Learning disabilities in Darier's disease patients.

Science.gov (United States)

Dodiuk-Gad, R; Lerner, M; Breznitz, Z; Cohen-Barak, E; Ziv, M; Shani-Adir, A; Amichai, B; Zlotogorski, A; Shalev, S; Rozenman, D

2014-03-01

Neuropsychiatric features and intellectual difficulties have been reported in studies of Darier's disease. Learning disabilities have never been reported or evaluated systematically in these patients. To assess the prevalence of learning disabilities in 76 patients with Darier's disease, and cognitive functioning in 19 of them. The data were collected by two methods: a questionnaire, as part of a larger study on the clinical characteristics of 76 patients; and neuropsychological measures for the assessment of learning disabilities in 19 of them. Thirty-one of the 76 patients reported learning disabilities (41%) and 56 (74%) reported a family history of learning disabilities. Significant differences were found between the 19 patients evaluated on cognitive tasks and a control group of 42 skilled learners on subtraction and multiplication tasks. Six (32%) of the 19 were identified as having reading difficulties and five (26%) exhibited low performance on the Concentration Performance Test. All patients had general cognitive ability in the average range. Findings suggest an association between Darier's disease and learning disabilities, a heretofore unreported association, pointing to the need to obtain personal and family history of such disabilities in order to refer cases of clinical concern for further study. © 2013 The Authors Journal of the European Academy of Dermatology and Venereology © 2013 European Academy of Dermatology and Venereology.

Machine learning of big data in gaining insight into successful treatment of hypertension.

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Koren, Gideon; Nordon, Galia; Radinsky, Kira; Shalev, Varda

2018-06-01

Despite effective medications, rates of uncontrolled hypertension remain high. Treatment protocols are largely based on randomized trials and meta-analyses of these studies. The objective of this study was to test the utility of machine learning of big data in gaining insight into the treatment of hypertension. We applied machine learning techniques such as decision trees and neural networks, to identify determinants that contribute to the success of hypertension drug treatment on a large set of patients. We also identified concomitant drugs not considered to have antihypertensive activity, which may contribute to lowering blood pressure (BP) control. Higher initial BP predicts lower success rates. Among the medication options and their combinations, treatment with beta blockers appears to be more commonly effective, which is not reflected in contemporary guidelines. Among numerous concomitant drugs taken by hypertensive patients, proton pump inhibitors (PPIs), and HMG CO-A reductase inhibitors (statins) significantly improved the success rate of hypertension. In conclusions, machine learning of big data is a novel method to identify effective antihypertensive therapy and for repurposing medications already on the market for new indications. Our results related to beta blockers, stemming from machine learning of a large and diverse set of big data, in contrast to the much narrower criteria for randomized clinic trials (RCTs), should be corroborated and affirmed by other methods, as they hold potential promise for an old class of drugs which may be presently underutilized. These previously unrecognized effects of PPIs and statins have been very recently identified as effective in lowering BP in preliminary clinical observations, lending credibility to our big data results.

The patient as experience broker in clinical learning.

Science.gov (United States)

Stockhausen, Lynette J

2009-05-01

A review of the literature reveals deficit information on patient's involvement in student's learning. The study presented in this paper investigates how the educationally unprepared patient engages with students and experienced clinicians to become involved in learning and teaching encounters. As a qualitative study 14 adult patients were interviewed to determine how they perceived experienced clinicians and students engage in learning and teaching moments and how the patient contributes to students learning to care. Revealed is a new and exciting dimension in learning and teaching in the clinical environment. Patients as experience brokers are positioned in a unique learning triad as they mediate and observe teaching and learning to care between students and experienced clinicians whilst also becoming participants in teaching to care. Further investigation is warranted to determine the multi-dimensional aspects of patients' involvement in student learning in various clinical environments. Future studies have the potential to represent a new educational perspective (andragogy).

Procedural Memory: Computer Learning in Control Subjects and in Parkinson’s Disease Patients

Directory of Open Access Journals (Sweden)

C. Thomas-Antérion

1996-01-01

Full Text Available We used perceptual motor tasks involving the learning of mouse control by looking at a Macintosh computer screen. We studied 90 control subjects aged between sixteen and seventy-five years. There was a significant time difference between the scales of age but improvement was the same for all subjects. We also studied 24 patients with Parkinson's disease (PD. We observed an influence of age and also of educational levels. The PD patients had difficulties of learning in all tests but they did not show differences in time when compared to the control group in the first learning session (Student's t-test. They learned two or four and a half times less well than the control group. In the first test, they had some difficulty in initiating the procedure and learned eight times less well than the control group. Performances seemed to be heterogeneous: patients with only tremor (seven and patients without treatment (five performed better than others but learned less. Success in procedural tasks for the PD group seemed to depend on the capacity to initiate the response and not on the development of an accurate strategy. Many questions still remain unanswered, and we have to study different kinds of implicit memory tasks to differentiate performance in control and basal ganglia groups.

E-learning for medical education: reflections of learners on patients.

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Walsh, Kieran

2018-01-01

There is a growing research interest in how healthcare professionals learn online. This paper reports an analysis of reflections that relate to patients from users of an e-learning resource, BMJ Learning. Healthcare professionals who use BMJ Learning are encouraged to reflect on their learning. Over one year, all of the learners' reflections that related to patients were captured by the programme's software and were analysed using thematic analysis. A number of key themes emerged from this analysis: many learners reflected on patients in the context of their disease; many learners reflected on how they had put their learning into action or planned to put their learning into action for the benefit of patients; many learners reflected on how they would pass on what they had learned to patients; learners greatly appreciated patients contributing to the learning. Learners predominantly reflect about patients in the context of their disease. The reflections demonstrate that learners are keen to put their learning into action for the benefit of their patients. Learners' reflections show a keen interest in the patient-centredness of the learning resources.

Clinical and ethical implications of placebo effects: enhancing patients' benefits from pain treatment.

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Klinger, Regine; Flor, Herta

2014-01-01

Expectancy and learning are the core psychological mechanisms of placebo analgesia. They interact with further psychological processes such as emotions and motivations (e.g., anxiety, desire for relief), somatic focus, or cognitions (e.g., attitudes toward the treatment). The development of placebo responsiveness and the actual placebo response in a person is the result of the complex interaction between factors traced back to the individual learning history related to analgesic drugs or treatments and factors of the current context referring to the analgesic or placebo treatment. The aim of this chapter is to depict these complex interactions in a new model of analgesic placebo effects. It joins aspects of the learning history (preexisting experiences and preexisting expectations) of a patient with aspects of the current context (current expectation as a result of external and internal situation in which a pain medication/treatment/placebo is taken, e.g., current information about pain medication, current specific context/cues, desire for pain relief, certainty about upcoming pain relief, current expectation about pain reducing course, current selective attention, increased pain experience, or decreased pain experience). In order to exploit placebo efficacy for an analgesic treatment it is worthwhile to assess in which direction each of these factors exerts its influence in order to maximize placebo effects for a specific patient. By applying placebo mechanisms in this differentiated way, the efficacy of pain treatment can be deliberately boosted.

The effectiveness of integration of virtual patients in a collaborative learning activity.

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Marei, Hesham F; Donkers, Jeroen; Van Merrienboer, Jeroen J G

2018-05-07

Virtual patients (VPs) have been recently integrated within different learning activities. To compare between the effect of using VPs in a collaborative learning activity and using VPs in an independent learning activity on students' knowledge acquisition, retention and transfer. For two different topics, respectively 82 and 76 dental students participated in teaching, learning and assessment sessions with VPs. Students from a female campus and from a male campus have been randomly assigned to condition (collaborative and independent), yielding four experimental groups. Each group received a lecture followed by a learning session using two VPs per topic. Students were administrated immediate and delayed written tests as well as transfer tests using two VPs to assess their knowledge in diagnosis and treatment. For the treatment items of the immediate and delayed written tests, females outperformed males in the collaborative VP group but not in the independent VP group. On the female campus, the use of VPs in a collaborative learning activity is more effective than its use as an independent learning activity in enhancing students' knowledge acquisition and retention. However, the collaborative use of VPs by itself is not enough to produce consistent results across different groups of students and attention should be given to all the factors that would affect students' interaction.

Strategies in probabilistic feedback learning in Parkinson patients OFF medication.

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Bellebaum, C; Kobza, S; Ferrea, S; Schnitzler, A; Pollok, B; Südmeyer, M

2016-04-21

Studies on classification learning suggested that altered dopamine function in Parkinson's Disease (PD) specifically affects learning from feedback. In patients OFF medication, enhanced learning from negative feedback has been described. This learning bias was not seen in observational learning from feedback, indicating different neural mechanisms for this type of learning. The present study aimed to compare the acquisition of stimulus-response-outcome associations in PD patients OFF medication and healthy control subjects in active and observational learning. 16 PD patients OFF medication and 16 controls were examined with three parallel learning tasks each, two feedback-based (active and observational) and one non-feedback-based paired associates task. No acquisition deficit was seen in the patients for any of the tasks. More detailed analyses on the learning strategies did, however, reveal that the patients showed more lose-shift responses during active feedback learning than controls, and that lose-shift and win-stay responses more strongly determined performance accuracy in patients than controls. For observational feedback learning, the performance of both groups correlated similarly with the performance in non-feedback-based paired associates learning and with the accuracy of observed performance. Also, patients and controls showed comparable evidence of feedback processing in observational learning. In active feedback learning, PD patients use alternative learning strategies than healthy controls. Analyses on observational learning did not yield differences between patients and controls, adding to recent evidence of a differential role of the human striatum in active and observational learning from feedback. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

The barriers to patient-driven treatment in mental health: why patients may choose to follow their own path.

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Greenall, Paul

2006-01-01

The paper aims to explore the barriers that currently exist to patient-driven treatment within the field of mental health care and reform. This study represents action learning research using grounded theory to explore a possible causal basis for recidivism related to non-compliance with medication. Interviews addressed concerns from the literature around perceived barriers to patient-driven treatment evidenced by non-compliance with medically recommended pharmaceutical treatment. Results were correlated to look for emergent themes that were used to form the basis for subsequent interview questions. An analysis of the resulting emergent themes illustrated the importance of participatory treatment and coaching rather than medically applied paternalistic care, which is seen as encouraging learned helplessness on the part of patients. Similar helplessness was also revealed in clinicians themselves. Patients' awareness of their own needs and demands for more services place clients and the caregivers at odds over appropriate care in an environment of limited resources. The research was limited to only a small number of interviewees in one institution, all of whom were closely associated with mental illness in various capacities. The grounded theory nature of the research does, however, provide a framework for more research in other institutions to test and further explore some of the findings. The study demonstrated a reinforcement of Maslow's theory of needs hierarchy. The study illustrated a step-wise approach to treatment to decrease the rate of failure and recidivism in mental health care. The provision of a stable living environment was viewed as instrumental in improving patients' compliance with pharmaceutical treatment. An action plan was therefore created to initiate the support of a transitional/emergency house by various community groups in partnership with pharmaceutical manufacturing companies. Recidivism in mental health-created by non-compliance in

Advances in Patient Classification for Traditional Chinese Medicine: A Machine Learning Perspective

Science.gov (United States)

Zhao, Changbo; Li, Guo-Zheng; Wang, Chengjun; Niu, Jinling

2015-01-01

As a complementary and alternative medicine in medical field, traditional Chinese medicine (TCM) has drawn great attention in the domestic field and overseas. In practice, TCM provides a quite distinct methodology to patient diagnosis and treatment compared to western medicine (WM). Syndrome (ZHENG or pattern) is differentiated by a set of symptoms and signs examined from an individual by four main diagnostic methods: inspection, auscultation and olfaction, interrogation, and palpation which reflects the pathological and physiological changes of disease occurrence and development. Patient classification is to divide patients into several classes based on different criteria. In this paper, from the machine learning perspective, a survey on patient classification issue will be summarized on three major aspects of TCM: sign classification, syndrome differentiation, and disease classification. With the consideration of different diagnostic data analyzed by different computational methods, we present the overview for four subfields of TCM diagnosis, respectively. For each subfield, we design a rectangular reference list with applications in the horizontal direction and machine learning algorithms in the longitudinal direction. According to the current development of objective TCM diagnosis for patient classification, a discussion of the research issues around machine learning techniques with applications to TCM diagnosis is given to facilitate the further research for TCM patient classification. PMID:26246834

Advances in Patient Classification for Traditional Chinese Medicine: A Machine Learning Perspective.

Science.gov (United States)

Zhao, Changbo; Li, Guo-Zheng; Wang, Chengjun; Niu, Jinling

2015-01-01

As a complementary and alternative medicine in medical field, traditional Chinese medicine (TCM) has drawn great attention in the domestic field and overseas. In practice, TCM provides a quite distinct methodology to patient diagnosis and treatment compared to western medicine (WM). Syndrome (ZHENG or pattern) is differentiated by a set of symptoms and signs examined from an individual by four main diagnostic methods: inspection, auscultation and olfaction, interrogation, and palpation which reflects the pathological and physiological changes of disease occurrence and development. Patient classification is to divide patients into several classes based on different criteria. In this paper, from the machine learning perspective, a survey on patient classification issue will be summarized on three major aspects of TCM: sign classification, syndrome differentiation, and disease classification. With the consideration of different diagnostic data analyzed by different computational methods, we present the overview for four subfields of TCM diagnosis, respectively. For each subfield, we design a rectangular reference list with applications in the horizontal direction and machine learning algorithms in the longitudinal direction. According to the current development of objective TCM diagnosis for patient classification, a discussion of the research issues around machine learning techniques with applications to TCM diagnosis is given to facilitate the further research for TCM patient classification.

Using a biopsychosocial perspective in the treatment of fibromyalgia patients.

Science.gov (United States)

Turk, Dennis C; Adams, Leah M

2016-05-01

Fibromyalgia (FM) is a complex illness that manifests in different ways across individuals. Given that there are currently no known cures for FM, like treatment for other chronic diseases, interventions focus on learning strategies to alleviate symptom severity, to cope with and manage residual symptoms of the illness and to maximize health-related quality of life despite symptoms. In this article, we highlight the need for providers to adopt a biopsychosocial perspective for understanding and addressing patients with FM, noting that biological, psychosocial and behavioral factors function interdependently to affect a person's experience and adaptation. A cognitive-behavioral approach, which incorporates a biopsychosocial perspective, is detailed, along with specific treatment considerations for helping patients with FM manage their symptoms.

Cross-trial prediction of treatment outcome in depression: a machine learning approach.

Science.gov (United States)

Chekroud, Adam Mourad; Zotti, Ryan Joseph; Shehzad, Zarrar; Gueorguieva, Ralitza; Johnson, Marcia K; Trivedi, Madhukar H; Cannon, Tyrone D; Krystal, John Harrison; Corlett, Philip Robert

2016-03-01

Antidepressant treatment efficacy is low, but might be improved by matching patients to interventions. At present, clinicians have no empirically validated mechanisms to assess whether a patient with depression will respond to a specific antidepressant. We aimed to develop an algorithm to assess whether patients will achieve symptomatic remission from a 12-week course of citalopram. We used patient-reported data from patients with depression (n=4041, with 1949 completers) from level 1 of the Sequenced Treatment Alternatives to Relieve Depression (STAR*D; ClinicalTrials.gov, number NCT00021528) to identify variables that were most predictive of treatment outcome, and used these variables to train a machine-learning model to predict clinical remission. We externally validated the model in the escitalopram treatment group (n=151) of an independent clinical trial (Combining Medications to Enhance Depression Outcomes [COMED]; ClinicalTrials.gov, number NCT00590863). We identified 25 variables that were most predictive of treatment outcome from 164 patient-reportable variables, and used these to train the model. The model was internally cross-validated, and predicted outcomes in the STAR*D cohort with accuracy significantly above chance (64·6% [SD 3·2]; p<0·0001). The model was externally validated in the escitalopram treatment group (N=151) of COMED (accuracy 59·6%, p=0.043). The model also performed significantly above chance in a combined escitalopram-buproprion treatment group in COMED (n=134; accuracy 59·7%, p=0·023), but not in a combined venlafaxine-mirtazapine group (n=140; accuracy 51·4%, p=0·53), suggesting specificity of the model to underlying mechanisms. Building statistical models by mining existing clinical trial data can enable prospective identification of patients who are likely to respond to a specific antidepressant. Yale University. Copyright © 2016 Elsevier Ltd. All rights reserved.

Natural speech algorithm applied to baseline interview data can predict which patients will respond to psilocybin for treatment-resistant depression.

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Carrillo, Facundo; Sigman, Mariano; Fernández Slezak, Diego; Ashton, Philip; Fitzgerald, Lily; Stroud, Jack; Nutt, David J; Carhart-Harris, Robin L

2018-04-01

Natural speech analytics has seen some improvements over recent years, and this has opened a window for objective and quantitative diagnosis in psychiatry. Here, we used a machine learning algorithm applied to natural speech to ask whether language properties measured before psilocybin for treatment-resistant can predict for which patients it will be effective and for which it will not. A baseline autobiographical memory interview was conducted and transcribed. Patients with treatment-resistant depression received 2 doses of psilocybin, 10 mg and 25 mg, 7 days apart. Psychological support was provided before, during and after all dosing sessions. Quantitative speech measures were applied to the interview data from 17 patients and 18 untreated age-matched healthy control subjects. A machine learning algorithm was used to classify between controls and patients and predict treatment response. Speech analytics and machine learning successfully differentiated depressed patients from healthy controls and identified treatment responders from non-responders with a significant level of 85% of accuracy (75% precision). Automatic natural language analysis was used to predict effective response to treatment with psilocybin, suggesting that these tools offer a highly cost-effective facility for screening individuals for treatment suitability and sensitivity. The sample size was small and replication is required to strengthen inferences on these results. Copyright © 2018 Elsevier B.V. All rights reserved.

Learning Pelvic Examination with Professional Patients

OpenAIRE

S Shrestha; B Wijma; K Swahnberg; K Siwe

2010-01-01

Performing pelvic examination is a vital skill to learn during gynecological and obstetrical training. It's a difficult maneuver to master as there is very little to see and more to feel and interpret. In addition, learning PE in usual clinical set-up has been found to induce lot of stress and anxiety among both the patients and the students. Students fear of hurting the patients and being judged inept, whereas patients feel embarrassed having to expose their most intimate body parts for lear...

Investigating the Ketogenic Diet As Treatment for Primary Aggressive Brain Cancer: Challenges and Lessons Learned

Directory of Open Access Journals (Sweden)

Kenneth A. Schwartz

2018-02-01

Full Text Available Survival of glioblastoma multiforme (GBM with the current recommended treatment is poor. Reported median survivals are approximately 8–15 months. Based on recent publications from animal models, combining cancer drugs, radiation, and diet-metabolic treatments may be a new route to better survivals. To investigate this possibility, we have begun a clinical trial that has enrolled 15 subjects using a ketogenic diet (KD as an addition to current standard treatments that include surgery, radiation therapy, and chemotherapy. Of the 15 enrolled, 10 completed the protocol. This perspective describes the challenges and lessons learned during this clinical trial and discusses the critical elements that are essential for investigating treatment with a KD. We also reviewed and compared various types of KDs. We believe that the diet selected should be standardized within individual clinical trials, and more importantly, the patients’ blood should be monitored for glucose and ketones twice daily so that the supervising dietitian can work with the patient and their caregivers to make appropriate changes in the diet. Compliance with the diet is best in highly motivated patients who have excellent home support from a family member or a friend who can help to overcome administrative, physical, and cognition deficiencies associated with the disease. Treatment of GBM using a KD represents a reasonable investigative approach. This perspective summarizes the challenges and lessons learned implementing and continuing KD therapy while the patients are concurrently being treated with radiation and chemotherapy.

The effects of utilizing a near-patient e-learning tool on medical student learning.

Science.gov (United States)

Selzer, Rob; Tallentire, Victoria R; Foley, Fiona

2015-01-01

This study aimed to develop a near-patient, e-learning tool and explore student views on how utilization of such a tool influenced their learning. Third year medical students from Monash University in Melbourne, Australia were invited to trial a novel, near-patient, e-learning tool in two separate pilots within the ward environment. All participating students were invited to contribute to focus groups which were audio-recorded, transcribed verbatim and thematically analyzed. Four focus groups were conducted with a total of 17 participants. The emerging themes revealed influences on the students' learning both prior to and during a clinical encounter, as well as following completion of an e-learning module. The unifying concept which linked all six themes and formed the central feature of the experience was patient-centered learning. This occurred through the acquisition of contextualized knowledge and the facilitation of workplace integration. Utilization of a near-patient e-learning tool influences medical student learning in a number of complex, inter-related ways. Clinical e-learning tools are poised to become more commonplace and provide many potential benefits to student learning. However, incorporation of technology into clinical encounters requires specific skills which should form an integral part of primary medical training.

[Chronic noncancer pain and patient education: a place for e-learning?].

Science.gov (United States)

Braillard, Olivia; Cedraschi, Christine; Jesaimani, Ameena; Piguet, Valérie

2015-06-24

Chronic non cancerous pain considerably limits the patients' quality of life. Yet, chronic non cancerous pain has a prevalence as high as 25% to 35%, Therapeutic education allows to work on the knowledge and know-how about the disease, the treatment, the management of health resources and health behaviors. E-learning uses new technologies of communication to improve the quality of learning by facilitating access to the resources and favoring the interactivity. It is attractive by its wide accessibility and its limited logistic needs. The level of proof of its efficacy is weak, mainly because of methodological limitations. Some good quality studies are promising, with a positive effect of e-learning programs on pain intensity, disability, autonomy and medication misuse.

Implicit Learning Abilities Predict Treatment Response in Autism Spectrum Disorders

Science.gov (United States)

2015-09-01

early behavioral interventions are the most effective treatment for Autism Spectrum Disorder (ASD), but almost half of the children do not make...behavioral intervention . 2. KEYWORDS Autism Spectrum Disorder , implicit learning, associative learning, individual differences, functional Magnetic...2 AWARD NUMBER: W81XWH-14-1-0261 TITLE: Implicit Learning Abilities Predict Treatment Response in Autism Spectrum Disorders PRINCIPAL

Patient Safety and Organizational Learning

DEFF Research Database (Denmark)

Zinck Pedersen, Kirstine

pragmatism, situated learning theory and science and technology studies, the paper contrasts the notion of ‘systemic’ learning expressed by the safety policy program with notions of learning as a socio-materially situated practice. Based on fieldwork conducted in 2010 in a Danish university hospital, I...... propose that learning, and more specifically learning from critical incidents, should be understood as a practical and experience-based activity as well as an equally individual and social achievement, which is always formed in relation to the specificities of the concrete situation. Parting from......The key trope of patient safety policy is learning. With the motto of going from ‘a culture of blame to a learning culture’, the safety program introduces a ‘systemic perspective’ to facilitate openness and willingness to talk about failures, hereby making failures into a system property. Within...

Teamwork, organizational learning, patient safety and job outcomes.

Science.gov (United States)

Goh, Swee C; Chan, Christopher; Kuziemsky, Craig

2013-01-01

This article aims to encourage healthcare administrators to consider the learning organization concept and foster collaborative learning among teams in their attempt to improve patient safety. Relevant healthcare, organizational behavior and human resource management literature was reviewed. A patient safety culture, fostered by healthcare leaders, should include an organizational culture that encourages collaborative learning, replaces the blame culture, prioritizes patient safety and rewards individuals who identify serious mistakes. As healthcare institution staffs are being asked to deliver more complex medical services with fewer resources, there is a need to understand how hospital staff can learn from other organizational settings, especially the non-healthcare sectors. The paper provides suggestions for improving patient safety which are drawn from the health and business management literature.

Evaluation of an E-Learning Course for Clubfoot Treatment in Tanzania: A Multicenter Study.

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Vaca, Silvia D; Warstadt, Nicholus M; Ngayomela, Isidor H; Nungu, Rachel; Kowero, Emmanuel S; Srivastava, Sakti

2018-01-01

In total, 80% of clubfoot cases occur in low- and middle-income countries, where lack of clinical knowledge of the Ponseti method of treatment presents as a major barrier to treatment. This study aims to determine the effectiveness of an electronic learning course to teach clinicians in Tanzania Ponseti method theory. A total of 30 clinicians were recruited from clinics with high referral rates for clubfoot patients and invited to 1 of 3 training sites: Mbeya (n = 15), Zanzibar (n = 10), and Mwanza (n = 5). Baseline knowledge, measured through a pretest, was compared to performance on a posttest after e-learning course completion. Scores for Mbeya and Zanzibar participants improved from 44 ± 12.5 to 69.8 ± 16.5 ( P  e-learning course may be an effective method of disseminating Ponseti method theory in Tanzania. Successful implementation requires an understanding of the device availability and technology literacy of the users.

Correlating learning and memory improvements to long-term potentiation in patients with brain injury

Institute of Scientific and Technical Information of China (English)

Xingfu Peng; Qian Yu

2008-01-01

patients clinically present with various manifestations,such as paralysis and sensory disability,which closely correlate to injured regions.In addition,learning and memory abilities decrease in brain injury patients and LTP decreases following brain injury.Brain tissue injury will lead to brain functional deficits. Hippocampal LTP is very sensitive.Difficulties in LTP induction are apparent even prior to morphological changes in brain tissue.There are no specific treatments for learning and memory functional deficits following brain injury.At present,behavioral and compensative therapies are the typical forms of rehabilitation.These results indicate that rehabilitation promotes learning and memory functional recovery in brain injury patients by speeding up LTP formation in the hippocampal CA3 region.CONCLUSION:Rehabilitation intervention increases LTP formation in the hippocampal CA3 region and recovers learning and memory functions in brain injury patients.

Analysis of Blended Learning Implementation on Waste Treatment Subjects in Agricultural Vocational School

Science.gov (United States)

Sugiarti, Y.; Nurmayani, S.; Mujdalipah, S.

2018-02-01

Waste treatment is one of the productive subjects in vocational high school in programs of Agricultural Processing Technology which is one of the objectives learning has been assigned in graduate competency standards (SKL) of Vocational High School. Based on case studies that have been conducted in SMK Pertanian Pembangunan Negeri Lembang, waste treatment subjects had still use the lecture method or conventional method, and students are less enthusiastic in learning process. Therefore, the implementation of more interactive learning models such as blended learning with Edmodo is one of alternative models to resolve the issue. So, the purpose of this study is to formulate the appropriate learning syntax for the implementation of blended learning with Edmodo to agree the requirement characteristics of students and waste treatment subject and explain the learning outcome obtained by students in the cognitive aspects on the subjects of waste treatment. This research was conducted by the method of classroom action research (CAR) with a Mc. Tagart model. The result from this research is the implementation of blended learning with Edmodo on the subjects of waste treatment can improve student learning outcomes in the cognitive aspects with the maximum increase in the value of N-gain 0.82, as well as student learning completeness criteria reaching 100% on cycle 2. Based on the condition of subject research the formulation of appropriate learning syntax for implementation of blended learning model with Edmodo on waste treatment subject are 1) Self-paced learning, 2) Group networking, 3) Live Event- collaboration, 4) Association - communication, 5) Assessment - Performance material support. In summary, implementation of blended learning model with Edmodo on waste treatment subject can improve improve student learning outcomes in the cognitive aspects and conducted in five steps on syntax.

End-stage renal disease treatment options education: What matters most to patients and families.

Science.gov (United States)

St Clair Russell, Jennifer; Boulware, L Ebony

2018-03-01

Treatment modality education can offer many important benefits to patients and their families. Evidence suggests such education can increase use of home dialysis, reduce catheter use, decrease 90-day mortality, and increase transplantation. While these benefits are encouraging, not all patients are offered options education and when they are, it may not be presented in a way that is immediately applicable to them and their lives. Furthermore, little is known regarding specific characteristics (e.g. format such as group or individual or in-person or online, duration, teaching methods, location, content) of educational programs that are most successful. No single approach has emerged as a best practice. In the absence of such evidence, adult learning principles, such as involving patients and families in the development programs and materials, can serve as a guide for educational development. Adult learning principles can enhance options education, evolving them from information delivery to a person-centered, values-based endeavor that helps match treatment to values and lifestyle. © 2018 Wiley Periodicals, Inc.

Patients as educators: interprofessional learning for patient-centred care.

Science.gov (United States)

Towle, Angela; Godolphin, William

2013-01-01

Patients with chronic conditions have unique expertise that enhances interprofessional education. Although their active involvement in education is increasing, patients have minimal roles in key educational tasks. A model that brings patients and students together for patient-centred learning, with faculty playing a supportive role, has been described in theory but not yet implemented. To identify issues involved in creating an educational intervention designed and delivered by patients and document outcomes. An advisory group of community members, students and faculty guided development of the intervention (interprofessional workshops). Community educators (CEs) were recruited through community organizations with a healthcare mandate. Workshops were planned by teams of key stakeholders, delivered by CEs, and evaluated by post-workshop student questionnaires. Workshops were delivered by CEs with epilepsy, arthritis, HIV/AIDS and two groups with mental health problems. Roles and responsibilities of planning team members that facilitated control by CEs were identified. Ten workshops attended by 142 students from 15 different disciplines were all highly rated. Workshop objectives defined by CEs and student learning both closely matched dimensions of patient-centredness. Our work demonstrates feasibility and impact of an educational intervention led by patient educators facilitated but not controlled by faculty.

LOCUS OF CONTROL AND LEARNED HELPLESSNESS PHENOMENON IN PATIENTS WITH CHRONIC INTERNAL DISEASES

Directory of Open Access Journals (Sweden)

Grekhov R.A.

2016-04-01

Full Text Available The article discloses the concept of locus of control (or the level of subjective control, the phenomenon of learned helplessness in the framework of psychosomatic medicine, and their impact on the efficacy of treatment process. The data on the impact of these factors on the daily living and emotional state of patients, their interpersonal and social relationships, the reasons for the formation of learned helplessness are listened. The alternative psychophysiological treatment methods for emotional and behavioral disorders in psychosomatic diseases, in particular the effectiveness of biofeedback therapy in different types of physical pathology, which opens up the possibility of the patient to implement self-regulation mechanisms are presented. Biofeedback is a practically single psychophysiological evidence-based method of alternative medicine and it is regarded as a branch of behavioral therapy, which aims not only to the regulation of psychophysiological state, but also to shift the external locus of control to the inside. During the application of biofeedback, developed “functional system of self-regulation” form its perfect result. Biofeedback is the process of achieving a greater patient’s awareness of many physiological functions of his body, primarily with the use of tools that provide him with information on his activities, in order to obtain the possibility to manage the systems of his body by his own discretion. The probable mechanism of therapeutic action is the cognitive effect of biofeedback experiences, learning skills of self-control which patients had never happened before. The faith of the patient in his ability to control the symptoms of the disease is considered as a critical value, not a degree of measurable physiological changes.

Neuroblastoma Treatment (PDQ®)—Patient Version

Science.gov (United States)

Neuroblastoma treatment may include surgery, observation, chemotherapy, radiation therapy, radioactive iodine, and high-dose chemotherapy with stem cell transplant and targeted therapy. Treatment also depends on risk category. Learn more in this expert-reviewed summary.

An Organizational Learning Framework for Patient Safety.

Science.gov (United States)

Edwards, Marc T

Despite concerted effort to improve quality and safety, high reliability remains a distant goal. Although this likely reflects the challenge of organizational change, persistent controversy over basic issues suggests that weaknesses in conceptual models may contribute. The essence of operational improvement is organizational learning. This article presents a framework for identifying leverage points for improvement based on organizational learning theory and applies it to an analysis of current practice and controversy. Organizations learn from others, from defects, from measurement, and from mindfulness. These learning modes correspond with contemporary themes of collaboration, no blame for human error, accountability for performance, and managing the unexpected. The collaborative model has dominated improvement efforts. Greater attention to the underdeveloped modes of organizational learning may foster more rapid progress in patient safety by increasing organizational capabilities, strengthening a culture of safety, and fixing more of the process problems that contribute to patient harm.

Considering patient values and treatment preferences enhances patient involvement in rectal cancer treatment decision making.

Science.gov (United States)

Kunneman, Marleen; Marijnen, Corrie A M; Baas-Thijssen, Monique C M; van der Linden, Yvette M; Rozema, Tom; Muller, Karin; Geijsen, Elisabeth D; Stiggelbout, Anne M; Pieterse, Arwen H

2015-11-01

The shared decision making (SDM) model states that patients' values and preferences should be clarified to choose a strategy that best fits the patient. This study aimed to assess whether values and preferences of rectal cancer patients are voiced and considered in deciding about preoperative radiotherapy (PRT), and whether this makes patients feel more involved in treatment decision making. Pre-treatment consultations of radiation oncologists and patients eligible for PRT were audiotaped (N=90). Tapes were transcribed and coded to identify patients' values and treatment preferences. Patients filled in a post-consultation questionnaire on their perceived involvement in decision making (N=60). Patients' values were voiced for 62/611 of benefits/harms addressed (10%), in 38/90 consultations (42%; maximum 4 values per consultation), and most often related to major long-term treatment outcomes. Patients' treatment preferences were discussed in 20/90 consultations (22%). In 16/90 consultations (18%), the oncologists explicitly indicated to consider patients' values or preferences. Patients perceived a significantly more active role in decision making if their values or preferences had been voiced or considered. Patients' values and treatment preferences are voiced or considered in a minority of consultations. If they are, this increases patients' perceived involvement in the decision making process. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Preserved learning and memory following 5-fluorouracil and cyclophosphamide treatment in rats.

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Long, Jeffrey M; Lee, Garrick D; Kelley-Bell, Bennett; Spangler, Edward L; Perez, Evelyn J; Longo, Dan L; de Cabo, Rafael; Zou, Sige; Rapp, Peter R

2011-11-01

Some patients experience enduring cognitive impairment after cancer treatment, a condition termed "chemofog". Animal models allow assessment of chemotherapy effects on learning and memory per se, independent of changes due to cancer itself or associated health consequences such as depression. The present study examined the long-term learning and memory effects of a chemotherapy cocktail used widely in the treatment of breast cancer, consisting of 5-fluorouracil (5FU) and cyclophosphamide (CYP). Eighty 5-month old male F344 rats received contextual and cued fear conditioning before treatment with saline, or a low or high dose drug cocktail (50mg/kg CYP and 75 mg/kg 5FU, or 75 mg/kg CYP and 120 mg/kg 5FU, i.p., respectively) every 30 days for 2 months. After a 2-month, no-drug recovery, both long-term retention and new task acquisition in the water maze and 14-unit T-maze were assessed. Neither dose of the CYP/5FU cocktail impaired retrograde fear memory despite marked toxicity documented by enduring weight loss and 50% mortality at the higher dose. Acquisition in the water maze and Stone maze was also normal relative to controls in rats treated with CYP/5FU. The results contribute to a growing literature suggesting that learning and memory mediated by the hippocampus can be relatively resistant to chemotherapy. Future investigation may need to focus on assessments of processing speed, executive function and attention, and the possible interactive contribution of cancer itself and aging to the post-treatment development of cognitive impairment. Copyright © 2011 Elsevier Inc. All rights reserved.

Endodontic treatment in geriatric patients

Directory of Open Access Journals (Sweden)

Milly Armilya Andang

2007-11-01

Full Text Available With the increased number of geriatric population, it is predicted that the need for dental treatment also increases. The needs for esthetic factors and function of geriatric patient are maybe similar to young patient. The number of geriatric patients who refuse dental extraction is increasing if there are still other alternative. They can be more convinced when the clinician said that the dental disease experienced is a focal infection so that the loss of the tooth can be accepted as the best option. But if it is possible, they will prefer endodontic treatment, because they want to keep their teeth according to the treatment plan or based on patient's request, as a less traumatic alternative compared to extraction.Endodontic treatment consideration for geriatric patient is quite similar to younger patients. The technique is also the same, although the problem may be bigger. The problem or obstacle that may arise in endodontic treatment for geriatric patient relates to the visit duration, problems during x-ray, problems in defining root canal location, vertical root fracture, and in some cases, decreased pulp tissue recovery ability. Due to the fact that the challenge is quite big, the success of endodontic treatment in geriatric patients needs to be considered. This paper will explain the endodontic treatment prognosis for geriatric patients.

[Treatment of patients with osteoarthritis].

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Vargas Negrín, Francisco; Medina Abellán, María D; Hermosa Hernán, Juan Carlos; de Felipe Medina, Ricardo

2014-01-01

The therapeutic management of patients with osteoarthritis aims to decrease pain and inflammation, improve physical function, and to apply safe and effective treatments. A patient-centered approach implies the active participation of the patient in the design of the treatment plan and in timely and informed decision-making at all stages of the disease. The nucleus of treatment is patient education, physical activity and therapeutic exercise, together with weight control in overweight or obese patients. Self-care by the individual and by the family is fundamental in day-to-day patient management. The use of physical therapies, technical aids (walking sticks, etc.) and simple analgesics, opium alkaloids, and antiinflammatory drugs have demonstrated effectiveness in controlling pain, improving physical function and quality of life and their use is clearly indicated in the treatment of osteoarthritis. Conservative surgery and joint replacement is indicated when treatment goals are not achieved in specific patients. Copyright © 2014 Elsevier España, S.L. All rights reserved.

Teleheath Technology as E-Learning: Learning and Practicing Interprofessional Patient Care

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Shortridge, Ann; Ross, Heather; Randall, Ken; Ciro, Carrie; Loving, Gary

2018-01-01

Teaching team-based patient competencies to health sciences students has proven to be a challenging endeavor. This paper describes two hands-on learning experiences and their subsequent evaluation. In both of these experiences telehealth technology served as both a distance education e-learning technology, as well as a medium to provide patient…

Mr. Trump: How I learned to stop worrying and love the patient-aggressor.

Science.gov (United States)

Coren, Sidney

2018-05-01

This paper offers an integration of social issues, psychoanalytic theory, and analytic experience in the treatment of a patient whose political values and identifications differed significantly from my own. Our political leanings facilitated a dynamic tension of difference, power, and aggression that mirrored how each of us felt in relation to the current social-political milieu. In particular, the sadomasochistic dynamics on display in the treatment offered me a unique way of understanding my relationship with my patient and opened new ways of understanding the political present. In the end, I learned to stop worrying about getting rid of anger, aggression, and splitting, and instead to embrace what these feelings and behaviors can tell me as a therapist, and what they can inform for my patients about the nature of relationality, identity, and difference. © 2018 Wiley Periodicals, Inc.

The effect of electroconvulsive therapy (ECT) on implicit memory: skill learning and perceptual priming in patients with major depression.

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Vakil, E; Grunhaus, L; Nagar, I; Ben-Chaim, E; Dolberg, O T; Dannon, P N; Schreiber, S

2000-01-01

While explicit memory in amnesics is impaired, their implicit memory remains preserved. Memory impairment is one of the side effects of electroconvulsive therapy (ECT). ECT patients are expected to show impairment on explicit but not implicit tasks. The present study examined 17 normal controls and 17 patients with severe major depressive disorder who underwent right unilateral ECT. Patients were tested in three sessions: 24-48 hours prior to, 24-48 hours following the first ECT, and 24-48 hours following the eighth ECT. The controls were tested in three sessions, at time intervals that paralleled those of the patients. Implicit memory was tested by the perceptual priming task - Partial Picture-Identification (PPI). The skill learning task used entailed solving the Tower of Hanoi puzzle (TOHP). Explicit memory was tested by picture recall from the PPI task, verbal recall of information regarding the TOHP, and by the Visual Paired Association (VPA) test. Results showed that explicit questions about the implicit tasks were impaired following ECT treatment. Patients' learning ability, as measured by the VPA task, was only impaired in the first testing session, prior to ECT treatment, reflecting the effect of depression. In addition, groups only differed in the first session on the learning rate of the skill learning task. Perceptual priming was preserved in the patients' group in all sessions, indicating that it is resilient to the effect of depression and ECT. The results are interpreted in terms of the differential effect of depression and ECT on explicit and implicit memory.

Predicting tDCS treatment outcomes of patients with major depressive disorder using automated EEG classification.

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Al-Kaysi, Alaa M; Al-Ani, Ahmed; Loo, Colleen K; Powell, Tamara Y; Martin, Donel M; Breakspear, Michael; Boonstra, Tjeerd W

2017-01-15

Transcranial direct current stimulation (tDCS) is a promising treatment for major depressive disorder (MDD). Standard tDCS treatment involves numerous sessions running over a few weeks. However, not all participants respond to this type of treatment. This study aims to investigate the feasibility of identifying MDD patients that respond to tDCS treatment based on resting-state electroencephalography (EEG) recorded prior to treatment commencing. We used machine learning to predict improvement in mood and cognition during tDCS treatment from baseline EEG power spectra. Ten participants with a current diagnosis of MDD were included. Power spectral density was assessed in five frequency bands: delta (0.5-4Hz), theta (4-8Hz), alpha (8-12Hz), beta (13-30Hz) and gamma (30-100Hz). Improvements in mood and cognition were assessed using the Montgomery-Åsberg Depression Rating Scale and Symbol Digit Modalities Test, respectively. We trained the classifiers using three algorithms (support vector machine, extreme learning machine and linear discriminant analysis) and a leave-one-out cross-validation approach. Mood labels were accurately predicted in 8 out of 10 participants using EEG channels FC4-AF8 (accuracy=76%, p=0.034). Cognition labels were accurately predicted in 10 out of 10 participants using channels pair CPz-CP2 (accuracy=92%, p=0.004). Due to the limited number of participants (n=10), the presented results mainly aim to serve as a proof of concept. These finding demonstrate the feasibility of using machine learning to identify patients that will respond to tDCS treatment. These promising results warrant a larger study to determine the clinical utility of this approach. Copyright © 2016 Elsevier B.V. All rights reserved.

Learning Style Preferences of Elderly Coronary Artery Disease Patients.

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Theis, Saundra L.; Merritt, Sharon L.

1992-01-01

The Patient Learning Styles Questionnaire derived from Canfield and administered to 134 elderly coronary artery disease patients revealed the following order of learning preferences: structure, iconics, listening, direct experience, reading, achievement, affiliation, and eminence. Level of education significantly influenced preferred learning…

Standardised patient-simulated practice learning

African Journals Online (AJOL)

Teaching strategies must link theory to practice, foster critical thinking, be relevant and stimulate ... Standardised patient-simulated practice learning: A rich pedagogical .... relationship for them to grow and develop from novice to expert. They.

The chemotherapeutic agent paclitaxel selectively impairs reversal learning while sparing prior learning, new learning and episodic memory.

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Panoz-Brown, Danielle; Carey, Lawrence M; Smith, Alexandra E; Gentry, Meredith; Sluka, Christina M; Corbin, Hannah E; Wu, Jie-En; Hohmann, Andrea G; Crystal, Jonathon D

2017-10-01

Chemotherapy is widely used to treat patients with systemic cancer. The efficacy of cancer therapies is frequently undermined by adverse side effects that have a negative impact on the quality of life of cancer survivors. Cancer patients who receive chemotherapy often experience chemotherapy-induced cognitive impairment across a variety of domains including memory, learning, and attention. In the current study, the impact of paclitaxel, a taxane derived chemotherapeutic agent, on episodic memory, prior learning, new learning, and reversal learning were evaluated in rats. Neurogenesis was quantified post-treatment in the dentate gyrus of the same rats using immunostaining for 5-Bromo-2'-deoxyuridine (BrdU) and Ki67. Paclitaxel treatment selectively impaired reversal learning while sparing episodic memory, prior learning, and new learning. Furthermore, paclitaxel-treated rats showed decreases in markers of hippocampal cell proliferation, as measured by markers of cell proliferation assessed using immunostaining for Ki67 and BrdU. This work highlights the importance of using multiple measures of learning and memory to identify the pattern of impaired and spared aspects of chemotherapy-induced cognitive impairment. Copyright © 2017 Elsevier Inc. All rights reserved.

Phantom motor execution facilitated by machine learning and augmented reality as treatment for phantom limb pain: a single group, clinical trial in patients with chronic intractable phantom limb pain.

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Ortiz-Catalan, Max; Guðmundsdóttir, Rannveig A; Kristoffersen, Morten B; Zepeda-Echavarria, Alejandra; Caine-Winterberger, Kerstin; Kulbacka-Ortiz, Katarzyna; Widehammar, Cathrine; Eriksson, Karin; Stockselius, Anita; Ragnö, Christina; Pihlar, Zdenka; Burger, Helena; Hermansson, Liselotte

2016-12-10

Phantom limb pain is a debilitating condition for which no effective treatment has been found. We hypothesised that re-engagement of central and peripheral circuitry involved in motor execution could reduce phantom limb pain via competitive plasticity and reversal of cortical reorganisation. Patients with upper limb amputation and known chronic intractable phantom limb pain were recruited at three clinics in Sweden and one in Slovenia. Patients received 12 sessions of phantom motor execution using machine learning, augmented and virtual reality, and serious gaming. Changes in intensity, frequency, duration, quality, and intrusion of phantom limb pain were assessed by the use of the numeric rating scale, the pain rating index, the weighted pain distribution scale, and a study-specific frequency scale before each session and at follow-up interviews 1, 3, and 6 months after the last session. Changes in medication and prostheses were also monitored. Results are reported using descriptive statistics and analysed by non-parametric tests. The trial is registered at ClinicalTrials.gov, number NCT02281539. Between Sept 15, 2014, and April 10, 2015, 14 patients with intractable chronic phantom limb pain, for whom conventional treatments failed, were enrolled. After 12 sessions, patients showed statistically and clinically significant improvements in all metrics of phantom limb pain. Phantom limb pain decreased from pre-treatment to the last treatment session by 47% (SD 39; absolute mean change 1·0 [0·8]; p=0·001) for weighted pain distribution, 32% (38; absolute mean change 1·6 [1·8]; p=0·007) for the numeric rating scale, and 51% (33; absolute mean change 9·6 [8·1]; p=0·0001) for the pain rating index. The numeric rating scale score for intrusion of phantom limb pain in activities of daily living and sleep was reduced by 43% (SD 37; absolute mean change 2·4 [2·3]; p=0·004) and 61% (39; absolute mean change 2·3 [1·8]; p=0·001), respectively. Two of four

Persons' various experiences of learning processes in patient education for osteoarthritis, a qualitative phenomenographic approach.

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Larsson, Ingalill; Sundén, Anne; Ekvall Hansson, Eva

2018-03-30

Patient education (PE) is a core treatment of osteoarthritis (OA) with the aim to increase persons' knowledge, self-efficacy, and empowerment. To describe person's various experiences of learning processes in PE for OA. Phenomenography. Semi-structured interviews were performed with the same persons, pre- (11) and post- (9) education. Various experiences on learning processes were found and were described in an outcome space. Achieving knowledge describes self-regulated learning and strongly relates to Control, which describes a high order cognitive learning skill, and minor to Confirm, which describes a cognitive learning skill based on recognition and application. Receiving knowledge describes the expectancy of learning regulated from the educator and strongly relates to Comply, which describes a low-order cognitive learning skill, and minor to Confirm. Different experiences of motivation and learning impact on persons' learning processes which, in turn, influence the persons' capability to accomplish self-efficacy and empowerment. The outcome space may serve as a basis for discussions between healthcare educators involved in PE to better understand what learning implies and to develop PE further.

