Renal denervation in patients with resistant hypertension: six-month results.

Science.gov (United States)

Dores, Hélder; de Sousa Almeida, Manuel; de Araújo Gonçalves, Pedro; Branco, Patrícia; Gaspar, Augusta; Sousa, Henrique; Canha Gomes, Angela; Andrade, Maria João; Carvalho, Maria Salomé; Campante Teles, Rui; Raposo, Luís; Mesquita Gabriel, Henrique; Pereira Machado, Francisco; Mendes, Miguel

2014-04-01

Increased activation of the sympathetic nervous system plays a central role in the pathophysiology of hypertension (HTN). Catheter-based renal denervation (RDN) was recently developed for the treatment of resistant HTN. To assess the safety and efficacy of RDN for blood pressure (BP) reduction at six months in patients with resistant HTN. In this prospective registry of patients with essential resistant HTN who underwent RDN between July 2011 and May 2013, the efficacy of RDN was defined as ≥ 10 mm Hg reduction in office systolic blood pressure (SBP) six months after the intervention. In a resistant HTN outpatient clinic, 177 consecutive patients were evaluated, of whom 34 underwent RDN (age 62.7 ± 7.6 years; 50.0% male). There were no vascular complications, either at the access site or in the renal arteries. Of the 22 patients with complete six-month follow-up, the response rate was 81.8% (n=18). The mean office SBP reduction was 22 mm Hg (174 ± 23 vs. 152 ± 22 mm Hg; p<0.001) and 9 mm Hg in diastolic BP (89 ± 16 vs. 80 ± 11 mm Hg; p=0.006). The number of antihypertensive drugs (5.5 ± 1.0 vs. 4.6 ± 1.1; p=0.010) and pharmacological classes (5.4 ± 0.7 vs. 4.6 ± 1.1; p=0.009) also decreased significantly. Of the 24-hour ambulatory BP monitoring and echocardiographic parameters analyzed, there were significant reductions in diastolic load (45 ± 29 vs. 27 ± 26%; p=0.049) and in left ventricular mass index (174 ± 56 vs. 158 ± 60 g/m(2); p=0.014). In this cohort of patients with resistant HTN, RDN was safe and effective, with a significant BP reduction at six-month follow-up. Copyright © 2013 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

Treatment of port-wine stains with flash lamp pumped pulsed dye laser on Indian skin: A six year study

Directory of Open Access Journals (Sweden)

Chandroth Ponnambath Thajudheen

2014-01-01

Full Text Available Context: Port-wine stain (PWS is one of the commonly encountered congenital cutaneous vascular lesions, with an equal sex distribution. Pulsed dye lasers (PDL have revolutionized the treatment of both congential and acquired cutaneous vascular lesions. The pulsed dye lasers owing to its superior efficacy and safety profile have become the gold standard for the management of port-wine stains. Aims: To evaluate the efficacy and side effects of pulsed dye laser for the management of Port-wine stain on Indian skin. Materials and Methods: Seventy five patients of Fitzpatrick skin types IV&V with PWS underwent multiple treatments with PDL (V beam-Candela over a period of six years at monthly intervals. Laser parameters were wavelength 595nm, spot sizes 7-10mm, fluence 6-12 j/cm2, pulse duration 0.45-10ms, along with cryogen cooling. Serial photographs were taken before and after every session. Clinical improvement scores of comparable photographs using a quartile grading (o=80% were judged independently by two dermatologists after the series of treatment. Minimum number of treatments was 6 and maximum 17.They were followed up at six monthly intervals to observe re darkening of PWS. Results: No patient showed total clearance.Grade3 improvement was observed in 70 % of children and 50% of adults after 8-10 sessions. Children showed better and faster response than adults. Thirty percent of patients developed post inflammatory hyper pigmentation which resolved over a period of six to eight weeks. Two patients had superficial scarring due to stacking of pulses. None of the patients showed re darkening of PWS till now. Conclusion: Pulsed dye laser is an effective and safe treatment for port-wine stain in Indian skin.

Readability evaluation of Internet-based patient education materials related to the anesthesiology field.

Science.gov (United States)

De Oliveira, Gildasio S; Jung, Michael; Mccaffery, Kirsten J; McCarthy, Robert J; Wolf, Michael S

2015-08-01

The main objective of the current investigation was to assess the readability of Internet-based patient education materials related to the field of anesthesiology. We hypothesized that the majority of patient education materials would not be written according to current recommended readability grade level. Online patient education materials describing procedures, risks, and management of anesthesia-related topics were identified using the search engine Google (available at www.google.com) using the terms anesthesia, anesthesiology, anesthesia risks, and anesthesia care. Cross-sectional evaluation. None. Assessments of content readability were performed using validated instruments (Flesch-Kincaid Grade Formulae, the Gunning Frequency of Gobbledygook, the New Dale-Chall Test, the Fry graph, and the Flesch Reading Ease score). Ninety-six Web sites containing Internet patient education materials (IPEMs) were evaluated. The median (interquartile range) readability grade level for all evaluated IPEMs was 13.5 (12.0-14.6). All the evaluated documents were classified at a greater readability level than the current recommended readability grade, P Internet-based patient education materials related to the field of anesthesiology are currently written far above the recommended readability grade level. High complexity of written education materials likely limits access of information to millions of American patients. Redesign of online content of Web sites that provide patient education material regarding anesthesia could be an important step in improving access to information for patients with poor health literacy. Copyright © 2015 Elsevier Inc. All rights reserved.

Folate and folic acid in the periconceptional period: recommendations from official health organizations in thirty-six countries worldwide and WHO.

Science.gov (United States)

Gomes, Sandra; Lopes, Carla; Pinto, Elisabete

2016-01-01

To summarize the recommendations on folate intake and folic acid supplementation and fortification in the periconceptional period, aimed at prevention of neural tube defects (NTD), provided by official health organizations in different countries worldwide and WHO. Information on recommendations for folate and folic acid intake in the periconceptional period was gathered from the websites of official national health organizations of several countries worldwide and from the WHO website. WHO, selected developed countries and emerging economies, totalling thirty-six countries worldwide (some European, BRICS, G8, Asian Tiger/Asian Dragon and Australia). Recommendations differ between countries, although the majority (69·4 %) recommend a healthy diet plus a folic acid supplement of 400 µg/d from preconception (4-12 weeks) until the end of the first trimester of pregnancy (8-12 weeks). The same recommendation is issued by the WHO. Dosages for women at high risk of NTD are up to 4-5 mg/d (for 41·7 % of studied countries). The recommended intake for folate is in the range of 300-400 µg/d for women of childbearing age and 500-600 µg/d for pregnant women in different countries and WHO. Five countries emphasize the importance of a healthy diet rendering supplementation needless. By contrast, five others advise a healthy diet and supplementation plus mandatory fortification. Only one mentions the importance of ensuring an adequate folate status and refers to checking with a health-care provider on the need for supplements. Different recommendations regarding folate and folic acid, seeking NTD prevention, are available worldwide; however, most countries and WHO focus on a healthy diet and folic acid supplementation of 400 µg/d periconceptionally.

Economic evaluation of closure cap barrier materials study

Energy Technology Data Exchange (ETDEWEB)

Serrato, M.G.; Bhutani, J.S.; Mead, S.M.

1993-09-01

Volume II of the Economic Evaluation of the Closure Cap Barrier Materials, Revision I contains detailed cost estimates for closure cap barrier materials. The cost estimates incorporate the life cycle costs for a generic hazardous waste seepage basin closure cap under the RCRA Post Closure Period of thirty years. The economic evaluation assessed six barrier material categories. Each of these categories consists of several composite cover system configurations, which were used to develop individual cost estimates. The information contained in this report is not intended to be used as a cost estimating manual. This information provides the decision makers with the ability to screen barrier materials, cover system configurations, and identify cost-effective materials for further consideration.

Economic evaluation of closure cap barrier materials study

International Nuclear Information System (INIS)

Serrato, M.G.; Bhutani, J.S.; Mead, S.M.

1993-09-01

Volume II of the Economic Evaluation of the Closure Cap Barrier Materials, Revision I contains detailed cost estimates for closure cap barrier materials. The cost estimates incorporate the life cycle costs for a generic hazardous waste seepage basin closure cap under the RCRA Post Closure Period of thirty years. The economic evaluation assessed six barrier material categories. Each of these categories consists of several composite cover system configurations, which were used to develop individual cost estimates. The information contained in this report is not intended to be used as a cost estimating manual. This information provides the decision makers with the ability to screen barrier materials, cover system configurations, and identify cost-effective materials for further consideration

Using Six Sigma methodology to reduce patient transfer times from floor to critical-care beds.

Science.gov (United States)

Silich, Stephan J; Wetz, Robert V; Riebling, Nancy; Coleman, Christine; Khoueiry, Georges; Abi Rafeh, Nidal; Bagon, Emma; Szerszen, Anita

2012-01-01

In response to concerns regarding delays in transferring critically ill patients to intensive care units (ICU), a quality improvement project, using the Six Sigma process, was undertaken to correct issues leading to transfer delay. To test the efficacy of a Six Sigma intervention to reduce transfer time and establish a patient transfer process that would effectively enhance communication between hospital caregivers and improve the continuum of care for patients. The project was conducted at a 714-bed tertiary care hospital in Staten Island, New York. A Six Sigma multidisciplinary team was assembled to assess areas that needed improvement, manage the intervention, and analyze the results. The Six Sigma process identified eight key steps in the transfer of patients from general medical floors to critical care areas. Preintervention data and a root-cause analysis helped to establish the goal transfer-time limits of 3 h for any individual transfer and 90 min for the average of all transfers. The Six Sigma approach is a problem-solving methodology that resulted in almost a 60% reduction in patient transfer time from a general medical floor to a critical care area. The Six Sigma process is a feasible method for implementing healthcare related quality of care projects, especially those that are complex. © 2011 National Association for Healthcare Quality.

A six-gene signature predicts survival of patients with localized pancreatic ductal adenocarcinoma.

Directory of Open Access Journals (Sweden)

Jeran K Stratford

2010-07-01

Full Text Available Pancreatic ductal adenocarcinoma (PDAC remains a lethal disease. For patients with localized PDAC, surgery is the best option, but with a median survival of less than 2 years and a difficult and prolonged postoperative course for most, there is an urgent need to better identify patients who have the most aggressive disease.We analyzed the gene expression profiles of primary tumors from patients with localized compared to metastatic disease and identified a six-gene signature associated with metastatic disease. We evaluated the prognostic potential of this signature in a training set of 34 patients with localized and resected PDAC and selected a cut-point associated with outcome using X-tile. We then applied this cut-point to an independent test set of 67 patients with localized and resected PDAC and found that our signature was independently predictive of survival and superior to established clinical prognostic factors such as grade, tumor size, and nodal status, with a hazard ratio of 4.1 (95% confidence interval [CI] 1.7-10.0. Patients defined to be high-risk patients by the six-gene signature had a 1-year survival rate of 55% compared to 91% in the low-risk group.Our six-gene signature may be used to better stage PDAC patients and assist in the difficult treatment decisions of surgery and to select patients whose tumor biology may benefit most from neoadjuvant therapy. The use of this six-gene signature should be investigated in prospective patient cohorts, and if confirmed, in future PDAC clinical trials, its potential as a biomarker should be investigated. Genes in this signature, or the pathways that they fall into, may represent new therapeutic targets. Please see later in the article for the Editors' Summary.

Piribedil and pathological gambling in six parkinsonian patients.

Science.gov (United States)

Micheli, Federico E; Giugni, Juan C; Espinosa, Micke E De Arco; Calvo, Daniela S; Raina, Gabriela B

2015-02-01

Impulse control disorders (ICD) in Parkinson's disease (PD) have attracted increasing interest. They are characterized by the inability to control the impulse to perform an act that can be detrimental to them or to others. Although dopamine agonists (DA), as a group, have been associated with impulse control disorders (ICD), piribedil has rarely been reported to cause them. Case reports of six parkinsonian patients on piribedil presenting pathological gambling (PG). All of the patients presented ICD associated with piribedil use. Two of them received this medication as first treatment and four of them who had developed ICDs secondary to other DA that reappeared with piribedil. Despite piribedil is commercially available in only a few countries, it should be considered in the differential diagnosis of PG in patients with PD.

Piribedil and Pathological Gambling in six Parkinsonian patients

Directory of Open Access Journals (Sweden)

Federico E. Micheli

2015-02-01

Full Text Available Impulse control disorders (ICD in Parkinson's disease (PD have attracted increasing interest. They are characterized by the inability to control the impulse to perform an act that can be detrimental to them or to others. Although dopamine agonists (DA, as a group, have been associated with impulse control disorders (ICD, piribedil has rarely been reported to cause them. Method Case reports of six parkinsonian patients on piribedil presenting pathological gambling (PG. Results All of the patients presented ICD associated with piribedil use. Two of them received this medication as first treatment and four of them who had developed ICDs secondary to other DA that reappeared with piribedil. Conclusion Despite piribedil is commercially available in only a few countries, it should be considered in the differential diagnosis of PG in patients with PD.

Klebsiella Pneumoniae Liver Abscess: A Case Series of Six Asian Patients.

Science.gov (United States)

Oikonomou, Katerina G; Aye, Myint

2017-09-26

BACKGROUND Liver abscesses represent a serious infection of hepatic parenchyma and are associated with significant morbidity and mortality. The emergence of a new hypervirulent variant of Klebsiella pneumoniae, which can cause serious infections in the Asian population, is under investigation. We report a case series of six Asian patients hospitalized at our institution from January 2013 to November 2015 for liver abscess due to Klebsiella pneumoniae. CASE REPORT Charts of six Asian patients were retrospectively reviewed. Four patients were male and two were female. The mean age was 53 years (range: 35-64 years). All patients had no known past medical history of immunodeficiency. Three patients had multiple liver abscesses at the time of initial presentation. In five patients, the source of entry of the pathogenic microorganism was unknown and in one patient the suspected source of entry was the gastrointestinal tract. In three patients there was also concomitant Klebsiella pneumoniae bacteremia. The mean duration of antibiotic treatment was seven weeks and the mean duration of hospital stay was 13.5 days. CONCLUSIONS Liver abscess should always be included in the differential diagnosis in cases of sepsis without obvious source and/or in the clinical scenarios of fever, abdominal pain, and liver lesions.

Older patients can accurately recall their preoperative health status six weeks following total hip arthroplasty.

Science.gov (United States)

Marsh, Jackie; Bryant, Dianne; MacDonald, Steven J

2009-12-01

In clinical trials, use of patient recall data would be beneficial when the collection of baseline data is impossible, such as in trauma situations. We investigated the ability of older patients to accurately recall their preoperative quality of life, function, and general health status at six weeks following total hip arthroplasty. We randomized consecutive patients who were fifty-five years of age or older into two groups. At each assessment, patients completed self-report questionnaires (at four weeks preoperatively, on the day of surgery, and at six weeks and three months postoperatively for Group 1 and at six weeks and three months postoperatively for Group 2). At six weeks postoperatively, all patients completed the questionnaires on the basis of their recollection of their preoperative health status. We evaluated the validity and reliability of recall ratings, the degree of error in recall ratings, and the effects of the use of recall data on power and sample size requirements. A total of 174 patients (mean age, seventy-one years) who were undergoing either primary or revision total hip arthroplasty were randomized and included in the analysis (118 patients were in Group 1 and fifty-six were in Group 2). Agreement between actual and recalled data was excellent for disease-specific questionnaires (intraclass correlation coefficient, 0.86, 0.87, and 0.88) and moderate for generic health measures (intraclass correlation coefficient, 0.48, 0.58, and 0.60). Increased error associated with recalled ratings compared with actual ratings necessitates minimal increases in sample size or results in small decreases in power. Patients undergoing total hip arthroplasty can accurately recall their preoperative health status at six weeks postoperatively.

The meaning of pharmacological treatment for schizophrenic patients.

Science.gov (United States)

Vedana, Kelly Graziani Giacchero; Miasso, Adriana Inocenti

2014-01-01

to understand the meaning of medication therapy for schizophrenic patients and formulate a theoretical model about the study phenomenon. a qualitative approach was employed, using Symbolic Interactionism as the theoretical and Grounded Theory as the methodological framework. The research was developed between 2008 and 2010 at three community mental health services in the interior of the State of São Paulo - Brazil. Thirty-six patients and thirty-six family members were selected through theoretical sampling. The data were mainly collected through open interviews and observation and simultaneously analyzed through open, axial and selective coding. the meaning of the pharmacotherapy is centered on the phenomenon "Living with a help that bothers", which expresses the patients' ambivalence towards the medication and determines their decision making. The insight, access, limitations for self-administration of the drugs and interactions with family members and the health team influenced the patient's medication-related behavior. the theory presented in this study provides a comprehensive, contextualized, motivational and dynamic understanding of the relation the patient experiences and indicates potentials and barriers to follow the medication treatment.

Treatment strategy for trigeminal neuralgia: a thirty years experience.

Science.gov (United States)

Broggi, Giovanni; Ferroli, Paolo; Franzini, Angelo

2008-05-01

Trigeminal neuralgia is an invalidating disease when become drug-resistant. The only possible treatment is surgery with different modalities, percutaneous, open surgery or radiosurgery. The thirty years experience at the Fondazione Istituto Neurologico C. Besta, Milano, Italy suggests that these surgical strategies are successful in pain control in short and long term period in more than 90% of cases, with a low rate of side effects and high improvement of quality of life. The type of surgery should be tailored on the particular patient considering age, general physical condition, neuroradiological assessment in which MRI with dedicated sequences are mandatory, and also patient's attitude.

Preferences of Freestall Housed Dairy Cows to Different Bedding Materials

OpenAIRE

MITEV, Jurii; VARLYAKOV, Ivan; MITEVA, Tchonka; VASILEV, Nasko; GERGOVSKA, Jivka; UZUNOVA, Krassimira; DIMOVA, Vania

2012-01-01

ABSTRACT The purpose of this study was to examine the behaviour of dairy cows during the rest periods and their preferences to different bedding materials with limited amount of straw as well as the hygienic score of dairy cows. Thirty-six Holstein dairy cows at the first to fourth lactation with live weight 610±58 kg and milk yield of 7364±1202 liter for 305 days of lactation were used for the experiment. Three types of bedding materials were used for the preference tes...

Intoxication by star fruit (Averrhoa carambola) in six dialysis patients? (Preliminary report)

Science.gov (United States)

Neto, M M; Robl, F; Netto, J C

1998-03-01

We observed six cases of patients in a dialysis programme who were apparently intoxicated by ingestion of star fruit. After ingestion of 2-3 fruits or 150-200 ml of the fruit juice, the six patients, who had previously been stable in a regular dialysis programme, developed a variety of symptoms ranging from insomnia and hiccups to agitation, mental confusion and (in one case) death. In preliminary investigations to characterize the hypothetical neurotoxin in the fruit, an extract, when injected intraperitoneally or intracerebroventricularly in rats, provoked persistent convulsions of the tonic-clonic type. It appears that star fruit (Averrhoa carambola) contains an excitatory neurotoxin. Patients with renal failure on conservative or dialysis treatment should be dissuaded from ingestion of the fruit.

Comparative analysis of online patient education material pertaining to hepatitis and its complications.

Science.gov (United States)

Gulati, Rishabh; Nawaz, Mohammad; Pyrsopoulos, Nikolaos T

2016-05-01

Approximately 50% of patients leave the doctor's office with a poor understanding of their diagnosis. Online patient education websites are becoming a major source of information for many of the patients. Here, we determine the reading grade level of online patient education materials on hepatitis B, hepatitis C, cirrhosis, and hepatocellular cancer and compare it with the National Institutes of Health-recommended reading grade level of sixth to seventh grade or under. A Google search was performed to retrieve patient reading materials. Text was modified to remove medical terms that were defined within the article. Documents were then divided into categories of introduction, risk factors, symptoms, diagnosis, treatment, and prevention. Each document was then analyzed using six validated readability tests to determine the grade level and complexity on the basis of the number of words, syllables, or number of uncommon words. Modified documents had a mean readability score of 10.23, although the recommended score is less than 7.0. Cirrhosis had the highest reading grade level, with a median of 11.3, whereas hepatitis B and hepatocellular carcinoma had the easiest readability, with a median of 9.5. Furthermore, treatment subsection was the most difficult, with a median score of 10.8. Patient reading materials reviewed in this study were written well above the recommended reading grade level. These findings suggest review of patient education materials in an effort to close the gap between the average reading level and the reading materials.

Gastroscopic screening in 80 patients with pernicious anaemia.

OpenAIRE

Stockbrügger, R W; Menon, G G; Beilby, J O; Mason, R R; Cotton, P B

1983-01-01

We have studied 80 patients with pernicious anaemia. Upper gastrointestinal endoscopy (with biopsy and cytology) showed no lesion other than atrophic gastritis in 34 patients. Thirty three patients, however, had varying degrees of gastric mucosal dysplasia, which was detected more frequently by histology than by cytology. The endoscopic appearance of the mucosa was abnormal in four of the six patients with moderate dysplasia, and in all three patients with severe dysplasia. One patient was fo...

Two Hundred Thirty-Six Children With Developmental Hydrocephalus: Causes and Clinical Consequences.

Science.gov (United States)

Tully, Hannah M; Ishak, Gisele E; Rue, Tessa C; Dempsey, Jennifer C; Browd, Samuel R; Millen, Kathleen J; Doherty, Dan; Dobyns, William B

2016-03-01

Few systematic assessments of developmental forms of hydrocephalus exist. We reviewed magnetic resonance images (MRIs) and clinical records of patients with infancy-onset hydrocephalus. Among 411 infants, 236 had hydrocephalus with no recognizable extrinsic cause. These children were assigned to 1 of 5 subtypes and compared on the basis of clinical characteristics and developmental and surgical outcomes. At an average age of 5.3 years, 72% of children were walking independently and 87% could eat by mouth; in addition, 18% had epilepsy. Distinct patterns of associated malformations and syndromes were observed within each subtype. On average, children with aqueductal obstruction, cysts, and encephaloceles had worse clinical outcomes than those with other forms of developmental hydrocephalus. Overall, 53% of surgically treated patients experienced at least 1 shunt failure, but hydrocephalus associated with posterior fossa crowding required fewer shunt revisions. We conclude that each subtype of developmental hydrocephalus is associated with distinct clinical characteristics, syndromology, and outcomes, suggesting differences in underlying mechanisms. © The Author(s) 2015.

Neuroleptic induced tardive dyskinesa in a patient on treatment for ...

African Journals Online (AJOL)

In this case, a thirty six year old patient on treatment for schizophrenia is described with severe tardive dyskinesia. The most likely cause is long term treatment with two highly potent typical antipsychotic medications. The patient was initially treated with Benzhexol, an anticholinergic agent with the potential to induce or ...

The meaning of pharmacological treatment for schizophrenic patients

Directory of Open Access Journals (Sweden)

Kelly Graziani Giacchero Vedana

2014-08-01

Full Text Available OBJECTIVE: to understand the meaning of medication therapy for schizophrenic patients and formulate a theoretical model about the study phenomenon.METHOD: a qualitative approach was employed, using Symbolic Interactionism as the theoretical and Grounded Theory as the methodological framework. The research was developed between 2008 and 2010 at three community mental health services in the interior of the State of São Paulo - Brazil. Thirty-six patients and thirty-six family members were selected through theoretical sampling. The data were mainly collected through open interviews and observation and simultaneously analyzed through open, axial and selective coding.RESULTS: the meaning of the pharmacotherapy is centered on the phenomenon "Living with a help that bothers", which expresses the patients' ambivalence towards the medication and determines their decision making. The insight, access, limitations for self-administration of the drugs and interactions with family members and the health team influenced the patient's medication-related behavior.CONCLUSION: the theory presented in this study provides a comprehensive, contextualized, motivational and dynamic understanding of the relation the patient experiences and indicates potentials and barriers to follow the medication treatment.

The First Six Years of Building and Implementing a Return-to-Work Service for Patients with Acquired Brain Injury. The Rapid-Return-to-Work-Cohort-Study.

Science.gov (United States)

Haveraaen, L; Brouwers, E P M; Sveen, U; Skarpaas, L S; Sagvaag, H; Aas, R W

2017-12-01

Background and objective Despite large activity worldwide in building and implementing new return-to-work (RTW) services, few studies have focused on how such implementation processes develop. The aim of this study was to examine the development in patient and service characteristics the first six years of implementing a RTW service for persons with acquired brain injury (ABI). Methods The study was designed as a cohort study (n=189). Data were collected by questionnaires, filled out by the service providers. The material was divided into, and analyzed with, two implementation phases. Non-parametrical statistical methods and hierarchical regression analyses were applied on the material. Results The number of patients increased significantly, and the patient group became more homogeneous. Both the duration of the service, and the number of consultations and group session days were significantly reduced. Conclusion The patient group became more homogenous, but also significantly larger during the first six years of building the RTW service. At the same time, the duration of the service decreased. This study therefore questions if there is a lack of consensus on the intensity of work rehabilitation for this group.

Review of thirty patients with bone chondroblastoma

Directory of Open Access Journals (Sweden)

Slavković Slobodan

2005-01-01

Full Text Available Background/Aim. To analyse the results of the treatment of the patients with the diagnosis of chondroblastoma, to confirm the possible malignancy and to recommend the best and the safest method of the treatment. Methods. We reviewed the cases of 30 patients with chondroblastoma who were treated between 1975 and 2004. Data were obtained using complete medical documentation, physical examinations, radiographic findings, and the available additional diagnostic procedures. Results. We found that the proximal part of the tibia, proximal part of the humerus, and distal part of the femur were the most common sites of the tumor in 63% of the cases. The higher prevalence of chondroblastoma in male patients was found, especially in the second decade of life. The patients were treated with different surgical procedures after histologically confirmed chondroblastoma. In 1 of the patients, radiation therapy was performed because the lesion recurred, after which the malignant transformation of chondroblastoma occurred. We found two more malignant chondroblastomas, one of which had been diagnosed as a primary tumor. Seven patients had a local recurrence, one of them had a second recurrence and the malignant transformation of chondroblastoma. The only solution was a below knee amputation. Conclusion. Chondroblastoma of bone is a rare lesion with the high local recurrence rate. We emphasized the need for an adequate and rapid diagnosis, including histological verification. The treatment was strictly surgical. The basic goal of the treatment was to avoid tumor penetration into articular cavity and/or local soft tissues. Malignant chondroblastoma of bone should be treated with radical surgical resection, avoiding any adjuvant therapy.

Patient satisfaction and efficacy of vacuum-assisted excision biopsy of fibroadenomas

Energy Technology Data Exchange (ETDEWEB)

Thurley, P. [Nottingham Breast Institute, Nottingham University Hospitals NHS Trust, Nottingham (United Kingdom)], E-mail: pthurley@doctors.org.uk; Evans, A.; Hamilton, L.; James, J.; Wilson, R. [Nottingham Breast Institute, Nottingham University Hospitals NHS Trust, Nottingham (United Kingdom)

2009-04-15

Aim: To establish the efficacy, complications, and patient satisfaction for vacuum-assisted biopsy (VAB) excision of fibroadenomas. Materials and methods: All patients referred for VAB of benign lesions from 11 December 2002 to 30 November 2006 were identified prospectively, and the following data were recorded: age, histology, lesion size, and completeness of excision. A questionnaire was sent at least a year after the procedure to assess pain, complications, residual palpable lesions, and cosmetic result. Results: One hundred and thirty-four patients were referred for VAB, 81 had fibroadenomas. Fifty-nine percent replied to the questionnaire. Fifty-four percent of patients reported no pain during the procedure, 8% rated their pain at {>=}3/10. Thirty-two percent had no pain the week after the procedure, 55% had pain {>=}3/10. Seventy-nine percent had no palpable mass at the site of the original lesion. Ninety-four percent would recommend the procedure to others and would prefer further VAB to surgery. Bruising was common, one patient required aspiration of a haematoma. Six percent developed infections, all resolved with antibiotic therapy. Eighty-five percent of patients were completely satisfied with the cosmetic result. Interval ultrasound was performed in 36 patients. A palpable mass was present in 11%, a non-palpable mass in 19%, and no mass in 70%. Conclusion: VAB excision is well-tolerated, safe, and popular with a high initial success rate for fibroadenomas. Bruising and pain are common the week after the procedure.

