and fibrosis be specifically validated in people with Type 2 diabetes. © 2017 Diabetes UK.

  1. Effect of chocolate and mate tea on the lipid profile of individuals with HIV/AIDS on antiretroviral therapy: A clinical trial.

    Science.gov (United States)

    Souza, Suelen J; Petrilli, Aline A; Teixeira, Andrea M; Pontilho, Patricia M; Carioca, Antonio A; Luzia, Liania A; Souza, José M; Damasceno, Nágila R; Segurado, Aluisio A; Rondó, Patricia H

    HIV/AIDS is generally associated with dyslipidemia and oxidative imbalance, which are caused by the infection itself and by antiretroviral therapy (ART). The flavonoids, found in cocoa and yerba mate, have antioxidant and hypolipidemic properties. The aim of this study was to evaluate the effects of the consumption of dark chocolate and mate tea on the lipid profiles of individuals with HIV/AIDS who are undergoing ART. A randomized, double-blind, placebo-controlled crossover clinical trial was conducted with 92 patients receiving ART for ≥6 mo and with viral suppression. The participants were randomized to receive either 65 g of chocolate (with 2148 mg polyphenols) or placebo chocolate (without polyphenols) or 3 g of mate tea (with 107 mg total phenols and 84.24 mg chlorogenic acid) or placebo mate (without polyphenols) for 15 d each, separated by a washout period of 15 d. The lipid profile, including determination of electronegative low-density lipoprotein, was determined after each intervention. The data were analyzed by analysis of variance using the pkcross procedure of the Stata 11.0 software. Analysis of variance revealed a significant overall difference in mean high-density lipoprotein cholesterol (HDL-C) between all supplements (P = 0.047). Using the paired t test, the effect was attributed to the consumption of dark chocolate (P = 0.046). The other parameters investigated were not improved. The consumption of dark chocolate for 15 d improved HDL-C concentrations of individuals with HIV/AIDS undergoing ART, possibly due to the presence of fatty acids (stearic acid), polyphenols, and theobromine. This fact is important for the cardiovascular protection of these individuals. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. A study on epidemiological profile of anxiety disorders among people living with HIV/AIDS in a sub-Saharan Africa HIV clinic.

    Science.gov (United States)

    Olagunju, Andrew T; Adeyemi, Joseph D; Ogbolu, Raphael E; Campbell, Elizabeth A

    2012-11-01

    The aim of this study is to find out the prevalence, types and correlates of anxiety disorders among people living with HIV/AIDS (PLWHA) attending a sub-Saharan Africa HIV clinic. Three hundred HIV positive adults were subjected to semi-structured clinical interview using the Schedule for Clinical Assessment in Neuropsychiatry to diagnose anxiety disorders in them. Additionally, a socio-demographic/clinical profile questionnaire designed for the study was administered to the study participants. The prevalence of anxiety disorders among PLWHA in this study was 21.7 %, and anxiety disorder unspecified (6.2 %), mixed anxiety-depressive disorder (5.3 %) and social phobia (4 %) among others were the subtypes of anxiety disorders elicited among the participants. Lack of family support [correlation coefficient (r) = 0.212, P disorders; while younger age group (r = -0.126, P = 0.039) and negative previous mental illness (r = -0.894, P = 0.021) seem protective against anxiety disorders in this study. Our findings suggest a high burden of anxiety disorders among PLWHA and up to five-folds when compared to the general population. Thus, integration of proactive mental health screening as well as treatment services with inclusion of targeted intervention for anxiety disorders among PLWHA is recommended.

  3. A standardised, generic, validated approach to stratify the magnitude of clinical benefit that can be anticipated from anti-cancer therapies: the European Society for Medical Oncology Magnitude of Clinical Benefit Scale (ESMO-MCBS).

    Science.gov (United States)

    Cherny, N I; Sullivan, R; Dafni, U; Kerst, J M; Sobrero, A; Zielinski, C; de Vries, E G E; Piccart, M J

    2015-08-01

    The value of any new therapeutic strategy or treatment is determined by the magnitude of its clinical benefit balanced against its cost. Evidence for clinical benefit from new treatment options is derived from clinical research, in particular phase III randomised trials, which generate unbiased data regarding the efficacy, benefit and safety of new therapeutic approaches. To date, there is no standard tool for grading the magnitude of clinical benefit of cancer therapies, which may range from trivial (median progression-free survival advantage of only a few weeks) to substantial (improved long-term survival). Indeed, in the absence of a standardised approach for grading the magnitude of clinical benefit, conclusions and recommendations derived from studies are often hotly disputed and very modest incremental advances have often been presented, discussed and promoted as major advances or 'breakthroughs'. Recognising the importance of presenting clear and unbiased statements regarding the magnitude of the clinical benefit from new therapeutic approaches derived from high-quality clinical trials, the European Society for Medical Oncology (ESMO) has developed a validated and reproducible tool to assess the magnitude of clinical benefit for cancer medicines, the ESMO Magnitude of Clinical Benefit Scale (ESMO-MCBS). This tool uses a rational, structured and consistent approach to derive a relative ranking of the magnitude of clinically meaningful benefit that can be expected from a new anti-cancer treatment. The ESMO-MCBS is an important first step to the critical public policy issue of value in cancer care, helping to frame the appropriate use of limited public and personal resources to deliver cost-effective and affordable cancer care. The ESMO-MCBS will be a dynamic tool and its criteria will be revised on a regular basis. © The Author 2015. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For

  4. Demographic and clinical data in acquired hemophilia A: results from the European Acquired Haemophilia Registry (EACH2).

    Science.gov (United States)

    Knoebl, P; Marco, P; Baudo, F; Collins, P; Huth-Kühne, A; Nemes, L; Pellegrini, F; Tengborn, L; Lévesque, H

    2012-04-01

    Acquired hemophilia A (AHA) is a rare autoimmune disease caused by autoantibodies against coagulation factor VIII and characterized by spontaneous hemorrhage in patients with no previous family or personal history of bleeding. Although data on several AHA cohorts have been collected, limited information is available on the optimal management of AHA. The European Acquired Hemophilia Registry (EACH2) was established to generate a prospective, large-scale, pan-European database on demographics, diagnosis, underlying disorders, bleeding characteristics, treatment and outcome of AHA patients. Five hundred and one (266 male, 235 female) patients from 117 centers and 13 European countries were included in the registry between 2003 and 2008. In 467 cases, hemostasis investigations and AHA diagnosis were triggered by a bleeding event. At diagnosis, patients were a median of 73.9 years. AHA was idiopathic in 51.9%; malignancy or autoimmune diseases were associated with 11.8% and 11.6% of cases. Fifty-seven per cent of the non-pregnancy-related cases were male. Four hundred and seventy-four bleeding episodes were reported at presentation, and hemostatic therapy initiated in 70.5% of patients. Delayed diagnosis significantly impacted treatment initiation in 33.5%. Four hundred and seventy-seven patients underwent immunosuppression, and 72.6% achieved complete remission. Representing the largest collection of consecutive AHA cases to date, EACH2 facilitates the analysis of a variety of open questions in AHA. © 2012 International Society on Thrombosis and Haemostasis.

  5. The 2011-2012 pilot European Society of Cardiology Sentinel Registry of Transcatheter Aortic Valve Implantation: 12-month clinical outcomes.

    Science.gov (United States)

    Gilard, Martine; Schlüter, Michael; Snow, Thomas M; Dall'Ara, Gianni; Eltchaninoff, Helene; Moat, Neil; Goicolea, Javier; Ussia, Gian Paolo; Kala, Petr; Wenaweser, Peter; Zembala, Marian; Nickenig, Georg; Price, Susanna; Alegria Barrero, Eduardo; Iung, Bernard; Zamorano, Pepe; Schuler, Gerhard; Corti, Roberto; Alfieri, Ottavio; Prendergast, Bernard; Ludman, Peter; Windecker, Stephan; Sabate, Manel; Witkowski, Adam; Danenberg, Haim; Schroeder, Erwin; Romeo, Francesco; Macaya, Carlos; Derumeaux, Geneviève; Laroche, Cécile; Pighi, Michele; Serdoz, Roberta; Di Mario, Carlo

    2016-05-17

    Our aim was to assess one-year outcomes of patients enrolled in the pilot European Sentinel Registry of Transcatheter Aortic Valve Implantation (TAVI). One-year outcomes of 4,571 patients (81.4±7.2 years, 2,291 [50.1%] male) receiving TAVI with the SAPIEN XT (57.3%) or CoreValve prosthesis at 137 European centres were analysed using Kaplan-Meier and Cox proportional hazards regression techniques. At one year, 3,341 patients were alive, 821 had died, and 409 were lost to follow-up. Of 2,125 patients who underwent functional assessment, 1,916 (90%) were in New York Heart Association (NYHA) Class I/II at one year, with functional improvement from baseline noted in 1,682 patients (88%). One-year survival based on 4,564 patients was estimated at 79.1%. Independent baseline predictors of mortality were increasing age and logistic EuroSCORE, the presence of NYHA III/IV, chronic obstructive pulmonary disease, and atrial fibrillation. Female gender was associated with a 4% survival benefit at one year. Vascular access routes other than transfemoral were associated with poorer survival. Procedural failure and major periprocedural complications had an adverse impact on survival. Contemporary European experience attests to the effectiveness of routine TAVI in unselected elderly patients.

  6. The education and training of clinical medical physicists in 25 European, 2 North American and 2 Australasian countries: similarities and differences.

    Science.gov (United States)

    Stefanoyiannis, A P; Christofides, S; Psichis, K; Geoghegan, D S; Gerogiannis, I; Round, W H; Geronikola-Trapali, X; Armeniakos, I; Kaplanis, P A; Prentakis, A; Chatziioannou, S N

    2012-07-01

    The clinical medical physicist is part of a team responsible for safe and competent provision of radiation-based diagnostic examinations and therapeutic practices. To ensure that the physicist can provide an adequate service, sufficient education and training is indispensable. The aim of this study is to provide a structured description of the present status of the clinical medical physicist education and training framework in 25 European, 2 North American and 2 Australasian countries. For this study, data collection was based on a questionnaire prepared by the European Federation of Organizations in Medical Physics (EFOMP) and filled-in either by the corresponding scientific societies-organizations or by the authors. In the majority of cases, a qualified medical physicist should have an MSc in medical physics and 1-3 years of clinical experience. Education and training takes place in both universities and hospitals and the total duration of the programs ranges from 2.5 to 9 years. In 56% of all European countries, it is mandatory to hold a diploma or license to work as a medical physicist, the situation being similar in Australasian and 4 states of USA. Generally, there are national registers of medical physicists with inclusion on the register being voluntary. There are renewal mechanisms in the registers usually based on a Continuing Professional Development (CPD) system. In conclusion, a common policy is followed in general, on topics concerning education and training as well as the practice of the medical physicist profession, notwithstanding the presence of a few differences. Copyright © 2011 Associazione Italiana di Fisica Medica. All rights reserved.

  7. Cutaneous manifestations in patients with mastocytosis: Consensus report of the European Competence Network on Mastocytosis; the American Academy of Allergy, Asthma & Immunology; and the European Academy of Allergology and Clinical Immunology.

    Science.gov (United States)

    Hartmann, Karin; Escribano, Luis; Grattan, Clive; Brockow, Knut; Carter, Melody C; Alvarez-Twose, Ivan; Matito, Almudena; Broesby-Olsen, Sigurd; Siebenhaar, Frank; Lange, Magdalena; Niedoszytko, Marek; Castells, Mariana; Oude Elberink, Joanna N G; Bonadonna, Patrizia; Zanotti, Roberta; Hornick, Jason L; Torrelo, Antonio; Grabbe, Jürgen; Rabenhorst, Anja; Nedoszytko, Boguslaw; Butterfield, Joseph H; Gotlib, Jason; Reiter, Andreas; Radia, Deepti; Hermine, Olivier; Sotlar, Karl; George, Tracy I; Kristensen, Thomas K; Kluin-Nelemans, Hanneke C; Yavuz, Selim; Hägglund, Hans; Sperr, Wolfgang R; Schwartz, Lawrence B; Triggiani, Massimo; Maurer, Marcus; Nilsson, Gunnar; Horny, Hans-Peter; Arock, Michel; Orfao, Alberto; Metcalfe, Dean D; Akin, Cem; Valent, Peter

    2016-01-01

    Cutaneous lesions in patients with mastocytosis are highly heterogeneous and encompass localized and disseminated forms. Although a classification and criteria for cutaneous mastocytosis (CM) have been proposed, there remains a need to better define subforms of cutaneous manifestations in patients with mastocytosis. To address this unmet need, an international task force involving experts from different organizations (including the European Competence Network on Mastocytosis; the American Academy of Allergy, Asthma & Immunology; and the European Academy of Allergology and Clinical Immunology) met several times between 2010 and 2014 to discuss the classification and criteria for diagnosis of cutaneous manifestations in patients with mastocytosis. This article provides the major outcomes of these meetings and a proposal for a revised definition and criteria. In particular, we recommend that the typical maculopapular cutaneous lesions (urticaria pigmentosa) should be subdivided into 2 variants, namely a monomorphic variant with small maculopapular lesions, which is typically seen in adult patients, and a polymorphic variant with larger lesions of variable size and shape, which is typically seen in pediatric patients. Clinical observations suggest that the monomorphic variant, if it develops in children, often persists into adulthood, whereas the polymorphic variant may resolve around puberty. This delineation might have important prognostic implications, and its implementation in diagnostic algorithms and future mastocytosis classifications is recommended. Refinements are also suggested for the diagnostic criteria of CM, removal of telangiectasia macularis eruptiva perstans from the current classification of CM, and removal of the adjunct solitary from the term solitary mastocytoma. Copyright © 2015 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  8. Aid and Authoritarianism in Africa

    DEFF Research Database (Denmark)

    In 2013 almost half of Africa’s top aid recipients were ruled by authoritarian regimes. While the West may claim to promote democracy and human rights, in practice major bilateral and international donors, such as USAID , DFID , the World Bank and the European Commission, have seen their aid...... policies become ever more entangled with the survival of their authoritarian protégés. Local citizens thus find themselves at the receiving end of a compromise between aid agencies and government elites, in which development policies are shaped in the interests of maintaining the status quo. Aid...... and Authoritarianism in Africa sheds light on the political intricacies and moral dilemmas raised by the relationship between foreign aid and autocratic rule in Africa. Through contributions by leading experts exploring the revival of authoritarian development politics in Ethiopia, Uganda, Rwanda, Cameroon, Mozambique...