Childhood Rhabdomyosarcoma Treatment (PDQ®)—Patient Version

Science.gov (United States)

Treatment of children with rhabdomyosarcoma often includes chemotherapy, radiation therapy, and surgery. Learn about the signs, tests to diagnose, survival, treatment, and clinical trials for children with rhabdomyosarcoma in this expert-reviewed summary.

Gastric Cancer Treatment (PDQ®)—Patient Version

Science.gov (United States)

Gastric (stomach) cancer treatment can include surgery, chemotherapy, radiation therapy, chemoradiation, and targeted therapy. Learn more about the diagnosis, treatment, and prognosis of newly diagnosed and recurrent gastric cancer in this expert-reviewed summary.

Educating patients: understanding barriers, learning styles, and teaching techniques.

Science.gov (United States)

Beagley, Linda

2011-10-01

Health care delivery and education has become a challenge for providers. Nurses and other professionals are challenged daily to assure that the patient has the necessary information to make informed decisions. Patients and their families are given a multitude of information about their health and commonly must make important decisions from these facts. Obstacles that prevent easy delivery of health care information include literacy, culture, language, and physiological barriers. It is up to the nurse to assess and evaluate the patient's learning needs and readiness to learn because everyone learns differently. This article will examine how each of these barriers impact care delivery along with teaching and learning strategies will be examined. Copyright © 2011 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.

The management of radiation treatment error through incident learning

International Nuclear Information System (INIS)

Clark, Brenda G.; Brown, Robert J.; Ploquin, Jodi L.; Kind, Anneke L.; Grimard, Laval

2010-01-01

Purpose: To assess efficacy of an incident learning system in the management of error in radiation treatment. Materials and methods: We report an incident learning system implementation customized for radiation therapy where any 'unwanted or unexpected change from normal system behaviour that causes or has the potential to cause an adverse effect to persons or equipment' is reported, investigated and learned from. This system thus captures near-miss (potential) and actual events. Incidents are categorized according to severity, type and origin. Results: Our analysis spans a period of 3 years with an average accrual of 11.6 incidents per week. We found a significant reduction in actual incidents of 28% and 47% in the second and third year when compared to the first year (p < 0.001), which we attribute to the many interventions prompted by the analysis of incidents reported. We also saw a similar significant reduction in incidents generated at the treatment unit correlating with the introduction of direct treatment parameter transfer and electronic imaging (p < 0.001). Conclusions: Implementation of an incident learning system has helped us to establish a just environment where all staff members report deviations from normal system behaviour and thus generate evidence to initiate safety improvements.

Decision tree-based learning to predict patient controlled analgesia consumption and readjustment

Directory of Open Access Journals (Sweden)

Hu Yuh-Jyh

2012-11-01

Full Text Available Abstract Background Appropriate postoperative pain management contributes to earlier mobilization, shorter hospitalization, and reduced cost. The under treatment of pain may impede short-term recovery and have a detrimental long-term effect on health. This study focuses on Patient Controlled Analgesia (PCA, which is a delivery system for pain medication. This study proposes and demonstrates how to use machine learning and data mining techniques to predict analgesic requirements and PCA readjustment. Methods The sample in this study included 1099 patients. Every patient was described by 280 attributes, including the class attribute. In addition to commonly studied demographic and physiological factors, this study emphasizes attributes related to PCA. We used decision tree-based learning algorithms to predict analgesic consumption and PCA control readjustment based on the first few hours of PCA medications. We also developed a nearest neighbor-based data cleaning method to alleviate the class-imbalance problem in PCA setting readjustment prediction. Results The prediction accuracies of total analgesic consumption (continuous dose and PCA dose and PCA analgesic requirement (PCA dose only by an ensemble of decision trees were 80.9% and 73.1%, respectively. Decision tree-based learning outperformed Artificial Neural Network, Support Vector Machine, Random Forest, Rotation Forest, and Naïve Bayesian classifiers in analgesic consumption prediction. The proposed data cleaning method improved the performance of every learning method in this study of PCA setting readjustment prediction. Comparative analysis identified the informative attributes from the data mining models and compared them with the correlates of analgesic requirement reported in previous works. Conclusion This study presents a real-world application of data mining to anesthesiology. Unlike previous research, this study considers a wider variety of predictive factors, including PCA

Improving Outcome of Psychosocial Treatments by Enhancing Memory and Learning

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Harvey, Allison G.; Lee, Jason; Williams, Joseph; Hollon, Steven D.; Walker, Matthew P.; Thompson, Monique A.; Smith, Rita

2014-01-01

Mental disorders are prevalent and lead to significant impairment. Progress toward establishing treatments has been good. However, effect sizes are small to moderate, gains may not persist, and many patients derive no benefit. Our goal is to highlight the potential for empirically-supported psychosocial treatments to be improved by incorporating insights from cognitive psychology and research on education. Our central question is: If it were possible to improve memory for content of sessions of psychosocial treatments, would outcome substantially improve? This question arises from five lines of evidence: (a) mental illness is often characterized by memory impairment, (b) memory impairment is modifiable, (c) psychosocial treatments often involve the activation of emotion, (d) emotion can bias memory and (e) memory for psychosocial treatment sessions is poor. Insights from scientific knowledge on learning and memory are leveraged to derive strategies for a transdiagnostic and transtreatment cognitive support intervention. These strategies can be applied within and between sessions and to interventions delivered via computer, the internet and text message. Additional novel pathways to improving memory include improving sleep, engaging in exercise and imagery. Given that memory processes change across the lifespan, services to children and older adults may benefit from cognitive support. PMID:25544856

Patient specific actual size 3D printed models for patient education in glioma treatment: first experiences.

Science.gov (United States)

van de Belt, Tom H; Nijmeijer, Hugo; Grim, David; Engelen, Lucien Jlpg; Vreeken, Rinaldo; van Gelder, Marleen Mmj; Laan, Mark Ter

2018-06-02

Cancer patients need high quality information about the disease stage, treatment options and side effects. High quality information can also improve health literacy, shared decision-making and satisfaction. We created patient-specific 3D models of tumours including surrounding functional areas, and assessed what patients with glioma actually value (or fear) about these models when they are used to educate them about the relation between their tumour and specific brain parts, the surgical procedure, and risks. We carried out an explorative study with adult glioma patients, who underwent functional MRI and DTi as part of the pre-operative work-up. All participants received an actual size 3D model, printed based on fMRI and DTi imaging. Semi-structured interviews were held to identify facilitators and barriers for using the model, and perceived effects. A model was successfully created for all 11 participants. A total of 18 facilitators and 8 barriers were identified. The model improved patients' understanding about their situation, that it was easier to ask questions to their neurosurgeon based on their model and that it supported their decision about the preferred treatment. A perceived barrier for using the 3D model was that it could be emotionally confronting, particularly in an early phase of the disease process. Positive effects were related to psychological domains including coping, learning effects and communication. Patient-specific 3D models are promising and simple tools that could help patients with glioma to better understand their situation, treatment options and risks. They have the potential to improve shared decision-making. Copyright © 2018 The Author(s). Published by Elsevier Inc. All rights reserved.

The use of errorless learning strategies for patients with Alzheimer's disease: a literature review.

Science.gov (United States)

Li, Ruijie; Liu, Karen P Y

2012-12-01

The aim of this article was to review the evidence of errorless learning on learning outcomes in patients with early-stage Alzheimer's disease. A computer-aided literature search from 1999 to 2011 was carried out using MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO and PsycArticles. Keywords included 'errorless learning or practice' and 'Alzheimer's disease'. Four studies that fulfilled the inclusion criteria were selected and reviewed. Two of the studies were clinical controlled trials: one was a single-group pretest-post-test trial and the other was a multiple single-participant study. Demographic variables, design, treatment and outcome measures were summarized. Recall trials were used as the primary outcome measure. Results indicate that the use of errorless learning promotes better retention of specific types of information. Errorless learning is effective in memory rehabilitation of older adults with Alzheimer's disease. However, it would require more studies with unified outcome measures to allow for the formulation of standardized clinical protocol and recommendations.

Improvement in verbal memory performance in depressed in-patients after treatment with electroconvulsive therapy.

Science.gov (United States)

Biedermann, S V; Bumb, J M; Demirakca, T; Ende, G; Sartorius, A

2016-12-01

Electroconvulsive therapy (ECT) is a highly effective and well-tolerated therapy for severe and treatment-resistant depression. Cognitive side-effects are still feared by some patients and clinicians. Importantly, cognitive impairments are among the most disabling symptoms of depression itself. Patients suffering from a severe episode of depression were treated with either ECT or treatment as usual (TAU) in an in-patient setting. Matched healthy participants served as controls (HC). Verbal memory was tested with the California Verbal Learning Test (CVLT) before the specific treatment started (ECT = 15, TAU = 16, HC = 31) and 2 months after the last ECT session or 2 months after discharge respectively. Before the specific treatment started, depressed patients performed substantially worse compared with HC in total, short- and long-delay recall in the CVLT, while the ECT group showed the worst performance. More severely depressed patients showed worse performances in these measures. Intriguingly, verbal memory showed a significant improvement in ECT-treated patients, but not in the other groups. No differences between the groups were found at follow-up. Contrary to the widely feared assumption that ECT has long-term impact on memory functions, we found evidence that ECT is superior to TAU in improving verbal memory in depressed patients. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Childhood Astrocytoma Treatment (PDQ®)—Patient Version

Science.gov (United States)

Childhood astrocytomas can be benign (not cancer) or malignant (cancer). Learn more about the types of astrocytoma, signs and symptoms, diagnosis, prognosis, and treatment of astrocytomas that are newly diagnosed or have come back after treatment in this expert-reviewed summary.

Bladder Cancer Treatment (PDQ®)—Patient Version

Science.gov (United States)

Treatment of bladder cancer depends on the stage of the cancer. Treatment options include different types of surgery (transurethral resection, radical and partial cystectomy, and urinary diversion), radiation therapy, chemotherapy, and immunotherapy. Learn more about how bladder cancer is treated.

Communication Skills in Patient-Doctor Interactions: Learning from Patient Complaints

Directory of Open Access Journals (Sweden)

Janine W.Y. Kee

2018-06-01

Full Text Available Purpose: Despite communication skills training in medical school, junior doctors continue to demonstrate poor patient-doctor communication skills, where patient unhappiness from the encounter often manifests as patient complaints. We sought to identify crucial communication skills that should be incorporated in the communications curriculum by learning from patient complaints, to explore how the communication lapses occur. Method: 38 cases of anonymized negative patient feedback about junior doctors were analysed using qualitative content analysis. A two-step fine-coding system involving four researchers was employed. Results: Four main themes of communication errors were identified, namely: non-verbal (eye contact, facial expression and paralanguage, verbal (active listening and inappropriate choice of words, and content (poor quantity and quality of information provided; and poor attitudes (lack of respect and empathy. Discussion: Patient-doctor communication is a complex interpersonal interaction that requires an understanding of each party׳s emotional state. We identified important but overlooked communication lapses such as non-verbal paralinguistic elements that should be incorporated into communications curriculum, with an emphasis on dialectical learning. These include integrating these findings into a simulation-based communications module for training doctors at a post-graduate level as well as monitoring and analyzing patient complaints regularly to iteratively update the content of the training module. Beyond these skills training, there is also a need to highlight negative emotions of doctors in future research, as it influences their communication patterns and attitudes towards patients, ultimately shaping how patients perceive them. Keywords: Communication skills training, Patient complaints, Patient negative feedback, Patient-Doctor communication, Residency training

Patient-relevant treatment goals in psoriasis.

Science.gov (United States)

Blome, Christine; Gosau, Ramona; Radtke, Marc A; Reich, Kristian; Rustenbach, Stephan J; Spehr, Christina; Thaçi, Diamant; Augustin, Matthias

2016-03-01

Patient-oriented care requires therapeutic decisions to agree with the patients' treatment needs and goals. This study addressed the following questions: What is important to psoriasis patients starting systemic treatment? How stable are these preferences within the first year of treatment? Are treatment goals associated with age, gender, or treatment success? The importance of treatment goals was assessed for patients with moderate-to-severe psoriasis in the German Psoriasis Registry (PsoBest) at baseline (onset of a systemic treatment; n = 3066) and at a 1-year follow-up (n = 1444) using the Patient Benefit Index (PBI). Treatment success was measured with PBI global score and Psoriasis Area Severity Index (PASI). Patients with moderate-to-severe psoriasis pursued a wide range of different goals. The most general treatment goals were rated most relevant, including skin healing and quick skin improvement (94.8/94.5 % "quite" or "very" important), confidence in the therapy (93.0 %), control over the disease (92.3 %), and a clear diagnosis and therapy (89.6 %). Further important goals related to not being in fear of the disease getting worse (84.8 %), reduction in itching (83.9 %), burning (70.6 %), and pain (60.6 %) as well as attaining a normal everyday life (78.4 %) and low treatment burden (64.2-77.9 %). Goals were mostly not associated with sex and gender. Goal importance slightly increased with treatment success. In a substantial proportion of patients (30.3-54.7 %) goal importance changed within 1 year after onset of systemic treatment. We conclude that treatment goal importance should be assessed in clinical practice on a regular basis.

Perspectives of newly diagnosed advanced cancer patients receiving dignity therapy during cancer treatment.

Science.gov (United States)

Dose, Ann Marie; Rhudy, Lori M

2018-01-01

Dignity therapy is a psychosocial intervention that has been used primarily at the end of life to improve quality of life and other patient outcomes, but many individuals are unable to complete it due to health decline and death. The purpose of this study was to identify what individuals with advanced pancreatic or lung cancer with limited life expectancy, undergoing active cancer treatment describe during the dignity therapy intervention as important to them when not immediately facing end of life. Twenty patients undergoing chemotherapy for advanced cancer participated in a dignity therapy intervention study. Initial interviews were analyzed using descriptive content analysis. Family provided the overall context and background for emerging themes of defining events, accomplishments, and God's plan, which led to lessons learned, and resulted in messages of hope. Interviews were often autobiographical in nature and contained much reminiscence, consistent with dignity therapy's intent. Few participants spoke about their cancer diagnoses during the interview. This study adds unique insight into the use of dignity therapy for those still receiving active cancer treatment, different from work by others in which it was offered only at end of life. As part of supportive care, clinicians need to validate the importance of family to those with advanced cancer and to provide opportunities for patients to share what they have learned throughout life and to impart messages of hope to those closest to them.

How Do Korsakoff Patients Learn New Concepts?

Science.gov (United States)

Pitel, Anne Lise; Beaunieux, Helene; Guillery-Girard, Berengere; Witkowski, Thomas; de la Sayette, Vincent; Viader, Fausto; Desgranges, Beatrice; Eustache, Francis

2009-01-01

The goal of the present investigation was to assess semantic learning in Korsakoff patients (KS), compared with uncomplicated alcoholics (AL) and control subjects (CS), taking the nature of the information to-be-learned and the episodic memory profiles of the three groups into account. Ten new complex concepts, each illustrated by a photo and…

How organizational learning is associated with patient rights: a qualitative content analysis.

Science.gov (United States)

Heidari, Shahin; Nayeri, Nahid Dehghan; Ravari, Ali; Sabzevari, Sakineh

2016-01-01

Nowadays, patient rights, particularly receiving favorable health care based on modern knowledge, informed consent, and privacy, are important issues in health care delivery systems. Organizational learning is considered an important factor influencing health care quality and patient rights. However, there is little evidence regarding this issue. The present study was conducted to explore the role of organizational learning in patient rights from clinical nurses' viewpoint. This qualitative study was conducted through conventional content analysis. In total, 18 nurses who met the inclusion criteria participated in this study through purposive sampling with maximum variation. Data were gathered through 20 in-depth, semi-structured interviews, which continued until data saturation was achieved. Data collection also included constant and simultaneous comparative analyses. Data analysis led to four major themes: conservation of patient safety, providing favorable care, being the patient's advocate, and informing the patients. All the participants believed that organizational learning could play a vital role in respecting patient rights and interests. Participants believed that their efforts to conduct organizational learning, tried to improve respecting the patient rights via conservation of patient safety, trying to improve quality of care, being an advocate, and informing the patient. It would be appreciable if nursing managers honored the commitment of the nurses for learning, highlight their role as defenders of patient rights, and encourage them to initiate organizational learning.

How organizational learning is associated with patient rights: a qualitative content analysis

Directory of Open Access Journals (Sweden)

Shahin Heidari

2016-07-01

Full Text Available Background: Nowadays, patient rights, particularly receiving favorable health care based on modern knowledge, informed consent, and privacy, are important issues in health care delivery systems. Organizational learning is considered an important factor influencing health care quality and patient rights. However, there is little evidence regarding this issue. Objective: The present study was conducted to explore the role of organizational learning in patient rights from clinical nurses’ viewpoint. Design: This qualitative study was conducted through conventional content analysis. In total, 18 nurses who met the inclusion criteria participated in this study through purposive sampling with maximum variation. Data were gathered through 20 in-depth, semi-structured interviews, which continued until data saturation was achieved. Data collection also included constant and simultaneous comparative analyses. Results: Data analysis led to four major themes: conservation of patient safety, providing favorable care, being the patient's advocate, and informing the patients. All the participants believed that organizational learning could play a vital role in respecting patient rights and interests. Conclusions: Participants believed that their efforts to conduct organizational learning, tried to improve respecting the patient rights via conservation of patient safety, trying to improve quality of care, being an advocate, and informing the patient. It would be appreciable if nursing managers honored the commitment of the nurses for learning, highlight their role as defenders of patient rights, and encourage them to initiate organizational learning.

Simulation of patient encounters using a virtual patient in periodontology instruction of dental students: design, usability, and learning effects in history-taking skills

DEFF Research Database (Denmark)

Janda, M.S.; Mattheos, N.; Nattestad, A.

2004-01-01

computer-assisted learning, effectiveness of learning, health education, patient simulation, virtual patient......computer-assisted learning, effectiveness of learning, health education, patient simulation, virtual patient...

Prenatal treatment prevents learning deficit in Down syndrome model.

Science.gov (United States)

Incerti, Maddalena; Horowitz, Kari; Roberson, Robin; Abebe, Daniel; Toso, Laura; Caballero, Madeline; Spong, Catherine Y

2012-01-01

Down syndrome is the most common genetic cause of mental retardation. Active fragments of neurotrophic factors release by astrocyte under the stimulation of vasoactive intestinal peptide, NAPVSIPQ (NAP) and SALLRSIPA (SAL) respectively, have shown therapeutic potential for developmental delay and learning deficits. Previous work demonstrated that NAP+SAL prevent developmental delay and glial deficit in Ts65Dn that is a well-characterized mouse model for Down syndrome. The objective of this study is to evaluate if prenatal treatment with these peptides prevents the learning deficit in the Ts65Dn mice. Pregnant Ts65Dn female and control pregnant females were randomly treated (intraperitoneal injection) on pregnancy days 8 through 12 with saline (placebo) or peptides (NAP 20 µg +SAL 20 µg) daily. Learning was assessed in the offspring (8-10 months) using the Morris Watermaze, which measures the latency to find the hidden platform (decrease in latency denotes learning). The investigators were blinded to the prenatal treatment and genotype. Pups were genotyped as trisomic (Down syndrome) or euploid (control) after completion of all tests. two-way ANOVA followed by Neuman-Keuls test for multiple comparisons, PDown syndrome-placebo; n = 11) did not demonstrate learning over the five day period. DS mice that were prenatally exposed to peptides (Down syndrome-peptides; n = 10) learned significantly better than Down syndrome-placebo (ptreatment with the neuroprotective peptides (NAP+SAL) prevented learning deficits in a Down syndrome model. These findings highlight a possibility for the prevention of sequelae in Down syndrome and suggest a potential pregnancy intervention that may improve outcome.

Jian Nao Ning for Treatment of Memory Impairment in Patients with Mild or Moderate Multi-infarct Dementia

Institute of Scientific and Technical Information of China (English)

田金洲; 尹军祥; 刘峘; 杨承芝; 王永炎

2002-01-01

Forty patients with multi-infarct dementia (MID) were randomly assigned to the treatment group (25 cases) treated with Jian Nao Ning (健脑宁JNN) and the duxil control group (15 cases). Memory function were assessed at baseline and endpoint using memory subscales of a battery of New Psychometric Tests (Chinese version) including mini-mental state examination (MMSE), verbal memory, and non-verbal memory, etc. After treatment, the mean scores of verbal memory in the Hopkins Verbal Learning Test (P<0.05) and total memory scores of memory items (P<0.001) in JNN group increased significantly; and improvement in episodic memory function including story recall (immediate and delayed), delayed word recall, verbal learning and verbal recognition and visual recognition in the JNN group was better than that in the duxil control group, suggesting that JNN can obviously improve memory function for the patients with mild or moderate multi-infarct dementia.

Communication and patient participation influencing patient recall of treatment discussions.

Science.gov (United States)

Richard, Claude; Glaser, Emma; Lussier, Marie-Thérèse

2017-08-01

Patient recall of treatment information is a key variable towards chronic disease (CD) management. It is unclear what communication and patient participation characteristics predict recall. To assess what aspects of doctor-patient communication predict patient recall of medication information. To describe lifestyle treatment recall, in CD primary care patients. Observational study within a RCT. Community-based primary care (PC) practices. Family physicians (n=18): practicing >5 years, with a CD patient caseload. Patients (n=159): >40 years old, English speaking, computer literate, off-target hypertension, type II diabetes and/or dyslipidaemia. Patient characteristics: age, education, number of CDs. Information characteristics: length of encounter, medication status, medication class. Communication variables: socio-emotional utterances, physician dominance and communication control scores and PACE (ask, check and express) utterances, measured by RIAS. Number of medication themes, dialogue and initiative measured by MEDICODE. Recall of CD, lifestyle treatment and medication information. Frequency of lifestyle discussions varied by topic. Patients recalled 43% (alcohol), 52% (diet) to 70% (exercise) of discussions. Two and a half of six possible medication themes were broached per medication discussion. Less than one was recalled. Discussing more themes, greater dialogue and patient initiative were significant predictors of improved medication information recall. Critical treatment information is infrequently exchanged. Active patient engagement and explicit conversations about medications are associated with improved treatment information recall in off-target CD patients followed in PC. Providers cannot take for granted that long-term off-target CD patients recall information. They need to encourage patient participation to improve recall of treatment information. © 2016 The Authors. Health Expectations Published by John Wiley & Sons Ltd.

Comparison of student learning in the out-patient clinic and ward round.

Science.gov (United States)

Davis, M H; Dent, J A

1994-05-01

In undergraduate medical education there is a trend away from ward-based teaching towards out-patient and community-based teaching. To study the potential effects of this altered emphasis on student learning, a pilot group of final-year medical students at the University of Dundee was asked to keep individual structured log-books. These contained details of patients seen during their 3-week orthopaedic attachment in both a ward and out-patient setting. A comparison of perceived learning in the two settings showed that students learned more from attending an out-patient clinic than a ward round, but did not make full use of the learning potential of either. The setting did not particularly influence the balance of learning as categorized here but only the ward round supplied experience of surgical complications. The amount of learning taking place in an out-patient clinic was influenced by student ability, measured by examination performance, but not by clinic work-load. The implications of increased use of out-patient clinics and the advantages and disadvantages of the approach employed are discussed. It is concluded that in the situation studied student learning in the outpatient setting is as good as or superior to the ward setting but should not totally replace it.

Evidence of some strategic preservation of episodic learning in patients with schizophrenia.

Science.gov (United States)

Thuaire, Flavien; Izaute, Marie; Bacon, Elisabeth

2012-01-30

The aim of this study was to gain a better understanding of schizophrenia patients' strategic use of learning time allocation during encoding, and determine whether they are able to use their monitoring and previous performances to adapt their learning behavior efficiently. Schizophrenia is considered to be a pathology of consciousness as well as being associated with impaired awareness of cognitive processes. In this study, after a learning session, individuals may express a Judgment of Learning (JOL), which reflects their sense of being able to retrieve the information later and which forms the basis for their decision whether or not to carry on learning. The introspective abilities of schizophrenia patients and subsequent strategic control of study time during the encoding of easy or difficult word pairs were investigated in 23 patients and 23 healthy comparison subjects. In spite of their memory impairment, patients were able to judge the difficulty of the word pairs with accuracy and adapt their learning time accordingly. Schizophrenia patients are sensitive to difficulty when rating JOLs and afterwards controlling study time. Monitoring their knowledge at the start helped patients to adapt their learning efficiently. These findings may be of value for cognitive remediation. © 2011 Elsevier Ltd. All rights reserved.

Patient Safety Learning Systems: A Systematic Review and Qualitative Synthesis.

Science.gov (United States)

2017-01-01

A patient safety learning system (sometimes called a critical incident reporting system) refers to structured reporting, collation, and analysis of critical incidents. To inform a provincial working group's recommendations for an Ontario Patient Safety Event Learning System, a systematic review was undertaken to determine design features that would optimize its adoption into the health care system and would inform implementation strategies. The objective of this review was to address two research questions: (a) what are the barriers to and facilitators of successful adoption of a patient safety learning system reported by health professionals and (b) what design components maximize successful adoption and implementation? To answer the first question, we used a published systematic review. To answer the second question, we used scoping study methodology. Common barriers reported in the literature by health care professionals included fear of blame, legal penalties, the perception that incident reporting does not improve patient safety, lack of organizational support, inadequate feedback, lack of knowledge about incident reporting systems, and lack of understanding about what constitutes an error. Common facilitators included a non-accusatory environment, the perception that incident reporting improves safety, clarification of the route of reporting and of how the system uses reports, enhanced feedback, role models (such as managers) using and promoting reporting, legislated protection of those who report, ability to report anonymously, education and training opportunities, and clear guidelines on what to report. Components of a patient safety learning system that increased successful adoption and implementation were emphasis on a blame-free culture that encourages reporting and learning, clear guidelines on how and what to report, making sure the system is user-friendly, organizational development support for data analysis to generate meaningful learning outcomes

Route learning in amnesia: a comparison of trial-and-error and errorless learning in patients with the Korsakoff syndrome.

Science.gov (United States)

Kessels, Roy P C; van Loon, Eke; Wester, Arie J

2007-10-01

To examine the errorless learning approach using a procedural memory task (i.e. learning of actual routes) in patients with amnesia, as compared to trial-and-error learning. Counterbalanced self-controlled cases series. Psychiatric hospital (Korsakoff clinic). A convenience sample of 10 patients with the Korsakoff amnestic syndrome. All patients learned a route in four sessions on separate days using an errorless approach and a different route using trial-and-error. Error rate was scored during route learning and standard neuro-psychological tests were administered (i.e. subtest route recall of the Rivermead Behavioural Memory Test (RBMT) and the Dutch version of the California Verbal Learning Test (VLGT)). A significant learning effect was found in the trial-and-error condition over consecutive sessions (P = 0.006), but no performance difference was found between errorless and trial-and-error learning of the routes. VLGT performance was significantly correlated with a trial-and-error advantage (P Korsakoff syndrome (severe amnesia).

'The challenge to take charge of life with long-term illness': nurses' experiences of supporting patients' learning with the didactic model.

Science.gov (United States)

Andersson, Susanne; Svanström, Rune; Ek, Kristina; Rosén, Helena; Berglund, Mia

2015-12-01

The aim of this implementation study is to describe nurses' experiences of supporting patient learning using the model called 'The challenge to take charge of life with long-term illness'. Supporting patient learning for those suffering from a long-term illness is a complex art in nursing. Genuine learning occurs at a deep and existential level. If the patient's resistance to illness can be challenged and reflected upon, the patient may take charge of his/her life. The project lasted for 2 years and was initiated by a former patient on an assisted haemodialysis ward and involved 14 registered nurses. The project began with a session to review patients' learning and the didactic model. Monthly reflective meetings and group supervisions were held that focused on the nurses' experiences of supporting patient learning. Notes were written during these reflective meetings and group sessions. Data collected from interviews, notes and written stories were subjected to phenomenological analysis. Three aspects of nurses' experiences of the learning support approach were assessed: To have the courage to listen sincerely, a movement from providing information to supporting learning, and to let the patient indicate the direction. The approach resulted in an increased focus on genuine dialogue and the courage to encourage patients to take charge of their health process. The changes in nurses' approach to learning support reveal that they shift from providing information on the disease, illness and treatment to strengthening and supporting the patient in making decisions and taking responsibility. For nurses, the change entails accepting the patient's goals and regarding their own role as supportive rather than controlling. The didactic model and involved supervision contributed to the change in the nurses' approach. The didactic model might be useful in caring for persons with long-term illness, making the care more person-centred and enhancing the patient's self-care ability. �

Patients' approaches to students' learning at a clinical education ward--an ethnographic study.

Science.gov (United States)

Manninen, Katri; Henriksson, Elisabet Welin; Scheja, Max; Silén, Charlotte

2014-07-02

It is well known that patients' involvement in health care students' learning is essential and gives students opportunities to experience clinical reasoning and practice clinical skills when interacting with patients. Students encounter patients in different contexts throughout their education. However, looking across the research providing evidence about learning related to patient-student encounters reveals a lack of knowledge about the actual learning process that occurs in encounters between patients and students. The aim of this study was to explore patient-student encounters in relation to students' learning in a patient-centered health-care setting. An ethnographic approach was used to study the encounters between patients and students. The setting was a clinical education ward for nursing students at a university hospital with eight beds. The study included 10 observations with 11 students and 10 patients. The observer followed one or two students taking care of one patient. During the fieldwork observational and reflective notes were taken. After each observation follow-up interviews were conducted with each patient and student separately. Data were analyzed using an ethnographic approach. The most striking results showed that patients took different approaches in the encounters with students. When the students managed to create a good atmosphere and a mutual relationship, the patients were active participants in the students' learning. If the students did not manage to create a good atmosphere, the relationship became one-way and the patients were passive participants, letting the students practice on their bodies but without engaging in a dialogue with the students. Patient-student encounters, at a clinical education ward with a patient-centred pedagogical framework, can develop into either a learning relationship or an attending relationship. A learning relationship is based on a mutual relationship between patients and students resulting in patients

Lessons Learned from Developing a Patient Engagement Panel: An OCHIN Report.

Science.gov (United States)

Arkind, Jill; Likumahuwa-Ackman, Sonja; Warren, Nate; Dickerson, Kay; Robbins, Lynn; Norman, Kathy; DeVoe, Jennifer E

2015-01-01

There is renewed interest in patient engagement in clinical and research settings, creating a need for documenting and publishing lessons learned from efforts to meaningfully engage patients. This article describes early lessons learned from the development of OCHIN's Patient Engagement Panel (PEP). OCHIN supports a national network of more than 300 community health centers (CHCs) and other primary care settings that serve over 1.5 million patients annually across nearly 20 states. The PEP was conceived in 2009 to harness the CHC tradition of patient engagement in this new era of patient-centered outcomes research and to ensure that patients were engaged throughout the life cycle of our research projects, from conception to dissemination. Developed by clinicians and researchers within our practice-based research network, recruitment of patients to serve as PEP members began in early 2012. The PEP currently has a membership of 18 patients from 3 states. Over the past 24 months, the PEP has been involved with 12 projects. We describe developing the PEP and challenges and lessons learned (eg, recruitment, funding model, creating value for patient partners, compensation). These lessons learned are relevant not only for research but also for patient engagement in quality improvement efforts and other clinical initiatives. © Copyright 2015 by the American Board of Family Medicine.

Repeated morphine treatment influences operant and spatial learning differentially

Institute of Scientific and Technical Information of China (English)

Mei-Na WANG; Zhi-Fang DONG; Jun CAO; Lin XU

2006-01-01

Objective To investigate whether repeated morphine exposure or prolonged withdrawal could influence operant and spatial learning differentially. Methods Animals were chronically treated with morphine or subjected to morphine withdrawal. Then, they were subjected to two kinds of learning: operant conditioning and spatial learning.Results The acquisition of both simple appetitive and cued operant learning was impaired after repeated morphine treatment. Withdrawal for 5 weeks alleviated the impairments. Single morphine exposure disrupted the retrieval of operant memory but had no effect on rats after 5-week withdrawal. Contrarily, neither chronic morphine exposure nor 5-week withdrawal influenced spatial learning task of the Morris water maze. Nevertheless, the retrieval of spatial memory was impaired by repeated morphine exposure but not by 5-week withdrawal. Conclusion These observations suggest that repeated morphine exposure can influence different types of learning at different aspects, implicating that the formation of opiate addiction may usurp memory mechanisms differentially.

Childhood Thyroid Cancer Treatment (PDQ®)—Patient Version

Science.gov (United States)

Childhood thyroid cancer treatment usually includes surgery and may include radioactive iodine therapy, targeted therapy, and hormone replacement therapy. Learn more about the diagnosis and treatment of childhood thyroid cancer in this expert-reviewed summary.

Extra-corporeal liver BNCT for the treatment of diffuse metastases: What was learned and what is still to be learned

Energy Technology Data Exchange (ETDEWEB)

Zonta, A. [Department of Surgery, University of Pavia, Pavia (Italy)], E-mail: aris.zonta@pv.infn.it; Pinelli, T. [Department of Nuclear and Theoretical Physics, University of Pavia, Pavia (Italy); National Institute of Nuclear Physics (INFN) Pavia Section, Pavia (Italy); Prati, U.; Roveda, L. [Oncologic Surgery, Cancer Center of Excellence Fond. ' T. Campanella' , Catanzaro (Italy); Ferrari, C.; Clerici, A.M.; Zonta, C. [Department of Surgery, University of Pavia, Pavia (Italy); Mazzini, G. [Department of Animal Biol., IGM-CNR Histochemistry and Cytometry Section, Pavia (Italy); Dionigi, P. [Department of Surgery, University of Pavia, Pavia (Italy); Altieri, S.; Bortolussi, S. [Department of Nuclear and Theoretical Physics, University of Pavia, Pavia (Italy); National Institute of Nuclear Physics (INFN) Pavia Section, Pavia (Italy); Bruschi, P. [Department of Nuclear and Theoretical Physics, University of Pavia, Pavia (Italy); Fossati, F. [Department of Nuclear and Theoretical Physics, University of Pavia, Pavia (Italy); National Institute of Nuclear Physics (INFN) Pavia Section, Pavia (Italy)

2009-07-15

Almost eight years ago, in December 2001, we performed for the first time in the world thermal neutron irradiation on an isolated liver of a patient. The organ was affected by diffuse metastases of a colon carcinoma and had been previously loaded with a {sup 10}B compound. In July 2003, the same procedure was applied again on a patient for the treatment of unresectable and incurable hepatic metastases of a carcinoma of the rectum. Both patients are dead at present. Now we can analyze in depth the clinical history of these patients and evaluate the effectiveness of this therapy. From this exciting experience we learned much, and we also found out about complications till then unknown, which need to be studied and addressed experimentally. Unfortunately we can base our conclusions just on the experience we had with these two patients. We could have been much more detailed and firm in our statements if the number of clinical cases was larger. The BNCT Pavia project has been suspended, but it is more than likely to resume in a short time. Good findings were many. The procedure is feasible; the original concept of complete immersion of the diseased liver in a homogeneous neutron field proved effective and winning. The tumor masses resulted completely necrotic and unknown metastases too appeared radically treated; healthy hepatic tissue was preserved from both morphological and functional points of view; no symptoms of cirrhosis appeared even four years after treatment. For the long term surviving patient, quality of life was excellent. Other findings require to be tackled in depth. The 'post-irradiation syndrome' we observed in both patients, with identical symptoms and biochemical derangements, creates a dramatic-even though totally reversible-clinical condition, that is the probable cause of death for our second patient, suffering from cardiomyopathy, 33 days after treatment. For the first patient, recurrences were a late yet fatal complication, for which

Machine learning-based patient specific prompt-gamma dose monitoring in proton therapy

Science.gov (United States)

Gueth, P.; Dauvergne, D.; Freud, N.; Létang, J. M.; Ray, C.; Testa, E.; Sarrut, D.

2013-07-01

Online dose monitoring in proton therapy is currently being investigated with prompt-gamma (PG) devices. PG emission was shown to be correlated with dose deposition. This relationship is mostly unknown under real conditions. We propose a machine learning approach based on simulations to create optimized treatment-specific classifiers that detect discrepancies between planned and delivered dose. Simulations were performed with the Monte-Carlo platform Gate/Geant4 for a spot-scanning proton therapy treatment and a PG camera prototype currently under investigation. The method first builds a learning set of perturbed situations corresponding to a range of patient translation. This set is then used to train a combined classifier using distal falloff and registered correlation measures. Classifier performances were evaluated using receiver operating characteristic curves and maximum associated specificity and sensitivity. A leave-one-out study showed that it is possible to detect discrepancies of 5 mm with specificity and sensitivity of 85% whereas using only distal falloff decreases the sensitivity down to 77% on the same data set. The proposed method could help to evaluate performance and to optimize the design of PG monitoring devices. It is generic: other learning sets of deviations, other measures and other types of classifiers could be studied to potentially reach better performance. At the moment, the main limitation lies in the computation time needed to perform the simulations.

Machine learning-based patient specific prompt-gamma dose monitoring in proton therapy

International Nuclear Information System (INIS)

Gueth, P; Freud, N; Létang, J M; Sarrut, D; Dauvergne, D; Ray, C; Testa, E

2013-01-01

Online dose monitoring in proton therapy is currently being investigated with prompt-gamma (PG) devices. PG emission was shown to be correlated with dose deposition. This relationship is mostly unknown under real conditions. We propose a machine learning approach based on simulations to create optimized treatment-specific classifiers that detect discrepancies between planned and delivered dose. Simulations were performed with the Monte-Carlo platform Gate/Geant4 for a spot-scanning proton therapy treatment and a PG camera prototype currently under investigation. The method first builds a learning set of perturbed situations corresponding to a range of patient translation. This set is then used to train a combined classifier using distal falloff and registered correlation measures. Classifier performances were evaluated using receiver operating characteristic curves and maximum associated specificity and sensitivity. A leave-one-out study showed that it is possible to detect discrepancies of 5 mm with specificity and sensitivity of 85% whereas using only distal falloff decreases the sensitivity down to 77% on the same data set. The proposed method could help to evaluate performance and to optimize the design of PG monitoring devices. It is generic: other learning sets of deviations, other measures and other types of classifiers could be studied to potentially reach better performance. At the moment, the main limitation lies in the computation time needed to perform the simulations. (paper)

Treatment consumption and treatment re-enrollment in GHB-dependent patients in The Netherlands.

Science.gov (United States)

van Noorden, Martijn S; Mol, Ton; Wisselink, Jeroen; Kuijpers, Wil; Dijkstra, Boukje A G

2017-07-01

The objective of this study was to assess treatment consumption and re-enrollment in treatment in patients with gamma-hydroxybutyrate (GHB)-dependence in Dutch Addiction Treatment Centers (ATCs) in comparison with other addictions. A cohort-study using nationwide administrative data from regular Dutch ATCs associated with the Dutch National Alcohol and Drugs Information System (LADIS), covering an estimated 95% of ATCs. We selected in- and out-patients with alcohol, drug and/or behavioral addictions with a first treatment episode in 2008-2011 and consecutive treatments until 2013 (n=71,679). Patients still in treatment at that date (n=3686; 5.1%), forensic patients (n=1949; 2.7%) and deceased patients (n=570; 0.8%) were excluded, leaving 65,474 patients (91.3%). Of those, 596 (0.9%) patients had GHB dependence. We analyzed number of treatment contacts, treatment duration, admissions and admission duration of the first treatment episode, and re-enrollment (defined as having started a second treatment episode in the study period). GHB-dependent patients showed the highest number of treatment contacts, duration of treatment and chance of being admitted. Re-enrollment rates were 2-5 times higher in GHB-dependent patients than other patients with adjusted HR of other addictions ranging from 0.18 (95% confidence interval [CI]: 0.15-0.21) to 0.53 (95% CI: 0.47-0.61). This study demonstrates high levels of treatment consumption and high rates of treatment re-enrollment in GHB-dependent patients. These findings highlight the urgency of developing effective relapse prevention interventions for GHB-dependent patients. Copyright © 2017 Elsevier B.V. All rights reserved.

Radiation protection of patients during radiotherapy treatment

International Nuclear Information System (INIS)

Novotny, Josef

2008-01-01

The focus of the lecture was on concomitant doses. The learning objectives were as follows: (1) to investigate the origin of concomitant doses; (2) to assess concomitant doses from different sources; (3) to evaluate potential risk from patient from concomitant doses; and (4) to learn procedures for reduction and optimisation of concomitant doses. (P.A.)

Childhood Nasopharyngeal Cancer Treatment (PDQ®)—Patient Version

Science.gov (United States)

Childhood nasopharyngeal cancer treatment options include chemotherapy, external and internal radiation therapy, surgery, and immunotherapy (interferon). Learn more about the risk factors, symptoms, tests to diagnose, and treatment of childhood nasopharyngeal cancer in this expert-reviewed summary.

Structural MRI-Based Predictions in Patients with Treatment-Refractory Depression (TRD.

Directory of Open Access Journals (Sweden)

Blair A Johnston

Full Text Available The application of machine learning techniques to psychiatric neuroimaging offers the possibility to identify robust, reliable and objective disease biomarkers both within and between contemporary syndromal diagnoses that could guide routine clinical practice. The use of quantitative methods to identify psychiatric biomarkers is consequently important, particularly with a view to making predictions relevant to individual patients, rather than at a group-level. Here, we describe predictions of treatment-refractory depression (TRD diagnosis using structural T1-weighted brain scans obtained from twenty adult participants with TRD and 21 never depressed controls. We report 85% accuracy of individual subject diagnostic prediction. Using an automated feature selection method, the major brain regions supporting this significant classification were in the caudate, insula, habenula and periventricular grey matter. It was not, however, possible to predict the degree of 'treatment resistance' in individual patients, at least as quantified by the Massachusetts General Hospital (MGH-S clinical staging method; but the insula was again identified as a region of interest. Structural brain imaging data alone can be used to predict diagnostic status, but not MGH-S staging, with a high degree of accuracy in patients with TRD.

Standardised patient-simulated practice learning: A rich ...

African Journals Online (AJOL)

This study investigates the use of standardised patients (SPs) in a simulated patient interview as a learning strategy to bridge the theory-practice gap. Simulation helps students to develop skills such as communication, higher cognitive thinking, decision-making and problem-solving. There is evidence to support the use of ...

Relative risk of probabilistic category learning deficits in patients with schizophrenia and their siblings

Science.gov (United States)

Weickert, Thomas W.; Goldberg, Terry E.; Egan, Michael F.; Apud, Jose A.; Meeter, Martijn; Myers, Catherine E.; Gluck, Mark A; Weinberger, Daniel R.

2010-01-01

Background While patients with schizophrenia display an overall probabilistic category learning performance deficit, the extent to which this deficit occurs in unaffected siblings of patients with schizophrenia is unknown. There are also discrepant findings regarding probabilistic category learning acquisition rate and performance in patients with schizophrenia. Methods A probabilistic category learning test was administered to 108 patients with schizophrenia, 82 unaffected siblings, and 121 healthy participants. Results Patients with schizophrenia displayed significant differences from their unaffected siblings and healthy participants with respect to probabilistic category learning acquisition rates. Although siblings on the whole failed to differ from healthy participants on strategy and quantitative indices of overall performance and learning acquisition, application of a revised learning criterion enabling classification into good and poor learners based on individual learning curves revealed significant differences between percentages of sibling and healthy poor learners: healthy (13.2%), siblings (34.1%), patients (48.1%), yielding a moderate relative risk. Conclusions These results clarify previous discrepant findings pertaining to probabilistic category learning acquisition rate in schizophrenia and provide the first evidence for the relative risk of probabilistic category learning abnormalities in unaffected siblings of patients with schizophrenia, supporting genetic underpinnings of probabilistic category learning deficits in schizophrenia. These findings also raise questions regarding the contribution of antipsychotic medication to the probabilistic category learning deficit in schizophrenia. The distinction between good and poor learning may be used to inform genetic studies designed to detect schizophrenia risk alleles. PMID:20172502

Accelerated iTBS treatment in depressed patients differentially modulates reward system activity based on anhedonia.

Science.gov (United States)

Duprat, Romain; Wu, Guo-Rong; De Raedt, Rudi; Baeken, Chris

2017-08-09

Accelerated intermittent theta-burst stimulation (aiTBS) anti-depressive working mechanisms are still unclear. Because aiTBS may work through modulating the reward system and the level of anhedonia may influence this modulation, we investigated the effect of aiTBS on reward responsiveness in high and low anhedonic MDD patients. In this registered RCT (NCT01832805), 50 MDD patients were randomised to a sham-controlled cross-over aiTBS treatment protocol over the left dorsolateral prefrontal cortex (DLPFC). Patients performed a probabilistic learning task in fMRI before and after each week of stimulation. Task performance analyses did not show any significant effects of aiTBS on reward responsiveness, nor differences between both groups of MDD patients. However, at baseline, low anhedonic patients displayed higher neural activity in the caudate and putamen. After the first week of aiTBS treatment, in low anhedonic patients we found a decreased neural activity within the reward system, in contrast to an increased activity observed in high anhedonic patients. No changes were observed in reward related neural regions after the first week of sham stimulation. Although both MDD groups showed no differences in task performance, our brain imaging findings suggest that left DLPFC aiTBS treatment modulates the reward system differently according to anhedonia severity.

Adult Primary Liver Cancer Treatment (PDQ®)—Patient Version

Science.gov (United States)

Treatment of liver cancer in adults depends on the stage. Treatment options include hepatectomy, liver transplant, ablation, electroporation therapy (EPT), embolization therapy, targeted therapy, and/or radiation therapy. Learn more about treatment for the different stages of liver cancer.

Work Placements as Learning Environments for Patient Safety: Finnish and British Preregistration Nursing Students' Important Learning Events

Science.gov (United States)

Tella, Susanna; Smith, Nancy-Jane; Partanen, Pirjo; Turunen, Hannele

2016-01-01

Learning to ensure patient safety in complex health care environments is an internationally recognised concern. This article explores and compares Finnish (n = 22) and British (n = 32) pre-registration nursing students' important learning events about patient safety from their work placements in health care organisations. Written descriptions were…

Hairy Cell Leukemia Treatment (PDQ®)—Patient Version

Science.gov (United States)

Hairy cell leukemia treatment options include watchful waiting when there are no symptoms, chemotherapy, biologic therapy, surgery, and targeted therapy. Learn more about the diagnosis and treatment of newly diagnosed and recurrent hairy cell leukemia in this expert-reviewed summary.

How clerkship students learn from real patients in practice settings

NARCIS (Netherlands)

Steven, Kathryn; Wenger, Etienne; Boshuizen, Els; Scherpbier, Albert; Dornan, Tim

2018-01-01

Purpose To explore how undergraduate medical students learn from real patients in practice settings, the factors that affect their learning, and how clerkship learning might be enhanced. Method In 2009, 22 medical students in the three clerkship years of an undergraduate medical program in the

Social learning contributions to the etiology and treatment of functional abdominal pain and inflammatory bowel disease in children and adults

Institute of Scientific and Technical Information of China (English)

Rona L Levy; Shelby L Langer; William E Whitehead

2007-01-01

This paper reviews empirical work on cognitive and social learning contributions to the etiology and treatment of illness behavior associated with functional abdominal pain and inflammatory bowel disease. A particular emphasis is placed on randomized controlled trials,the majority of which are multi-modal in orientation,incorporating elements of cognitive behavioral therapy,social learning, and relaxation. Based on this review,we offer methodological and clinical suggestions: (1)Research investigations should include adequate sample sizes, long-term follow-up assessments, and a credible,active control group. (2) Standard gastrointestinal practice should include, when appropriate, learning opportunities for patients and family members, for example, instruction regarding the encouragement of wellness behavior.