Patient satisfaction and efficacy of vacuum-assisted excision biopsy of fibroadenomas

International Nuclear Information System (INIS)

Thurley, P.; Evans, A.; Hamilton, L.; James, J.; Wilson, R.

2009-01-01

Aim: To establish the efficacy, complications, and patient satisfaction for vacuum-assisted biopsy (VAB) excision of fibroadenomas. Materials and methods: All patients referred for VAB of benign lesions from 11 December 2002 to 30 November 2006 were identified prospectively, and the following data were recorded: age, histology, lesion size, and completeness of excision. A questionnaire was sent at least a year after the procedure to assess pain, complications, residual palpable lesions, and cosmetic result. Results: One hundred and thirty-four patients were referred for VAB, 81 had fibroadenomas. Fifty-nine percent replied to the questionnaire. Fifty-four percent of patients reported no pain during the procedure, 8% rated their pain at ≥3/10. Thirty-two percent had no pain the week after the procedure, 55% had pain ≥3/10. Seventy-nine percent had no palpable mass at the site of the original lesion. Ninety-four percent would recommend the procedure to others and would prefer further VAB to surgery. Bruising was common, one patient required aspiration of a haematoma. Six percent developed infections, all resolved with antibiotic therapy. Eighty-five percent of patients were completely satisfied with the cosmetic result. Interval ultrasound was performed in 36 patients. A palpable mass was present in 11%, a non-palpable mass in 19%, and no mass in 70%. Conclusion: VAB excision is well-tolerated, safe, and popular with a high initial success rate for fibroadenomas. Bruising and pain are common the week after the procedure

The clinical and radiological importance of extraarticular contrast material leakage into adjacent synovial compartments on ankle MR arthrography in patients with OCD and anterolateral impingement

Energy Technology Data Exchange (ETDEWEB)

Ogul, Hayri, E-mail: drhogul@gmail.com [Department of Radiology, Medical Faculty, Ataturk University, Erzurum (Turkey); Guzel, Yunus [Department of Orthopaedics and Traumatology, Medical Faculty, Ordu University, Ordu (Turkey); Pirimoglu, Berhan [Department of Radiology, Medical Faculty, Ataturk University, Erzurum (Turkey); Tuncer, Kutsi [Department of Orthopedic, Medical Faculty, Ataturk University, Erzurum (Turkey); Polat, Gokhan; Ergun, Fatih; Sade, Recep; Bayraktutan, Ummugulsum; Yuce, Ihsan; Kantarci, Mecit [Department of Radiology, Medical Faculty, Ataturk University, Erzurum (Turkey)

2016-10-15

Purpose: To evaluate the tibiotalar joint capacity and the localisation, frequency and amount of extravasation in patients with extraarticular contrast material leakage into adjacent synovial compartments on ankle magnetic resonance (MR) arthrography. Materials and methods: Sites of extravasation were determined in the ankle MR arthrograms of 69 patients. Thirty-four patients without extraarticular contrast material leakage into locations unrelated to the injection path were included as a control group. Volumetric measurements of extraarticular contrast material leakage and the tibiotalar joint capacity were performed on a three dimensional (3D) volume measurement workstation. Results: Extravasation of contrast material occurred through the anterior, posterior, and anterolateral recesses of the tibiotalar joint. The most common site of extravasation was along the flexor hallucis longus tendon synovium (24.6%). The amount of extravasation was significantly higher in patients with ankle osteochondritis dissecans (OCD) than in patients with a different diagnosis (p = 0.039). Loose bodies were detected in all OCD’s patients with insufficient tibiotalar joint distention. Conclusions: Connections between the ankle joint and neighboring synovial compartments can decrease the diagnostic value of ankle MR arthrography examinations due to inadequate joint distention. Large injection volumes should be used for ankle MR arthrography of patients with OCD (especially OCD’s patients with loose body) and impingement syndrome.

The clinical and radiological importance of extraarticular contrast material leakage into adjacent synovial compartments on ankle MR arthrography in patients with OCD and anterolateral impingement

International Nuclear Information System (INIS)

Ogul, Hayri; Guzel, Yunus; Pirimoglu, Berhan; Tuncer, Kutsi; Polat, Gokhan; Ergun, Fatih; Sade, Recep; Bayraktutan, Ummugulsum; Yuce, Ihsan; Kantarci, Mecit

2016-01-01

Purpose: To evaluate the tibiotalar joint capacity and the localisation, frequency and amount of extravasation in patients with extraarticular contrast material leakage into adjacent synovial compartments on ankle magnetic resonance (MR) arthrography. Materials and methods: Sites of extravasation were determined in the ankle MR arthrograms of 69 patients. Thirty-four patients without extraarticular contrast material leakage into locations unrelated to the injection path were included as a control group. Volumetric measurements of extraarticular contrast material leakage and the tibiotalar joint capacity were performed on a three dimensional (3D) volume measurement workstation. Results: Extravasation of contrast material occurred through the anterior, posterior, and anterolateral recesses of the tibiotalar joint. The most common site of extravasation was along the flexor hallucis longus tendon synovium (24.6%). The amount of extravasation was significantly higher in patients with ankle osteochondritis dissecans (OCD) than in patients with a different diagnosis (p = 0.039). Loose bodies were detected in all OCD’s patients with insufficient tibiotalar joint distention. Conclusions: Connections between the ankle joint and neighboring synovial compartments can decrease the diagnostic value of ankle MR arthrography examinations due to inadequate joint distention. Large injection volumes should be used for ankle MR arthrography of patients with OCD (especially OCD’s patients with loose body) and impingement syndrome.

Evaluation of patients with oral lichenoid lesions by dental patch testing and results of removal of the dental restoration material

Directory of Open Access Journals (Sweden)

Emine Buket Şahin

2016-12-01

Full Text Available Background and Design: Oral lichenoid lesions (OLL are contact stomatitis characterized by white reticular or erosive patches, plaque-like lesions that are clinically and histopathologically indistinguishable from oral lichen planus (OLP. Amalgam dental fillings and dental restoration materials are among the etiologic agents. In the present study, it was aimed to evaluate the standard and dental series patch tests in patients with OLL in comparison to a control group and evaluate our results. Materials and Methods: Thirty-three patients with OLL or OLP and 30 healthy control subjects, who had at least one dental restoration material and/or dental filling, were included in the study. Both groups received standard series and dental patch test and the results were evaluated simultaneously. Results: The most frequent allergens in the dental series patch test in the patient group were palladium chloride (n=4; 12.12% and benzoyl peroxide (n=2, 6.06%. Of the 33 patients with OLL; 8 had positive reaction to allergents in the standard patch test series and 8 had positive reaction in the dental patch test series. There was no significant difference in the rate of patch test reaction to the dental and standard series between the groups. Ten patients were advised to have the dental restoration material removed according to the results of the patch tests. The lesions improved in three patients [removal of all amalgam dental fillings (n=1, replacement of all amalgam dental fillings with an alternative filling material (n=1 and replacement of the dental prosthesis (n=1] following the removal or replacement of the dental restoration material. Conclusion: Dental patch test should be performed in patients with OLL and dental restoration material. Dental filling and/or prosthesis should be removed/replaced if there is a reaction against a dental restoration material-related allergen.

The meaning of pharmacological treatment for schizophrenic patients1

Science.gov (United States)

Vedana, Kelly Graziani Giacchero; Miasso, Adriana Inocenti

2014-01-01

OBJECTIVE: to understand the meaning of medication therapy for schizophrenic patients and formulate a theoretical model about the study phenomenon. METHOD: a qualitative approach was employed, using Symbolic Interactionism as the theoretical and Grounded Theory as the methodological framework. The research was developed between 2008 and 2010 at three community mental health services in the interior of the State of São Paulo - Brazil. Thirty-six patients and thirty-six family members were selected through theoretical sampling. The data were mainly collected through open interviews and observation and simultaneously analyzed through open, axial and selective coding. RESULTS: the meaning of the pharmacotherapy is centered on the phenomenon "Living with a help that bothers", which expresses the patients' ambivalence towards the medication and determines their decision making. The insight, access, limitations for self-administration of the drugs and interactions with family members and the health team influenced the patient's medication-related behavior. CONCLUSION: the theory presented in this study provides a comprehensive, contextualized, motivational and dynamic understanding of the relation the patient experiences and indicates potentials and barriers to follow the medication treatment. PMID:25296152

Long-term Survival of Six Patients with Glioblastoma Multiforme: Case Series and Review of the Literature

Directory of Open Access Journals (Sweden)

Shapour Omidvari

2012-04-01

Full Text Available The median overall survival in glioblastoma multiforme is usually less than one year. Long-term survival is rare and is seen in only 3%-6% of GBM patients. The present study reports the characteristics and treatment outcomes of six cases of glioblastoma multiforme with long-term survival. A literature review is also presented.Between 1990 and 2008, 217 glioblastoma multiforme patients have been treated at our center of which six cases (four males survived for three years or longer. The mean age of the six cases was 25.7 years. All patients received postoperative radiotherapy with a mean dose of 55 gray and four patients received nitrosourea-based chemotherapy.Patients' mean survival was 5.2 years. The results of this study and review of the literature have indicated that long-term (more than three years survival is exceptional and mainly observed in younger patients with good performance status and following complete surgical tumor resection.

[Reducing patient waiting time for the outpatient phlebotomy service using six sigma].

Science.gov (United States)

Kim, Yu Kyung; Song, Kyung Eun; Lee, Won Kil

2009-04-01

One of the challenging issues of the outpatient phlebotomy services at most hospitals is that patients have a long wait. The outpatient phlebotomy team of Kyungpook National University Hospital applied six sigma breakthrough methodologies to reduce the patient waiting time. The DMAIC (Define, Measure, Analyze, Improve, and Control) model was employed to approach the project. Two hundred patients visiting the outpatient phlebotomy section were asked to answer the questionnaires at inception of the study to ascertain root causes. After correction, we surveyed 285 patients for same questionnaires again to follow-up the effects. A defect was defined as extending patient waiting time so long and at the beginning of the project, the performance level was 2.61 sigma. Using fishbone diagram, all the possible reasons for extending patient waiting time were captured, and among them, 16 causes were proven to be statistically significant. Improvement plans including a new receptionist, automatic specimen transport system, and adding one phlebotomist were put into practice. As a result, the number of patients waited more than 5 min significantly decreased, and the performance level reached 3.0 sigma in December 2007 and finally 3.35 sigma in July 2008. Applying the six sigma, the performance level of waiting times for blood drawing exceeding five minutes were improved from 2.61 sigma to 3.35 sigma.

The Thirty-Meter Telescope

Indian Academy of Sciences (India)

2016-01-27

Jan 27, 2016 ... The Thirty-Meter Telescope international observatory will enable transformational observations over the full cosmic timeline all the way from the first luminous objects in the Universe to the planets and moons of our own solar system. To realize its full scientific potential, TMT will be equipped with a powerful ...

Can Patients Comprehend the Educational Materials that Hospitals Provide about Common IR Procedures?

Science.gov (United States)

Sadigh, Gelareh; Hawkins, C Matthew; O'Keefe, John J; Khan, Ramsha; Duszak, Richard

2015-08-01

To assess the readability of online education materials offered by hospitals describing commonly performed interventional radiology (IR) procedures. Online patient education materials from 402 hospitals selected from the Medicare Hospital Compare database were assessed. The presence of an IR service was determined by representation in the Society of Interventional Radiology physician finder directory. Patient online education materials about (i) uterine artery embolization for fibroid tumors, (ii) liver cancer embolization, (iii) varicose vein treatment, (iv) central venous access, (v) inferior vena cava (IVC) filter placement, (vi) nephrostomy tube insertion, (vii) gastrostomy tube placement, and (viii) vertebral augmentation were targeted and assessed by using six validated readability scoring systems. Of 402 hospitals sampled, 156 (39%) were presumed to offer IR services. Of these, 119 (76%) offered online patient education material for one or more of the eight service lines. The average readability scores corresponding to grade varied between the ninth- and 12th-grade levels. All were higher than the recommended seventh-grade level (P Reading Ease scores ranged from 42 to 69, corresponding with fairly difficult to difficult readability for all service lines except IVC filter and gastrostomy tube placement, which corresponded with standard readability. A majority of hospitals offering IR services provide at least some online patient education material. Most, however, are written significantly above the reading comprehension level of most Americans. More attention to health literacy by hospitals and IR physicians is warranted. Copyright © 2015 SIR. Published by Elsevier Inc. All rights reserved.

Cooled Radiofrequency Ablation of the Genicular Nerves for Chronic Pain due to Knee Osteoarthritis: Six-Month Outcomes.

Science.gov (United States)

McCormick, Zachary L; Korn, Marc; Reddy, Rajiv; Marcolina, Austin; Dayanim, David; Mattie, Ryan; Cushman, Daniel; Bhave, Meghan; McCarthy, Robert J; Khan, Dost; Nagpal, Geeta; Walega, David R

2017-09-01

Determine outcomes of cooled radiofrequency ablation (C-RFA) of the genicular nerves for treatment of chronic knee pain due to osteoarthritis (OA). Cross-sectional survey. Academic pain medicine center. Consecutive patients with knee OA and 50% or greater pain relief following genicular nerve blocks who underwent genicular nerve C-RFA. Survey administration six or more months after C-RFA. Pain numeric rating scale (NRS), Medication Quantification Scale III (MQSIII), Patient Global Impression of Change (PGIC), and total knee arthroplasty (TKA) data were collected. Logistic regression was used to identify factors that predicted treatment success. Thirty-three patients (52 discrete knees) met inclusion criteria. Thirty-five percent (95% confidence interval [CI] = 22-48) of procedures resulted in the combined outcome of 50% or greater reduction in NRS score, reduction of 3.4 or more points in MQSIII score, and PGIC score consistent with "very much improved/improved." Nineteen percent (95% CI = 10-33) of procedures resulted in complete pain relief. Greater duration of pain and greater than 80% pain relief from diagnostic blocks were identified as predictors of treatment success. The accuracy of the model was 0.88 (95% CI = 0.78-0.97, P  <   0.001). Genicular C-RFA demonstrated a success rate of 35% based on a robust combination of outcome measures, and 19% of procedures resulted in complete relief of pain at a minimum of six months of follow-up. Report of 80% or greater relief from diagnostic blocks and duration of pain of less than five years are associated with high accuracy in predicting treatment success. Further prospective study is needed to optimize the patient selection protocol and success rate of this procedure. © 2017 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Cutting Balloon Angioplasty (CBA) for the Treatment of Renal Artery Fibromuscular Dysplasia (FMD) in Six Patients: 5-Year Long-Term Results

International Nuclear Information System (INIS)

Cotroneo, Antonio Raffaele; Amoroso, Luigi; Giammarino, Alberto; Galasso, Daniele; Taglialatela, Francesco; Timpani, Carmine; Gabrielli, Daniela

2017-01-01

PurposeTo evaluate long-term outcomes in terms of hypertension control, recurrent stenosis, and reinterventions from patients who underwent cutting balloon angioplasty (CBA) for symptomatic renal artery fibromuscular dysplasia (FMD).Materials and MethodsFrom 2011, six consecutive renal artery FMD women underwent CBA for poorly controlled hypertension, despite antihypertensive therapy. Follow-up consisted of blood pressure monitoring and duplex ultrasonography at 1, 6, and 12 months and thereafter annually for 5 years.ResultsAll treatments were technically successful. Recurrence of hypertension was found in two patients within 12 months, and reinterventions were performed using CBA.ConclusionResults show the efficacy of CBA for renal artery FMD.

Cutting Balloon Angioplasty (CBA) for the Treatment of Renal Artery Fibromuscular Dysplasia (FMD) in Six Patients: 5-Year Long-Term Results

Energy Technology Data Exchange (ETDEWEB)

Cotroneo, Antonio Raffaele [“G. d’Annunzio” University, Chieti-Pescara, Department of Neuroscience and Imaging, Institute of Radiology, Section of Diagnostic Imaging and Therapy-Radiology Division (Italy); Amoroso, Luigi [“G. d’Annunzio” University, Chieti-Pescara, Nephrology Clinical Institute, Department of Medicine (Italy); Giammarino, Alberto; Galasso, Daniele; Taglialatela, Francesco; Timpani, Carmine; Gabrielli, Daniela, E-mail: d.gabrielli@rad.unich.it [“G. d’Annunzio” University, Chieti-Pescara, Department of Neuroscience and Imaging, Institute of Radiology, Section of Diagnostic Imaging and Therapy-Radiology Division (Italy)

2017-04-15

PurposeTo evaluate long-term outcomes in terms of hypertension control, recurrent stenosis, and reinterventions from patients who underwent cutting balloon angioplasty (CBA) for symptomatic renal artery fibromuscular dysplasia (FMD).Materials and MethodsFrom 2011, six consecutive renal artery FMD women underwent CBA for poorly controlled hypertension, despite antihypertensive therapy. Follow-up consisted of blood pressure monitoring and duplex ultrasonography at 1, 6, and 12 months and thereafter annually for 5 years.ResultsAll treatments were technically successful. Recurrence of hypertension was found in two patients within 12 months, and reinterventions were performed using CBA.ConclusionResults show the efficacy of CBA for renal artery FMD.

Thirty Years Later: Evolution of Treatment for Acute Left Main Coronary Artery Occlusion

Directory of Open Access Journals (Sweden)

Moshe Y. Flugelman

2016-01-01

Full Text Available Acute occlusion of left main coronary artery is a catastrophic event. We describe two patients with acute occlusion of the left main coronary artery treated thirty years apart. The first patient was treated in 1982 and survived the event without revascularization but developed severe heart failure. His survival was so unusual that it merited a case report at that time. The second patient was treated at the end of 2015. Early revascularization resulted in myocardial reperfusion and near normal left ventricular function. These patients exemplify the progress in therapeutic cardiology over the last 30 years.

Orbital fractures treated in Auckland from 2010-2015: review of patient outcomes.

Science.gov (United States)

Anand, Lanit; Sealey, Christopher

2017-07-07

The purpose of this study was to review patient outcomes from surgical reconstruction of isolated orbital fractures, performed by the Auckland District Health Board (ADHB) Oral and Maxillofacial Surgery service (OMFS), from 2010 to 2015. In particular, we wished to assess titanium as an orbital reconstructive material and compare outcomes with the international literature. Hospital records for 103 adults (>18 years old) who underwent repair of isolated orbital fractures by the OMFS department at Middlemore Hospital, between 2010 and 2015, were reviewed. Information collected included patient characteristics, cause of injury, type of reconstruction material used and post-operative complications. Patients were then followed up by means of a verbal telephone questionnaire. The majority of patients were male in the 18-30 year age group, with interpersonal violence being the leading cause of injury. Titanium was the preferred choice of reconstructive material. Seven patients required return to theatre to resolve post-operative complications. Sixty-four patients could be contacted by telephone (12 months to six years follow-up). Thirty patients, who could not be contacted by telephone, did attend clinic follow-up and were assessed from their hospital records (minimum of one month follow-up). Ten patients could not be contacted by telephone and had not attended clinic follow-up. Problems with diplopia, paraesthesia and cosmesis were within complication rates reported in the literature. Patients with isolated orbital fractures, treated by the Oral and Maxillofacial Surgery Department in Auckland from 2010-2015, were reviewed. Titanium was the most commonly used reconstructive material and proved to be well tolerated. Complication rates were within international norms.

Dissemination of the nurse-administered Tobacco Tactics intervention versus usual care in six Trinity community hospitals: study protocol for a comparative effectiveness trial

Directory of Open Access Journals (Sweden)

Duffy Sonia A

2012-08-01

Full Text Available Abstract Background The objectives of this smoking cessation study among hospitalized smokers are to: 1 determine provider and patient receptivity, barriers, and facilitators to implementing the nurse-administered, inpatient Tobacco Tactics intervention versus usual care using face-to-face feedback and surveys; 2 compare the effectiveness of the nurse-administered, inpatient Tobacco Tactics intervention versus usual care across hospitals, units, and patient characteristics using thirty-day point prevalence abstinence at thirty days and six months (primary outcome post-recruitment; and 3 determine the cost-effectiveness of the nurse-administered, inpatient Tobacco Tactics intervention relative to usual care including cost per quitter, cost per life-year saved, and cost per quality-adjusted life-year saved. Methods/Design This effectiveness study will be a quasi-experimental design of six Michigan community hospitals of which three will get the nurse-administered Tobacco Tactics intervention and three will provide their usual care. In both the intervention and usual care sites, research assistants will collect data from patients on their smoking habits and related variables while in the hospital and at thirty days and six months post-recruitment. The intervention will be integrated into the experimental sites by a research nurse who will train Master Trainers at each intervention site. The Master Trainers, in turn, will teach the intervention to all staff nurses. Research nurses will also conduct formative evaluation with nurses to identify barriers and facilitators to dissemination. Descriptive statistics will be used to summarize the results of surveys administered to nurses, nurses’ participation rates, smokers’ receipt of specific cessation services, and satisfaction with services. General estimating equation analyses will be used to determine differences between intervention groups on satisfaction and quit rates, respectively, with

Thirty six treatments with radiodine after the administration of TSH recombinant in 26 patients with carcinoma differentiated from thyroid gland

International Nuclear Information System (INIS)

Pitoia, F.; Passerieu, M.; Bruno, O.D.; Niepomniszcze, H.

2004-01-01

The released studies that confirm the safety and efficacy the TSH recombinant (rhTSH) led to an increase in the interest for the use in the patients' preparation with thyroid remanents normal or differenced thyroid carcinoma persistent/recurrent, before the administration of therapeutic radioiodine doses in some situations, when it is impossible the suspension of the hormonal therapy thyroid. The objective is to evaluate the effectiveness of the administration of therapeutic doses of radioiodine after the administration of rhTSH

Determination of the total attenuation coefficient for six contact lens materials using the Beer-Lambert law.

Science.gov (United States)

Hull, C C; Crofts, N C

1996-03-01

The Beer-Lambert law has been used to determine the total attenuation coefficient, mu t, of three hard and three soft contact lens materials. The three hard contact lens materials were PMMA, Polycon II and Boston IV whereas the 3 soft materials were chosen with differing water contents of 38, 55 and 70%, respectively. The total attenuation coefficients of all six materials were obtained from measurements of the axial transmission at 632.8 nm of a series of plano powered lenses varying in axial thickness from 0.5 to 3.5 mm. The value of the total attenuation coefficient depends on both scattering and absorption and hence PMMA and Boston IV, which both incorporated a handling tint, showed significantly higher values (P 0.5) was found between any of the hydrated soft contact lens materials tested.

Generation and Characterization of Six Recombinant Botulinum Neurotoxins as Reference Material to Serve in an International Proficiency Test

Directory of Open Access Journals (Sweden)

Jasmin Weisemann

2015-11-01

Full Text Available The detection and identification of botulinum neurotoxins (BoNT is complex due to the existence of seven serotypes, derived mosaic toxins and more than 40 subtypes. Expert laboratories currently use different technical approaches to detect, identify and quantify BoNT, but due to the lack of (certified reference materials, analytical results can hardly be compared. In this study, the six BoNT/A1–F1 prototypes were successfully produced by recombinant techniques, facilitating handling, as well as improving purity, yield, reproducibility and biosafety. All six BoNTs were quantitatively nicked into active di-chain toxins linked by a disulfide bridge. The materials were thoroughly characterized with respect to purity, identity, protein concentration, catalytic and biological activities. For BoNT/A1, B1 and E1, serotypes pathogenic to humans, the catalytic activity and the precise protein concentration were determined by Endopep-mass spectrometry and validated amino acid analysis, respectively. In addition, BoNT/A1, B1, E1 and F1 were successfully detected by immunological assays, unambiguously identified by mass spectrometric-based methods, and their specific activities were assigned by the mouse LD50 bioassay. The potencies of all six BoNT/A1–F1 were quantified by the ex vivo mouse phrenic nerve hemidiaphragm assay, allowing a direct comparison. In conclusion, highly pure recombinant BoNT reference materials were produced, thoroughly characterized and employed as spiking material in a worldwide BoNT proficiency test organized by the EQuATox consortium.

Padma-28, et urtepraeparat, øger gangdistancen hos patienter med claudicatio intermittens

DEFF Research Database (Denmark)

Drabaek, H; Mehlsen, J; Petersen, J R

1994-01-01

Thirty-six patients with stable intermittent claudication were randomized in a doubleblind study either to treatment with two tablets of Padma-28 twice daily (containing 340 mg dried herbal mixture composed according to an ancient lamaistic prescription) or placebo for four months. Effect...

Cytogenetic comparisons of synchronous carcinomas and polyps in patients with colorectal cancer

DEFF Research Database (Denmark)

Bardi, G; Parada, L A; Bomme, L

1997-01-01

Thirty tumorous lesions from seven patients with colorectal cancer were short-term cultured and cytogenetically analysed: 16 non-adenomatous polyps, six adenomas, seven carcinomas, including one in polyp, and one lymph node metastasis. Clonal chromosome aberrations were found in 20 samples in 100...

Patient informed governance of distributed research networks: results and discussion from six patient focus groups.

Science.gov (United States)

Mamo, Laura A; Browe, Dennis K; Logan, Holly C; Kim, Katherine K

2013-01-01

Understanding how to govern emerging distributed research networks is essential to their success. Distributed research networks aggregate patient medical data from many institutions leaving data within the local provider security system. While much is known about patients' views on secondary medical research, little is known about their views on governance of research networks. We conducted six focus groups with patients from three medical centers across the U.S. to understand their perspectives on privacy, consent, and ethical concerns of sharing their data as part of research networks. Participants positively endorsed sharing their health data with these networks believing that doing so could advance healthcare knowledge. However, patients expressed several concerns regarding security and broader ethical issues such as commercialism, public benefit, and social responsibility. We suggest that network governance guidelines move beyond strict technical requirements and address wider socio-ethical concerns by fully including patients in governance processes.