  9. Improving Clinical Information on Head CT Requisitions From the Emergency Department to Aid Interpretation and Billing Efficiency.

    Science.gov (United States)

    Barron, Dillon; Spiegel, Thomas; Katzman, Gregory L; Haas, Kateland; Ali, Saad

    2018-01-01

    The accuracy of radiologic interpretations is higher when appropriate clinical information is provided, as is the likelihood of reimbursement for the studies. The purpose of this project was to evaluate and improve the quality of clinical information provided on head CT requisitions from an urban emergency department (ED). In a prospective study conducted from July 2015 to May 2016, attending neuroradiologists evaluated 1100 randomly selected ED requisitions for unenhanced head CT, grading them for clinical and billing adequacy on a scale of 0-2. After acquisition of baseline data (400 studies), an intervention was performed that consisted of education of ED staff on the importance of clinical information in requisitions. A reminder slide was placed on a large screen in the ED staff working area with examples of appropriate history. Postintervention data (700 studies) were subsequently obtained. Mean scores and payment lag time before versus after the intervention were compared by Wilcoxon rank sum test. Statistically significant improvement was found in mean scores after the intervention for both clinical (1.32 to 1.43, p = 0.003) and billing (1.64 to 1.74, p = 0.02) adequacy categories. The percentage of studies with a score of 2 increased in both categories, and the percentages of 0 and 1 scores declined. There was a 21.1-day decrease in payment lag time (from 75.8 to 54.7 days, p < 0.0001). The quality of clinical information provided on imaging requisitions by ED faculty and residents improved after a fairly simple intervention. Billing efficiency improved, and payment lag time decreased substantially.

  10. Uncontrolled viral replication as a risk factor for non-AIDS severe clinical events in HIV-infected patients on long-term antiretroviral therapy: APROCO/COPILOTE (ANRS CO8) cohort study.

    Science.gov (United States)

    Ferry, Tristan; Raffi, François; Collin-Filleul, Fidéline; Dupon, Michel; Dellamonica, Pierre; Waldner, Anne; Strady, Christophe; Chêne, Geneviève; Leport, Catherine; Moing, Vincent Le

    2009-08-01

    To determine risk factor for non-AIDS severe clinical events in HIV-infected patients on long-term combination antiretroviral therapy (cART). A validation committee reviewed each severe clinical event that occurred in the APROCO/COPILOTE (ANRS CO8) cohort that enrolled 1281 patients in 1997-1999 at the initiation of cART containing protease inhibitor. Probability of the occurrence of a first non-AIDS, cART-related, and AIDS-defining event was estimated, and potential determinants were studied using Cox regression models. During a median follow-up of 7.3 years, the incidence of non-AIDS events was higher than that of cART-related and AIDS-defining events (10.5, 3.6, and 2.6 per 100 patient-years, respectively). Bacterial (mainly airway) infections were the most frequent non-AIDS events (23.4%) followed by non-AIDS-defining malignancies and cardiovascular events (both 9.5%). Factors independently associated with the occurrence of a first non-AIDS event were age >60 years [hazard ratio (HR) 2.1; 95% confidence interval (CI): 1.3 to 3.2] and CD4 4 log10 copies per milliliter at the time of the event (HR 1.9; 95% CI: 1.5 to 2.5). Optimization and permanent continuation of long-term antiretroviral therapy in HIV-infected patients is the best strategy to prevent or reduce the occurrence of non-AIDS severe morbidity.

  11. Clinical outcome endpoints in heart failure trials : a European Society of Cardiology Heart Failure Association consensus document

    NARCIS (Netherlands)

    Zannad, Faiez; Garcia, Angeles Alonso; Anker, Stefan D.; Armstrong, Paul W.; Calvo, Gonzalo; Cleland, John G. F.; Cohn, Jay N.; Dickstein, Kenneth; Domanski, Michael J.; Ekman, Inger; Filippatos, Gerasimos S.; Gheorghiade, Mihai; Hernandez, Adrian F.; Jaarsma, Tiny; Koglin, Joerg; Konstam, Marvin; Kupfer, Stuart; Maggioni, Aldo P.; Mebazaa, Alexandre; Metra, Marco; Nowack, Christina; Pieske, Burkert; Pina, Ileana L.; Pocock, Stuart J.; Ponikowski, Piotr; Rosano, Giuseppe; Ruilope, Luis M.; Ruschitzka, Frank; Severin, Thomas; Solomon, Scott; Stein, Kenneth; Stockbridge, Norman L.; Stough, Wendy Gattis; Swedberg, Karl; Tavazzi, Luigi; Voors, Adriaan A.; Wasserman, ScottM.; Woehrle, Holger; Zalewski, Andrew; McMurray, John J. V.

    2013-01-01

    Endpoint selection is a critically important step in clinical trial design. It poses major challenges for investigators, regulators, and study sponsors, and it also has important clinical and practical implications for physicians and patients. Clinical outcomes of interest in heart failure trials

  12. Brand Aid

    DEFF Research Database (Denmark)

    Richey, Lisa Ann; Ponte, Stefano

    A critical account of the rise of celebrity-driven “compassionate consumption” Cofounded by the rock star Bono in 2006, Product RED exemplifies a new trend in celebrity-driven international aid and development, one explicitly linked to commerce, not philanthropy. Brand Aid offers a deeply informed...

  13. Enfrentamento, aspectos clínicos e sociodemográficos de pessoas vivendo com HIV/Aids Coping, clinical and sociodemographic aspects of people living with HIV/Aids

    Directory of Open Access Journals (Sweden)

    Eliane Maria Fleury Seidl

    2005-12-01

    Full Text Available O estudo objetivou descrever as estrat��gias de enfrentamento adotadas por pessoas portadoras de HIV/Aids e identificar associações entre modalidades de enfrentamento e variáveis sociodemográficas (sexo, escolaridade e situação conjugal e médico-clínica (condição sintomática e assintomática. A amostra de conveniência foi composta de 241 pessoas soropositivas, 161 (66,8% homens, de 20 a 64 anos (M=37,4; DP=7,8, 169 (70,1% sintomáticas. A coleta de dados incluiu questionários estruturados e a Escala Modos de Enfrentamento de Problemas (EMEP, com aplicação individual assistida e preenchimento da EMEP sem a presença do pesquisador. Os resultados indicaram a variabilidade das estratégias de enfrentamento, com predomínio de enfrentamento focalizado no problema. Em mulheres e pessoas com níveis mais baixos de escolaridade predominaram enfrentamento focalizado na emoção e busca de práticas religiosas. Os resultados fornecem subsídios para a intervenção psicológica em se tratando de pessoas soropositivas. Limitações da conceituação e da avaliação do enfrentamento são discutidas, devendo ser consideradas em estudos futuros.The study aimed at describing coping strategies of people living with HIV/AIDS and identifying associations between modalities of coping and sociodemographic variables such as sex, schooling and marital status, as well as clinical ones (symptomatic versus asymptomatic conditions. A convenience sample was composed with 241 HIV+ people, 161 (66,8% were men between the ages of 20 and 64 (M=37,4, 169 (70,1% symptomatic. The instruments used included structured questionnaires and a Brazilian version of a scale for measure strategies of coping, with assisted application and fulfilling of scale without the presence of researchers. Results showed variability in the coping strategies used, with predomination of problem-focused coping. Amongst women and less educated individuals there was a prevalence of

  14. A large survey among European trainees in clinical microbiology and infectious disease on training systems and training adequacy: identifying the gaps and suggesting improvements.

    Science.gov (United States)

    Yusuf, E; Ong, D S Y; Martin-Quiros, A; Skevaki, C; Cortez, J; Dedić, K; Maraolo, A E; Dušek, D; Maver, P J; Sanguinetti, M; Tacconelli, E

    2017-02-01

    The purpose of this investigation was to perform a survey among European clinical microbiology (CM) and infectious disease (ID) trainees on training satisfaction, training tools, and competency assessment. An online, anonymous survey in the English language was carried out between April and July 2015. There were 25 questions: seven in a 5-point Likert scale (1: worst scenario, 5: best scenario) and the remainder as closed multiple-choice questions in five areas (satisfaction, adequacy, system, mentorship, and evaluation of training). Included were 419 respondents (215 CM, 159 ID, and 45 combined CM/ID) from 31 European countries [mean age (standard deviation) 32.4 (5.3) years, 65.9 % women]. Regarding satisfaction on the training scheme, CM and ID scored 3.6 (0.9) and 3.2 (1.0), respectively. These scores varied between countries, ranging from 2.5 (1.0) for Italian ID to 4.3 (0.8) for Danish CM trainees. The majority of respondents considered training in management and health economics inadequate and e-learning and continuing medical education programs insufficient. Many trainees (65.3 % of CM and 62.9 % of ID) would like to have more opportunities to spend a part of their training abroad and expected their mentor to be more involved in helping with future career plans (63.5 % of CM and 53.4 % of ID) and practical skills (53.0 % of CM and 61.2 % of ID). Two-thirds of the respondents across the specialties agreed that a European exam should be developed, but half of them thought it should not be made mandatory. This survey shows high heterogeneity in training conditions in European countries, identifies perceived gaps in training, and suggests areas for improvements.

  15. Core Outcome Domains for Clinical Trials on Somatic Symptom Disorder, Bodily Distress Disorder, and Functional Somatic Syndromes: European Network on Somatic Symptom Disorders Recommendations.

    Science.gov (United States)

    Rief, Winfried; Burton, Chris; Frostholm, Lisbeth; Henningsen, Peter; Kleinstäuber, Maria; Kop, Willem J; Löwe, Bernd; Martin, Alexandra; Malt, Ulrik; Rosmalen, Judith; Schröder, Andreas; Shedden-Mora, Meike; Toussaint, Anne; van der Feltz-Cornelis, Christina

    The harmonization of core outcome domains in clinical trials facilitates comparison and pooling of data, and simplifies the preparation and review of research projects and comparison of risks and benefits of treatments. Therefore, we provide recommendations for the core outcome domains that should be considered in clinical trials on the efficacy and effectiveness of interventions for somatic symptom disorder, bodily distress disorder, and functional somatic syndromes. The European Network on Somatic Symptom Disorders group of more than 20 experts in the field met twice in Hamburg to discuss issues of assessment and intervention research in somatic symptom disorder, bodily distress disorder, and functional somatic syndromes. The consensus meetings identified core outcome domains that should be considered in clinical trials evaluating treatments for somatic symptom disorder and associated functional somatic syndromes. The following core domains should be considered when defining ascertainment methods in clinical trials: a) classification of somatic symptom disorder/bodily distress disorder, associated functional somatic syndromes, and comorbid mental disorders (using structured clinical interviews), duration of symptoms, medical morbidity, and prior treatments; b) location, intensity, and interference of somatic symptoms; c) associated psychobehavioral features and biological markers; d) illness consequences (quality of life, disability, health care utilization, health care costs; e) global improvement and treatment satisfaction; and f) unwanted negative effects. The proposed criteria are intended to improve synergies of clinical trials and to facilitate decision making when comparing different treatment approaches. These recommendations should not result in inflexible guidelines, but increase consistency across investigations in this field.

  16. Ethical and practical challenges in implementing informed consent in HIV/AIDS clinical trials in developing or resource-limited countries.