From learning to memory: what flies can tell us about intellectual disability treatment.

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Alaura eAndroschuk

2015-06-01

Full Text Available Intellectual disability (ID, previously known as mental retardation, affects 3 % of the population and remains without pharmacological treatment. ID is characterized by impaired general mental abilities with associated defects in adaptive function in which onset occurs before 18 years old. In severe ID, genetic causes are increasingly recognized in large part due to genome-wide techniques such as microarrays and exome sequencing. Unfortunately drug discovery for treatment of ID has not followed the same pace as gene discovery, leaving clinicians, patients and families without the ability to ameliorate symptoms. Despite this, several model organisms have proven valuable in developing and screening candidate drugs. One such model organism is the fruit fly Drosophila. First, we review the current understanding of memory in human and its model in Drosophila. Second, we describe key signaling pathways involved in ID and memory such as the cAMP-CREB pathway, the regulation of protein synthesis, the role of receptors and anchoring proteins, the role of neuronal proliferation, and finally the role of neurotransmitters. Third, we characterize the types of memory defects found in patients with ID. Finally, we discuss how important insights gained from Drosophila learning and memory could be translated in clinical research to lead to better treatment development.

Endovascular repair as a sole treatment in multiple aneurysms in patient with SLE

International Nuclear Information System (INIS)

Dineva, S.; Al-Amin, M.; Demetriou, S.; Tsetis, D.

2013-01-01

Full text: Introduction: Most aneurysms are local manifestations of systemic disease. For patients over 65 years the incidence of aneurysm of the abdominal aorta (AAA) is approximately 5-6% in men and 1-2 % for women. The presence of both the AAA and aneurysms in other location is even rarer, and this percentage is likely increase further in patients with systemic lupus erythematosus (SLE). What you will learn: We present a rare clinical case of endovascular treatment of multifocal aneurysm including post catheterization pseudoaneurysm. The patient is a 73 years old woman with a history of SLE and age-related comorbidity. Originally an endovascular treatment of aneurysms of the abdominal aorta and right common iliac artery was used. Two years later a successfully endovascular treatment of aneurysm of the right renal artery was conducted, which however is complicated by the formation of a pseudoaneurysm in access through the left femoral artery. The late one is again treated endovascular by placement of a covered stent after failure of percutaneous injection of 1000 UI thrombin. Discussion: Adult patients with a long history of SLE are unsuitable candidates for surgical treatment of aneurysmal disease, especially in its multifocal form. In our case we have taken multistep successful endovascular procedures, including technically hard placing of the stent at the site of the right renal aneurysms, and post catheterization pseudoaneurysm. Conclusion: Multifocal aneurysmal vascular changes due to macroangiopathia in SLE can be treated alone by endovascular means in multi-stages procedures

Tuberculosis Treatment Adherence of Patients in Kosovo.

Science.gov (United States)

Krasniqi, Shaip; Jakupi, Arianit; Daci, Armond; Tigani, Bahri; Jupolli-Krasniqi, Nora; Pira, Mimoza; Zhjeqi, Valbona; Neziri, Burim

2017-01-01

The poor patient adherence in tuberculosis (TB) treatment is considered to be one of the most serious challenges which reflect the decrease of treatment success and emerging of the Multidrug Resistance-TB (MDR-TB). To our knowledge, the data about patients' adherence to anti-TB treatment in our country are missing. This study was aimed to investigate the anti-TB treatment adherence rate and to identify factors related to eventual nonadherence among Kosovo TB patients. This study was conducted during 12 months, and the survey was a descriptive study using the standardized questionnaires with total 324 patients. The overall nonadherence for TB patient cohort was 14.5%, 95% CI (0.109-0.188). Age and place of residence are shown to have an effect on treatment adherence. Moreover, the knowledge of the treatment prognosis, daily dosage, side effects, and length of treatment also play a role. This was also reflected in knowledge regarding compliance with regular administration of TB drugs, satisfaction with the treatment, interruption of TB therapy, and the professional monitoring in the administration of TB drugs. The level of nonadherence TB treatment in Kosovar patients is not satisfying, and more health care worker's commitments need to be addressed for improvement.

Professionals learning together with patients: An exploratory study of a collaborative learning Fellowship programme for healthcare improvement.

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Myron, Rowan; French, Catherine; Sullivan, Paul; Sathyamoorthy, Ganesh; Barlow, James; Pomeroy, Linda

2018-05-01

Improving the quality of healthcare involves collaboration between many different stakeholders. Collaborative learning theory suggests that teaching different professional groups alongside each other may enable them to develop skills in how to collaborate effectively, but there is little literature on how this works in practice. Further, though it is recognised that patients play a fundamental role in quality improvement, there are few examples of where they learn together with professionals. To contribute to addressing this gap, we review a collaborative fellowship in Northwest London, designed to build capacity to improve healthcare, which enabled patients and professionals to learn together. Using the lens of collaborative learning, we conducted an exploratory study of six cohorts of the year long programme (71 participants). Data were collected using open text responses from an online survey (n = 31) and semi-structured interviews (n = 34) and analysed using an inductive open coding approach. The collaborative design of the Fellowship, which included bringing multiple perspectives to discussions of real world problems, was valued by participants who reflected on the safe, egalitarian space created by the programme. Participants (healthcare professionals and patients) found this way of learning initially challenging yet ultimately productive. Despite the pedagogical and practical challenges of developing a collaborative programme, this study indicates that opening up previously restricted learning opportunities as widely as possible, to include patients and carers, is an effective mechanism to develop collaborative skills for quality improvement.

Conservative treatment of patients with tarsal coalitions

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A. V. Sapogoosky

2015-01-01

Full Text Available Tarsal coalition is a pathological condition with abnormal fusion between two or more tarsal bones. The aim of the study was to evaluate effectiveness of conservative treatment in patients with tarsal coalitions. The treatment included reducing the intensity of physical activity, medication, orthotics, physiotherapy. For evaluation of effectiveness of the treatment, we used the AOFAS scale. The results of the study demonstrated that conservative treatment in patients with tarsal coalitions was focused onon temporary pain release. Conservative treatment has limited efficacy for patients with symptomatic tarsal coalitions because of short pain release in the majority of children (98 %. The indications for conservative treatment in patients with symptomatic tarsal coalitions should be pain and hindfoot valgus less than 15°. In other cases, conservative treatment should be considered as preoperative preparation.

Tuberculosis treatment among smear positive tuberculosis patients

International Nuclear Information System (INIS)

Munir, M.K.; Iqbal, R.; Shabbir, I.; Chaudhry, K

2012-01-01

Tuberculosis is a major health problem in many parts of the world. Delay in initiation of the treatment may result in prolonged infectious state, drug resistance, relapse and death. Objectives: To determine the factors responsible for not starting tuberculosis treatment among smear positive tuberculosis patients. Study type, settings and duration: This cross sectional study was done at Pakistan Medical Research Council TB Research Center, King Edward Medical University, Lahore, from fifth March 2010 to fifth December 2010. Patients and Methods: Fifty sputum smear positive patients of tuberculosis who did not register themselves in treatment register and presumably did not initiate anti tuberculosis treatment were contacted using telephone or traced by their home addresses. Once contact was established, they were inquired about the reasons for not starting tuberculosis treatment. Results: Of 50 patients 38(76%)belonged to the lower socio economic class and 12(24%) to the lower middle class. Fourteen patients (28%) were illiterate and 23(46%) had only 8 years of education. Of the 50 cases 41(82%) were taking treatment from traditional healers and 4% did not go back to the DOTS program. Physical condition of the patient, social, domestic and religious issues also played some role in default. Conclusions: Lack of health education and poverty were the main factors responsible for non compliance from treatment. Policy message: Sputum testing sites should have a paramedic who should educate the patients about the benefits of treatment and the dangers of default or partial treatment. (author)

Evaluation of patient involvement in a systematic review and meta-analysis of individual patient data in cervical cancer treatment

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Vale Claire L

2012-05-01

Full Text Available Abstract Background In April 2005, researchers based at the Medical Research Council Clinical Trials Unit, set out to involve women affected by cervical cancer in a systematic review and meta-analysis of individual patient data to evaluate treatments for this disease. Each of the women had previously been treated for cervical cancer. Following completion of the meta-analysis, we aimed to evaluate the process of involvement from the researcher and research partner perspective. Methods An advisory group was first established to give advice on recruiting, supporting and involving women and led to efforts to recruit women to take part in the systematic review using different approaches. Evaluation of the process and outcomes of the partnership between the systematic reviewers and the patients, in respect to what the partnership achieved; what worked well and what were the difficulties; what was learned and the resource requirements, took place during the conduct of the meta-analysis and again after completion of the project. Results Six women, each of whom had received treatments for cervical cancer, were recruited as Patient Research Partners and five of these women subsequently took part in a variety of activities around the systematic review. They attended progress meetings and all but one attended a meeting at which the first results of the review were presented to all collaborators and gave feedback. Three of the women also became involved in a further related research project which led to an editorial publication from the patient perspective and also participated, along with two lead researchers, in the evaluation of the process and outcomes. While they were generally positive about the experience, one Patient Research Partner questioned the extent of the impact patients could make to the systematic review process. Conclusions In general, researchers and patient research partners felt that they had learned a lot from the process and considered

Sleep disturbances in treatment-seeking OCD-patients: Changes after concentrated exposure treatment.

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Nordahl, Håkon; Havnen, Audun; Hansen, Bjarne; Öst, Lars-Göran; Kvale, Gerd

2018-04-01

Research indicates that patients with Obsessive Compulsive Disorder (OCD) frequently suffer from comorbid sleep difficulties, and that these difficulties often are not clinically recognized and diagnosed. There has been limited research investigating if comorbid sleep difficulties impair treatment outcome for OCD and if the sleep difficulties change following OCD-treatment. Thirty-six patients with obsessive compulsive disorder underwent concentrated exposure treatment delivered in a group over four consecutive days and were assessed with measures of OCD, depressive symptoms and sleep disturbance at three different time points (pre, post and 6 months follow-up). The sample was characterized by a high degree of comorbidity with other psychiatric disorders. At pre-treatment nearly 70% of the patients reported sleep difficulties indicative of primary insomnia. The results showed that patients had large reductions of OCD-symptoms as well as significant improvements in sleep disturbance assessed after treatment, and that these improvements were maintained at follow-up. Sleep disturbance did not impair treatment outcome, on the contrary patients with higher degree of sleep disturbance at pre-treatment had better outcome on OCD-symptoms after treatment. The results indicated that the majority of the OCD sample suffered from sleep disturbances and that these sleep disturbances were significantly reduced following adequate treatment of OCD without specific sleep interventions. However, a proportion of the patients suffered from residual symptoms of insomnia after treatment. © 2017 Scandinavian Psychological Associations and John Wiley & Sons Ltd.

Patients with Parkinson's disease learn to control complex systems-an indication for intact implicit cognitive skill learning.

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Witt, Karsten; Daniels, Christine; Daniel, Victoria; Schmitt-Eliassen, Julia; Volkmann, Jens; Deuschl, Günther

2006-01-01

Implicit memory and learning mechanisms are composed of multiple processes and systems. Previous studies demonstrated a basal ganglia involvement in purely cognitive tasks that form stimulus response habits by reinforcement learning such as implicit classification learning. We will test the basal ganglia influence on two cognitive implicit tasks previously described by Berry and Broadbent, the sugar production task and the personal interaction task. Furthermore, we will investigate the relationship between certain aspects of an executive dysfunction and implicit learning. To this end, we have tested 22 Parkinsonian patients and 22 age-matched controls on two implicit cognitive tasks, in which participants learned to control a complex system. They interacted with the system by choosing an input value and obtaining an output that was related in a complex manner to the input. The objective was to reach and maintain a specific target value across trials (dynamic system learning). The two tasks followed the same underlying complex rule but had different surface appearances. Subsequently, participants performed an executive test battery including the Stroop test, verbal fluency and the Wisconsin card sorting test (WCST). The results demonstrate intact implicit learning in patients, despite an executive dysfunction in the Parkinsonian group. They lead to the conclusion that the basal ganglia system affected in Parkinson's disease does not contribute to the implicit acquisition of a new cognitive skill. Furthermore, the Parkinsonian patients were able to reach a specific goal in an implicit learning context despite impaired goal directed behaviour in the WCST, a classic test of executive functions. These results demonstrate a functional independence of implicit cognitive skill learning and certain aspects of executive functions.

Neural mechanisms of reinforcement learning in unmedicated patients with major depressive disorder.

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Rothkirch, Marcus; Tonn, Jonas; Köhler, Stephan; Sterzer, Philipp

2017-04-01

According to current concepts, major depressive disorder is strongly related to dysfunctional neural processing of motivational information, entailing impairments in reinforcement learning. While computational modelling can reveal the precise nature of neural learning signals, it has not been used to study learning-related neural dysfunctions in unmedicated patients with major depressive disorder so far. We thus aimed at comparing the neural coding of reward and punishment prediction errors, representing indicators of neural learning-related processes, between unmedicated patients with major depressive disorder and healthy participants. To this end, a group of unmedicated patients with major depressive disorder (n = 28) and a group of age- and sex-matched healthy control participants (n = 30) completed an instrumental learning task involving monetary gains and losses during functional magnetic resonance imaging. The two groups did not differ in their learning performance. Patients and control participants showed the same level of prediction error-related activity in the ventral striatum and the anterior insula. In contrast, neural coding of reward prediction errors in the medial orbitofrontal cortex was reduced in patients. Moreover, neural reward prediction error signals in the medial orbitofrontal cortex and ventral striatum showed negative correlations with anhedonia severity. Using a standard instrumental learning paradigm we found no evidence for an overall impairment of reinforcement learning in medication-free patients with major depressive disorder. Importantly, however, the attenuated neural coding of reward in the medial orbitofrontal cortex and the relation between anhedonia and reduced reward prediction error-signalling in the medial orbitofrontal cortex and ventral striatum likely reflect an impairment in experiencing pleasure from rewarding events as a key mechanism of anhedonia in major depressive disorder. © The Author (2017). Published by Oxford

Selected problems associated with the treatment and care for patients with colostomy ? part 1

OpenAIRE

Muzyczka, Katarzyna; Kachaniuk, Hanna; Szadowska-Szlachetka, Zdzis?awa; Charzy?ska-Gula, Marianna; Kocka, Katarzyna; Bartoszek, Agnieszka; Celej-Szuster, Jolanta

2013-01-01

The study presents a short historical background and practical application of intestinal ostomy as a treatment method of various intestinal disorders and injuries. Ostomy is a purposeful connection of the lumen of the intestine with abdominal integuments by surgery. After the surgical formation of the intestinal fistula, the patient must adjust to the new situation, gain basic knowledge and learn procedures of ostomy care. Thus, professional medical assistance is extremely important. The stud...

Studying depression using imaging and machine learning methods.

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Patel, Meenal J; Khalaf, Alexander; Aizenstein, Howard J

2016-01-01

Depression is a complex clinical entity that can pose challenges for clinicians regarding both accurate diagnosis and effective timely treatment. These challenges have prompted the development of multiple machine learning methods to help improve the management of this disease. These methods utilize anatomical and physiological data acquired from neuroimaging to create models that can identify depressed patients vs. non-depressed patients and predict treatment outcomes. This article (1) presents a background on depression, imaging, and machine learning methodologies; (2) reviews methodologies of past studies that have used imaging and machine learning to study depression; and (3) suggests directions for future depression-related studies.

Debriefing after Human Patient Simulation and Nursing Students' Learning

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Benhuri, Gloria

2014-01-01

Human Patient Simulation (HPS) exercises with life-like computerized manikins provide clinical experiences for nursing students in a safe environment followed by debriefing that promotes learning. Quantitative research in techniques to support learning from debriefing is limited. The purpose of the quantitative quasi-experimental study using a…

Breast Cancer Treatment (PDQ®)—Patient Version

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Breast cancer treatment depends on several factors and can include combinations of surgery, chemotherapy, radiation, hormone, and targeted therapy. Learn more about how breast cancer is diagnosed and treated in this expert-reviewed summary.

Tuberculosis Treatment Adherence of Patients in Kosovo

Directory of Open Access Journals (Sweden)

Shaip Krasniqi

2017-01-01

Full Text Available Setting. The poor patient adherence in tuberculosis (TB treatment is considered to be one of the most serious challenges which reflect the decrease of treatment success and emerging of the Multidrug Resistance-TB (MDR-TB. To our knowledge, the data about patients’ adherence to anti-TB treatment in our country are missing. Objective. This study was aimed to investigate the anti-TB treatment adherence rate and to identify factors related to eventual nonadherence among Kosovo TB patients. Design. This study was conducted during 12 months, and the survey was a descriptive study using the standardized questionnaires with total 324 patients. Results. The overall nonadherence for TB patient cohort was 14.5%, 95% CI (0.109–0.188. Age and place of residence are shown to have an effect on treatment adherence. Moreover, the knowledge of the treatment prognosis, daily dosage, side effects, and length of treatment also play a role. This was also reflected in knowledge regarding compliance with regular administration of TB drugs, satisfaction with the treatment, interruption of TB therapy, and the professional monitoring in the administration of TB drugs. Conclusion. The level of nonadherence TB treatment in Kosovar patients is not satisfying, and more health care worker’s commitments need to be addressed for improvement.

Adult Central Nervous System Tumors Treatment (PDQ®)—Patient Version

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Adult central nervous system tumor treatment may include surgery, radiosurgery, radiation therapy, chemotherapy, surveillance, and targeted therapy. Treatment depends on the tumor type. Learn more about brain and spinal tumor treatment in this expert-reviewed summary.

Learning patient-centred communication: The journey and the territory.

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Cushing, Annie M

2015-10-01

The student entering medical school is about to undergo a socialisation process that profoundly shapes their development as a professional. A central feature is the formal and informal curriculum on the doctor-patient relationship and patient-centred communication. In this paper I will chart some of the features of the student journey which might impact on learning and practice. The medical undergraduate's role is largely that of observer and learner, rather than a provider of care, so much of the formal teaching on patient-centred communication is within simulated practice. Clinical practice environments are the most powerful influences on learning about professional behaviour. Challenges for educational practitioners include how to support authenticity in learners, respond to their agendas, and foster insight to enable flexibility about communication in different contexts. Parallels between the doctor-patient relationship and the student-tutor relationship are explored for their relevance. A number of educational theories can inform curriculum design and educational practice, notably Vygotsky's Zone of Proximal Development. Application of this and other social learning theories, together with students' reflections can enrich our planning of educational interventions and understanding of their impact. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Contingency learning deficits and generalization in chronic unilateral hand pain patients.

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Meulders, Ann; Harvie, Daniel S; Bowering, Jane K; Caragianis, Suzanne; Vlaeyen, Johan W S; Moseley, G Lorimer

2014-10-01

Contingency learning, in particular the formation of danger beliefs, underpins conditioned fear and avoidance behavior, yet equally important is the formation of safety beliefs. That is, when threat beliefs and accompanying fear/avoidance spread to technically safe cues, it might cause disability. Indeed, such over generalization has been advanced as a trans-diagnostic pathologic marker, but it has not been investigated in chronic pain. Using a novel hand pain scenario contingency learning task, we tested the hypotheses that chronic hand pain patients demonstrate less differential pain expectancy judgments because of poor safety learning and demonstrate broader generalization gradients than healthy controls. Participants viewed digitized 3-dimensional hands in different postures presented in random order (conditioned stimulus [CS]) and rated the likelihood that a fictive patient would feel pain when moving the hand into that posture. Subsequently, the outcome (pain/no pain) was presented on the screen. One hand posture was followed by pain (CS+), another was not (CS-). Generalization was tested using novel hand postures (generalization stimuli) that varied in how similar they were to the original conditioned stimuli. Patients, but not healthy controls, demonstrated a contingency learning deficit determined by impaired safety learning, but not by exaggerated pain expectancy toward the CS+. Patients showed flatter, asymmetric generalization gradients than the healthy controls did, with higher pain expectancy for novel postures that were more similar to the original CS-. The results clearly uphold our hypotheses and suggest that contingency learning deficits might be important in the development and maintenance of the chronic pain-related disability. Chronic hand pain patients demonstrate 1) reduced differential contingency learning determined by a lack of safety belief formation, but not by exaggerated threat belief formation, and 2) flatter, asymmetric

Patient/parent expectations of orthodontic treatment.

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Obilade, Omolara Abiodun; da Costa, Oluranti Olatokunbo; Sanu, Oluwatosin Oluyemi

2017-03-01

Expectations of orthodontic treatment may differ between the patient and their parents, as the parents' expectations may not reflect those of the child. The aim of this study, therefore, was to determine the expectations of patients and their parents. This was a clinic-based, comparative, cross-sectional study involving 110 patients aged between 10 and 19 years, as well as their accompanying parents or guardians. The expectations of both patients and parents were determined using a questionnaire developed by Sayers and Newton. Results showed that the expectations of the patients and parents differed significantly in a number of areas with the parents' expectations often exceeding those of the patients. Both patients and parents were found to be ignorant about some aspects of orthodontic treatment, with 47.3% of patients and 39.1% of parents unaware of the duration of orthodontic treatment and, as such, requiring information from their clinicians. The results highlight the importance of patient education and counseling as well as the need to focus on the individual patient and not assume that their expectations mirror those of the accompanying parent. Copyright © 2016. Published by Elsevier Masson SAS.

Relationship between patient characteristics and treatment allocation for patients with personality disorders.

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van Manen, Janine G; Andrea, Helene; van den Eijnden, Ellen; Meerman, Anke M M A; Thunnissen, Moniek M; Hamers, Elisabeth F M; Huson, Nelleke; Ziegler, Uli; Stijnen, Theo; Busschbach, Jan J V; Timman, Reinier; Verheul, Roel

2011-10-01

Within a large multi-center study in patients with personality disorders, we investigated the relationship between patient characteristics and treatment allocation. Personality pathology, symptom distress, treatment history, motivational factors, and sociodemographics were measured at intake in 923 patients, who subsequently enrolled in short-term or long-term outpatient, day hospital, or inpatient psychotherapy for personality pathology. Logistic regressions were used to examine the predictors of allocation decisions. We found a moderate relationship (R(2) = 0.36) between patient characteristics and treatment setting, and a weak relationship (R(2) = 0.18) between patient characteristics and treatment duration. The most prominent predictors for setting were: symptom distress, cluster C personality pathology, level of identity integration, treatment history, motivation, and parental responsibility. For duration the most prominent predictor was age. We conclude from this study that, in addition to pathology and motivation factors, sociodemographics and treatment history are related to treatment allocation in clinical practice.

Patients' and parents' expectations of orthodontic treatment.

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Hiemstra, Renske; Bos, Annemieke; Hoogstraten, Johan

2009-12-01

To investigate the expectations of children and their primary care-givers towards orthodontic treatment and to compare the results with those of a UK sample. A questionnaire survey of children and their primary care-givers attending for their first consultation. The Department of Orthodontics at the Academic Centre for Dentistry Amsterdam (ACTA), the Netherlands. A total of 168 subjects (84 patients and 84 parents) completed the questionnaire. The children were aged 10 to 14 years. The responses of the children and parents and differences between boys and girls were examined using parametric statistical methods. The data from the Dutch sample were compared with a similar UK sample. Patients and parents shared similar expectations of orthodontic treatment, with the exception of expectations of having a brace fitted at the first appointment, orthodontic treatment involving headgear, any problems with orthodontic treatment, duration of orthodontic treatment and concerning reactions from the public. Among the child participants, boys and girls only differed in their expectations of orthodontic treatment involving jaw surgery. Differences between Dutch and English participants were found regarding the first visit, type of orthodontic treatment, reactions from the public, and pain and problems with orthodontic treatment. Since the expectations of patients and their parents differ on several aspects, effective communication between the orthodontist, patient and parent is considered to be essential. Our hypothesis that Dutch patients' and parents' expectations of orthodontic treatment differ from the expectations of English patients and parents was supported.

Patient experiences of acute myeloid leukemia: A qualitative study about diagnosis, illness understanding, and treatment decision-making.

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LeBlanc, Thomas W; Fish, Laura J; Bloom, Catherine T; El-Jawahri, Areej; Davis, Debra M; Locke, Susan C; Steinhauser, Karen E; Pollak, Kathryn I

2017-12-01

Patients with acute myeloid leukemia (AML) face a unique, difficult situation characterized by sudden changes in health, complex information, and pressure to make quick treatment decisions amid sizeable tradeoffs. Yet, little is known about patients' experiences with AML. We used qualitative methods to learn about their experiences with diagnosis and treatment decision-making to identify areas for improvement. We recruited hospitalized patients with AML to participate in semi-structured qualitative interviews about their experiences being diagnosed with AML, receiving information, and making a treatment decision. Interviews were conducted during their hospitalization for induction chemotherapy. We analyzed data by using a constant comparison approach. Thirty-two patients completed an interview. Four main themes emerged: (a) shock and suddenness, (b) difficulty processing information, (c) poor communication, and (d) uncertainty. Patients frequently described their diagnosis as shocking. They also felt that the amount of information was too great and too difficult to process, which negatively impacted their understanding. Patients frequently described a lack of emotional support from clinicians and described uncertainty about their prognosis, the number and nature of available treatments, and what to expect from treatment. Acute myeloid leukemia poses a sudden, emotionally challenging, information-laden situation, where little time is available to make important decisions. This results in difficulty processing information and is sometimes complicated by a lack of emotive communication from clinicians. Results indicate a need for targeted interventions to improve AML patients' understanding of illness and treatment options and to address their traumatic experiences around diagnosis. Copyright © 2016 John Wiley & Sons, Ltd.

[Biofeedback treatment for acute whiplash patients].

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Gálvez-Hernández, Carmen Lizette; Rodríguez-Ortiz, María Dolores; Del Río-Portilla, Yolanda

2016-01-01

The aim of this study is to evaluate the physiological and psychological effect after an electromyographic biofeedback treatment in combination with progressive muscular relaxation training in patients with acute whiplash. Twelve patients with acute whiplash volunteered to participate in a quasi-experimental design and a control group. Two months maximum after car accident, severity levels II and I. previous history of persistent pain or serious previous injury. The groups were randomly divided in two (treatment and waiting list groups). We used electromyographic measures of the trapezius muscles with psychometric tests: Beck Anxiety and Depression Inventory; Oswestry Pain Disability Questionnaire; Visual Analog Scale of Pain; TAMPA Scale for Kinesiophobia. The treatment consisted in electromyographic biofeedback after progressive muscular relaxation training. There were significant intra-group differences before and after treatment in muscular symmetry and subjective pain perception in the treatment group. We achieved a significant change (clinical and statistical) in subjective pain perception and muscular symmetry. This study highlights the importance of multidisciplinary work in acute pain patients and the effectiveness of clinical psychophysiological strategies with acute whiplash patients.

Childhood Craniopharyngioma Treatment (PDQ®)—Patient Version

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Childhood craniopharyngiomas are benign (not cancer) brain tumors found near the pituitary gland. Learn about the signs, tests to diagnose, and treatment (surgery, radiation therapy, chemotherapy, and immunotherapy) of pediatric craniopharyngioma in this expert-reviewed summary.

Patient perceptions of multiple sclerosis and its treatment

Directory of Open Access Journals (Sweden)

de Seze J, Borgel F, Brudon F

2012-04-01

Full Text Available Jérôme de Seze1, Florent Borgel2, Frédérique Brudon31Department of Neurology CHRU de Strasbourg, Strasbourg, 2Medical Center, Grenoble, 3Clinique du Tonkin, Villeurbanne, FranceBackground: In order to improve the treatment outcome in multiple sclerosis, it is important to document the factors that influence adherence to therapy. The purpose of this study was to determine patient perceptions and awareness of multiple sclerosis and its treatment, treatment adherence, and impact on quality of life and daily living.Methods: This was a cross-sectional observational study performed in France. Each participating neurologist included the first three patients with relapsing-remitting multiple sclerosis who consulted after the start of the study. Data on clinical features were collected from a physician questionnaire and on disease and treatment perception and on quality of life from a patient autoquestionnaire.Results: A total of 175 neurologists entered 202 patients in the study. The mean duration of disease was 8.0 ± 7.0 years, and immunomodulatory treatment had been administered for a mean duration of 3.0 ± 2.0 years. A total of 166 patients (82.2% were treated with interferon-ß preparations and 36 patients (17.8% with glatiramer acetate. Eighty-five patients (42.1% reported missing their injections from time to time and 36 patients (17.8% reported “drug holidays”. The most frequently given reason for nonadherence was forgetfulness (38.7% of cases. Eighty-six patients (42.6% and 70 patients (34.7% claimed to be well informed about their disease and treatment, respectively. Adherence was significantly higher in well informed patients (P = 0.035. The majority of patients (176 patients, 87.1% intended continuing their current treatment and 49.5% considered that their current treatment might reduce relapses. The most frequently reported side effect was muscle pain (124 patients, 61.4%.Conclusion: Patient understanding of treatment for disease

Patient satisfaction after receiving dental treatment among patients ...

African Journals Online (AJOL)

Background: Patient satisfaction is one of the indicators of the quality of care. Therefore it is one of the tools for evaluating the quality of care. Aim: To determine patient satisfaction after receiving dental treatment among patients attending public dental clinics in Dar-Es-Salaam. Material and methods: Five public dental clinics ...

WE-F-BRB-03: Inclusion of Data-Driven Risk Predictions in Radiation Treatment Planning in the Context of a Local Level Learning Health System

International Nuclear Information System (INIS)

McNutt, T.

2015-01-01

Advancements in informatics in radiotherapy are opening up opportunities to improve our ability to assess treatment plans. Models on individualizing patient dose constraints from prior patient data and shape relationships have been extensively researched and are now making their way into commercial products. New developments in knowledge based treatment planning involve understanding the impact of the radiation dosimetry on the patient. Akin to radiobiology models that have driven intensity modulated radiotherapy optimization, toxicity and outcome predictions based on treatment plans and prior patient experiences may be the next step in knowledge based planning. In order to realize these predictions, it is necessary to understand how the clinical information can be captured, structured and organized with ontologies and databases designed for recall. Large databases containing radiation dosimetry and outcomes present the opportunity to evaluate treatment plans against predictions of toxicity and disease response. Such evaluations can be based on dose volume histogram or even the full 3-dimensional dose distribution and its relation to the critical anatomy. This session will provide an understanding of ontologies and standard terminologies used to capture clinical knowledge into structured databases; How data can be organized and accessed to utilize the knowledge in planning; and examples of research and clinical efforts to incorporate that clinical knowledge into planning for improved care for our patients. Learning Objectives: Understand the role of standard terminologies, ontologies and data organization in oncology Understand methods to capture clinical toxicity and outcomes in a clinical setting Understand opportunities to learn from clinical data and its application to treatment planning Todd McNutt receives funding from Philips, Elekta and Toshiba for some of the work presented

Meaningful Learning Moments on a Family Medicine Clerkship: When Students Are Patient Centered.

Science.gov (United States)

Huang, William Y; Rogers, John C; Nelson, Elizabeth A; Wright, Crystal C; Teal, Cayla R

2016-04-01

Reflection after patient encounters is an important aspect of clinical learning. After our medical school instituted a reflection paper assignment for all clerkships, we wanted to learn about the types of encounters that students found meaningful on a family medicine clerkship and how they impacted students' learning. Family and Community Medicine Clerkship students completed a reflection paper after the clerkship, based on guidelines that were used for all clerkship reflection papers at our medical school. Two reviewers independently organized student responses into themes and then jointly prioritized common themes and negotiated any initial differences into other themes. A total of 272 reflection papers describing an actual learning moment in patient care were submitted during the study period of January 2011--December 2012. In describing actions performed, students most frequently wrote about aspects of patient-centered care such as listening to the patient, carefully assessing the patient's condition, or giving a detailed explanation to the patient. In describing effects of those actions, students wrote about what they learned about the patient-physician interaction, the trust that patients demonstrated in them, the approval they gained from their preceptors, and the benefits they saw from their actions. An important contribution of a family medicine clerkship is the opportunity for students to further their skills in patient-centered care and realize the outcomes of providing that type of care.

Comparison of explicit and incidental learning strategies in memory-impaired patients.

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Smith, Christine N; Urgolites, Zhisen J; Hopkins, Ramona O; Squire, Larry R

2014-01-07

Declarative memory for rapidly learned, novel associations is thought to depend on structures in the medial temporal lobe (MTL), whereas associations learned more gradually can sometimes be supported by nondeclarative memory and by structures outside the MTL. A recent study suggested that even rapidly learned associations can be supported by structures outside the MTL when an incidental encoding procedure termed "fast mapping" (FM) is used. We tested six memory-impaired patients with bilateral damage to hippocampus and one patient with large bilateral lesions of the MTL. Participants saw photographs and names of animals, plants, and foods that were previously unfamiliar (e.g., mangosteen). Instead of asking participants to study name-object pairings for a later memory test (as with traditional memory instructions), participants answered questions that allowed them to infer which object corresponded to a particular name. In a second condition, participants learned name-object associations of unfamiliar items by using standard, explicit encoding instructions (e.g., remember the mangosteen). In FM and explicit encoding conditions, patients were impaired (and performed no better than a group that was given the same tests but had not previously studied the material). The same results were obtained in a second experiment that used the same procedures with modifications to allow for more robust learning and more reliable measures of performance. Thus, our results with the FM procedure and memory-impaired patients yielded the same deficits in learning and memory that have been obtained by using other more traditional paradigms.

[Treatment of tuberculosis in patients with comorbidities].

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Abe, Masahiro; Fujita, Akira

2013-12-01

Early detection and appropriate treatment are the keys to tuberculosis control. In particular, providing appropriate treatment for tuberculosis in patients with HIV infection, rheumatoid arthritis (RA), chronic hepatic disease, or renal failure necessitating hemodialysis, and taking appropriate measures against adverse reactions to antituberculosis drugs are issues of critical importance. This mini-symposium, four experts explained the current status of "treatment of tuberculosis in patients with comorbidities" and proposed measures to address these problems. Dr. Aoki talked about "HIV infection complicated by tuberculosis." To the next, Dr. Yoshinaga gave a talk on "treatment of tuberculosis in RA patients receiving biological agents. Further, Dr. Sasaki lectured on "tuberculosis in patients with hepatic disease/impairment". Lastly, Dr. Takamori gave a lecture on "tuberculosis in patients with renal disease and those on hemodialysis. Tuberculosis patients often have some underlying diseases, and adverse reactions caused by antituberculosis drugs, such as hepatic and renal impairments, are matters of concern. I believe that this mini-symposium has provided useful information for physicians engaged in tuberculosis treatment and for many other healthcare professionals as well.

Intrinsic motivation and metacognition as predictors of learning potential in patients with remitted schizophrenia.

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Tas, Cumhur; Brown, Elliot C; Esen-Danaci, Aysen; Lysaker, Paul H; Brüne, Martin

2012-08-01

Previous research has suggested that neurocognitive functioning predicts best the potential of patients with schizophrenia to acquire newly learned material, which, in turn may impact patients' social functioning. Recent studies have also shown that intrinsic motivation and metacognitive abilities play a decisive role in social functioning in schizophrenia. Accordingly, the present study sought to examine the relationship between intelligence, motivation, metacognition, and learning during a cognitive remediation experimental training. We hypothesized that metacognition and intrinsic motivation would have a strong relationship and independently predict learning potential. Thirty-two patients with schizophrenia who fulfilled the criteria of functional remission were recruited. In a pre-training-post experimental design, patients' learning potential was assessed using previously defined cognitive remediation training for WCST. Intrinsic motivation was examined using Intrinsic Motivation Inventory for schizophrenia; mastery, a domain of metacognition, was measured using the Metacognitive Assessment Scale. Metacognition significantly correlated with subdomains of intrinsic motivation. Patients with higher intrinsic motivation and preserved metacognition improved more in the learning paradigm compared to poorly motivated patients and patients with reduced metacognitive abilities. In particular, "mastery" was determined as an independent predictor of learning potential. Motivation and metacognition are important predictors of learning in schizophrenia. Psychological interventions in schizophrenia may therefore consider incorporating techniques to stimulate metacognitive and motivational abilities as well as developing individualized training programs. Copyright © 2012 Elsevier Ltd. All rights reserved.

Predicting activities of daily living for cancer patients using an ontology-guided machine learning methodology.

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Min, Hua; Mobahi, Hedyeh; Irvin, Katherine; Avramovic, Sanja; Wojtusiak, Janusz

2017-09-16

Bio-ontologies are becoming increasingly important in knowledge representation and in the machine learning (ML) fields. This paper presents a ML approach that incorporates bio-ontologies and its application to the SEER-MHOS dataset to discover patterns of patient characteristics that impact the ability to perform activities of daily living (ADLs). Bio-ontologies are used to provide computable knowledge for ML methods to "understand" biomedical data. This retrospective study included 723 cancer patients from the SEER-MHOS dataset. Two ML methods were applied to create predictive models for ADL disabilities for the first year after a patient's cancer diagnosis. The first method is a standard rule learning algorithm; the second is that same algorithm additionally equipped with methods for reasoning with ontologies. The models showed that a patient's race, ethnicity, smoking preference, treatment plan and tumor characteristics including histology, staging, cancer site, and morphology were predictors for ADL performance levels one year after cancer diagnosis. The ontology-guided ML method was more accurate at predicting ADL performance levels (P ontologies. This study demonstrated that bio-ontologies can be harnessed to provide medical knowledge for ML algorithms. The presented method demonstrates that encoding specific types of hierarchical relationships to guide rule learning is possible, and can be extended to other types of semantic relationships present in biomedical ontologies. The ontology-guided ML method achieved better performance than the method without ontologies. The presented method can also be used to promote the effectiveness and efficiency of ML in healthcare, in which use of background knowledge and consistency with existing clinical expertise is critical.

The relationship between organizational leadership for safety and learning from patient safety events.

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Ginsburg, Liane R; Chuang, You-Ta; Berta, Whitney Blair; Norton, Peter G; Ng, Peggy; Tregunno, Deborah; Richardson, Julia

2010-06-01

To examine the relationship between organizational leadership for patient safety and five types of learning from patient safety events (PSEs). Forty-nine general acute care hospitals in Ontario, Canada. A nonexperimental design using cross-sectional surveys of hospital patient safety officers (PSOs) and patient care managers (PCMs). PSOs provided data on organization-level learning from (a) minor events, (b) moderate events, (c) major near misses, (d) major event analysis, and (e) major event dissemination/communication. PCMs provided data on organizational leadership (formal and informal) for patient safety. Hospitals were the unit of analysis. Seemingly unrelated regression was used to examine the influence of formal and informal leadership for safety on the five types of learning from PSEs. The interaction between leadership and hospital size was also examined. Formal organizational leadership for patient safety is an important predictor of learning from minor, moderate, and major near-miss events, and major event dissemination. This relationship is significantly stronger for small hospitals (learning from safety events. Formal leadership support for safety is of particular importance in small organizations where the economic burden of safety programs is disproportionately large and formal leadership is closer to the front lines.

Distance Learning Can Be as Effective as Traditional Learning for Medical Students in the Initial Assessment of Trauma Patients

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Shervin Farahmand

2016-10-01

Full Text Available Distance learning is expanding and replacing the traditional academic medical settings. Managing trauma patients seems to be a prerequisite skill for medical students. This study has been done to evaluate the efficiency of distance learning on performing the initial assessment and management in trauma patients, compared with the traditional learning among senior medical students. One hundred and twenty senior medical students enrolled in this single-blind quasi-experimental study and were equally divided into the experimental (distance learning and control group (traditional learning. All participants did a written MCQ before the study. The control group attended a workshop with a 50-minute lecture on initial management of trauma patients and a case simulation scenario followed by a hands-on session. On the other hand, the experimental group was given a DVD with a similar 50-minute lecture and a case simulation scenario, and they also attended a hands-on session to practice the skills. Both groups were evaluated by a trauma station in an objective structured clinical examination (OSCE after a month. The performance in the experimental group was statistically better (P=0.001 in OSCE. Distance learning seems to be an appropriate adjunct to traditional learning.

Dental treatment for handicapped patients; sedation vs general anesthesia and update of dental treatment in patients with different diseases

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Corcuera-Flores, José R.; Delgado-Muñoz, José M.; Ruiz-Villandiego, José C.; Maura-Solivellas, Isabel

2014-01-01

Dental treatment on Handicapped Patients is often difficult because many people with a wide range of ages (from children to the elderly) with different pathologies that can affect the oral cavity and differ widely are included in this group. This situation creates some controversy, because according to pathology, each patient will be treated differently depending on collaboration, general health status, age or medication used to treat this pathologies. According to this situation we can opt for an outpatient treatment without any kind of previous medication, a treatment under conscious or deep sedation or a under general anesthesia treatment. With this systematic review is intended to help clarify in which cases patients should be treated under general anesthesia, sedation (conscious or deep) or outpatient clinic without any medication, as well as clarify what kind of treatments can be carried in private dental clinics and which should be carried out in a hospital. It will also discuss the most common diseases among this group of patients and the special care to be taken for their dental treatment. Key words:Hospital dentistry, handicapped patient. PMID:24121922

Studying depression using imaging and machine learning methods

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Meenal J. Patel

2016-01-01

Full Text Available Depression is a complex clinical entity that can pose challenges for clinicians regarding both accurate diagnosis and effective timely treatment. These challenges have prompted the development of multiple machine learning methods to help improve the management of this disease. These methods utilize anatomical and physiological data acquired from neuroimaging to create models that can identify depressed patients vs. non-depressed patients and predict treatment outcomes. This article (1 presents a background on depression, imaging, and machine learning methodologies; (2 reviews methodologies of past studies that have used imaging and machine learning to study depression; and (3 suggests directions for future depression-related studies.

Patients' and parents' concerns and decisions about orthodontic treatment.

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Kazancı, Fatih; Aydoğan, Cihan; Alkan, Özer

2016-01-01

Patients' and parents' expectations are important in orthodontic treatment decision making. The literature generally demonstrates the perceived benefits of orthodontic treatment, but patients' and their parents' concerns about orthodontic treatment have not been investigated comprehensively. The aim of this study was to identify patients' and parents' concerns about orthodontic treatment and compare them according to sex, age, and treatment demand level. One hundred and eighty-nine children and their parents were interviewed about concerns related to orthodontic treatment. Patients and parents were asked about orthodontic treatment decisions. Answers were recorded as "yes," "no," or "don't know." Chi-squared and Fisher's exact tests were used to compare concerns between age groups, sexes, and treatment demand levels. Kappa statistics were used to assess agreement between patients and their parents. Concerns about orthodontic treatment were gathered under 10 items as follows: "feeling pain," "the appearance of braces," "being teased," "avoiding smiling," "speech problems," "dietary changes," "problems with transportation," "economic problems," "long treatment duration," and "missing school." There was no statistically significant difference in concerns between the sexes or age groups. Some concern items and treatment demand were inversely related in patients. The results of this study demonstrate patients' and parents' concerns about orthodontic treatment. Differences between the concerns of patients with different treatment demands imply that children might reject orthodontic treatment because of their concerns. Appropriate consultation of patients addressing their concerns may help reduce anxiety and improve the acceptance of treatment.

The relationship between novel word learning and anomia treatment success in adults with chronic aphasia.

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Dignam, Jade; Copland, David; Rawlings, Alicia; O'Brien, Kate; Burfein, Penni; Rodriguez, Amy D

2016-01-29

Learning capacity may influence an individual's response to aphasia rehabilitation. However, investigations into the relationship between novel word learning ability and response to anomia therapy are lacking. The aim of the present study was to evaluate the novel word learning ability in post-stroke aphasia and to establish the relationship between learning ability and anomia treatment outcomes. We also explored the influence of locus of language breakdown on novel word learning ability and anomia treatment response. 30 adults (6F; 24M) with chronic, post-stroke aphasia were recruited to the study. Prior to treatment, participants underwent an assessment of language, which included the Comprehensive Aphasia Test and three baseline confrontation naming probes in order to develop sets of treated and untreated items. We also administered the novel word learning paradigm, in which participants learnt novel names associated with unfamiliar objects and were immediately tested on recall (expressive) and recognition (receptive) tasks. Participants completed 48 h of Aphasia Language Impairment and Functioning Therapy (Aphasia LIFT) over a 3 week (intensive) or 8 week (distributed) schedule. Therapy primarily targeted the remediation of word retrieval deficits, so naming of treated and untreated items immediately post-therapy and at 1 month follow-up was used to determine therapeutic response. Performance on recall and recognition tasks demonstrated that participants were able to learn novel words; however, performance was variable and was influenced by participants' aphasia severity, lexical-semantic processing and locus of language breakdown. Novel word learning performance was significantly correlated with participants' response to therapy for treated items at post-therapy. In contrast, participants' novel word learning performance was not correlated with therapy gains for treated items at 1 month follow-up or for untreated items at either time point. Therapy intensity

Orthodontic Treatment Consideration in Diabetic Patients.

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Almadih, Ahmed; Al-Zayer, Maryam; Dabel, Sukainh; Alkhalaf, Ahmed; Al Mayyad, Ali; Bardisi, Wajdi; Alshammari, Shouq; Alsihati, Zainab

2018-02-01

Although orthodontic treatment is commonly indicated for young healthy individuals, recent trends showed an increase in number of older individuals undergoing orthodontic interventions. The increased age resulted in a proportionate increase in the prevalence of systemic diseases facing dentists during orthodontic procedures, especially diabetes mellitus. This necessitates that dentists should be aware of the diagnosis of diabetes mellitus and its early signs particularly in teeth and oral cavity. It is also essential for them to understand the implications of diabetes on orthodontic treatment and the measures to be considered during managing those patients. In this review, we focused on the impact of diabetes mellitus on orthodontic treatment. We also summarized the data from previous studies that had explained the measures required to be taken into consideration during managing those patients. We included both human and animal studies to review in depth the pathophysiological mechanisms by which diabetes affects orthodontic treatment outcome. In conclusion, this review emphasizes the need to carefully identify early signs and symptoms of diabetes mellitus in patients demanding orthodontic treatment and to understand the considerations to be adopted before and during treating these patients.

Risk factors for treatment default among re-treatment tuberculosis patients in India, 2006.