Global Stratigraphy of Venus: Analysis of a Random Sample of Thirty-Six Test Areas

Science.gov (United States)

Basilevsky, Alexander T.; Head, James W., III

1995-01-01

The age relations between 36 impact craters with dark paraboloids and other geologic units and structures at these localities have been studied through photogeologic analysis of Magellan SAR images of the surface of Venus. Geologic settings in all 36 sites, about 1000 x 1000 km each, could be characterized using only 10 different terrain units and six types of structures. These units and structures form a major stratigraphic and geologic sequence (from oldest to youngest): (1) tessera terrain; (2) densely fractured terrains associated with coronae and in the form of remnants among plains; (3) fractured and ridged plains and ridge belts; (4) plains with wrinkle ridges; (5) ridges associated with coronae annulae and ridges of arachnoid annulae which are contemporary with wrinkle ridges of the ridged plains; (6) smooth and lobate plains; (7) fractures of coronae annulae, and fractures not related to coronae annulae, which disrupt ridged and smooth plains; (8) rift-associated fractures; and (9) craters with associated dark paraboloids, which represent the youngest 1O% of the Venus impact crater population (Campbell et al.), and are on top of all volcanic and tectonic units except the youngest episodes of rift-associated fracturing and volcanism; surficial streaks and patches are approximately contemporary with dark-paraboloid craters. Mapping of such units and structures in 36 randomly distributed large regions (each approximately 10(exp 6) sq km) shows evidence for a distinctive regional and global stratigraphic and geologic sequence. On the basis of this sequence we have developed a model that illustrates several major themes in the history of Venus. Most of the history of Venus (that of its first 80% or so) is not preserved in the surface geomorphological record. The major deformation associated with tessera formation in the period sometime between 0.5-1.0 b.y. ago (Ivanov and Basilevsky) is the earliest event detected. In the terminal stages of tessera fon

Multipolar hepatic radiofrequency ablation using up to six applicators: preliminary results

International Nuclear Information System (INIS)

Bruners, P.; Schmitz-Rode, T.; Guenther, R.W.; Mahnken, A.

2008-01-01

Purpose: to evaluate the clinical feasibility and safety of hepatic radiofrequency (RF) ablation using a multipolar RF system permitting the simultaneous use of up to six electrodes. Materials and methods: ten patients (3 female, 7 male, mean age 61) suffering from 29 hepatic metastases (range: 1-5) of different tumors were treated with a modified multipolar RF system (CelonLab Power, Celon Medical Instruments, Teltow, Germany) operating four to six needle-shaped internally cooled RF applicators. The procedure duration, applied energy and generator output were recorded during the intervention. The treatment result and procedure-related complications were analyzed. The achieved coagulation volume was calculated on the basis of contrast-enhanced CT scans 24 hours after RF ablation. Results: complete tumor ablation was achieved in all cases as determined by the post-interventional lack of contrast enhancement in the target region using four applicators in five patients, five applicators in one patient and six applicators in four patients. A mean energy deposition of 353.9 ± 176.2 kJ resulted in a mean coagulation volume of 115.9 ± 79.5 cm 3 . The mean procedure duration was 74.9 ± 21.2 minutes. Four patients showed an intraabdominal hemorrhage which necessitated further interventional treatment (embolization; percutaneous histoacryl injection) in two patients. (orig.)

Tympanogram findings in patients with cleft palates aged six months to seven years

Science.gov (United States)

Yanti, A.; Widiarni, D.; Alviandi, W.; Tamin, S.; Mansyur, M.

2017-08-01

Cleft palate is one of the most common congenital craniofacial deformities. Otitis media with effusion (OME) is a middle ear disease having a prevalence of almost 90% in patients with cleft palates. Tympanometry is a fast, safe, non-invasive, and easy tool for diagnosing middle ear disease qualitatively and quantitatively. Studies have been conducted using tympanometry to detect middle ear conditions in patients with cleft palates, but no research has studied tympanogram findings in patients with cleft palates in Indonesia. The aim of this study is to determine the tympanogram findings in Indonesian children aged six months to seven years with cleft palates. This is a cross-sectional study of 30 patients (17 males and 13 females) with Veau classification of palatal clefts aged six months to seven years (median 26.5 months) who underwent tympanometry examinations using a 226 Hztympanometer. Tympanograms were classified using the Jerger/Liden classification. Examinations of 58 ears found that type B tympanograms occurred most frequently (70.7%). The quantitative values of tympanometry analyzed included SAA (0.1-0.2 cm3), TPP value (-197.2-(-146.8 daPa)), Vec value (0.5-0.6 cm3), and gradient value (0.03-0.07 cm3). Using the Fisher test, a significant relationship was found between age and type of tympanogram (p = 0.0039) with the risk of type B and C tympanograms in infants (6-60 months) as high as 4.8 times that of children without cleft palates. The type B tympanogram was most frequently seen in patients with cleft palates aged six months to seven years old with the quantitative values of tympanometry lower than the normal values. Therefore, there was a significant difference in the type of tympanogram seen with age.

Studi Implementasi Lean Six Sigma dengan Pendekatan Value Stream Mapping untuk Mereduksi Idle Time Material pada Gudang Pelat dan Profil

Directory of Open Access Journals (Sweden)

Wawan Widiatmoko

2013-03-01

Full Text Available Peningkatan volume kegiatan industri maritim di Indonesia menuntut industri perkapalan di daerah Surabaya untuk lebih meningkatkan pelayanan baik berupa bangunan baru maupun reparasi kapal. Berdasarkan hal tersebut galangan harus mampu mengelola proses produksi dengan baik sehingga menghasilkan keuntungan yang maksimum. Salah satunya adalah proses inventory dan transport of materials yang efektif. Tugas akhir bertujuan untuk mengetahui sistem inventori yang diterapkan oleh perusahaan yang dijadikan sampel serta idle time material pelat dan profil yang ada di gudang bahan baku dengan menggunakan metode lean six sigma dengan pendekatan value stream mapping. Dari hasil perhitungan menggunakan diperoleh nilai sigma perhitungan idle time sebesar 0.1976 sehingga perlu dilakukan upaya peningkatan nilai sigma pengadaan material itu sendiri. Berdasarkan hasil analisa penyebab adanya idle time dengan menggunakan RCA diperoleh beberapa faktor yaitu : rendahnya nilai sigma penggunaan material, tidak tercapainya target pengerjaan pada proses fabrikasi, proses pengadaan material yang tidak mempertimbangkan strategi proses pembangunan kapal. Dengan penerapan lean six sigma dengan pendekatan value stream mapping dihasilkan usulan perbaikan proses inventori di perusahaan antara lain : meningkatkan nilai sigma penggunaan material, melakukan strategi pembelian material sesuai strategi pembangunan kapal berdasarkan zona, memperbaiki kerjasama dengan supplier material pelat dan profil. Pembuatan future state mapping mendapatkan usulan perbaikan dengan pembuatan perencanaan pengadaan material dengan mempertimbangkan strategi pembangunan kapal berdasarkan zona pembangunannya. Diperoleh strategi pengadaan material yang dilakukan sebanyak 4 kali order.

Patients' satisfaction with the Nuss procedure

International Nuclear Information System (INIS)

Ishimaru, Tetsuya; Iwanaka, Tadashi; Uchida, Hiroo; Kawashima, Hiroshi; Gotoh, Chikashi; Satoh, Kaori; Yoshida, Mariko; Kitano, Yoshihiro

2009-01-01

The purpose of this study is to investigate the satisfaction of patients who have already finished bar removal. Fifty-four patients with pectus excavatum underwent the Nuss procedure between July 2000 and December 2007 and the bar was removed in 41 of them at our hospital. A telephone questionnaire was administered to their parents or the patients (12 years old or older). The questions were as follows: self-assessment of the present thoracic form on a 5-point scale, whether it was good to have undergone the Nuss procedure (Y/N), whether the patient will recommend this procedure to another patient (Y/N). Thirty-nine patients responded to the questionnaire. Median age at the bar insertion was 83 months (range: 63-189 months). The bar was removed about 2 years after the initial operation. The median period after removal was 29 months ( range: 2-65 months). The mean point for the thoracic form was 4.2 (5 points: 20, 4 points: 11, 3 points: 5, 2 points: 3). Thirty-eight patients answered that they were satisfied with this procedure. Thirty-four patients answered that they would recommend this procedure to another patient. Eight patients reported that redepression occurred after bar removal. Six of them are under observation because their thoracic deformity is mild. Patients' satisfaction with the Nuss procedure was high. However, our study shows the possibility of post-removal recurrence. There seems to be a tendency for patients to assess their thoracic form more strictly than the doctors. (author)

Assessment of online patient education materials from major ophthalmologic associations.

Science.gov (United States)

Huang, Grace; Fang, Christina H; Agarwal, Nitin; Bhagat, Neelakshi; Eloy, Jean Anderson; Langer, Paul D

2015-04-01

Patients are increasingly using the Internet to supplement finding medical information, which can be complex and requires a high level of reading comprehension. Online ophthalmologic materials from major ophthalmologic associations should be written at an appropriate reading level. To assess ophthalmologic online patient education materials (PEMs) on ophthalmologic association websites and to determine whether they are above the reading level recommended by the American Medical Association and National Institutes of Health. Descriptive and correlational design. Patient education materials from major ophthalmology websites were downloaded from June 1, 2014, through June 30, 2014, and assessed for level of readability using 10 scales. The Flesch Reading Ease test, Flesch-Kincaid Grade Level, Simple Measure of Gobbledygook test, Coleman-Liau Index, Gunning Fog Index, New Fog Count, New Dale-Chall Readability Formula, FORCAST scale, Raygor Readability Estimate Graph, and Fry Readability Graph were used. Text from each article was pasted into Microsoft Word and analyzed using the software Readability Studio professional edition version 2012.1 for Windows. Flesch Reading Ease score, Flesch-Kincaid Grade Level, Simple Measure of Gobbledygook grade, Coleman-Liau Index score, Gunning Fog Index score, New Fog Count, New Dale-Chall Readability Formula score, FORCAST score, Raygor Readability Estimate Graph score, and Fry Readability Graph score. Three hundred thirty-nine online PEMs were assessed. The mean Flesch Reading Ease score was 40.7 (range, 17.0-51.0), which correlates with a difficult level of reading. The mean readability grade levels ranged as follows: 10.4 to 12.6 for the Flesch-Kincaid Grade Level; 12.9 to 17.7 for the Simple Measure of Gobbledygook test; 11.4 to 15.8 for the Coleman-Liau Index; 12.4 to 18.7 for the Gunning Fog Index; 8.2 to 16.0 for the New Fog Count; 11.2 to 16.0 for the New Dale-Chall Readability Formula; 10.9 to 12.5 for the FORCAST scale; 11

Reducing patients' falls rate in an Academic Medical Center (AMC) using Six Sigma "DMAIC" approach.

Science.gov (United States)

Kuwaiti, Ahmed Al; Subbarayalu, Arun Vijay

2017-05-08

Purpose The purpose of this paper is to evaluate the impact of adopting the Six Sigma define, measure, analyze, improve and control (DMAIC) approach in reducing patients fall rate in an Academic Medical Center, Saudi Arabia. Design/methodology/approach A prospective study design was adopted and this study was conducted at King Fahd Hospital of the University (KFHU) during the year 2014. Based on the historical data of the patients' falls reported at KFHU during the year 2013, the goal was fixed to reduce the falls rate from 7.18 toSix Sigma "DMAIC" approach improves the processes related to the prevention of falls. A greater reduction in patients falls rate (over 70 percent) was observed after the implementation of the improvement strategy.

A Technological Comparison of Six Processes for the Production of Reduction-Grade Alumina from Non-Bauxitic Raw Materials

Science.gov (United States)

Bengtson, K. B.

The U. S. Bureau of Mines, by means of a contract with Kaiser Engineers and with Kaiser Aluminum & Chemical Corporation as a subcontractor, has sponsored a technological and an economic evaluation of six candidate processes for the manufacture of alumina from certain U. S. raw materials other than bauxite. This paper describes each process. Flow diagrams and the total energy requirement for each process are included. Important characteristics affecting the economics of producing alumina by each process are discussed, and some presently unsolved technical problems are identified. The extraction of alumina from clay via hydrochloric acid with iron separation by solvent extraction, and the crystallization of intermediate AlCl3·6H2O through the introduction of HCl gas into the pregnant mother liquor, appears to be technically feasible and the most attractive of the six raw material/process combinations.

REDUCING AND OPTIMIZING THE CYCLE TIME OF PATIENTS DISCHARGE PROCESS IN A HOSPITAL USING SIX SIGMA DMAIC APPROACH

Directory of Open Access Journals (Sweden)

S. Arun Vijay

2014-06-01

Full Text Available A lengthy and in-efficient process of discharging in-patients from the Hospital is an essential component that needs to be addressed in order to improve the quality of Health care facility. Even though, several quality methodologies are adopted to improve such services in Hospitals, the implementation of Six Sigma DMAIC methodology to improve the Hospital discharge process is much limited in the Literature. Thus, the objective of this research is to reduce the cycle time of the Patients discharge process using Six Sigma DMAIC Model in a multidisciplinary hospital setting in India. This study had been conducted through the five phases of the Six Sigma DMAIC Model using different Quality tools and techniques. This study suggested various improvement strategies to reduce the cycle time of Patients discharge process and after its implementation; there is a 61% reduction in the cycle time of the Patients discharge process. Also, a control pl an check sheet has been developed to sustain the Improvements obtained. This Study would be an eye opener for the Health Care Managers to reduce and optimize the cycle time of Patients discharge process in Hospitals using Six Sigma DMAIC Model.

The War Powers Resolution: After Thirty-Six Years

Science.gov (United States)

2010-04-22

integrity of the Panama Canal treaties, and apprehend General Manuel Noriega, who had been accused of massive electoral fraud in the Panamanian elections...that city. (59) Congo and Gabon. On March 27, 1997, President Clinton notified Congress “consistent with the War Powers Resolution,” that on March 25...1997, a standby evacuation force of U.S. military personnel had been deployed to Congo and Gabon to provide enhanced security for American private

Survey of sexual educational needs in radiation oncology patients

International Nuclear Information System (INIS)

Chen, L.; Sweeney, P.; Wallace, G.; Neish, P.; Vijayakumar, S.

1997-01-01

Purpose: To assess the knowledge of and need for education about sexuality in oncology patients treated with radiation therapy. Methods and Materials: Patients who received radiation therapy for any disease site were given a self-assessment survey to complete to determine their opinions on sexuality and needs for sexual education. The surveys were given to patients on follow-up visit seen approximately 6 months to 2 years after radiation therapy. All patients were diagnosed with a malignancy and asked to participate on a voluntary basis; confidentiality was ensured by excluding any identifying patient information on the survey form. Respondents were polled with a survey that consisted of 17 questions about their sexual activity. Questions were broadly categorized into the following: definition of sexual activity, frequency of sexual activity prior to and after diagnosis and treatment of cancer, perception of sexual attractiveness, sexual satisfaction in the relationship, patient perception of partner's sexual satisfaction in the relationship, educational needs with regard to sexuality after therapy for cancer, and demographic information. Results: All patients were over age 18, and received radiation therapy as part of the treatment. Patients with all disease sites were included in the survey, regardless of stage or diagnosis. A total of 28 patients completed the survey form, which was approved by our institutional review board. Forty-three percent of patients felt that the cancer diagnosis or treatment effect was the cause of not engaging in sexual intercourse. Fifty percent reported not having the same sexual desire as before the diagnosis of cancer, while 46% reported having the same sexual desire as prior to the diagnosis of cancer. Forty-six percent felt less attractive than before the diagnosis of cancer, while 43% felt the same as before diagnosis. Thirty-six percent of patients received no information with regards to sexuality and cancer, while 18% received

Comparison of chemotherapy and hematopoietic stem cell ...

African Journals Online (AJOL)

2013-02-19

Feb 19, 2013 ... scores before and after hematopoietic stem cell transplantation (HSCT) and chemotherapy. Materials and Methods: Thirty-six patients undergoing HSCT were included in the study. A pre-HSCT dental treatment protocol was implemented that consisted of restoration of all active carious lesions, treatment of ...

Change of patients' perceptions of telemedicine after brief use

NARCIS (Netherlands)

Cranen, Karlijn; Cranen, Karlijn; Huis in 't Veld, M.H.A.; IJzerman, Maarten Joost; Vollenbroek-Hutten, Miriam Marie Rosé

Objective: This study aims to investigate whether patients' perceptions regarding a Web-based telemedicine service, for instruction and monitoring of an exercise program, change after brief use. Materials and Methods: Thirty patients were allocated, matched on gender and age, to a control group (10)

Efficacy of anidulafungin in 539 patients with invasive candidiasis: a patient-level pooled analysis of six clinical trials

NARCIS (Netherlands)

Kullberg, B.J.; Vasquez, J.; Mootsikapun, P.; Nucci, M.; Paiva, J.A.; Garbino, J.; Yan, J.L.; Aram, J.; Capparella, M.R.; Conte, U.; Schlamm, H.; Swanson, R.; Herbrecht, R.

2017-01-01

Objectives: To evaluate the efficacy of anidulafungin for the treatment of candidaemia and invasive candidiasis in a large dataset, including patients with deep-seated tissue candidiasis, neutropenia and infection due to non- albicans Candida species. Methods: Data were pooled from six prospective,

Dislocation following total knee arthroplasty: A report of six cases

Directory of Open Access Journals (Sweden)

Villanueva Manuel

2010-01-01

Full Text Available Background: Dislocation following total knee arthroplasty (TKA is the worst form of instability. The incidence is from 0.15 to 0.5%. We report six cases of TKA dislocation and analyze the patterns of dislocation and the factors related to each of them. Materials and Methods: Six patients with dislocation of knee following TKA are reported. The causes for the dislocations were an imbalance of the flexion gap (n=4, an inadequate selection of implants (n=1, malrotation of components (n=1 leading to incompetence of the extensor mechanism, or rupture of the medial collateral ligament (MCC. The patients presented complained of pain, giving way episodes, joint effusion and difficulty in climbing stairs. Five patients suffered posterior dislocation while one anterior dislocation. An urgent closed reduction of dislocation was performed under general anaesthesia in all patients. All patients were operated for residual instability by revision arthroplasty after a period of conservative treatment. Results: One patient had deep infection and knee was arthrodesed. Two patients have a minimal residual lag for active extension, including a patient with a previous patellectomy. Result was considered excellent or good in four cases and fair in one, without residual instability. Five out of six patients in our series had a cruciate retaining (CR TKA designs: four were revised to a posterior stabilized (PS TKA and one to a rotating hinge design because of the presence of a ruptured MCL. Conclusion: Further episodes of dislocation or instability will be prevented by identifying and treating major causes of instability. The increase in the level of constraint and correction of previous technical mistakes is mandatory.

Six sigma tools for a patient safety-oriented, quality-checklist driven radiation medicine department.

Science.gov (United States)

Kapur, Ajay; Potters, Louis

2012-01-01

The purpose of this work was to develop and implement six sigma practices toward the enhancement of patient safety in an electronic, quality checklist-driven, multicenter, paperless radiation medicine department. A quality checklist process map (QPM), stratified into consultation through treatment-completion stages was incorporated into an oncology information systems platform. A cross-functional quality management team conducted quality-function-deployment and define-measure-analyze-improve-control (DMAIC) six sigma exercises with a focus on patient safety. QPM procedures were Pareto-sorted in order of decreasing patient safety risk with failure mode and effects analysis (FMEA). Quantitative metrics for a grouped set of highest risk procedures were established. These included procedural delays, associated standard deviations and six sigma Z scores. Baseline performance of the QPM was established over the previous year of usage. Data-driven analysis led to simplification, standardization, and refinement of the QPM with standard deviation, slip-day reduction, and Z-score enhancement goals. A no-fly policy (NFP) for patient safety was introduced at the improve-control DMAIC phase, with a process map interlock imposed on treatment initiation in the event of FMEA-identified high-risk tasks being delayed or not completed. The NFP was introduced in a pilot phase with specific stopping rules and the same metrics used for performance assessments. A custom root-cause analysis database was deployed to monitor patient safety events. Relative to the baseline period, average slip days and standard deviations for the risk-enhanced QPM procedures improved by over threefold factors in the NFP period. The Z scores improved by approximately 20%. A trend for proactive delays instead of reactive hard stops was observed with no adverse effects of the NFP. The number of computed potential no-fly delays per month dropped from 60 to 20 over a total of 520 cases. The fraction of computed

Placing wireless tablets in clinical settings for patient education.

Science.gov (United States)

Stribling, Judy C; Richardson, Joshua E

2016-04-01

The authors explored the feasibility and possible benefit of tablet-based educational materials for patients in clinic waiting areas. We distributed eight tablets preloaded with diagnosis-relevant information in two clinic waiting areas. Patients were surveyed about satisfaction, usability, and effects on learning. Technical issues were resolved. Thirty-seven of forty patients completed the survey. On average, the patients were satisfied in all categories. Placing tablet-based educational materials in clinic waiting areas is relatively easy to implement. Patients using tablets reported satisfaction across three domains: usability, education, and satisfaction.

Linking Six Sigma to simulation: a new roadmap to improve the quality of patient care.

Science.gov (United States)

Celano, Giovanni; Costa, Antonio; Fichera, Sergio; Tringali, Giuseppe

2012-01-01

Improving the quality of patient care is a challenge that calls for a multidisciplinary approach, embedding a broad spectrum of knowledge and involving healthcare professionals from diverse backgrounds. The purpose of this paper is to present an innovative approach that implements discrete-event simulation (DES) as a decision-supporting tool in the management of Six Sigma quality improvement projects. A roadmap is designed to assist quality practitioners and health care professionals in the design and successful implementation of simulation models within the define-measure-analyse-design-verify (DMADV) or define-measure-analyse-improve-control (DMAIC) Six Sigma procedures. A case regarding the reorganisation of the flow of emergency patients affected by vertigo symptoms was developed in a large town hospital as a preliminary test of the roadmap. The positive feedback from professionals carrying out the project looks promising and encourages further roadmap testing in other clinical settings. The roadmap is a structured procedure that people involved in quality improvement can implement to manage projects based on the analysis and comparison of alternative scenarios. The role of Six Sigma philosophy in improvement of the quality of healthcare services is recognised both by researchers and by quality practitioners; discrete-event simulation models are commonly used to improve the key performance measures of patient care delivery. The two approaches are seldom referenced and implemented together; however, they could be successfully integrated to carry out quality improvement programs. This paper proposes an innovative approach to bridge the gap and enrich the Six Sigma toolbox of quality improvement procedures with DES.

Morphine use in the last six days of life of patients with HIV/AIDS at ...

African Journals Online (AJOL)

Care provision is shared between professional nurses and non-professional community-based caregivers, who are trained by Hospice. For challenging symptoms, respite or terminal care, the hospice has a six-bed IPU to which patients can be admitted for short periods. The AIDS patients admitted to the IPU of the study ...

Six health care trends that will reshape the patient-provider dynamic.

Science.gov (United States)

Liao, Joshua M; Emanuel, Ezekiel J; Navathe, Amol S

2016-09-01

Six trends - movement towards value-based payment, rapid adoption of digital health technology, care delivery in non-traditional settings, development of individualized clinical guidelines, increased transparency, and growing cultural awareness about the harms of medical overuse - are driving the US health care system towards a future defined by quality- and patient-centric care. Health care organizations are responding to these changes by implementing provider and workforce changes, pursuing stronger payer-provider integration, and accelerating the use of digital technology and data. While these efforts can also improve the clinical relationship and create positive system redesign among health care organizations, they require alignment between organizational and physician incentives that can inadvertently harm the dynamic between patients and providers. Organizations can utilize several strategies to preserve the patient-physician relationship and advance the positive benefits of new organizational strategies while guarding against unintended consequences. Copyright © 2016 Elsevier Inc. All rights reserved.

Readability assessment of online thyroid surgery patient education materials.

Science.gov (United States)

Patel, Chirag R; Cherla, Deepa V; Sanghvi, Saurin; Baredes, Soly; Eloy, Jean Anderson

2013-10-01

Published guidelines recommend written health information be written at or below the sixth-grade level. We evaluate the readability of online materials related to thyroid surgery. Thyroid surgery materials were evaluated using Flesch Reading Ease Score (FRES), Flesch Kincaid Grade Level (FKGL), Gunning Frequency of Gobbledygook (GFOG), and Simple Measure of Gobbledygook (SMOG). Thirty-one documents were evaluated. FRES scores ranged from 29.3 to 67.8 (possible range = 0 to 100), and averaged 50.5. FKGL ranged from 6.9 to 14.9 (possible range = 3 to 12), and averaged 10.4. SMOG scores ranged from 11.8 to 14.5 (possible range = 3 to 19), and averaged 13.0. GFOG scores ranged from 10.6 to 18.0 (possible range = 3 to 19), and averaged 13.5. Readability scores for online thyroid surgery materials are higher (i.e., more difficult) than the recommended levels. However, readability is only one aspect of comprehension. Written information should be designed with that fact in mind. Copyright © 2013 Wiley Periodicals, Inc.

Readability assessment of online urology patient education materials.

Science.gov (United States)

Colaco, Marc; Svider, Peter F; Agarwal, Nitin; Eloy, Jean Anderson; Jackson, Imani M

2013-03-01

The National Institutes of Health, American Medical Association, and United States Department of Health and Human Services recommend that patient education materials be written at a fourth to sixth grade reading level to facilitate comprehension. We examined and compared the readability and difficulty of online patient education materials from the American Urological Association and academic urology departments in the Northeastern United States. We assessed the online patient education materials for difficulty level with 10 commonly used readability assessment tools, including the Flesch Reading Ease Score, Flesch-Kincaid Grade Level, Simple Measure of Gobbledygook, Gunning Frequency of Gobbledygook, New Dale-Chall Test, Coleman-Liau index, New Fog Count, Raygor Readability Estimate, FORCAST test and Fry score. Most patient education materials on the websites of these programs were written at or above the eleventh grade reading level. Urological online patient education materials are written above the recommended reading level. They may need to be simplified to facilitate better patient understanding of urological topics. Copyright © 2013 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Patient-reported outcomes among patients using exenatide twice daily or insulin in clinical practice in six European countries

DEFF Research Database (Denmark)

Reaney, Matthew; Mathieu, Chantal; Ostenson, Claes-Göran

2013-01-01

who did not meet this endpoint) and Diabetes Health Profile-18 scores (versus the main cohorts). High levels of missing data were observed for all PRO measures in both cohorts compared with those for clinical outcomes. CONCLUSIONS: These data from a clinical practice study support those from clinical...... clinical practice are lacking. We examined PROs in patients initiating injectable treatment in the CHOICE (CHanges to treatment and Outcomes in patients with type 2 diabetes initiating InjeCtablE therapy) study. METHODS: CHOICE was a 24-month, prospective observational study conducted in six European......BACKGROUND: Improvements in the clinical condition of patients with type 2 diabetes are often accompanied by improvements in health-related quality of life and other patient-reported outcomes (PROs), but data assessing injectable treatment initiation from the patient's perspective in routine...

Experience in thyroid scintigraphy with Ethiopian patients

International Nuclear Information System (INIS)

Demena, Solomon

1993-01-01

One thousand and thirty seven thyroid scintigraphy examinations done in the Nuclear Medicine Unit of Tikur Anbesma Hospital, Addis Abeba, Ethiopia between December 1984 and September 1989 were analyzed to assess their diagnostic value. Thirty one percent of the referrals were to investigate clinically detectable solitary nodules, and of these fifty-six percent had ''cold'' nodules and twenty-three percent ''hot'' nodules. Fifty-five percent of the referrals for evaluation of goitre were for multi nodular goitres and twelve percent for diffuse. Thirteen of fifty-three cases with suspected ectopic thyroid tissue were positive. Little useful information was obtained in the evaluation of goitre. It is concluded that thyroid scintigraphy was an unnecessary investigation in the evaluation of goitres in euthyroid patients. Its primary role was in the investigation of the solitary nodule, ectopic thyroid tissue and the retresternal goitre. Therefore, only selected patients should be investigated with thyroid scintigraphy

Readability of Written Materials for CKD Patients: A Systematic Review.