    Science.gov (United States)

    Mystakidou, Kyriaki; Panagiotou, Irene; Katsaragakis, Stelios; Tsilika, Eleni; Parpa, Efi

    2009-09-01

    Ethical issues regarding HIV/AIDS human research in the developing world remain under continuous evaluation; a critical area of concern includes informed consent. This paper reviews several of the most important ethical and practical aspects of informed consent in HIV research in developing countries. Enhancement of overall understanding of such key issues might promote higher ethical standards of future research. The major objective was to address informed consent in human research in non-Western societies, and specifically in HIV clinical trials of affected adults. Secondary end-points included the consent complexities in HIV research involving vulnerable patient populations in resource-limited nations, such as children, adolescents and women. A systematic review of the published literature using MEDLINE and EMBASE from 1998 until December 2008 was performed, using the search terms 'HIV/AIDS', 'informed consent', 'clinical trials', 'developing world'. Ethical complexities such as participants' diminished autonomy, coercion or monetary inducement, language difficulties, illiteracy or lack of true understanding of the entire study, cultural barriers mainly due to communitarianism and social diversities were identified in the 44 studies reviewed. Informed consent of vulnerable patient populations must be tailored to their sex and developmental age, while counselling is fundamental. Children and adolescents' assent must be ensured. Local language is to be used, while trusted community leaders and local cultural representatives may convey information. Despite the heterogeneity of studies, similarities were identified. Providing adequate and comprehensive information and assessing the true understanding of the research represent fundamental prerequisites. Potential solutions to the critical areas of concern include peer counselling and meetings with local community leaders or local cultural representatives. International investigators of HIV human research should bear

  17. Epidemiologic and clinical characteristics of pregnant women living with HIV/AIDS in a region of Southern Brazil where the subtype C of HIV-1 infection predominates

    Directory of Open Access Journals (Sweden)

    Sandra Aparecida Manenti

    Full Text Available Southern Brazil has the highest prevalence rate of AIDS in the country and is the only region in the Americas where HIV-1 subtype C prevails. OBJECTIVE: We evaluated the epidemiologic and clinical characteristics of pregnant women living with HIV/AIDS in the South region of Santa Catarina, Brazil. METHODS: All pregnant women with HIV infection attending the obstetric outpatient clinic of Criciúma, State of Santa Catarina, in 2007 (n = 46 were invited to participate. Data of 36 eligible participants were obtained through a standardized questionnaire. RESULTS: The great majority were young, with a steady partner, low family income, low education level and referring early first sexual intercourse. Many reported use of illicit non-injecting drugs (55.5% and unprotected sex with partners that were HIV-positive (57.7%, injecting drug user (22.2%, male inmate (19.4%, truck driver (13.8%, with history of sexually transmitted disease (11.1% or men who have sex with men (MSM (2.8%. Most (66.7% of the participants had their HIV diagnosis done during the pregnancy, 7 (19.4% had a previous history of HIV mother-to-child transmission. Therapy based on highly active antiretroviral therapy (94% was initiated at 19.3 weeks on average and 33% showed irregular antiretroviral adherence. CONCLUSION: These results confirm previous data on HIV epidemiology in Brazil and suggest that the women partners' sexual behavior and unprotected sexual intercourse are important aspects of HIV epidemic. Additional efforts in education, prophylaxis and medication adherence are needed.

  18. Clinical implementation of an objective computer-aided protocol for intervention in intra-treatment correction using electronic portal imaging.

    Science.gov (United States)

    Van den Heuvel, F; De Neve, W; Verellen, D; Coghe, M; Coen, V; Storme, G

    1995-06-01

    In order to test the feasibility of a protocol for intra-fractional adjustment of the patient position, during radiation therapy treatment in the pelvic region, a two-fold study is carried out. The protocol involves an objective quantitative measurement of the error in positioning starting from the comparison of a portal image with a reference image. The first part of the study applies the protocol to determine the efficacy of adjustment using subjective determination of the positioning errors by a clinician by measuring the residual errors after adjustment. A group of 13 patients was followed extensively throughout their treatment, analyzing 240 fields. In the second part the measurement itself determines the extent of readjustment of the position. Throughout the procedure elapsed time is measured to determine the extra time involved in using this procedure. For this part a group of 21 patients was followed yielding statistics on 218 fields. Using this computer aided protocol it is shown that systematic as well as random errors can be reduced to standard deviations of the order of 1 mm. The price to pay however is additional treatment time up to 58% of the treatment time without the protocol. Time analysis shows that the largest part of the added time is spent on the readjustment of the patients' position adding a mean of 37% of time to the treatment of one field. This is despite the fact that the readjustment was performed using a remote couch controller. Finally a statistical analysis shows that it is possible to select patients benefiting from the use of such a protocol after a limited number of fractions.

  19. 'Mind the gap' between the development of therapeutic innovations and the clinical practice in oncology: A proposal of the European Organisation for Research and Treatment of Cancer (EORTC) to optimise cancer clinical research.

    Science.gov (United States)

    Kempf, Emmanuelle; Bogaerts, Jan; Lacombe, Denis; Liu, Lifang

    2017-11-01

    In Europe, most of the cancer clinical research dedicated to therapeutic innovations aims primarily at regulatory approval. Once an anticancer drug enters the common market, each member state determines its real-world use based on its own criteria: pricing, reimbursement and clinical indications. Such an innovation-centred clinical research landscape might neglect patient-relevant issues in real-world setting, such as comparative effectiveness of distinct treatment options or long-term safety monitoring. The European Organisation for Research and Treatment of Cancer (EORTC) advocates reforming the current 'innovation-centred' system to a truly 'patient-centred' paradigm with systematically coordinated applied clinical research in conjunction with drug development, featuring the following strategy. Copyright © 2017 Elsevier Ltd. All rights reserved.

  20. Prevalence and factors associated with probable HIV dementia in an African population: a cross-sectional study of an HIV/AIDS clinic population.

    Science.gov (United States)

    Nakku, Juliet; Kinyanda, Eugene; Hoskins, Susan

    2013-05-03

    The HIV/AIDS infection is common in sub-Saharan Africa and is associated with psychological and neuro- cognitive impairment. These conditions, however, remain largely unrecognized. In this study we aimed to determine the prevalence of probable HIV dementia (PHD) in an HIV clinic population in Uganda and to delineate the factors associated with such impairment in these HIV positive individuals. Six hundred eighty HIV clinic attendees were surveyed in a cross sectional study. PHD was assessed using the International Dementia Scale (IHDS). Standardized measures were also used to assess clinical, psychological, social and demographic variables. Respondents were aged 18 years and above and did not have severe physical or mental health conditions. Multivariate analysis was conducted to identify associations between PHD and various factors. The prevalence of probable HIV dementia was 64.4%. PHD was significantly associated with increasing stress scores and psychosocial impairment but not with age, BMI, CD4 count, use of HAART, or a diagnosis of depression or alcohol dependence. The prevalence of probable HIV dementia in an ambulatory adult HIV positive population in Uganda was 64.4%. Increasing stress scores and psychosocial impairment were significant contributing factors. Clinicians need to be aware of this and to make efforts to identify neuro-cognitive impairment. Secondly there is need for more studies to better understand the relationship between PHD and stress in HIV populations so as to inform patient care.

  1. Nutritional and clinical status, and dietary patterns of people living with HIV/AIDS in ambulatory care in Sao Paulo, Brazil.

    Science.gov (United States)

    Silva, Erika Ferrari Rafael; Lewi, David Salomão; Vedovato, Gabriela Milhassi; Garcia, Vânia Regina Salles; Tenore, Simone Barros; Bassichetto, Katia Cristina

    2010-12-01

    Nutrition currently plays a key role in the treatment of people living with HIV/AIDS (PLHA), especially in the case of metabolic alterations due to highly active antiretroviral therapy (HAART), which could be related to cardiovascular diseases (CD). to describe the nutritional and clinical status, and the quality of diet of PLHA. It is a cross-sectional study involving a network of ambulatory care facilities for PLHA in the city of São Paulo, Brazil. Patients, in use of HAART or not, were selected from December 2004 to may 2006, through routine clinic visits. We collected: socio-demographic, clinical, biochemical, anthropometric measures and dietary data. Diet quality was evaluated according to a "protecting" or "non-protecting" pattern of consumption scores for CD. The sample had 238 patients on HAART and 76 without treatment. Mean serum levels of total cholesterol, triglycerides and glucose were higher in the HAART group (p nutritional and metabolic conditions among patients on HAART associated with CD. It is necessary to manage health intervention programs for PLHA in order to control cardiovascular risk factors before final outcomes.

  2. Comment on: Martelletti et al. Refractory chronic migraine: a consensus statement on clinical definition from the European Headache Federation

    Science.gov (United States)

    2014-01-01

    In this letter, we present the Austrian proposal for diagnostic criteria of refractory chronic migraine and we discuss the consensensus statement of the European Headache Feaderation. We focus in particular on the definition of adequate prophylactic treatment, the management of medication overuse and the requirement for CSF analyses in patients with refractory chronic migraine. In our proposal, the criteria for adequate treatment and recommendations for dealing with medication overuse are more explicit than in the EHF proposal, whereas the requirements for CSF analyses and measurement of CSF pressure are not as strict. PMID:25418797

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

    Science.gov (United States)

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

    2015-02-01

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

  4. Emerging medical informatics with case-based reasoning for aiding clinical decision in multi-agent system.

    Science.gov (United States)

    Shen, Ying; Colloc, Joël; Jacquet-Andrieu, Armelle; Lei, Kai

    2015-08-01

    This research aims to depict the methodological steps and tools about the combined operation of case-based reasoning (CBR) and multi-agent system (MAS) to expose the ontological application in the field of clinical decision support. The multi-agent architecture works for the consideration of the whole cycle of clinical decision-making adaptable to many medical aspects such as the diagnosis, prognosis, treatment, therapeutic monitoring of gastric cancer. In the multi-agent architecture, the ontological agent type employs the domain knowledge to ease the extraction of similar clinical cases and provide treatment suggestions to patients and physicians. Ontological agent is used for the extension of domain hierarchy and the interpretation of input requests. Case-based reasoning memorizes and restores experience data for solving similar problems, with the help of matching approach and defined interfaces of ontologies. A typical case is developed to illustrate the implementation of the knowledge acquisition and restitution of medical experts. Copyright © 2015 Elsevier Inc. All rights reserved.

  5. Chronic obstructive pulmonary disease: Usefulness of clinical signs, bronchoalveolar lavage, and lung biopsy as diagnostic and prognostic aids

    Science.gov (United States)

    Naylor, Jonathan M.; Clark, Edward G.; Clayton, Hilary M.

    1992-01-01

    We examined 18 horses with clinical signs of chronic obstructive pulmonary disease (COPD) using physical examination, cytological and bacteriological evaluation of bronchoalveolar fluid, and percutaneous lung biopsy. In 16 cases, histological examination of lung tissue confirmed the diagnosis of COPD. Two horses were excluded: one had uncomplicated bacterial pneumonia and in the other a satisfactory lung biopsy could not be obtained. In horses with COPD, the most common historical complaint was coughing, which was reported in 88%. The most frequently detected abnormal finding on physical examination was abnormal lung sounds; these were detected in 69% of horses at rest and in 88% of horses breathing deeply into a bag. A novel finding was that 29% of horses had lung sounds that were quieter than would be expected for the degree of respiratory effort. Horses with COPD had increased percentages of neutrophils and decreased percentages of lymphocytes and macrophages in their bronchoalveolar lavage fluid. Bronchiolar neutrophil infiltration and peribronchiolar mast cell accumulation in lung biopsy tissue had the highest correlation with clinical condition. The severity of pathological changes in biopsies of lung did not predict whether the horse would die in the two to four year follow-up period. Horses that died in the follow-up period were more severely affected clinically at initial presentation than horses that were alive at the end of the follow-up period. PMID:17424075

  6. Repeated Measurement of Absolute and Relative Judgments of Loudness: Clinical Relevance for Prescriptive Fitting of Aided Target Gains for soft, Comfortable, and Loud, But Ok Sound Levels.

    Science.gov (United States)

    Formby, Craig; Payne, JoAnne; Yang, Xin; Wu, Delphanie; Parton, Jason M

    2017-02-01

    This study was undertaken with the purpose of streamlining clinical measures of loudness growth to facilitate and enhance prescriptive fitting of nonlinear hearing aids. Repeated measures of loudness at 500 and 3,000 Hz were obtained bilaterally at monthly intervals over a 6-month period from three groups of young adult listeners. All volunteers had normal audiometric hearing sensitivity and middle ear function, and all denied problems related to sound tolerance. Group 1 performed judgments of soft and loud, but OK for presentation of ascending sound levels. We defined these judgments operationally as absolute judgments of loudness. Group 2 initially performed loudness judgments across a continuum of seven loudness categories ranging from judgments of very soft to uncomfortably loud for presentation of ascending sound levels per the Contour Test of Loudness; we defined these judgments as relative judgments of loudness. In the same session, they then performed the absolute judgments for soft and loud, but OK sound levels. Group 3 performed the same set of loudness judgments as did group 2, but the task order was reversed such that they performed the absolute judgments initially within each test session followed by the relative judgments. The key findings from this study were as follows: (1) Within group, the absolute and relative tasks yielded clinically similar judgments for soft and for loud, but OK sound levels. These judgments were largely independent of task order, ear, frequency, or trial order within a given session. (2) Loudness judgments increased, on average, by ∼3 dB between the first and last test session, which is consistent with the commonly reported acclimatization effect reported for incremental changes in loudness discomfort levels as a consequence of chronic bilateral hearing aid use. (3) Measured and predicted comfortable judgments of loudness were in good agreement for the individual listener and for groups of listeners. These comfortable

  7. Rationale and clinical utility of the darunavir–cobicistat combination in the treatment of HIV/AIDS

    Directory of Open Access Journals (Sweden)

    Putcharoen O

    2015-10-01

    Full Text Available Opass Putcharoen,1 Tanya Do,2 Anchalee Avihingsanon,2 Kiat Ruxrungtham1,2 1Department of Medicine, Faculty of Medicine, Chulalongkorn University, 2The HIV Netherlands Australia Thailand (HIV-NAT Research Collaboration, The Thai Red Cross AIDS Research Center, Bangkok, Thailand Abstract: This article is to provide an update overview of cobicistat (COBI-boosted darunavir in response to its recent approval by the US Food and Drug Administration, and inclusion as an alternative first-line regime in the 2015 treatment guidelines in the US. COBI is a relatively new non-antiretroviral cytochrome P450 3A inhibitor or pharmacoenhancer. The rationale behind COBI development was to provide an alternative to ritonavir (RTV as a protease inhibitor pharmacoenhancer, due to associated adverse events with short- and long-term RTV use, such as gastrointestinal intolerability, drug–drug interactions, insulin resistance, lipodystrophy, and hyperlipidemia. Although in vitro studies suggest that COBI may result in a lower incidence of undesired drug–drug interactions and lipid-associated disorders than RTV, not all Phase III studies have well addressed these issues, and the data are limited. However, Phase III studies have demonstrated tolerability, noninferiority, and bioequivalence of COBI compared to RTV. Two main advantages of COBI over RTV-containing regimes have been noted as follows: 1 COBI has no anti-HIV activity; therefore, resistance to COBI as a booster in addition to protease inhibitor resistance is of little concern, allowing for COBI-containing regimes in future. 2 COBI’s solubility and dissolution rate allow for co-formulated/fixed-dose combination products. Nonetheless, prior to initiating COBI-containing treatment regimens, the following should be considered: 1 COBI may increase serum creatinine levels and reduce estimated glomerular filtration rate (GFR without affecting actual GFR; 2 potential drug–drug interaction data are insufficient