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Jha, Ugra Mohan; Satyanarayana, Srinath; Dewan, Puneet K; Chadha, Sarabjit; Wares, Fraser; Sahu, Suvanand; Gupta, Devesh; Chauhan, L S

2010-01-25

Under India's Revised National Tuberculosis Control Programme (RNTCP), >15% of previously-treated patients in the reported 2006 patient cohort defaulted from anti-tuberculosis treatment. To assess the timing, characteristics, and risk factors for default amongst re-treatment TB patients. For this case-control study, in 90 randomly-selected programme units treatment records were abstracted from all 2006 defaulters from the RNTCP re-treatment regimen (cases), with one consecutively-selected non-defaulter per case. Patients who interrupted anti-tuberculosis treatment for >2 months were classified as defaulters. 1,141 defaulters and 1,189 non-defaulters were included. The median duration of treatment prior to default was 81 days (25%-75% interquartile range 44-117 days) and documented retrieval efforts after treatment interruption were inadequate. Defaulters were more likely to have been male (adjusted odds ratio [aOR] 1.4, 95% confidence interval [CI] 1.2-1.7), have previously defaulted anti-tuberculosis treatment (aOR 1.3 95%CI 1.1-1.6], have previous treatment from non-RNTCP providers (AOR 1.3, 95%CI 1.0-1.6], or have public health facility-based treatment observation (aOR 1.3, 95%CI 1.1-1.6). Amongst the large number of re-treatment patients in India, default occurs early and often. Improved pre-treatment counseling and community-based treatment provision may reduce default rates. Efforts to retrieve treatment interrupters prior to default require strengthening.

Measurable improvement in patient safety culture: A departmental experience with incident learning.

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Kusano, Aaron S; Nyflot, Matthew J; Zeng, Jing; Sponseller, Patricia A; Ermoian, Ralph; Jordan, Loucille; Carlson, Joshua; Novak, Avrey; Kane, Gabrielle; Ford, Eric C

2015-01-01

Rigorous use of departmental incident learning is integral to improving patient safety and quality of care. The goal of this study was to quantify the impact of a high-volume, departmental incident learning system on patient safety culture. A prospective, voluntary, electronic incident learning system was implemented in February 2012 with the intent of tracking near-miss/no-harm incidents. All incident reports were reviewed weekly by a multiprofessional team with regular department-wide feedback. Patient safety culture was measured at baseline with validated patient safety culture survey questions. A repeat survey was conducted after 1 and 2 years of departmental incident learning. Proportional changes were compared by χ(2) or Fisher exact test, where appropriate. Between 2012 and 2014, a total of 1897 error/near-miss incidents were reported, representing an average of 1 near-miss report per patient treated. Reports were filed by a cross section of staff, with the majority of incidents reported by therapists, dosimetrists, and physicists. Survey response rates at baseline and 1 and 2 years were 78%, 80%, and 80%, respectively. Statistically significant and sustained improvements were noted in several safety metrics, including belief that the department was openly discussing ways to improve safety, the sense that reports were being used for safety improvement, and the sense that changes were being evaluated for effectiveness. None of the surveyed dimensions of patient safety culture worsened. Fewer punitive concerns were noted, with statistically significant decreases in the worry of embarrassment in front of colleagues and fear of getting colleagues in trouble. A comprehensive incident learning system can identify many areas for improvement and is associated with significant and sustained improvements in patient safety culture. These data provide valuable guidance as incident learning systems become more widely used in radiation oncology. Copyright © 2015

Treatment preferences of psychotherapy patients with chronic PTSD.

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Markowitz, John C; Meehan, Kevin B; Petkova, Eva; Zhao, Yihong; Van Meter, Page E; Neria, Yuval; Pessin, Hayley; Nazia, Yasmin

2016-03-01

Patient treatment preference may moderate treatment effect in major depressive disorder (MDD) studies. Little research has addressed preference in posttraumatic stress disorder (PTSD); almost none has assessed actual patients' PTSD psychotherapy preferences. From a 14-week trial of chronic PTSD comparing prolonged exposure, relaxation therapy, and interpersonal psychotherapy, we report treatment preferences of the 110 randomized patients, explore preference correlates, and assess effects on treatment outcome. Patients recruited between 2008 and 2013 with chronic DSM-IV PTSD (Clinician-Administered PTSD Scale [CAPS] score ≥ 50) received balanced, scripted psychotherapy descriptions prerandomization and indicated their preferences. Analyses assessed relationships of treatment attitudes to demographic and clinical factors. We hypothesized that patients randomized to preferred treatments would have better outcomes, and to unwanted treatment worse outcomes. Eighty-seven patients (79%) voiced treatment preferences or disinclinations: 29 (26%) preferred prolonged exposure, 29 (26%) preferred relaxation therapy, and 56 (50%) preferred interpersonal psychotherapy (Cochran Q = 18.46, P psychotherapy (Cochran Q = 22.71, P psychotherapy preferences to outcome. Despite explanations emphasizing prolonged exposure's greater empirical support, patients significantly preferred interpersonal psychotherapy. Preference subtly affected psychotherapy outcome; depression appeared an important moderator of the effect of unwanted treatment on outcome. Potential biases to avoid in future research are discussed. ClinicalTrials.gov identifier: NCT00739765. © Copyright 2015 Physicians Postgraduate Press, Inc.

Patient Characteristics Associated with HCV Treatment Adherence, Treatment Completion, and Sustained Virologic Response in HIV Coinfected Patients

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Glenn Wagner

2011-01-01

Full Text Available Background. Hepatitis C (HCV treatment efficacy among HIV patients is limited by poor treatment adherence and tolerance, but few studies have examined the psychosocial determinants of treatment adherence and outcomes. Methods. Chart abstracted and survey data were collected on 72 HIV patients who had received pegylated interferon and ribavirin to assess correlates of treatment adherence, completion, and sustained virologic response (SVR. Results. Nearly half (46% the sample had active psychiatric problems and 13% had illicit drug use at treatment onset; 28% reported <100% treatment adherence, 38% did not complete treatment (mostly due to virologic nonresponse, and intent to treat SVR rate was 49%. Having a psychiatric diagnosis was associated with nonadherence, while better HCV adherence was associated with both treatment completion and SVR. Conclusions. Good mental health may be an indicator of HCV treatment adherence readiness, which is in turn associated with treatment completion and response, but further research is needed with new HCV treatments emerging.

Preferences for learning different types of genome sequencing results among young breast cancer patients: Role of psychological and clinical factors.

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Kaphingst, Kimberly A; Ivanovich, Jennifer; Lyons, Sarah; Biesecker, Barbara; Dresser, Rebecca; Elrick, Ashley; Matsen, Cindy; Goodman, Melody

2018-01-29

The growing importance of genome sequencing means that patients will increasingly face decisions regarding what results they would like to learn. The present study examined psychological and clinical factors that might affect these preferences. 1,080 women diagnosed with breast cancer at age 40 or younger completed an online survey. We assessed their interest in learning various types of genome sequencing results: risk of preventable disease or unpreventable disease, cancer treatment response, uncertain meaning, risk to relatives' health, and ancestry/physical traits. Multivariable logistic regression was used to examine whether being "very" interested in each result type was associated with clinical factors: BRCA1/2 mutation status, prior genetic testing, family history of breast cancer, and psychological factors: cancer recurrence worry, genetic risk worry, future orientation, health information orientation, and genome sequencing knowledge. The proportion of respondents who were very interested in learning each type of result ranged from 16% to 77%. In all multivariable models, those who were very interested in learning a result type had significantly higher knowledge about sequencing benefits, greater genetic risks worry, and stronger health information orientation compared to those with less interest (p-values psychological factors. Shared decision-making approaches that increase knowledge about genome sequencing and incorporate patient preferences for health information and learning about genetic risks may help support patients' informed choices about learning different types of sequencing results. © Society of Behavioral Medicine 2018.

Root canal treatment and special needs patients.

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Yap, E; Parashos, P; Borromeo, G L

2015-04-01

To identify current trends of root canal treatment for patients with special needs. A postal questionnaire was sent to General Dentists in Victoria, Australia and Endodontists and Special Needs Dentists across Australia to determine the extent of root canal treatment performed on special needs patients. Over a four-month period, 1120 questionnaires were distributed with an overall response rate of 63.9% (n = 716). Response rates were 63.2% (n = 655), 68.5% (n = 50) and 100.0% (n = 11) amongst General Dentists, Endodontists and Special Needs Dentists, respectively. Endodontists (95.7%) and Special Needs Dentists (100.0%) performed significantly more root canal treatment on adult patients with special needs compared with 51.2% of General Dentists, (P special needs patients compared with only 29.7% of General Dentists (P special needs patients was more likely to be carried out by specialist dental practitioners who were more likely to utilize a pharmacological approach for behaviour guidance and to perform single-visit root canal treatment compared with General Dentists. A multidisciplinary approach for special needs patients who require root canal treatment provides an opportunity for these patients to retain their dentition. © 2014 International Endodontic Journal. Published by John Wiley & Sons Ltd.

Learning from social media: utilizing advanced data extraction techniques to understand barriers to breast cancer treatment.

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Freedman, Rachel A; Viswanath, Kasisomayajula; Vaz-Luis, Ines; Keating, Nancy L

2016-07-01

Past examinations of breast cancer treatment barriers have typically included registry, claims-based, and smaller survey studies. We examined treatment barriers using a novel, comprehensive, social media analysis of online, candid discussions about breast cancer. Using an innovative toolset to search postings on social networks, message boards, patient communities, and topical sites, we performed a large-scale qualitative analysis. We examined the sentiments and barriers expressed about breast cancer treatments by Internet users during 1 year (2/1/14-1/31/15). We categorized posts based on thematic patterns and examined trends in discussions by race/ethnicity (white/black/Hispanic) when this information was available. We identified 1,024,041 unique posts related to breast cancer treatment. Overall, 57 % of posts expressed negative sentiments. Using machine learning software, we assigned treatment barriers for 387,238 posts (38 %). Barriers included emotional (23 % of posts), preferences and spiritual/religious beliefs (21 %), physical (18 %), resource (15 %), healthcare perceptions (9 %), treatment processes/duration (7 %), and relationships (7 %). Black and Hispanic (vs. white) users more frequently reported barriers related to healthcare perceptions, beliefs, and pre-diagnosis/diagnosis organizational challenges and fewer emotional barriers. Using a novel analysis of diverse social media users, we observed numerous breast cancer treatment barriers that differed by race/ethnicity. Social media is a powerful tool, allowing use of real-world data for qualitative research, capitalizing on the rich discussions occurring spontaneously online. Future research should focus on how to further employ and learn from this type of social intelligence research across all medical disciplines.

How do disease perception, treatment features, and dermatologist–patient relationship impact on patients assuming topical treatment? An Italian survey

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Burroni AG

2015-02-01

Full Text Available Anna Graziella Burroni,1 Mariella Fassino,2 Antonio Torti,3 Elena Visentin4 1IRCCS University Hospital San Martino, IST National Institute for Cancer Research, Genoa, Italy; 2Department of Psychology, Specialization School in Clinical Psychology, University of Turin, Turin, Italy; 3Dermatology practice, Milan, Italy; 4HTA and Scientific Support, CSD Medical Research Srl, Milan, Italy Background: Psoriasis largely affects daily activities and social interactions and has a strong impact on patients’ quality of life. Psoriatic patients have different attitudes toward their condition. Topical medications are essential for the treatment of psoriasis, but the majority of patients do not adhere to these therapies. Objective: The history of treatment success or failure seems to influence patient attitude toward topical therapy. Therefore, it is important to understand the psychological, experiential, and motivational aspects that could be critical for treatment adherence, and to describe the different attitudes toward topical treatment. Furthermore, the physician–patient relationship and the willingness to trust the dermatologist may have a substantial role in encouraging or discouraging patients’ attitudes toward topical therapy. Methods: A survey was designed to collect aspects that could be relevant to understanding different patient attitudes toward psoriasis and its treatments. A total of 495 self-administered questionnaires compiled by psoriatic patients were analyzed from 20 Italian specialized hospital centers in order to provide a nationwide picture. Results: Psoriatic patients have different perceptions and experiences in relation to their condition: half of them consider psoriasis as a disease, while the other half consider psoriasis as a disorder or a nuisance. Topical therapy is the most widely used treatment, even though it is not considered the most effective one and often perceived to be cosmetic. The main findings are: 1

Patients' experience with nonsurgical treatment for lumbar spinal stenosis: a qualitative study.

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Bove, Allyn M; Lynch, Andrew D; Ammendolia, Carlo; Schneider, Michael

2018-04-01

Lumbar spinal stenosis (LSS) is a highly prevalent disease in older adults that causes significant limitations in walking and other daily activities. Research into optimal nonsurgical treatment approaches for LSS is lacking. The purpose of this qualitative study is to assess the opinions of participants in a randomized clinical trial of nonsurgical LSS treatments regarding the interventions they received, factors contributing to adherence to the interventions, and methods of outcomes assessment. This study used a qualitative focus group design conducted at an academic research center. Individuals participating in a randomized clinical trial (RCT) for non-surgical LSS treatment were invited to discuss their study treatments and general experiences with LSS. The three treatment arms in the study were medical care, community-based group exercise, and clinic-based manual therapy and individual exercise. Following coding of qualitative data, kappa statistic was used to calculate agreement between observers. Themes were identified and agreed upon by both coders. This study was funded by the Patient-Centered Outcomes Research Institute (PCORI). Fifty individuals (28 women, mean age 73±7.7 years) participated in a focus group. Two focus groups based on modified grounded theory were held for participants of each of the three treatment arms, for a total of six focus groups. Discussion topics included perceived effectiveness of the assigned treatment, suggestions for improvement, barriers and facilitators to completing treatment, and opinions of research outcome measures. Several themes were evident across all treatment groups. First, patients prefer individualized treatment that is tailored to their specific impairments and functional limitations. They also want to learn self-management strategies to rely less upon formal health care providers. Participants consistently stated that exercise improved their pain levels and physical function. However, they noted that these

Reliability of the Cardiac Patients Learning Needs Inventory (CPLNI) for use in Portugal.

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Galdeano, Luzia E; Furuya, Rejane K; Rodrigues, Manuel A; Dantas, Rosana A S; Rossi, Lídia A

2014-06-01

To perform the semantic validation and to evaluate the reliability and the presence of ceiling and floor effects of the Cardiac Patients Learning Needs Inventory in Portuguese patients with coronary artery disease. Information should be selected based on what patients know and need to learn, which means that the teaching process should be based on each person's needs. The Cardiac Patients Learning Needs Inventory is aimed at identifying the cardiac patients' individual learning needs. Methodological research design. Two hundred patients hospitalised at the coronary intensive care unit or at the cardiothoracic surgery unit of a public hospital in Lisbon answered the adapted version of the Cardiac Patients Learning Needs Inventory. Internal consistency was estimated based on Cronbach's alpha. Scores above 0·50 were considered acceptable. Stability was measured through test-retest and calculated using student's t test. Significance was set at 0·05. Patients' mean age was 65 years (SD = 11·8), and most were men (152; 76%). Cronbach's alpha for the total scale was high in the first and second measurement (0·91), and for seven domains, it was acceptable in the first and second measurement (range from 0·50-0·89). No statistically significant difference was found between mean scores on the first and second measurement. Lower diversity was observed in the answers, most of which ranged between important and very important (ceiling-effect). The adapted version for use in Portugal maintained the conceptual, semantic and idiomatic equivalences of the original version and showed adequate reliability. RELEVANCE TO CLINICAL PRACTICES: Owing to the lack of validated instruments translated into Portuguese, to measure cardiac patients' learning needs, this study entails important clinical and theoretical implications. © 2012 Blackwell Publishing Ltd.

Promotion of self-directed learning using virtual patient cases.

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Benedict, Neal; Schonder, Kristine; McGee, James

2013-09-12

To assess the effectiveness of virtual patient cases to promote self-directed learning (SDL) in a required advanced therapeutics course. Virtual patient software based on a branched-narrative decision-making model was used to create complex patient case simulations to replace lecture-based instruction. Within each simulation, students used SDL principles to learn course objectives, apply their knowledge through clinical recommendations, and assess their progress through patient outcomes and faculty feedback linked to their individual decisions. Group discussions followed each virtual patient case to provide further interpretation, clarification, and clinical perspective. Students found the simulated patient cases to be organized (90%), enjoyable (82%), intellectually challenging (97%), and valuable to their understanding of course content (91%). Students further indicated that completion of the virtual patient cases prior to class permitted better use of class time (78%) and promoted SDL (84%). When assessment questions regarding material on postoperative nausea and vomiting were compared, no difference in scores were found between the students who attended the lecture on the material in 2011 (control group) and those who completed the virtual patient case on the material in 2012 (intervention group). Completion of virtual patient cases, designed to replace lectures and promote SDL, was overwhelmingly supported by students and proved to be as effective as traditional teaching methods.

Precision Medicine in Cancer Treatment

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Precision medicine helps doctors select cancer treatments that are most likely to help patients based on a genetic understanding of their disease. Learn about the promise of precision medicine and the role it plays in cancer treatment.

Treatment Opportunities in Patients With Metabolic Myopathies

DEFF Research Database (Denmark)

Ørngreen, Mette Cathrine; Vissing, John

2017-01-01

the development of new therapeutic options. Enzyme replacement therapy with rGAA has revolutionized treatment of early onset Pompe disease. Supplements of riboflavin, carnitine, and sucrose show promise in patients with respectively riboflavin-responsive multiple acyl-CoA dehydrogenase deficiency, primary...... carnitine deficiency, and McArdle disease. Treatment with citric acid cycle intermediates supply by triheptanoin seems promising in patients with glucogenoses, and studies are ongoing in patients with McArdle disease. Summary Treatment of metabolic myopathies primarily relies on avoiding precipitating...

Childhood Liver Cancer Treatment (PDQ®)—Patient Version

Science.gov (United States)

Childhood liver cancer treatment options include surgery, watchful waiting, chemotherapy, radiation therapy, ablation therapy, and antiviral therapy. Learn more about newly diagnosed and recurrent childhood liver cancer in this expert-reviewed summary.

Treatment of avoidance behavior as an adjunct to exposure therapy: Insights from modern learning theory.

Science.gov (United States)

Treanor, Michael; Barry, Tom J

2017-09-01

Pathological avoidance of benign stimuli is a hallmark of anxiety and related disorders, and exposure-based treatments have often encouraged the removal of avoidance, or safety behaviors, due to their negative effects on extinction learning. Unfortunately, empirical evidence suggests that avoidance behaviors can persist following treatment, and the mere availability of avoidance behavior can be sufficient to renew fear following successful extinction learning. The present paper critically examines the function of avoidance behavior through the lens of modern learning theory, and speculates on novel behavioral and pharmacological strategies for targeting avoidance as an adjunct to current evidence-based treatments. Copyright © 2017. Published by Elsevier Ltd.

Multisite prediction of 4-week and 52-week treatment outcomes in patients with first-episode psychosis: a machine learning approach

NARCIS (Netherlands)

Koutsouleris, Nikolaos; Kahn, René S.; Chekroud, Adam M.; Leucht, Stefan; Falkai, Peter; Wobrock, Thomas; Derks, Eske M.; Fleischhacker, Wolfgang W.; Hasan, Alkomiet

2016-01-01

Background At present, no tools exist to estimate objectively the risk of poor treatment outcomes in patients with first-episode psychosis. Such tools could improve treatment by informing clinical decision-making before the commencement of treatment. We tested whether such a tool could be

Treatment preferences of patients with binge eating disorder.

Science.gov (United States)

Brody, Michelle L; Masheb, Robin M; Grilo, Carlos M

2005-05-01

The current study examined the treatment preferences of obese patients with binge eating disorder (BED). Participants were 103 consecutive patients with BED who responded to advertisements for treatment studies looking for persons who wanted to "stop binge eating and lose weight." In addition to completing comprehensive assessment batteries, participants were provided descriptions of cognitive-behavioral therapy (CBT) and behavioral weight loss therapy (BWL) after which they were asked to choose and rate their preferred treatment. Sixty-three percent of participants stated they preferred CBT. Treatment preferences were not associated with (1) histories of obesity, dieting, binge eating, or weight cycling, (2) current obesity or eating disorder features, or (3) psychological features such as depression or self-esteem levels. In contrast, participants' stated treatment preferences were aligned with their perception of their primary problem (eating disorder vs. obesity) and their primary goals for treatment (stop binge eating vs. lose weight). The patients who preferred CBT based their treatment selection more on their problem perception than on their primary treatment goal, whereas the patients who preferred BWL selected treatment based more on their primary treatment goal (weight loss) than on their problem perception. Obese patients with BED express treatment preferences that are not associated with variability in their clinical characteristics but are aligned with their perception of their primary problem and with their primary goals for treatment. Copyright 2005 by Wiley Periodicals, Inc

Informing patients of risks inherent in treatment.

Science.gov (United States)

Griffith, Richard; Tengnah, Cassam

2009-11-01

Consent to treatment lies at the heart of autonomous decision making by patients who are entitled to make a free choice about whether to accept or refuse treatment. To help patients arrive at their decision district nurses must ensure that they give sufficient information about the nature and risks inherent in the treatment to allow an informed choice to be made. This article considers how much information regarding risks needs to be disclosed. It discusses how the law requires a different level of disclosure for patients who ask no questions about risks, those who make general enquiries about risks and those who ask specific questions about the risks inherent in treatment.

Hand gestures support word learning in patients with hippocampal amnesia.

Science.gov (United States)

Hilverman, Caitlin; Cook, Susan Wagner; Duff, Melissa C

2018-06-01

Co-speech hand gesture facilitates learning and memory, yet the cognitive and neural mechanisms supporting this remain unclear. One possibility is that motor information in gesture may engage procedural memory representations. Alternatively, iconic information from gesture may contribute to declarative memory representations mediated by the hippocampus. To investigate these alternatives, we examined gesture's effects on word learning in patients with hippocampal damage and declarative memory impairment, with intact procedural memory, and in healthy and in brain-damaged comparison groups. Participants learned novel label-object pairings while producing gesture, observing gesture, or observing without gesture. After a delay, recall and object identification were assessed. Unsurprisingly, amnesic patients were unable to recall the labels at test. However, they correctly identified objects at above chance levels, but only if they produced a gesture at encoding. Comparison groups performed well above chance at both recall and object identification regardless of gesture. These findings suggest that gesture production may support word learning by engaging nondeclarative (procedural) memory. © 2018 Wiley Periodicals, Inc.

Effects of treatment position and patient immobilization on the variability of patient motion in the treatment of prostate cancer patients

International Nuclear Information System (INIS)

Nguyen, A.; Washington, M.; Wyman, B.; Song, P.; Bauml, J.; Tobias, R.; Vaida, F.; Chen, G.; Vijayakumar, S.; Reese, Michael

1995-01-01

Purpose/Objective: As dose-escalation is being attempted in the treatment of prostate cancer, uncertainties in patient position due to day-to-day setup has become increasingly critical. We present results from an ongoing study of the variability of patient positioning in prone versus supine treatment positions, as well as with and without immobilization using an aquaplast cast. Materials and Methods: We compared the probability and the amount of day-to-day movement of patients with prostate cancer. Patients were divided into three groups: (a) those treated supine without immobilization, (b) those treated supine and immobilized with an aquaplast cast over the abdomen and pelvis, and (c) those treated prone and similarly immobilized in aquaplast. The three components of patient motion - cephalo-caudad, anterior-posterior, and lateral - were examined separately. Portal films, taken at least once a week during treatment, were compared to simulation films and appropriate changes were made on the next day before treatment. This film record was used in our retrospective analysis of patient motion. To study the probability of movement we carried out a Likelihood Ratio test (LR) on a sample of 43 patients (20, 15, and 8 in treatment positions (a), (b), and (c) respectively). To study the amount of movement, templates with outlines of bony landmarks were generated based on the simulation film and overlaid on the portal film to measure the displacement. Results: Our measurements are summarized in the table below, where the p values for the difference in probability of movement (leftmost three columns) comes from the LR test and the amount of movement (rightmost three columns) is expressed as an average accompanied by a root-mean-square, in millimeters. Conclusions: From the data so far analyzed, patients treated supine and immobilized in an aquaplast cast -- group (b) -- exhibit the lowest probability of cephalo-caudad and anterior-posterior movement. In addition, although

Treatment in a specialised out-patient mood disorder clinic v. standard out-patient treatment in the early course of bipolar disorder

DEFF Research Database (Denmark)

Kessing, Lars Vedel; Hansen, Hanne Vibe; Hvenegaard, Anne

2013-01-01

BACKGROUND: Little is known about whether treatment in a specialised out-patient mood disorder clinic improves long-term prognosis for patients discharged from initial psychiatric hospital admissions for bipolar disorder. AIMS: To assess the effect of treatment in a specialised out-patient mood...... disorder clinic v. standard decentralised psychiatric treatment among patients discharged from one of their first three psychiatric hospital admissions for bipolar disorder. METHOD: Patients discharged from their first, second or third hospital admission with a single manic episode or bipolar disorder were...... randomised to treatment in a specialised out-patient mood disorder clinic or standard care (ClinicalTrials.gov: NCT00253071). The primary outcome measure was readmission to hospital, which was obtained from the Danish Psychiatric Central Register. RESULTS: A total of 158 patients with mania/bipolar disorder...

Treatment of bone metastases with palliative radiotherapy: Patients' treatment preferences

International Nuclear Information System (INIS)

Szumacher, Ewa; Llewellyn-Thomas, Hillary; Franssen, Edmee; Chow, Edward; Boer, Gerrit de; Danjoux, Cyril; Hayter, Charles; Barnes, Elizabeth; Andersson, Lourdes

2005-01-01

Purpose: To determine the proportion of patients undergoing palliative radiotherapy (RT) for bone pain who would like to participate in the decision-making process, and to determine their choice of palliative RT regimen (2000 cGy in five fractions vs. 800 cGy in one fraction) for painful bone metastases. Methods and Materials: Eligible patients were approached and all patients agreeing to participate provided written informed consent. Patients' decisional preferences were studied using a five-statement preference instrument. A decision board was used to help patients decide their preferred palliative RT regimen. Factors influencing patients' choices were studied using a visual analog scale. Results: A total of 101 patients were enrolled in the study (55 women and 46 men). The preferences for decision-making were as follows: 30 active, 47 collaborative, and 24 passive. Most (55 [76%] of 72) patients favored one fraction of palliative RT (95% confidence interval, 65-86%). Patients were more likely to select the 800 cGy in one fraction because of the convenience of the treatment plan (odds ratio, 1.024; 95% confidence interval, 1.004-1044) but were less likely to choose it because of the chance of bone fracture (odds ratio, 0.973; 95% confidence interval, 0.947-1.000) compared with 2000 cGy in five fractions. Conclusion: Most participating patients preferred to decide either by themselves or with the radiation oncologists which treatment option they preferred. An 800-cGy-in-one-fraction regimen was favored, independent of the treated site. The convenience of the treatment plan and the likelihood of bone fracture were the most important factors influencing patients' choice

Patient Treatment File (PTF)

Data.gov (United States)

Department of Veterans Affairs — This database is part of the National Medical Information System (NMIS). The Patient Treatment File (PTF) contains a record for each inpatient care episode provided...

Patient Satisfaction in Military Dental Treatment Facilities

Science.gov (United States)

2006-03-07

the variance in regards to overall satisfaction. 15. SUBJECT TERMS Dentistry, Patient Satisfaction, Military, Consumer Satisfaction, Dental... patient satisfaction in military dental treatment facilities. Dental health is extremely important for the military as dental assets are not always... customer satisfaction is an important component of military dental care. Quarterly patient satisfaction reports are generated for each dental treatment

Perceptual Learning as a potential treatment for amblyopia: a mini-review

Science.gov (United States)

Levi, Dennis M.; Li, Roger W.

2009-01-01

Amblyopia is a developmental abnormality that results from physiological alterations in the visual cortex and impairs form vision. It is a consequence of abnormal binocular visual experience during the “sensitive period” early in life. While amblyopia can often be reversed when treated early, conventional treatment is generally not undertaken in older children and adults. A number of studies over the last twelve years or so suggest that Perceptual Learning (PL) may provide an important new method for treating amblyopia. The aim of this mini-review is to provide a critical review and “meta-analysis” of perceptual learning in adults and children with amblyopia, with a view to extracting principles that might make PL more effective and efficient. Specifically we evaluate: What factors influence the outcome of perceptual learning?Specificity and generalization – two sides of the coin.Do the improvements last?How does PL improve visual function?Should PL be part of the treatment armamentarium? A review of the extant studies makes it clear that practicing a visual task results in a long-lasting improvement in performance in an amblyopic eye. The improvement is generally strongest for the trained eye, task, stimulus and orientation, but appears to have a broader spatial frequency bandwidth than in normal vision. Importantly, practicing on a variety of different tasks and stimuli seems to transfer to improved visual acuity. Perceptual learning operates via a reduction of internal neural noise and/or through more efficient use of the stimulus information by retuning the weighting of the information. The success of PL raises the question of whether it should become a standard part of the armamentarium for the clinical treatment of amblyopia, and suggests several important principles for effective perceptual learning in amblyopia. PMID:19250947

Patients' preferences for headache acute and preventive treatment.

Science.gov (United States)

Mitsikostas, Dimos D; Belesioti, Ioanna; Arvaniti, Chryssa; Mitropoulou, Euthymia; Deligianni, Christina; Kasioti, Elina; Constantinidis, Theodoros; Dermitzakis, Manolis; Vikelis, Michail

2017-10-06

We aimed to explore patients' preferences for headache treatments with a self-administered questionnaire including the Q-No questionnaire for nocebo. Questionnaires from 514 outpatients naïve to neurostimulation and monoclonal antibodies were collected. Patients assessed that the efficacy of a treatment is more important than safety or route of administration. They preferred to use an external neurostimulation device for both acute (67.1%) and preventive treatment (62.8%). Most patients preferred to take a pill (86%) than any other drug given parenterally for symptomatic pharmaceutical treatment. For preventive pharmaceutical treatment, most patients preferred to take a pill once per day (52%) compared to an injection either subcutaneously or intravenously each month (9% and 4%), or three months (15% and 11%). 56.6% of all participants scored more than 15 in Q-No questionnaire indicating potential nocebo behaviors that contributed significantly in their choices. These patient preferences along with efficacy and safety data may help physicians better choose the right treatment for the right person.

Using a high-fidelity patient simulator with first-year medical students to facilitate learning of cardiovascular function curves.

Science.gov (United States)

Harris, David M; Ryan, Kathleen; Rabuck, Cynthia

2012-09-01

Students are relying on technology for learning more than ever, and educators need to adapt to facilitate student learning. High-fidelity patient simulators (HFPS) are usually reserved for the clinical years of medical education and are geared to improve clinical decision skills, teamwork, and patient safety. Finding ways to incorporate HFPS into preclinical medical education represents more of a challenge, and there is limited literature regarding its implementation. The main objective of this study was to implement a HFPS activity into a problem-based curriculum to enhance the learning of basic sciences. More specifically, the focus was to aid in student learning of cardiovascular function curves and help students develop heart failure treatment strategies based on basic cardiovascular physiology concepts. Pretests and posttests, along with student surveys, were used to determine student knowledge and perception of learning in two first-year medical school classes. There was an increase of 21% and 22% in the percentage of students achieving correct answers on a posttest compared with their pretest score. The median number of correct questions increased from pretest scores of 2 and 2.5 to posttest scores of 4 and 5 of a possible total of 6 in each respective year. Student survey data showed agreement that the activity aided in learning. This study suggests that a HFPS activity can be implemented during the preclinical years of medical education to address basic science concepts. Additionally, it suggests that student learning of cardiovascular function curves and heart failure strategies are facilitated.

Describing treatment effects to patients.

Science.gov (United States)

Moxey, Annette; O'Connell, Dianne; McGettigan, Patricia; Henry, David

2003-11-01

To examine the impact of different presentations of equivalent information (framing) on treatment decisions faced by patients. A systematic review of the published literature was conducted. English language publications allocating participants to different frames were retrieved using electronic and bibliographic searches. Two reviewers examined each article for inclusion, and assessed methodological quality. Study characteristics were tabulated and where possible, relative risks (RR; 95% confidence intervals) were calculated to estimate intervention effects. Thirty-seven articles, yielding 40 experimental studies, were included. Studies examined treatment (N = 24), immunization (N = 5), or health behavior scenarios (N = 11). Overall, active treatments were preferred when outcomes were described in terms of relative rather than absolute risk reductions or number needed to treat. Surgery was preferred to other treatments when treatment efficacy was presented in a positive frame (survival) rather than a negative frame (mortality) (relative risk [RR] = 1.51, 95% confidence interval [CI], 1.39 to 1.64). Framing effects were less obvious for immunization and health behavior scenarios. Those with little interest in the behavior at baseline were influenced by framing, particularly when information was presented as gains. In studies judged to be of good methodological quality and/or examining actual decisions, the framing effect, although still evident, was less convincing compared to the results of all included studies. Framing effects varied with the type of scenario, responder characteristics, scenario manipulations, and study quality. When describing treatment effects to patients, expressing the information in more than one way may present a balanced view to patients and enable them to make informed decisions.

A Selective Role for Dopamine in Learning to Maximize Reward But Not to Minimize Effort: Evidence from Patients with Parkinson's Disease.

Science.gov (United States)

Skvortsova, Vasilisa; Degos, Bertrand; Welter, Marie-Laure; Vidailhet, Marie; Pessiglione, Mathias

2017-06-21

Instrumental learning is a fundamental process through which agents optimize their choices, taking into account various dimensions of available options such as the possible reward or punishment outcomes and the costs associated with potential actions. Although the implication of dopamine in learning from choice outcomes is well established, less is known about its role in learning the action costs such as effort. Here, we tested the ability of patients with Parkinson's disease (PD) to maximize monetary rewards and minimize physical efforts in a probabilistic instrumental learning task. The implication of dopamine was assessed by comparing performance ON and OFF prodopaminergic medication. In a first sample of PD patients ( n = 15), we observed that reward learning, but not effort learning, was selectively impaired in the absence of treatment, with a significant interaction between learning condition (reward vs effort) and medication status (OFF vs ON). These results were replicated in a second, independent sample of PD patients ( n = 20) using a simplified version of the task. According to Bayesian model selection, the best account for medication effects in both studies was a specific amplification of reward magnitude in a Q-learning algorithm. These results suggest that learning to avoid physical effort is independent from dopaminergic circuits and strengthen the general idea that dopaminergic signaling amplifies the effects of reward expectation or obtainment on instrumental behavior. SIGNIFICANCE STATEMENT Theoretically, maximizing reward and minimizing effort could involve the same computations and therefore rely on the same brain circuits. Here, we tested whether dopamine, a key component of reward-related circuitry, is also implicated in effort learning. We found that patients suffering from dopamine depletion due to Parkinson's disease were selectively impaired in reward learning, but not effort learning. Moreover, anti-parkinsonian medication restored the

Patients' perceptions, treatment need, and complexity of orthodontic re-treatment

NARCIS (Netherlands)

Ren, Yijin; Boxum, Christo; Sandham, John

The aim of the present study was to investigate the subjective perception and objective treatment need and complexity of patients seeking orthodontic re-treatment. One hundred subjects (66 females, 34 males, age 26.7+/-8.2 years) seeking re-treatment were asked to complete a questionnaire which was

The Implementation of Aptitude Treatment Interaction (ATI to Improve Learning Motivation of Low Achievement Students

Directory of Open Access Journals (Sweden)

Syawal - Syawal

2017-10-01

Full Text Available This research was classroom action research, which aims at improving students' motivation of their poor performance through learning model Aptitude Treatment Interaction (ATI on VII.3 grade students of SMP Negeri 6 Parepare. Aptitude Treatment Interaction (ATI can serve individual student differences by adjusting treatment or learning method with students' abilities. The use of this model was emphasizing to create small groups of students that have achievement alike. Students with have low academic achievement based on test results and teacher interview will be grouped into one group and will be given preferential treatment by tutoring intensity rather than the group of high academic achievement. Subjects of this research were students of class VII.3 SMP Negeri 6 Parepare which is consist of 25 students. This research was conducted in two cycles. The procedure of this research involved four phases: (1 planning, (2 Implementation of action, (3 observation, (4 Reflection. The data collection was done by observation, tests, and questionnaires for each cycle after giving treatment through learning model Aptitude Treatment Interaction (ATI. Data collected were analyzed using quantitative and qualitative analysis. The results of this research indicate that the Aptitude Treatment Interaction (ATI can be an alternative method to improve learning motivation of low achievement students. The results of this research also showed that the Aptitude Treatment Interaction (ATI can be an alternative to problem-solving in the classroom, especially for low achievement students.

Tuberculosis Treatment in Patients with Comorbidities

OpenAIRE

Kang, Young Ae

2014-01-01

Tuberculosis is a significant infectious problem in elderly patients with comorbidities in Korea. The age-associated diseases such as malignancy and diabetes mellitus may increase the risk of tuberculosis in this population. The medication treatments of tuberculosis in patients with comorbidities can cause adverse reactions to antituberculosis drugs and inadequate treatment responses. Thus, clinicians must carefully monitor the toxicity of antituberculosis therapy and the efficacy of treatmen...

Who gets the most out of cognitive behavioral therapy for anxiety disorders? The role of treatment dose and patient engagement.

Science.gov (United States)

Glenn, Daniel; Golinelli, Daniela; Rose, Raphael D; Roy-Byrne, Peter; Stein, Murray B; Sullivan, Greer; Bystritksy, Alexander; Sherbourne, Cathy; Craske, Michelle G

2013-08-01

The present study explored treatment dose and patient engagement as predictors of treatment outcome in cognitive behavioral therapy (CBT) for anxiety disorders. Measures of high versus low treatment dose and high versus low patient engagement in CBT were compared as predictors of 12- and 18-month outcomes for patients being treated for anxiety disorders with CBT (with or without concurrent pharmacotherapy) in primary care settings as part of a randomized controlled effectiveness trial of the Coordinated Anxiety Learning and Management (CALM) intervention. Measures of dose (attendance, exposure completion) and engagement in CBT (homework adherence, commitment) were collected throughout treatment, and blinded follow-up phone assessments of outcome measures (12-item Brief Symptom Inventory, Patient Health Questionnaire 8, Sheehan Disability Scale) were completed at 12 and 18 months. Propensity score weighting controlled for baseline differences in demographics and symptom severity between patients with high and low dose and engagement. These analyses included the 439 patients who selected CBT as treatment modality. Completing exposures, having high attendance, and being more adherent to completing homework predicted better outcomes across all measures at 12 and 18 months, and high CBT commitment predicted better outcomes on all measures at 18 months. This study found that higher treatment dose and patient engagement in CBT for anxiety disorders were stable and robust predictors of greater reductions in anxiety symptoms, depression symptoms, and functional disability. PsycINFO Database Record (c) 2013 APA, all rights reserved.

Does phasic trauma treatment make patients with dissociative identity disorder treatment more dissociative?

Science.gov (United States)

Brand, Bethany; Loewenstein, Richard J

2014-01-01

Proponents of the iatrogenic model of the etiology of dissociative identity disorder (DID) have expressed concern that treatment focused on direct engagement and interaction with dissociated self-states harms DID patients. However, empirical data have shown that this type of DID treatment is beneficial. Analyzing data from the prospective Treatment of Patients With Dissociative Disorders (TOP DD) Study, we test empirically whether DID treatment is associated with clinically adverse manifestations of dissociated self-states: acting so differently that one feels like different people, hearing voices, and dissociative amnesia. We show that, over the course of the study, there were significant decreases in feeling like different people and hearing voices. These results indicate that this form of DID treatment does not lead to symptomatic worsening in these dimensions, as predicted by the iatrogenic model. Indeed, treatment provided by TOP DD therapists reduced, rather than increased, the extent to which patients experienced manifestations of pathological dissociation. Because severe symptomatology and impairment are associated with DID, iatrogenic harm may come from depriving DID patients of treatment that targets DID symptomatology.

Management and treatment outcomes of patients enrolled in MDR-TB treatment in Viet Nam.

Science.gov (United States)

Phuong, N T M; Nhung, N V; Hoa, N B; Thuy, H T; Takarinda, K C; Tayler-Smith, K; Harries, A D

2016-03-21

The programmatic management of drug-resistant tuberculosis (TB) in Viet Nam has been rapidly scaled up since 2009. To document the annual numbers of patients enrolled for multidrug-resistant tuberculosis (MDR-TB) treatment during 2010-2014 and to determine characteristics and treatment outcomes of patients initiating treatment during 2010-2012. A retrospective cohort study using national reports and data from the national electronic data system for drug-resistant TB. The number of patients enrolled annually for MDR-TB treatment increased from 97 in 2010 to 1522 in 2014. The majority of patients were middle-aged men who had pulmonary disease and had failed a retreatment regimen; 77% had received ⩾2 courses of TB treatment. Favourable outcomes (cured and treatment completed) were attained in 73% of patients. Unfavourable outcomes included loss to follow-up (12.5%), death (8%) and failure (6.3%). Having had ⩾2 previous treatment courses and being human immunodeficiency virus-positive were associated with unfavourable outcomes. Increasing numbers of patients are being treated for MDR-TB each year with good treatment outcomes under national programme management in Viet Nam. However, there is a need to increase case detection-currently at 30% of the estimated 5100 MDR-TB cases per year, reduce adverse outcomes and improve monitoring and evaluation.

Behavioral and neuroimaging evidence for overreliance on habit learning in alcohol-dependent patients.

Science.gov (United States)

Sjoerds, Z; de Wit, S; van den Brink, W; Robbins, T W; Beekman, A T F; Penninx, B W J H; Veltman, D J

2013-12-17

Substance dependence is characterized by compulsive drug-taking despite negative consequences. Animal research suggests an underlying imbalance between goal-directed and habitual action control with chronic drug use. However, this imbalance, and its associated neurophysiological mechanisms, has not yet been experimentally investigated in human drug abusers. The aim of the present study therefore was to assess the balance between goal-directed and habit-based learning and its neural correlates in abstinent alcohol-dependent (AD) patients. A total of 31 AD patients and 19 age, gender and education matched healthy controls (HC) underwent functional magnetic resonance imaging (fMRI) during completion of an instrumental learning task designed to study the balance between goal-directed and habit learning. Task performance and task-related blood oxygen level-dependent activations in the brain were compared between AD patients and healthy matched controls. Findings were additionally associated with duration and severity of alcohol dependence. The results of this study provide evidence for an overreliance on stimulus-response habit learning in AD compared with HC, which was accompanied by decreased engagement of brain areas implicated in goal-directed action (ventromedial prefrontal cortex and anterior putamen) and increased recruitment of brain areas implicated in habit learning (posterior putamen) in AD patients. In conclusion, this is the first human study to provide experimental evidence for a disturbed balance between goal-directed and habitual control by use of an instrumental learning task, and to directly implicate cortical dysfunction to overreliance on inflexible habits in AD patients.

Patients' and parents' concerns and decisions about orthodontic treatment

OpenAIRE

Kazanc?, Fatih; Aydo?an, Cihan; Alkan, ?zer

2016-01-01

Objective Patients' and parents' expectations are important in orthodontic treatment decision making. The literature generally demonstrates the perceived benefits of orthodontic treatment, but patients' and their parents' concerns about orthodontic treatment have not been investigated comprehensively. The aim of this study was to identify patients' and parents' concerns about orthodontic treatment and compare them according to sex, age, and treatment demand level. Methods One hundred and eigh...

What the patient wants: Addressing patients' treatment targets in an integrative group psychotherapy programme.

Science.gov (United States)

Kealy, David; Joyce, Anthony S; Weber, Rainer; Ehrenthal, Johannes C; Ogrodniczuk, John S

2018-02-13

Limited empirical attention has been devoted to individualized treatment objectives in intensive group therapy for personality dysfunction. This study investigated patients' ratings of distress associated with individual therapy goals - referred to as target object severity - in an intensive Evening Treatment Programme for patients with personality dysfunction. Change in target objective severity was examined in a sample of 81 patients who completed treatment in an intensive, integrative group therapy programme. Correlation and regression analyses were used to examine associations between change in target object severity and patients' pre-treatment diagnosis, symptom distress, and treatment outcome expectancy, and between change in target objective severity and patients' ratings of group therapy process (group climate, therapeutic alliance, group cohesion). The relationship between change in target objective severity and longer-range life satisfaction was also examined in a subsample of patients who rated life satisfaction at follow-up. While change in target objective severity was not significantly related to pre-treatment variables, significant associations were found with several aspects of group therapy process. Patients' experience of a highly engaged group climate was uniquely associated with improvement in target object severity. Such improvement was significantly related to longer-term life satisfaction after controlling for general symptom change. The working atmosphere in group therapy contributes to patients' progress regarding individual treatment targets, and such progress is an important factor in later satisfaction. Attention to individualized treatment targets deserves further clinical and research attention in the context of integrative group therapy for personality dysfunction. This study found that patients attending an integrative group treatment programme for personality dysfunction experienced significant improvement in severity of distress

Learned helplessness: effects of response requirement and interval between treatment and testing.

Science.gov (United States)

Hunziker, M H L; Dos Santos, C V

2007-11-01

Three experiments investigated learned helplessness in rats manipulating response requirements, shock duration, and intervals between treatment and testing. In Experiment 1, rats previously exposed to uncontrollable or no shocks were tested under one of four different contingencies of negative reinforcement: FR 1 or FR 2 escape contingency for running, and FR1 escape contingency for jumping (differing for the maximum shock duration of 10s or 30s). The results showed that the uncontrollable shocks produced a clear operant learning deficit (learned helplessness effect) only when the animals were tested under the jumping FR 1 escape contingency with 10-s max shock duration. Experiment 2 isolated of the effects of uncontrollability from shock exposure per se and showed that the escape deficit observed using the FR 1 escape jumping response (10-s shock duration) was produced by the uncontrollability of shock. Experiment 3 showed that using the FR 1 jumping escape contingency in the test, the learned helplessness effect was observed one, 14 or 28 days after treatment. These results suggest that running may not be an appropriate test for learned helplessness, and that many diverging results found in the literature might be accounted for by the confounding effects of respondent and operant contingencies present when running is required of rats.

A conceptual framework for patient-centered fertility treatment.

Science.gov (United States)

Duthie, Elizabeth A; Cooper, Alexandra; Davis, Joseph B; Schoyer, Katherine D; Sandlow, Jay; Strawn, Estil Y; Flynn, Kathryn E

2017-09-07

Patient-centered care is a pillar of quality health care and is important to patients experiencing infertility. In this study we used empirical, in-depth data on couples' experiences of infertility treatment decision making to inform and revise a conceptual framework for patient-centered fertility treatment that was developed based on health care professionals' conceptualizations of fertility treatment, covering effectiveness, burden, safety, and costs. In this prospective, longitudinal mixed methods study, we collected data from both members (separately) of 37 couples who scheduled an initial consult with a reproductive specialist. Data collection occurred 1 week before the initial consultation, 1 week after the initial consultation, and then roughly 2, 4, 8, and 12 months later. Data collection included semi-structured qualitative interviews, self-reported questionnaires, and medical record review. Interviews were recorded, transcribed, and content analyzed in NVivo. A single coder analyzed all transcripts, with > 25% of transcripts coded by a second coder to ensure quality control and consistency. Content analysis of the interview transcripts revealed 6 treatment dimensions: effectiveness, physical and emotional burden, time, cost, potential risks, and genetic parentage. Thus, the revised framework for patient-centered fertility treatment retains much from the original framework, with modification to one dimension (from safety to potential risks) and the addition of two dimensions (time and genetic parentage). For patients and their partners making fertility treatment decisions, tradeoffs are explicitly considered across dimensions as opposed to each dimension being considered on its own. Patient-centered fertility treatment should account for the dimensions of treatment that patients and their partners weigh when making decisions about how to add a child to their family. Based on the lived experiences of couples seeking specialist medical care for

I will always be with you: traditional and complementary therapists' perspectives on patient-therapist-doctor communication regarding treatment of Arab patients with cancer in Israel.