Science.gov (United States)

Morony, Suzanne; Flynn, Michaela; McCaffery, Kirsten J; Jansen, Jesse; Webster, Angela C

2015-06-01

The "average" patient has a literacy level of US grade 8 (age 13-14 years), but this may be lower for people with chronic kidney disease (CKD). Current guidelines suggest that patient education materials should be pitched at a literacy level of around 5th grade (age 10-11 years). This study aims to evaluate the readability of written materials targeted at patients with CKD. Systematic review. Patient information materials aimed at adults with CKD and written in English. Patient education materials designed to be printed and read, sourced from practices in Australia and online at all known websites run by relevant international CKD organizations during March 2014. Quantitative analysis of readability using Lexile Analyzer and Flesch-Kincaid tools. We analyzed 80 materials. Both Lexile Analyzer and Flesch-Kincaid analyses suggested that most materials required a minimum of grade 9 (age 14-15 years) schooling to read them. Only 5% of materials were pitched at the recommended level (grade 5). Readability formulas have inherent limitations and do not account for visual information. We did not consider other media through which patients with CKD may access information. Although the study covered materials from the United States, United Kingdom, and Australia, all non-Internet materials were sourced locally, and it is possible that some international paper-based materials were missed. Generalizability may be limited due to exclusion of non-English materials. These findings suggest that patient information materials aimed at patients with CKD are pitched above the average patient's literacy level. This issue is compounded by cognitive decline in patients with CKD, who may have lower literacy than the average patient. It suggests that information providers need to consider their audience more carefully when preparing patient information materials, including user testing with a low-literacy patient population. Copyright © 2015 National Kidney Foundation, Inc. Published by

[The Need of a New Integral Approach to the Care of Patient with Severe Mental Disorder Thirty Years after the Psychiatric Reform].

Science.gov (United States)

Madoz-Gúrpide, Agustín; Ballesteros Martín, Juan Carlos; Leira Sanmartín, Mónica; García Yagüe, Ernesto

2017-01-18

More than thirty years have passed since the beginning of the psychiatric reform, a period of intense and relevant social, scientific and cultural changes which have directly impacted on mental disorders and their management. Improvement in psychopharmacological treatment, a new model of physician-patient relationship, patient´s empowerment as a key issue and the fight against social stigma related to mental health disorders, changes in clinical governance and health policy, the assistential burden derived from the treatment of less severe pathology in mental health community centers, improvements in teamwork and coordination with other resources involved… are some of the relevant changes which determine the scene of community-based mental health assistance. We think this is a right time to check the state of the community-based care programmes for severe mental disorders, and the role of mental health center. We propose to have a reflexion about two relevant topics: where we are and where we are heading.

Influence of citric acid on the surface texture of glass ionomer restorative materials.

Science.gov (United States)

Reddy, Dappili Swami Ranga; Kumar, Ramachandran Anil; Venkatesan, Sokkalingam Mothilal; Narayan, Gopal Shankar; Duraivel, Dasarathan; Indra, Rajamani

2014-09-01

This study determined the effectiveness of G-coat plus surface protective agent over petroleum jelly on the surface texture of conventional Glass ionomer restorative materials. Three chemically cured conventional glass ionomer restorative materials type II, type IX and ketac molar were evaluated in this study. Sixty specimens were made for each restorative material. They were divided into two groups of thirty specimens each. Of the sixty specimens, thirty were coated with G-coat plus (a nano-filler coating) and the rest with petroleum jelly. Thirty samples of both protective coating agents were randomly divided into six groups of five specimens and conditioned in citric acid solutions of differing pH (pH 2, 3, 4, 5, 6 & 7). Each specimen was kept in citric acid for three hours a day, and the rest of time stored in salivary substitute. This procedure was repeated for 8 days. After conditioning, the surface roughness (Ra, μm) of each specimen was measured using a surface profilometer (Taylor & Habson, UK). Data was analyzed using one-way analysis of variance (ANOVA) and Tukey's HSD test at a significance level of 0.05. The surface textures of all the tested glass ionomer restorative materials protected with G-coat plus were not significantly affected by acids at low pH. The surface textures of all the tested glass ionomer restorative materials protected with petroleum jelly coating were significantly affected by acids at low pH. The effects of pH on the surface texture of glass ionomer restoratives are material dependent. Among all the materials tested the surface texture of Type II GIC (Group I) revealed marked deterioration when conditioned in solutions of low pH and was statistically significant. Hence, a protective coating either with G-coat plus or with light polymerized low viscosity unfilled resin adhesives is mandatory for all the glass ionomer restorations to increase the wear resistance of the restorative materials.

Placing wireless tablets in clinical settings for patient education

Directory of Open Access Journals (Sweden)

Judy C. Stribling, MA, MLS

2016-11-01

Full Text Available Objective: The authors explored the feasibility and possible benefit of tablet-based educational materials for patients in clinic waiting areas. Methods: We distributed eight tablets preloaded with diagnosis-relevant information in two clinic waiting areas. Patients were surveyed about satisfaction, usability, and effects on learning. Technical issues were resolved. Results: Thirty-seven of forty patients completed the survey. On average, the patients were satisfied in all categories. Conclusions: Placing tablet-based educational materials in clinic waiting areas is relatively easy to implement. Patients using tablets reported satisfaction across three domains: usability, education, and satisfaction.

Patient training in cancer pain management using integrated print and video materials: a multisite randomized controlled trial.

Science.gov (United States)

Syrjala, Karen L; Abrams, Janet R; Polissar, Nayak L; Hansberry, Jennifer; Robison, Jeanne; DuPen, Stuart; Stillman, Mark; Fredrickson, Marvin; Rivkin, Saul; Feldman, Eric; Gralow, Julie; Rieke, John W; Raish, Robert J; Lee, Douglas J; Cleeland, Charles S; DuPen, Anna

2008-03-01

Standard guidelines for cancer pain treatment routinely recommend training patients to reduce barriers to pain relief, use medications appropriately, and communicate their pain-related needs. Methods are needed to reduce professional time required while achieving sustained intervention effectiveness. In a multisite, randomized controlled trial, this study tested a pain training method versus a nutrition control. At six oncology clinics, physicians (N=22) and nurses (N=23) enrolled patients (N=93) who were over 18 years of age, with cancer diagnoses, pain, and a life expectancy of at least 6 months. Pain training and control interventions were matched for materials and method. Patients watched a video followed by about 20 min of manual-standardized training with an oncology nurse focused on reviewing the printed material and adapted to individual concerns of patients. A follow-up phone call after 72 h addressed individualized treatment content and pain communication. Assessments at baseline, one, three, and 6 months included barriers, the Brief Pain Inventory, opioid use, and physician and nurse ratings of their patients' pain. Trained versus control patients reported reduced barriers to pain relief (P6 on a 0-10 scale) at 1-month outcomes (P=.03). Physician and nurse ratings were closer to patients' ratings of pain for trained versus nutrition groups (P=.04 and print materials, with brief individualized training, effectively improved pain management over time for cancer patients of varying diagnostic and demographic groups.

Changes in six-minute walking distance during pulmonary rehabilitation in patients with COPD and in healthy subjects

Directory of Open Access Journals (Sweden)

Imen Ben Cheikh Rejbi

2010-07-01

Full Text Available Imen Ben Cheikh Rejbi1, Yassine Trabelsi1, Afef Chouchene1, Wafa Ben Turkia1, Helmi Ben Saad1, Abdelkarim Zbidi1, Abdelhamid Kerken2, Zouhair Tabka11Department of Physiology and Lung Testing, Faculty of Medicine of Sousse, Tunisia; 2Department of Biophysics, Faculty of Medicine of Monastir, TunisiaBackground: The six-minute walking distance (6MWD test has demonstrated validity and reliability to assess changes in functional capacity following pulmonary rehabilitation in patients with chronic obstructive lung disease. However, no attempt has been made to establish an iterative measurement of 6MWD during the overall period of pulmonary rehabilitation. Therefore, the aim of this study was to evaluate the impact of a twelve-week rehabilitation program on the iterative weekly measurement of 6MWD in chronic obstructive pulmonary disease (COPD patients and healthy subjects.Methods: Twenty-six patients with COPD and nine age-matched healthy subjects were studied. Measurements were taken at baseline and after twelve weeks except for the 6MWD. The exercise measurements included a six-minute walking test (6MWT and an incremental exercise test. Oxygen saturation, heart rate, and dyspnea will be monitored during all these tests. Results: At baseline there were significant differences between groups, except in age, body mass index, and oxygen saturation. After 12 weeks, there was no significant change in lung function in patients with COPD and healthy subjects. The 6MWD, peak oxygen uptake VO2peak and anaerobic threshold increased significantly after training in both groups (P < 0.01. The averaged trace of the 6MWD of patients with COPD and healthy subjects was followed-up respectively by a logarithmic and linear fitting. 6MWD showed a plateau after eight weeks in patients with COPD, however, it increased continually overall in healthy subjects.Conclusion: Both patients with COPD and healthy subjects demonstrated functional responses to training but with

Since Yesterday: The Nineteen Thirties in America. By Frederick Allen Lewis. New York: Bantam Books, 1939. 292pp. Since Yesterday: The Nineteen Thirties in America. By Frederick Allen Lewis. New York: Bantam Books, 1939. 292pp.

Directory of Open Access Journals (Sweden)

Eileen Klink

2008-04-01

Full Text Available Material Covered: A compendium of events, people, places, and settings of the Thirties, this book offers information on: 1.chronology and impact of events on national and international levels–from the prelude to the Panic, September 3, 1929, through the outbreak of the war with Germany, September 3, 1939. 2.major political and business figures plus celebrities of the era–Hoover, Roosevelt, Hitler, Charles Lindbergh, Fred & Gracie Allen, etc. 3.influential organizations and unions. 4.statistical information and analysis. 5. day–to–day life—e.g., the books, magazines, and newspapers; films and radio programs; automobiles; fashions; the weather. Material Covered: A compendium of events, people, places, and settings of the Thirties, this book offers information on: 1.chronology and impact of events on national and international levels–from the prelude to the Panic, September 3, 1929, through the outbreak of the war with Germany, September 3, 1939. 2.major political and business figures plus celebrities of the era–Hoover, Roosevelt, Hitler, Charles Lindbergh, Fred & Gracie Allen, etc. 3.influential organizations and unions. 4.statistical information and analysis. 5. day–to–day life—e.g., the books, magazines, and newspapers; films and radio programs; automobiles; fashions; the weather.

Six-minute walking-induced systemic inflammation and oxidative stress in muscle-wasted COPD patients.

NARCIS (Netherlands)

Helvoort, H.A.C. van; Heijdra, Y.F.; Boer, R.C. de; Swinkels, A.; Thijs, H.M.; Dekhuijzen, P.N.R.

2007-01-01

BACKGROUND: Systemic inflammation and oxidative stress are potential mechanisms for muscle wasting in COPD patients. Six-minute walking testing (6MWT) has been suggested as simple and valid exercise test in COPD that is well tolerated, and reflective of activities of daily living. The present study

Readability Assessment of Internet-Based Patient Education Materials Related to Parathyroid Surgery.

Science.gov (United States)

Patel, Chirag R; Sanghvi, Saurin; Cherla, Deepa V; Baredes, Soly; Eloy, Jean Anderson

2015-07-01

Patient education is critical in obtaining informed consent and reducing preoperative anxiety. Written patient education material (PEM) can supplement verbal communication to improve understanding and satisfaction. Published guidelines recommend that health information be presented at or below a sixth-grade reading level to facilitate comprehension. We investigate the grade level of online PEMs regarding parathyroid surgery. A popular internet search engine was used to identify PEM discussing parathyroid surgery. Four formulas were used to calculate readability scores: Flesch Reading Ease (FRE), Flesch-Kincaid Grade Level (FKGL), Gunning Frequency of Gobbledygook (GFOG), and Simple Measure of Gobbledygook (SMOG). Thirty web-based articles discussing parathyroid surgery were identified. The average FRE score was 42.8 (±1 standard deviation [SD] 16.3; 95% confidence interval [CI], 36.6-48.8; range, 6.1-71.3). The average FKGL score was 11.7 (±1 SD 3.3; 95% CI, 10.5-12.9; range, 6.1-19.0). The SMOG scores averaged 14.2 (±1 SD 2.6; 95% CI, 13.2-15.2; range, 10.7-21.9), and the GFOG scores averaged 15.0 (±1 SD 3.5; 95% CI, 13.7-16.3; range, 10.6-24.8). Online PEM on parathyroid surgery is written above the recommended sixth-grade reading level. Improving readability of PEM may promote better health education and compliance. © The Author(s) 2015.

Comparative Readability of Shoulder and Elbow Patient Education Materials within Orthopaedic Websites.

Science.gov (United States)

Beutel, Bryan G; Danna, Natalie R; Melamed, Eitan; Capo, John T

2015-12-01

There is growing concern that the readability of online orthopaedic patient education materials are too difficult for the general public to fully understand. It is recommended that this information be at the sixth grade reading level or lower. This study compared the readability of shoulder and elbow education articles from the American Academy of Orthopaedic Surgeons (AAOS) and American Society for Surgery of the Hand (ASSH) websites. Seventy-six patient education articles from the AAOS and ASSH concerning shoulder and elbow disorders were evaluated. Each article was assessed for the number of years since its last update, word count, percentage of passive sentences, Flesch Reading Ease score, Flesch-Kincaid grade level, Simple Measure of Gobbledygook (SMOG) grade, and New Dale-Chall grade level. Only one article was at or below the sixth grade reading level. The AAOS and ASSH articles had the following respective scores: a mean Flesch Reading Ease score of 54.3 and 51.8, Flesch-Kincaid grade level of 9.4 and 10.3, SMOG grade of 8.5 and 9.4, and New Dale-Chall grade of 10.4 and 11.0. Articles from the AAOS were longer (p education materials regarding the shoulder and elbow on the AAOS and ASSH websites have readability scores above the recommended reading level. These may be too challenging for the majority of patients to read and consequently serve as a barrier to proper patient education. Reducing the percentage of passive sentences may serve as a novel target for improving readability.

Neuroblastoma of the olfactory nerve - radiotherapeutic experiences with six patients

International Nuclear Information System (INIS)

Herzog, J.; Schmidt, B.; Petersen, D.; Schabet, M.

1988-01-01

Six patients with neuroblastomas of the olfactory nerve (aesthesioneuroblastoma) are presented who were irradiated between 1983 and 1986. Clinical manifestations, diagnostics, histology, therapy, and courses are compared and discused with regard to a survey of literature. An attempt is made to find out the value of radiotherapy in the treatment of this rare disease. In stage A (tumor restricted to the nasal cavity, 1 patient), a local tumor control of up to now 28 months could be achieved by a treatment combination of surgery and radiotherapy. A treatment consisting of surgery or radiotherapy alone should even in this stage only be performed in connection with a close follow-up because of the increased local recurrence risk. Five patients suffered from tumors of stage C (tumor extent beyond the paranasal sinuses). A good palliative effect was obtained temporarily by radiotherapy alone in three out of these patients showing large inoperable tumors and rapidly progressing clinical symptoms. A complete remission now lasting 16 months was achieved only in one patient by radical surgery with unilateral evisceration of orbit and homogenous postirradiation. In case of stage C tumors it is recommended to perform, if possible, a radical tumor excision with evisceration of orbit in case of unilateral manifestation in the orbit and a postirradiation applying a radical, largevolume technique. In order to reduce the risk of radiogenic cerebral necroses, it should be attempted to avoid dose maxima as they can occur when applying a combined ventro-dorsal and lateral irradiation technique. (orig./MG) [de

17. The Thirty Years War

OpenAIRE

Blamires, David

2013-01-01

Without any question the period of the Thirty Years War, from 1618 to 1648, was one of the most horrifying in the history of Germany. Not only were huge numbers of soldiers killed in battle in virtually every part of the Holy Roman Empire, but even greater numbers of the civilian population died in the conflict or through starvation or disease. Houses, churches, villages and towns were burnt and destroyed, and by the end of the war the population had been reduced from about sixteen millions t...

Autoantibodies other than anti-desmogleins in pemphigus vulgaris patients

Directory of Open Access Journals (Sweden)

Marwah Adly Saleh

2017-01-01

Full Text Available Background: Pemphigus vulgaris (PV is an immunoglobulin G-mediated autoimmune bullous skin disease. Nonorgan-specific antibodies were detected in Tunisian and Brazilian pemphigus patients with different prevalence. Materials and Methods: Fifty PV patients and fifty controls were screened for antinuclear antibodies (ANAs, anti-smooth muscle antibodies (ASMAs, anti-parietal antibodies (APAs, anti-mitochondrial antibodies, and Anti-nuclear cytoplasmic antibodies (ANCA by indirect immunofluorescence. Results: Thirty-nine patients were female and 11 were male. Fifteen patients did not receive treatment before while 35 patients were on systemic steroid treatment ± azathioprine. Twenty (40% of the PV patients and 1 (2% control had positive ANA. ANA was significantly higher in PV patients than controls, P< 0.0001. ASMAs were detected in 20 (40% PV patients and none of the controls. ASMA was significantly higher in PV patients than controls, P< 0.0001. No significant difference was detected between treated and untreated regarding ANA, P - 0.11. However, there was a significant difference between treated and untreated regarding ASMA, P- 0.03. Six patients (12% and none of the controls had positive APA. There was a significant difference between the patients and the controls in APA. P- 0.027. Conclusion: Egyptian PV patients showed more prevalent ANA, ASMA, and APA than normal controls. Follow-up of those patients is essential to detect the early development of concomitant autoimmune disease. Environmental factors might account for the variability of the nonorgan-specific antibodies among different populations.

Assessment of the quality of life in maxillectomy patients: A longitudinal study.

Science.gov (United States)

Kumar, Pradeep; Alvi, Habib Ahmad; Rao, Jitendra; Singh, Balendra Pratap; Jurel, Sunit Kumar; Kumar, Lakshya; Aggarwal, Himanshi

2013-02-01

To longitudinally assess the quality of life in maxillectomy patients rehabilitated with obturator prosthesis. Thirty-six subjects were enrolled in the span of 16 months, out of which six were dropouts. Subjects (age group 20-60 years) with maxillary defects, irrespective of the cause, planned for definite obturator prosthesis, were recruited. The Hindi version of European Organization for Research and Treatment of Cancer, Head and Neck version 1 of Quality of Life Questionnaire was used before surgical intervention and one month after definitive obturator. Questionnaire includes 35 questions related to the patient's physical health, well being, psychological status, social relation and environmental conditions. The data were processed with statistical package for social science (SPSS). Probability level of Pmaxillectomy defects.

Readability assessment of online patient education materials provided by the European Association of Urology.

Science.gov (United States)

Betschart, Patrick; Zumstein, Valentin; Bentivoglio, Maico; Engeler, Daniel; Schmid, Hans-Peter; Abt, Dominik

2017-12-01

To assess the readability of the web-based patient education material provided by the European Association of Urology. English patient education materials (PEM) as available in May 2017 were obtained from the EAU website. Each topic was analyzed separately using six well-established readability assessment tools, including Flesch-Kincaid Grade Level (FKGL), SMOG Grade Level (SMOG), Coleman-Liau Index (CLI), Gunning Fog Index (GFI), Flesch Reading Ease Formula (FRE) and Fry Readability Graph (FRG). A total of 17 main topics were identified of which separate basic and in-depth information is provided for 14 topics. Calculation of grade levels (FKGL, SMOG, CLI, GFI) showed readability scores of 7th-13th grade for basic information, 8th-15th grade for in-depth information and 7th-15th grade for single PEM. Median FRE score was 54 points (range 45-65) for basic information and 56 points (41-64) for in-depth information. The FRG as a graphical assessment revealed only 13 valid results with an approximate 8th-17th grade level. The EAU provides carefully worked out PEM for 17 urological topics. Although improved readability compared to similar analyses was found, a simplification of certain chapters might be helpful to facilitate better patient understanding.

six six six paradox : [luuletused] / Triin Tasuja

Index Scriptorium Estoniae

Tasuja, Triin

2008-01-01

Sisu: six six six paradox ; cat stevens ; "vahel tundub, et mu ümber..." ; sääse ; Salaalaealised ; kolkalapsed ; longin mööda lumiseid tänavaid ; punkrock dekadents ; "Igast kirjaneitsist..." ; "mina olengi see saikochick..."

Clinical outcome of percutaneous RF-ablation of non-operable patients with liver metastasis from breast cancer

DEFF Research Database (Denmark)

Kümler, Iben; Parner, Vibeke Kirk; Tuxen, Malgorzata K.

2015-01-01

PURPOSE: Despite improved anti-neoplastic treatment the prognosis for patients with liver metastases from metastatic breast cancer remains poor. MATERIALS AND METHODS: Thirty-two consecutive patients with metastatic breast cancer treated with radiofrequency ablation (RFA) at the Department of Onc...

DEPLOYMENT OF SIX SIGMA METHODOLOGY IN PHACOEMULSIFICATION CATARACT SURGERY

Directory of Open Access Journals (Sweden)

Ibrahim SAHBAZ

2014-04-01

Full Text Available The purpose of this study is to show how a public eye care center in Turkey initiated Six Sigma principles to reduce the number of complications encountered during and after phacoemulsification cataract surgeries. To analyze the 3-year data, main tools of Six Sigma’s Define-Measure-Analyze-Improve-Control (DMAIC improvement cycle such as SIPOC table, Fishbone Diagram and, Failure, Mode and Effect Analysis were implemented. Experience of the ophthalmic surgeon, patient’s anatomy, cooperation of patient during the surgery, sterilization and hygiene, attention of assistant surgeon, calibration of equipment and quality/chemical composition of intraocular material were identified to be Critical-to-Quality (CTQ factors for a successful phacoemulsification cataract surgery. The most frequently occurring complication was found to be iris atrophy. The process sigma level for the process was found to be 3.958.

Homeopathy and health related Quality of Life: a patient satisfaction survey in six European countries and Brazil.

Science.gov (United States)

Van Wassenhoven, Michel; Goossens, Maria; Anelli, Marco; Sermeus, Guy; Kupers, Peter; Morgado, Carlos; Martin, Eduardo; Bezerra, Melissa

2014-10-01

Many patients throughout the world consult homeopathic medical doctors. Using a similar methodology as in a first survey published in 2002 a second survey was done including 919 adults receiving homeopathic treatment in six European countries and Brazil aimed to look at who are they, their reasons for consultations and expectations and satisfaction with homeopathy prescribed by a homeopathic doctor after a follow-up time of six months. An initial questionnaire included demographic information and questions for assessing health-related Quality of Life (QoL). A follow-up questionnaire collected data on changes in QoL. 77% patients had initially used conventional treatments and 23% other non-conventional treatments. Satisfaction of patients with the medical homeopathic consultation is high. The difference between the final QoL scores after six months and the baseline are positive. Reported differences between baseline and final index range from 3.87 to 10.41 depending on diagnosis. Taking 7% as a reference value for 'minimal clinically significant difference', this is reached for 3 of 8 conditions. Changes in complaint limitations visual scales are positive. Conclusions on clinical impact must be cautious. 6% of the patients experienced side-effects which they attributed to homeopathic treatment. 7.8% of the patients reported significant aggravation at the beginning of the homeopathic treatment and 26.2% slight aggravation of symptoms. The satisfaction of patients using a medical homeopathic approach is linked to the perceived competence of the doctor homeopath, the perceived improvement of the main complaints limitations and the time dedicated to them by the doctor. Copyright © 2014 The Faculty of Homeopathy. Published by Elsevier Ltd. All rights reserved.

Differences in perceived difficulty in print and online patient education materials.

Science.gov (United States)

Farnsworth, Michael

2014-01-01

Written patient education materials frequently exceed the reading ability of the general public. Patients are often intimidated by the task of reading patient education materials, perceiving the materials’ difficulty levels as prohibitive, even when they do not exceed the patients’ reading abilities. It is unclear how the delivery mechanism--print or a computer screen--affects a patient’s reading experience through his/her perception of its difficulty. To determine whether first-year college students perceived online or print-based patient education materials as more difficult to read. Convenience sampling of first-year college students. Some first-year college students perceived online patient education materials to be more difficult to read than print-based ones--even when the reading level of the patient education materials was similar. Demographic information about this sample’s high levels of digital literacy suggests that other populations might also perceive online patient education materials as more difficult to read than print-based equivalents. Patients’ perceptions of the difficulty of patient education materials influenced their ability to effectively learn from those materials. This article concludes with a call for more research into patients’ perceptions of difficulty of patient education materials in print vs on a screen.

Determination of serum leptin and vascular endothelial growth factor (VEGF) contents in patients with breast cancer

International Nuclear Information System (INIS)

Huang Xudong; Jin Wentao; Pan Meizhen

2006-01-01

Objective: To investigate the serum expression of leptin and vascular endothelial growth factor (VEGF) in patients with breast cancer and assess its diagnostic significance. Methods: Thirty-six patients with breast cancer and thirty-one patients with benign breast disorders entered this study. Serum concentration of leptin (with RIA) and VEGF ( with ELISA) were determined in these patients before operation as well as in 56 controls. All the tested subjects were post-menopausal women. Results: The difference between the leptin levels in the controls and patients with benign breast disorders was significantly; 80 was the difference between the leptin levels in controls and patients with breast cancer. Significant difference also existed between the VEGF levels in controls and patients with cancer as well as between the levels in patients with benign breast disease and patients with cancer. Also, the serum leptin and VEGF levels in the cancerous patients with axillary metastasis were significantly higher than those in patients without metastasis. Conclusion: Serum leptin and VEGF might be taken as diagnostic tumor markers for malignanay and metastasis in patients with breast cancer. (authors)

Clinical variability of neuroacanthocytosis syndromes-a series of six patients with long follow-up.