  8. Magnetic resonance imaging for the clinical management of rectal cancer patients: recommendations from the 2012 European Society of Gastrointestinal and Abdominal Radiology (ESGAR) consensus meeting

    Energy Technology Data Exchange (ETDEWEB)

    Beets-Tan, Regina G.H. [Maastricht University Medical Centre+, Maastricht (Netherlands); Maastricht University Medical Centre+, Department of Radiology, P.O. Box 5800, AZ, Maastricht (Netherlands); Lambregts, Doenja M.J.; Maas, Monique [Maastricht University Medical Centre+, Maastricht (Netherlands); Bipat, Shandra; Stoker, Jaap [Academic Medical Centre, Amsterdam (Netherlands); Barbaro, Brunella [Catholic University School of Medicine, Rome (Italy); Caseiro-Alves, Filipe; Curvo-Semedo, Luis [Coimbra University Hospitals, Coimbra (Portugal); Fenlon, Helen M. [Mater Misericordiae University Hospital, Dublin (Ireland); Gollub, Marc J. [Memorial Sloan-Kettering Cancer Center, New York (United States); Gourtsoyianni, Sofia [University Hospital of Heraklion, Crete (Greece); Guy' s and St. Thomas' NHS FT, London (United Kingdom); Halligan, Steve; Taylor, Stuart A. [University College London, Centre for Medical Imaging, London (United Kingdom); Hoeffel, Christine [Reims University Hospital, Reims (France); Kim, Seung Ho [Inje University Haeundae Paik Hospital, Busan (Korea, Republic of); Laghi, Andrea [Sapienza - University of Rome, Rome (Italy); Maier, Andrea [Medical University of Vienna, Vienna (Austria); Rafaelsen, Soeren R. [Vejle Hospital, Vejle (Denmark); Torkzad, Michael R. [Uppsala University, Uppsala (Sweden); Blomqvist, Lennart [Karolinska University Hospital and Karolinska Institutet, Stockholm (Sweden)

    2013-09-15

    To develop guidelines describing a standardised approach regarding the acquisition, interpretation and reporting of magnetic resonance imaging (MRI) for clinical staging and restaging of rectal cancer. A consensus meeting of 14 abdominal imaging experts from the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) was conducted following the RAND-UCLA Appropriateness Method. Two independent (non-voting) chairs facilitated the meeting. Two hundred and thirty-six items were scored by participants for appropriateness and classified subsequently as appropriate or inappropriate (defined by {>=} 80 % consensus) or uncertain (defined by < 80 % consensus). Items not reaching 80 % consensus were noted. Consensus was reached for 88 % of items: recommendations regarding hardware, patient preparation, imaging sequences, angulation, criteria for MRI assessment and MRI reporting were constructed from these. These expert consensus recommendations can be used as clinical guidelines for primary staging and restaging of rectal cancer using MRI. (orig.)

  9. A large multi-centre European study validates high-sensitivity C-reactive protein (hsCRP) as a clinical biomarker for the diagnosis of diabetes subtypes

    DEFF Research Database (Denmark)

    Thanabalasingham, G.; Shah, N.; Vaxillaire, M.

    2011-01-01

    An accurate molecular diagnosis of diabetes subtype confers clinical benefits; however, many individuals with monogenic diabetes remain undiagnosed. Biomarkers could help to prioritise patients for genetic investigation. We recently demonstrated that high-sensitivity C-reactive protein (hs......CRP) levels are lower in UK patients with hepatocyte nuclear factor 1 alpha (HNF1A)-MODY than in other diabetes subtypes. In this large multi-centre study we aimed to assess the clinical validity of hsCRP as a diagnostic biomarker, examine the genotype-phenotype relationship and compare different hsCRP assays....... High-sensitivity CRP levels were analysed in individuals with HNF1A-MODY (n = 457), glucokinase (GCK)-MODY (n = 404), hepatocyte nuclear factor 4 alpha (HNF4A)-MODY (n = 54) and type 2 diabetes (n = 582) from seven European centres. Three common assays for hsCRP analysis were evaluated. We excluded 121...

  10. The European Hematology Association Roadmap for European Hematology Research : A consensus document

    NARCIS (Netherlands)

    Engert, Andreas; Balduini, Carlo; Brand, Anneke; Coiffier, Bertrand; Cordonnier, Catherine; Döhner, Hartmut; de Wit, Thom Duyvené; Eichinger, Sabine; Fibbe, Willem; Green, Tony; de Haas, Fleur; Iolascon, Achille; Jaffredo, Thierry; Rodeghiero, Francesco; Salles, Gilles; Schuringa, Jan Jacob

    The European Hematology Association (EHA) Roadmap for European Hematology Research highlights major achievements in diagnosis and treatment of blood disorders and identifies the greatest unmet clinical and scientific needs in those areas to enable better funded, more focused European hematology

  11. The European Hematology Association Roadmap for European Hematology Research : a consensus document

    NARCIS (Netherlands)

    Engert, Andreas; Balduini, Carlo; Brand, Anneke; Coiffier, Bertrand; Cordonnier, Catherine; Döhner, Hartmut; de Wit, Thom Duyvené; Eichinger, Sabine; Fibbe, Willem; Green, Tony; de Haas, Fleur; Iolascon, Achille; Jaffredo, Thierry; Rodeghiero, Francesco; Salles, Gilles; Schuringa, Jan Jacob

    The European Hematology Association (EHA) Roadmap for European Hematology Research highlights major achievements in diagnosis and treatment of blood disorders and identifies the greatest unmet clinical and scientific needs in those areas to enable better funded, more focused European hematology

  12. Pulmonary embolism rule-out criteria (PERC) rule in European patients with low implicit clinical probability (PERCEPIC): a multicentre, prospective, observational study.

    Science.gov (United States)

    Penaloza, Andrea; Soulié, Caroline; Moumneh, Thomas; Delmez, Quentin; Ghuysen, Alexandre; El Kouri, Dominique; Brice, Christian; Marjanovic, Nicolas S; Bouget, Jacques; Moustafa, Fares; Trinh-Duc, Albert; Le Gall, Catherine; Imsaad, Lionel; Chrétien, Jean-Marie; Gable, Béatrice; Girard, Philippe; Sanchez, Olivier; Schmidt, Jeannot; Le Gal, Grégoire; Meyer, Guy; Delvau, Nicolas; Roy, Pierre-Marie

    2017-12-01

    The ability of the pulmonary embolism rule-out criteria (PERC) to exclude pulmonary embolism without further testing remains debated outside the USA, especially in the population with suspected pulmonary embolism who have a high prevalence of the condition. Our main objective was to prospectively assess the predictive value of negative PERC to rule out pulmonary embolism among European patients with low implicit clinical probability. We did a multicentre, prospective, observational study in 12 emergency departments in France and Belgium. We included consecutive patients aged 18 years or older with suspected pulmonary embolism. Patients were excluded if they had already been hospitalised for more than 2 days, had curative anticoagulant therapy in progress for more than 48 h, or had a diagnosis of thromboembolic disease documented before admission to emergency department. Physicians completed a standardised case report form comprising implicit clinical probability assessment (low, moderate, or high) and a list of risk factors including criteria of the PERC rule. They were asked to follow international recommendations for diagnostic strategy, masked to PERC assessment. The primary endpoint was the proportion of patients with low implicit clinical probability and negative PERC who had venous thromboembolic events, diagnosed during initial diagnostic work-up or during 3-month follow-up, as externally adjudicated by an independent committee masked to the PERC and clinical probability assessment. The upper limit of the 95% CI around the 3-month thromboembolic risk was set at 3%. We did all analyses by intention to treat, including all patients with complete follow-up. This trial is registered with ClinicalTrials.gov, number NCT02360540. Between May 1, 2015, and April 30, 2016, 1773 consecutive patients with suspected pulmonary embolism were prospectively assessed for inclusion, of whom 1757 were included. 1052 (60%) patients were classed as having low clinical probability

  13. Clinical use of quantitative cardiac perfusion PET: rationale, modalities and possible indications. Position paper of the Cardiovascular Committee of the European Association of Nuclear Medicine (EANM).

    Science.gov (United States)

    Sciagrà, Roberto; Passeri, Alessandro; Bucerius, Jan; Verberne, Hein J; Slart, Riemer H J A; Lindner, Oliver; Gimelli, Alessia; Hyafil, Fabien; Agostini, Denis; Übleis, Christopher; Hacker, Marcus

    2016-07-01

    Until recently, PET was regarded as a luxurious way of performing myocardial perfusion scintigraphy, with excellent image quality and diagnostic capabilities that hardly justified the additional cost and procedural effort. Quantitative perfusion PET was considered a major improvement over standard qualitative imaging, because it allows the measurement of parameters not otherwise available, but for many years its use was confined to academic and research settings. In recent years, however, several factors have contributed to the renewal of interest in quantitative perfusion PET, which has become a much more readily accessible technique due to progress in hardware and the availability of dedicated and user-friendly platforms and programs. In spite of this evolution and of the growing evidence that quantitative perfusion PET can play a role in the clinical setting, there are not yet clear indications for its clinical use. Therefore, the Cardiovascular Committee of the European Association of Nuclear Medicine, starting from the experience of its members, decided to examine the current literature on quantitative perfusion PET to (1) evaluate the rationale for its clinical use, (2) identify the main methodological requirements, (3) identify the remaining technical difficulties, (4) define the most reliable interpretation criteria, and finally (5) tentatively delineate currently acceptable and possibly appropriate clinical indications. The present position paper must be considered as a starting point aiming to promote a wider use of quantitative perfusion PET and to encourage the conception and execution of the studies needed to definitely establish its role in clinical practice.

  14. International Neurocognitive Normative Study: Neurocognitive Comparison Data in Diverse Resource Limited Settings: AIDS Clinical Trials Group A5271

    Science.gov (United States)

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

    2016-01-01

    Summary ACTG A5271 collected neurocognitive normative comparison test data in 2400 at-risk HIV seronegative participants from Brazil, India, Malawi, Peru, South Africa, Thailand and Zimbabwe. The participants were enrolled in strata by site (10 levels), age (2 levels), education (2 levels), and gender (2 levels). These data provide necessary normative data infrastructure for future clinical research and care in these diverse resource limited settings. Infrastructure for conducting neurological research in resource limited settings (RLS) is limited. The lack of neurological and neuropsychological (NP) assessment, and normative data needed for clinical interpretation impede research and clinical care. Here we report on ACTG 5271, which provided neurological training of clinical site personnel, and collected neurocognitive normative comparison data in diverse settings. At 10 sites in seven RLS countries, we provided training for NP assessments. We collected normative comparison data on HIV- participants from Brazil (n=240), India (n=480), Malawi (n=481), Peru (n=239), South Africa (480), Thailand (n=240) and Zimbabwe (n=240). Participants had a negative HIV test within 30 days before standardized NP exams were administered at baseline, and 770 at six-months. Participants were enrolled in 8 strata, gender (female and male), education (<10 years and ≥ 10 years), and age (<35 years and ≥35 years). Of 2400 enrolled, 770 completed the six-month follow up. As expected, significant between-country differences were evident in all the neurocognitive test scores (p<.0001). There was variation between the age, gender and education strata on the neurocognitive tests. Age and education were important variables for all tests; older participants had poorer performance and those with higher education had better performance. Women had better performance on verbal learning/memory and speed of processing tests, while men performed better on motor tests. This study provides the

  15. Survey of national guidelines, education and training on phlebotomy in 28 European countries: an original report by the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) working group for the preanalytical phase (WG-PA).

    Science.gov (United States)

    Simundic, Ana-Maria; Cornes, Michael; Grankvist, Kjell; Lippi, Giuseppe; Nybo, Mads; Kovalevskaya, Svjetlana; Sprongl, Ludek; Sumarac, Zorica; Church, Stephen

    2013-08-01

    European questionnaire survey was conducted by the European Federation of Clinical Chemistry and Laboratory Medicine Working Group for the Preanalytical Phase (EFLM WG-PA) to assess how phlebotomy is performed in EFLM countries, including differences in personnel, level of education and skills, and to investigate the presence and compliance of national phlebotomy guidelines on this matter. A questionnaire was constructed containing questions elucidating different aspects of the organization behind the phlebotomy praxis on a national basis, including questions on the staff performing phlebotomy, the education of these staff members, and the existence of and adherence to national guidelines. All 39 EFLM member countries were invited to participate. In total 28/39 (72%) EFLM member countries responded. Seven out of the 28 (25%) have national phlebotomy guidelines and five have implemented other guidelines. The estimated compliance with phlebotomy guidance for the laboratories in the countries that have national guidelines available is poor, regardless to whether the phlebotomy was under the laboratory control or not. Most countries were interested in EFLM guidelines and to participate in a pilot EFLM preanalytical phase external quality assessment (EQA) scheme. In the responding EFLM member countries, the majority of phlebotomy is performed by nurses and laboratory technicians. Their basic education is generally 4-5 years of high school, followed by 2-5 years of colleague or university studies. Only a third (10/28; 36%) of the participating member countries has any specific training available as a continuous educational resource. A specific training for phlebotomy is not part of the education required to become qualified in 6/28 (21%) and 9/28 (32%) of countries for nurses and laboratory technicians, respectively. In countries and professions where training is required, most require more than 5 h of training. Based on the results of this survey we conclude the

  16. Massive Access Control Aided by Knowledge-Extraction for Co-Existing Periodic and Random Services over Wireless Clinical Networks.