Science.gov (United States)

Popper-Giveon, Ariela; Schiff, Elad; Ben-Arye, Eran

2012-12-01

In 2008, an Integrative Oncology Program was implemented at the Clalit Oncology Service in Haifa, Israel, to promote patients' well-being during chemotherapy and advanced stages of disease. We hypothesized that studying the perceptions of Arab complementary and alternative medicine (CAM) therapists would facilitate development of a cross-culturally integrative oncology approach. Semi-structured interviews were held with 27 Arab therapists who use medicinal herbs, the Quran and various CAM modalities, with the aim of characterizing their treatment practices and learning about their perspectives regarding conventional cancer care. Thematic analysis revealed that therapists act as go-betweens, mediating between patients and conventional physicians. Therapists translate diagnoses into Arabic and elucidate key concepts. They tend to perceive their role as gatekeepers accompanying patients through the conventional health system, referring them for further examinations, and providing CAM-based supportive care consultation. CAM therapists have an essential role in supportive care of Arab patients with cancer. Triangular patient-therapist-oncologist communication may have an impact on patients' experience and treatment quality. Recognition of CAM therapists as mediators between patients' health beliefs and conventional perceptions of care may improve doctor-patient dialogue and facilitate supportive care provision in a cross-cultural context. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Treatment acceptability and preferences for managing severe health anxiety: Perceptions of internet-delivered cognitive behaviour therapy among primary care patients.

Science.gov (United States)

Soucy, Joelle N; Hadjistavropoulos, Heather D

2017-12-01

While cognitive behaviour therapy (CBT) is an established treatment for health anxiety, there are barriers to service access. Internet-delivered cognitive behaviour therapy (ICBT) has demonstrated effectiveness and has the potential to improve access to treatment. Nevertheless, it is unknown how patients perceive ICBT relative to other interventions for health anxiety and what factors predict ICBT acceptability. This study investigated these questions. Primary care patients (N = 116) who reported elevated levels of health anxiety were presented three treatment vignettes that each described a different protocol for health anxiety (i.e., medication, CBT, ICBT). Acceptability and credibility of the treatments were assessed following the presentation of each vignette. Participants then ranked the three treatments and provided a rational for their preferences. The treatments were similarly rated as moderately acceptable. Relative to medication and ICBT, CBT was perceived as the most credible treatment for health anxiety. The highest preference ranks were for CBT and medication. Regression analyses indicated that lower computer anxiety, past medication use, and lower ratings of negative cognitions about difficulty coping with an illness significantly predicted greater ICBT acceptability. Health anxiety was not assessed with a diagnostic interview. Primary care patients were recruited through a Qualtrics panel. Patients did not have direct experience with treatment but learned about treatment options through vignettes. Medication and CBT are preferred over ICBT. If ICBT is to increase treatment access, methods of improving perceptions of this treatment option are needed. Copyright © 2017 Elsevier Ltd. All rights reserved.

Dual-modality impairment of implicit learning of letter-strings versus color-patterns in patients with schizophrenia.

Science.gov (United States)

Chiu, Ming-Jang; Liu, Kristina; Hsieh, Ming H; Hwu, Hai-Gwo

2005-12-12

Implicit learning was reported to be intact in schizophrenia using artificial grammar learning. However, emerging evidence indicates that artificial grammar learning is not a unitary process. The authors used dual coding stimuli and schizophrenia clinical symptom dimensions to re-evaluate the effect of schizophrenia on various components of artificial grammar learning. Letter string and color pattern artificial grammar learning performances were compared between 63 schizophrenic patients and 27 comparison subjects. Four symptom dimensions derived from a Chinese Positive and Negative Symptom Scale ratings were correlated with patients' artificial grammar implicit learning performances along the two stimulus dimensions. Patients' explicit memory performances were assessed by verbal paired associates and visual reproduction subtests of the Wechsler Memory Scales Revised Version to provide a contrast to their implicit memory function. Schizophrenia severely hindered color pattern artificial grammar learning while the disease affected lexical string artificial grammar learning to a lesser degree after correcting the influences from age, education and the performance of explicit memory function of both verbal and visual modalities. Both learning performances correlated significantly with the severity of patients' schizophrenic clinical symptom dimensions that reflect poor abstract thinking, disorganized thinking, and stereotyped thinking. The results of this study suggested that schizophrenia affects various mechanisms of artificial grammar learning differently. Implicit learning, knowledge acquisition in the absence of conscious awareness, is not entirely intact in patients with schizophrenia. Schizophrenia affects implicit learning through an impairment of the ability of making abstractions from rules and at least in part decreasing the capacity for perceptual learning.

Dual-modality impairment of implicit learning of letter-strings versus color-patterns in patients with schizophrenia

Directory of Open Access Journals (Sweden)

Hwu Hai-Gwo

2005-12-01

Full Text Available Abstract Background Implicit learning was reported to be intact in schizophrenia using artificial grammar learning. However, emerging evidence indicates that artificial grammar learning is not a unitary process. The authors used dual coding stimuli and schizophrenia clinical symptom dimensions to re-evaluate the effect of schizophrenia on various components of artificial grammar learning. Methods Letter string and color pattern artificial grammar learning performances were compared between 63 schizophrenic patients and 27 comparison subjects. Four symptom dimensions derived from a Chinese Positive and Negative Symptom Scale ratings were correlated with patients' artificial grammar implicit learning performances along the two stimulus dimensions. Patients' explicit memory performances were assessed by verbal paired associates and visual reproduction subtests of the Wechsler Memory Scales Revised Version to provide a contrast to their implicit memory function. Results Schizophrenia severely hindered color pattern artificial grammar learning while the disease affected lexical string artificial grammar learning to a lesser degree after correcting the influences from age, education and the performance of explicit memory function of both verbal and visual modalities. Both learning performances correlated significantly with the severity of patients' schizophrenic clinical symptom dimensions that reflect poor abstract thinking, disorganized thinking, and stereotyped thinking. Conclusion The results of this study suggested that schizophrenia affects various mechanisms of artificial grammar learning differently. Implicit learning, knowledge acquisition in the absence of conscious awareness, is not entirely intact in patients with schizophrenia. Schizophrenia affects implicit learning through an impairment of the ability of making abstractions from rules and at least in part decreasing the capacity for perceptual learning.

Reduced autobiographical memory specificity is associated with impaired discrimination learning in anxiety disorder patients

Science.gov (United States)

Lenaert, Bert; Boddez, Yannick; Vervliet, Bram; Schruers, Koen; Hermans, Dirk

2015-01-01

Associative learning plays an important role in the development of anxiety disorders, but a thorough understanding of the variables that impact such learning is still lacking. We investigated whether individual differences in autobiographical memory specificity are related to discrimination learning and generalization. In an associative learning task, participants learned the association between two pictures of female faces and a non-aversive outcome. Subsequently, six morphed pictures functioning as generalization stimuli (GSs) were introduced. In a sample of healthy participants (Study 1), we did not find evidence for differences in discrimination learning as a function of memory specificity. In a sample of anxiety disorder patients (Study 2), individuals who were characterized by low memory specificity showed deficient discrimination learning relative to high specific individuals. In contrast to previous findings, results revealed no effect of memory specificity on generalization. These results indicate that impaired discrimination learning, previously shown in patients suffering from an anxiety disorder, may be—in part—due to limited memory specificity. Together, these studies emphasize the importance of incorporating cognitive variables in associative learning theories and their implications for the development of anxiety disorders. In addition, re-analyses of the data (Study 3) showed that patients suffering from panic disorder showed higher outcome expectancies in the presence of the stimulus that was never followed by an outcome during discrimination training, relative to patients suffering from other anxiety disorders and healthy participants. Because we used a neutral, non-aversive outcome (i.e., drawing of a lightning bolt), these data suggest that learning abnormalities in panic disorder may not be restricted to fear learning, but rather reflect a more general associative learning deficit that also manifests in fear irrelevant contexts. PMID

Treatment outcomes for substance abuse among adolescents with learning disorders.

Science.gov (United States)

Yu, Jennifer W; Buka, Stephen L; Fitzmaurice, Garrett M; McCormick, Marie C

2006-07-01

This paper assesses whether chemically dependent adolescents with comorbid learning disorders (LDs) derived less effective treatment results when compared to chemically dependent adolescents without LD and examines the moderating effects of prior treatments, treatment length, and treatment completion. Two hundred one adolescents were recruited between 1992 and 1993 from Massachusetts residential treatment centers and subsequently followed up 6 months after enrollment. Compared to chemically dependent teenagers without LD, those with LD were twice as likely to re-use substances at least once by follow-up. LD teenagers were more likely to attend Alcoholics/Narcotics Anonymous if they had prior admissions to treatment programs and longer treatment length. LD teenagers who completed treatment also experienced a greater decrease in current depression compared to LD teenagers not completing the treatment. This study is the first to consider outcomes of substance abuse treatment for adolescents with LD and contributes to the growing literature on comorbidity and substance abuse treatment.

Involuntary admission may support treatment outcome and motivation in patients receiving assertive community treatment.

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Kortrijk, Hans Erik; Staring, A B P; van Baars, A W B; Mulder, C L

2010-02-01

Patients with severe mental illness who are treated in assertive community treatment (ACT) teams are sometimes involuntarily admitted when they are dangerous to themselves or others, and are not motivated for treatment. However, the consequences of involuntary admission in terms of psychosocial outcome and treatment motivation are largely unknown. We hypothesized that involuntary admission would improve psychosocial outcome and not adversely affect their treatment motivation. In the context of routine 6-monthly outcome monitoring in the period January 2003-March 2008, we used the Health of the Nation Outcome Scales (HoNOS) and a motivation-for-treatment scale to assess 260 severely mentally ill patients at risk for involuntary admission. Mixed models with repeated measures were used for data analyses. During the observation period, 77 patients (30%) were involuntarily admitted. Relative to patients who were not involuntarily admitted, these patients improved significantly in HoNOS total scores (F = 17,815, df = 1, p < 0.001) and in motivation for treatment (F = 28.139, df = 1, p < 0.001). Patients who were not involuntarily admitted had better HoNOS and motivation scores at baseline, but did not improve. Involuntary admission in the context of ACT was associated with improvements in psychosocial outcome and motivation for treatment. There are no indications that involuntary admission leads to deterioration in psychosocial outcome or worsening of motivation for treatment.

Online virtual-patient cases versus traditional problem-based learning in advanced pharmacy practice experiences.

Science.gov (United States)

Al-Dahir, Sara; Bryant, Kendrea; Kennedy, Kathleen B; Robinson, Donna S

2014-05-15

To evaluate the efficacy of faculty-led problem-based learning (PBL) vs online simulated-patient case in fourth-year (P4) pharmacy students. Fourth-year pharmacy students were randomly assigned to participate in either online branched-case learning using a virtual simulation platform or a small-group discussion. Preexperience and postexperience student assessments and a survey instrument were completed. While there were no significant differences in the preexperience test scores between the groups, there was a significant increase in scores in both the virtual-patient group and the PBL group between the preexperience and postexperience tests. The PBL group had higher postexperience test scores (74.8±11.7) than did the virtual-patient group (66.5±13.6) (p=0.001). The PBL method demonstrated significantly greater improvement in postexperience test scores than did the virtual-patient method. Both were successful learning methods, suggesting that a diverse approach to simulated patient cases may reach more student learning styles.

TH-B-BRC-00: How to Identify and Resolve Potential Clinical Errors Before They Impact Patients Treatment: Lessons Learned

Energy Technology Data Exchange (ETDEWEB)

NONE

2016-06-15

Radiation treatment consists of a chain of events influenced by the quality of machine operation, beam data commissioning, machine calibration, patient specific data, simulation, treatment planning, imaging and treatment delivery. There is always a chance that the clinical medical physicist may make or fail to detect an error in one of the events that may impact on the patient’s treatment. In the clinical scenario, errors may be systematic and, without peer review, may have a low detectability because they are not part of routine QA procedures. During treatment, there might be errors on machine that needs attention. External reviews of some of the treatment delivery components by independent reviewers, like IROC, can detect errors, but may not be timely. The goal of this session is to help junior clinical physicists identify potential errors as well as the approach of quality assurance to perform a root cause analysis to find and eliminate an error and to continually monitor for errors. A compilation of potential errors will be presented by examples of the thought process required to spot the error and determine the root cause. Examples may include unusual machine operation, erratic electrometer reading, consistent lower electron output, variation in photon output, body parts inadvertently left in beam, unusual treatment plan, poor normalization, hot spots etc. Awareness of the possibility and detection of error in any link of the treatment process chain will help improve the safe and accurate delivery of radiation to patients. Four experts will discuss how to identify errors in four areas of clinical treatment. D. Followill, NIH grant CA 180803.

TH-B-BRC-00: How to Identify and Resolve Potential Clinical Errors Before They Impact Patients Treatment: Lessons Learned

International Nuclear Information System (INIS)

2016-01-01

Radiation treatment consists of a chain of events influenced by the quality of machine operation, beam data commissioning, machine calibration, patient specific data, simulation, treatment planning, imaging and treatment delivery. There is always a chance that the clinical medical physicist may make or fail to detect an error in one of the events that may impact on the patient’s treatment. In the clinical scenario, errors may be systematic and, without peer review, may have a low detectability because they are not part of routine QA procedures. During treatment, there might be errors on machine that needs attention. External reviews of some of the treatment delivery components by independent reviewers, like IROC, can detect errors, but may not be timely. The goal of this session is to help junior clinical physicists identify potential errors as well as the approach of quality assurance to perform a root cause analysis to find and eliminate an error and to continually monitor for errors. A compilation of potential errors will be presented by examples of the thought process required to spot the error and determine the root cause. Examples may include unusual machine operation, erratic electrometer reading, consistent lower electron output, variation in photon output, body parts inadvertently left in beam, unusual treatment plan, poor normalization, hot spots etc. Awareness of the possibility and detection of error in any link of the treatment process chain will help improve the safe and accurate delivery of radiation to patients. Four experts will discuss how to identify errors in four areas of clinical treatment. D. Followill, NIH grant CA 180803

Autistic Learning Disabilities and Individualizing Treatment for Autistic Spectrum Disorders.

Science.gov (United States)

Siegel, Bryna

1999-01-01

This article evaluates three early intervention approaches--applied behavior analysis, TEAACH (Treatment and Education of Autistic and Related Communication Handicapped Children), a structured classroom-based program, and relationship therapy/"floor time"--to identify which aspects of each approach complement individual learning styles…

[Treatment motivation in patients with chronic cardiorenal syndrome].

Science.gov (United States)

Efremova, E V; Shutov, A M; Borodulina, E O

2015-01-01

To study treatment motivation in patients with chronic heart failure (CHF) and in those with CHF concurrent with chronic kidney disease (CKD). A total of 203 patients (130 men and 73 women; mean age, 61.8±9.6 years) with CHF diagnosed and assessed in accordance with the National Guidelines of the All-Russian Research Society of Cardiology and the Heart Failure Society for the diagnosis and treatment of CHF (third edition, 2009) were examined. CKD was diagnosed according to the 2012 National Guidelines of the Research Nephrology Society of Russia. A group of patients with chronic cardiorenal syndrome (CRS) included those with CHF and CKD with a glomerular filtration rate (GFR) of motivation for non-drug and drug treatments were assessed in patients with chronic CRS. CFR was 67.7±17.2 ml/min/1.73 m2; chronic CRS was observed in 89 (44%) patients. Psychological functioning assessment showed that the patients with chronic CRS as compared with those with CHF without CKD had high anxiety and maladaptive disease attitudes. CHF treatment motivation (compliance with lifestyle modification and medication) was proved inadequate and detected only in 31 (15.3%) patients with CHF regardless of the presence of CKD. The specific features of psychological functioning, which affected treatment motivation, were seen in patients with chronic CRS: those who were lowly motivated had a euphoric attitude towards their disease (p=0.03); those who were satisfactorily motivated showed an emotive accentuation of character (p=0.002). The presence of CKD aggravates the clinical course of CHF and negatively affects the psychological functioning of patients with CHF. The patients with chronic CRS are characterized by a low level of motivation for both drug and non-drug treatments, which should be taken into account when managing this cohort of patients.

Machine learning techniques to examine large patient databases.

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Meyfroidt, Geert; Güiza, Fabian; Ramon, Jan; Bruynooghe, Maurice

2009-03-01

Computerization in healthcare in general, and in the operating room (OR) and intensive care unit (ICU) in particular, is on the rise. This leads to large patient databases, with specific properties. Machine learning techniques are able to examine and to extract knowledge from large databases in an automatic way. Although the number of potential applications for these techniques in medicine is large, few medical doctors are familiar with their methodology, advantages and pitfalls. A general overview of machine learning techniques, with a more detailed discussion of some of these algorithms, is presented in this review.

Development and validation of the Patient Experience with Treatment and Self-management (PETS): a patient-reported measure of treatment burden.

Science.gov (United States)

Eton, David T; Yost, Kathleen J; Lai, Jin-Shei; Ridgeway, Jennifer L; Egginton, Jason S; Rosedahl, Jordan K; Linzer, Mark; Boehm, Deborah H; Thakur, Azra; Poplau, Sara; Odell, Laura; Montori, Victor M; May, Carl R; Anderson, Roger T

2017-02-01

The purpose of this study was to develop and validate a new comprehensive patient-reported measure of treatment burden-the Patient Experience with Treatment and Self-management (PETS). A conceptual framework was used to derive the PETS with items reviewed and cognitively tested with patients. A survey battery, including a pilot version of the PETS, was mailed to 838 multi-morbid patients from two healthcare institutions for validation. A total of 332 multi-morbid patients returned completed surveys. Diagnostics supported deletion and consolidation of some items and domains. Confirmatory factor analysis supported a domain model for scaling comprised of 9 factors: medical information, medications, medical appointments, monitoring health, interpersonal challenges, medical/healthcare expenses, difficulty with healthcare services, role/social activity limitations, and physical/mental exhaustion. Scales showed good internal consistency (α range 0.79-0.95). Higher PETS scores, indicative of greater treatment burden, were correlated with more distress, less satisfaction with medications, lower self-efficacy, worse physical and mental health, and lower convenience of healthcare (Ps health literacy, less adherence to medications, and more financial difficulties reported higher PETS scores (Ps < 0.01). A comprehensive patient-reported measure of treatment burden can help to better characterize the impact of treatment and self-management burden on patient well-being and guide care toward minimally disruptive medicine.

Refusal of Treatment by Mentally Competent Patient: The Choice of Doctor-Patient Relationship Models

Directory of Open Access Journals (Sweden)

Andrei M. Beliaev

2010-01-01

Full Text Available Introduction: In modern medicine professional relationship between the clinician and the patient is patient-centered. Patients become actively involved in the treatment decision making process and are encouraged to express their health-related preferences. Some patients may, however, refuse a favorable risk/benefit ratio treatment. This manuscript presents three cases of refusal of treatment by mentally competent surgical patients and discusses differences in their management. Conclusion: To achieve the best medical outcome for patients who possess the Actual Understanding test of mental competence clinicians use the deliberate model of medical professional relationship. For patients demonstrating the Understanding test of mental competence and wishing to utilize their health-related preferences physicians are obliged to deploy the interpretive model of doctor-patient relationship. In mentally competent patients with an illness-induced acute psychological regression the interpretive model of doctor-patient relationship as an initial strategy and cognitive behavior therapy can be useful in modifying treatment rejecting behavior and improving medical outcome.

Refining Prediction in Treatment-Resistant Depression: Results of Machine Learning Analyses in the TRD III Sample.

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Kautzky, Alexander; Dold, Markus; Bartova, Lucie; Spies, Marie; Vanicek, Thomas; Souery, Daniel; Montgomery, Stuart; Mendlewicz, Julien; Zohar, Joseph; Fabbri, Chiara; Serretti, Alessandro; Lanzenberger, Rupert; Kasper, Siegfried

The study objective was to generate a prediction model for treatment-resistant depression (TRD) using machine learning featuring a large set of 47 clinical and sociodemographic predictors of treatment outcome. 552 Patients diagnosed with major depressive disorder (MDD) according to DSM-IV criteria were enrolled between 2011 and 2016. TRD was defined as failure to reach response to antidepressant treatment, characterized by a Montgomery-Asberg Depression Rating Scale (MADRS) score below 22 after at least 2 antidepressant trials of adequate length and dosage were administered. RandomForest (RF) was used for predicting treatment outcome phenotypes in a 10-fold cross-validation. The full model with 47 predictors yielded an accuracy of 75.0%. When the number of predictors was reduced to 15, accuracies between 67.6% and 71.0% were attained for different test sets. The most informative predictors of treatment outcome were baseline MADRS score for the current episode; impairment of family, social, and work life; the timespan between first and last depressive episode; severity; suicidal risk; age; body mass index; and the number of lifetime depressive episodes as well as lifetime duration of hospitalization. With the application of the machine learning algorithm RF, an efficient prediction model with an accuracy of 75.0% for forecasting treatment outcome could be generated, thus surpassing the predictive capabilities of clinical evaluation. We also supply a simplified algorithm of 15 easily collected clinical and sociodemographic predictors that can be obtained within approximately 10 minutes, which reached an accuracy of 70.6%. Thus, we are confident that our model will be validated within other samples to advance an accurate prediction model fit for clinical usage in TRD. © Copyright 2017 Physicians Postgraduate Press, Inc.

Patient satisfaction with treatment in first-episode psychosis

DEFF Research Database (Denmark)

Haahr, Ulrik Helt; Simonsen, Erik; Røssberg, Jan Ivar

2012-01-01

Purpose: To examine first-episode psychotic patients' satisfaction with elements of a comprehensive 2-year treatment program. Subjects and method: The TIPS (Early Treatment and Intervention in Psychosis) project provided a 2-year treatment program consisting of milieu therapy (inpatient), individ......Purpose: To examine first-episode psychotic patients' satisfaction with elements of a comprehensive 2-year treatment program. Subjects and method: The TIPS (Early Treatment and Intervention in Psychosis) project provided a 2-year treatment program consisting of milieu therapy (inpatient......), individual psychotherapy, family intervention and medication. Of 140 patients at baseline, 112 were included at 2-year follow-up. Eighty-four participants were interviewed using a questionnaire eliciting levels of satisfaction with different treatment elements at two of the four sites. Results: Participants...... and non-participants did not differ on demographic or clinical data at baseline. Of those participating, 75% were satisfied with treatment in general. Individual and milieu therapy received higher rating than medication or family intervention. No predictors of general satisfaction with treatment were...

Skill learning in patients with moderate Alzheimer's disease: a prospective pilot-study of waltz-lessons.

Science.gov (United States)

Rösler, Alexander; Seifritz, Erich; Kräuchi, Kurt; Spoerl, David; Brokuslaus, Ilona; Proserpi, Sara-Maria; Gendre, Annekäthi; Savaskan, Egemen; Hofmann, Marc

2002-12-01

The authors report the effect of a 12-day prospective, blinded dance-learning trial in 5 patients with moderate Alzheimer's disease (AD) and 5 age-matched depressed patients. Patients with AD showed a significant effect in procedural learning whereas depressed patients did not. These findings suggest potential implications for therapeutic interventions in patients with moderate AD. Copyright 2002 John Wiley & Sons, Ltd.

Quantitative EEG neurofeedback for the treatment of pediatric attention-deficit/hyperactivity disorder, autism spectrum disorders, learning disorders, and epilepsy.

Science.gov (United States)

Hurt, Elizabeth; Arnold, L Eugene; Lofthouse, Nicholas

2014-07-01

Neurofeedback (NF) using surface electroencephalographic signals has been used to treat various child psychiatric disorders by providing patients with video/audio information about their brain's electrical activity in real-time. Research data are reviewed and clinical recommendations are made regarding NF treatment of youth with attention deficit/hyperactivity disorder, autism, learning disorders, and epilepsy. Most NF studies are limited by methodological issues, such as failure to use or test the validity of a full-blind or sham NF. The safety of NF treatment has not been thoroughly investigated in youth or adults, although clinical experience suggests reasonable safety. Copyright © 2014 Elsevier Inc. All rights reserved.

Cognitive Training and Work Therapy for the Treatment of Verbal Learning and Memory Deficits in Veterans With Alcohol Use Disorders.

Science.gov (United States)

Bell, Morris D; Vissicchio, Nicholas A; Weinstein, Andrea J

2016-01-01

This study focused on the efficacy of cognitive training for verbal learning and memory deficits in a population of older veterans with alcohol use disorders. Veterans with alcohol use disorders, who were in outpatient treatment at VA facilities and in early-phase recovery (N = 31), were randomized to receive a three-month trial of daily cognitive training plus work therapy (n = 15) or work therapy alone (n = 16), along with treatment as usual. Participants completed assessments at baseline and at three- and six-month follow-ups; the Hopkins Verbal Learning Task (HVLT) was the primary outcome measure. Participants were primarily male (97%) and in their mid-50s (M = 55.16, SD = 5.16) and had been sober for 1.64 (SD = 2.81) months. Study retention was excellent (91% at three-month follow-up) and adherence to treatment in both conditions was very good. On average, participants in the cognitive training condition had more than 41 hours of cognitive training, and both conditions had more than 230 hours of productive activity. HVLT results at three-month follow-up revealed significant condition effects favoring cognitive training for verbal learning (HVLT Trial-3 T-score, p cognitive training condition with clinically significant verbal memory deficits (p therapy alone condition and a trend toward significance for verbal learning deficits, which was not sustained at six-month follow-up. This National Institute on Drug Abuse-funded pilot study demonstrates that cognitive training within the context of another activating intervention (work therapy) may have efficacy in remediating verbal learning and memory deficits in patients with alcohol use disorder. Findings indicate a large effect for cognitive training in this pilot study, which suggests that further research is warranted. This study is registered on ClinicalTrials.gov (NCT 01410110).

Training in Good Psychiatric Management for Borderline Personality Disorder in Residency: An Aide to Learning Supportive Psychotherapy for Challenging-to-Treat Patients.

Science.gov (United States)

Bernanke, Joel; McCommon, Benjamin

2018-01-01

Given many competing demands, psychotherapy training to competency is difficult during psychiatric residency. Good Psychiatric Management for borderline personality disorder (GPM) offers an evidence-based, simplified, psychodynamically informed framework for the outpatient management of patients with borderline personality disorder, one of the most challenging disorders psychiatric residents must learn to treat. In this article, we provide an overview of GPM, and show that training in GPM meets a requirement for training in supportive psychotherapy; builds on psychodynamic psychotherapy training; and applies to other severe personality disorders, especially narcissistic personality disorder. We describe the interpersonal hypersensitivity model used in GPM as a straightforward way for clinicians to collaborate with patients in organizing approaches to psychoeducation, treatment goals, case management, use of multiple treatment modalities, and safety. A modification of the interpersonal hypersensitivity model that includes intra-personal hypersensitivity can be used to address narcissistic problems often present in borderline personality disorder. We argue that these features make GPM ideally suited for psychiatry residents in treating their most challenging patients, provide clinical examples to illustrate these points, and report the key lessons learned by a psychiatry resident after a year of GPM supervision.

Learning from Negative Feedback in Patients with Major Depressive Disorder is Attenuated by SSRI Antidepressants

Directory of Open Access Journals (Sweden)

Mohammad M. Herzallah

2013-09-01

Full Text Available One barrier to interpreting past studies of cognition and Major Depressive Disorder (MDD has been the failure in many studies to adequately dissociate the effects of MDD from the potential cognitive side effects of Selective Serotonin Reuptake Inhibitors (SSRI use. To better understand how remediation of depressive symptoms affects cognitive function in MDD, we evaluated three groups of subjects: medication-naïve patients with MDD, medicated patients with MDD receiving the SSRI paroxetine and healthy control subjects. All were administered a category-learning task that allows for dissociation between learning from positive feedback (reward versus learning from negative feedback (punishment. Healthy subjects learned significantly better from positive feedback than medication-naïve and medicated MDD groups, whose learning accuracy did not differ significantly. In contrast, medicated patients with MDD learned significantly less from negative feedback than medication-naïve patients with MDD and healthy subjects, whose learning accuracy was comparable. A comparison of subject’s relative sensitivity to positive versus negative feedback showed that both the medicated MDD and healthy control groups conform to Kahneman and Tversky’s (1979 Prospect Theory, which expects losses (negative feedback to loom psychologically slightly larger than gains (positive feedback. However, medicated MDD and HC profiles are not similar, which indicates that the state of medicated MDD is not ‘normal’ when compared to HC, but rather balanced with less learning from both positive and negative feedback. On the other hand, medication-naïve patients with MDD violate Prospect Theory by having significantly exaggerated learning from negative feedback. This suggests that SSRI antidepressants impair learning from negative feedback, while having negligible effect on learning from positive feedback. Overall, these findings shed light on the importance of dissociating the

Evaluation of patient preferences towards treatment during extended hours for patients receiving radiation therapy for the treatment of cancer: A time trade-off study

International Nuclear Information System (INIS)

Brown, Alison M.; Atyeo, John; Field, Nikki; Cox, Jennifer; Bull, Colin; Gebski, Val J.

2009-01-01

Background: To reduce the waiting time between diagnosis and the start of radiation therapy, some departments have introduced appointments outside of conventional working hours, but the inconvenience this may cause to patients is unknown. We examined, from the patient's perspective, whether reduced waiting times to treatment would be sufficient to trade off against potentially inconvenient appointment times. Method: We interviewed patients receiving radiation therapy at a major teaching hospital between January and May 2005. Two patient groups were considered: those treated during conventional working hours (8.30 am to 4.30 pm), and those treated outside these hours. Patients were asked to trade a reduction in waiting time to the start of treatment against treatment outside conventional working hours. Results: Of 129 patients interviewed, 77 were treated during conventional working hours and 52 outside these hours. Fifty-seven (44%) were male and 52 (40%) were aged over 60 years. To prefer treatment out of working hours, patients being treated during conventional working hours required a larger reduction in waiting time (odds ratio 2.36, 95% CI 0.97-5.76). Patients with curable disease and those who had made few changes in their lifestyle throughout the treatment were more likely to accept treatment outside of conventional working hours. Conclusion: It is impractical to satisfy the treatment-time preferences of all patients. However, many patients prefer treatment outside of normal treatment times if this would reduce the time until the start of radiation therapy. Evaluating the effect of waiting times on patients' perceptions of their disease control provides important information in allocating treatment hours and appointment times

SURGICAL TREATMENT OF ENDOMETRIOSIS IN INFERTILE PATIENTS

Directory of Open Access Journals (Sweden)

Andrej Vogler

2003-12-01

Full Text Available Background. Endometriosis is nowadays probably the most frequent cause of infertility or subfertility and is revealed in approximately 30–40% of infertile women. The association between fertility and minimal or mild endometriosis remains unclear and controversial. Moderate and severe forms of the disease distort anatomical relations in the minor pelvis, resulting in infertility. The goals of endometriosis treatment are relief of pain symptoms, prevention of the disease progression and fertility improvement. Treatment of stages I and II endometriosis (according to the R-AFS classification may be expectative, medical or surgical. In severely forms of the disease (stage III and IV the method of choice is surgical treatment. Combined medical and surgical treatment is justified only in cases, in which the complete endometriotic tissue removal is not possible or recurrence of pain symptoms occur. Nowadays, laparoscopic surgical treatment is the golden standard being the diagnostic and therapeutic tool during the same procedure. The aim of this study was to evaluate the fertility rate after surgical treatment of different stages of endometriosis.Patients and methods. In prospectively designed study 100 infertile women were included. The only known cause of infertility was endometriosis. In group A there were 51 patients with stage I and II endometriosis, whereas in group B there were 49 patients with stage III and IV of the disease. Endometriosis was diagnosed and treated laparoscopically. Endometriotic implants were removed either with bipolar coagulation or CO2 laser vaporisation, whereas adhesions were sharp or blunt dissected, and endometriomas stripped out of ovaries. Pregnancy rates were calculated for both groups of patients, and statistically compared between the groups.Results. Mean age of patients was 29.25 (SD ± 4.08 years and did not significantly differ between the groups of patients (29.5 years in group A and 29 years in group B. In

Associations between nutritional status, weight loss, radiotherapy treatment toxicity and treatment outcomes in gastrointestinal cancer patients.

Science.gov (United States)

Hill, Amanda; Kiss, Nicole; Hodgson, Belinda; Crowe, Timothy C; Walsh, Adam D

2011-02-01

Patients with gastrointestinal cancers are susceptible to nutritional deterioration which may be compounded by radiotherapy treatment toxicities. This study aimed to determine whether nutritional status at radiotherapy commencement or changes in nutritional status throughout radiotherapy were associated with treatment toxicity and outcomes in gastrointestinal cancer patients. Seventy-three gastrointestinal cancer patients receiving curative radiotherapy underwent medical record audits assessing body weight, radiotherapy toxicity, unplanned treatment breaks or hospital admissions and completion of prescribed treatment/s. Nutritional status was assessed in a subset of patients (n = 11) using the Patient-Generated Subjective Global Assessment tool. Seventy-five percent of patients lost weight throughout radiotherapy. Weight loss was significantly greater in patients experiencing unplanned radiotherapy breaks (-3.1% vs -1.6%, p nutritional status during radiotherapy (as measured by weight loss) may be associated with poorer short-term treatment outcomes in gastrointestinal cancer patients. Patient numbers were too small to definitively determine the effect of nutritional status at radiotherapy commencement or changes in nutritional status throughout radiotherapy (defined by PG-SGA) on treatment outcomes. Further research is required to investigate this in larger, longer-term studies. Copyright © 2010. Published by Elsevier Ltd.

Teaching patient care to students: A blended learning approach in radiography education

Energy Technology Data Exchange (ETDEWEB)

Bleiker, Jill, E-mail: j.bleiker@ex.ac.uk [College of Engineering, Mathematics and Physical Sciences, University of Exeter, Stocker Road, Exeter EX4 4QL (United Kingdom); Knapp, Karen M.; Frampton, Ian [College of Engineering, Mathematics and Physical Sciences, University of Exeter, Stocker Road, Exeter EX4 4QL (United Kingdom)

2011-08-15

Understanding the complexity of the patient-practitioner interaction is a challenging area for radiography students early in their programmes. A small scale research project was undertaken to develop blended learning resources for the teaching of patient care to radiography students. Its purpose was to utilise experiences gathered from interviews with ex-patients to produce video clips of patient-practitioner interactions so that students might gain some insight into the reality of the clinical setting, thus enabling them to link theory with practice. A total of eight interviews with ex-patients were carried out and the transcripts used to generate scripts which were enacted and filmed by a professional acting company. Thematic analysis of the study data initiated the generation of scenarios, which formed the basis of the videos. Twelve scenes showing patient-practitioner interactions in various parts of a medical imaging department and four 'talking heads' clips were produced. These were loaded onto the university's virtual learning environment and made available for viewing together with self-test and evaluation questionnaires. A pilot study was carried out; evaluation of the videos by second year student radiographers was positive. The main study was carried out using first year students with similarly positive findings and the videos are now publically available for teaching purposes. Further work in this promising area of e-learning could further utilise patients' experiences, and using the same technology, might offer students of other professions the opportunity to gain vicarious experience prior to their first encounters with patients and the general public. In conclusion, research leading to the production of simulations of real-life patient-practitioner interactions delivered using blended learning is a useful pedagogical tool in the education of radiography students.

Teaching patient care to students: A blended learning approach in radiography education

International Nuclear Information System (INIS)

Bleiker, Jill; Knapp, Karen M.; Frampton, Ian

2011-01-01

Understanding the complexity of the patient-practitioner interaction is a challenging area for radiography students early in their programmes. A small scale research project was undertaken to develop blended learning resources for the teaching of patient care to radiography students. Its purpose was to utilise experiences gathered from interviews with ex-patients to produce video clips of patient-practitioner interactions so that students might gain some insight into the reality of the clinical setting, thus enabling them to link theory with practice. A total of eight interviews with ex-patients were carried out and the transcripts used to generate scripts which were enacted and filmed by a professional acting company. Thematic analysis of the study data initiated the generation of scenarios, which formed the basis of the videos. Twelve scenes showing patient-practitioner interactions in various parts of a medical imaging department and four 'talking heads' clips were produced. These were loaded onto the university's virtual learning environment and made available for viewing together with self-test and evaluation questionnaires. A pilot study was carried out; evaluation of the videos by second year student radiographers was positive. The main study was carried out using first year students with similarly positive findings and the videos are now publically available for teaching purposes. Further work in this promising area of e-learning could further utilise patients' experiences, and using the same technology, might offer students of other professions the opportunity to gain vicarious experience prior to their first encounters with patients and the general public. In conclusion, research leading to the production of simulations of real-life patient-practitioner interactions delivered using blended learning is a useful pedagogical tool in the education of radiography students.

Serial position learning effects in patients with aneurysms of the anterior communicating artery.

Science.gov (United States)

Stefanova, Elka; Kostic, Vladimir S; Ziropadja, Ljubomir; Markovic, Milan; Ocic, Gordana

2002-08-01

Ruptured and repaired Anterior Communicating Artery (ACoA) aneurysm can result in devastating impairments involving memory, executive function, confabulation, and personality changes. This study tested serial position learning effects (SPEs) in patients following repaired and ruptured ACoA aneurysm, using results on the Rey Auditory Verbal Learning Test (RAVLT). Thirty patients with ruptured aneurysms of the ACoA and 31 matched controls were included in the study. The primacy-recency effects were maintained during five learning trials in ACoA group, albeit at an overall lower level than in the controls. There was no difference in primacy-recency relation across five learning trials in ACoA group. On the delayed recall trial the patient group demonstrated neither a primacy, nor a recency phenomenon, reflecting a lack of recall of any parts of the word list. This kind of primacy-recency profile across learning trials in ACoA group has no similarity with SPE results in frontal lesion groups, or with SPE distributions in other amnesic disorders, despite the fact that memory and executive deficits were evident in our ACoA group.

Time to learn: the outlook for renewal of patient-centred education in the digital age.

Science.gov (United States)

Glick, T H; Moore, G T

2001-05-01

Major forces in society and within health systems are fragmenting patient care and clinical learning. The distancing of physician and trainee from the patient undermines learning about the patient-doctor relationship. The disconnection of care and learning from one successive venue to another impedes the ability of trainees to learn about illness longitudinally. As a conceptual piece, our methods have been those of witnessing the experiences of patients, practitioners, and students over time and observing the impact of fragmented systems and changing expectations on care and learning. We have reflected on the opportunities created by digital information systems and interactive telemedicine to help renew essential relationships. Although there is, as yet, little in the literature on educational or health outcomes of this kind of technological enablement, we anticipate opportunities for a renewed focus on the patient in that patient's own space and time. Multimedia applications can achieve not only real-time connections, but can help construct a "virtual patient" as a platform for supervision and assessment, permitting preceptors to evaluate trainee-patient interactions, utilization of Web-based data and human resources, and on-line professionalism. Just as diverse elements in society are capitalizing upon digital technology to create advantageous relationships, all of the elements in the complex systems of health care and medical training can be better connected, so as to put the patient back in the centre of care and the trainee's ongoing relationship to the patient back in the centre of education.

Treatment choices and outcomes of patients with manometrically diagnosed achalasia.

Science.gov (United States)

Yeung, J C; Finley, C; Hanna, W C; Miller, L; Ferri, L; Urbach, D R; Darling, G E

2016-07-01

This prospective population-based study was designed to evaluate treatment choices in patients with new manometrically diagnosed achalasia and their outcomes. Patients referred to the esophageal function laboratory were enrolled after a new manometric diagnosis of achalasia. Patients completed an initial achalasia symptom score validated questionnaire on their symptom severity, duration, treatment pre-diagnosis and Medical Outcomes Study 36-item Short-Form (SF-36) survey. Treatment decisions were made by the referring physician and the patient. Follow-up questionnaires were completed every 3 months for 1 year. Patients who chose not to undergo treatment at 1-year follow-up completed another questionnaire after 5 years. Between January 2004 and January 2005, 83 of 124 eligible patients were enrolled. Heller myotomy was performed on 31 patients, three patients received botulinum toxin injections, and 25 patients received 29 pneumatic balloon dilatations. Twenty-four patients chose to receive no treatment. Following treatment, patients treated with surgery, dilatation and botulinum toxin had an average improvement in achalasia symptom score of 23 +/- 12.2, 17 +/- 10.9, and 9 +/- 14, respectively. Patients receiving no treatment had worsening symptoms with a symptom score change of -3.5 +/- 11.4. Surgery and dilatation resulted in significant improvement (P treatment. In univariate logistic regression, symptom severity score (odds ratio [OR] 1.04, 95% confidence interval [CI] 1.00 to 1.08), sphincter tone (OR 1.04, 95% CI 1.00 to 1.09), difficulty swallowing liquids (OR 3.21, 95% 1.15 to 8.99), waking from sleep (OR 2.75, 95% 1.00 to 7.61), and weight loss (OR 5.99, 95% CI 1.93 to 18.58) were all significant in predicting that patients would select treatment. In the multivariate analysis, older age (OR 1.05, 95% CI 1.01 to 1.09) and weight loss (OR 3.91, 95% CI 1.02 to 15.2) were statistically significant for undergoing treatment. At 5 years, five (21%) of those who

SURGICAL TREATMENT OF POLYCYSTIC OVARIES IN INFERTILE PATIENTS

Directory of Open Access Journals (Sweden)

Martina Ribič Pucelj

2003-12-01

Full Text Available Background. Polycystic ovaries (PCO are manifested either independently or as a syndrome (PCOS. They are one of the commonest endocrinopathy in women of reproductive age. Despite a variable clinical picture one of the leading symptoms is infertility for anovulation. Surgical treatment of the disease witnessed a revival after the introduction of minimally invasive operative laparoscopy. Various techniques of ovarian tissue destruction have been applied, the most common being laparoscopic electrocoagulation of the ovaries (LECO. The aim of this retrospective study was to assess the pregnancy rates and pregnancy outcomes following LECO.Patients and methods. From 1993 and 2000 inclusive LECO was performed at the Reproductive Unit, Department of Obstetrics and Gynecology Ljubljana in 222 infertile patients with PCO(S, in whom previous medical ovulation induction failed or in whom overreaction of the ovaries to gonadotropin treatment occurred. To the questionnaire, mailed to the patients, 185 (83.3% responded. The evaluation of the outcome of LECO treatment involved 157 patients, since the patients who underwent in vitro fertilization (IVF-ET treatment for other causes of infertility prior to LECO, were exclude from the analysis. LECO was performed under general endotracheal anesthesia using a 3-puncture technique. On each ovary 5– 15 (mean 10 punctures were made with a monopolar electric needle, energy of 300 W, and duration of 4 seconds. Statistical analysis was done using Chi-square test and odds ratios.Results. After LECO 99 (63.3% of the 157 patients conceived, 56 (54.6% spontaneously and 43 (45.4% after additional postoperative ovarian stimulation. Pregnancy was registered in 58 (59.0% patients with primary, and in 41 (41% patients with secondary infertility, in 20 (57% patients with PCO, 79 (65% with PCOS, in 71 (64.1% patients with a normal partner’s spermiogram, and in 28 (46.1% patients with the partner’s oligoasthenoteratospermia of

Treatment of Acoustic Neuroma

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... Home Learn Treatment Options Overview English English Arabic Catalan Chinese (Simplified) Chinese (Traditional) Danish French German Greek ... for delivering stereotactic radiation have improved, an increasing number of patients have chosen to receive stereotactic radiosurgery ...

Studies of long-term noopept and afobazol treatment in rats with learned helplessness neurosis.

Science.gov (United States)

Uyanaev, A A; Fisenko, V P

2006-08-01

Long-lasting effects of new Russian psychotropic drugs Noopept and Afobazol on active avoidance conditioning and formation of learned helplessness neurosis were studied on an original experimental model in rats. Noopept eliminated the manifestations of learned helplessness after long-term (21-day) treatment by increasing the percent of trained animals. Afobazol was low effective in preventing manifestations of learned helplessness, but if used for a long time, it reduced the incidence of learned helplessness development by increasing the percent of untrained animals.

Patient-relevant needs and treatment goals in nail psoriasis

DEFF Research Database (Denmark)

Blome, C; Costanzo, A; Dauden, E.

2016-01-01

, but not with age or disease duration. Manual dexterity and social interaction were of particular importance. Goal importance and quality of life were associated, but not redundant (r = 0.612, p ...PURPOSE: Patient-centered health care implies that medical decisions are made jointly by physician and patient, based on patient needs. Aims were to (a) identify treatment goals for a new questionnaire on patient needs and benefits in nail psoriasis treatment; (b) analyze the importance...... of treatment goals in patients with nail psoriasis in general and in defined subgroups; and (c) determine the association between overall treatment goal importance and quality of life. METHODS: The study comprised the following steps: qualitative survey on needs and burdens in 120 patients; development...

Compiling a register of patients with moderate or severe learning disabilities: experience at one United Kingdom general practice

Science.gov (United States)

2011-01-01

Background Identifying patients with learning disabilities within primary care is central to initiatives for improving the health of this population. UK general practitioners (GPs) receive additional income for maintaining registers of patients with learning disabilities as part of the Quality and Outcomes Framework (QOF), and may opt to provide Directed Enhanced Services (DES), which requires practices to maintain registers of patients with moderate or severe learning disabilities and offer them annual health checks. Objectives This paper describes the development of a register of patients with moderate or severe learning disabilities at one UK general practice. Methods A Read code search of one UK general practice's electronic medical records was conducted in order to identify patients with learning disabilities. Confirmation of diagnoses was sought by scrutinising records and GP verification. Cross-referencing with the practice QOF register of patients with learning disabilities of any severity, and the local authority's list of clients with learning disabilities, was performed. Results Of 15 001 patients, 229 (1.5%) were identified by the Read code search as possibly having learning disabilities. Scrutiny of records and GP verification confirmed 64 had learning disabilities and 24 did not, but the presence or absence of learning disability remained unclear in 141 cases. Cross-referencing with the QOF register (n=81) and local authority list (n=49) revealed little overlap. Conclusion Identifying learning disability and assessing its severity are tasks GPs may be unfamiliar with, and relying on Read code searches may result in under-detection. Further research is needed to define optimum strategies for identifying, cross-referencing and validating practice-based registers of patients with learning disabilities. PMID:22479290

Compiling a register of patients with moderate or severe learning disabilities: experience at one United Kingdom general practice.