Science.gov (United States)

Dulski, J; Sołtan, W; Schinwelski, M; Rudzińska, M; Wójcik-Pędziwiatr, M; Wictor, L; Schön, F; Puschmann, A; Klempíř, J; Tilley, L; Roth, J; Tacik, P; Fujioka, S; Drozdowski, W; Sitek, E J; Wszolek, Z; Sławek, J

2016-08-01

To provide clinical clues to differential diagnosis in patients with chorea and other movement disorders with blood acanthocytes. We present a long-term video accompanied follow-up of six Caucasian patients with neuroacanthocytosis from several centers, three diagnosed with chorea-acanthocytosis (ChAc): 34-y.o.(no.1), 36-y.o.(no.2), 43-y.o.(no.3), two diagnosed with McLeod Syndrome (MLS): 52-y.o.(no.4), 61-y.o.(no.5) and one 63-y.o.(no.6), a brother of no.5, with clinical suspicion of MLS. Additionally we report pathological findings of the mother of two brothers with MLS reported in our series with acanthocytes on peripheral blood smear The patients had an unremarkable family history and were asymptomatic until adulthood. Patients no. 1,2,4,5,6 developed generalized chorea and patient no. 3 had predominant bradykinesia. Patients no. 1,2,3 had phonic and motor tics, additionally patients no. 1 and 2 exhibited peculiar oromandibular dystonia with tongue thrusting. In patients no. 2 and 3 dystonic supination of feet was observed, patient no. 3 subsequently developed bilateral foot drop. Patients no. 2 and 4 had signs of muscle atrophy. Tendon reflexes were decreased or absent and electroneurography demonstrated sensorimotor neuropathy in patients no. 1,2,3,4,5, except no. 6. Generalized seizures were seen in patients no. 2,3,5,6 and myoclonic jerks in patient no. 1. Cognitive deterioration was reported in patients no. 1,2,3,5,6. Serum creatine kinase levels were elevated in all six patients. We highlight the variability of clinical presentation of neuroacanthocytosis syndromes and the long time from the onset to diagnosis with the need to screen the blood smears in uncertain cases, however, as in one of our cases acanthocytes may even be not found. Based on our observations and data from the literature we propose several red flags that should raise the suspicion of an NA syndrome in a patient with a movement disorder: severe orofacial dyskinesia with tongue and lip

Differences in Perceived Difficulty in Print and Online Patient Education Materials

Science.gov (United States)

Farnsworth, Michael

2014-01-01

Context: Written patient education materials frequently exceed the reading ability of the general public. Patients are often intimidated by the task of reading patient education materials, perceiving the materials’ difficulty levels as prohibitive, even when they do not exceed the patients’ reading abilities. It is unclear how the delivery mechanism—print or a computer screen—affects a patient’s reading experience through his/her perception of its difficulty. Objective: To determine whether first-year college students perceived online or print-based patient education materials as more difficult to read. Design: Convenience sampling of first-year college students. Results: Some first-year college students perceived online patient education materials to be more difficult to read than print-based ones—even when the reading level of the patient education materials was similar. Demographic information about this sample’s high levels of digital literacy suggests that other populations might also perceive online patient education materials as more difficult to read than print-based equivalents. Patients’ perceptions of the difficulty of patient education materials influenced their ability to effectively learn from those materials. Conclusion: This article concludes with a call for more research into patients’ perceptions of difficulty of patient education materials in print vs on a screen. PMID:25662526

Role of dental restoration materials in oral mucosal lichenoid lesions

Directory of Open Access Journals (Sweden)

Rajneesh Sharma

2015-01-01

Full Text Available Background: Dental restorative materials containing silver-mercury compounds have been known to induce oral lichenoid lesions. Objectives: To determine the frequency of contact allergy to dental restoration materials in patients with oral lichenoid lesions and to study the effect of removal of the materials on the lesions. Results: Forty-five patients were recruited in three groups of 15 each: Group A (lesions in close contact with dental materials, Group B (lesions extending 1 cm beyond the area of contact and Group C (no topographic relationship. Thirty controls were recruited in two groups of 15 individuals each: Group D (oral lichenoid lesions but no dental material and Group E (dental material but no oral lichenoid lesions. Patch tests were positive in 20 (44.5% patients. Mercury was the most common allergen to elicit a positive reaction in eight patients, followed by nickel (7, palladium (5, potassium dichromate (3, balsam of Peru, gold sodium thiosulphate 2 and tinuvin (2 and eugenol (1, cobalt chloride (1 and carvone (1. Seven patients elicited positive response to more than one allergen. In 13 of 20 patients who consented to removal of the dental material, complete healing was observed in 6 (30%, marked improvement in 7 (35% and no improvement in 7 (35% patients. Relief of symptoms was usually observed 3 months after removal. Limitations: Limited number of study subjects and short follow up after removal/replacement of dental restoration materials are the main limitations of this study. Conclusion: Contact allergy to amalgam is an important etiologic factor in oral lichenoid lesions and removal of restorative material should be offered to patients who have lesions in close proximity to the dental material.

A Pilot Study on Telephone Cognitive Behavioral Therapy for Patients Six-Months Post-Bariatric Surgery

Science.gov (United States)

Cassin, Stephanie E.; Wnuk, Susan; Du, Chau; Jackson, Timothy; Hawa, Raed; Parikh, Sagar V.

2017-01-01

Objective This study aimed to determine the feasibility and preliminary efficacy of a post-operative telephone-based cognitive behavioral therapy intervention (Tele-CBT) in improving eating pathology and psychosocial functioning. Methods Six-month post-operative bariatric surgery patients (n = 19) received six sessions of Tele-CBT. Study outcome variables included binge eating (BES), emotional eating (EES), depressive symptoms (PHQ-9), and anxiety symptoms (GAD-7). Results Retention was 73.7 % post-intervention. Tele-CBT resulted in significant reductions in mean difference scores on BES, EES-Total, EES-Anxiety, EES-Anger, PHQ9, and GAD7. Tele-CBT patients experienced a mean weight loss of 8.62 ± 15.02 kg between 6-months post-surgery (pre-Tele-CBT) and 12-months post-surgery. Conclusions These preliminary results suggest that post-surgery Tele-CBT is feasible and can improve post-surgery symptoms of psychopathology in this uncontrolled study, supporting the need for a randomized controlled trial. PMID:27491293

Most American Academy of Orthopaedic Surgeons' online patient education material exceeds average patient reading level.

Science.gov (United States)

Eltorai, Adam E M; Sharma, Pranav; Wang, Jing; Daniels, Alan H

2015-04-01

Advancing health literacy has the potential to improve patient outcomes. The American Academy of Orthopaedic Surgeons' (AAOS) online patient education materials serve as a tool to improve health literacy for orthopaedic patients; however, it is unknown whether the materials currently meet the National Institutes of Health/American Medical Association's recommended sixth grade readability guidelines for health information or the mean US adult reading level of eighth grade. The purposes of this study were (1) to evaluate the mean grade level readability of online AAOS patient education materials; and (2) to determine what proportion of the online materials exceeded recommended (sixth grade) and mean US (eighth grade) reading level. Reading grade levels for 99.6% (260 of 261) of the online patient education entries from the AAOS were analyzed using the Flesch-Kincaid formula built into Microsoft Word software. Mean grade level readability of the AAOS patient education materials was 9.2 (SD ± 1.6). Two hundred fifty-one of the 260 articles (97%) had a readability score above the sixth grade level. The readability of the AAOS articles exceeded the sixth grade level by an average of 3.2 grade levels. Of the 260 articles, 210 (81%) had a readability score above the eighth grade level, which is the average reading level of US adults. Most of the online patient education materials from the AAOS had readability levels that are far too advanced for many patients to comprehend. Efforts to adjust the readability of online education materials to the needs of the audience may improve the health literacy of orthopaedic patients. Patient education materials can be made more comprehensible through use of simpler terms, shorter sentences, and the addition of pictures. More broadly, all health websites, not just those of the AAOS, should aspire to be comprehensible to the typical reader.

Differences in Perceived Difficulty in Print and Online Patient Education Materials

OpenAIRE

Farnsworth, Michael

2014-01-01

Patients are often intimidated by the task of reading patient education materials, perceiving the materials’ difficulty levels as prohibitive, even when they do not exceed the patients’ reading abilities. Some first-year college students perceived online patient education materials to be more difficult to read than print-based ones—even when the reading level of the patient education materials was similar. Patients’ perceptions of the difficulty of patient education materials influenced their...

[Simultaneous determination of six fluorescent whitening agents in plastic and paper packaging materials by high performance liquid chromatography].

Science.gov (United States)

Zhang, Juzhou; Ji, Shuilin; Cai, Huimei; Li, Jing; Wang, Yongxin; Wang, Jingqiu

2017-11-08

A novel analytical method was developed for the simultaneous determination of six fluorescent whitening agents (FWAs:FWA 135, FWA 184, FWA 185, FWA 199, FWA 378 and FWA 393) in paper and plastic food packaging materials by high performance liquid chromatography with fluorescence detection (HPLC-FLD). The sample was extracted with mixed solution of chloroform and acetonitrile (3:7, v/v), then cleaned up by HLB solid phase extraction column. Qualitative and quantitative analyses were carried out by HPLC. The sample was separated on a Phenomenex C18 column using acetonitrile and 5 mmol/L ammonium acetate aqueous solution as mobile phases. The results indicated that the linear range of FWA393 was 15-1500 μg/L and the linear ranges of the other five FWAs were 5-500 μg/L with correlation coefficients greater than 0.999. The recoveries in spiked samples were between 80.4% and 125.0% with RSDs ( n =6) of 1%-13%. Furthermore, this method was applied to analyze 12 samples in the market to verify the practicality of the method. The method showed the advantages of simplicity, high recovery and good precision, and is suitable for the detection of the six fluorescent whitening agents in food packaging materials.

Thirty-Seven Years of Service with ESO!

Science.gov (United States)

Breysacher, J.

2002-12-01

On December 1st, 2002, after thirty- seven years of service, first in Chile and then in Garching, Ms. Christa Euler will leave ESO to enjoy a welldeserved retirement. Among the current staff, she is probably the only person who started her career at ESO just four years after the Organization was founded.

Orlistat for Six Months in Overweight and Obese Patients

Directory of Open Access Journals (Sweden)

Alfredo Halpern

2010-01-01

Full Text Available Objective. To assess the efficacy and tolerability of the association sibutramine (10–20 mg/day and orlistat (120 mg 2-3 times a day in the treatment of obesity in a six-month open trial. Methods. 446 overweight and obese patients who sought treatment for obesity in a private clinic were assessed every 2 weeks during a period of 3 and 6 months. Results. After 3 months, the mean weight loss was 10.5 kg (−9.8% of the initial weight, =263, and after 6 months, the mean weight loss was 13.9 kg (−12.8% of the initial weight, =97. The tolerability of such association was quite acceptable and coherent with the action mechanism of each component. Conclusions. The association of orlistat and sibutramine is quite efficient and it seems to promote a higher rate of weight loss than that reported in clinical studies performed with each drug separately.

Assessment of Pneumatic Balloon Dilation in Patients with Symptomatic Relapse after Failed Heller Myotomy: A Single Center Experience.

Science.gov (United States)

Amani, Mohammad; Fazlollahi, Narges; Shirani, Shapour; Malekzadeh, Reza; Mikaeli, Javad

2016-01-01

BACKGROUND Although Heller myotomy is one of the most effective treatments for achalasia, it may be associated with early or late symptom relapse in some patients. Therefore, additional treatment is required to achieve better control of symptoms. To evaluate the safety and efficacy of pneumatic balloon dilation (PBD) in patients with symptom relapse after Heller myotomy. METHODS Thirty six post-myotomy patients were evaluated from 1993 to 2013. Six patients were excluded from the analysis because of comorbid diseases or epiphrenic diverticula. Thirty patients were treated with PBD. Primary outcome was defined as a decrease in symptom score to 4 or less and a reduction greater than 80% from the baseline in the volume of barium in timed barium esophagogram in 6 weeks. Achalasia symptom score (ASS) was assessed at 1.5, 3, 6, and 12 months after treatment and then every six months in all patients and PBD was repeated in case of symptom relapse (ASS>4). RESULTS The mean age of the patients was 45.5±13.9 years (range: 21-73). Primary outcome was observed in 25 patients (83%). The mean ASS of the patients dropped from 7.8 before treatment to 1.3±2.0 at 1.5 months after treatment (p=0.0001). The mean volume and height of barium decreased from 43.1±33.4 and 7.1±4.7 to 6.0±17.1 and 1.1±2.2, respectively (p=0.003, p=0.003). The mean duration of follow-up was 11.8±6.3 years. At the end of the study, 21 patients (70%) reported sustained good response. No major complications such as perforation or gross bleeding were seen. CONCLUSION PBD is an effective and safe treatment option for achalasia in patients with symptom relapse after Heller myotomy.

The effect of modified trampoline training on balance, gait, and falls efficacy of stroke patients

OpenAIRE

Hahn, Joohee; Shin, Seonhae; Lee, Wanhee

2015-01-01

[Purpose] This research was conducted to investigate the effects of modified trampoline training on the balance, gait, and falls efficacy of stroke patients. [Subjects] Twenty-four stroke patients participated in this study. The subjects were randomly allocated to one of two groups: the trampoline group (n=12) or the control group (n=12). [Methods] Both groups participated in conventional physical therapy for thirty minutes per day, three times a week for six weeks. The trampoline group also ...

Robust Soft Textile Transfer Case for Contaminated Materials

Science.gov (United States)

2017-08-28

least thirty-six pounds per square inch; remain leak -proof after a thirty foot drop when filled with water to at least a ninety-eight percent...shipping standards for use require a leak -proof seal without an allowance for pressure relief. While the container would likely never need to be re...after the insertion of the contents; be puncture Attorney Docket No. 300153 3 of 17 resistant; be leak -proof at a hydrostatic pressure of at

Treatment by oral creatine, L-arginine and L-glycine in six severely affected patients with creatine transporter defect

NARCIS (Netherlands)

Valayannopoulos, V.; Boddaert, N.; Chabli, A.; Barbier, V.; Desguerre, I.; Philippe, A.; Afenjar, A.; Mazzuca, M.; Cheillan, D.; Munnich, A.; de Keyzer, Y.; Jakobs, C.A.J.M.; Salomons, G.S.; de Lonlay, P.

2012-01-01

Background X-linked cerebral creatine deficiency is caused by the deficiency of the creatine transporter (CTP) encoded by the SLC6A8 gene. Patients and Methods We report here a series of six patients with severe CTP deficiency, four males and two females; clinical presentations include mild to

The effect of modified trampoline training on balance, gait, and falls efficacy of stroke patients.

Science.gov (United States)

Hahn, Joohee; Shin, Seonhae; Lee, Wanhee

2015-11-01

[Purpose] This research was conducted to investigate the effects of modified trampoline training on the balance, gait, and falls efficacy of stroke patients. [Subjects] Twenty-four stroke patients participated in this study. The subjects were randomly allocated to one of two groups: the trampoline group (n=12) or the control group (n=12). [Methods] Both groups participated in conventional physical therapy for thirty minutes per day, three times a week for six weeks. The trampoline group also took part in trampoline training for thirty minutes per day, three times a week for six weeks. We evaluated balance (Berg balance scale, timed up and go test), gait (dynamic gait index), and falls efficacy (falls efficacy scale-K) to confirm the effects of the intervention. [Results] Both the trampoline and the control group showed significant improvements in balance, gait, and falls efficacy compared to before the intervention, and the improvements were significantly greater in the trampoline group than in the control group. [Conclusion] Modified trampoline training resulted in significantly improved balance, dynamic gait, and falls efficacy of stroke patients compared to the control group. These results suggest that modified trampoline training is feasible and effective at improving balance, dynamic gait, and falls efficacy after stroke.

Breast-conserving therapy in patients with bilateral breast cancer: Do today's treatment choices burn bridges for tomorrow?

International Nuclear Information System (INIS)

Gilroy, Jeffrey S.; Morris, Christopher G.; Mendenhall, Nancy Price

2005-01-01

Purpose: To determine how often initial treatment choices limit treatment options for subsequent breast cancer management in patients undergoing breast-conserving therapy (BCT), in particular with treatment of internal mammary nodes. Methods and Materials: Between January 1985 and June 2001, 464 women with pathologic Stage 0, I, and II (T0-2, N0-1) breast cancer underwent BCT at our institution. All 464 patients had computed tomography-based treatment planning. In patients with bilateral breast cancer, the planning computed tomography scans were used to determine the impact initial radiation therapy fields had on treatment options for subsequent contralateral breast cancer. Results: There were 500 breast cancers diagnosed in 464 patients. Thirty-six patients (8%) had bilateral breast cancer with 9 (2%) synchronous and 27 (6%) metachronous primaries. In 80 patients, the ipsilateral internal mammary nodes were explicitly treated. Initial breast cancer treatment choices impacted subsequent treatment decisions for the contralateral breast in only 2 of 464 patients (0.4%) in the study: 2 of 80 patients (2.5%) whose internal mammary nodes were treated, and 2 of 27 patients (7.4%) who developed metachronous bilateral breast cancer. Conclusions: Initial BCT, including internal mammary node irradiation, rarely compromised future contralateral breast-conserving therapy

Patients with collagen vascular disease and dyspnea. The value of gallium scanning and bronchoalveolar lavage in predicting response to steroid therapy and clinical outcome

International Nuclear Information System (INIS)

Greene, N.B.; Solinger, A.M.; Baughman, R.P.

1987-01-01

Patients with collagen vascular disease with or without pulmonary symptoms were studied to determine the value of gallium scan and bronchoalveolar lavage (BAL) in predicting clinical outcome and response to steroid therapy. Thirty-six subjects, 20 with progressive dyspnea, were studied. Gallium uptake was seen in the lung in 17 of the 20 progressively dyspneic patient's and none of the 16 nonprogressive patients. The BAL fluid in the progressive patients had a higher percentage of neutrophils (13.4 percent +/- 2.88) and lymphocytes (16.1 percent +/- 2.75) than in the nonprogressive patients (neutrophils = 3.3 +/- 1.30 percent; lymphocytes = 5.6 +/- 1.57 percent. Of the 19 progressive patients who were treated with steroids or cyclophosphamide, six had only increased neutrophils in their BAL fluid and all died. The remaining 13 treated progressive patients had increased lymphocytes or a normal BAL (two patients): six had improvement in their vital capacity, six have had stable function, and one died. We found gallium scan and BAL useful in assessing progressive pulmonary fibrosis in collagen vascular disease

[Ovarian tissue cryopreservation in cancer patients--six years of clinical experience].

Science.gov (United States)

Huser, M; Záková, J; Crha, I; Smardová, L; Král, Z; Revel, A; Ventruba, P

2012-04-01

Presentation of clinical results and experience with this technique during past six years. Original paper. Gynekologicko-porodnická klinika LF MU a FN Brno, Interní hemato-onkologická klinika LF MU a FN Brno, Department of Obstetrics and Gynecology. Hadassah University Hospital Ein-Karem, Jerusalem, Izrael. Ovarian tissue cryopreservation (OTC) and its future auto-transplantation becomes an alternative for patients to prevent serious damage of ovarian function by oncology treatment. Patient is indicated to OTC in case of high risk of ovarian failure due to planned chemotherapy and impossibility to use other oncofertility techniques. Ovarian tissue harvesting is done by laparoscopy in short-term general anesthesia. After tissue processing the samples are cryopreserved in programmable automatic freezer or by vitrification. The auto-transplantation of ovarian tissue is planned after the complete cure of patient's malignancy. Our workplace doesn't have own experience with tissue transplantation - until now cryopreserved tissue has not yet been utilized by the patients. Clinical experience with this technique gained by our team during academic stay in abroad Israeli clinic is presented. During the years of 2005-2011 the OTC was performed in 19 cancer patients before chemotherapy. In majority of cases, patients suffered from blood or lymph node systemic malignancy (84%). Average age of women was 26 years. The patient set consisted of mostly nulliparous women (88%). Patient's average body mass index was 23,9 kg/m2. The length of systemic chemotherapy averaged 7.1 months. Time from fertility preservation counseling to chemotherapy was not exceeding one week (7.2 days on average). Ovarian tissue harvesting was conducted by laparoscopic surgery in all cases. The length of surgery did not exceed 60 minutes and no surgical complications were observed. The case of ovarian tissue transplantation performed on abroad university settings is discussed. In the consensus of with

Lean Six Sigma in a hospital

NARCIS (Netherlands)

van den Heuvel, J.; Does, R.J.M.M.; de Koning, H.

2006-01-01

Abstract Hospitals today face major challenges. Patients demand quality of care to be improved continuously. Health insurance companies demand the lowest possible prices. Lean Six Sigma is a program that can help healthcare providers to achieve these (seemingly) conflicting goals. Lean Six Sigma is

DNA microarray genotyping and virulence and antimicrobial resistance gene profiling of methicillin-resistant Staphylococcus aureus bloodstream isolates from renal patients.

LENUS (Irish Health Repository)

McNicholas, Sinead

2012-02-01

Thirty-six methicillin-resistant Staphylococcus aureus (MRSA) bloodstream isolates from renal patients were genetically characterized by DNA microarray analysis and spa typing. The isolates were highly clonal, belonging mainly to ST22-MRSA-IV. The immune evasion and enterotoxin gene clusters were found in 29\\/36 (80%) and 33\\/36 (92%) isolates, respectively.

DNA microarray genotyping and virulence and antimicrobial resistance gene profiling of methicillin-resistant Staphylococcus aureus bloodstream isolates from renal patients.

LENUS (Irish Health Repository)

McNicholas, Sinead

2011-12-01

Thirty-six methicillin-resistant Staphylococcus aureus (MRSA) bloodstream isolates from renal patients were genetically characterized by DNA microarray analysis and spa typing. The isolates were highly clonal, belonging mainly to ST22-MRSA-IV. The immune evasion and enterotoxin gene clusters were found in 29\\/36 (80%) and 33\\/36 (92%) isolates, respectively.

In which preterm labor-patients is intravenous maintenance tocolysis effective?

Science.gov (United States)

Yoneda, Satoshi; Yoneda, Noriko; Fukuta, Kaori; Shima, Tomoko; Nakashima, Akitoshi; Shiozaki, Arihiro; Yoshino, Osamu; Kigawa, Mika; Yoshida, Taketoshi; Saito, Shigeru

2018-03-01

We evaluated whether maintenance tocolysis (intravenous ritodrine hydrochloride and/or magnesium sulfate) was effective in cases of spontaneous preterm labor with intact membranes. One hundred and thirty preterm labor patients who reached 36 weeks of gestation by maintenance tocolysis were selected. Immediate delivery (ID) after ceasing maintenance tocolysis was defined as an 'effective case'. The correlated factors between ID and no immediate delivery (NID) were statistically analyzed. Thirty-six patients delivered maintenance tocolysis (27.7%) and were defined as effective cases. Multiple logistic regression analysis revealed that amniotic fluid interleukin-8 at admission (≥ 2.3 ng/mL; odds ratio [OR] 5.6, 95% confidence interval [CI] 2.1-17.6; P Maintenance tocolysis may be effective in limited cases with mild intra-amniotic inflammation, in lean women and in cerclage cases. Maintenance tocolysis should be ceased in cases without these clinical factors when clinical symptoms disappear. © 2017 Japan Society of Obstetrics and Gynecology.

Assessing readability of patient education materials: current role in orthopaedics.

Science.gov (United States)

Badarudeen, Sameer; Sabharwal, Sanjeev

2010-10-01

Health literacy is the single best predictor of an individual's health status. It is important to customize health-related education material to the individual patient's level of reading skills. Readability of a given text is the objective measurement of the reading skills one should possess to understand the written material. In this article, some of the commonly used readability assessment tools are discussed and guidelines to improve the comprehension of patient education handouts are provided. Where are we now? Several healthcare organizations have recommended the readability of patient education materials be no higher than sixth- to eighth-grade level. However, most of the patient education materials currently available on major orthopaedic Web sites are written at a reading level that may be too advanced for comprehension by a substantial proportion of the population. WHERE DO WE NEED TO GO?: There are several readily available and validated tools for assessing the readability of written materials. While use of audiovisual aids such as video clips, line drawings, models, and charts can enhance the comprehension of a health-related topic, standard readability tools cannot construe such enhancements. HOW DO WE GET THERE?: Given the variability in the capacity to comprehend health-related materials among individuals seeking orthopaedic care, stratifying the contents of patient education materials at different levels of complexity will likely improve health literacy and enhance patient-centered communication.

MR imaging-guided cryoablation of metastatic brain tumours: initial experience in six patients

International Nuclear Information System (INIS)

Li, Chengli; Wu, Lebin; Song, Jiqing; Liu, Ming; Lv, Yubo; Sequeiros, Roberto Blanco

2010-01-01

The objective was to evaluate the initial experience and safety of magnetic resonance imaging (MRI)-guided transcranial cryoablation in cystic metastatic brain tumours. Seven cystic metastatic brain tumours in six patients were treated with cryoablation. The approval from the local ethics committee and individual patient consent were acquired before the study. Before the procedure the tumours were detected with conventional CT or MRI. The procedure was performed under local anaesthesia and conscious sedation. A 0.23-T open MRI system with optical tracking was used for procedural planning, instrument guidance and procedural monitoring of the ice ball formation. An MR-compatible, argon-based cryoablation system was used. The schedule of follow-up imaging ranged from 12 days to 12 months. Seven treatment sessions were performed. All the cryoprobes were successfully inserted into the target with one pass. All the patients tolerated the procedure well without experiencing any neurological deficits during the treatment phase or during the immediate post-treatment period. One patient died 12 days after cryoablation. MR-guided and monitored metastasis brain tumour cryoablation is technically feasible and may represent an alternative treatment in selected patients. (orig.)

Childhood sexual abuse in adult patients with borderline personality disorder

Directory of Open Access Journals (Sweden)

Preethi Menon

2016-01-01

Full Text Available Background: Researchers have found elevated rates of childhood sexual abuse (CSA in borderline personality disorder (BPD patients. They have also implicated the role of CSA later in BPD. However, there has been a scarcity of studies regarding this in Indian population. Objectives: To profile the occurrence of CSA and its parameters in BPD patients and to document symptomatology of BPD associated with CSA. Materials and Methods: Thirty-six consecutive patients with BPD were administered with a two-staged semi-structured interview by different interviewers with the first stage for collecting sociodemographic details and confirming BPD diagnosis and the second stage for collecting information about CSA. Results: Of 36 BPD patients, 16 (44.44% reported a history of definite CSA. The majority of CSA associated with BPD were having characteristics of onset at 7–12 years, <10 occasions of abuse, perpetrator being a close relative or a close acquaintance and genital type of CSA. Identity disturbances (P = 0.0354, recurrent suicidal/self-harm behavior (P = 0.0177, and stress-related paranoid/dissociative symptoms (P = 0.0177 were significantly associated with the presence of CSA while unstable interpersonal relationships (P = 0.001 were significantly associated with the absence of CSA. Conclusion: Significant proportion of BPD patients reported CSA. The specific symptom profile of BPD patients can be used to predict the presence of CSA in these patients, which has a direct implication in the treatment of these patients.

Revision of the subfamily Opiinae (Hymenoptera, Braconidae from Hunan (China, including thirty-six new species and two new genera

Directory of Open Access Journals (Sweden)

Li Xi-Ying

2013-02-01

Full Text Available The species of the subfamily Opiinae (Hymenoptera: Braconidae from Hunan (Oriental China are revised and illustrated. Thirty-six new species are described: Apodesmia bruniclypealis Li & van Achterberg, sp. n., A. melliclypealis Li & van Achterberg, sp. n., Areotetes albiferus Li & van Achterberg, sp. n., Areotetes carinuliferus Li & van Achterberg, sp. n., A. striatiferus Li & van Achterberg, sp. n., Coleopioides diversinotum Li & van Achterberg, sp. n., C. postpectalis Li & van Achterberg, sp. n., Fopius dorsopiferus Li, van Achterberg & Tan, sp. n., Indiopius chenae Li & van Achterberg, sp. n., Opiognathus aulaciferus Li & van Achterberg, sp. n., O. brevibasalis Li & van Achterberg, sp. n., Opius crenuliferus Li & van Achterberg, sp. n., O. malarator Li, van Achterberg & Tan, sp. n., O. monilipalpis Li & van Achterberg, sp. n., O. pachymerus Li & van Achterberg, sp. n., O. songi Li & van Achterberg, sp. n., O. youi Li & van Achterberg, sp. n., O. zengi Li & van Achterberg, sp. n., Phaedrotoma acuticlypeata Li & van Achterberg, sp. n., P.angiclypeata Li & van Achterberg, sp. n., P. antenervalis Li & van Achterberg, sp. n., P. depressiclypealis Li & van Achterberg, sp. n., P. flavisoma Li & van Achterberg, sp. n., P. nigrisoma Li & van Achterberg, sp. n., P. protuberator Li & van Achterberg, sp. n., P. rugulifera Li & van Achterberg, sp. n., Li & van Achterberg, P. striatinota Li & van Achterberg, sp. n., P. vermiculifera Li & van Achterberg, sp. n., Rhogadopsis latipennis Li & van Achterberg, sp. n., R. longicaudifera Li & van Achterberg, sp. n., R. maculosa Li, van Achterberg & Tan, sp. n., R. obliqua Li & van Achterberg, sp. n., R. sculpturator Li & van Achterberg, sp. n., Utetes longicarinatus Li & van Achterberg, sp. n. and Xynobius notauliferus Li & van Achterberg, sp. n. Areotetes van Achterberg & Li, gen. n. (type species: Areotetes carinuliferus sp. n. and Coleopioides van Achterberg & Li, gen. n. (type species: Coleopioides

Patient satisfaction of tooth supported overdentures utilizing ball attachments

OpenAIRE

Nassar, Hossam I.