    Science.gov (United States)

    Du, Qinghe; Zhao, Weidong; Li, Weimin; Zhang, Xuelin; Sun, Bo; Song, Houbing; Ren, Pinyi; Sun, Li; Wang, Yichen

    2016-07-01

    The prosperity of e-health is boosted by fast development of medical devices with wireless communications capability such as wearable devices, tiny sensors, monitoring equipments, etc., which are randomly distributed in clinic environments. The drastically-increasing population of such devices imposes new challenges on the limited wireless resources. To relieve this problem, key knowledge needs to be extracted from massive connection attempts dispersed in the air towards efficient access control. In this paper, a hybrid periodic-random massive access (HPRMA) scheme for wireless clinical networks employing ultra-narrow band (UNB) techniques is proposed. In particular, the proposed scheme towards accommodating a large population of devices include the following new features. On one hand, it can dynamically adjust the resource allocated for coexisting periodic and random services based on the traffic load learned from signal collision status. On the other hand, the resource allocation within periodic services is thoroughly designed to simultaneously align with the timing requests of differentiated services. Abundant simulation results are also presented to demonstrate the superiority of the proposed HPRMA scheme over baseline schemes including time-division multiple access (TDMA) and random access approach, in terms of channel utilization efficiency, packet drop ratio, etc., for the support of massive devices' services.

  17. HIV / AIDS

    Science.gov (United States)

    ... in the United States and the international community. Globally, AIDS-related deaths have dropped by 45 percent ... Career Stage Postdocs' Guide to Gaining Independence Small Business Programs Compare NIAID’s Small Business Programs High-Priority ...

  18. Patient-Centered Decision Support: Formative Usability Evaluation of Integrated Clinical Decision Support With a Patient Decision Aid for Minor Head Injury in the Emergency Department.

    Science.gov (United States)

    Melnick, Edward R; Hess, Erik P; Guo, George; Breslin, Maggie; Lopez, Kevin; Pavlo, Anthony J; Abujarad, Fuad; Powsner, Seth M; Post, Lori A

    2017-05-19

    The Canadian Computed Tomography (CT) Head Rule, a clinical decision rule designed to safely reduce imaging in minor head injury, has been rigorously validated and implemented, and yet expected decreases in CT were unsuccessful. Recent work has identified empathic care as a key component in decreasing CT overuse. Health information technology can hinder the clinician-patient relationship. Patient-centered decision tools to support the clinician-patient relationship are needed to promote evidence-based decisions. Our objective is to formatively evaluate an electronic tool that not only helps clinicians at the bedside to determine the need for CT use based on the Canadian CT Head Rule but also promotes evidence-based conversations between patients and clinicians regarding patient-specific risk and patients' specific concerns. User-centered design with practice-based and participatory decision aid development was used to design, develop, and evaluate patient-centered decision support regarding CT use in minor head injury in the emergency department. User experience and user interface (UX/UI) development involved successive iterations with incremental refinement in 4 phases: (1) initial prototype development, (2) usability assessment, (3) field testing, and (4) beta testing. This qualitative approach involved input from patients, emergency care clinicians, health services researchers, designers, and clinical informaticists at every stage. The Concussion or Brain Bleed app is the product of 16 successive iterative revisions in accordance with UX/UI industry design standards. This useful and usable final product integrates clinical decision support with a patient decision aid. It promotes shared use by emergency clinicians and patients at the point of care within the emergency department context. This tablet computer app facilitates evidence-based conversations regarding CT in minor head injury. It is adaptable to individual clinician practice styles. The resultant tool

  19. [Thread-moxa in Zhuang folk medicine combined with acupuncture and external application drugs on AIDS patients with herpes zoster: a clinical observation].

    Science.gov (United States)

    Liu, Zhen-wei; Mo, Jin-hua; Pang, Jun; Deng, Xin

    2013-08-01

    To observe the efficacy of thread-moxa in Zhuang folk medicine (TM) combined with acupuncture and external application drugs for AIDS patients with herpes zoster (AHZ). A randomized, controlled clinical trial was conducted in 60 patients with AHZ. They were randomly assigned to the treatment group (treated with TM combined with acupuncture and Jingwanhong Scald Ointment) and the control group (treated with Famciclovir Tablet, nimesulide dispersible tablet, vitamin B1, ribavirin ointment). The treatment course was 14 days for both groups.The clinical efficacy, significant efficiency visual analog scale score (VAS), sleep quality score (QS), the postherpetic neuralgia rate in 1 year after treatment were observed. The markedly effective rate was significantly higher in the treatment group than in the control group (86.7% vs. 53.3%, P vs. 80.0%, P > 0.05). The post-treatment VAS, QS, the time for pain disappearance, skin repair, crusting, and 1-year postherpetic neuralgia incidence rate were significantly lower in the treatment group than in the control group (P acupuncture and Jingwanhong Scald Ointment was effective for treating AHZ patients. It relieved pain quickly, shortened their course of disease, and improved their quality of sleep.

  20. Magnitude of Anemia and Associated Factors among Pediatric HIV/AIDS Patients Attending Zewditu Memorial Hospital ART Clinic, Addis Ababa, Ethiopia

    Directory of Open Access Journals (Sweden)

    Hylemariam Mihiretie

    2015-01-01

    Full Text Available Background. Anemia is one of the most commonly observed hematological abnormalities and an independent prognostic marker of HIV disease. The aim of this study was to determine the magnitude of anemia and associated factors among pediatric HIV/AIDS patients attending Zewditu Memorial Hospital (ZMH ART Clinic in Addis Ababa, Ethiopia. Methods. A cross-sectional study was conducted among pediatric HIV/AIDS patients of Zewditu Memorial Hospital (ZMH between August 05, 2013, and November 25, 2013. A total of 180 children were selected consecutively. Stool specimen was collected and processed. A structured questionnaire was used to collect data on sociodemographic characteristics and associated risk factors. Data were entered into EpiData 3.1.1. and were analyzed using SPSS version 16 software. Logistic regressions were applied to assess any association between explanatory factors and outcome variables. Results. The total prevalence of anemia was 22.2% where 21 (52.5%, 17 (42.5%, and 2 (5.0% patients had mild, moderate, and severe anemia. There was a significant increase in severity and prevalence of anemia in those with CD4+ T cell counts below 350 cells/μL (P<0.05. Having intestinal parasitic infections (AOR = 2.7, 95% CI, 1.1–7.2, having lower CD4+ T cell count (AOR = 3.8, 95% CI, 1.6–9.4, and being HAART naïve (AOR = 2.3, 95% CI, 1.6–9.4 were identified as significant predictors of anemia. Conclusion. Anemia was more prevalent and severe in patients with low CD4+ T cell counts, patients infected with intestinal parasites/helminthes, and HAART naïve patients. Therefore, public health measures and regular follow-up are necessary to prevent anemia.

  1. Typical investigational medicinal products follow relatively uniform regulations in 10 European Clinical Research Infrastructures Network (ECRIN) countries

    DEFF Research Database (Denmark)

    Gluud, Christian; Kubiak, Christine; Whitfield, Kate

    2012-01-01

    In order to facilitate multinational clinical research, regulatory requirements need to become international and harmonised. The EU introduced the Directive 2001/20/EC in 2004, regulating investigational medicinal products in Europe.......In order to facilitate multinational clinical research, regulatory requirements need to become international and harmonised. The EU introduced the Directive 2001/20/EC in 2004, regulating investigational medicinal products in Europe....

  2. Psychosocial Aspects of HIV and AIDS and the Evaluation of Preventive Strategies: Report on a WHO Meeting (Lisbon, Portugal, May 28-June 1, 1990). WHO Regional Publications, European Series, No. 36.

    Science.gov (United States)

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

    The spread of Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) depends very much on the way people behave. Individuals from some groups have been successfully persuaded to modify behaviors that put them at increased risk of HIV infection. The salient questions for future AIDS prevention and control programs are…

  3. AIDS IN DENTISTRY

    African Journals Online (AJOL)

    prompted the use of half body irradiation in epidemic Kaposi's sarcoma. literature has scanty informotion on irradiation of ... J.A.M.A., 252: 934.935,1984. 3 .. 4. Harri" J.W., Reed, lA, Kapo,i', sarcoma in AIDS: ... There has been laxity in standards of infection control not only in dental clinics but in general health care system.

  4. Prediction of deep vein thrombosis after elective hip replacement surgery by preoperative clinical and haemostatic variables: the ECAT DVT Study. European Concerted Action on Thrombosis.

    Science.gov (United States)

    Lowe, G D; Haverkate, F; Thompson, S G; Turner, R M; Bertina, R M; Turpie, A G; Mannucci, P M

    1999-06-01

    The European Concerted Action on Thrombosis (ECAT) DVT Study was a collaborative study of preoperative haemostatic tests in prediction of DVT (diagnosed by routine bilateral venography) after elective hip replacement. 480 patients were recruited in 11 centres across Europe. Clinical risk factors were assessed, and stored citrated plasma aliquots were centrally assayed for 29 haemostatic factors according to the ECAT methodology. 120 (32%) of 375 evaluable patients had DVT, and 41 (11%) had proximal DVT. Among clinical variables, DVT was significantly associated with increased age, obesity, and possibly non-use of stockings. Of the 29 haemostatic factors, mean preoperative levels were significantly higher in patients with subsequent DVT (on univariate analyses) for factor VIII activity, prothrombin fragment F1+2, thrombin-antithrombin complexes, and fibrin D-dimer; and significantly lower for APTT and APC sensitivity ratio. Factor V Leiden was also associated with DVT. Most of these variables were also associated with age, while D-dimer was higher in patients with varicose veins. On multivariate analyses including clinical variables, only a shorter APTT (locally but not centrally performed) and APC resistance showed a statistically significant association with DVT. We conclude that (a) DVT is common after elective hip replacement despite prophylaxis; (b) the study provides some evidence that DVT is associated with a preoperative hypercoaguable state; and (c) preoperative haemostatic tests do not add significantly to prediction of DVT from clinical variables, with the possible exception of APC resistance.

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

    Science.gov (United States)

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

    2016-09-01

    Patient safety is a leading challenge in healthcare and from the laboratory perspective it is now well established that preanalytical errors are the major contributor to the overall rate of diagnostic and therapeutic errors. To address this, the European Federation of Clinical Chemistry and Laboratory Medicine Working Group for Preanalytical Phase (EFLM WG-PRE) was established to lead in standardization and harmonization of preanalytical policies and practices at a European level. One of the key activities of the WG-PRE is the organization of the biennial EFLM-BD conference on the preanalytical phase to provide a forum for National Societies (NS) to discuss their issues. Since 2012, a year after the first Preanalytical phase conference, there has been a rapid growth in the number of NS with a working group engaged in preanalytical phase activities and there are now at least 19 countries that have one. As a result of discussions with NS at the third conference held in March 2015 five key areas were identified as requiring harmonisation. These were test ordering, sample transport and storage, patient preparation, sampling procedures and management of unsuitable specimens. The article below summarises the work that has and will be done in these areas. The goal of this initiative is to ensure the EFLM WG-PRE produces work that meets the needs of the European laboratory medicine community. Progress made in the identified areas will be updated at the next preanalytical phase conference and show that we have produced guidance that has enhanced standardisation in the preanalytical phase and improved patient safety throughout Europe. © The Author(s) 2016.

  6. Developing a New Computer-Aided Clinical Decision Support System for Prediction of Successful Postcardioversion Patients with Persistent Atrial Fibrillation.

    Science.gov (United States)

    Sterling, Mark; Huang, David T; Ghoraani, Behnaz

    2015-01-01

    We propose a new algorithm to predict the outcome of direct-current electric (DCE) cardioversion for atrial fibrillation (AF) patients. AF is the most common cardiac arrhythmia and DCE cardioversion is a noninvasive treatment to end AF and return the patient to sinus rhythm (SR). Unfortunately, there is a high risk of AF recurrence in persistent AF patients; hence clinically it is important to predict the DCE outcome in order to avoid the procedure's side effects. This study develops a feature extraction and classification framework to predict AF recurrence patients from the underlying structure of atrial activity (AA). A multiresolution signal decomposition technique, based on matching pursuit (MP), was used to project the AA over a dictionary of wavelets. Seven novel features were derived from the decompositions and were employed in a quadratic discrimination analysis classification to predict the success of post-DCE cardioversion in 40 patients with persistent AF. The proposed algorithm achieved 100% sensitivity and 95% specificity, indicating that the proposed computational approach captures detailed structural information about the underlying AA and could provide reliable information for effective management of AF.