Science.gov (United States)

Lodge, Keri-Michèle; Milnes, David; Gilbody, Simon M

2011-03-01

Background Identifying patients with learning disabilities within primary care is central to initiatives for improving the health of this population. UK general practitioners (GPs) receive additional income for maintaining registers of patients with learning disabilities as part of the Quality and Outcomes Framework (QOF), and may opt to provide Directed Enhanced Services (DES), which requires practices to maintain registers of patients with moderate or severe learning disabilities and offer them annual health checks.Objectives This paper describes the development of a register of patients with moderate or severe learning disabilities at one UK general practice.Methods A Read code search of one UK general practice's electronic medical records was conducted in order to identify patients with learning disabilities. Confirmation of diagnoses was sought by scrutinising records and GP verification. Cross-referencing with the practice QOF register of patients with learning disabilities of any severity, and the local authority's list of clients with learning disabilities, was performed.Results Of 15 001 patients, 229 (1.5%) were identified by the Read code search as possibly having learning disabilities. Scrutiny of records and GP verification confirmed 64 had learning disabilities and 24 did not, but the presence or absence of learning disability remained unclear in 141 cases. Cross-referencing with the QOF register (n=81) and local authority list (n=49) revealed little overlap.Conclusion Identifying learning disability and assessing its severity are tasks GPs may be unfamiliar with, and relying on Read code searches may result in under-detection. Further research is needed to define optimum strategies for identifying, cross-referencing and validating practice-based registers of patients with learning disabilities.

'Rapid Learning health care in oncology' - an approach towards decision support systems enabling customised radiotherapy'.

Science.gov (United States)

Lambin, Philippe; Roelofs, Erik; Reymen, Bart; Velazquez, Emmanuel Rios; Buijsen, Jeroen; Zegers, Catharina M L; Carvalho, Sara; Leijenaar, Ralph T H; Nalbantov, Georgi; Oberije, Cary; Scott Marshall, M; Hoebers, Frank; Troost, Esther G C; van Stiphout, Ruud G P M; van Elmpt, Wouter; van der Weijden, Trudy; Boersma, Liesbeth; Valentini, Vincenzo; Dekker, Andre

2013-10-01

An overview of the Rapid Learning methodology, its results, and the potential impact on radiotherapy. Rapid Learning methodology is divided into four phases. In the data phase, diverse data are collected about past patients, treatments used, and outcomes. Innovative information technologies that support semantic interoperability enable distributed learning and data sharing without additional burden on health care professionals and without the need for data to leave the hospital. In the knowledge phase, prediction models are developed for new data and treatment outcomes by applying machine learning methods to data. In the application phase, this knowledge is applied in clinical practice via novel decision support systems or via extensions of existing models such as Tumour Control Probability models. In the evaluation phase, the predictability of treatment outcomes allows the new knowledge to be evaluated by comparing predicted and actual outcomes. Personalised or tailored cancer therapy ensures not only that patients receive an optimal treatment, but also that the right resources are being used for the right patients. Rapid Learning approaches combined with evidence based medicine are expected to improve the predictability of outcome and radiotherapy is the ideal field to study the value of Rapid Learning. The next step will be to include patient preferences in the decision making. Copyright © 2013 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

Collaborative learning in nursing simulation: near-peer teaching using standardized patients.

Science.gov (United States)

Owen, Amy M; Ward-Smith, Peggy

2014-03-01

Simulation in nursing education uses specific patient scenarios to provide students with hands-on learning experiences. A near-peer teaching experience, using upper-level nursing students as standardized patients, was created as an educational intervention. The premises of social cognitive theory, which include cognitive, behavioral, and environmental factors, were incorporated into this teaching activity. The upper-level students played the role of a patient, while they also practiced leadership, teaching, and mentoring of first-semester nursing students. In the scenario, the first-semester students provided care to the patient, while focusing on safety, identifying the problem, and practicing clinical decision making. Faculty were present to provide guidance and promote communication in debriefing. Near-peer teaching provided a learning opportunity for all students, facilitated teamwork, and encouraged knowledge and skills attainment. Copyright 2014, SLACK Incorporated.

Childhood Acute Myeloid Leukemia Treatment (PDQ®)—Patient Version

Science.gov (United States)

Childhood acute myeloid leukemia and other myeloid malignancies treatment may include chemotherapy, radiation therapy, stem cell transplant, and targeted therapy. Learn more about AML and myelodysplastic/myeloproliferative diseases in this expert-reviewed summary.

Using Active Learning to Identify Health Information Technology Related Patient Safety Events.

Science.gov (United States)

Fong, Allan; Howe, Jessica L; Adams, Katharine T; Ratwani, Raj M

2017-01-18

The widespread adoption of health information technology (HIT) has led to new patient safety hazards that are often difficult to identify. Patient safety event reports, which are self-reported descriptions of safety hazards, provide one view of potential HIT-related safety events. However, identifying HIT-related reports can be challenging as they are often categorized under other more predominate clinical categories. This challenge of identifying HIT-related reports is exacerbated by the increasing number and complexity of reports which pose challenges to human annotators that must manually review reports. In this paper, we apply active learning techniques to support classification of patient safety event reports as HIT-related. We evaluated different strategies and demonstrated a 30% increase in average precision of a confirmatory sampling strategy over a baseline no active learning approach after 10 learning iterations.

Vaginismus Treatment: Clinical Trials Follow Up 241 Patients.

Science.gov (United States)

Pacik, Peter T; Geletta, Simon

2017-06-01

Vaginismus is mostly unknown among clinicians and women. Vaginismus causes women to have fear, anxiety, and pain with penetration attempts. To present a large cohort of patients based on prior published studies approved by an institutional review board and the Food and Drug Administration using a comprehensive multimodal vaginismus treatment program to treat the physical and psychologic manifestations of women with vaginismus and to record successes, failures, and untoward effects of this treatment approach. Assessment of vaginismus included a comprehensive pretreatment questionnaire, the Female Sexual Function Index (FSFI), and consultation. All patients signed a detailed informed consent. Treatment consisted of a multimodal approach including intravaginal injections of onabotulinumtoxinA (Botox) and bupivacaine, progressive dilation under conscious sedation, indwelling dilator, follow-up and support with office visits, phone calls, e-mails, dilation logs, and FSFI reports. Logs noting dilation progression, pain and anxiety scores, time to achieve intercourse, setbacks, and untoward effects. Post-treatment FSFI scores were compared with preprocedure scores. One hundred seventy-one patients (71%) reported having pain-free intercourse at a mean of 5.1 weeks (median = 2.5). Six patients (2.5%) were unable to achieve intercourse within a 1-year period after treatment and 64 patients (26.6%) were lost to follow-up. The change in the overall FSFI score measured at baseline, 3 months, 6 months, and 1 year was statistically significant at the 0.05 level. Three patients developed mild temporary stress incontinence, two patients developed a short period of temporary blurred vision, and one patient developed temporary excessive vaginal dryness. All adverse events resolved by approximately 4 months. One patient required retreatment followed by successful coitus. A multimodal program that treated the physical and psychologic aspects of vaginismus enabled women to achieve

Preparing patients with cancer who work and treatment responsiveness.

Science.gov (United States)

Kamau, Caroline

2017-03-01

Many patients with life-limiting illnesses continue to work because of financial reasons and because work provides good psychosocial support. A lack of appropriate advice/support through patient education could, however, make having a job detrimental to well-being (eg, symptom worsening). This study investigated the frequency with which patients received information that empowers their understanding of their condition, treatment, side effects of treatment and the likely impact on occupational functioning. A cross-sectional study. An analysis of survey data from 3457 patients with cancer in employment. Logistic regression showed that patients who received information about the impact of cancer on work life or education are 1.72 times more likely to have a positive treatment outcome. Patients who receive written information about the type of cancer are 1.99 times more likely to have a positive treatment outcome. Also, patients who receive written information before a cancer-related operation are 1.90 times more likely to have a positive treatment outcome. Information about the side effects of cancer treatment produces worse odds of a positive treatment outcome (0.65-1). A stepwise logistic regression analysing the effects irrespective of current employment status in 6710 patients showed that preparing them produces nearly twice better odds of cancer treatment responsiveness. Palliative care teams should consider ways of actively advising patients who work. Whereas the results showed evidence of good practice in cancer care, there is a need to ensure that all working patients with potentially life-limiting illnesses receive similar support. 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/.

Fixed dose 131-I treatment in Basedow patients

International Nuclear Information System (INIS)

Klisarova, A; Bochev, P.; Hristosov, K.

2003-01-01

The choice of a treatment for Basedow patients is still unsolved problem. The treatment with 131-I has certain advantages but the determination of the individual therapeutic dose is impossible. The aim of the study is to assess the efficiency of the treatment with a fixed dose. 23 patient have been treated, 30 women and 3 men, age between 48 and 78. All patients are with chronic disease with relapses (1 to 4 relapses). 5 of the patients are with a thyrotoxic heart, 3 - with ophtalmopatia, 2 - with toxic medicamentous hepatitis and 2 with allergies to thyreostatics. Before the treatment with 131-I all patients have been in euthyroid state with normal levels of the peripheral hormones. All patients have received initial doses of 5 mCi 131-I. The hormone levels have been followed on 3rd, 6th, 12th and 24th month after the uptake. From a total of 23 patients, in 3 cases a transitional hypothyroidism has been found between 3th and 6th month, in 3 patients - permanent hypothyroidism. In 5 patients after the 6th month an additional dose of 5 mCi 131-I is given (in one woman a permanent hypothyroidism is reached). Four of the patients have been with a significant thyroid hyperplasia with volume above 60 ml. In three patients in the period between 6th and 12th month a slight hyperthyroidism is registered, which have been suppressed by a low dose thyreostatic. A year after the treatment they have been found euthyroid. The decision for giving a second dose have been based on the evident heptahydrate symptomatic s and the persisting increased thyroid volume. In one case it is observed an acute thyrotoxicosis for 3-5 days after the 131 I uptake. No cases of worsening of the eye symptoms are observed. In conclusion, the treatment with 131 I is a appropriate method for patients with cardiovascular complications, contraindication for surgery or side effects of the thyreostatic treatment. the dose od 5 mCi is sufficient for patients with mild to medium form of Basedow disease and a

Learning to care for older patients: hospitals and nursing homes as learning environments.

Science.gov (United States)

Huls, Marije; de Rooij, Sophia E; Diepstraten, Annemie; Koopmans, Raymond; Helmich, Esther

2015-03-01

A significant challenge facing health care is the ageing of the population, which calls for a major response in medical education. Most clinical learning takes place within hospitals, but nursing homes may also represent suitable learning environments in which students can gain competencies in geriatric medicine. This study explores what students perceive as the main learning outcomes of a geriatric medicine clerkship in a hospital or a nursing home, and explicitly addresses factors that may stimulate or hamper the learning process. This qualitative study falls within a constructivist paradigm: it draws on socio-cultural learning theory and is guided by the principles of constructivist grounded theory. There were two phases of data collection. Firstly, a maximum variation sample of 68 students completed a worksheet, giving brief written answers on questions regarding their geriatric medicine clerkships. Secondly, focus group discussions were conducted with 19 purposively sampled students. We used template analysis, iteratively cycling between data collection and analysis, using a constant comparative process. Students described a broad range of learning outcomes and formative experiences that were largely distinct from their learning in previous clerkships with regard to specific geriatric knowledge, deliberate decision making, end-of-life care, interprofessional collaboration and communication. According to students, the nursing home differed from the hospital in three aspects: interprofessional collaboration was more prominent; the lower resources available in nursing homes stimulated students to be creative, and students reported having greater autonomy in nursing homes compared with the more extensive educational guidance provided in hospitals. In both hospitals and nursing homes, students not only learn to care for older patients, but also describe various broader learning outcomes necessary to become good doctors. The results of our study, in particular the

Organizational Learning in Health Care Organizations

Directory of Open Access Journals (Sweden)

Savithiri Ratnapalan

2014-02-01

Full Text Available The process of collective education in an organization that has the capacity to impact an organization’s operations, performance and outcomes is called organizational learning. In health care organizations, patient care is provided through one or more visible and invisible teams. These teams are composed of experts and novices from diverse backgrounds working together to provide coordinated care. The number of teams involved in providing care and the possibility of breakdowns in communication and coordinated care increases in direct proportion to sophisticated technology and treatment strategies of complex disease processes. Safe patient care is facilitated by individual professional learning; inter-professional team learning and system based organizational learning, which encompass modified context specific learning by multiple teams and team members in a health care organization. Organizational learning in health care systems is central to managing the learning requirements in complex interconnected dynamic systems where all have to know common background knowledge along with shared meta-knowledge of roles and responsibilities to execute their assigned functions, communicate and transfer the flow of pertinent information and collectively provide safe patient care. Organizational learning in health care is not a onetime intervention, but a continuing organizational phenomenon that occurs through formal and informal learning which has reciprocal association with organizational change. As such, organizational changes elicit organizational learning and organizational learning implements new knowledge and practices to create organizational changes.

Learning statistical correlation for fast prostate registration in image-guided radiotherapy

International Nuclear Information System (INIS)

Shi Yonghong; Liao Shu; Shen Dinggang

2011-01-01

Purpose: In adaptive radiation therapy of prostate cancer, fast and accurate registration between the planning image and treatment images of the patient is of essential importance. With the authors' recently developed deformable surface model, prostate boundaries in each treatment image can be rapidly segmented and their correspondences (or relative deformations) to the prostate boundaries in the planning image are also established automatically. However, the dense correspondences on the nonboundary regions, which are important especially for transforming the treatment plan designed in the planning image space to each treatment image space, are remained unresolved. This paper presents a novel approach to learn the statistical correlation between deformations of prostate boundary and nonboundary regions, for rapidly estimating deformations of the nonboundary regions when given the deformations of the prostate boundary at a new treatment image. Methods: The main contributions of the proposed method lie in the following aspects. First, the statistical deformation correlation will be learned from both current patient and other training patients, and further updated adaptively during the radiotherapy. Specifically, in the initial treatment stage when the number of treatment images collected from the current patient is small, the statistical deformation correlation is mainly learned from other training patients. As more treatment images are collected from the current patient, the patient-specific information will play a more important role in learning patient-specific statistical deformation correlation to effectively reflect prostate deformation of the current patient during the treatment. Eventually, only the patient-specific statistical deformation correlation is used to estimate dense correspondences when a sufficient number of treatment images have been acquired from the current patient. Second, the statistical deformation correlation will be learned by using a

‘Rapid Learning health care in oncology’ – An approach towards decision support systems enabling customised radiotherapy’

International Nuclear Information System (INIS)

Lambin, Philippe; Roelofs, Erik; Reymen, Bart; Velazquez, Emmanuel Rios; Buijsen, Jeroen; Zegers, Catharina M.L.; Carvalho, Sara; Leijenaar, Ralph T.H.; Nalbantov, Georgi; Oberije, Cary; Scott Marshall, M.; Hoebers, Frank; Troost, Esther G.C.; Stiphout, Ruud G.P.M. van; Elmpt, Wouter van; Weijden, Trudy van der; Boersma, Liesbeth; Valentini, Vincenzo; Dekker, Andre

2013-01-01

Purpose: An overview of the Rapid Learning methodology, its results, and the potential impact on radiotherapy. Material and results: Rapid Learning methodology is divided into four phases. In the data phase, diverse data are collected about past patients, treatments used, and outcomes. Innovative information technologies that support semantic interoperability enable distributed learning and data sharing without additional burden on health care professionals and without the need for data to leave the hospital. In the knowledge phase, prediction models are developed for new data and treatment outcomes by applying machine learning methods to data. In the application phase, this knowledge is applied in clinical practice via novel decision support systems or via extensions of existing models such as Tumour Control Probability models. In the evaluation phase, the predictability of treatment outcomes allows the new knowledge to be evaluated by comparing predicted and actual outcomes. Conclusion: Personalised or tailored cancer therapy ensures not only that patients receive an optimal treatment, but also that the right resources are being used for the right patients. Rapid Learning approaches combined with evidence based medicine are expected to improve the predictability of outcome and radiotherapy is the ideal field to study the value of Rapid Learning. The next step will be to include patient preferences in the decision making

The effect of errorless learning on quality of life in patients with Korsakoff’s syndrome

Science.gov (United States)

Rensen, Yvonne CM; Egger, Jos IM; Westhoff, Josette; Walvoort, Serge JW; Kessels, Roy PC

2017-01-01

Background Errorless learning (EL) is a promising rehabilitation principle for (re)learning instrumental activities in patients with amnesia, including patients with Korsakoff’s syndrome (KS). Successfully (re)learning tasks might improve the sense of competence and independence, and subsequently the quality of life. Quality of life in patients with KS has received limited attention, and no studies have been conducted to experimentally examine the effect of EL on quality of life in patients in this patient group. Materials and methods The QUALIDEM, an observation scale for quality of life, was completed by professional nurses before and after EL training in a group of fifty-one patients with KS. This scale was also completed for a group of thirty-one control patients receiving care as usual but no EL training. Results Quality of life was significantly increased on eight of the nine subscales in the Korsakoff group who participated in an EL training. There was a trend toward a significant increase in “positive affect” (ie, the ninth subscale). In contrast, no changes over time were found on any of the subscales in the control group that did not participate in any EL training. Conclusion Despite severe memory impairments, patients with KS still have the potential to (partially) (re)learn tasks using EL. This potential should be exploited, as the successes of (re)-learning might improve the quality of life of Korsakoff patients in nursing homes. PMID:29225465

Orthodontic treatment in patients with aggressive periodontitis.

Science.gov (United States)

Carvalho, Cássio Volponi; Saraiva, Luciana; Bauer, Flávio Paim Falcão; Kimura, Rui Yoshio; Souto, Maria Luisa Silveira; Bernardo, Carlos Cheque; Pannuti, Cláudio Mendes; Romito, Giuseppe Alexandre; Pustiglioni, Francisco Emílio

2018-04-01

Aggressive periodontitis (AP) is a condition that promotes breakdown of the periodontal tissues in a short time. In severe cases, pathologic migration of teeth and tooth loss can occur, producing esthetic and functional problems for the patient. Orthodontic treatment may be recommended to restore esthetics and masticatory function. We assessed the effects of orthodontic movement in the periodontal tissues of treated patients with AP. Ten subjects (ages 25.0 ± 5.22 years) with AP received periodontal treatment followed by orthodontic treatment. Maintenance sessions were performed monthly under a strict dental biofilm control. They were compared with 10 periodontally healthy subjects (ages 22.9 ± 5.23 years) who received orthodontic treatment. Probing pocket depth, clinical attachment level, bleeding on probing, and dental plaque index were measured at baseline, after orthodontic treatment, and after 4 months. Statistical analysis showed improvement in all clinical parameters between baseline and 4 months after orthodontic treatment: probing pocket depth (0.29 mm), clinical attachment level (0.38 mm), bleeding on probing (4.0%), and dental plaque index (11%). The periodontal parameters of the AP patients remained stable during orthodontic treatment under strict biofilm control. Copyright © 2018 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.

Patient knowledge on stroke risk factors, symptoms and treatment options.

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Faiz, Kashif Waqar; Sundseth, Antje; Thommessen, Bente; Rønning, Ole Morten

2018-01-01

Public campaigns focus primarily on stroke symptom and risk factor knowledge, but patients who correctly recognize stroke symptoms do not necessarily know the reason for urgent hospitalization. The aim of this study was to explore knowledge on stroke risk factors, symptoms and treatment options among acute stroke and transient ischemic attack patients. This prospective study included patients admitted to the stroke unit at the Department of Neurology, Akershus University Hospital, Norway. Patients with previous cerebrovascular disease, patients receiving thrombolytic treatment and patients who were not able to answer the questions in the questionnaire were excluded. Patients were asked two closed-ended questions: "Do you believe that stroke is a serious disorder?" and "Do you believe that time is of importance for stroke treatment?". In addition, patients were asked three open-ended questions where they were asked to list as many stroke risk factors, stroke symptoms and stroke treatment options as they could. A total of 173 patients were included, of whom 158 (91.3%) confirmed that they regarded stroke as a serious disorder and 148 patients (85.5%) considered time being of importance. In all, 102 patients (59.0%) could not name any treatment option. Forty-one patients (23.7%) named one or more adequate treatment options, and they were younger ( p options, which may contribute to reduce prehospital delay and onset-to-treatment-time.

Psychiatric disorders of patients seeking obesity treatment

Directory of Open Access Journals (Sweden)

Lin Hung-Yen

2013-01-01

Full Text Available Abstract Background Obese and overweight people have a higher risk of both chronic physical illness and mental illness. Obesity is reported to be positively associated with psychiatric disorders, especially in people who seek obesity treatment. At the same time, obesity treatment may be influenced by psychological factors or personality characteristics. This study aimed to understand the prevalence of mental disorders among ethnic Chinese who sought obesity treatment. Methods Subjects were retrospectively recruited from an obesity treatment center in Taiwan. The obesity treatments included bariatric surgery and non-surgery treatment. All subjects underwent a standardized clinical evaluation with two questionnaires and a psychiatric referral when needed. The psychiatric diagnosis was made thorough psychiatric clinic interviews using the SCID. A total of 841 patients were recruited. We compared the difference in psychiatric disorder prevalence between patients with surgical and non-surgical treatment. Results Of the 841 patients, 42% had at least one psychiatric disorder. Mood disorders, anxiety disorders and eating disorders were the most prevalent categories of psychiatric disorders. Females had more mood disorders and eating disorders than males. The surgical group had more binge-eating disorder, adjustment disorder, and sleep disorders than the non-surgical group. Conclusion A high prevalence of psychiatric disorders was found among ethnic Chinese seeking obesity treatment. This is consistent with study results in the US and Europe.

Pharmacological Treatment of ADHD in Addicted Patients: What Does the Literature Tell Us?

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Carpentier, Pieter-Jan; Levin, Frances R.

2017-01-01

Learning objectives After participating in this activity, learners should be better able to: Evaluate pharmacologic treatment of attention deficit/hyperactivity disorder (ADHD) in patients with substance use disorder (SUD)Assess the causes of the diminished efficacy of ADHD medication in patients with comorbid SUD Objective Substance use disorder (SUD) and attention-deficit/hyperactivity disorder (ADHD) frequently co-occur, and the presence of ADHD complicates the treatment of the addiction. Pharmacotherapy is a potent intervention in childhood and adult ADHD, but findings have been mixed in adolescent and adult ADHD patients with SUDs. This review focuses on several contributing factors and possible explanations, with implications both for future research and for clinical practice. Method This systematic review examined all randomized, placebo-controlled trials of pharmacotherapy for ADHD in adult and adolescent SUD patients. Results The number of studies is limited, and several studies are hampered by qualitative flaws. The results, in general, are inconclusive for most medications studied, but more recent trials using psychostimulants in robust dosing have demonstrated significantly positive results. Conclusion In reviewing these trials, possible explanations relating to the particular characteristics and problems of this complex patient group are discussed. Several factors, including ADHD symptom severity, psychiatric comorbidity, persistent drug use, choice of medication, and concomitant psychosocial intervention, influence study results. Taking these factors into account may improve the likelihood of detecting significant effects in future research, as the recent positive trials have indicated, and may help in the appropriate selection of pharmacotherapy in clinical practice. PMID:28272130

Eye injury treatment in intensive care unit patients

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L. K. Moshetova

2015-01-01

Full Text Available Aim. To describe eye injuries in intensive care unit (ICU patients with multitrauma, to study conjunctival microflora in these patients, and to develop etiologically and pathogenically targeted treatment and prevention of wound complications.Materials and methods. Study group included 50 patients (54 eyes with combined mechanical cerebral and eye injury. All patients underwent possible ophthalmological examination (biomicroscopy, ophthalmoscopy and ocular fundus photographing with portative fundus camera, tonometry, cranial CT and MRT, and bacteriological study of conjunctival smears. Results. Modern methods of ophthalmological examination of ICU patients provided correct diagnosis and prediction of wound healing. Eye injury treatment schedule provided maximum possible results in all ICU patients. Hospitalacquired infection results in asymptomatic dissemination of pathogenic microbes on ocular surface. Conclusions. 14-day topical treatment with antimicrobials, steroids, and NSAIDs reduces posttraumatic inflammation caused by mechanical eye injuries in ICU patients. Bacteriological studies of conjunctival smears demonstrate the presence of pathogenic flora in ICU patients. In these patients, the most effective antibacterial agents are third-generation fluoroquinolones. 

Performance monitoring and empathy during active and observational learning in patients with major depression.

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Thoma, Patrizia; Norra, Christine; Juckel, Georg; Suchan, Boris; Bellebaum, Christian

2015-07-01

Previous literature established a link between major depressive disorder (MDD) and altered reward processing as well as between empathy and (observational) reward learning. The aim of the present study was to assess the effects of MDD on the electrophysiological correlates - the feedback-related negativity (FRN) and the P300 - of active and observational reward processing and to relate them to trait cognitive and affective empathy. Eighteen patients with MDD and 16 healthy controls performed an active and an observational probabilistic reward-learning task while event- related potentials were recorded. Also, participants were assessed with regard to self-reported cognitive and affective trait empathy. Relative to healthy controls, patients with MDD showed overall impaired learning and attenuated FRN amplitudes, irrespective of feedback valence and learning type (active vs. observational), but comparable P300 amplitudes. In the patient group, but not in controls, higher trait perspective taking scores were significantly correlated with reduced FRN amplitudes. The pattern of results suggests impaired prediction error processing and a negative effect of higher trait empathy on feedback-based learning in patients with MDD. Copyright © 2015 Elsevier B.V. All rights reserved.

Discriminate the response of Acute Myeloid Leukemia patients to treatment by using proteomics data and Answer Set Programming.

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Chebouba, Lokmane; Miannay, Bertrand; Boughaci, Dalila; Guziolowski, Carito

2018-03-08

During the last years, several approaches were applied on biomedical data to detect disease specific proteins and genes in order to better target drugs. It was shown that statistical and machine learning based methods use mainly clinical data and improve later their results by adding omics data. This work proposes a new method to discriminate the response of Acute Myeloid Leukemia (AML) patients to treatment. The proposed approach uses proteomics data and prior regulatory knowledge in the form of networks to predict cancer treatment outcomes by finding out the different Boolean networks specific to each type of response to drugs. To show its effectiveness we evaluate our method on a dataset from the DREAM 9 challenge. The results are encouraging and demonstrate the benefit of our approach to distinguish patient groups with different response to treatment. In particular each treatment response group is characterized by a predictive model in the form of a signaling Boolean network. This model describes regulatory mechanisms which are specific to each response group. The proteins in this model were selected from the complete dataset by imposing optimization constraints that maximize the difference in the logical response of the Boolean network associated to each group of patients given the omic dataset. This mechanistic and predictive model also allow us to classify new patients data into the two different patient response groups. We propose a new method to detect the most relevant proteins for understanding different patient responses upon treatments in order to better target drugs using a Prior Knowledge Network and proteomics data. The results are interesting and show the effectiveness of our method.

[Integral treatment for bedridden patients].

Science.gov (United States)

García-Verdugo, M Fernanda Arroyo; Garrido Hernández, M Teresa; Rosell Palomo, Ricardo

2007-05-01

Spinal cord injuries are one of the traumatic injuries which produce the greatest number of patients who are bedridden or incapacitated. Physical effects acquire such importance that one can not forget to attend to aspects as basic as hygiene, correct posture during their bedridden stay or the daily task to transfer patients to the various support elements they need to utilize. Nursing care for patients suffering spinal cord injuries comprise the fundamental axis on which a correct recuperation rotates. At the same time, proper treatment care will lead to a future improvement in a patient's quality of life.

Dynamics of study strategies and teacher regulation in virtual patient learning activities: a cross sectional survey.

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Edelbring, Samuel; Wahlström, Rolf

2016-04-23

Students' self-regulated learning becomes essential with increased use of exploratory web-based activities such as virtual patients (VPs). The purpose was to investigate the interplay between students' self-regulated learning strategies and perceived benefit in VP learning activities. A cross-sectional study (n = 150) comparing students' study strategies and perceived benefit of a virtual patient learning activity in a clinical clerkship preparatory course. Teacher regulation varied among three settings and was classified from shared to strong. These settings were compared regarding their respective relations between regulation strategies and perceived benefit of the virtual patient activity. Self-regulation learning strategy was generally associated with perceived benefit of the VP activities (rho 0.27, p strategies can increase the value of flexible web-based learning resources to students.

Antipsychotic drug treatment for patients with schizophrenia: theoretical background, clinical considerations and patients preferences

DEFF Research Database (Denmark)

Nielsen, René Ernst; Nielsen, Jimmi

2009-01-01

  The cornerstone in treatment of psychosis is antipsychotic drugs. Treatment options have increased over the years; newer antipsychotic drugs with a proposed efficacy regarding negative and cognitive symptoms, but also a shift in side-effects from neurological side-effects to metabolic side......-effects have arisen as the new challenge. The basis of successful pharmacological treatment is a fundamental understanding of the mechanisms of action, the desired effects and side-effects of antipsychotic drugs, a good relationship with the patient and a thorough monitoring of the patient before and during...... treatment. The clinically relevant aspects of antipsychotic drug treatment are reviewed; mechanism of antipsychotic drug action, clinical considerations in treatment, switching antipsychotic drugs, polypharmacy, safety and patient preference.  ...

Utilizing Patient E-learning in an Intervention Study on Preoperative Smoking Cessation.

Science.gov (United States)

Wong, Jean; Raveendran, Raviraj; Chuang, Junior; Friedman, Zeev; Singh, Mandeep; Patras, Jayadeep; Wong, David T; Chung, Frances

2018-05-01

Patients who smoke put themselves at increased risk for serious surgical complications, yet it is not currently routine practice to educate patients about the risk of complications due to smoking. Computer-based smoking cessation programs are increasingly being utilized in the general population and may overcome some of the barriers such as lack of time, knowledge, and training to provide interventions. Our objective was to develop and implement a patient e-learning program designed for surgical patients as part of a multifaceted program aimed at assisting them to quit smoking and to determine the factors cross-sectionally and longitudinally associated with abstinence. In this prospective multicenter study, smokers undergoing elective noncardiac surgery participated in a preoperative smoking cessation program consisting of a patient e-learning program, brief advice, educational pamphlet, tobacco quitline referral, letter to the primary care physician, and pharmacotherapy. The patient e-learning program described (1) the benefits of quitting smoking before surgery; (2) how to quit smoking; and (3) how to cope while quitting. The 7-day point prevalence (PP) abstinence on the day of surgery and at 1, 3 and 6 six months after surgery was separately assessed, and factors most associated with abstinence were identified using multivariable logistic regression analysis. Generalized estimating equation methods were used to estimate effect of the factors associated with abstinence longitudinally. The reach of the program was assessed with the number of smokers who participated in the program versus the number of patients who were referred to the program. A total of 459 patients (68.9% of eligible patients) participated. The 7-day PP abstinence at day of surgery, 1 month, 3 months, and 6 months was 22%, 29%, 25%, and 22%, respectively. The variables predicting abstinence at 6 months were use of pharmacotherapy (odds ratio [OR], 7.32; 95% confidence interval [CI], 3

Factors related to treatment refusal in Taiwanese cancer patients.

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Chiang, Ting-Yu; Wang, Chao-Hui; Lin, Yu-Fen; Chou, Shu-Lan; Wang, Ching-Ting; Juang, Hsiao-Ting; Lin, Yung-Chang; Lin, Mei-Hsiang

2015-01-01

Incidence and mortality rates for cancer have increased dramatically in the recent 30 years in Taiwan. However, not all patients receive treatment. Treatment refusal might impair patient survival and life quality. In order to improve this situation, we proposed this study to evaluate factors that are related to refusal of treatment in cancer patients via a cancer case manager system. This study analysed data from a case management system during the period from 2010 to 2012 at a medical center in Northern Taiwan. We enrolled a total of 14,974 patients who were diagnosed with cancer. Using the PRECEDE Model as a framework, we conducted logistic regression analysis to identify independent variables that are significantly associated with refusal of therapy in cancer patients. A multivariate logistic regression model was also applied to estimate adjusted the odds ratios (ORs) with 95% confidence intervals (95%CI). A total of 253 patients (1.69%) refused treatment. The multivariate logistic regression result showed that the high risk factors for refusal of treatment in cancer patient included: concerns about adverse effects (prefuse treatment have poor survival. The present study provides evidence of factors that are related to refusal of therapy and might be helpful for further application and improvement of cancer care.

Patient-Treatment Matching Improves Compliance of Alcoholics in Outpatient Treatment

DEFF Research Database (Denmark)

Nielsen, Anette Søgaard; Nielsen, Bent; Wraae, Olaf

1998-01-01

curves. The consequence of compliance for long-term prognosis was described by means of the Addiction Severity Index. The form of treatment in itself had no importance for compliance. However, correct matching of a patient and a treatment structure resulted in a compliance rate of 63% as opposed to 38...

Advances in Patient Classification for Traditional Chinese Medicine: A Machine Learning Perspective

Directory of Open Access Journals (Sweden)

Changbo Zhao

2015-01-01

data analyzed by different computational methods, we present the overview for four subfields of TCM diagnosis, respectively. For each subfield, we design a rectangular reference list with applications in the horizontal direction and machine learning algorithms in the longitudinal direction. According to the current development of objective TCM diagnosis for patient classification, a discussion of the research issues around machine learning techniques with applications to TCM diagnosis is given to facilitate the further research for TCM patient classification.

The Treatment of Achalasia in Obese Patients.

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Wesp, Julie A; Farrell, Timothy M

2018-04-01

Epidemiological studies have demonstrated that obesity is frequently associated with esophageal motility disorders. Morbid obesity and achalasia may coexist in the same patient. The management of the morbidly obese patient with achalasia is complex and the most effective treatment remains controversial. The aim of this study is to review the pathophysiology, clinical presentation, diagnostic evaluation, and treatment of achalasia in morbidly obese patients. PubMed search from January 1990 to July 2017, including the following terms: achalasia, morbid obesity, bariatric, and treatment. Achalasia in the setting of morbid obesity may be successfully treated by endoscopic or surgical methods. Surgeons may choose to add a bariatric procedure, with various strategies present in the literature. A review of the present literature suggests that the preferred approach to achalasia in the morbidly obese patient is to address both disease processes simultaneously with a laparoscopic Heller myotomy and a Roux-en-Y gastric bypass. Roux-en-Y gastric bypass is cited by most experts as the bariatric procedure of choice, given its antireflux benefits. A well-powered study, comparing the various approaches to the treatment of achalasia in the setting of morbid obesity, is required to establish a consensus.

Lack of tolerable treatment options for patients with schizophrenia

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Citrome L

2015-12-01

Full Text Available Leslie Citrome,1 Anna Eramo,2 Clement Francois,2 Ruth Duffy,3 Susan N Legacy,3 Steve J Offord,3 Holly B Krasa,3 Stephen S Johnston,4 Alice Guiraud-Diawara,5 Siddhesh A Kamat,3 Patricia Rohman3 1Department of Psychiatry and Behavioral Sciences, New York Medical College, Valhalla, NY, 2Lundbeck, Deerfield, IL, 3Otsuka America Pharmaceuticals, Princeton, NJ, 4Truven Health Analytics, Bethesda, MD, USA; 5Lundbeck SAS, Issy-les-Moulineaux, France Purpose: Atypical antipsychotics (AAs, an effective treatment for schizophrenia, have a range of pharmacologic properties leading to differences in tolerability as well as heterogeneity in treatment response. Individual patient characteristics must be considered when making treatment choices, especially from an adverse event (AE or tolerability perspective. Despite the availability of numerous AAs, after appraising patient characteristics at the time of treatment selection, physicians may quickly run out of tolerable treatment options. Patients and methods: AE risk factors, defined as having either a prior history of an AE or a risk factor for that AE, were determined for Medicaid-insured and Commercially insured patients using database analysis. Patients receiving AA treatment between January 1, 2010 and December 31, 2012 defined the index date of first observed AA prescription during this period. Nine AAs were evaluated for association with AE risk factors as informed by drug prescribing information from the different manufacturers and published meta-analyses. The proportion of patients with pre-index AE risk factors prescribed an AA associated with that risk factor was then determined. Results: A high proportion of patients (>80% were prescribed an AA associated with extrapyramidal symptoms or akathisia despite experiencing extrapyramidal symptoms or akathisia prior to AA treatment initiation. Similar trends were observed among patients with diabetes (>60% and obesity (>40%. From the nine treatment

Treatment consumption and treatment re-enrollment in GHB-dependent patients in the Netherlands

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Noorden, M.S. van; Mol, T.; Wisselink, J.; Kuijpers, W.G.T.; Dijkstra, B.A.G.

2017-01-01

Background: The objective of this study was to assess treatment consumption and re-enrollment in treatment in patients with gamma-hydroxybutyrate (GHB)-dependence in Dutch Addiction Treatment Centers (ATCs) in comparison with other addictions. Methods: A cohort-study using nationwide administrative data from regular Dutch ATCs associated with the Dutch National Alcohol and Drugs Information System (LADIS), covering an estimated 95% of ATCs. We selected in- and out-patients with alcohol, drug ...

The Prescription Opioid Addiction Treatment Study: What have we learned.

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Weiss, Roger D; Rao, Vinod

2017-04-01

The multi-site Prescription Opioid Addiction Treatment Study (POATS), conducted by the National Drug Abuse Treatment Clinical Trials Network, was the largest clinical trial yet conducted with patients dependent upon prescription opioids (N=653). In addition to main trial results, the study yielded numerous secondary analyses, and included a 3.5-year follow-up study, the first of its kind with this population. This paper reviews key findings from POATS and its follow-up study. The paper summarizes the POATS design, main outcomes, predictors of outcome, subgroup analyses, the predictive power of early treatment response, and the long-term follow-up study. POATS examined combinations of buprenorphine-naloxone of varying duration and counseling of varying intensity. The primary outcome analysis showed no overall benefit to adding drug counseling to buprenorphine-naloxone and weekly medical management. Only 7% of patients achieved a successful outcome (abstinence or near-abstinence from opioids) during a 4-week taper and 8-week follow-up; by comparison, 49% of patients achieved success while subsequently stabilized on buprenorphine-naloxone. Long-term follow-up results were more encouraging, with higher abstinence rates than in the main trial. Patients receiving opioid agonist treatment at the time of follow-up were more likely to have better outcomes, though a sizeable number of patients succeeded without agonist treatment. Some patients initiated risky use patterns, including heroin use and drug injection. A limitation of the long-term follow-up study was the low follow-up rate. POATS was the first large-scale study of the treatment of prescription opioid dependence; its findings can influence both treatment guidelines and future studies. Copyright © 2017 The Author(s). Published by Elsevier B.V. All rights reserved.

Deep learning in pharmacogenomics: from gene regulation to patient stratification.

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Kalinin, Alexandr A; Higgins, Gerald A; Reamaroon, Narathip; Soroushmehr, Sayedmohammadreza; Allyn-Feuer, Ari; Dinov, Ivo D; Najarian, Kayvan; Athey, Brian D

2018-05-01

This Perspective provides examples of current and future applications of deep learning in pharmacogenomics, including: identification of novel regulatory variants located in noncoding domains of the genome and their function as applied to pharmacoepigenomics; patient stratification from medical records; and the mechanistic prediction of drug response, targets and their interactions. Deep learning encapsulates a family of machine learning algorithms that has transformed many important subfields of artificial intelligence over the last decade, and has demonstrated breakthrough performance improvements on a wide range of tasks in biomedicine. We anticipate that in the future, deep learning will be widely used to predict personalized drug response and optimize medication selection and dosing, using knowledge extracted from large and complex molecular, epidemiological, clinical and demographic datasets.

[Development of a multimedia learning DM diet education program using standardized patients and analysis of its effects on clinical competency and learning satisfaction for nursing students].

Science.gov (United States)

Hyun, Kyung Sun; Kang, Hyun Sook; Kim, Won Ock; Park, Sunhee; Lee, Jia; Sok, Sohyune

2009-04-01

The purpose of this study was to develop a multimedia learning program for patients with diabetes mellitus (DM) diet education using standardized patients and to examine the effects of the program on educational skills, communication skills, DM diet knowledge and learning satisfaction. The study employed a randomized control posttest non-synchronized design. The participants were 108 third year nursing students (52 experimental group, 56 control group) at K university in Seoul, Korea. The experimental group had regular lectures and the multimedia learning program for DM diet education using standardized patients while the control group had regular lectures only. The DM educational skills were measured by trained research assistants. The students who received the multimedia learning program scored higher for DM diet educational skills, communication skills and DM diet knowledge compared to the control group. Learning satisfaction of the experimental group was higher than the control group, but statistically insignificant. Clinical competency was improved for students receiving the multimedia learning program for DM diet education using standardized patients, but there was no statistically significant effect on learning satisfaction. In the nursing education system there is a need to develop and apply more multimedia materials for education and to use standardized patients effectively.

Improving treatment times for patients with in-hospital stroke using a standardized protocol.

Science.gov (United States)

Koge, Junpei; Matsumoto, Shoji; Nakahara, Ichiro; Ishii, Akira; Hatano, Taketo; Sadamasa, Nobutake; Kai, Yasutoshi; Ando, Mitsushige; Saka, Makoto; Chihara, Hideo; Takita, Wataru; Tokunaga, Keisuke; Kamata, Takahiko; Nishi, Hidehisa; Hashimoto, Tetsuya; Tsujimoto, Atsushi; Kira, Jun-Ichi; Nagata, Izumi

2017-10-15

Previous reports have shown significant delays in treatment of in-hospital stroke (IHS). We developed and implemented our IHS alert protocol in April 2014. We aimed to determine the influence of implementation of our IHS alert protocol. Our implementation processes comprise the following four main steps: IHS protocol development, workshops for hospital staff to learn about the protocol, preparation of standardized IHS treatment kits, and obtaining feedback in a monthly hospital staff conference. We retrospectively compared protocol metrics and clinical outcomes of patients with IHS treated with intravenous thrombolysis and/or endovascular therapy between before (January 2008-March 2014) and after implementation (April 2014-December 2016). Fifty-five patients were included (pre, 25; post, 30). After the implementation, significant reductions occurred in the median time from stroke recognition to evaluation by a neurologist (30 vs. 13.5min, pvs. 26.5min, pvs. 16min, p=0.02). The median time from first neuroimaging to endovascular therapy had a tendency to decrease (75 vs. 53min, p=0.08). There were no differences in the favorable outcomes (modified Rankin scale score of 0-2) at discharge or the incidence of symptomatic intracranial hemorrhage between the two periods. Our IHS alert protocol implementation saved time in treating patients with IHS without compromising safety. Copyright © 2017 Elsevier B.V. All rights reserved.

Individual treatment selection for patients with posttraumatic stress disorder.

Science.gov (United States)

Deisenhofer, Anne-Katharina; Delgadillo, Jaime; Rubel, Julian A; Böhnke, Jan R; Zimmermann, Dirk; Schwartz, Brian; Lutz, Wolfgang

2018-04-16

Trauma-focused cognitive behavioral therapy (Tf-CBT) and eye movement desensitization and reprocessing (EMDR) are two highly effective treatment options for posttraumatic stress disorder (PTSD). Yet, on an individual level, PTSD patients vary substantially in treatment response. The aim of the paper is to test the application of a treatment selection method based on a personalized advantage index (PAI). The study used clinical data for patients accessing treatment for PTSD in a primary care mental health service in the north of England. PTSD patients received either EMDR (N = 75) or Tf-CBT (N = 242). The Patient Health Questionnaire (PHQ-9) was used as an outcome measure for depressive symptoms associated with PTSD. Variables predicting differential treatment response were identified using an automated variable selection approach (genetic algorithm) and afterwards included in regression models, allowing the calculation of each patient's PAI. Age, employment status, gender, and functional impairment were identified as relevant variables for Tf-CBT. For EMDR, baseline depressive symptoms as well as prescribed antidepressant medication were selected as predictor variables. Fifty-six percent of the patients (n = 125) had a PAI equal or higher than one standard deviation. From those patients, 62 (50%) did not receive their model-predicted treatment and could have benefited from a treatment assignment based on the PAI. Using a PAI-based algorithm has the potential to improve clinical decision making and to enhance individual patient outcomes, although further replication is necessary before such an approach can be implemented in prospective studies. © 2018 Wiley Periodicals, Inc.

[Orthodontic treatment of Class III patients with mandibular asymmetry].

Science.gov (United States)

Duan, Yin-Zhong; Huo, Na; Chen, Lei; Chen, Xue-Peng; Lin, Yang

2008-12-01

To investigate the treatment outcome of Class III patients with dental, functional and mild skeletal mandibular asymmetry. Thirty-five patients (14 males and 21 females) with dental, functional and mild skeletal mandibular asymmetry were selected. The age range of the patients was 7 - 22 years with a mean age of 16.5 years. Dental mandibular asymmetry was treated with expansion of maxillary arch to help the mandible returning to normal position. Functional mandibular asymmetry was treated with activator or asymmetrical protraction and Class III elastics. Mild skeletal mandibular asymmetry was treated with camouflage treatment. Good occlusal relationships were achieved and facial esthetics was greatly improved after orthodontic treatment in patients with dental and functional mandibular asymmetry. However, patients with skeletal mandibular asymmetry should be treated with both extraction and genioplasty. Orthodontic treatment was suitable for patients with dental and functional mandibular asymmetry, while combined orthodontics and surgery could get good results in patients with skeletal mandibular asymmetry.

Current treatments for patients with Alzheimer disease.

Science.gov (United States)

Osborn, Gerald G; Saunders, Amanda Vaughn

2010-09-01

There is neither proven effective prevention for Alzheimer disease nor a cure for patients with this disorder. Nevertheless, a spectrum of biopsychosocial therapeutic measures is available for slowing progression of the illness and enhancing quality of life for patients. These measures include a range of educational, psychological, social, and behavioral interventions that remain fundamental to effective care. Also available are a number of pharmacologic treatments, including prescription medications approved by the US Food and Drug Administration for Alzheimer disease, "off-label" uses of medications to manage target symptoms, and controversial complementary therapies. Physicians must make the earliest possible diagnosis to use these treatments most effectively. Physicians' goals should be to educate patients and their caregivers, to plan long-term care options, to maximally manage concurrent illnesses, to slow and ameliorate the most disabling symptoms, and to preserve effective functioning for as long as possible. The authors review the various current treatments for patients with Alzheimer disease.

Patient preferences in the treatment of diabetic retinopathy

Directory of Open Access Journals (Sweden)

Wirostko B

2011-05-01

Full Text Available Barbara Wirostko1, Kathleen Beusterien2, Jessica Grinspan2, Thomas Ciulla3, John Gonder4, Alexandra Barsdorf1, Andreas Pleil51Pfizer, New York, NY, USA; 2Oxford Outcomes, Bethesda, MD, USA; 3Midwest Eye Institute, Indianapolis, IN, USA; 4Ivey Eye Institute, London, Ontario, Canada; 5Pfizer Inc, San Diego, CA, USAObjective: Accounting for patient preferences may be especially important in diabetes mellitus, given the challenge in identifying factors associated with treatment adherence. Although preference studies have been performed in diabetes, none have examined treatments used in diabetic retinopathy (DR. The objective of this study was to elicit patient preferences for attributes associated with antivascular endothelial growth factor, focal and panretinal laser, and steroid therapy used in DR management.Methods: A cross-sectional conjoint survey was administered to DR patients at three Canadian eye centers. The survey involved making tradeoffs among 11 DR treatment attributes, including the chance of improving vision and risks of adverse events over a 1-year treatment period. Attribute utilities were summed for each product profile to determine the most preferred treatment.Results: Based on the results from 161 patients, attributes affecting visual functioning, including improving visual acuity and reducing adverse events (eg, chance of cataracts, were more important than those not directly affecting vision (eg, administration. Overall, 52%, 20%, 17%, and 11% preferred the product profiles matching to the antivascular endothelial growth factor, steroid, focal laser, and panretinal laser therapies. Preferences did not vary substantially by previous treatment experience, age, or type of DR (macular edema, proliferative DR, both or neither, with the exception that more macular edema only patients preferred focal laser over steroid treatment (19% versus 14%, respectively.Conclusions: When considering the potential effects of treatment over a 1

Post-treatment fertility in patients with testicular cancer

International Nuclear Information System (INIS)

Fossaa, S.D.; Aabyholm, T.; Normann, N.; Jetne, V.