2016-01-01

Statement of problem: Teeth retained overdenture therapy is an alternative treatment rarely used in cases with few remaining teeth. Purpose: The aim of this study was to evaluate the patient satisfaction associated with teeth retained maxillary and mandibular overdentures utilizing ready made ball attachment. Materials and methods: Thirty patients treated with teeth retained overdenture utilizing ready made ball attachment. Participants completed a series of questionnaires (OHIP-14 ques...

[Impairment and disability in patients with a severe ischemic cerebral infarction at admission to the rehabilitation center and six months after stroke].

Science.gov (United States)

Prevo, A J; Dijkman, M M; Le Fèvre, F A

1998-03-21

Evaluation of impairment and disability in stroke patients with a severe cortical infarction at admission as well as six months after the stroke. Prospective and descriptive study. Rehabilitation Centre Heliomare, Wijk aan Zee, the Netherlands. Between 1 January 1987 en 31 May 1992 stroke patients were admitted to the rehabilitation centre with a severe, first ever, cortical infarction without any comorbidity. The patients were dependent in activities of daily living and wheel-chair-bound. Motor and neuropsychological impairment and disability were evaluated at admission to the rehabilitation centre as well as six months after the stroke. Return to home and length of stay were evaluated. 43 patients were included. Recovery of arm and hand function was very poor (there was complete paresis at admission in 33 patients (77%) and six months after the CVA in 25 patients (58%)); recovery of the affected leg was reasonable (complete paresis in 10 (23%) and 0 patients, respectively). Cognitive deficits diminished in severity, but remained noticeable in three-quarters of the patients. Independent walking was achieved by 30 patients (70%), independence in personal activities of daily living by 32 patients (74%) and returning home by 36 patients (84%). The mean hospital stay was 26 weeks (SD: 9.26; range: 11-30). Prognosis of personal independence and returning home after a severe cortical infarction was rather good despite poor recovery of motor and cognitive impairment.

Waardenburg syndrome type 2 in an african patient

Directory of Open Access Journals (Sweden)

H. Otman S

2005-01-01

Full Text Available A thirty six year-old African man, born in the Southern part of Libya, presented with congenital deafness and white forelock, variable-sized hypopigmented, depigmented patches and hyperpigmented islands within the areas of hypomelanosis affecting the upper parts of the trunk, both arms and forearms. The nasal root was hypertrophied, but there was a lack of lateral displacement of medial canthi. We report this case of Waardenburg syndrome type 2 (WS 2. As no treatment is available for patients with WS 2, prompt diagnosis and referral to a hearing specialist are crucial for the normal development of patients affected with this condition.

Value assignment of nutrient concentrations in five standard reference materials and six reference materials.

Science.gov (United States)

Sharpless, K E; Gill, L M

2000-01-01

A number of food-matrix reference materials (RMs) are available from the National Institute of Standards and Technology (NIST) and from Agriculture Canada through NIST. Most of these materials were originally value-assigned for their elemental composition (major, minor, and trace elements), but no additional nutritional information was provided. Two of the materials were certified for selected organic constituents. Ten of these materials (Standard Reference Material [SRM] 1,563 Cholesterol and Fat-Soluble Vitamins in Coconut Oil [Natural and Fortified], SRM 1,566b Oyster Tissue, SRM 1,570a Spinach Leaves, SRM 1,974a Organics in Mussel Tissue (Mytilus edulis), RM 8,415 Whole Egg Powder, RM 8,418 Wheat Gluten, RM 8,432 Corn Starch, RM 8,433 Corn Bran, RM 8,435 Whole Milk Powder, and RM 8,436 Durum Wheat Flour) were recently distributed by NIST to 4 laboratories with expertise in food analysis for the measurement of proximates (solids, fat, protein, etc.), calories, and total dietary fiber, as appropriate. SRM 1846 Infant Formula was distributed as a quality control sample for the proximates and for analysis for individual fatty acids. Two of the materials (Whole Egg Powder and Whole Milk Powder) were distributed in an earlier interlaboratory comparison exercise in which they were analyzed for several vitamins. Value assignment of analyte concentrations in these 11 SRMs and RMs, based on analyses by the collaborating laboratories, is described in this paper. These materials are intended primarily for validation of analytical methods for the measurement of nutrients in foods of similar composition (based on AOAC INTERNATIONAL's fat-protein-carbohydrate triangle). They may also be used as "primary control materials" in the value assignment of in-house control materials of similar composition. The addition of proximate information for 10 existing reference materials means that RMs are now available from NIST with assigned values for proximates in 6 of the 9 sectors of

Improving the readability of online foot and ankle patient education materials.

Science.gov (United States)

Sheppard, Evan D; Hyde, Zane; Florence, Mason N; McGwin, Gerald; Kirchner, John S; Ponce, Brent A

2014-12-01

Previous studies have shown the need for improving the readability of many patient education materials to increase patient comprehension. This study's purpose was to determine the readability of foot and ankle patient education materials and to determine the extent readability can be improved. We hypothesized that the reading levels would be above the recommended guidelines and that decreasing the sentence length would also decrease the reading level of these patient educational materials. Patient education materials from online public sources were collected. The readability of these articles was assessed by a readability software program. The detailed instructions provided by the National Institutes of Health (NIH) were then used as a guideline for performing edits to help improve the readability of selected articles. The most quantitative guideline, lowering all sentences to less than 15 words, was chosen to show the effect of following the NIH recommendations. The reading levels of the sampled articles were above the sixth to seventh grade recommendations of the NIH. The MedlinePlus website, which is a part of the NIH website, had the lowest reading level (8.1). The articles edited had an average reduction of 1.41 grade levels, with the lowest reduction in the Medline articles of 0.65. Providing detailed instructions to the authors writing these patient education articles and implementing editing techniques based on previous recommendations could lead to an improvement in the readability of patient education materials. This study provides authors of patient education materials with simple editing techniques that will allow for the improvement in the readability of online patient educational materials. The improvement in readability will provide patients with more comprehendible education materials that can strengthen patient awareness of medical problems and treatments. © The Author(s) 2014.

A feasible, aesthetic quality evaluation of implant-supported single crowns: an analysis of validity and reliability

DEFF Research Database (Denmark)

Hosseini, Mandana; Gotfredsen, Klaus

2012-01-01

OBJECTIVES: To test the reliability and validity of six aesthetic parameters and to compare the professional- and patient-reported aesthetic outcomes. MATERIAL AND METHODS: Thirty-four patients with 66 implant-supported premolar crowns were included. Two prosthodontists and 11 dental students......,24) were found between patient and professional evaluations. CONCLUSIONS: The feasibility, reliability and validity of the CIS make the parameters useful for quality control of implant-supported restorations. The professional- and patient-reported aesthetic outcomes had no significant correlation....... and the internal consistency were analysed by Cohen's ¿ and Cronbach's a, respectively. The validity of CIS parameters was tested against the corresponding Visual Analogue Scales (VAS) scores. The Spearman correlation coefficients were used. Six aesthetic Oral Health Impact Profile (OHIP) questions were correlated...

A Clinical and Electrophysiological Study of Peripheral Neuropathies in Predialysis Chronic Kidney Disease Patients and Relation of Severity of Peripheral Neuropathy with Degree of Renal Failure

Science.gov (United States)

Jasti, Dushyanth Babu; Mallipeddi, Sarat; Apparao, A.; Vengamma, B.; Sivakumar, V.; Kolli, Satyarao

2017-01-01

Objective: To study the prevalence, clinical features, electrophysiological features, and severity of peripheral neuropathy in predialysis chronic kidney disease (CKD) patients with respect to severity of renal failure and presence of diabetes mellitus. Materials and Methods: Between May 2015 and December 2016, 200 predialysis CKD patients were assessed prospectively. Results: The prevalence of peripheral neuropathy in predialysis CKD patients in the present study was 45% based on clinical symptoms and 90% electrophysiologically. Mean age of 200 predialysis CKD patients who participated in the study was 53.2 ± 13.2 years. One hundred and thirty-six (68%) patients were male and 64 (32%) patients were female. Mean duration of disease was 2.2 ± 1.6 years. Nearly 45% patients of patients had asymptomatic peripheral neuropathy in the present study, which was more common in mild-to-moderate renal failure group. One hundred twenty-six patients (63%) had definite damage and 54 patients (27%) had early damage. In mild-to-moderate renal failure (n = 100) and severe renal failure patients (n = 100), 88% and 92% had significant peripheral neuropathy, respectively. Most common nerves involved were sural nerve, median sensory nerve, and ulnar sensory nerve. Diabetic patients (97%) showed more severe and high prevalence of peripheral neuropathy when compared to nondiabetic patients (83%). Most common patterns were pure axonal sensorimotor neuropathy and mixed sensorimotor neuropathy. Conclusion: Peripheral neuropathy is common in predialysis patients, prevalence and severity of which increases as renal failure worsens. Predialysis patients with diabetes show higher prevalence and severity of peripheral neuropathy when compared with nondiabetics. PMID:29204008

Experience with polyclonal immunoglobulin therapy in poly trauma patients with severe sepsis

International Nuclear Information System (INIS)

Janjua, S.K.; Hussain, R.M.; Mohsin, S.T.; Iqbal, A.; Mishwani, A.H.

2011-01-01

To evaluate the effects of intravenous immunoglobulin therapy on progression of severe sepsis in patients of poly trauma. Design: Quasi-experimental study. Place and Duration of Study: Combined Military Hospital Peshawar from June 2008 to Dec 2009. Patients and Methods: Forty six patients of poly trauma with severe sepsis were included. Along with the standard management i.e., surgical management, fluid resuscitation, antibiotics, analgesics, ionotropic, ventilatory and nutritional support, IVIG 5% (intravenous immunoglobulin) was infused over a period of 6 hours and repeated for three consecutive days. Sequential Organ Failure Assessment (SOFA) score was used to assess the progress in all the patients. Results: At the time of enrolment mean SOFA score was 5.41+- 1.127 and on the 15 day it was 1.62 +- 2.24, mean age was 39.21+10.26 years. Thirty four patients (73.91%) developed gram negative sepsis and eighteen patients (39.13%) developed septic shock. Mean duration of stay in ICU and on ventilatory support was 20.80+9.61 and 10.52 + 5.52 days respectively. Thirty five days mortality rate of these patients was 30.43%. Conclusion: The IVIG administration, when used along with the standard management appears to improve significantly the prognosis in patients of poly trauma with severe sepsis. (author)

Decreasing Turnaround Time and Increasing Patient Satisfaction in a Safety Net Hospital-Based Pediatrics Clinic Using Lean Six Sigma Methodologies.

Science.gov (United States)

Jayasinha, Yasangi

2016-01-01

Increasingly, health care quality indicators are focusing on patient-centeredness as an indicator of performance. The National Quality Forum lists assessment of patient experience, often conducted using patient surveys, as a top priority. We developed a patient-reported time stamp data collection tool that was used to collect cycle times in a safety net hospital-based outpatient pediatrics clinic. Data were collected using patient-reported survey to obtain cycle times in Pediatric clinic, as well as qualitative and quantitative patient satisfaction data. Several rapid-cycle improvements were performed using Lean Six Sigma methodologies to reduce cycle time by eliminating waste and revise unnecessary processes to improve operational effectiveness and patient and staff satisfaction. A total of 94 surveys were collected and revealed average cycle time of 113 minutes. Our measured patient satisfaction rating was 87%. Discharge and check-in processes were identified as the least efficient and were targeted for intervention. Following implementation, the overall cycle time was decreased from 113 to 90 minutes. Patient satisfaction ratings increased from 87% to 95%. We demonstrate that using Lean Six Sigma tools can be invaluable to clinical restructuring and redesign and results in measurable, improved outcomes in care delivery.

Influence of pleural drain insertion in lung function of patients undergoing coronary artery bypass grafting.

Science.gov (United States)

Ozelami Vieira, Irinea Beatriz Carvalho; Vieira, Fabiano F; Abrão, João; Gastaldi, Ada Clarice

2012-01-01

Longitudinal, prospective, randomized, blinded Trial to assess the influence of pleural drain (non-toxic PVC) site of insertion on lung function and postoperative pain of patients undergoing coronary artery bypass grafting in the first three days post-surgery and immediately after chest tube removal. Thirty six patients scheduled for elective myocardial revascularization with cardiopulmonary bypass (CPB) were randomly allocated into two groups: SX group (subxiphoid) and IC group (intercostal drain). Spirometry, arterial blood gases, and pain tests were recorded. Thirty one patients were selected, 16 in SX group and 15 in IC group. Postoperative (PO) spirometric values were higher in SX than in IC group (ppleural drain location on breathing. PaO(2) on the second PO increased significantly in SX group compared with IC group (pDrain with insertion in the subxiphoid region causes less change in lung function and discomfort, allowing better recovery of respiratory parameters. Copyright © 2012 Elsevier Editora Ltda. All rights reserved.

Preference for different relaxation techniques by COPD patients: comparison between six techniques

Directory of Open Access Journals (Sweden)

Hyl

2016-09-01

Full Text Available Michael E Hyland,1 David MG Halpin,2 Sue Blake,3 Clare Seamark,3 Margaret Pinnuck,3 David Ward,3 Ben Whalley,1 Colin J Greaves,4 Adam L Hawkins,5 Dave Seamark3 1School of Psychology, University of Plymouth, Plymouth, 2Department of Respiratory Medicine, Royal Devon and Exeter Hospital, Exeter, 3Honiton Group Practice, Honiton, 4University of Exeter Medical School, Exeter, 5GSK House, Brentford, UK Background: A review of the effectiveness of relaxation techniques for chronic obstructive pulmonary disease patients has shown inconsistent results, but studies have varied in terms of technique and outcome measures. Aim: To determine patient preference for different relaxation techniques. Methods: Chronic obstructive pulmonary disease patients were presented with six techniques via a DVD and asked to rate the techniques in terms of effectiveness, rank in order of likely use, and comment. Results: Patients differed in the technique preferred and reason for that preference, but the most commonly preferred technique both for effectiveness and ease of use was “thinking of a nice place” followed by progressive relaxation and counting. Familiarity and ease of activity were commonly given reasons for preference. Conclusion: Rather than providing patients with a single technique that they might find difficult to implement, these results suggest that it would be better to give a choice. “Thinking of a nice place” is a popular but under-investigated technique. Keywords: COPD exacerbation, anxiety, relaxation techniques

Cross border reproductive care in six European countries

DEFF Research Database (Denmark)

de Mouzon, J; Pennings, G; Ferraretti, A P

2010-01-01

The quantity and the reasons for seeking cross border reproductive care are unknown. The present article provides a picture of this activity in six selected European countries receiving patients.......The quantity and the reasons for seeking cross border reproductive care are unknown. The present article provides a picture of this activity in six selected European countries receiving patients....

Readability of Online Patient Education Materials From the AAOS Web Site

Science.gov (United States)

Badarudeen, Sameer; Unes Kunju, Shebna

2008-01-01

One of the goals of the American Academy of Orthopaedic Surgeons (AAOS) is to disseminate patient education materials that suit the readability skills of the patient population. According to standard guidelines from healthcare organizations, the readability of patient education materials should be no higher than the sixth-grade level. We hypothesized the readability level of patient education materials available on the AAOS Web site would be higher than the recommended grade level, regardless when the material was available online. Readability scores of all articles from the AAOS Internet-based patient information Web site, “Your Orthopaedic Connection,” were determined using the Flesch-Kincaid grade formula. The mean Flesch-Kincaid grade level of the 426 unique articles was 10.43. Only 10 (2%) of the articles had the recommended readability level of sixth grade or lower. The readability of the articles did not change with time. Our findings suggest the majority of the patient education materials available on the AAOS Web site had readability scores that may be too difficult for comprehension by a substantial portion of the patient population. PMID:18324452

Six-minute walk test and respiratory muscle strength in patients with uncontrolled severe asthma: a pilot study.

Science.gov (United States)

Pereira, Luiz Fernando Ferreira; Mancuzo, Eliane Viana; Rezende, Camila Farnese; Côrrea, Ricardo de Amorim

2015-01-01

To evaluate respiratory muscle strength and six-minute walk test (6MWT) variables in patients with uncontrolled severe asthma (UCSA). This was a cross-sectional study involving UCSA patients followed at a university hospital. The patients underwent 6MWT, spirometry, and measurements of respiratory muscle strength, as well as completing the Asthma Control Test (ACT). The Mann-Whitney test was used in order to analyze 6MWT variables, whereas the Kruskal-Wallis test was used to determine whether there was an association between the use of oral corticosteroids and respiratory muscle strength. We included 25 patients. Mean FEV1 was 58.8 ± 21.8% of predicted, and mean ACT score was 14.0 ± 3.9 points. No significant difference was found between the median six-minute walk distance recorded for the UCSA patients and that predicted for healthy Brazilians (512 m and 534 m, respectively; p = 0.14). During the 6MWT, there was no significant drop in SpO2. Mean MIP and MEP were normal (72.9 ± 15.2% and 67.6 ± 22.2%, respectively). Comparing the patients treated with at least four courses of oral corticosteroids per year and those treated with three or fewer, we found no significant differences in MIP (p = 0.15) or MEP (p = 0.45). Our findings suggest that UCSA patients are similar to normal subjects in terms of 6MWT variables and respiratory muscle strength. The use of oral corticosteroids has no apparent impact on respiratory muscle strength.

Patients' identification and reporting of unsafe events at six hospitals in Japan.

Science.gov (United States)

Hasegawa, Tomonori; Fujita, Shigeru; Seto, Kanako; Kitazawa, Takefumi; Matsumoto, Kunichika

2011-11-01

Hospitals and other health care organizations have increasingly recognized the need to engage patients as participants in patient safety. A study was conducted to compare patients' and health care staff's identification and reporting of such events. A questionnaire was administered at six hospitals in Japan to outpatients and inpatients from November 2004 through February 2007. Patients were asked to respond to questions about experiences of possibly unsafe events. Patients experiencing such events were then asked about the events and whether they had reported their experience to health care staff. A specialist panel classified reported events as "uneasy-dissatisfying" or "unsafe." The response rates of outpatients and inpatients were 85.4% (1,506/1,764) and 54.3% (1,738/3,198), respectively. Among the respondents (> or = 20 years of age), 125 (8.7%) of the outpatients and 185 (10.9%) of the inpatients experienced uneasy-dissatisfying or unsafe events; 35 (2.4%) of the outpatients and 67 (4.0%) of the inpatients experienced unsafe events, the percent increasing with hospital stay. Only 38 (30.4%) of the outpatients and 62 (33.5%) of the inpatients reported the unsafe events to health care staff Only 17.1% of unsafe events reported by inpatients were identified by the in-house reporting systems of adverse events and near misses. For the uneasy-dissatisfying or unsafe events that patients did not think necessary to report, the patients often felt they were self-evident or easily identifiable by health care staff, had difficulty evaluating the event, did not expect their report to bring any improvement, or even felt that reporting it would create some disadvantage in their medical treatment. Patient reporting programs and in-house reporting systems, among other detection methods, should be regarded as complementary sources of information.

SU-E-T-760: Tolerance Design for Site-Specific Range in Proton Patient QA Process Using the Six Sigma Model

International Nuclear Information System (INIS)

Lah, J; Shin, D; Kim, G

2015-01-01

Purpose: To show how tolerance design and tolerancing approaches can be used to predict and improve the site-specific range in patient QA process in implementing the Six Sigma. Methods: In this study, patient QA plans were selected according to 6 site-treatment groups: head &neck (94 cases), spine (76 cases), lung (89 cases), liver (53 cases), pancreas (55 cases), and prostate (121 cases), treated between 2007 and 2013. We evaluated a model of the Six Sigma that determines allowable deviations in design parameters and process variables in patient-specific QA, where possible, tolerance may be loosened, then customized if it necessary to meet the functional requirements. A Six Sigma problem-solving methodology is known as DMAIC phases, which are used stand for: Define a problem or improvement opportunity, Measure process performance, Analyze the process to determine the root causes of poor performance, Improve the process by fixing root causes, Control the improved process to hold the gains. Results: The process capability for patient-specific range QA is 0.65 with only ±1 mm of tolerance criteria. Our results suggested the tolerance level of ±2–3 mm for prostate and liver cases and ±5 mm for lung cases. We found that customized tolerance between calculated and measured range reduce that patient QA plan failure and almost all sites had failure rates less than 1%. The average QA time also improved from 2 hr to less than 1 hr for all including planning and converting process, depth-dose measurement and evaluation. Conclusion: The objective of tolerance design is to achieve optimization beyond that obtained through QA process improvement and statistical analysis function detailing to implement a Six Sigma capable design

SU-E-T-760: Tolerance Design for Site-Specific Range in Proton Patient QA Process Using the Six Sigma Model

Energy Technology Data Exchange (ETDEWEB)

Lah, J [Myongji Hospital, Goyang, Gyeonggi-do (Korea, Republic of); Shin, D [National Cancer Center, Goyang-si, Gyeonggi-do (Korea, Republic of); Kim, G [University of California, San Diego, La Jolla, CA (United States)

2015-06-15

Purpose: To show how tolerance design and tolerancing approaches can be used to predict and improve the site-specific range in patient QA process in implementing the Six Sigma. Methods: In this study, patient QA plans were selected according to 6 site-treatment groups: head &neck (94 cases), spine (76 cases), lung (89 cases), liver (53 cases), pancreas (55 cases), and prostate (121 cases), treated between 2007 and 2013. We evaluated a model of the Six Sigma that determines allowable deviations in design parameters and process variables in patient-specific QA, where possible, tolerance may be loosened, then customized if it necessary to meet the functional requirements. A Six Sigma problem-solving methodology is known as DMAIC phases, which are used stand for: Define a problem or improvement opportunity, Measure process performance, Analyze the process to determine the root causes of poor performance, Improve the process by fixing root causes, Control the improved process to hold the gains. Results: The process capability for patient-specific range QA is 0.65 with only ±1 mm of tolerance criteria. Our results suggested the tolerance level of ±2–3 mm for prostate and liver cases and ±5 mm for lung cases. We found that customized tolerance between calculated and measured range reduce that patient QA plan failure and almost all sites had failure rates less than 1%. The average QA time also improved from 2 hr to less than 1 hr for all including planning and converting process, depth-dose measurement and evaluation. Conclusion: The objective of tolerance design is to achieve optimization beyond that obtained through QA process improvement and statistical analysis function detailing to implement a Six Sigma capable design.

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

Acceleration of direct identification of S.aureus versus Coagulase Negative Staphylococci from blood culture material: a comparison of six bacterial DNA extraction methods

NARCIS (Netherlands)

Prof. Dr. C.A. Bruggeman; Drs H. Kreeftenberg; Dr. Ir. P.F.G. Wolffs; Drs A.J.M. Loonen; Dr. A.J.C. van den Brule, van den; Drs A.R. Jansz

2010-01-01

To accelerate differentiation between Staphylococcus aureus and Coagulase Negative Staphylococci (CNS), this study aimed to compare six different DNA extraction methods from 2 commonly used blood culture materials, i.e. BACTEC and Bact/ALERT. Furthermore, we analyzed the effect of reduced blood

Dentin bond strength of two resin-ceramic computer-aided design/computer-aided manufacturing (CAD/CAM) materials and five cements after six months storage.

Science.gov (United States)

Flury, Simon; Schmidt, Stefanie Zita; Peutzfeldt, Anne; Lussi, Adrian

2016-10-01

The aim was to investigate dentin bond strength of two resin-ceramic materials and five cements after 24 h and six months storage. Cylinders (n=15/group) of Lava Ultimate (3M ESPE) and VITA ENAMIC (VITA Zahnfabrik) were cemented to mid-coronal dentin of 300 extracted human molars with RelyX Ultimate (3M ESPE), PANAVIA F2.0 (Kuraray), Variolink II (Ivoclar Vivadent), els cem (Saremco Dental), or Ketac Cem Plus (3M ESPE). Shear bond strength (SBS) was measured after 24 h or six months storage (37°C, 100% humidity) and statistically analyzed (significance level: α=0.05). SBS varied markedly between Lava Ultimate and VITA ENAMIC, between the five cements, and between storage of either 24 h or six months. After six months, SBS was highest when Lava Ultimate was cemented with RelyX Ultimate and when VITA ENAMIC was cemented with RelyX Ultimate or with Variolink II. Lava Ultimate was somewhat more sensitive to storage than was VITA ENAMIC.

Fiber-enriched diet helps to control symptoms and improves esophageal motility in patients with non-erosive gastroesophageal reflux disease.

Science.gov (United States)

Morozov, Sergey; Isakov, Vasily; Konovalova, Mariya

2018-06-07

To investigate the effect of dietary fiber on symptoms and esophageal function testing parameters in non-erosive gastroesophageal reflux disease (GERD) (NERD) patients. Thirty-six NERD patients with low (gastroesophageal refluxes (GER) decreased from 67.9 ± 17.7 to 42.4 ± 13.5 ( P reflux time decreased from 10.6 ± 12.0 min to 5.3 ± 3.7 min ( P gastroesophageal refluxes, and a decrease of heartburn frequency per week in NERD.

TOLERANCE SENSITIVITY ANALYSIS: THIRTY YEARS LATER

Directory of Open Access Journals (Sweden)

Richard E. Wendell

2010-12-01

Full Text Available Tolerance sensitivity analysis was conceived in 1980 as a pragmatic approach to effectively characterize a parametric region over which objective function coefficients and right-hand-side terms in linear programming could vary simultaneously and independently while maintaining the same optimal basis. As originally proposed, the tolerance region corresponds to the maximum percentage by which coefficients or terms could vary from their estimated values. Over the last thirty years the original results have been extended in a number of ways and applied in a variety of applications. This paper is a critical review of tolerance sensitivity analysis, including extensions and applications.

Six-month evaluation of a resin/dentin interface created by methacrylate and silorane-based materials

Directory of Open Access Journals (Sweden)

Renata Kirita Doi SAMPAIO

2013-01-01

Full Text Available Objectives This study aimed to compare the micro-tensile bond strength of methacrylate resin systems to a silorane-based restorative system on dentin after 24 hours and six months water storage. Material and Methods The restorative systems Adper Single Bond 2/Filtek Z350 (ASB, Clearfil SE Bond/Z350 (CF, Adper SE Plus/Z350 (ASEP and P90 Adhesive System/Filtek P90 (P90 were applied on flat dentin surfaces of 20 third molars (n=5. The restored teeth were sectioned perpendicularly to the bonding interface to obtain sticks (0.8 mm2 to be tested after 24 hours (24 h and 6 months (6 m of water storage, in a universal testing machine at 0.5 mm/min. The data was analyzed via two-way Analysis of Variance/Bonferroni post hoc tests at 5% global significance. Results Overall outcomes did not indicate a statistical difference for the resin systems (p=0.26 nor time (p=0.62. No interaction between material × time was detected (p=0.28. Mean standard-deviation in MPa at 24 h and 6 m were: ASB 31.38 (4.53 and 30.06 (1.95, CF 34.26 (3.47 and 32.75 (4.18, ASEP 29.54 (4.14 and 33.47 (2.47, P90 30.27 (2.03 and 31.34 (2.19. Conclusions The silorane-based system showed a similar performance to methacrylate-based materials on dentin. All systems were stable in terms of bond strength up to 6 month of water storage.