  7. AIDS: the hidden enemy.

    Science.gov (United States)

    Tinker, J; Sabatier, R

    1987-01-01

    This article discusses the acquired immunodeficiency syndrome (AIDS) epidemic an its effect on developing countries, with emphasis on Africa. The AIDS death toll will be high in the US: 180,000 by 1991, but it will be in the millions in developing countries. In Africa, AIDS is mainly transmitted heterosexually, is as prevalent among women as among men, and is taking a serious toll among professional classes and young wage earners. The social costs of funerals has increased, and company clinics and sick pay funds have been overwhelmed. In Uganda, the epidemic adds to the state of psychological shock people have sufferred because of the civil war. Medical professionals have been hard-pressed to acquire equipment for testing blood for the virus, although there have been efforts to protect blood supplies through exhaustive testing. Endemic tuberculosis becomes an even more serious problem in developing countries, since AIDS lowers resistance to it. AIDS also effects many developing country children, usually through infected mothers, who can transmit AIDS through breast milk or during pregnancy of birth. This poses a dilemma for promoters of breastfeeding. It is also feared that innoculation of immunosuppressed children may be dangerous. The global picture suggests that Africa is hardest hit: seropositivity prevalence ranges from 0.7% of Congo blood donors to 33% of male donors in Lusaka Zambia. Brazil's cases are mainly homosexual, and in Asia the prevalence is mostly low, although there is a great potential danger in countries where prostitution and heroin addiction are prevalent. The only effective weapon against AIDS is education and blood testing to prevent spread. Despite good education programs in some countries, e.g. Rwanda, there is still widespread ignorance of how AIDS is spread.

  8. Achieving 2003 European lipid goals with rosuvastatin and comparator statins in 6743 patients in real-life clinical practice: DISCOVERY meta-analysis.

    Science.gov (United States)

    Middleton, A; Binbrek, A S; Fonseca, F A H; Wilpshaar, W; Watkins, C; Strandberg, T E

    2006-06-01

    There is an increasing body of evidence to support the benefits of reducing low-density lipoprotein cholesterol (LDL-C) levels and this has been reflected in a lowering of LDL-C goals recommended by international guidelines. Therefore, there is a growing need for effective lipid-modifying therapies to optimise the achievement of these more stringent LDL-C goals. A meta-analysis of data pooled from five studies participating in the DISCOVERY (DIrect Statin COmparison of LDL-C Values: an Evaluation of Rosuvastatin therapY) Programme was performed to compare the effect of rosuvastatin treatment with other statins in real-life clinical practice. These studies included 6743 patients with hypercholesterolaemia from different ethnicities, countries and cultural environments. The meta-analysis showed that significantly more patients receiving rosuvastatin 10 mg achieved the 2003 European LDL-C goals compared with those who received atorvastatin 10 mg or simvastatin 20 mg (p patients receiving rosuvastatin 10 mg also achieved the 2003 European total cholesterol goal compared with those on atorvastatin 10 mg (p patients to achieve lipid goals at recommended start doses. In addition, all statins studied were well tolerated and confirmed that rosuvastatin had a similar safety profile to other statins.

  9. Practices in security and confidentiality of HIV/AIDS patients' information: A national survey among staff at HIV outpatient clinics in Vietnam.

    Directory of Open Access Journals (Sweden)

    Nguyen Khac Hai

    Full Text Available Breach of confidentiality or invasion of privacy from the collection and use of medical records, particularly those of patients with HIV/AIDS or other diseases sensitive to stigmatization, should be prevented by all related stakeholders in healthcare settings. The main focus of this study was to assess practices regarding security and confidentiality of HIV-related information among staff at HIV outpatient clinics (HIV-OPCs in Vietnam.A descriptive cross-sectional study was conducted at all 312 HIV-OPCs across the country using an online survey technique.In general, the staff practices for securing and protecting patient information were at acceptable levels. Most staff had proper measures and practices for maintaining data security; however, the protection of patient confidentiality, particularly for data access, sharing, and transfer still required improvement. Most HIV-OPC staff had good or moderate knowledge and positive perceptions towards security and confidentiality issues. Staff who were not trained in the practice of security measures differed significantly from those who were trained (OR: 3.74; 95%CI: 1.44-9.67; staff needing improved knowledge levels differed significantly from those with good (OR: 5.20; 95%CI: 2.39-11.32 and moderate knowledge levels (OR: 5.10; 95%CI: 2.36-11.00; and staff needing improved perception levels differed significantly from those with good (i.e., with 100% proper practices and moderate perception levels (OR: 5.67; 95%CI: 2.93-10.95. Staff who were not trained in the protection of data confidentiality differed significantly from those who were trained (OR: 2.18; 95%CI: 1.29-3.65.Training is an important factor to help raise the levels of proper practices regarding confidentiality and security, to improve knowledge and raise awareness about change among staff. The operation and management of HIV treatment and care in Vietnam are currently transitioning from separate healthcare clinics (HIV-OPC into units

  10. Patient-reported outcomes among patients using exenatide twice daily or insulin in clinical practice in six European countries

    DEFF Research Database (Denmark)

    Reaney, Matthew; Mathieu, Chantal; Ostenson, Claes-Göran

    2013-01-01

    countries. Patients initiated exenatide twice daily (BID) or insulin based on a physician's clinical judgement. Clinical and PRO data were collected at baseline (injectable therapy initiation) and after approximately 3, 6, 12, 18 and 24 months. The two treatment cohorts had different baseline......BACKGROUND: Improvements in the clinical condition of patients with type 2 diabetes are often accompanied by improvements in health-related quality of life and other patient-reported outcomes (PROs), but data assessing injectable treatment initiation from the patient's perspective in routine...... characteristics; therefore, no statistical comparisons of endpoints between main cohorts were conducted. RESULTS: There were 2388 patients eligible for analysis (exenatide BID cohort, n = 1114; insulin cohort, n = 1274). Mean positive changes in Impact of Weight on Quality of Life-Lite (IWQOL-Lite) total score...

  11. Clinical presentation of parvovirus B19 infection in HIV-infected patients with and without AIDS Manifestações clínicas da infecção por parvovírus B19 em pacientes HIV-positivos com e sem AIDS

    Directory of Open Access Journals (Sweden)

    Sérgio Setúbal

    2003-04-01

    Full Text Available Human parvovirus B19 replicates in erythrocyte precursors. Usually, there are no apparent hematological manifestations. However, in individuals with high erythrocyte turnover, as in patients with sickle-cell disease and in the fetus, the infection may lead to severe transient aplasia and hydrops fetalis, respectively. In AIDS patients, persistent infection may result in chronic anemia. By contrast, in HIV-positive patients without AIDS the infection evolves as a mild exanthematous disease. Two clinical descriptions exemplify these forms of presentation. In the first, an AIDS patient presented with bone marrow failure that responded to immunoglobulin. In the second, an HIV-positive patient without AIDS had a morbilliform rash, and needed no treatment. Knowing that an AIDS patient has chronic B19 anemia lessens concern about drug anemia; protects the patient from invasive diagnostic maneuvers; and prevents the patient from disseminating the infection. In AIDS patients with pure red cell aplasia, a search for parvovirus B19 DNA in the serum or in the bone marrow is warranted.O parvovírus B19 replica-se em precursores eritróides. Não há geralmente manifestações hematológicas aparentes. Entretanto, nas altas taxas de reposição de eritrócitos, como as que ocorrem na anemia falciforme ou no feto, a infecção pode resultar, respectivamente, em aplasia transitória e hidropisia fetal. Em pacientes com AIDS, a infecção persistente pode resultar em anemia crônica. Já num paciente HIV-positivo sem AIDS, a infecção evolui como uma doença exantemática leve. Duas descrições exemplificam estas diferentes modalidades de apresentação clínica. Na primeira, um paciente com AIDS apresentou aplasia medular que respondeu a imunoglobulina. Na segunda, um paciente HIV-positivo sem AIDS apresentou um exantema morbiliforme, que cedeu sem tratamento. Diagnosticar a anemia crônica por B19 diminui as preocupações infundadas sobre anemia por drogas

  12. Three-dimensional imaging provides valuable clinical data to aid in unilateral tissue expander-implant breast reconstruction.

    Science.gov (United States)

    Tepper, Oren M; Karp, Nolan S; Small, Kevin; Unger, Jacob; Rudolph, Lauren; Pritchard, Ashley; Choi, Mihye

    2008-01-01

    The current approach to breast reconstruction remains largely subjective and is based on physical examination and visual-estimates of breast size. Thus, the overall success of breast reconstruction is limited by the inability of plastic surgeons to objectively assess breast volume and shape, which may result in suboptimal outcomes. A potential solution to this obstacle may be three-dimensional (3D) imaging, which can provide unique clinical data that was previously unattainable to plastic surgeons. The following study represents a prospective analysis of patient volunteers undergoing unilateral tissue expander (TE)-implant reconstruction by one of the two senior authors (MC, NSK). All patients underwent unilateral mastectomy with immediate or delayed insertion of a TE, followed by an exchange for a permanent silicone or saline implant. 3D scans were obtained during routine pre- and postoperative office visits. The 3D breast-volume calculations served as a guide for surgical management. Twelve patients have completed 3D-assisted unilateral breast reconstruction to date. These patients represent a wide range of body habitus and breast size/shape; 3D volume range from 136 to 518 cm(3). The mean baseline breast asymmetry in this group was 12.0 +/- 10.8%. Contralateral symmetry procedures were performed in eleven patients, consisting of the following: mastopexy (n = 6), augmentation (n = 1), mastopexy/augmentation (n = 2), and reduction mammoplasty (n = 2). Reconstruction was completed in a total number of 2 (n = 10) or 3 (n = 2) operations. Overall breast symmetry improved at the completion of reconstruction in the majority of patients, with an average postoperative symmetry of 95.1 +/- 4.4% (relative to 88% preoperatively). 3D imaging serves a valuable adjunct to TE-implant breast reconstruction. This technology provides volumetric data that can help guide breast reconstruction, such as in choosing the initial TE size, total volume of expansion, and final implant size

  13. Subclinical atherosclerosis among HIV-infected adults attending HIV/AIDS care at two large ambulatory HIV clinics in Uganda.

    Science.gov (United States)

    Ssinabulya, Isaac; Kayima, James; Longenecker, Chris; Luwedde, Mary; Semitala, Fred; Kambugu, Andrew; Ameda, Faith; Bugeza, Sam; McComsey, Grace; Freers, Juergen; Nakanjako, Damalie

    2014-01-01

    The increased immune activation and inflammation of chronic HIV-infection and the characteristic dyslipidemias associated with HIV infection and antiretroviral therapy (ART) contribute to an increased risk of atherosclerotic vascular disease among HIV-infected adults. There is an emerging need to understand determinants of cardiovascular disease (CVD) among individuals aging with HIV in sub-Saharan Africa. We determined the prevalence of subclinical atherosclerosis [carotid intima media thickness (CIMT) ≥ 0.78 mm] and its correlation with traditional CVD risk factors among HIV-infected adults. In a cross-sectional study, HIV-infected adults (ART-naïve and ART-treated) were consecutively selected from patients' enrollment registers at two large HIV clinics at Mulago Hospital, Kampala, Uganda. We measured traditional CVD risk factors including age, biophysical profile, fasting blood sugar and serum lipid profile as well as biomarkers of inflammation. High resolution ultrasound was used to measure common carotid CIMT. Of 245 patients, Median age [Interquartile range (IQR)] 37 years (31-43), 168 (69%) were females; and 100 (41%) were ART-treated for at least 7 years. Overall, 34/186 (18%) had subclinical atherosclerosis; of whom 15/108 (14%) were ART-naïve whereas 19/78 (24%) were ART-treated. Independent predictors of subclinical atherosclerosis included age [odds ratio (OR) 1.83 per 5-year increase in age; 95% confidence interval (CI) 1.24-2.69; p = 0.002], body mass index (BMI); OR 1.15; CI 1.01-1.31; p = 0.041 and high low density lipoprotein (LDL) [OR 2.99; CI 1.02-8.78, p = 0.046]. High sensitivity C-reactive protein (hsCRP) was positively correlated with traditional cardio-metabolic risk factors including waist circumference (r = 0.127, p = 0.05), triglycerides (r = 0.19, p = 0.003) and Total Cholesterol: High Density Lipoprotein ratio (TC:LDL) (r = 0.225, pUganda. Traditional CVD risk factors were associated with subclinical atherosclerosis. We recommend

  14. Subclinical atherosclerosis among HIV-infected adults attending HIV/AIDS care at two large ambulatory HIV clinics in Uganda.

    Directory of Open Access Journals (Sweden)

    Isaac Ssinabulya

    Full Text Available The increased immune activation and inflammation of chronic HIV-infection and the characteristic dyslipidemias associated with HIV infection and antiretroviral therapy (ART contribute to an increased risk of atherosclerotic vascular disease among HIV-infected adults. There is an emerging need to understand determinants of cardiovascular disease (CVD among individuals aging with HIV in sub-Saharan Africa. We determined the prevalence of subclinical atherosclerosis [carotid intima media thickness (CIMT ≥ 0.78 mm] and its correlation with traditional CVD risk factors among HIV-infected adults.In a cross-sectional study, HIV-infected adults (ART-naïve and ART-treated were consecutively selected from patients' enrollment registers at two large HIV clinics at Mulago Hospital, Kampala, Uganda. We measured traditional CVD risk factors including age, biophysical profile, fasting blood sugar and serum lipid profile as well as biomarkers of inflammation. High resolution ultrasound was used to measure common carotid CIMT.Of 245 patients, Median age [Interquartile range (IQR] 37 years (31-43, 168 (69% were females; and 100 (41% were ART-treated for at least 7 years. Overall, 34/186 (18% had subclinical atherosclerosis; of whom 15/108 (14% were ART-naïve whereas 19/78 (24% were ART-treated. Independent predictors of subclinical atherosclerosis included age [odds ratio (OR 1.83 per 5-year increase in age; 95% confidence interval (CI 1.24-2.69; p = 0.002], body mass index (BMI; OR 1.15; CI 1.01-1.31; p = 0.041 and high low density lipoprotein (LDL [OR 2.99; CI 1.02-8.78, p = 0.046]. High sensitivity C-reactive protein (hsCRP was positively correlated with traditional cardio-metabolic risk factors including waist circumference (r = 0.127, p = 0.05, triglycerides (r = 0.19, p = 0.003 and Total Cholesterol: High Density Lipoprotein ratio (TC:LDL (r = 0.225, p<0.001.The prevalence of subclinical atherosclerosis was 18% among HIV-infected adults in Uganda

  15. Fiscal state aid and real estate collective investment vehicles (CIVs)

    NARCIS (Netherlands)

    Vermeulen, H.