1986-01-01

Sperm analysis and serum hormone measurements (LH, FSH, testosterone) were performed in 29 patients after orchiectomy for seminoma before and after irradiation. Before radiotherapy 14 of 20 orchiectomised patients were azoospermic or had impaired spermatogenesis. A minimum sperm count was found 1 year after radiotherapy with gradual improvement up to 2 years. The recovery of sperm cell production was impaired most in patients with pre-treatment sperm counts < 3 million/ ml. Serum testosterone remained at low normal levels throughout the observation period. The mean serum FSH was increased 1 year after radiotherapy but returned to normal in 50% of patients within 3 years after treatment. This post-treatment increase in FSH was significantly correlated with increased pre-treatment FSH but not with the gonadal dose, which was 1 to 3% of the target dose. Severe disturbances in spermatogenesis, observed 2 to 3 years after radiotherapy for early seminoma, are likely to be the expression of a highly impaired pre-treatment sperm cell production and only to a lesser degree dependent on the irradiation of the remaining testicle. (author)

LC-REHAB: randomised trial assessing the effect of a new patient education method--learning and coping strategies--in cardiac rehabilitation.

Science.gov (United States)

Lynggaard, Vibeke; May, Ole; Beauchamp, Alison; Nielsen, Claus Vinther; Wittrup, Inge

2014-12-13

Due to improved treatments and ageing population, many countries now report increasing prevalence in rates of ischemic heart disease and heart failure. Cardiac rehabilitation has potential to reduce morbidity and mortality, but not all patients complete. In light of favourable effects of cardiac rehabilitation it is important to develop patient education methods which can enhance adherence to this effective program. The LC-REHAB study aims to compare the effect of a new patient education strategy in cardiac rehabilitation called 'learning and coping' to that of standard care. Further, this paper aims to describe the theoretical basis and details of this intervention. Open parallel randomised controlled trial conducted in three hospital units in Denmark among patients recently discharged with ischemic heart disease or heart failure. Patients are allocated to either the intervention group with learning and coping strategies incorporated into standard care in cardiac rehabilitation or the control group who receive the usual cardiac rehabilitation program. Learning and coping consists of two individual clarifying interviews, participation of experienced patients as educators together with health professionals and theory based, situated and inductive teaching. Usual care in cardiac rehabilitation is characterised by a structured deductive teaching style with use of identical pre-written slides in all hospital units. In both groups, cardiac rehabilitation consists of training three times a week and education once a week over eight weeks. The primary outcomes are adherence to cardiac rehabilitation, morbidity and mortality, while secondary outcomes are quality of life (SF-12, Health education impact questionnaire and Major Depression Inventory) and lifestyle and risk factors (Body Mass Index, waist circumference, blood pressure, exercise work capacity, lipid profile and DXA-scan). Data collection occurs four times; at baseline, at immediate completion of cardiac

Health Informatics via Machine Learning for the Clinical Management of Patients.

Science.gov (United States)

Clifton, D A; Niehaus, K E; Charlton, P; Colopy, G W

2015-08-13

To review how health informatics systems based on machine learning methods have impacted the clinical management of patients, by affecting clinical practice. We reviewed literature from 2010-2015 from databases such as Pubmed, IEEE xplore, and INSPEC, in which methods based on machine learning are likely to be reported. We bring together a broad body of literature, aiming to identify those leading examples of health informatics that have advanced the methodology of machine learning. While individual methods may have further examples that might be added, we have chosen some of the most representative, informative exemplars in each case. Our survey highlights that, while much research is taking place in this high-profile field, examples of those that affect the clinical management of patients are seldom found. We show that substantial progress is being made in terms of methodology, often by data scientists working in close collaboration with clinical groups. Health informatics systems based on machine learning are in their infancy and the translation of such systems into clinical management has yet to be performed at scale.

Patient misconceptions concerning lumbar spondylosis diagnosis and treatment.

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Franz, Eric W; Bentley, J Nicole; Yee, Patricia P S; Chang, Kate W C; Kendall-Thomas, Jennifer; Park, Paul; Yang, Lynda J S

2015-05-01

OBJECT Patient outcome measures are becoming increasingly important in the evaluation of health care quality and physician performance. Of the many novel measures currently being explored, patient satisfaction and other subjective measures of patient experience are among the most heavily weighted. However, these subjective measures are strongly influenced by a number of factors, including patient demographics, level of understanding of the disorder and its treatment, and patient expectations. In the present study, patients referred to a neurosurgery clinic for degenerative spinal disorders were surveyed to determine their understanding of lumbar spondylosis diagnosis and treatment. METHODS A multiple-choice, 6-question survey was distributed to all patients referred to a general neurosurgical spine clinic at a tertiary care center over a period of 11 months as a quality improvement initiative to assist the provider with individualized patient counseling. The survey consisted of questions designed to assess patient understanding of the role of radiological imaging in the diagnosis and treatment of low-back and leg pain, and patient perception of the indications for surgical compared with conservative management. Demographic data were also collected. RESULTS A total of 121 surveys were included in the analysis. More than 50% of the patients indicated that they would undergo spine surgery based on abnormalities found on MRI, even without symptoms; more than 40% of patients indicated the same for plain radiographs. Similarly, a large proportion of patients (33%) believed that back surgery was more effective than physical therapy in the treatment of back pain without leg pain. Nearly one-fifth of the survey group (17%) also believed that back injections were riskier than back surgery. There were no significant differences in survey responses among patients with a previous history of spine surgery compared with those without previous spine surgery. CONCLUSIONS These

MULTIDISCIPLINARY APPROACH TO SUPPORTING TREATMENT COMPLIANCE IN TUBERCULOSIS PATIENTS

Directory of Open Access Journals (Sweden)

T. V. Sherstneva

2017-01-01

Full Text Available The article presents the algorithm for working with tuberculosis patients in TB hospital, providing implementation of multidisciplinary patient-centered activities for early diagnostics of psychiatric and social disorders, therapy and rehabilitation of concurrent psychiatric disorders and addictions. Multidisciplinary approach to activities within TB unit is aimed at improvement of treatment compliance of tuberculosis patients. The training programme has been developed in order to improve competency of medical personnel on the issue of treatment interruption prevention and motivating patients to undergo the continuous treatment.

Online Learning of Safe Patient Transfers in Occupational Therapy Education

Directory of Open Access Journals (Sweden)

Cynthia L. Hayden D. H. Ed., OTR/L, CHT

2013-02-01

Full Text Available Online higher education is steadily increasing. For programs in allied health to be offered effectively in an elearning format, clinical psychomotor skills need to be addressed. The aim of this research was to design, implement, and evaluate an online safe patient transfers module for occupational therapy assistant (OTAstudents. The efficacy of teaching safe patient transfers in an e-learning environment was appraised using both quantitative and qualitative analysis. The applied research project was completed at a Tennessee community college. A convenience sample of eighteen students participated in the pilot study. Twenty-five studentsparticipated in the subsequent study. The instructional design of the course was based on Mager’s CriterionReferenced Instruction model. Streaming video was used as the delivery method for course material. A pretest/posttest evaluated the students’ cognitive knowledge of safe patient transfers. A behavioral transferscompetency checklist was used to rate videotapes of students’ performance of assisted stand pivot and dependent sliding board transfers. Research findings indicated students were able to learn this psychomotor clinical skill online with beginning proficiency. A paired t-test showed marked improvement of cognitive knowledge. A student learning survey revealed the majority of students preferred at least one hands-on classroom session where instructor feedback and interaction with classmates confirmed safe and effectiveclinical technique.

A comparative review of the options for treatment of erectile dysfunction: which treatment for which patient?

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Hatzimouratidis, Konstantinos; Hatzichristou, Dimitrios G

2005-01-01

The field of erectile dysfunction (ED) has been revolutionised over the last two decades. Several treatment options are available today, most of which are associated with high efficacy rates and favourable safety profiles. A MEDLINE search was undertaken in order to evaluate all currently available data on treatment modalities for ED. Phosphodiesterase type 5 (PDE5) inhibitors (sildenafil, tadalafil, vardenafil) are currently the first-choice of most physicians and patients for the treatment of ED. PDE5 inhibitors have differences in their pharmacological profiles, the most obvious being the long duration of action of tadalafil, but there are no data supporting superiority for any one of them in terms of efficacy or safety. Sublingual apomorphine has limited efficacy compared with the PDE5 inhibitors, and its use is limited to patients with mild ED. Treatment failures with oral drugs may be due to medication, clinician and patient issues. The physician needs to address all of these issues in order to identify true treatment failures. Patients who are truly unresponsive to oral drugs may be offered other treatment options.Intracavernous injections of alprostadil alone, or in combination with other vasoactive agents (papaverine and phentolamine), remain an excellent treatment option, with proven efficacy and safety over time. Topical pharmacotherapy is appealing in nature, but currently available formulations have limited efficacy. Vacuum constriction devices may be offered mainly to elderly patients with occasional intercourse attempts, as younger patients show limited preference because of the unnatural erection that is associated with this treatment modality. Penile prostheses are generally the last treatment option offered, because of invasiveness, cost and non-reversibility; however, they are associated with high satisfaction rates in properly selected patients. All treatment options are associated with particular strengths and weaknesses. A patient

Education on electrical phenomena involved in electroporation-based therapies and treatments: a blended learning approach.

Science.gov (United States)

Čorović, Selma; Mahnič-Kalamiza, Samo; Miklavčič, Damijan

2016-04-07

Electroporation-based applications require multidisciplinary expertise and collaboration of experts with different professional backgrounds in engineering and science. Beginning in 2003, an international scientific workshop and postgraduate course electroporation based technologies and treatments (EBTT) has been organized at the University of Ljubljana to facilitate transfer of knowledge from leading experts to researches, students and newcomers in the field of electroporation. In this paper we present one of the integral parts of EBTT: an e-learning practical work we developed to complement delivery of knowledge via lectures and laboratory work, thus providing a blended learning approach on electrical phenomena involved in electroporation-based therapies and treatments. The learning effect was assessed via a pre- and post e-learning examination test composed of 10 multiple choice questions (i.e. items). The e-learning practical work session and both of the e-learning examination tests were carried out after the live EBTT lectures and other laboratory work. Statistical analysis was performed to compare and evaluate the learning effect measured in two groups of students: (1) electrical engineers and (2) natural scientists (i.e. medical doctors, biologists and chemists) undergoing the e-learning practical work in 2011-2014 academic years. Item analysis was performed to assess the difficulty of each item of the examination test. The results of our study show that the total score on the post examination test significantly improved and the item difficulty in both experimental groups decreased. The natural scientists reached the same level of knowledge (no statistical difference in total post-examination test score) on the post-course test take, as do electrical engineers, although the engineers started with statistically higher total pre-test examination score, as expected. The main objective of this study was to investigate whether the educational content the e-learning

An evaluation of patient's decisions regarding dental prosthetic treatment

Directory of Open Access Journals (Sweden)

Nupur D Shrirao

2016-01-01

Full Text Available Introduction: For fabricating dental prostheses that meet patients' demands and have good longevity and function, appropriate treatment planning and decision-making are required. Therefore, not only technical skills and clinical judgment of the dentist are needed, but also patients' attitude toward treatment plays a critical role in posttreatment satisfaction. Aim: The aim of this study is to investigate the factors affecting decision-making and the selection of dental prosthesis by the patients. Materials and Methods: A cross-sectional survey to determine patients' attitudes about replacement of teeth was conducted. This survey was performed with the help of a prevalidated questionnaire, which contained the demographic data of every patient, whether or not they accept the treatment plan proposed by the dentist, and a close-ended multiple choice question stating the reasons cited by them if they decline the proposed treatment plan. Results: The data were subjected to statistical analysis by Chi-square test at a significance level of P< 0.05. A relationship between the demographical information such as age, gender, educational status, marital status, and monthly income of each patient and the single best reason opted by them to not undergo the proposed treatment plan was established. Conclusions: In the sample of population studied, most of the patients declined the proposed treatment plan and accepted the alternate one. High expenditure is the most common reason for this rejection.

Effects of alcoholic beverage treatment on spatial learning and fear memory in mice.

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Hashikawa-Hobara, Narumi; Mishima, Shuta; Nagase, Shotaro; Morita, Keishi; Otsuka, Ami; Hashikawa, Naoya

2018-04-24

Although chronic ethanol treatment is known to impair learning and memory, humans commonly consume a range of alcoholic beverages. However, the specific effects of some alcoholic beverages on behavioral performance are largely unknown. The present study compared the effects of a range of alcoholic beverages (plain ethanol solution, red wine, sake and whiskey; with a matched alcohol concentration of 10%) on learning and memory. 6-week-old C57BL6J mice were orally administered alcohol for 7 weeks. The results revealed that red wine treatment exhibited a trend toward improvement of spatial memory and advanced extinction of fear memory. Additionally, red wine treatment significantly increased mRNA levels of brain-derived neurotrophic factor (BDNF) and N-methyl-D-aspartate (NMDA) receptors in mice hippocampus. These results support previous reports that red wine has beneficial effects.

Clinician and cancer patient views on patient participation in treatment decision-making: a quantitative and qualitative exploration

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Pieterse, A H; Baas-Thijssen, M C M; Marijnen, C A M; Stiggelbout, A M

2008-01-01

Patient participation in treatment decision-making is being increasingly advocated, although cancer treatments are often guideline-driven. Trade-offs between benefits and side effects underlying guidelines are made by clinicians. Evidence suggests that clinicians are inaccurate at predicting patient values. The aim was to assess what role oncologists and cancer patients prefer in deciding about treatment, and how they view patient participation in treatment decision-making. Seventy disease-free cancer patients and 60 oncologists (surgical, radiation, and medical) were interviewed about their role preferences using the Control Preferences Scale (CPS) and about their views on patient participation using closed- and open-ended questions. Almost all participants preferred treatment decisions to be the outcome of a shared process. Clinicians viewed participation more often as reaching an agreement, whereas 23% of patients defined participation exclusively as being informed. Of the participants, ⩾81% thought not all patients are able to participate and ⩾74% thought clinicians are not always able to weigh the pros and cons of treatment for patients, especially not quality as compared with length of life. Clinicians seemed reluctant to share probability information on the likely impact of adjuvant treatment. Clinicians should acknowledge the legitimacy of patients' values in treatment decisions. Guidelines should recommend elicitation of patient values at specific decision points. PMID:18781148

Herpesvirus infections in immunocompromised patients : treatment, treatment failure and antiviral resistance

NARCIS (Netherlands)

Beek, Martha Trijntje van der

2012-01-01

The research described in this thesis aims to study determinants of the course and outcome of treatment of herpesvirus infections in immunocompromised patients. Both viral factors, such as antiviral resistance, and patient factors, including immunological parameters, were investigated. Techniques to

Age at treatment and long-term performance results in medulloblastoma

International Nuclear Information System (INIS)

Chin, H.W.; Maruyama, Y.

1984-01-01

Medulloblastoma is highly radioresponsive, and recent treatment results have improved greatly since the introduction of megavoltage machine in 1960s. There is increasing evidence for the potential cure of medulloblastoma if properly treated in its early stages. The curable group represents approximately 75% of diagnosed patients. Long-term treatment effects were examined in this study. The study reveals age-dependent late effects in learning ability; the patients less than 4-years-old at treatment had major learning problems; patients of 5 to 7 years old performed at satisfactory-to-low passing levels in school work; patients older than 8 years old had no major intellectual impairment. Short stature was common when growth potential was present at the time of therapy, but endocrine tests were generally negative. These observations indicate special educational requirement needs, especially for children treated at a young age

Sexuality in gynecological patients undergoing radiation therapy treatments

International Nuclear Information System (INIS)

Dolan, M.E.

1987-01-01

The gynecology patient undergoing radiation therapy treatments may experience physiological and psychological problems related to sexuality. The needs of this group must be met by the radiation oncology staff by their being informed, interested, and experienced in dealing with sexual problems created by radiation therapy treatments. Opportunities to obtain information and for discussion about how the disease and its treatments will affect sexual functioning must be provided for the patient and partner. It is important to remember that the ability to seek and preserve gratifying sexual function is of great importance to almost all women, regardless of age. The patient may feel much personal distress related to the disease, the treatments, and how they affect the way she feels as a sexual human being. Opportunities must be provided to share the feelings created by the treatment process and trained therapists should be available when intensive sexual counseling is needed

Metastatic Squamous Neck Cancer with Occult Primary Treatment (PDQ®)—Patient Version

Science.gov (United States)

Metastatic squamous neck cancer with occult primary (unknown primary) treatment options include surgery, radiation therapy, or a combination of both. Learn more about the diagnosis and treatment of these tumors in this expert-reviewed summary.

Mobile technology supporting trainee doctors' workplace learning and patient care: an evaluation.

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Hardyman, Wendy; Bullock, Alison; Brown, Alice; Carter-Ingram, Sophie; Stacey, Mark

2013-01-21

The amount of information needed by doctors has exploded. The nature of knowledge (explicit and tacit) and processes of knowledge acquisition and participation are complex. Aiming to assist workplace learning, Wales Deanery funded "iDoc", a project offering trainee doctors a Smartphone library of medical textbooks. Data on trainee doctors' (Foundation Year 2) workplace information seeking practice was collected by questionnaire in 2011 (n = 260). iDoc baseline questionnaires (n = 193) collected data on Smartphone usage alongside other workplace information sources. Case reports (n = 117) detail specific instances of Smartphone use. Most frequently (daily) used information sources in the workplace: senior medical staff (80% F2 survey; 79% iDoc baseline); peers (70%; 58%); and other medical/nursing team staff (53% both datasets). Smartphones were used more frequently by males (p mobile technology used for simple (information-based), complex (problem-based) clinical questions and clinical procedures (skills-based scenarios). From thematic analysis, the Smartphone library assisted: teaching and learning from observation; transition from medical student to new doctor; trainee doctors' discussions with seniors; independent practice; patient care; and this 'just-in-time' access to reliable information supported confident and efficient decision-making. A variety of information sources are used regularly in the workplace. Colleagues are used daily but seniors are not always available. During transitions, constant access to the electronic library was valued. It helped prepare trainee doctors for discussions with their seniors, assisting the interchange between explicit and tacit knowledge.By supporting accurate prescribing and treatment planning, the electronic library contributed to enhanced patient care. Trainees were more rapidly able to medicate patients to reduce pain and more quickly call for specific assessments. However, clinical decision-making often requires

[Relevance between expectations before treatment, new symptoms and satisfaction after treatment in patients with pelvic organ prolapse].

Science.gov (United States)

Wang, Yu; Han, Jinsong; Zhang, Kun; Zhu, Fuli; Yang, Junfang; Wang, Yiting

2015-09-01

To investigate the relevance between expectations before treatment, new symptoms and satisfaction after treatment of the pelvic organ prolapse (POP) patients. Made a collection of 75 cases of POP patients at Peking University Third Hospital, who were affected by the POP symptoms and came to our clinic for treatment from January to December in 2013. Prospectively investigate the patients' expectations before treatment, which were the most troubling symptoms to be solved. According to treatment we divided the patients into surgery and pessary groups. Two groups were followed up with the degree to achieve the desired goals using patient global impression of improvement (PGI-I), new symptoms and satisfaction after treatment, try to find the relevance between expectations before treatment, new symptoms and satisfaction after treatment. There were 47 (63%, 47/75) patients in the surgical group and 28 (37%, 28/75) patients in the pessary group. The top three problems for patients were friction when walking (25%, 19/75), dysuria (23%, 17/75) and the feeling of vaginal prolapse (19%, 14/75). The follow-up rate was of 93% (70/75), follow-up time was (5 ± 4) months. Satisfaction score after treatment of surgical group was higher than that of pessary group [(4.9 ± 0.4) versus (4.0 ± 1.3) scores, P satisfaction scores was relevant (P = 0.021). The availability of new symptoms and satisfaction scores was relevant (P = 0.001). When achieving higher expectations to the treatment and no more new symptoms, the satisfaction score after treatment is higher.

Donepezil treatment in ethnically diverse patients with Alzheimer disease.

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Tinklenberg, Jared R; Kraemer, Helena C; Yaffe, Kristine; O'Hara, Ruth; Ringman, John M; Ashford, John W; Yesavage, Jerome A; Taylor, Joy L

2015-04-01

To compare the outcome of donepezil treatment in ethnically diverse Alzheimer disease (AD) patients with ethnically diverse AD patients who did not receive donepezil. Patients meeting NINCDS-ADRA criteria for probable or possible AD from a consortium of California sites were systematically followed for at least 1 year in this prospective, observational study. Their treatment regimens, including prescription of donepezil, were determined by their individual physician according to his or her usual criteria. Patients self-identified their ethnicity. The 64 ethnically diverse AD patients who completed the study and received donepezil treatment had an average 1-year decline of 2.30 points (standard deviation: 3.9) on the 30-point Mini-Mental State Exam compared with a 1.70-point (standard deviation: 4.2) decline in the 74 ethnically diverse completers who received no donepezil or other anti-AD drugs during the study period. This difference was not statistically significant. The overall Cohen effect size of this treatment-associated difference was estimated at -0.15. After using propensity analyses and other techniques to assess factors that could bias prescribing decisions, the lack of benefits associated with donepezil treatment remained. The lack of donepezil benefits also remained when more traditional analyses were applied to these data. Ethnically diverse AD patients in this study apparently did not benefit from 1 year of donepezil treatment. These unpromising results are in contrast to modest benefits of donepezil treatment measured in a directly comparable California study involving white non-Latino AD patients. Published by Elsevier Inc.

What patient characteristics make clinicians recommend brief treatment?

NARCIS (Netherlands)

Schaefer, B. A.; Koeter, M. W. J.; Wouters, L.; Emmelkamp, P. M. G.; Schene, A. H.

2003-01-01

Objective: Assessing self-rated items that might have an impact on clinicians recommending brief treatment (BT) over unlimited or long-term treatment (ULT). Method: On the basis of patient self-report data we compared patients referred by clinicians to BT (n =71) with those referred to ULT (n =145).

Physical therapy methods in the treatment and rehabilitation of cancer patients

International Nuclear Information System (INIS)

Kucherova, T. Ya.; Choinzonov, E. L.; Tuzikov, S. A.; Vusik, M. V.; Doroshenko, A. V.; Velikaya, V. V.; Gribova, O. V.; Startseva, Zh. A.

2016-01-01

The results of the effective use of magnetic laser therapy in the treatment and rehabilitation of cancer patients were presented. The effect of magnetic-laser therapy in the treatment of radiation-induced reactions in the patients with head and neck cancer and in the patients with breast cancer was analyzed. High efficiency of lymphedema and lymphorrhea treatment in the postoperative period in the patients with breast cancer was proved. The results of rehabilitation of the patients with gastric cancer after surgical treatment were presented. These data indicate a high effectiveness of different physical methods of treatment and rehabilitation of cancer patients.

Applying machine learning to predict patient-specific current CD 4 ...

African Journals Online (AJOL)

This work shows the application of machine learning to predict current CD4 cell count of an HIV-positive patient using genome sequences, viral load and time. A regression model predicting actual CD4 cell counts and a classification model predicting if a patient's CD4 cell count is less than 200 was built using a support ...

The patient's duty to adhere to prescribed treatment: an ethical analysis.

Science.gov (United States)

Resnik, David B

2005-04-01

This article examines the ethical basis for the patient's duty to adhere to the physician's treatment prescriptions. The article argues that patients have a moral duty to adhere to the physician's treatment prescriptions, once they have accepted treatment. Since patients still retain the right to refuse medical treatment, their duty to adhere to treatment prescriptions is a prima facie duty, which can be overridden by their other ethical duties. However, patients do not have the right to refuse to adhere to treatment prescriptions if their non-adherence poses a significant threat to other people. This paper also discusses the use of written agreements between physicians and patients as a strategy for promoting patient adherence.

Results of treatment in irradiated testicular seminoma patients

International Nuclear Information System (INIS)

Kellokump-Lehtinen, P.

1990-01-01

Excellent treatment results have been acieved historically with postoperative radiotherapy in testicular seminoma. In this retrospective study the treatment results of 211 patients with Stage I/II testicular seminoma treated in Finland during the years 1970-1983 were evaluated. 176 (84%) patients received postoperative radiotherapy alone. In addition to radiotherapy, 26 (12%) patients received chemotherapy during the primary treatment. There were 129 Stage I (61%), 66 Stage IIA-B (31%) and 16 Stage IIC (8%) tumors. The 5-year survival rate was 95% in Stage I, 87% in Stage IIA-B and 73% in Stage IIC. In Stage I, seven relapses (relapse rate 6%) occured after irradiation; three of them were cured with second-line therapies. None of the relapses occurred within the radiotherapy field. In Stage IIA-B, 31 patients had only parailiacic + aortic irradiation, 25 patients received both parailiacic + aortic and mediastinal irradiation. With both radiotherapy techniques there was no significant difference in the number of relapses (seven and three) and in the remission rate (94% and 96%). Radiotherapy alone was used on four Stage IIC patients and one of them died during the primary treatment. Two of them relapsed, but could be cured with chemotherapy. These results correspond to those reported in the literature and tye suggest that prophylactic mediastinal irradiation is unneccessary in Stage IIA-B patients. Stage IIC patients should receive chemotherapy initially. (author). 19 refs.; 2 figs.; 2 tabs

An Innovative Framework for Delivering Psychotherapy to Patients With Treatment-Resistant Posttraumatic Stress Disorder: Rationale for Interactive Motion-Assisted Therapy.

Science.gov (United States)

van Gelderen, Marieke J; Nijdam, Mirjam J; Vermetten, Eric

2018-01-01

Despite an array of evidence-based psychological treatments for patients with a posttraumatic stress disorder (PTSD), a majority of patients do not fully benefit from the potential of these therapies. In veterans with PTSD, up to two-thirds retain their diagnosis after psychotherapy and often their disorder is treatment-resistant, which calls for improvement of therapeutic approaches for this population. One of the factors hypothesized to underlie low response in PTSD treatment is high behavioral and cognitive avoidance to traumatic reminders. In the current paper we explore if a combination of personalized virtual reality, multi-sensory input, and walking during exposure can enhance treatment engagement, overcome avoidance, and thereby optimize treatment effectiveness. Virtual reality holds potential to increase presence and in-session attention and to facilitate memory retrieval. Multi-sensory input such as pictures and music can personalize this experience. Evidence for the positive effect of physical activity on fear extinction and associative thinking, as well as embodied cognition theories, provide a rationale for decreased avoidance by literally approaching cues of the traumatic memories. A dual-attention task further facilitates new learning and reconsolidation. These strategies have been combined in an innovative framework for trauma-focused psychotherapy, named Multi-modular Motion-assisted Memory Desensitization and Reconsolidation (3MDR). In this innovative treatment the therapeutic setting is changed from the face-to-face sedentary position to a side-by-side activating context in which patients walk toward trauma-related images in a virtual environment. The framework of 3MDR has been designed as a boost for patients with treatment-resistant PTSD, which is illustrated by three case examples. The intervention is discussed in context of other advancements in treatment for treatment-resistant PTSD. Novel elements of this approach are activation

An Innovative Framework for Delivering Psychotherapy to Patients With Treatment-Resistant Posttraumatic Stress Disorder: Rationale for Interactive Motion-Assisted Therapy

Directory of Open Access Journals (Sweden)

Marieke J. van Gelderen

2018-05-01

Full Text Available Despite an array of evidence-based psychological treatments for patients with a posttraumatic stress disorder (PTSD, a majority of patients do not fully benefit from the potential of these therapies. In veterans with PTSD, up to two-thirds retain their diagnosis after psychotherapy and often their disorder is treatment-resistant, which calls for improvement of therapeutic approaches for this population. One of the factors hypothesized to underlie low response in PTSD treatment is high behavioral and cognitive avoidance to traumatic reminders. In the current paper we explore if a combination of personalized virtual reality, multi-sensory input, and walking during exposure can enhance treatment engagement, overcome avoidance, and thereby optimize treatment effectiveness. Virtual reality holds potential to increase presence and in-session attention and to facilitate memory retrieval. Multi-sensory input such as pictures and music can personalize this experience. Evidence for the positive effect of physical activity on fear extinction and associative thinking, as well as embodied cognition theories, provide a rationale for decreased avoidance by literally approaching cues of the traumatic memories. A dual-attention task further facilitates new learning and reconsolidation. These strategies have been combined in an innovative framework for trauma-focused psychotherapy, named Multi-modular Motion-assisted Memory Desensitization and Reconsolidation (3MDR. In this innovative treatment the therapeutic setting is changed from the face-to-face sedentary position to a side-by-side activating context in which patients walk toward trauma-related images in a virtual environment. The framework of 3MDR has been designed as a boost for patients with treatment-resistant PTSD, which is illustrated by three case examples. The intervention is discussed in context of other advancements in treatment for treatment-resistant PTSD. Novel elements of this approach are

Chronic 5-HT4 receptor agonist treatment restores learning and memory deficits in a neuroendocrine mouse model of anxiety/depression.

Science.gov (United States)

Darcet, Flavie; Gardier, Alain M; David, Denis J; Guilloux, Jean-Philippe

2016-03-11

Cognitive disturbances are often reported as serious invalidating symptoms in patients suffering from major depression disorders (MDD) and are not fully corrected by classical monoaminergic antidepressant drugs. If the role of 5-HT4 receptor agonists as cognitive enhancers is well established in naïve animals or in animal models of cognitive impairment, their cognitive effects in the context of stress need to be examined. Using a mouse model of anxiety/depression (CORT model), we reported that a chronic 5-HT4 agonist treatment (RS67333, 1.5mg/kg/day) restored chronic corticosterone-induced cognitive deficits, including episodic-like, associative and spatial learning and memory impairments. On the contrary, a chronic monoaminergic antidepressant drug treatment with fluoxetine (18mg/kg/day) only partially restored spatial learning and memory deficits and had no effect in the associative/contextual task. These results suggest differential mechanisms underlying cognitive effects of these drugs. Finally, the present study highlights 5-HT4 receptor stimulation as a promising therapeutic mechanism to alleviate cognitive symptoms related to MDD. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Psychodrama and the Treatment of Narcissistic and Borderline Patients.

Science.gov (United States)

Olsson, Peter A

2018-01-01

Psychiatric clinicians are faced with the challenge of remaining flexible and psychotherapeutically relevant to the broadening scope of patients with severe narcissistic and borderline personality disorders. Diagnostic sophistication among mental health professionals, increased availability of psychotherapy services, and economic pressures combine to cause the public to expect cost-effective, successful, and shorter duration of treatments. These treatment challenges are particularly poignant with the treatment of those narcissistic and borderline patients who have meager capacity for insight and limited verbal skills. This article describes the use of psychodynamically oriented and informed psychodrama for the treatment of narcissistic and borderline patients.

Treatment selection for stage IIIA Hodgkin's disease patients

International Nuclear Information System (INIS)

Prosnitz, L.R.; Cooper, D.; Cox, E.B.; Kapp, D.S.; Farber, L.R.

1985-01-01

Two treatment policies for the therapy of patients with Stage IIIA Hodgkin's disease are compared. From 1969-1976, 49 newly diagnosed and pathologically staged IIIA patients received total nodal irradiation (TNI) alone (no liver irradiation). Although actuarial survival was 80% at 5 years and 68% at 10 years, actuarial freedom from relapse was only 38% at 5 years. Accordingly, a new treatment policy was instituted in 1976. Patients with either CS IIIA disease, multiple splenic nodules, IIIA with a large mediastinal mass or III 2 , received combined modality therapy (combination chemotherapy and irradiation). All others received TNI. Thirty-six patients have been treated under the new program. The actuarial survival is 90% at 5 years and the relapse-free survival is 87%, suggesting the superiority of this approach. Complications from the treatments are discussed

The use of observation on patients who self-harm: Lessons from a learning disability service

Directory of Open Access Journals (Sweden)

Peter Thomas Sandy

2016-12-01

Conclusion: Observation is a useful practice in in-patient learning disability services, which can be used to prevent or reduce the incidence of self-harm in these settings. This approach should therefore be an integral part of nurses' daily therapeutic activities in in-patient learning disability services.

Examining the Impact of Patient-Reported Hope for Improvement and Patient Satisfaction with Clinician/Treatment on the Outcome of Major Depressive Disorder Treatment.

Science.gov (United States)

IsHak, Waguih William; Vilhauer, Jennice; Kwock, Richard; Wu, Fan; Gohar, Sherif; Collison, Katherine; Thomas, Shannon Nicole; Naghdechi, Lancer; Elashoff, David

This analysis aims at examining if patient-reported variables such as hope for improvement and patient satisfaction with clinician/treatment could influence the outcome major depressive disorder (MDD) treatment, namely depression remission, in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial. Retrospective cohort study. The STAR*D study was conducted at 18 primary care and 23 psychiatric care settings in the United States from 2001-2007 and was funded by the National Institute of Mental health (NIMH). The analysis contained in this manuscript was conceptualized at the Cedars-Sinai Department of Psychiatry and Behavioral Neurosciences and performed at the UCLA School of Public Health. Using data from STAR*D, the current study used logistic regression and survival analyses to examine the relationship between depressive symptoms remission and two sets of self-reported factors: Hope for improvement and, Patient satisfaction with treatment/clinician. First, more than 90% of STAR*D patients reported having high hope for improvement (agree or strongly agree) and more than 66% endorsed high satisfaction with clinicians and more than 50% expressed high satisfaction with treatments (very or mostly satisfied). Second, hope for improvement was predictive of depression remission (pdepression remission in contrast to satisfaction with clinician/treatment. Future studies should prospectively incorporate patients' subjective attitudes regarding hope for improvement and satisfaction with clinicians and treatments as mediators and moderators of MDD treatment success.

Evaluating the Clinical Learning Environment: Resident and Fellow Perceptions of Patient Safety Culture.

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Bump, Gregory M; Calabria, Jaclyn; Gosman, Gabriella; Eckart, Catherine; Metro, David G; Jasti, Harish; McCausland, Julie B; Itri, Jason N; Patel, Rita M; Buchert, Andrew

2015-03-01

The Accreditation Council for Graduate Medical Education has begun to evaluate teaching institutions' learning environments with Clinical Learning Environment Review visits, including trainee involvement in institutions' patient safety and quality improvement efforts. We sought to address the dearth of metrics that assess trainee patient safety perceptions of the clinical environment. Using the Hospital Survey on Patient Safety Culture (HSOPSC), we measured resident and fellow perceptions of patient safety culture in 50 graduate medical education programs at 10 hospitals within an integrated health system. As institution-specific physician scores were not available, resident and fellow scores on the HSOPSC were compared with national data from 29 162 practicing providers at 543 hospitals. Of the 1337 residents and fellows surveyed, 955 (71.4%) responded. Compared with national practicing providers, trainees had lower perceptions of patient safety culture in 6 of 12 domains, including teamwork within units, organizational learning, management support for patient safety, overall perceptions of patient safety, feedback and communication about error, and communication openness. Higher perceptions were observed for manager/supervisor actions promoting patient safety and for staffing. Perceptions equaled national norms in 4 domains. Perceptions of patient safety culture did not improve with advancing postgraduate year. Trainees in a large integrated health system have variable perceptions of patient safety culture, as compared with national norms for some practicing providers. Administration of the HSOPSC was feasible and acceptable to trainees, and may be used to track perceptions over time.

Endoscopic treatment of vesicoureteral reflux in pediatric patients

Directory of Open Access Journals (Sweden)

Jong Wook Kim

2013-04-01

Full Text Available Endoscopic treatment is a minimally invasive treatment for managing patients with vesicoureteral reflux (VUR. Although several bulking agents have been used for endoscopic treatment, dextranomer/hyaluronic acid is the only bulking agent currently approved by the U.S. Food and Drug Administration for treating VUR. Endoscopic treatment of VUR has gained great popularity owing to several obvious benefits, including short operative time, short hospital stay, minimal invasiveness, high efficacy, low complication rate, and reduced cost. Initially, the success rates of endoscopic treatment have been lower than that of open antireflux surgery. However, because injection techniques have been developed, a recent study showed higher success rates of endoscopic treatment than open surgery in the treatment of patients with intermediate- and high-grade VUR. Despite the controversy surrounding its effectiveness, endoscopic treatment is considered a valuable treatment option and viable alternative to long-term antibiotic prophylaxis.

Optimizing patient treatment decisions in an era of rapid technological advances: the case of hepatitis C treatment.

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Liu, Shan; Brandeau, Margaret L; Goldhaber-Fiebert, Jeremy D

2017-03-01

How long should a patient with a treatable chronic disease wait for more effective treatments before accepting the best available treatment? We develop a framework to guide optimal treatment decisions for a deteriorating chronic disease when treatment technologies are improving over time. We formulate an optimal stopping problem using a discrete-time, finite-horizon Markov decision process. The goal is to maximize a patient's quality-adjusted life expectancy. We derive structural properties of the model and analytically solve a three-period treatment decision problem. We illustrate the model with the example of treatment for chronic hepatitis C virus (HCV). Chronic HCV affects 3-4 million Americans and has been historically difficult to treat, but increasingly effective treatments have been commercialized in the past few years. We show that the optimal treatment decision is more likely to be to accept currently available treatment-despite expectations for future treatment improvement-for patients who have high-risk history, who are older, or who have more comorbidities. Insights from this study can guide HCV treatment decisions for individual patients. More broadly, our model can guide treatment decisions for curable chronic diseases by finding the optimal treatment policy for individual patients in a heterogeneous population.

Student nurses' learning processes in interaction with psychiatric patients

DEFF Research Database (Denmark)

Kragelund, Linda

2011-01-01

descriptive approach was chosen. The theoretical framework includes Jarvis’ concept of ‘disjuncture’, because it offers a theoretical way of understanding the empirical phenomenon of ‘non-routine-situations’. Heller’s concept of ‘everyday life activities’ is also drawn on, for its contribution......When the Danish government converted the national practice-oriented nursing qualification from a vocational course to a bachelor’s degree in 2002, the clinical training component was scaled back. Accordingly, mentors needed to optimise students’ learning from this curtailed clinical practice...... participant which takes place just after the researcher’s observation of the participant in interaction with a patient. The role of the researcher is to be a catalyst for the reflection. Using qualitative content analysis, a model of student nurses learning processes, termed the ‘Windmill of Learning...

Using standardized patients versus video cases for representing clinical problems in problem-based learning.

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Yoon, Bo Young; Choi, Ikseon; Choi, Seokjin; Kim, Tae-Hee; Roh, Hyerin; Rhee, Byoung Doo; Lee, Jong-Tae

2016-06-01

The quality of problem representation is critical for developing students' problem-solving abilities in problem-based learning (PBL). This study investigates preclinical students' experience with standardized patients (SPs) as a problem representation method compared to using video cases in PBL. A cohort of 99 second-year preclinical students from Inje University College of Medicine (IUCM) responded to a Likert scale questionnaire on their learning experiences after they had experienced both video cases and SPs in PBL. The questionnaire consisted of 14 items with eight subcategories: problem identification, hypothesis generation, motivation, collaborative learning, reflective thinking, authenticity, patient-doctor communication, and attitude toward patients. The results reveal that using SPs led to the preclinical students having significantly positive experiences in boosting patient-doctor communication skills; the perceived authenticity of their clinical situations; development of proper attitudes toward patients; and motivation, reflective thinking, and collaborative learning when compared to using video cases. The SPs also provided more challenges than the video cases during problem identification and hypotheses generation. SPs are more effective than video cases in delivering higher levels of authenticity in clinical problems for PBL. The interaction with SPs engages preclinical students in deeper thinking and discussion; growth of communication skills; development of proper attitudes toward patients; and motivation. Considering the higher cost of SPs compared with video cases, SPs could be used most advantageously during the preclinical period in the IUCM curriculum.

Vicarious experience affects patients' treatment preferences for depression.

Directory of Open Access Journals (Sweden)

Seth A Berkowitz

Full Text Available Depression is common in primary care but often under-treated. Personal experiences with depression can affect adherence to therapy, but the effect of vicarious experience is unstudied. We sought to evaluate the association between a patient's vicarious experiences with depression (those of friends or family and treatment preferences for depressive symptoms.We sampled 1054 English and/or Spanish speaking adult subjects from July through December 2008, randomly selected from the 2008 California Behavioral Risk Factor Survey System, regarding depressive symptoms and treatment preferences. We then constructed a unidimensional scale using item analysis that reflects attitudes about antidepressant pharmacotherapy. This became the dependent variable in linear regression analyses to examine the association between vicarious experiences and treatment preferences for depressive symptoms.Our sample was 68% female, 91% white, and 13% Hispanic. Age ranged from 18-94 years. Mean PHQ-9 score was 4.3; 14.5% of respondents had a PHQ-9 score >9.0, consistent with active depressive symptoms. Analyses controlling for current depression symptoms and socio-demographic factors found that in patients both with (coefficient 1.08, p = 0.03 and without (coefficient 0.77, p = 0.03 a personal history of depression, having a vicarious experience (family and friend, respectively with depression is associated with a more favorable attitude towards antidepressant medications.Patients with vicarious experiences of depression express more acceptance of pharmacotherapy. Conversely, patients lacking vicarious experiences of depression have more negative attitudes towards antidepressants. When discussing treatment with patients, clinicians should inquire about vicarious experiences of depression. This information may identify patients at greater risk for non-adherence and lead to more tailored patient-specific education about treatment.

[Effective treatment strategy in elderly breast cancer patients].

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Boér, Katalin

2005-01-02

High frequency of cancer in older people and the improvements in life expectancy do not allow older age to be a barrier to treatment. The age is one of the risk factors for breast cancer development, one third of all cases occur in women older than 70 years. To provide an overview of the available information on the main issues in the field of surgery, radiotherapy and medical approaches to the treatment of breast cancer in the elderly. The author discusses the treatment of breast cancer in the elderly, based on the data of literature. The assessment of any patient is the first step in the treatment process, performance status is more important than age. In older women a correct evaluation includes not only the basic medical history and the cancer staging, but also a detailed assessment of health and environment that may interfere with the therapeutic approach of the patient. Age is not a limitation for surgery, without any comorbidity it is safe, and operative mortality is low. The body self-image is important for most old women, they also wish to keep their breasts, so a conservative surgery and adjuvant radiotherapy should be offered to all, as long as the stage permits it. The selection of patients who are candidates for axillary dissection is based on selective lymph sentinel node technique which provides an optimal nodal staging with a minimal morbidity. The results of radiotherapy are as good as in younger patients, elderly women tolerate radiotherapy well. The inability to travel to the radiation facility is often the reason for omitting the radiation treatment and to choose a modified mastectomy. A promising alternative to the standard radiation treatment is the concept of intraoperative radiotherapy. Breast cancer in the elderly women is more likely to be well differentiated tumour, containing oestrogen and progesterone receptors. Based on these favourable prognostic factors, endocrine therapy is the standard treatment in adjuvant and metastatic setting

Telemedicine utilization to support the management of the burns treatment involving patient pathways in both developed and developing countries: a case study.

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Syed-Abdul, Shabbir; Scholl, Jeremiah; Chen, Chiehfeng Cliff; Santos, Martinho D P S; Jian, Wen-Shan; Liou, Der-Ming; Li, Yu-Chuan

2012-01-01

This case study reports on the utilization of telemedicine to support the management of the burns treatment in the islands of Sao Tome and Principe by Taipei Medical University-affiliated hospital in Taiwan. The authors share experiences about usage of telemedicine to support treatment of the burn victims in a low-income country that receive reconstructive surgery in a developed country. Throughout the entire care process, telemedicine has been used not only to provide an expert advice from distance but also to help establish and maintain the doctor-patient relationship, to keep patients in contact with their families, and to help educate and consult the medical personal physically present in Sao Tome and Principe. This case study presents the details of how this process has been conducted to date, on what were learned from this process, and on issues that should be considered to improve this process in the future. The authors plan to create instructional videos and post them on YouTube to aid clinical workers providing similar treatment during the acute care and rehabilitation process and also to support eLearning in many situations where it otherwise is not possible to use videoconferencing to establish real-time contact between doctors at the local site and remote specialists.

Collaborative work by using videoconferencing: opportunities for learning in daily medical practice.

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Lundvoll Nilsen, Line

2011-08-01

In this article, I explore what happens when general practitioners (GPs) and specialists meet using videoconferencing to collaborate on a patient's treatment. By using videoconferencing, GPs and specialists are offered opportunities to share and produce knowledge. The data corpus was 42 videotaped videoconferences. The treatment of one specific patient was selected.This patient was discussed over a period of 9 days, which constituted five videoconferences. I describe how GPs and specialists discuss treatment strategies and exemplify how knowledge sharing creates opportunities for learning in boundary zones across activity systems as a part of daily practice.The talk about the treatment occurs by information exchange and by consultation. Information exchange without any dilemmas presented might support decisions already made. Consultations wherein dilemmas are presented and solved by bridging knowledge gaps between the general practitioner and the specialist create opportunities for learning.

Laser in caries treatment--patients' experiences and opinions.

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Sarmadi, R; Hedman, E; Gabre, P

2014-02-01

The aim of this study was to obtain a deeper understanding of patient's experiences and perspectives after dental caries treatment with Er:YAG laser technology. Twelve patients aged 15-30 years who had undergone at least one laser caries excavation agreed to participate in an interview study. All the interviews were tape recorded and transcribed by a transcription agency. The transcribed texts were analysed using manifest and latent qualitative content analysis. The categories in this study were identified as choosing laser, understanding laser, encouraging dental care and my oral health. The motivation for laser treatment was described as dental fear in general, specific fear of needles or discomfort with the drill. The informants described the dentist's role as initiators of treatment and willing or unwilling facilitators. Laser treatment was described as safer and more carefully considered treatment. They felt generally safe with laser and were able to relax during the treatment. All interviewers described a positive impression of the laser, and words like 'up to date' and 'future-oriented' were used to describe laser. Laser treatment was considered less painful. The results indicate that patients find laser a feasible and convenient treatment option. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Patients knowledge about side effects of orthodontic treatment

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Mia Amalia

2011-07-01

Full Text Available Disharmonious of dental arrangement can possibly create problems for the patient, such as the masticatory function, esthetical, psychosocial, and also the increased risk of trauma and periodontal disease. These are reasons for a patient to seek orthodontic treatment. The aim of this study was to know the patient’s knowledge about the side effects possibility that they receive during orthodontic treatment. The side effects include pain experience during orthodontic treatment, the possibility of soft tissue damage, email demineralization, loss of tooth vitality, periodontal problem, root resorption, temporomandibular joint disorders, and relapse. A cross-sectional study was conducted in patients who registered at Orthodontic Department, Faculty of Dentistry, Universitas Indonesia on March-June 2009. The participants of this study were 100 patients, consist of 86 women and 14 men respectively. Twenty-seven questions about the side-effects of orthodontic treatment were used to obtain the patient’s knowledge and the result was categorized into 3 groups, good, average and poor. The result of the study showed that patient’s knowledge about the side effect of pain experience during orthodontic treatment was average and the patient’s knowledge about the possibility of soft tissue damage due to orthodontic treatment was good. However, the patient’s knowledge about the possibility of email demineralization, loss of tooth vitality, periodontal problem, root resorption, temporomandibular joint disorders and relapse due to orthodontic treatment was low.