Verification of the Patient Positioning in the Bellyboard Pelvic Radiotherapy

International Nuclear Information System (INIS)

Kasabasic, M.; Faj, D.; Smilovic Radojcic, D.; Svabic, M.; Ivkovic, A.; Jurkovic, S.

2008-01-01

The size and shape of the treatment fields applied in radiotherapy account for uncertainties in the daily set-up of the patients during the treatment. We investigated the accuracy of daily patient positioning in the bellyboard pelvic radiotherapy in order to find out the magnitude of the patients movement during the treatment. Translational as well as rotational movements of the patients are explored. Film portal imaging is used in order to find patient positioning error during the treatment of the pelvic region. Patients are treated in the prone position using the bellyboard positioning device. Thirty six patients are included in the study; 15 patients were followed during the whole treatment and 21 during the first 5 consecutive treatment days. The image acquisition was completed in 85 percent and systematic and random positioning errors in 453 images are analyzed. (author)

Resting and exercise haemodynamics in relation to six-minute walk test in patients with heart failure and preserved ejection fraction

DEFF Research Database (Denmark)

Wolsk, Emil; Kaye, David; Borlaug, Barry A

2018-01-01

AIMS: Patients with heart failure and preserved ejection fraction (HFpEF) are characterized by functional impairment and an abnormal haemodynamic response to exercise. The six-minute walk test (6MWT) serves as a standardized test for functional capacity quantification in heart failure patients, a...

Influence of citric acid on the surface texture of glass ionomer restorative materials

OpenAIRE

Reddy, Dappili Swami Ranga; Kumar, Ramachandran Anil; Venkatesan, Sokkalingam Mothilal; Narayan, Gopal Shankar; Duraivel, Dasarathan; Indra, Rajamani

2014-01-01

Aim: This study determined the effectiveness of G-coat plus surface protective agent over petroleum jelly on the surface texture of conventional Glass ionomer restorative materials. Materials and Methods: Three chemically cured conventional glass ionomer restorative materials type II, type IX and ketac molar were evaluated in this study. Sixty specimens were made for each restorative material. They were divided into two groups of thirty specimens each. Of the sixty specimens, thirty were...

Readability and suitability assessment of patient education materials in rheumatic diseases.

Science.gov (United States)

Rhee, Rennie L; Von Feldt, Joan M; Schumacher, H Ralph; Merkel, Peter A

2013-10-01

Web-based patient education materials and printed pamphlets are frequently used by providers to inform patients about their rheumatic disease. Little attention has been given to the readability and appropriateness of patient materials. The objective of this study was to examine the readability and suitability of commonly used patient education materials for osteoarthritis (OA), rheumatoid arthritis, systemic lupus erythematosus, and vasculitis. Five or 6 popular patient resources for each disease were chosen for evaluation. Readability was measured using the Flesch-Kincaid reading grade level and suitability was determined by the Suitability Assessment of Materials (SAM), a score that considers characteristics such as content, graphics, layout/topography, and cultural appropriateness. Three different reviewers rated the SAM score and means were used in the analysis. Twenty-three resources written on the 4 diseases were evaluated. The education material for all 4 diseases studied had readability above the eighth-grade level and readability did not differ among the diseases. Only 5 of the 23 resources received superior suitability scores, and 3 of these 5 resources were written for OA. All 4 diseases received adequate suitability scores, with OA having the highest mean suitability score. Most patient education materials for rheumatic diseases are written at readability levels above the recommended sixth-grade reading level and have only adequate suitability. Developing more appropriate educational resources for patients with rheumatic diseases may improve patient comprehension. Copyright © 2013 by the American College of Rheumatology.

The effect of foot reflexology on pain in patients with metastatic cancer.

Science.gov (United States)

Stephenson, Nancy; Dalton, Jo Ann; Carlson, John

2003-11-01

Thirty-six oncology inpatients participated in this third pilot study investigating the effects of foot reflexology in which equianalgesic dosing was calculated. Foot reflexology was found to have a positive immediate effect for patients with metastatic cancer who report pain, although there was no statistically significant effect at 3 hours after intervention or at 24 hours after intervention. Further study is suggested for foot reflexology delivered by family in the homes for management of cancer pain.

Survey of Saccadic Parameters Using Videonystagmography in Patients with Idiopathic Parkinson's Disease and Normal Subjects

Directory of Open Access Journals (Sweden)

Reza Hosseinabadi

2008-06-01

Full Text Available Background and Aim: Patients with Parkinson’s disease manifest oculomotor abnormalities. This is the consequence of basal ganglia impairment. The most common abnormalities include increased saccade latency, hypometric saccades and decreased saccade velocity. The purpose of this study was comparison of saccadic parameters using videonystagmography in patients with idiopathic Parkinson’s disease and normal subjects.Materials and Methods: In this cross sectional study, saccadic movements were investigated in thirty patients with idiopathic Parkinson’s disease and thirty age matched subjects were 35-70 years old. Saccade latency, velocity and accuracy were quantitatively analyzed. Results: Results of this study indicated increased saccade latency, reduction of saccade velocity and accuracy in patients with Parkinson’s disease(P<0.001.Conclusion: This study showed that patients with Parkinson’s disease manifest saccadic deficits. This suggests dopaminergic control of these ocular movements.

Analysis of the performance of women with fibromyalgia in the six-minute walk test and its relation with health and quality of life.

Science.gov (United States)

Latorre-Román, P; Santos-Campos, M; Heredia-Jimenez, J; Delgado-Fernández, M; Soto-Hermoso, V

2014-08-01

Fibromyalgia (FM) is a chronic syndrome characterized by widespread musculoskeletal pain that causes a significant reduction in functional capacity, affecting thus health and quality of life (QOL). The aim of the present study was to evaluate the performance of FM patients in the 6-Minute Walk Test (6MWT) and its relation with health and QOL. Thirty-six FM patients (all women), differentiated by degree of severity of disease, and 14 healthy women were evaluated. Distance walked in the 6MWT, cardiorespiratory responses, heart rate responses, kinematic parameters of gait, the results of the Fibromyalgia Impact Questionnaire (FIQ), and the results of the Short-Form Healthy Survey (SF-36) were analyzed. Women with FM covered a shorter distance in the 6MWT, had a lower cardiorespiratory response, and had lower spatio-temporal parameters of gait than healthy women. No correlation was found in FM patients between the total FIQ score and the distance walked in the 6MWT. The analysis of performance parameters in the 6MWT may be an element of clinical relevance in FM patients.

High Temperature Materials Laboratory sixth annual report, October 1992--September 1993

Energy Technology Data Exchange (ETDEWEB)

Tennery, V.J.; Foust, F.M.

1993-12-01

The High Temperature Materials Laboratory has completed its sixth year of operation as a designated Department of Energy User Facility at the Oak Ridge National Laboratory. Growth of the User Program is evidenced by the number of outside institutions executing user agreements since the facility began operation in 1987. A total of 172 nonproprietary agreements (88 university and 84 industry) and 35 proprietary agreements, (2 university, 33 industry) are now in effect. Six other government facilities have also participated in the User Program. Thirty-eight states are represented by these interactions. Ninety-four nonproprietary research proposals (44 from universities, 47 from industry, and 3 from other government facilities) and three proprietary proposals were considered during this reporting period. Nonproprietary research projects active in FY 1993 are summarized.

An Instrument to Measure Dental Students' Communication Skills With Patients in Six Specific Circumstances: An Exploratory Factor Analysis.

Science.gov (United States)

Aalboe, Joanna A; Schumacher, Mitzi M

2016-01-01

The aim of this study was to explore the internal structure of an instrument assessing dental students' confidence in their ability to communicate with patients in six specific circumstances (anxious, in pain, etc.) using exploratory factor analysis. In a Communication in the Dental Health Care Setting course at a U.S. dental school, second-year dental students in two years (2013 and 2014) responded to the six items on a survey instrument. Of the total 123 students, 122 fully completed the instrument, for a response rate of 99%. Analysis of the results identified a unidimensional scale with regards to patient-specific communication self-efficacy and explained 74% of the total variance. The scale had good internal consistency reflected by high Cronbach's alpha (α=0.929, 95% CI [0.907, 0.947]). These findings suggest the instrument may be a useful tool in assessing the development of patient communication skills in second-year dental students following a course in communication. Further exploration utilizing confirmatory analysis, determining predictive validity, and assessing convergent and discriminant evidence is warranted.

Automated selection of beam orientations and segmented intensity-modulated radiotherapy (IMRT) for treatment of oesophagus tumors

International Nuclear Information System (INIS)

Woudstra, Evert; Heijmen, Ben J.M.; Storchi, Pascal R.M.

2005-01-01

Background and purpose: For some treatment sites, there is evidence in the literature that five to nine equiangular input beam directions are enough for generating IMRT plans. For oesophagus cancer, there is a report showing that going from four to nine beams may even result in lower quality plans. In this paper, our previously published algorithm for automated beam angle selection (Cycle) has been extended to include segmented IMRT. For oesophagus cancer patients, we have investigated whether automated orientation selection from a large number of equiangular input beam directions (up to thirty-six) for IMRT optimisation can result in improved lung sparing. Materials and methods: CT-data from five oesophagus patients treated recently in our institute were used for this study. For a prescribed mean PTV dose of 55 Gy, Cycle was used in an iterative procedure to minimise the mean lung dose under the following hard constraints: standard deviation for PTV dose inhomogeneity 2% (1,1 Gy), maximum spinal cord dose 45 Gy. Conformal radiotherapy (CFRT) and IMRT plans for a standard four field oesophagus beam configuration were compared with IMRT plans generated by automated selection from nine or thirty-six equiangular input beam orientations. Comparisons were also made with dose distributions generated with our commercial treatment planning system (TPS), and with observations in the literature. Results: Using Cycle, automated orientation selection from nine or thirty-six input beam directions resulted in improved lung sparing compared to the four field set-ups. Compared to selection from nine input orientations, selection from thirty-six directions did always result in lower mean lung doses, sometimes with even fewer non-zero weight beams. On average only seven beams with a non-zero weight were enough for obtaining the lowest mean lung dose, yielding clinically feasible plans even in case of thirty-six input directions for the optimisation process. With our commercial TPS

Characteristic risk factors in cirrhotic patients for posthepatectomy complications: comparison with noncirrhotic patients.

Science.gov (United States)

Itoh, Shinji; Uchiyama, Hideaki; Kawanaka, Hirofumi; Higashi, Takahiro; Egashira, Akinori; Eguchi, Daihiko; Okuyama, Toshiro; Tateishi, Masahiro; Korenaga, Daisuke; Takenaka, Kenji

2014-02-01

There seemed to be characteristic risk factors in cirrhotic patients for posthepatectomy complications because these patients have less hepatic reserve as compared with noncirrhotic patients. The aim of the current study was to identify these characteristic risk factors in cirrhotic patients. We performed 419 primary hepatectomies for hepatocellular carcinoma. The patients were divided into the cirrhotic group (n = 198) and the noncirrhotic group (n = 221), and the risk factors for posthepatectomy complications were compared between the groups. Thirty-six cirrhotic patients (18.2%) experienced Clavien's Grade III or more complications. Tumor size, intraoperative blood loss, duration of operation, major hepatectomy (two or more segments), and necessity of blood transfusion were found to be significant risk factors in univariate analyses. Multivariate analysis revealed that major hepatectomy and intraoperative blood loss were independent risk factors for posthepatectomy complications in patients with cirrhosis. On the other hand, the duration of operation was only an independent risk factor for posthepatectomy complication in noncirrhotic patients. Cirrhotic patients should avoid a major hepatectomy and undergo a limited resection preserving as much liver tissue as possible and meticulous surgical procedures to lessen intraoperative blood loss are mandatory to prevent major posthepatectomy complications.

Retrospective analysis of two hundred thirty-five pediatric mandibular fracture cases.

Science.gov (United States)

Eskitascioglu, Teoman; Ozyazgan, Irfan; Coruh, Atilla; Gunay, Galip K; Yuksel, Esabil

2009-11-01

Maxillofacial fractures are encountered less commonly during childhood period due to anatomic, social, cultural, and environmental factors. Although the incidence of all maxillofacial fractures is 1% to 15% among pediatric and adolescent patients, this rate drops to less than 1% in children below 5 years age. Two hundred thirty-five cases (mandibular fracture were evaluated retrospectively. Patients records were examined in terms of age, gender, cause of fracture, fracture localization, number of fractures, fracture pattern, accompanying injuries, applied treatment methods, and complications. Mean age of cases was 9.2 years and 165 cases were male, 70 were female. Traffic accidents as the most common etiologic cause in all ages. Falls is the second most common cause which particularly affects children above age of 2 years. All cases had 333 fractures and the most common fracture localization was parasymphysis region (34%). The other most common fracture localizations were as follows: condyle (19%), corpus (13%), dentoalveolar region (12%), angulus (11%), symphysis region (9%), and ramus (2%). There was only a single fracture line in 145 cases, 40 cases had unilateral multiple and 50 cases had bilateral fracture lines. We applied symptomatic (conservative) treatment in 20 (8%) of our cases; fracture fixation with interdental wires or closed reduction methods were employed in 122 patients. Internal fixation with open reduction (OR) was performed on 51 (22%) patients. Both closed and OR techniques were carried out in 30 (13%) patients. Pediatric mandibular fractures, which are seen less frequently compared with those of adults, require a specific and different treatment. Although mostly less invasive methods are preferred, we believe that ORs should be considered when required.

Mini-open lateral retroperitoneal lumbar spine approach using psoas muscle retraction technique. Technical report and initial results on six patients.

Science.gov (United States)

Aghayev, Kamran; Vrionis, Frank D

2013-09-01

The main aim of this paper was to report reproducible method of lumbar spine access via a lateral retroperitoneal route. The authors conducted a retrospective analysis of the technical aspects and clinical outcomes of six patients who underwent lateral multilevel retroperitoneal interbody fusion with psoas muscle retraction technique. The main goal was to develop a simple and reproducible technique to avoid injury to the lumbar plexus. Six patients were operated at 15 levels using psoas muscle retraction technique. All patients reported improvement in back pain and radiculopathy after the surgery. The only procedure-related transient complication was weakness and pain on hip flexion that resolved by the first follow-up visit. Psoas retraction technique is a reliable technique for lateral access to the lumbar spine and may avoid some of the complications related to traditional minimally invasive transpsoas approach.

Analysis of the readability of patient education materials from surgical subspecialties.

Science.gov (United States)

Hansberry, David R; Agarwal, Nitin; Shah, Ravi; Schmitt, Paul J; Baredes, Soly; Setzen, Michael; Carmel, Peter W; Prestigiacomo, Charles J; Liu, James K; Eloy, Jean Anderson

2014-02-01

Patients are increasingly using the Internet as a source of information on medical conditions. Because the average American adult reads at a 7th- to 8th-grade level, the National Institutes of Health recommend that patient education material be written between a 4th- and 6th-grade level. In this study, we assess and compare the readability of patient education materials on major surgical subspecialty Web sites relative to otolaryngology. Descriptive and correlational design. Patient education materials from 14 major surgical subspecialty Web sites (American Society of Colon and Rectal Surgeons, American Association of Endocrine Surgeons, American Society of General Surgeons, American Society for Metabolic and Bariatric Surgery, American Association of Neurological Surgeons, American Congress of Obstetricians and Gynecologists, American Academy of Ophthalmology, American Academy of Orthopedic Surgeons, American Academy of Otolaryngology-Head and Neck Surgery, American Pediatric Surgical Association, American Society of Plastic Surgeons, Society for Thoracic Surgeons, and American Urological Association) were downloaded and assessed for their level of readability using 10 widely accepted readability scales. The readability level of patient education material from all surgical subspecialties was uniformly too high. Average readability levels across all subspecialties ranged from the 10th- to 15th-grade level. Otolaryngology and other surgical subspecialties Web sites have patient education material written at an education level that the average American may not be able to understand. To reach a broader population of patients, it might be necessary to rewrite patient education material at a more appropriate level. N/A. © 2013 The American Laryngological, Rhinological and Otological Society, Inc.

Six minute walk test in respiratory diseases: A university hospital experience

Directory of Open Access Journals (Sweden)

Al Ameri Hatem

2006-01-01

Full Text Available BACKGROUND: Six minutes walk test (6MWT, is a sub-maximal exercise test, used as a clinical indicator of the functional capacity, in patients with cardiopulmonary diseases. Its safety, validity, reliability and its correlation with several physiological instruments, are well studied. However, there are no published data on 6MWT, in the Saudi population. We are reviewing our experience with 6MWT and assessing its safety and its correlation with pulmonary function variables, in patients with pulmonary diseases, in our local population. MATERIALS AND METHODS: We consecutively studied patients with pulmonary diseases, who underwent 6MWT and pulmonary function test in King Khalid University Hospital, from June 2003 to December 2004. The 6MWTs were conducted according to the American Thoracic Society guidelines. Spirometry, lung volumes and diffusion capacity measurements were correlated with the absolute walked distance. RESULTS: One hundred and twenty nine tests were performed. All patients were of the Saudi community (59% female, with mean age of 43±15 years. Out of 129 patients, 65 patients had proven respiratory diagnosis. In all patients, the test were performed with no serious complications. The six minute walk distance (6MWD had correlation with patient′s height (r=+0.40, P < 0.001, but not with patients′ weight, BMI, borg scale, or oxygen saturation. The 6MWD correlated significantly with Dlco (r=+0.52, P < 0.01, FVC (r=+0.46, r< 0.001 and had a weaker relation with FEV1 (r=+0.31, P < 0.05. The test had no significant correlation with lung volumetric parameters (TLC, FRC and RV. CONCLUSION: 6MWT is simple and safe test in evaluating patients with chronic pulmonary diseases in the Saudi population. In our study, 6MWD showed correlation with spirometric parameters and diffusion capacity. Further studies are needed to evaluate 6MWT in a more homogenous patients′ population.

Thirty-seven transcription factor genes differentially respond to a ...

Indian Academy of Sciences (India)

Plant transcription factors and insect defence si. Thirty-seven transcription factor genes differentially respond to a harpin protein and affect resistance to the green peach aphid in Arabidopsis. HUNLIN. PIN. RUOXUE LIŲ, BEIBEI LÜ, XIAOMENG WANG, CHUNLING ZHANG, SHUPING ZHANG, JUN QIAN, LEI CHEN,.

Hypocretin-1 Levels Associate with Fragmented Sleep in Patients with Narcolepsy Type 1.

Science.gov (United States)

Alakuijala, Anniina; Sarkanen, Tomi; Partinen, Markku

2016-05-01

We aimed to analyze nocturnal sleep characteristics of patients with narcolepsy type 1 (narcolepsy with cataplexy) measured by actigraphy in respect to cerebrospinal fluid hypocretin-1 levels of the same patients. Actigraphy recording of 1-2 w and hypocretin-1 concentration analysis were done to thirty-six unmedicated patients, aged 7 to 63 y, 50% female. Twenty-six of them had hypocretin-1 levels under 30 pg/mL and the rest had levels of 31-79 pg/mL. According to actigraphy, patients with very low hypocretin levels had statistically significantly longer sleep latency (P = 0.033) and more fragmented sleep, indicated by both the number of immobile phases of 1 min (P = 0.020) and movement + fragmentation index (P = 0.049). There were no statistically significant differences in the actual sleep time or circadian rhythm parameters measured by actigraphy. Actigraphy gives additional information about the stabilization of sleep in patients with narcolepsy type 1. Very low hypocretin levels associate with more wake intruding into sleep. © 2016 Associated Professional Sleep Societies, LLC.

Analytical Results for 35 Mine-Waste Tailings Cores and Six Bed-Sediment Samples, and An Estimate of the Volume of Contaminated Material at Buckeye Meadow on Upper Basin Creek, Northern Jefferson County, Montana

Science.gov (United States)

Fey, David L.; Church, Stan E.; Finney, Christopher J.

1999-01-01

Metal-mining related wastes in the Boulder River basin study area in northern Jefferson County, Montana have been implicated in their detrimental effects on water quality with regard to acid-generation and toxic-metal solubilization. Flotation-mill tailings in the meadow below the Buckeye mine, hereafter referred to as the Buckeye mill-tailings site, have been identified as significant contributors to water quality degradation of Basin Creek, Montana. Basin Creek is one of three tributaries to the Boulder River in the study area; bed sediments and waters draining from the Buckeye mine have also been implicated. Geochemical analysis of 35 tailings cores and six bed-sediment samples was undertaken to determine the concentrations of Ag, As, Cd, Cu, Pb,and Zn present in these materials. These elements are environmentally significant, in that they can be toxic to fish and/or the invertebrate organisms that constitute their food. A suite of one-inch cores of dispersed flotation-mill tailings and underlying premining material was taken from a large, flat area north of Basin Creek near the site of the Buckeye mine. Thirty-five core samples were taken and divided into 204 subsamples. The samples were analyzed by ICP-AES (inductively coupled plasma-atomic emission spectroscopy) using a mixed-acid digestion. Results of the core analyses show that the elements listed above are present at moderate to very high concentrations (arsenic to 63,000 ppm, silver to 290 ppm, cadmium to 370 ppm, copper to 4,800 ppm, lead to 93,000 ppm, and zinc to 23,000 ppm). Volume calculations indicate that an estimated 8,400 metric tons of contaminated material are present at the site. Six bed-sediment samples were also subjected to the mixed-acid total digestion, and a warm (50°C) 2M HCl-1% H2O2 leach and analyzed by ICP-AES. Results indicate that bed sediments of Basin Creek are only slightly impacted by past mining above the Buckeye-Enterprise complex, moderately impacted at the upper (eastern

Patient counseling materials: The effect of patient health literacy on the comprehension of printed prescription drug information.

Science.gov (United States)

Patel, Amit; Bakina, Daria; Kirk, Jim; von Lutcken, Scott; Donnelly, Tom; Stone, William; Ashley-Collins, Heather; Tibbals, Karen; Ricker, Lynn; Adler, Jeffrey; Ewing, John; Blechman, Michelle; Fox, Sherry; Leopold, Will; Ryan, Daniel; Wray, Donna; Turkoz, Heather

2018-05-16

Counseling patients with written materials relies equally on patients' health literacy to understand their disease and its treatment, and the written materials' effectiveness communicating clearly in accessible and actionable ways. Only about 12% of the US population is adequately health literate. To explore the impact of reducing the health literacy demands of written patient health information. 805 patients were screened for health literacy, and recruited for balanced cohorts of adequate and low literacy, and high and normal blood pressure. Half of each patient cohort received either standard or "health literacy-friendly" drug summaries (i.e. Patient Package Inserts, or PPIs or "leaflets") along with a standardized health literacy assessment scale. The literacy-friendly drug summary improved comprehension of drug-related information overall from 50% to 71% correct responses. Adequate literacy patients improved from 58% correct to 90%, while lower literacy patients improved from 42% to 52% correct in response to the health literacy-friendly PPIs. Health literacy demands require special attention in developing and using written drug summary materials. Additionally, pharmacists should be provided additional information and counseling support materials to facilitate communications with low health literacy level patients. Copyright © 2018 Elsevier Inc. All rights reserved.

Dural metastases from prostate carcinoma: A systematic review of the literature apropos of six patients

International Nuclear Information System (INIS)

Vasconcelos Sobreira Guedes, Bruno de; Rocha, Antonio Jose da; Pereira Pinto Gama, Hugo; Silva, Carlos Jorge da

2011-01-01

Intracranial metastases are a rare manifestation of prostate carcinoma and the dura mater is the most affected site. We report a series of six patients with dural prostate metastases (DPM) and perform a systematic review of the current literature in order to depict imaging trademarks of this condition. This review points to a magnetic resonance imaging (MRI) pattern of meningeal involvement characterized by a diffuse smooth thickening, nodular appearance or dural-based masses. We also demonstrate an osteoblastic pattern of lesions, particularly in sphenoid wing, by computed tomography (CT) scans. We suggest that these imaging findings may support an elevated index of suspicion of DPM in elderly men, including those patients without urologic symptoms.

Atomic structure and electronic properties of the SixSb100-x phase-change memory material

DEFF Research Database (Denmark)

Verma, Ashok K.; Modak, Paritosh; Svane, Axel

2011-01-01

The electronic and structural properties of SixSb100-x (x∼16) materials are investigated using first-principles molecular dynamics simulations. Crystalline-liquid-amorphous phase transitions are examined and remarkable changes in the local structure around the Si atoms are found. The average Si...... coordination number 6 (3 long + 3 short Si-Sb bonds) of the crystalline phase changes to 4 (3 long Si-Sb + 1 short Si-Si bonds) by preserving three Si-Sb bonds in both the liquid and the amorphous phases. In the amorphous phase ∼90% of the Si atoms are fourfold coordinated compared to 40% in the liquid....... The electronic density of states is metal-like in both the crystalline and the liquid phases, but it exhibits a pseudogap at the Fermi level in the amorphous phase, reflecting the strong abundance of fourfold coordinated Si in the amorphous phase....

Improving hospital discharge time: a successful implementation of Six Sigma methodology.

Science.gov (United States)

El-Eid, Ghada R; Kaddoum, Roland; Tamim, Hani; Hitti, Eveline A

2015-03-01

Delays in discharging patients can impact hospital and emergency department (ED) throughput. The discharge process is complex and involves setting specific challenges that limit generalizability of solutions. The aim of this study was to assess the effectiveness of using Six Sigma methods to improve the patient discharge process. This is a quantitative pre and post-intervention study. Three hundred and eighty-six bed tertiary care hospital. A series of Six Sigma driven interventions over a 10-month period. The primary outcome was discharge time (time from discharge order to patient leaving the room). Secondary outcome measures included percent of patients whose discharge order was written before noon, percent of patients leaving the room by noon, hospital length of stay (LOS), and LOS of admitted ED patients. Discharge time decreased by 22.7% from 2.2 hours during the preintervention period to 1.7 hours post-intervention (P Six Sigma methodology can be an effective change management tool to improve discharge time. The focus of institutions aspiring to tackle delays in the discharge process should be on adopting the core principles of Six Sigma rather than specific interventions that may be institution-specific.

Generation of six multiple sclerosis patient-derived induced pluripotent stem cell lines.

Science.gov (United States)

Miquel-Serra, L; Duarri, A; Muñoz, Y; Kuebler, B; Aran, B; Costa, C; Martí, M; Comabella, M; Malhotra, S; Montalban, X; Veiga, A; Raya, A

2017-10-01

Multiple sclerosis (MS) is considered a chronic autoimmune disease of the central nervous system that leads to gliosis, demyelination, axonal damage and neuronal death. The MS disease aetiology is unknown, though a polymorphism of the TNFRSF1A gene, rs1800693, is known to confer an increased risk for MS. Using retroviral delivery of reprogramming transgenes, we generated six MS patient-specific iPSC lines with two distinct genotypes, CC or TT, of the polymorphism rs1800693. iPSC lines had normal karyotype, expressed pluripotency genes and differentiated into the three germ layers. These lines offer a good tool to study MS pathomechanisms and for drug testing. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

In vitro antifungal susceptibility to six antifungal agents of 229 Candida isolates from patients with diabetes mellitus.