    2011-01-01

    State aid is an issue that does not immediately come to mind on the topic of real estate collective investment vehicles (CIVs). Nevertheless the question of state aid plays an important role. Last year, the European Commission charged with the monitoring of state aid has taken an important decision

  16. Evaluating the short-term and long-term effects of an internet-based aural rehabilitation programme for hearing aid users in general clinical practice : a randomised controlled trial.

    OpenAIRE

    Malmberg, Milijana; Lunner, Thomas; Kähäri, Kim; Andersson, Gerhard

    2017-01-01

    OBJECTIVE: Guided internet-based intervention beyond hearing aid (HA) fitting has been shown to be efficacious in randomised controlled trials (RCTs). However, internet interventions have rarely been applied clinically as a part of regular aural rehabilitation (AR). Our aim was to evaluate the effectiveness of internet-based AR for HA users from a clinical population. OUTCOME MEASURES: The Hearing Handicap Inventory for the Elderly (HHIE) was used as the primary outcome measure, and the Commu...

  17. Development of a checklist of quality indicators for clinical trials in resource-limited countries: the French National Agency for Research on AIDS and Viral Hepatitis (ANRS) experience.

    Science.gov (United States)

    Hanna, Mina; Minga, Albert; Fao, Paulin; Borand, Laurence; Diouf, Assane; Mben, Jean-Marc; Gad, Rita R; Anglaret, Xavier; Bazin, Brigitte; Chene, Geneviève

    2013-04-01

    Since 1994, the French National Agency for Research on AIDS and Viral Hepatitis (ANRS) has funded research sites in resource-limited countries (RLCs). These sites implement research on human immunodeficiency virus (HIV) infection and Hepatitis C. In parallel, international regulations and recommendations for clinical trials have evolved and proliferated. However, little guidance exists on how these should be interpreted and applied within academic trials and in the context of RLCs. After developing a specific Ethical Charter for research in developing countries in 2002, ANRS developed a set of quality indicators (QIs) as a monitoring tool for assessing compliance to international guidelines. We describe here the development process, QIs adopted, and areas for improvement. In 2008, a group of experts was convened that included a researcher representing each ANRS site (Cote d'Ivoire, Senegal, Cameroun, Burkina Faso, Egypt, and Cambodia). Our structuring interaction development process combined evidence and expert opinion in two nominal group meetings to identify (1) clinical trial processes involved, (2) issues specific to RLCs in terms of Good Clinical Practice (GCP) and the application of ethical recommendations, and (3) checklists of QIs adapted to clinical trials conducted in RLCs. The trial process reviewed and proposed for RLCs was mostly similar to the one produced in wealthier countries. The scheme generated by our work group added two further processes: 'drug management' and 'biological investigations'. Specific issues regarding trial management in RLCs were therefore described for eight trial steps (1) protocol conception and seeking authorizations, (2) participant enrollment and follow-up, (3) site monitoring, (4) drug management, (5) biological investigations, (6) record management, (7) data management, and (8) site closeout. A total of 58 indicators were identified with at least one indicator for each trial process. Some trial activities require further

  18. Improving decision making about clinical trial participation - a randomised controlled trial of a decision aid for women considering participation in the IBIS-II breast cancer prevention trial

    National Research Council Canada - National Science Library

    Juraskova, I; Butow, P; Bonner, C; Bell, M L; Smith, A B; Seccombe, M; Boyle, F; Reaby, L; Cuzick, J; Forbes, J F

    2014-01-01

    .... This study investigated whether decision aids (DAs) can reduce decisional difficulties among women considering participation in the International Breast Cancer Intervention Study-II (IBIS-II) trial...

  19. State aid in banking sector

    Directory of Open Access Journals (Sweden)

    Jana Mikušová

    2012-01-01

    Full Text Available The financial crisis has hit Europe with a truly unprecedented power, which has in early 2008 expected only a very small circle of pessimists. After the first cracks began to appear on the mortgage market in the U.S., however, started an avalanche that rolls until today. In today’s globalized world, it would be very naive to believe that this would not have an impact on the European Union internal market.With the crisis in the banking sector, the Member States of the European Union fought against the crisis in various ways. Allocation of the state aid in the first months of the crisis took place within the existing rules, yet it was necessary to enclose these huge expenditures by rules and regulations issued by the European Commission.This article discusses the types of state aid, which were used at the time from the first wave of state aid granted by Member States from 2008 to 2010 and also assess the current situation together with the evaluation of the approach of the European Commission.

  20. Rapid detection and subtyping of European swine influenza viruses in porcine clinical samples by haemagglutinin- and neuraminidase-specific tetra- and triplex real-time RT-PCRs

    DEFF Research Database (Denmark)

    Henritzi, Dinah; Zhao, Na; Starick, Elke

    2016-01-01

    Background A diversifying pool of mammalian-adapted influenza A viruses (IAV) with largely unknown zoonotic potential is maintained in domestic swine populations worldwide. The most recent human influenza pandemic in 2009 was caused by a virus with genes originating from IAV isolated from swine....... Swine influenza viruses (SIV) are widespread in European domestic pig populations and evolve dynamically. Knowledge regarding occurrence, spread and evolution of potentially zoonotic SIV in Europe is poorly understood. Objectives Efficient SIV surveillance programmes depend on sensitive and specific...... algorithm is proposed for the combined detection in clinical samples and subtyping of SIV strains currently circulating in Europe that is based on a generic, M-gene-specific influenza A virus RT-qPCR. In a second step, positive samples are examined by tetraplex HA- and triplex NA-specific RT...

  1. Management of acute intestinal failure: A position paper from the European Society for Clinical Nutrition and Metabolism (ESPEN) Special Interest Group.

    Science.gov (United States)

    Klek, Stanislaw; Forbes, Alastair; Gabe, Simon; Holst, Mette; Wanten, Geert; Irtun, Øivind; Damink, Steven Olde; Panisic-Sekeljic, Marina; Pelaez, Rosa Burgos; Pironi, Loris; Blaser, Annika Reintam; Rasmussen, Henrik Højgaard; Schneider, Stéphane M; Thibault, Ronan; Visschers, Ruben G J; Shaffer, Jonathan

    2016-12-01

    Intestinal failure (IF) is the consequence of a reduction of gut function below the minimum necessary for the absorption of nutrients from the gastrointestinal tract. Types I and II comprise acute intestinal failure (AIF). Although its prevalence is relatively low, type II AIF is serious and requires specialist multidisciplinary care, often for prolonged periods before its resolution. The key aspects are: sepsis control, fluid and electrolyte resuscitation, optimization of nutritional status, wound care, appropriate surgery and active rehabilitation. The ESPEN Acute Intestinal Failure Special Interest Group (AIF SIG) has devised this position paper to provide a state-of-the-art overview of the management of type II AIF and to point out areas for future research. Copyright © 2016 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

  2. Types of Hearing Aids

    Science.gov (United States)

    ... Consumer Devices Consumer Products Hearing Aids Types of Hearing Aids Share Tweet Linkedin Pin it More sharing ... are some features for hearing aids? What are hearing aids? Hearing aids are sound-amplifying devices designed ...

  3. Cost-benefit assessment of using electronic health records data for clinical research versus current practices: Contribution of the Electronic Health Records for Clinical Research (EHR4CR) European Project.

    Science.gov (United States)

    Beresniak, Ariel; Schmidt, Andreas; Proeve, Johann; Bolanos, Elena; Patel, Neelam; Ammour, Nadir; Sundgren, Mats; Ericson, Mats; Karakoyun, Töresin; Coorevits, Pascal; Kalra, Dipak; De Moor, Georges; Dupont, Danielle

    2016-01-01

    The widespread adoption of electronic health records (EHR) provides a new opportunity to improve the efficiency of clinical research. The European EHR4CR (Electronic Health Records for Clinical Research) 4-year project has developed an innovative technological platform to enable the re-use of EHR data for clinical research. The objective of this cost-benefit assessment (CBA) is to assess the value of EHR4CR solutions compared to current practices, from the perspective of sponsors of clinical trials. A CBA model was developed using an advanced modeling approach. The costs of performing three clinical research scenarios (S) applied to a hypothetical Phase II or III oncology clinical trial workflow (reference case) were estimated under current and EHR4CR conditions, namely protocol feasibility assessment (S1), patient identification for recruitment (S2), and clinical study execution (S3). The potential benefits were calculated considering that the estimated reduction in actual person-time and costs for performing EHR4CR S1, S2, and S3 would accelerate time to market (TTM). Probabilistic sensitivity analyses using Monte Carlo simulations were conducted to manage uncertainty. Should the estimated efficiency gains achieved with the EHR4CR platform translate into faster TTM, the expected benefits for the global pharmaceutical oncology sector were estimated at €161.5m (S1), €45.7m (S2), €204.5m (S1+S2), €1906m (S3), and up to €2121.8m (S1+S2+S3) when the scenarios were used sequentially. The results suggest that optimizing clinical trial design and execution with the EHR4CR platform would generate substantial added value for pharmaceutical industry, as main sponsors of clinical trials in Europe, and beyond. Copyright © 2015 Elsevier Inc. All rights reserved.

  4. European initiative for the application of the International Classification of Functioning, Disability and Health: development of Clinical Assessment Schedules for specified rehabilitation services.

    Science.gov (United States)

    Prodinger, Birgit; Scheel-Sailer, Anke; Escorpizo, Reuben; Stucki, Gerold

    2017-04-01

    Clinical assessment schedule (CLAS) is a core part of the ICF-based implementation of functioning reporting across health conditions and along the continuum of care. The Physical and Rehabilitation Medicine Section and Board of the European Union of Medical Specialists (UEMS PRM) workshop held in January 2016 aimed to develop and specify a CLAS within the context of rehabilitation services. UEMS PRM Workshop in Nottwil, Switzerland, January 2016. PRM physicians representatives from 12 European countries, as well as Israel and Japan, mostly delegates of UEMS PRM Section and Board, and experts with other rehabilitation professional backgrounds. Participants were divided into 6 working groups and asked to specify what functioning aspects would be essential to document using the available ICF sets for the identified rehabilitation services contained in the newly developed service classification (ICSO-R): acute, post-acute and long-term rehabilitation services. The 7 ICF Generic and 23 Rehabilitation Set categories were confirmed as well as specific health condition categories for acute rehabilitation services (mobile team), for postacute rehabilitation services (general outpatient rehabilitation, musculoskeletal and neurological rehabilitation, as well as specialized SCI rehabilitation), and for long-term rehabilitation services (day clinic and rehabilitation provided in the community). While general principles of the CLAS were defined, the need to align the CLAS for a specific service, as well as across services along the continuum of care was highlighted. All groups deliberated on this topic; however, no conclusive statement was presented yet. The groups recognized a need for a systematic effort to identify data collection tools currently used. CLASs will serve in the future to ensure that functioning information is systematically and consistently collected across services, and thus respond also to various global reports and initiatives which stress the need for

  5. Extranodal NK/T-cell lymphoma, nasal type (ENKTL-NT): An update on epidemiology, clinical presentation, and natural history in North American and European cases

    Science.gov (United States)

    Haverkos, Bradley M.; Pan, Zenggang; Gru, Alejandro A.; Freud, Aharon G.; Rabinovitch, Rachel; Xu-Welliver, Meng; Otto, Brad; Barrionuevo, Carlos; Baiocchi, Robert A.; Rochford, Rosemary; Porcu, Pierluigi

    2016-01-01

    Extranodal NK/T-cell lymphoma, nasal type (ENKTL-NT) is an aggressive extranodal non-Hodgkin lymphoma most commonly occurring in East Asia and Latin America but with increasing incidence in the U.S. Data on epidemiology, disease presentation, and outcome for European and North American (“Western”) cases are very limited. We review published landmark clinical studies on ENKTL-NT in the West and report in detail recent data, including our institutional experience. We highlight key observations in its epidemiology, natural history, and trends in clinical management. In the U.S., ENKTL-NT is more common among Asian Pacific Islanders (API) and Hispanics compared to non-Hispanic whites. Published studies indicate less heterogeneity in clinical presentation in Western ENKTL-NT compared to Asian patients. While there is variation in age at diagnosis, presence of antecedent lymphoproliferative disorders, and outcomes among racial/ethnic groups, the universal association of ENKTL-NT with EBV and the poor response of this neoplasm to anthracycline-based therapy are consistent across all geographic areas. PMID:27778143

  6. Self-reported adherence to antiretroviral medications among participants in HIV clinical trials: the AACTG adherence instruments. Patient Care Committee & Adherence Working Group of the Outcomes Committee of the Adult AIDS Clinical Trials Group (AACTG).