Treatment preferences and involvement in treatment decision making of patients with endometrial cancer and clinicians.

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Kunneman, M; Pieterse, A H; Stiggelbout, A M; Nout, R A; Kamps, M; Lutgens, L C H W; Paulissen, J; Mattheussens, O J A; Kruitwagen, R F P M; Creutzberg, C L

2014-08-12

Vaginal brachytherapy (VBT) in high-intermediate-risk endometrial cancer (EC) provides a significant reduction in the risk of local cancer recurrence, but without survival benefit and with increased mucosal atrophy. Five-year local control is estimated to be similar for VBT and a watchful waiting policy (WWP), in which patients receive VBT combined with external radiation in case of a recurrence. Our aim was to assess treatment preferences of EC patients and clinicians regarding VBT and WWP, and to evaluate their preferred and perceived involvement in treatment decision making. Interviews were held with 95 treated EC patients. The treatment trade-off method was used to assess the minimally desired benefit from VBT in local control. Patients' preferred and perceived involvement in decision making were assessed using a questionnaire. Seventy-seven clinicians completed a questionnaire assessing their minimally desired benefit and preferred involvement in decision making. Minimally desired benefit of VBT was significantly lower for patients than for clinicians (median=0 vs 8%, Pdecision about VBT. However, irradiated patients indicated low perceived involvement in actual treatment decision making. We found variations between and within patients and clinicians in minimally desired benefit from VBT. However, the recurrence risk at which patients preferred VBT was low. Our results showed that patients consider active participation in decision making essential.

Implementation of a smartphone wireless accelerometer platform for establishing deep brain stimulation treatment efficacy of essential tremor with machine learning.

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LeMoyne, Robert; Tomycz, Nestor; Mastroianni, Timothy; McCandless, Cyrus; Cozza, Michael; Peduto, David

2015-01-01

Essential tremor (ET) is a highly prevalent movement disorder. Patients with ET exhibit a complex progressive and disabling tremor, and medical management often fails. Deep brain stimulation (DBS) has been successfully applied to this disorder, however there has been no quantifiable way to measure tremor severity or treatment efficacy in this patient population. The quantified amelioration of kinetic tremor via DBS is herein demonstrated through the application of a smartphone (iPhone) as a wireless accelerometer platform. The recorded acceleration signal can be obtained at a setting of the subject's convenience and conveyed by wireless transmission through the Internet for post-processing anywhere in the world. Further post-processing of the acceleration signal can be classified through a machine learning application, such as the support vector machine. Preliminary application of deep brain stimulation with a smartphone for acquisition of a feature set and machine learning for classification has been successfully applied. The support vector machine achieved 100% classification between deep brain stimulation in `on' and `off' mode based on the recording of an accelerometer signal through a smartphone as a wireless accelerometer platform.

The Medicinal Cannabis Treatment Agreement: Providing Information to Chronic Pain Patients Through a Written Document.

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Wilsey, Barth; Atkinson, J Hampton; Marcotte, Thomas D; Grant, Igor

2015-12-01

Pain practitioners would seem to have an obligation to understand and inform their patients on key issues of the evidence base on cannabinoid therapeutics. One way to fulfill this obligation might be to borrow from concepts developed in the prescription of opioids: the use of a written agreement to describe and minimize risks. Regrettably, the widespread adoption of opioids was undertaken while harmful effects were minimized; obviously, no one wants to repeat this misstep. This article describes a method of educating patients in a manner analogous to other treatment agreements. Surveys have demonstrated that pain is the most common indication for medical use of cannabis. As more individuals gain access to this botanical product through state ballot initiatives and legislative mandate, the pain specialist is likely to be confronted by patients either seeking such treatment where permitted, or otherwise inquiring about its potential benefits and harms, and alternative pharmaceuticals containing cannabinoids. PubMed searches were conducted using the following keywords: cannabis guidelines, harmful effects of cannabis, medical marijuana, medicinal cannabis, opioid cannabis interaction, cannabis dependence and cannabis abuse : The authors selected individual tenets a medicinal cannabis patient would be asked to review and acknowledge via signature. Undoubtedly, the knowledge base concerning risks will be an iterative process as we learn more about the long-term use of medicinal cannabis. But we should start the process now so that patients may be instructed about our current conception of what the use of medicinal cannabis entails.

Patient characteristics and treatment outcome in functional anorectal pain.

Science.gov (United States)

Atkin, Gary K; Suliman, Amna; Vaizey, Carolynne J

2011-07-01

Functional anorectal pain occurs in the absence of any clinical abnormality. It is common and disabling; it has previously been reported in only a few studies involving small patient numbers. This study aimed to report the clinical characteristics and treatment outcomes for patients with functional anorectal pain. Patient demographics, clinical history, and tests results for all referrals for anorectal physiological testing between 1997 and 2009 were prospectively recorded. For patients with functional anorectal pain, further information was gained from clinical notes. Clinical history, anorectal physiology, and radiological imaging data were recorded for all patients; treatment outcome was noted for patients treated and followed up at the present unit. One hundred seventy patients, 99 female, with a median age of 48 years (range, 18-86), were studied. Patients were classified as having chronic proctalgia (pain duration ≥20 min, 158 patients) or proctalgia fugax (pain duration proctalgia fugax had a higher internal anal sphincter thickness and resting pressure than patients with chronic proctalgia, whereas patients with a family history of similar symptoms were more likely to have proctalgia fugax and higher resting pressures and internal anal sphincter thickness compared with those without a family history of these symptoms. Patients referred for treatment underwent a range of interventions including biofeedback (29 patients, 17 improved), tricyclic antidepressants (26 patients, 10 improved), Botox injection (9 patients, 5 improved), and sacral nerve stimulation (3 patients, 2 improved). Biofeedback had the greatest treatment effect, especially in patients with defecatory dysfunction. Biofeedback is beneficial in the subset of patients with functional anorectal pain and difficulty with defecation. Tricyclic antidepressants, Botox, and sacral nerve stimulation may also have a role.

Radiation treatment in older patients: a framework for clinical decision making.

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Smith, Grace L; Smith, Benjamin D

2014-08-20

In older patients, radiation treatment plays a vital role in curative and palliative cancer therapy. Radiation treatment recommendations should be informed by a comprehensive, personalized risk-benefit assessment that evaluates treatment efficacy and toxicity. We review several clinical factors that distinctly affect efficacy and toxicity of radiation treatment in older patients. First, locoregional tumor behavior may be more indolent in older patients for some disease sites but more aggressive for other sites. Assessment of expected locoregional relapse risk informs the magnitude and timeframe of expected radiation treatment benefits. Second, assessment of the competing cancer versus noncancer mortality and morbidity risks contextualizes cancer treatment priorities holistically within patients' entire spectrum and time course of health needs. Third, assessment of functional reserve helps predict patients' acute treatment tolerance, differentiating those patients who are unlikely to benefit from treatment or who are at high risk for treatment complications. Potential radiation treatment options include immediate curative treatment, delayed curative treatment, and no treatment, with additional consideration given to altered radiation target, dose, or sequencing with chemotherapy and/or surgery. Finally, when cure is not feasible, palliative radiation therapy remains valuable for managing symptoms and achieving meaningful quality-of-life improvements. Our proposed decision-making framework integrates these factors to help radiation oncologists formulate strategic treatment recommendations within a multidisciplinary context. Future research is still needed to identify how advanced technologies can be judiciously applied in curative and palliative settings to enhance risk-benefit profiles of radiation treatment in older patients and more accurately quantify treatment efficacy in this group. © 2014 by American Society of Clinical Oncology.

Investigation of patient, tumour and treatment variables affecting residual motion for respiratory-gated radiotherapy

International Nuclear Information System (INIS)

George, R; Ramakrishnan, V; Siebers, J V; Chung, T D; Keall, P J

2006-01-01

not show significant time trends on average for any of the variables considered. The lack of significant time trends within and between sessions indicates that on average (1) there is no significant learning period for breathing training, (2) the patients did not experience training-related fatigue and (3) the margin component to account for residual motion during gated radiotherapy appears to remain constant throughout the treatment

Investigation of patient, tumour and treatment variables affecting residual motion for respiratory-gated radiotherapy

Energy Technology Data Exchange (ETDEWEB)

George, R [Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA (United States); Ramakrishnan, V [Department of Biostatistics, Virginia Commonwealth University, Richmond, VA (United States); Siebers, J V [Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA (United States); Chung, T D [Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA (United States); Keall, P J [Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA (United States)

2006-10-21

not show significant time trends on average for any of the variables considered. The lack of significant time trends within and between sessions indicates that on average (1) there is no significant learning period for breathing training, (2) the patients did not experience training-related fatigue and (3) the margin component to account for residual motion during gated radiotherapy appears to remain constant throughout the treatment.

Preparation of pediatric patients for treatment with proton beam therapy

International Nuclear Information System (INIS)

Mizumoto, Masashi; Oshiro, Yoshiko; Ayuzawa, Kaoru; Miyamoto, Toshio; Okumura, Toshiyuki; Fukushima, Takashi; Fukushima, Hiroko; Ishikawa, Hitoshi; Tsuboi, Koji; Sakurai, Hideyuki

2015-01-01

Purpose: Anesthesia is often used in proton beam therapy (PBT) for pediatric patients and this may prolong the treatment time. The aim of the study was to examine preparation of pediatric patients to allow smooth performance of PBT. Material and methods: Preparation was initiated 1–2 days before treatment planning CT and continued for 10 days. The patient first visited the facility to become familiar with the treatment room and staff. As the second step, the patient stayed in the treatment bed for a certain time with their mother, and then stayed on the treatment bed alone. Special fixtures painted with characters, music, and gifts were also prepared. Results: From 2010 to 2014, 111 pediatric patients underwent PBT. These patients were divided into 3 groups: 40 who could follow instructions well (group A, median age: 13.6 years old), 60 who could communicate, but found it difficult to stay alone for a long time (group B, median age: 4.6 years old), and 11 who could not follow instructions (group C, median age: 1.6 years old). Preparation was used for patients in group B. The mean treatment times in groups A, B and C were 13.6, 17.1, and 15.6 min, respectively, on PBT treatment days 2–6, and 11.8, 13.0, and 16.9 min, respectively, for the last 5 days of PBT treatment. The time reduction was significant in group B (p = 0.003). Conclusion: Preparation is useful for pediatric patients who can communicate. This approach allows PBT to be conducted more smoothly over a shorter treatment time

Balancing Patient Care and Student Education: Learning to Deliver Bad News in an Optometry Teaching Clinic

Science.gov (United States)

Spafford, Marlee M.; Schryer, Catherine F.; Creutz, Stefan

2009-01-01

Learning to counsel patients in a teaching clinic or hospital occurs in the presence of the competing agendas of patient care and student education. We wondered about the challenges that these tensions create for clinical novices learning to deliver bad news to patients. In this preliminary study, we audio-taped and transcribed the interviews of…

Factors related to orthodontic treatment time in adult patients

Directory of Open Access Journals (Sweden)

Ana Camila Esteves de Oliveira Melo

2013-10-01

Full Text Available INTRODUCTION: The length of time that it takes an orthodontist to treat adult patients varies widely. OBJECTIVE: The aim of this study was to investigate how different variables influence treatment time. METHODS: Seventy clinical case reports of successfully treated adult patients were examined. The patients were selected from 4,723 records held by three experienced orthodontists. The influence exerted by the following variables on treatment time was assessed: age, sex, facial pattern, severity of malocclusion (measured by the PAR index, sagittal relationship of canines, type of brackets (ceramic or metal, tooth extractions, missed appointments and orthodontic appliance issues/breakages, the latter being the dependent variable. Assessment was performed by multiple linear regression analysis, followed by the stepwise method with P < 0.05. RESULTS: The number of times a patient missed their appointment (no-show (R² = 14.4%, p < 0.0001 and the number of appliance issues/breakages (R² = 29.71%, p = 0.0037 significantly affected variability in treatment time, and these two variables together can predict 43.75% (R² total of the overall variability in treatment time. Other factors, such as canine relationship at the beginning of treatment, bracket type (metal or ceramic, tooth extractions, age at start of treatment, severity of the initial malocclusion, sex and facial pattern had no significant bearing on treatment time. CONCLUSIONS: The duration of orthodontic treatment in adults, when performed by experienced orthodontists, is mainly influenced by factors related to patient compliance. However, several factors which were not included in this study may contribute to variability in orthodontic treatment time.

Studying depression using imaging and machine learning methods

OpenAIRE

Patel, Meenal J.; Khalaf, Alexander; Aizenstein, Howard J.

2015-01-01

Depression is a complex clinical entity that can pose challenges for clinicians regarding both accurate diagnosis and effective timely treatment. These challenges have prompted the development of multiple machine learning methods to help improve the management of this disease. These methods utilize anatomical and physiological data acquired from neuroimaging to create models that can identify depressed patients vs. non-depressed patients and predict treatment outcomes. This article (1) presen...

Effects of Program and Patient Characteristics on Retention of Drug Treatment Patients.

Science.gov (United States)

Hser, Yih-Ing; Joshi, Vandana; Maglione, Margaret; Chou, Chih Ping; Anglin, M. Douglas

2001-01-01

Studied the effects of program and patient characteristics on patient retention in residential, out-patient, and methadone maintenance drug treatment programs. Data for 26,047 patients in 87 programs show that threshold retention rates were generally low for all 3 program types, although program practice and service provision played important…

Treatment seeking behaviour and prevalence of treatment delay among malaria patients along Thailand-Myanmar border in Tak province

Directory of Open Access Journals (Sweden)

Krit Sonkong

2015-04-01

Full Text Available Objective: To investigate treatment seeking behaviour and the prevalence of treatment delay of malaria patients. Methods: A cross-sectional study was conducted with malaria patients along the ThailandMyanmar border in Tak province, Thailand. Results: Most of patients (70.0% were treated for fever before receiving treatment at a malaria clinic or public hospital. The sources of initial treatments were self-treatment (64.0%, malaria clinics (20.0%, public hospital (11.0%, sub-district health promotion hospital (3.3%, and malaria posts (1.1%. Prevalence of patients delayed more than one day after onset of symptoms was 79.4%, but doctor delay of more than one day occurred in only 1.3%. The prevalence of treatment delay (total delay of more than one day was 79.6%. Patient delay and treatment delay were found to be significantly higher among hill tribe than Thai subjects (P=0.004 and 0.003, respectively but, there was no significant association between ethnicity and doctor delay (P=0.669. Conclusion: Patient delay in seeking treatment is a major problem along the ThailandMyanmar border in Tak province, especially in hill tribe people. Self-treatment accounted for most of initial treatment sought by patients.

[Hepatitis C treatment in special patient groups].

Science.gov (United States)

Berenguer, Marina; Jorquera, Francisco; Ángel Serra, Miguel; Sola, Ricard; Castellano, Gregorio

2014-07-01

The treatment plan for chronic hepatitis C in special populations varies according to comorbidity and the current evidence on treatment. In patients with hepatitis C virus and HIV coinfection, the results of dual therapy (pegylated interferon plus ribavirin) are poor. In patients with genotype 1 infection, triple therapy (dual therapy plus boceprevir or telaprevir) has doubled the response rate, but protease inhibitors can interact with some antiretroviral drugs and provoke more adverse effects. These disadvantages are avoided by the new, second-generation, direct-acting antiviral agents. In patients who are candidates for liver transplantation or are already liver transplant recipients, the optimal therapeutic option at present is to combine the new antiviral agents, with or without ribavirin and without interferon. The treatment of patients under hemodialysis due to chronic renal disease continues to be dual therapy (often with reduced doses of pegylated interferon and ribavirin), since there is still insufficient information on triple therapy and the new antiviral agents. In mixed cryoglobulinemia, despite the scarcity of experience, triple therapy seems to be superior to dual therapy and may be used as rescue therapy in non-responders to dual therapy. However, a decision must always be made on whether antiviral treatment should be used concomitantly or after immunosuppressive therapy. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

The representitativeness of patient position during the first treatment fractions

DEFF Research Database (Denmark)

Bertelsen, Anders; Nielsen, Morten; Westberg, Jonas

2009-01-01

BACKGROUND: During external radiotherapy daily or even weekly image verification of the patient position might be problematic due to the resulting workload. Therefore it has been customary to perform image verification only at the first treatment fraction. In this study it is investigated whether...... the patient position uncertainty at the initial three treatment fractions is representative for the uncertainty throughout the treatment course. METHODS: Seventy seven patients were treated using Elekta Synergy accelerators. The patients were immobilized during treatment by use of a customized VacFix bag...... and a mask of AquaPlast. Cone beam CT (CBCT) scans were performed at fractions 1, 2, and 3 and at the 10th and 20th treatment fractions. Displacements in patient position, translational and rotational, have been measured by an image registration of the CBCT and the planning CT scan. The displacements data...

Support patient search on pathology reports with interactive online learning based data extraction.

Science.gov (United States)

Zheng, Shuai; Lu, James J; Appin, Christina; Brat, Daniel; Wang, Fusheng

2015-01-01

Structural reporting enables semantic understanding and prompt retrieval of clinical findings about patients. While synoptic pathology reporting provides templates for data entries, information in pathology reports remains primarily in narrative free text form. Extracting data of interest from narrative pathology reports could significantly improve the representation of the information and enable complex structured queries. However, manual extraction is tedious and error-prone, and automated tools are often constructed with a fixed training dataset and not easily adaptable. Our goal is to extract data from pathology reports to support advanced patient search with a highly adaptable semi-automated data extraction system, which can adjust and self-improve by learning from a user's interaction with minimal human effort. We have developed an online machine learning based information extraction system called IDEAL-X. With its graphical user interface, the system's data extraction engine automatically annotates values for users to review upon loading each report text. The system analyzes users' corrections regarding these annotations with online machine learning, and incrementally enhances and refines the learning model as reports are processed. The system also takes advantage of customized controlled vocabularies, which can be adaptively refined during the online learning process to further assist the data extraction. As the accuracy of automatic annotation improves overtime, the effort of human annotation is gradually reduced. After all reports are processed, a built-in query engine can be applied to conveniently define queries based on extracted structured data. We have evaluated the system with a dataset of anatomic pathology reports from 50 patients. Extracted data elements include demographical data, diagnosis, genetic marker, and procedure. The system achieves F-1 scores of around 95% for the majority of tests. Extracting data from pathology reports could enable

Patients' information-seeking activity is associated with treatment compliance in inflammatory bowel disease patients.

Science.gov (United States)

Pittet, Valérie; Rogler, Gerhard; Mottet, Christian; Froehlich, Florian; Michetti, Pierre; de Saussure, Philippe; Burnand, Bernard; Vader, John-Paul

2014-06-01

Despite the chronic and relapsing nature of inflammatory bowel diseases (IBD), at least 30% to 45% of the patients are noncompliant to treatment. IBD patients often seek information about their disease. To examine the association between information-seeking activity and treatment compliance among IBD patients. To compare information sources and concerns between compliant and noncompliant patients. We used data from the Swiss IBD cohort study, and from a qualitative survey conducted to assess information sources and concerns. Crude and adjusted odds ratios (OR) for noncompliance were calculated. Differences in the proportions of information sources and concerns were compared between compliant and noncompliant patients. A total of 512 patients were included. About 18% (n = 99) of patients were reported to be noncompliant to drug treatment and two-thirds (n = 353) were information seekers. The OR for noncompliance among information seekers was 2.44 (95%CI: 1.34-4.41) after adjustment for confounders and major risk factors. General practitioners were 15.2% more often consulted (p = 0.019) among compliant patients, as were books and television (+13.1%; p = 0.048), whereas no difference in proportions was observed for sources such as internet or gastroenterologists. Information on tips for disease management were 14.2% more often sought among noncompliant patients (p = 0.028). No difference was observed for concerns on research and development on IBD or therapies. In Switzerland, IBD patients noncompliant to treatment were more often seeking disease-related information than compliant patients. Daily management of symptoms and disease seemed to be an important concern of those patients.

Treatment modalities for patients with gambling disorder.

Science.gov (United States)

Choi, Sam-Wook; Shin, Young-Chul; Kim, Dai-Jin; Choi, Jung-Seok; Kim, Seohee; Kim, Seung-Hyun; Youn, HyunChul

2017-01-01

Gambling disorder (GD) is defined as persistent and recurrent problematic gambling behavior leading to clinically significant impairment or distress. The prevalence of GD has been shown to be 1.2-7.1% in the general population. GD can severely impact on personal and vocational wellbeing as well as lead to financial problems, and has been known to be difficult to treat. This review describes the available pharmacotherapy/psychosocial treatments for GD patients, and summarizes data on the effectiveness of these GD treatments. This review refers to newly as well as previously published studies and guidelines. The description of pharmacotherapy mainly focuses on opioid receptor antagonists, selective serotonin reuptake inhibitors, and mood stabilizers. Psychosocial treatments/strategies mainly include cognitive behavioral therapy, motivational interviewing, and Gamblers Anonymous. We also introduce relatively novel treatment modalities. This review can help clinicians to decide treatment plans for their GD patients. In addition, it can be used as a reference for designing future research.

SU-E-J-254: Evaluating the Role of Mid-Treatment and Post-Treatment FDG-PET/CT in Predicting Progression-Free Survival and Distant Metastasis of Anal Cancer Patients Treated with Chemoradiotherapy

International Nuclear Information System (INIS)

Zhang, H; Wang, J; Chuong, M; D’Souza, W; Choi, W; Lu, W; Latifi, K; Hoffe, S; Moros, E; Saeed, Nadia; Tan, S; Shridhar, R

2015-01-01

Purpose: To evaluate the role of mid-treatment and post-treatment FDG-PET/CT in predicting progression-free survival (PFS) and distant metastasis (DM) of anal cancer patients treated with chemoradiotherapy (CRT). Methods: 17 anal cancer patients treated with CRT were retrospectively studied. The median prescription dose was 56 Gy (range, 50–62.5 Gy). All patients underwent FDG-PET/CT scans before and after CRT. 16 of the 17 patients had an additional FDG-PET/CT image at 3–5 weeks into the treatment (denoted as mid-treatment FDG-PET/CT). 750 features were extracted from these three sets of scans, which included both traditional PET/CT measures (SUVmax, SUVpeak, tumor diameters, etc.) and spatialtemporal PET/CT features (comprehensively quantify a tumor’s FDG uptake intensity and distribution, spatial variation (texture), geometric property and their temporal changes relative to baseline). 26 clinical parameters (age, gender, TNM stage, histology, GTV dose, etc.) were also analyzed. Advanced analytics including methods to select an optimal set of predictors and a model selection engine, which identifies the most accurate machine learning algorithm for predictive analysis was developed. Results: Comparing baseline + mid-treatment PET/CT set to baseline + posttreatment PET/CT set, 14 predictors were selected from each feature group. Same three clinical parameters (tumor size, T stage and whether 5-FU was held during any cycle of chemotherapy) and two traditional measures (pre- CRT SUVmin and SUVmedian) were selected by both predictor groups. Different mix of spatial-temporal PET/CT features was selected. Using the 14 predictors and Naive Bayes, mid-treatment PET/CT set achieved 87.5% accuracy (2 PFS patients misclassified, all local recurrence and DM patients correctly classified). Post-treatment PET/CT set achieved 94.0% accuracy (all PFS and DM patients correctly predicted, 1 local recurrence patient misclassified) with logistic regression, neural network or

SU-E-J-254: Evaluating the Role of Mid-Treatment and Post-Treatment FDG-PET/CT in Predicting Progression-Free Survival and Distant Metastasis of Anal Cancer Patients Treated with Chemoradiotherapy

Energy Technology Data Exchange (ETDEWEB)

Zhang, H; Wang, J; Chuong, M; D’Souza, W; Choi, W; Lu, W [University of Maryland School of Medicine, Baltimore, MD (United States); Latifi, K; Hoffe, S; Moros, E [Moffitt Cancer Center, Tampa, FL (United States); Saeed, Nadia [Brwon University, Providence, RI (United States); Tan, S [Huazhong University of Science & Technology, Wuhan (China); Shridhar, R [Florida Hospital, Orlando, FL (United States)

2015-06-15

Purpose: To evaluate the role of mid-treatment and post-treatment FDG-PET/CT in predicting progression-free survival (PFS) and distant metastasis (DM) of anal cancer patients treated with chemoradiotherapy (CRT). Methods: 17 anal cancer patients treated with CRT were retrospectively studied. The median prescription dose was 56 Gy (range, 50–62.5 Gy). All patients underwent FDG-PET/CT scans before and after CRT. 16 of the 17 patients had an additional FDG-PET/CT image at 3–5 weeks into the treatment (denoted as mid-treatment FDG-PET/CT). 750 features were extracted from these three sets of scans, which included both traditional PET/CT measures (SUVmax, SUVpeak, tumor diameters, etc.) and spatialtemporal PET/CT features (comprehensively quantify a tumor’s FDG uptake intensity and distribution, spatial variation (texture), geometric property and their temporal changes relative to baseline). 26 clinical parameters (age, gender, TNM stage, histology, GTV dose, etc.) were also analyzed. Advanced analytics including methods to select an optimal set of predictors and a model selection engine, which identifies the most accurate machine learning algorithm for predictive analysis was developed. Results: Comparing baseline + mid-treatment PET/CT set to baseline + posttreatment PET/CT set, 14 predictors were selected from each feature group. Same three clinical parameters (tumor size, T stage and whether 5-FU was held during any cycle of chemotherapy) and two traditional measures (pre- CRT SUVmin and SUVmedian) were selected by both predictor groups. Different mix of spatial-temporal PET/CT features was selected. Using the 14 predictors and Naive Bayes, mid-treatment PET/CT set achieved 87.5% accuracy (2 PFS patients misclassified, all local recurrence and DM patients correctly classified). Post-treatment PET/CT set achieved 94.0% accuracy (all PFS and DM patients correctly predicted, 1 local recurrence patient misclassified) with logistic regression, neural network or

Treatment with active orthodontic appliance in adult patient

OpenAIRE

Radeska, Ana; Radeski, Josif; Zlatanovska, Katerina; Papakoca, Kiro; Zarkova, Julija

2012-01-01

Aim: Showing the efficiency of orthodontic mobile appliance in treatment of adult patient Case summary: The patient A.K. Age 25 years whit forced progenia, bilateral hypodontia of the maxillary incisors and cross bite of 2 mm in front. The patient was treated with active orthodontic appliance whit bitten ridge and down labial arch. The treatment lasted 18 months after which periods is reached normal occlusion with normal overlap in front and closed diastema mediana. The hypodontia of the m...

Machine learning landscapes and predictions for patient outcomes

Science.gov (United States)

Das, Ritankar; Wales, David J.

2017-07-01

The theory and computational tools developed to interpret and explore energy landscapes in molecular science are applied to the landscapes defined by local minima for neural networks. These machine learning landscapes correspond to fits of training data, where the inputs are vital signs and laboratory measurements for a database of patients, and the objective is to predict a clinical outcome. In this contribution, we test the predictions obtained by fitting to single measurements, and then to combinations of between 2 and 10 different patient medical data items. The effect of including measurements over different time intervals from the 48 h period in question is analysed, and the most recent values are found to be the most important. We also compare results obtained for neural networks as a function of the number of hidden nodes, and for different values of a regularization parameter. The predictions are compared with an alternative convex fitting function, and a strong correlation is observed. The dependence of these results on the patients randomly selected for training and testing decreases systematically with the size of the database available. The machine learning landscapes defined by neural network fits in this investigation have single-funnel character, which probably explains why it is relatively straightforward to obtain the global minimum solution, or a fit that behaves similarly to this optimal parameterization.

Treatment of delirium with risperidone in cancer patients.

Science.gov (United States)

Kishi, Yasuhiro; Kato, Masashi; Okuyama, Toru; Thurber, Steven

2012-08-01

Antipsychotic medications have frequently been regarded as the treatment of choice for delirium. This study examined the clinical efficacy of risperidone for the treatment of delirium in cancer patients, combined with a repeated assessment of underlying medical severity levels. The study included consecutive referrals of 29 delirious cancer patients (mean age, 68.9 ± 12.5 years; male, 69%) to the psychiatric consultation service. Risperidone was given orally once per day (mean dosage, 1.4 ± 1.3 mg/day). Study participants were assessed using quantitative standardized scales of cognitive function, delirium, and physical impairment at baseline and at the end of the study (seventh day). Risperidone with routine clinical management was effective for the treatment of delirium: 48% of the patients responded and 38% achieved remission. The reduction of delirium severity occurred in 79% of the patients. Changes in delirium severity were unrelated to age, gender, general cognitive dysfunction, or to severity of attendant medical conditions. In addition to changes in agitation and perceptional disturbances, risperidone was also effective for other specific delirium symptoms. Risperidone with routine clinical management is effective in the treatment of delirium in advanced cancer patients, independent of changes in the underlying medical condition. © 2012 The Authors. Psychiatry and Clinical Neurosciences © 2012 Japanese Society of Psychiatry and Neurology.

Evaluating a patient's request for life-prolonging treatment: an ethical framework.

Science.gov (United States)

Winkler, Eva C; Hiddemann, Wolfgang; Marckmann, Georg

2012-11-01

Contrary to the widespread concern about over-treatment at the end of life, today, patient preferences for palliative care at the end of life are frequently respected. However, ethically challenging situations in the current healthcare climate are, instead, situations in which a competent patient requests active treatment with the goal of life-prolongation while the physician suggests best supportive care only. The argument of futility has often been used to justify unilateral decisions made by physicians to withhold or withdraw life-sustaining treatment. However, we argue that neither the concept of futility nor that of patient autonomy alone is apt for resolving situations in which physicians are confronted with patients' requests for active treatment. Instead, we integrate the relevant arguments that have been put forward in the academic discussion about 'futile' treatment into an ethical algorithm with five guiding questions: (1) Is there a chance that medical intervention will be effective in achieving the patient's treatment goal? (2) How does the physician evaluate the expected benefit and the potential harm of the treatment? (3) Does the patient understand his or her medical situation? (4) Does the patient prefer receiving treatment after evaluating the benefit-harm ratio and the costs? (5) Does the treatment require many resources? This algorithm shall facilitate approaching patients' requests for treatments deemed futile by the physician in a systematic way, and responding to these requests in an ethically appropriate manner. It thereby adds substantive considerations to the current procedural approaches of conflict resolution in order to improve decision making among physicians, patients and families.

Comparison of mania patients suitable for treatment trials versus clinical treatment.

Science.gov (United States)

Talamo, Alessandra; Baldessarini, Ross J; Centorrino, Franca

2008-08-01

It remains uncertain whether bipolar disorder (BPD) patients in randomized-controlled trials (RCTs) are sufficiently representative of clinically encountered patients as to guide clinical-therapeutic practice. We complied inclusion/exclusion criteria by frequency from reports of 21 RCTs for mania, and applied them in a pilot study of patients hospitalized for DSM-IV BPD manic/mixed states to compare characteristics and clinical responses of patients who did versus did not meet exclusion criteria. From 27 initially identified inclusion/exclusion criteria ranked by citation frequency, we derived six inclusion, and 10 non-redundant-exclusion factors. Of 67 consecutive patients meeting inclusion criteria, 15 (22.4%) potential "research subjects" met all 10 exclusion criteria. The remaining 52 "clinical patients" differed markedly on exclusion criteria, including more psychiatric co-morbidity, substance abuse, involuntary hospitalization, and suicide attempts or violence, but were otherwise similar. In both groups responses to clinically determined inpatient treatments were similar, including improvement in mania ratings. Based on applying reported inclusion/exclusion criteria for RCTs to a pilot sample of hospitalized-manic patients, those likely to be included in modern RCTs were similar to patients who would be excluded, most notably in short-term antimanic-treatment responses. The findings encourage further comparisons of subjects included/excluded from RCTs to test potential clinical generalizability of research findings. The pilot study is limited in numbers and exposure times with which to test for the minor differences between "research subjects" and "clinical patients." (c) 2008 John Wiley & Sons, Ltd.

Rapid learning: a breakthrough agenda.

Science.gov (United States)

Etheredge, Lynn M

2014-07-01

A "rapid-learning health system" was proposed in a 2007 thematic issue of Health Affairs. The system was envisioned as one that uses evidence-based medicine to quickly determine the best possible treatments for patients. It does so by drawing on electronic health records and the power of big data to access large volumes of information from a variety of sources at high speed. The foundation for a rapid-learning health system was laid during 2007-13 by workshops, policy papers, large public investments in databases and research programs, and developing learning systems. Challenges now include implementing a new clinical research system with several hundred million patients, modernizing clinical trials and registries, devising and funding research on national priorities, and analyzing genetic and other factors that influence diseases and responses to treatment. Next steps also should aim to improve comparative effectiveness research; build on investments in health information technology to standardize handling of genetic information and support information exchange through apps and software modules; and develop new tools, data, and information for clinical decision support. Further advances will require commitment, leadership, and public-private and global collaboration. Project HOPE—The People-to-People Health Foundation, Inc.

Storytelling and professional learning: a phenomenographic study of students' experience of patient digital stories in nurse education.

Science.gov (United States)

Christiansen, Angela

2011-04-01

This paper reports the findings of a phenomenographic study which sought to identify the different ways in which patient digital stories influence students' professional learning. Patient digital stories are short multimedia presentations that combine personal narratives, images and music to create a unique and often emotional story of a patients' experience of health care. While these are increasingly used in professional education little is known about how and what students learn through engagement with patient digital stories. Drawing upon interviews with 20 students within a pre-registration nursing programme in the UK, the study identifies four qualitatively different ways in which students approach and make sense of patient digital stories with implications for learning and professional identity development. Through an identification of the critical aspects of this variation valuable insights are generated into the pedagogic principles likely to engender transformational learning and patient centred practice. Copyright © 2010 Elsevier Ltd. All rights reserved.

Diagnostics and treatment of patients with polycystic ovary syndrome

Directory of Open Access Journals (Sweden)

Nataša Vrhkar

2018-02-01

Full Text Available Background. Polycystic ovary syndrome (PCOS is the most common female endocrinopathy of reproductive age affecting 15–22 % of women according to European standards. It is a multisystem reproductive-metabolic disorder and its diagnostics and treatment remain controversial. Women with PCOS are at increased risk of developing type II diabetes, metabolic syndrome, cardiovascular disease, depression, non-alcoholic fatty liver disease, endometrial hyperplasia and cancer and few other types of carcinoma. Due to all above, early correct diagnosis, treatment and permanent surveillance of PCOS are of great importance. The main difficulty with diagnosis of PCOS was until recently lack of clear diagnostic criteria. In 2003 the European Society for Human Reproduction and Embryology and the American Society for Reproductive Medicine published a definition of PCOS. For a diagnosis of PCOS two of three criteria have to be met: oligo- or chronic anovulation (less than 8 menses per year or menses that occur at intervals greater than 35 days, clinical or biochemical signs of hyperandrogenism (alopecia, hirsutism, seborrhoea, acne, virilism, polycystyc ovaries seen on vaginal ultrasound (VUS (presence of 12 or more follicles in both ovaries measuring 2–9 mm in diameter and/or ovarian volume larger than 10 cm3 of either or both ovaries. Exclusion of other diseases with similar clinical presentation is necessary. Treatment depends on the age of the patient, predominating clinical signs and aim we try to achieve. First-line treatment for all patients includes life-style changes and weight reduction in obese patients. Management of adolescent patients is aimed at abolishment of menses irregularity and endometrial protection, treatment of hyperandrogenism, obesity, and insulin resistance (IR. In the first-line treatment we also recommend oral hormonal contraceptives (OHC with non-androgenic gestagens (NG with or without antiandrogens (AA and topical dermatological

[Adherence to pharmacological treatment in adult patients undergoing hemodialysis].

Science.gov (United States)

Sgnaolin, Vanessa; Figueiredo, Ana Elizabeth Prado Lima

2012-06-01

Adherence to treatment in patients on hemodialysis is not a simple process. Strategies to promote adherence will meet the need for improvements in the process of orientation concerning the disease and its pharmacological treatment. To identify compliance with pharmacological treatment of patients on hemodialysis and the main factors related to it we used the Adherence Scale. Observational, descriptive and cross-sectional study. Interviews were conducted to collect socioeconomic, pharmacological data, as well as those regarding self-reported adherence to drug. Out of the 65 participants, 55.4% showed non-compliance. The mean number of drugs used was 4.1 ± 2.5 (self-report) and 6.2 ± 3.0 (prescription). Statistical analysis showed significant differences concerning compliance at different ages (> 60 years are more adherent). A significant proportion of patients have difficulty to comply with treatment and the main factor was forgetfulness. Regarding age, elderly patients are more adherent to treatment. The low level of knowledge about the used drugs may be one of the reasons for the lack of adherence, and the patient's orientation process by a team of multiprofessionals involved in assisting is a strategy to promote adherence.

Collaborative work and medical talk: opportunities for learning through knowledge sharing.

Science.gov (United States)

Nilsen, Line Lundvoll; Ludvigsen, Sten R

2010-01-01

Teleconsultations provide new opportunities for learning in medical settings. This study explores the conditions under which learning among physicians takes place. The empirical context is 47 real-time video conferences carried out to examine collaborative work and the medical talk involved. Sixteen of the observations were consultations wherein general practitioners (GPs) and specialists shared knowledge with the purpose of solving a medical problem related to a patient under treatment. In this exploratory study, the learning opportunities are seen as what medical practitioners with different types of expertise achieve through interaction while working with patients over periods of time. The analysis of medical talk in consultations shows that collaborative work among GPs and specialists creates a shared understanding of the patient's clinical history and treatment trajectory. As knowledge is demanded and attributed and gaps of knowledge become shared, consultations create a work tool that expands the medical work and talk. Collaborative work in and between different levels of the health care service expands knowledge, creates opportunities for learning in everyday settings, and improves the quality of knowledge distribution in the health care system.

EVALUATION OF TREATMENT FOR ELDERLY PATIENTS WITH MULTIPLEMYELOMA

Directory of Open Access Journals (Sweden)

Amela Kobaklić

2008-04-01

The result of our study indicates that combination chemotherapy with thalidomide iseffective treatment for elderly patients with multiple myeloma. Thalidomide in combination with other medications significantly extended medial overall survival, thereforthalidomide should be the reference treatment for elderly patients with multiple myelomafor the time being.Compering overall survival among different treatment centers we observed better survivalin our clinic, nevertheless multiple myeloma is stil a disease with severe prognosis. Withthat in mind we have high hopes for treating multiple myeloma with introduction of newdrugs (bortezomib, lenalomid

Testing of a Model with Latino Patients That Explains the Links Among Patient-Perceived Provider Cultural Sensitivity, Language Preference, and Patient Treatment Adherence.

Science.gov (United States)

Nielsen, Jessica D Jones; Wall, Whitney; Tucker, Carolyn M

2016-03-01

Disparities in treatment adherence based on race and ethnicity are well documented but poorly understood. Specifically, the causes of treatment nonadherence among Latino patients living in the USA are complex and include cultural and language barriers. The purpose of this study was to examine whether patients' perceptions in patient-provider interactions (i.e., trust in provider, patient satisfaction, and patient sense of interpersonal control in patient-provider interactions) mediate any found association between patient-perceived provider cultural sensitivity (PCS) and treatment adherence among English-preferred Latino (EPL) and Spanish-preferred Latino (SPL) patients. Data from 194 EPL patients and 361 SPL patients were obtained using questionnaires. A series of language-specific structural equation models were conducted to test the relationship between patient-perceived PCS and patient treatment adherence and the examined mediators of this relationship among the Latino patients. No significant direct effects of patient-perceived PCS on general treatment adherence were found. However, as hypothesized, several significant indirect effects emerged. Preferred language appeared to have moderating effects on the relationships between patient-perceived PCS and general treatment adherence. These results suggest that interventions to promote treatment adherence among Latino patients should likely include provider training to foster patient-defined PCS, trust in provider, and patient satisfaction with care. Furthermore, this training needs to be customized to be suitable for providing care to Latino patients who prefer speaking Spanish and Latino patients who prefer speaking English.

Management strategy for patients with gastroesophageal reflux disease: a comparison between empirical treatment with esomeprazole and endoscopy-oriented treatment.

Science.gov (United States)

Giannini, Edoardo G; Zentilin, Patrizia; Dulbecco, Pietro; Vigneri, Sergio; Scarlata, Pamela; Savarino, Vincenzo

2008-02-01

Whether patients with typical gastroesophageal reflux disease (GERD) symptoms and without alarm features should be treated empirically or undergo endoscopy first is a debated issue. In this study, our aim was to assess the efficacy, and to compare the direct costs and impact on health-related quality of life (HRQL), of two treatment strategies (empirical vs endoscopy-oriented treatment) in a large population of patients with GERD. In total, 612 patients were randomized to either empirical treatment with esomeprazole 40 mg once daily (od) (group 1, N = 309) or endoscopy and treatment according to endoscopic findings (group 2, N = 303, esomeprazole 40 mg od in patients with reflux esophagitis and esomeprazole 20 mg od in patients without esophagitis) for 4 wk, followed by esomeprazole 20 mg od maintenance treatment in both groups. Direct costs and HRQL were analyzed in both treatment arms. At the end of the acute treatment phase (week 4), 267 patients in group 1 (86.4%) and 265 patients in group 2 (87.5%) were considered responders to treatment (intention-to-treat analysis, P= 0.878). Empirical treatment proved to be cost-effective by saving 38.72 euros per treated patient. At the end of the maintenance phase (week 24), a similar proportion of patients responded to treatment in the two groups (71.8%vs 68.3%, P= 0.389). HRQL improved from baseline to week 24 in both groups (difference between study groups not significant). In patients with GERD, empirical treatment with esomeprazole proved to be cost-effective compared with endoscopy-oriented treatment, and did not negatively affect patient HRQL. These results should be taken into account in the management of GERD patients in clinical practice.

Motor skill learning and offline-changes in TGA patients with acute hippocampal CA1 lesions.

Science.gov (United States)

Döhring, Juliane; Stoldt, Anne; Witt, Karsten; Schönfeld, Robby; Deuschl, Günther; Born, Jan; Bartsch, Thorsten

2017-04-01

Learning and the formation of memory are reflected in various memory systems in the human brain such as the hippocampus based declarative memory system and the striatum-cortex based system involved in motor sequence learning. It is a matter of debate how both memory systems interact in humans during learning and consolidation and how this interaction is influenced by sleep. We studied the effect of an acute dysfunction of hippocampal CA1 neurons on the acquisition (on-line condition) and off-line changes of a motor skill in patients with a transient global amnesia (TGA). Sixteen patients (68 ± 4.4 yrs) were studied in the acute phase and during follow-up using a declarative and procedural test, and were compared to controls. Acute TGA patients displayed profound deficits in all declarative memory functions. During the acute amnestic phase, patients were able to acquire the motor skill task reflected by increasing finger tapping speed across the on-line condition, albeit to a lesser degree than during follow-up or compared to controls. Retrieval two days later indicated a greater off-line gain in motor speed in patients than controls. Moreover, this gain in motor skill performance was negatively correlated to the declarative learning deficit. Our results suggest a differential interaction between procedural and declarative memory systems during acquisition and consolidation of motor sequences in older humans. During acquisition, hippocampal dysfunction attenuates fast learning and thus unmasks the slow and rigid learning curve of striatum-based procedural learning. The stronger gains in the post-consolidation condition in motor skill in CA1 lesioned patients indicate a facilitated consolidation process probably occurring during sleep, and suggest a competitive interaction between the memory systems. These findings might be a reflection of network reorganization and plasticity in older humans and in the presence of CA1 hippocampal pathology. Copyright © 2016

Treatment with Ziprasidone for schizophrenia patients with OCD.

Science.gov (United States)

Juven-Wetzler, Alzbeta; Fostick, Leah; Cwikel-Hamzany, Shlomit; Balaban, Evgenya; Zohar, Joseph

2014-09-01

Comorbidity of obsessive-compulsive disorder (OCD) has been observed in about 15% of schizophrenic patients and has been associated with poor prognosis. Therefore, there is a need for specific treatment options for these patients (schizo-obsessive, ScOCD). This is an open, prospective study, aiming to test the efficacy of Ziprasidone (80-200mg/d) in ScOCD patients and comparing the response to the treatment between stable schizophrenic (N=16) and stable ScOCD (N=29) patients. Treatment effect with Ziprasidone was different in schizophrenic patients when stratified based on OCD comorbidity. Overall, the effect on OCD symptoms (as measured by the Yale Brown Obsessive Compulsive Scale, YBOCS) was found to be bimodal-either no response or exacerbation (for 45% of the patients, n=13) or significant improvement of symptoms (55%, n=16). Those who improved in OCD symptoms, improved also in negative and general schizophrenia symptoms, while ScOCD-unimproved group worsened in all symptoms. Whereas schizophrenic patients without OCD responded in a modest Gaussian distribution, they improved in schizophrenia negative symptoms and in general anxiety. This data suggests that schizo-obsessive disorder is a distinct and complex condition with more than one underlying pathogenesis. Definition of these ScOCD subgroups defined by their response to Ziprasidone might contribute to personalized medicine within the OCD-schizophrenia spectrum. Moreover, this finding suggests that ScOCD may be considered as a special schizophrenic subtype and its inclusion in schizophrenia treatment studies need to be further explored due to its divergent response. Copyright © 2014. Published by Elsevier B.V.

Social learning: medical student perceptions of geriatric house calls.

Science.gov (United States)

Abbey, Linda; Willett, Rita; Selby-Penczak, Rachel; McKnight, Roberta

2010-01-01

Bandura's social learning theory provides a useful conceptual framework to understand medical students' perceptions of a house calls experience at Virginia Commonwealth University School of Medicine. Social learning and role modeling reflect Liaison Committee on Medical Education guidelines for "Medical schools (to) ensure that the learning environment for medical students promotes the development of explicit and appropriate professional attributes (attitudes, behaviors, and identity) in their medical students." This qualitative study reports findings from open-ended survey questions from 123 medical students who observed a preceptor during house calls to elderly homebound patients. Their comments included reflections on the medical treatment as well as interactions with family and professional care providers. Student insights about the social learning process they experienced during house calls to geriatric patients characterized physician role models as dedicated, compassionate, and communicative. They also described patient care in the home environment as comprehensive, personalized, more relaxed, and comfortable. Student perceptions reflect an appreciation of the richness and complexity of details learned from home visits and social interaction with patients, families, and caregivers.