    Science.gov (United States)

    Chesney, M A; Ickovics, J R; Chambers, D B; Gifford, A L; Neidig, J; Zwickl, B; Wu, A W

    2000-06-01

    This paper describes the AACTG Adherence Instruments, which are comprised of two self-report questionnaires for use in clinical trials conducted by the Adult AIDS Clinical Trials Group (AACTG). The questionnaires were administered to 75 patients at ten AACTG sites in the USA. All patients were taking combination antiretroviral therapy (ART), including at least one protease inhibitor. Eleven per cent of patients reported missing at least one dose the day before the interview, and 17% reported missing at least one dose during the two days prior. The most common reasons for missing medications included 'simply forgot' (66%) and a number of factors often associated with improved health, including being busy (53%), away from home (57%) and changes in routine (51%). Less adherent patients reported lower adherence self-efficacy (p = 0.006) and were less sure of the link between non-adherence and the development of drug resistance (p = 0.009). They were also more likely to consume alcohol, to be employed outside the home for pay and to have enrolled in clinical trials to gain access to drugs (all p USA and abroad.

  7. Bone-anchored hearing aids in patients with acquired and congenital unilateral inner ear deafness (Baha CROS): clinical evaluation of 56 cases.

    Science.gov (United States)

    Hol, Myrthe K S; Kunst, Sylvia J W; Snik, Ad F M; Bosman, Arjan J; Mylanus, Emmanuel A M; Cremers, Cor W R J

    2010-07-01

    We performed an evaluation of the audiological and subjective benefits of the bone-anchored hearing aid (Baha) as a device for transcranial routing of sound (Baha CROS) in 56 patients with unilateral inner ear deafness. We performed a prospective clinical follow-up study in a tertiary referral center. Previously reported results of 29 patients were supplemented with a second series of 30 patients with unilateral inner ear deafness; 3 patients dropped out during the evaluation. Audiometric measurements were taken before and after Baha CROS fitting. Subjective benefits were quantified with 4 different patient questionnaires. The sound localization results in a well-structured test setting were not differentiable from chance. The 5 patients with congenital hearing loss showed better scores in the unaided sound localization measurements. Overall, most patients reported some subjective improvement in their capacity to localize sounds with the Baha CROS in daily life. The main effect of the Baha CROS was to alleviate the head shadow effect during the speech-in-noise test. Poor sound localization in this larger series of patients confirms the findings of previous studies. Improvements in the speech-in-noise scores corroborated the efficacy of the Baha CROS in alleviating the head shadow effect. The 4 different patient questionnaires revealed subjective benefit and satisfaction in various domains.

  8. Pulmonary complications of AIDS: radiologic features. [AIDS

    Energy Technology Data Exchange (ETDEWEB)

    Cohen, B.A.; Pomeranz, S.; Rabinowitz, J.G.; Rosen, M.J.; Train, J.S.; Norton, K.I.; Mendelson, D.S.

    1984-07-01

    Fifty-two patients with pulmonary complications of acquired immunodeficiency syndrome (AIDS) were studied over a 3-year period. The vast majority of the patients were homosexual; however, a significant number were intravenous drug abusers. Thirteen different organisms were noted, of which Pneumocystis carinii was by far the most common. Five patients had neoplasia. Most patients had initial abnormal chest films; however, eight patients subsequently shown to have Pneumocystis carinii pneumonia had normal chest films. A significant overlap in chest radiographic findings was noted among patients with different or multiple organisms. Lung biopsy should be an early consideration for all patients with a clinical history consistent with the pulmonary complications of AIDS. Of the 52 patients, 41 had died by the time this report was completed.

  9. European communion

    DEFF Research Database (Denmark)

    Manners, Ian James

    2013-01-01

    Political theory of European union, through an engagement between political concepts and theoretical understandings, provides a means of identifying the EU as a political object. It is argued that understanding the projects, processes and products of European union, based on ‘sharing’ or ‘communion......’, provides a better means of perceiving the EU as a political object rather than terms such as ‘integration’ or ‘co-operation’. The concept of ‘European communion’ is defined as the ‘subjective sharing of relationships’, understood as the extent to which individuals or groups believe themselves to be sharing...... relations (or not), and the consequences of these beliefs for European political projects, processes and products. By exploring European communion through an engagement with contemporary political theory, using very brief illustrations from the Treaty of Lisbon, the article also suggests that European...

  10. PUBLIC FINANCIAL AIDS - STATE FINANCIAL SUPPORT POLICY

    Directory of Open Access Journals (Sweden)

    POPEANGĂ VASILE

    2012-12-01

    Full Text Available State aid represents selective measures of public financial support granted for activities or areas to achieve general objectives, such as environmental protection, development of SMEs, development of disadvantaged areas, rescue and restructuring strategic businesses, etc. But, even if the public authorities support economic development, the state aids can distort normal competitive environment. It is therefore necessary to develop and implement precisely rules on how the public authorities can intervene on market by providing state aids. State aid may be compatible if it pursues clearly defined objectives of common interest with the general beneficial effects on economic development, and does not affect the trade between European Union Member States.

  11. Improved Neuropsychological and Neurological Functioning Across Three Antiretroviral Regimens in Diverse Resource-Limited Settings: AIDS Clinical Trials Group Study A5199, the International Neurological Study

    Science.gov (United States)

    Robertson, K.; Jiang, H.; Kumwenda, J.; Supparatpinyo, K.; Evans, S.; Campbell, T. B.; Price, R.; Tripathy, S.; Kumarasamy, N.; La Rosa, A.; Santos, B.; Silva, M. T.; Montano, S.; Kanyama, C.; Faesen, S.; Murphy, R.; Hall, C.; Marra, C. M.; Marcus, C.; Berzins, B.; Allen, R.; Housseinipour, M.; Amod, F.; Sanne, I.; Hakim, J.; Walawander, A.; Nair, A.

    2012-01-01

    Background. AIDS Clinical Trials Group (ACTG) A5199 compared the neurological and neuropsychological (NP) effects of 3 antiretroviral regimens in participants infected with human immunodeficiency virus type 1 (HIV-1) in resource-limited settings. Methods. Participants from Brazil, India, Malawi, Peru, South Africa, Thailand, and Zimbabwe were randomized to 3 antiretroviral treatment arms: A (lamivudine-zidovudine plus efavirenz, n = 289), B (atazanavir, emtricitabine, and didanosine-EC, n = 293), and C (emtricitabine-tenofovir-disoproxil fumarate plus efavirenz, n = 278) as part of the ACTG PEARLS study (A5175). Standardized neurological and neuropsychological (NP) screening examinations (grooved pegboard, timed gait, semantic verbal fluency, and finger tapping) were administered every 24 weeks from February 2006 to May 2010. Associations with neurological and neuropsychological function were estimated from linear and logistic regression models using generalized estimating equations. Results. The median weeks on study was 168 (Q1 = 96, Q3 = 192) for the 860 participants. NP test scores improved (P  .10). Significant country effects were noted on all NP tests and neurological outcomes (P < .01). Conclusions. The study detected no significant differences in neuropsychological and neurological outcomes between randomized ART regimens. Significant improvement occurred in neurocognitive and neurological functioning over time after initiation of ARTs. The etiology of these improvements is likely multifactorial, reflecting reduced central nervous system HIV infection, better general health, and practice effects. This study suggests that treatment with either of the World Health Organization –recommended first-line antiretroviral regimens in resource-limited settings will improve neuropsychological functioning and reduce neurological dysfunction. Clinical trials registration.  NCT00096824. PMID:22661489

  12. A survey of paediatric HIV programmatic and clinical management practices in Asia and sub-Saharan Africa--the International epidemiologic Databases to Evaluate AIDS (IeDEA).

    Science.gov (United States)

    2013-01-15

    There are limited data on paediatric HIV care and treatment programmes in low-resource settings. A standardized survey was completed by International epidemiologic Databases to Evaluate AIDS paediatric cohort sites in the regions of Asia-Pacific (AP), Central Africa (CA), East Africa (EA), Southern Africa (SA) and West Africa (WA) to understand operational resource availability and paediatric management practices. Data were collected through January 2010 using a secure, web-based software program (REDCap). A total of 64,552 children were under care at 63 clinics (AP, N=10; CA, N=4; EA, N=29; SA, N=10; WA, N=10). Most were in urban settings (N=41, 65%) and received funding from governments (N=51, 81%), PEPFAR (N=34, 54%), and/or the Global Fund (N=15, 24%). The majority were combined adult-paediatric clinics (N=36, 57%). Prevention of mother-to-child transmission was integrated at 35 (56%) sites; 89% (N=56) had access to DNA PCR for infant diagnosis. African (N=40/53) but not Asian sites recommended exclusive breastfeeding up until 4-6 months. Regular laboratory monitoring included CD4 (N=60, 95%), and viral load (N=24, 38%). Although 42 (67%) sites had the ability to conduct acid-fast bacilli (AFB) smears, 23 (37%) sites could conduct AFB cultures and 18 (29%) sites could conduct tuberculosis drug susceptibility testing. Loss to follow-up was defined as >3 months of lost contact for 25 (40%) sites, >6 months for 27 sites (43%) and >12 months for 6 sites (10%). Telephone calls (N=52, 83%) and outreach worker home visits to trace children lost to follow-up (N=45, 71%) were common. In general, there was a high level of patient and laboratory monitoring within this multiregional paediatric cohort consortium that will facilitate detailed observational research studies. Practices will continue to be monitored as the WHO/UNAIDS Treatment 2.0 framework is implemented.

  13. Tuberculosis in AIDS Patients

    Science.gov (United States)

    Nissapatorn, Veeranoot; Lee, Christopher; Ithoi, Init; Yik, Fong Mun; Abdullah, Khairul Anuar

    2003-01-01

    Tuberculosis is the top agenda among opportunistic diseases and the most leading cause of death in HIV/AIDS patients. A total of 406 AIDS patients were recruited in this retrospective and descriptive study. 123/406 (30.3%) were diagnosed as AIDS-related tuberculosis (TB). Their age range from 17 to 69 years with a mean (±SD) of 37.2 (±9.51. There were significant association between occupation, or mode of HIV transmission and tuberculosis infection (p< 0.05). Pulmonary tuberculosis 104/123 (84.6%) was the most common disease location among TB patients. We found the significant association between the clinical presentations i.e. fever, cough, sputum or hemoptysis and TB patients (p<0.05), moreover, the level of CD4 cell count plays a significant role in association with the disease (p<0.05) in this study. PMID:23365502

  14. Determinants of utilization of a no-cost HIV transition clinic: a cross-sectional study of young adults living with HIV/AIDS

    Directory of Open Access Journals (Sweden)

    Nyabigambo A

    2014-05-01

    =0.27, 95% CI =0.15–0.47; and not receiving counseling services (AOR =0.47, 95% CI =0.27–0.83. Regular utilization of the HTC by YALHA was low and utilization seems to be influenced by HIV infection stage and HIV counseling services, but not sociodemographic factors or community factors.Keywords: transition clinic, HIV/AIDS, young adults, service utilization, Uganda

  15. En Route towards European Clinical Breakpoints for Veterinary Antimicrobial Susceptibility Testing: A Position Paper Explaining the VetCAST Approach

    Directory of Open Access Journals (Sweden)

    Pierre-Louis Toutain

    2017-12-01

    Full Text Available VetCAST is the EUCAST sub-committee for Veterinary Antimicrobial Susceptibility Testing. Its remit is to define clinical breakpoints (CBPs for antimicrobial drugs (AMDs used in veterinary medicine in Europe. This position paper outlines the procedures and reviews scientific options to solve challenges for the determination of specific CBPs for animal species, drug substances and disease conditions. VetCAST will adopt EUCAST approaches: the initial step will be data assessment; then procedures for decisions on the CBP; and finally the release of recommendations for CBP implementation. The principal challenges anticipated by VetCAST are those associated with the differing modalities of AMD administration, including mass medication, specific long-acting product formulations or local administration. Specific challenges comprise mastitis treatment in dairy cattle, the range of species and within species breed considerations and several other variable factors not relevant to human medicine. Each CBP will be based on consideration of: (i an epidemiological cut-off value (ECOFF – the highest MIC that defines the upper end of the wild-type MIC distribution; (ii a PK/PD breakpoint obtained from pre-clinical pharmacokinetic data [this PK/PD break-point is the highest possible MIC for which a given percentage of animals in the target population achieves a critical value for the selected PK/PD index (fAUC/MIC or fT > MIC] and (iii when possible, a clinical cut-off, that is the relationship between MIC and clinical cure. For the latter, VetCAST acknowledges the paucity of such data in veterinary medicine. When a CBP cannot be established, VetCAST will recommend use of ECOFF as surrogate. For decision steps, VetCAST will follow EUCAST procedures involving transparency, consensus and independence. VetCAST will ensure freely available dissemination of information, concerning standards, guidelines, ECOFF, PK/PD breakpoints, CBPs and other relevant information

  16. Back-calculation and projection of the HIV/AIDS epidemic among homosexual/ bisexual men in three European countries: evalution of past projections and updates allowing for treatment effects.

    Science.gov (United States)

    Artzrouni, Marc

    2004-01-01

    This study critically evaluates the quality of 1990 back-calculations and long-term projections of the HIV/AIDS epidemic for homosexual/bisexual men in France, the Federal Republic of Germany, and the UK. The projection captured the general pattern observed in all three countries although the observed AIDS incidence peaked 2-3 years later and declined faster than had been projected. Total AIDS incidences from 1989 to 2000 were overestimated by 38.5% in France, and underestimated by 23.9 and 17.5% in western Germany and the UK. Updated back-calculations and projections to 2020 use AIDS incidence data up to 2000. The procedure incorporates an asymmetric long-tailed cumulative HIV curve as well as the increase in the median incubation period brought about by new therapies introduced during the 1990s. The results suggest that: (i) The rapid decrease in cases during the late 1990s was caused by a median incubation period that increased from 10 years to 21-23 years by the late 1990s. (ii) An imminent bottoming out followed by a protracted increase in