Science.gov (United States)

Manfredi, M; McCullough, M J; Polonelli, L; Conti, S; Al-Karaawi, Z M; Vescovi, P; Porter, S R

2006-06-01

The most common antifungal drugs in current clinical use for the treatment of oral candidosis are polyenes and azoles, mainly used topically. Poor glycaemic control in association with other local factors, such as the presence of oral dental prostheses, salivary pH, salivary flow rate and tobacco habits, may lead to the development of oral candidosis. Topical antifungal agents are frequently used to prevent the development of candidal infections in patients with poor metabolic control, particularly in the elderly wearing dentures. The aim of this study was to assess the antifungal susceptibility of Candida isolates to six antifungal agents using a commercially available kit, Fungitest. The isolated were collected from patients affected by diabetes mellitus from two different geographic localities (London, UK, and Parma, Italy) and from a group of healthy non-diabetic subjects. No differences in antifungal susceptibility to the six agents tested were observed between Candida isolates from diabetic and non-diabetic subjects. However, differences were observed between the two geographically different diabetes mellitus populations. Oral yeast isolates from diabetes mellitus patients in the UK more often displayed resistance or intermediate resistance to fluconazole (P=0.02), miconazole (Pdiabetes mellitus patients in Italy. In addition, more C. albicans isolates were found in diabetic and non-diabetic subjects that were susceptible to fluconazole (P=0.0008 and P=0.01, respectively) than non-albicans isolates. The difference in the antifungal resistance of isolates from the two populations of diabetes mellitus patients may be related to differences in the therapeutic management of candidal infections between the two centres.

[Approach of the sexuality of Alzheimer's disease patients according to caregivers' guides approach].

Science.gov (United States)

Ostrowski, Madeleine; Mietkiewicz, Marie-Claude

2015-12-01

If sexual behavior disorders are not a major symptom of Alzheimer's disease, they might be a source for suffering and hardship to the patient's entourage, especially since it is usually not easy to address sexuality. Guides for relatives have been devoted to improve their knowledge about the disease and to help providing best care for the patient. Thirty of the forty-six guides make references to sexual behavior disorders in Alzheimer's disease patients, sometimes in a few lines, sometimes in a few paragraphs illustrated by clinical vignettes. All these guides report two types of sexual disorders, loss of interest and decreased sexual activity, or inappropriate sexual behavior, and give advices to help relatives, spouses and children, managing the patient's sexual disorders without blaming the patients.

Readability of Spine-Related Patient Education Materials From Leading Orthopedic Academic Centers.

Science.gov (United States)

Ryu, Justine H; Yi, Paul H

2016-05-01

Cross-sectional analysis of online spine-related patient education materials from leading academic centers. To assess the readability levels of spine surgery-related patient education materials available on the websites of academic orthopedic surgery departments. The Internet is becoming an increasingly popular resource for patient education. Yet many previous studies have found that Internet-based orthopedic-related patient education materials from subspecialty societies are written at a level too difficult for the average American; however, no prior study has assessed the readability of spine surgery-related patient educational materials from leading academic centers. All spine surgery-related articles from the online patient education libraries of the top five US News & World Report-ranked orthopedic institutions were assessed for readability using the Flesch-Kincaid (FK) readability test. Mean readability levels of articles amongst the five academic institutions and articles were compared. We also determined the number of articles with readability levels at or below the recommended sixth- or eight-grade levels. Intraobserver and interobserver reliability of readability assessment were assessed. A total of 122 articles were reviewed. The mean overall FK grade level was 11.4; the difference in mean FK grade level between each department varied significantly (range, 9.3-13.4; P Online patient education materials related to spine from academic orthopedic centers are written at a level too high for the average patient, consistent with spine surgery-related patient education materials provided by the American Academy of Orthopaedic Surgeons and spine subspecialty societies. This study highlights the potential difficulties patients might have in reading and comprehending the information in publicly available education materials related to spine. N/A.

Persistent association of nailfold capillaroscopy changes and skin involvement over thirty-six months with duration of untreated disease in patients with juvenile dermatomyositis.

Science.gov (United States)

Christen-Zaech, Stéphanie; Seshadri, Roopa; Sundberg, Joyce; Paller, Amy S; Pachman, Lauren M

2008-02-01

To determine the association of changes on nailfold capillaroscopy with clinical findings and genotype in children with juvenile dermatomyositis (DM), in order to identify potential differences in disease course over 36 months. At diagnosis of juvenile DM in 61 children prior to the initiation of treatment, tumor necrosis factor alpha (TNFalpha) -308 allele and DQA1*0501 status was determined, juvenile DM Disease Activity Scores (DAS) were obtained, and nailfold capillaroscopy was performed. The disease course was monitored for 36 months. Variations within and between patients were assessed by regression analysis. At diagnosis, shorter duration of untreated disease (P = 0.05) and a lower juvenile DM skin DAS (P = 0.035) were associated with a unicyclic disease course. Over 36 months, end-row loop (ERL) regeneration was associated with lower skin DAS (P nailfold capillaroscopy changes. The correlation of nailfold capillaroscopy results with cutaneous but not with musculoskeletal signs of juvenile DM over a 36-month period suggests that the cutaneous and muscle vasculopathies have different pathophysiologic mechanisms. These findings indicate that efforts to identify the optimal treatment of cutaneous features in juvenile DM require greater attention.

Application of Six Sigma towards improving surgical outcomes.

Science.gov (United States)

Shukla, P J; Barreto, S G; Nadkarni, M S

2008-01-01

Six Sigma is a 'process excellence' tool targeting continuous improvement achieved by providing a methodology for improving key steps of a process. It is ripe for application into health care since almost all health care processes require a near-zero tolerance for mistakes. The aim of this study is to apply the Six Sigma methodology into a clinical surgical process and to assess the improvement (if any) in the outcomes and patient care. The guiding principles of Six Sigma, namely DMAIC (Define, Measure, Analyze, Improve, Control), were used to analyze the impact of double stapling technique (DST) towards improving sphincter preservation rates for rectal cancer. The analysis using the Six Sigma methodology revealed a Sigma score of 2.10 in relation to successful sphincter preservation. This score demonstrates an improvement over the previous technique (73% over previous 54%). This study represents one of the first clinical applications of Six Sigma in the surgical field. By understanding, accepting, and applying the principles of Six Sigma, we have an opportunity to transfer a very successful management philosophy to facilitate the identification of key steps that can improve outcomes and ultimately patient safety and the quality of surgical care provided.

Disclosing discourses: biomedical and hospitality discourses in patient education materials.

Science.gov (United States)

Öresland, Stina; Friberg, Febe; Määttä, Sylvia; Öhlen, Joakim

2015-09-01

Patient education materials have the potential to strengthen the health literacy of patients. Previous studies indicate that readability and suitability may be improved. The aim of this study was to explore and analyze discourses inherent in patient education materials since analysis of discourses could illuminate values and norms inherent in them. Clinics in Sweden that provided colorectal cancer surgery allowed access to written information and 'welcome letters' sent to patients. The material was analysed by means of discourse analysis, embedded in Derrida's approach of deconstruction. The analysis revealed a biomedical discourse and a hospitality discourse. In the biomedical discourse, the subject position of the personnel was interpreted as the messenger of medical information while that of the patients as the carrier of diagnoses and recipients of biomedical information. In the hospitality discourse, the subject position of the personnel was interpreted as hosts who invite and welcome the patients as guests. The study highlights the need to eliminate paternalism and fosters a critical reflective stance among professionals regarding power and paternalism inherent in health care communication. © 2015 John Wiley & Sons Ltd.

Uveitis profile and treatment response in Iranian patients with sarcoidosis.

Science.gov (United States)

Mahmoudzadeh, Pouya; Tousi, Adib; Ramezani, Alireza; Soheilian, Roham; Soheilian, Masoud

2015-06-01

The aim of the study was to assess the clinical features and treatment responses in Iranian patients with sarcoid uveitis. A retrospective review of patients diagnosed with sarcoid uveitis from 1996 to 2010 was performed in a referral clinic in Tehran, Iran. Demographic and clinical features of patients, treatment modalities and therapeutic responses, and outcomes were recorded. Sixty-six eyes from 36 patients were studied. Twenty cases had biopsy-proven sarcoidosis. Mean duration of follow-up was 44.7 ± 45 months (range 3-175). Thirty-six eyes (54.5 %) had intermediate uveitis, 25 (37.9 %) panuveitis, and 5 (7.6 %) anterior uveitis. Twenty patients (55.5 %) responded to both systemic and/or topical corticosteroids, and 16 (44.4 %) required immunomodulatory drugs for control of uveitis. All of the patients finally responded to treatment in the form of inflammation reduction and/or vision improvement. The average time interval before initial clinical response following treatment was 3.2 ± 3 months (range 1-72). This study disclosed a higher predominance of females and intermediate form of uveitis in Iranian patients with sarcoid uveitis. Use of immunomodulatory drugs combined with corticosteroids resulted in good visual outcome and control of uveitis with a possible fewer corticosteroid side effects.

SU-D-BRC-02: Application of Six Sigma Approach to Improve the Efficiency of Patient-Specific QA in Proton Therapy

International Nuclear Information System (INIS)

LAH, J; Shin, D; Manger, R; Kim, G

2016-01-01

Purpose: To show how the Six Sigma DMAIC (Define-Measure-Analyze-Improve-Control) can be used for improving and optimizing the efficiency of patient-specific QA process by designing site-specific range tolerances. Methods: The Six Sigma tools (process flow diagram, cause and effect, capability analysis, Pareto chart, and control chart) were utilized to determine the steps that need focus for improving the patient-specific QA process. The patient-specific range QA plans were selected according to 7 treatment site groups, a total of 1437 cases. The process capability index, Cpm was used to guide the tolerance design of patient site-specific range. We also analyzed the financial impact of this project. Results: Our results suggested that the patient range measurements were non-capable at the current tolerance level of ±1 mm in clinical proton plans. The optimized tolerances were calculated for treatment sites. Control charts for the patient QA time were constructed to compare QA time before and after the new tolerances were implemented. It is found that overall processing time was decreased by 24.3% after establishing new site-specific range tolerances. The QA failure for whole process in proton therapy would lead up to a 46% increase in total cost. This result can also predict how costs are affected by changes in adopting the tolerance design. Conclusion: We often believe that the quality and performance of proton therapy can easily be improved by merely tightening some or all of its tolerance requirements. This can become costly, however, and it is not necessarily a guarantee of better performance. The tolerance design is not a task to be undertaken without careful thought. The Six Sigma DMAIC can be used to improve the QA process by setting optimized tolerances. When tolerance design is optimized, the quality is reasonably balanced with time and cost demands.

SU-D-BRC-02: Application of Six Sigma Approach to Improve the Efficiency of Patient-Specific QA in Proton Therapy

Energy Technology Data Exchange (ETDEWEB)

LAH, J [Myongji Hospital, Goyang-si (Korea, Republic of); Shin, D [Proton Therapy Center, National Cancer Center, Goyang (Korea, Republic of); Manger, R; Kim, G [University of California, San Diego, La Jolla, CA (United States)

2016-06-15

Purpose: To show how the Six Sigma DMAIC (Define-Measure-Analyze-Improve-Control) can be used for improving and optimizing the efficiency of patient-specific QA process by designing site-specific range tolerances. Methods: The Six Sigma tools (process flow diagram, cause and effect, capability analysis, Pareto chart, and control chart) were utilized to determine the steps that need focus for improving the patient-specific QA process. The patient-specific range QA plans were selected according to 7 treatment site groups, a total of 1437 cases. The process capability index, Cpm was used to guide the tolerance design of patient site-specific range. We also analyzed the financial impact of this project. Results: Our results suggested that the patient range measurements were non-capable at the current tolerance level of ±1 mm in clinical proton plans. The optimized tolerances were calculated for treatment sites. Control charts for the patient QA time were constructed to compare QA time before and after the new tolerances were implemented. It is found that overall processing time was decreased by 24.3% after establishing new site-specific range tolerances. The QA failure for whole process in proton therapy would lead up to a 46% increase in total cost. This result can also predict how costs are affected by changes in adopting the tolerance design. Conclusion: We often believe that the quality and performance of proton therapy can easily be improved by merely tightening some or all of its tolerance requirements. This can become costly, however, and it is not necessarily a guarantee of better performance. The tolerance design is not a task to be undertaken without careful thought. The Six Sigma DMAIC can be used to improve the QA process by setting optimized tolerances. When tolerance design is optimized, the quality is reasonably balanced with time and cost demands.

A Stakeholder Analysis of the Navy's Thirty-Year Shipbuilding Plan

National Research Council Canada - National Science Library

O'Loughlin, Patrick R

2007-01-01

Using a stakeholder management approach, this thesis helps the U.S. Navy understand who the external stakeholders are with respect to the Thirty-Year Shipbuilding Plan, the priority of differing stakeholder claims, and the nature...

The relationship between the level of salivary alpha amylase activity and pain severity in patients with symptomatic irreversible pulpitis

Directory of Open Access Journals (Sweden)

Fatemeh Ahmadi-Motamayel

2013-08-01

Full Text Available Objectives Assessment of dental pain severity is very challenging in dentistry. Previous studies have suggested that elevated salivary alpha amylase may contribute to increased physical stresses. There is a close association between salivary alpha amylase and plasma norepinephrine under stressful physical conditions. The aim of this study was to evaluate the relationship between pain severity and salivary alpha amylase levels in patients with symptomatic irreversible pulpitis. Materials and Methods Thirty-six patients (20 females and 16 males with severe tooth pain due to symptomatic irreversible pulpitis were selected. The visual analogue scale (VAS score was used to assess the pain severity in each patient. Unstimulated whole saliva was collected, and the level of alpha amylase activity was assessed by the spectrophotometric method. Statistical analysis was performed using SPSS 13. Results The level of alpha amylase was significantly increased in the saliva in association with pain severity assessed by VAS. The salivary alpha amylase was also elevated with increased age and in males. Conclusions There was a significant correlation between the VAS pain scale and salivary alpha amylase level, which indicates this biomarker may be a good index for the objective assessment of pain intensity.

The correlation between pain perception among patients with six different orthodontic archwires and the degree of dental crowding

Directory of Open Access Journals (Sweden)

Marković Evgenija

2015-01-01

Full Text Available Introduction. Forces generated in orthodontic treatment with fixed appliances create tension and compression zones in the periodontal ligament resulting in a painful experience for patients. In the first phase of orthodontic treatment, when leveling of teeth is needed, nickel-titanium (NiTi archwires can be completely engaged in brackets, even in the cases of extreme crowding, exerting small forces. There is a great individual variation in the pain perception related to the application of orthodontic forces. Objective. The aim of this study was to investigate the pain perception among patients with dental crowding after insertion of six different NiTi orthodontic archwires as a part of fixed appliances in the first stage of orthodontic treatment. Methods. The study was conducted on a sample of 189 orthodontic patients receiving one of six different either superelastic or heat activated NiTi archwires, in the first phase of orthodontic treatment. Pain perception was evaluated in groups of patients with different degree of crowding. The modified McGill Pain Questionnaire with Visual Analogue Scale was used to evaluate the quality and intensity of pain. Statistical analysis was performed using simple descriptive statistics, and Pearson`s chi-square test with statistical significance of p<0.05. Results. Majority of patients reported pain as discomfort or pressure of moderate intensity caused by chewing or biting, started within 12 hours, carried on for 3-4 days, and decreased over time without self-medication. Conclusion. No correlation was found between pain perception among patients with different types of NiTi archwires and the degree of crowding.

MYO7A and USH2A gene sequence variants in Italian patients with Usher syndrome.

Science.gov (United States)

Sodi, Andrea; Mariottini, Alessandro; Passerini, Ilaria; Murro, Vittoria; Tachyla, Iryna; Bianchi, Benedetta; Menchini, Ugo; Torricelli, Francesca

2014-01-01

To analyze the spectrum of sequence variants in the MYO7A and USH2A genes in a group of Italian patients affected by Usher syndrome (USH). Thirty-six Italian patients with a diagnosis of USH were recruited. They received a standard ophthalmologic examination, visual field testing, optical coherence tomography (OCT) scan, and electrophysiological tests. Fluorescein angiography and fundus autofluorescence imaging were performed in selected cases. All the patients underwent an audiologic examination for the 0.25-8,000 Hz frequencies. Vestibular function was evaluated with specific tests. DNA samples were analyzed for sequence variants of the MYO7A gene (for USH1) and the USH2A gene (for USH2) with direct sequencing techniques. A few patients were analyzed for both genes. In the MYO7A gene, ten missense variants were found; three patients were compound heterozygous, and two were homozygous. Thirty-four USH2A gene variants were detected, including eight missense variants, nine nonsense variants, six splicing variants, and 11 duplications/deletions; 19 patients were compound heterozygous, and three were homozygous. Four MYO7A and 17 USH2A variants have already been described in the literature. Among the novel mutations there are four USH2A large deletions, detected with multiplex ligation dependent probe amplification (MLPA) technology. Two potentially pathogenic variants were found in 27 patients (75%). Affected patients showed variable clinical pictures without a clear genotype-phenotype correlation. Ten variants in the MYO7A gene and 34 variants in the USH2A gene were detected in Italian patients with USH at a high detection rate. A selective analysis of these genes may be valuable for molecular analysis, combining diagnostic efficiency with little time wastage and less resource consumption.

Continuous improvement program in ENUSA: personnel participation and six sigma

International Nuclear Information System (INIS)

Montes Navarro, J.

1998-01-01

Since the beginning of its activities ENUSA has been a company committed with the quality of its products and services. To talk about quality is something inherent in ENUSA's daily work ENUSA's position in the market depends on its capacity to satisfy customers expectations with the best products and services, as a result of an efficient management of its processes. The word quality in its broadest sense, means that any activity can be improved. ENUSA has implemented a continuous improvement program as part of its company change project. That program consists of six basic steps: 1.- Managers commitment. 2.- Organization for continuous improvement. 3.- Quality goals. 4.- Training and informing. 5.- Personnel participation. 6.- Methodology. ENUSA has introduced these six steps during 1997-98 period. It is important to point out the commitment degree at all the company levels, focusing the organization to the continuous improvement in a multifunctional way, following the business processes: - Board of Directors - Quality Steering Committee - Quality Improvement Groups (GMC) - Quality Operative Groups (GOC) - Suggestions Mailboxes The following GMC's have been set up and are operative. - Manufacturing GMC - Supplies GMC - Installation GMC - Design GMC - Quality System GM - Projects GMC - Administrative GMC These GMC's have established thirty-six Quality Operative Groups which carry out the improvement projects. The methodology chosen by ENUSA is known as ''SIX SIGMA''. Six sigma programs have proved their huge power in big companies as MOTOROLA and, recently, GE being recognized in all the quality fields. It is, by itself, a change program in which a quality improvement methods is structured with an excellent view of processes, products and services. (Author)

Treatment of fibromyalgia at the Maharishi Ayurveda Health Centre in Norway. A six-month follow-up study.

Science.gov (United States)

Rasmussen, L B; Mikkelsen, K; Haugen, M; Pripp, A H; Førre, Ø T

2009-01-01

Treatments offered at the Maharishi Ayurveda Health Centre in Norway are based on Maharishi Vedic medicine, which is also known as Maharishi Ayurveda. It is a consciousness based revival of the ancient Ayurvedic medicine tradition in India and is established by Maharishi Mahesh Yogi, the founder of the Transcendental Meditation (TM) technique. To conduct a pilot study of the effect of the treatment program at the Health Centre on fibromyalgia patients. Thirty-one women with diagnosed fibromyalgia received an individually designed Maharishi Vedic physiological purification therapy. All subjects received personal advice on diet based on Ayurvedic principles, including a novel approach to food into-lerance, and daily routines. In addition they were offered instruction in TM (for stress and pain management and personal development) (four subjects started), and recommended Ayurvedic herbal food products for home treatment. A modified Fibromyalgia Impact Questionnaire included a visual analogue scale for each of the seven outcomes: working ability, generalised pain, tiredness, stiffness, tiredness on arising, anxiety and depression. Pre-treatment scores were compared with scores at six-month follow-up for levels of statistical significance. Twenty-eight subjects (90%) completed the follow-up. The outcome measures were reduced by 25 to 46% by the study's endpoint: working ability (pmeditating control group the TM-subgroup showed statistically significant improvements for all outcome measures except depression. In this pilot study fibromyalgia patients undergoing treatment at Maharishi Ayurveda Health Centre in Norway showed significant improvements six months post treatment. Because fibromyalgia is considered a treatment-resistant condition, these encouraging results warrant further research.

IGF1 as a Potential Treatment for Rett Syndrome: Safety Assessment in Six Rett Patients

Directory of Open Access Journals (Sweden)

Giorgio Pini

2012-01-01

Full Text Available Rett syndrome (RTT is a devastating neurodevelopmental disorder that affects one in ten thousand girls and has no cure. The majority of RTT patients display mutations in the gene that codes for the methyl-CpG-binding protein 2 (MeCP2. Clinical observations and neurobiological analysis of mouse models suggest that defects in the expression of MeCP2 protein compromise the development of the central nervous system, especially synaptic and circuit maturation. Thus, agents that promote brain development and synaptic function, such as insulin-like growth factor 1 (IGF1, are good candidates for ameliorating the symptoms of RTT. IGF1 and its active peptide, (1–3 IGF1, cross the blood brain barrier, and (1–3 IGF1 ameliorates the symptoms of RTT in a mouse model of the disease; therefore they are ideal treatments for neurodevelopmental disorders, including RTT. We performed a pilot study to establish whether there are major risks associated with IGF1 administration in RTT patients. Six young girls with classic RTT received IGF1 subcutaneous injections twice a day for six months, and they were regularly monitored by their primary care physicians and by the unit for RTT in Versilia Hospital (Italy. This study shows that there are no risks associated with IGF1 administration.

Evaluation of written patient educational materials in the field of diagnostic imaging

International Nuclear Information System (INIS)

Ryhaenen, A.M.; Johansson, K.; Virtanen, H.; Salo, S.; Salanterae, S.; Leino-Kilpi, H.

2009-01-01

Aim: To evaluate the quality of written educational materials for diagnostic imaging (radiological and nuclear medicine) patients. Materials and methods: Written educational materials (n = 70) for diagnostic imaging patients were analysed. The materials were evaluated based on their external appearance (9 criteria), instructiveness (7), content (7), language and structure (8) and readability (1). Deductive content analysis was used. Quantified parts of the analyses were analysed by SAS for Windows. Dependence between criteria (32) was tested by Pearson correlation coefficients. Results: The external appearance fulfilled almost completely the criteria of good written education materials. The instructiveness was addressed clearly, except for the purpose of the material. The contents of materials dealt with bio-physiological, functional and cognitive dimensions of knowledge, while financial dimensions of knowledge were hardly dealt with at all. The language and the structure were reasonably good, but the language was partly in passive voice and the text contained strange words. Most of the education material was moderately easy to read. Conclusions: The results show that the quality of material was quite good in all dimensions. Only a small number of criteria were unsatisfactory. The results can be used to further improve written patient education materials and patient education in the imaging unit.

Revision of the subfamily Opiinae (Hymenoptera, Braconidae) from Hunan (China), including thirty-six new species and two new genera

Science.gov (United States)

Li, Xi-Ying; van Achterberg, Cornelis; Tan, Ji-Cai

2013-01-01

Abstract The species of the subfamily Opiinae (Hymenoptera: Braconidae) from Hunan (Oriental China) are revised and illustrated. Thirty-six new species are described: Apodesmia bruniclypealis Li & van Achterberg, sp. n., Apodesmia melliclypealis Li & van Achterberg, sp. n., Areotetes albiferus Li & van Achterberg, sp. n., Areotetes carinuliferus Li & van Achterberg, sp. n., Areotetes striatiferus Li & van Achterberg, sp. n., Coleopioides diversinotum Li & van Achterberg, sp. n., Coleopioides postpectalis Li & van Achterberg, sp. n., Fopius dorsopiferus Li, van Achterberg & Tan, sp. n., Indiopius chenae Li & van Achterberg, sp. n., Opiognathus aulaciferus Li & van Achterberg, sp. n., Opiognathus brevibasalis Li & van Achterberg, sp. n., Opius crenuliferus Li & van Achterberg, sp. n., Opius malarator Li, van Achterberg & Tan, sp. n., Opius monilipalpis Li & van Achterberg, sp. n., Opius pachymerus Li & van Achterberg, sp. n., Opius songi Li & van Achterberg, sp. n., Opius youi Li & van Achterberg, sp. n., Opius zengi Li & van Achterberg, sp. n., Phaedrotoma acuticlypeata Li & van Achterberg, sp. n., Phaedrotoma angiclypeata Li & van Achterberg, sp. n., Phaedrotoma antenervalis Li & van Achterberg, sp. n., Phaedrotoma depressiclypealis Li & van Achterberg, sp. n., Phaedrotoma flavisoma Li & van Achterberg, sp. n., Phaedrotoma nigrisoma Li & van Achterberg, sp. n., Phaedrotoma protuberator Li & van Achterberg, sp. n., Phaedrotoma rugulifera Li & van Achterberg, sp. n., Li & van Achterberg,Phaedrotoma striatinota Li & van Achterberg, sp. n., Phaedrotoma vermiculifera Li & van Achterberg, sp. n., Rhogadopsis latipennis Li & van Achterberg, sp. n., Rhogadopsis longicaudifera Li & van Achterberg, sp. n., Rhogadopsis maculosa Li, van Achterberg & Tan, sp. n., Rhogadopsis obliqua Li & van Achterberg, sp. n., Rhogadopsis sculpturator Li & van Achterberg, sp. n., Utetes longicarinatus Li & van Achterberg, sp. n. and Xynobius notauliferus Li & van Achterberg, sp. n. Areotetes

Retrospective evaluation of patients of gastroesophageal reflux disease treated with laparoscopic Nissen′s fundoplication

Directory of Open Access Journals (Sweden)

Nagpal Anish

2010-01-01

Full Text Available Aims: To evaluate retrospectively the outcome of laparoscopic fundoplication in a cohort of patients with typical symptoms of gastroesophageal reflux disease (GERD. Materials and Methods: Forty-two patients with typical symptoms of GERD, who were operated for laparoscopic Nissen′s fundoplication from March 2001 to August 2008, were studied. The study was limited to patients with positive findings on upper gastrointestinal (GI endoscopy done by us and "typical" symptoms (heartburn, regurgitation, and dysphagia of GERD. Laparoscopic Nissen′s fundoplication was performed when clinical assessment suggested adequate oesophageal motility and length. Only one patient who had negative endoscopic findings underwent a 24-h pH monitoring before surgery. Outcome measures included assessment of the relief of the primary symptom responsible for surgery in the early postoperative period; the patient′s evaluation of outcome, and quality of life after surgery. Results: Relief of the primary symptom responsible for surgery was achieved in 95.24% of patients at a mean follow-up of 28 months. Thirty-five patients were asymptomatic, two had minor gastrointestinal symptoms not requiring medical therapy, three patients had gastrointestinal symptoms requiring medical therapy/Proton Pump Inhibitors (PPI and in two patients the symptoms worsened after surgery. There were no deaths. Clinically significant complications occurred in six patients. Median hospital stay was 3 days, decreasing from 6 days in the first 10 patients to 3 days in the last 10 patients. Conclusions: Laparoscopic Nissen′s fundoplication is the choice of operation for clinically symptomatic GERD patients.

Does information overload prevent chronic patients from reading self-management educational materials?

Science.gov (United States)

Liu, Chung-Feng; Kuo, Kuang-Ming

2016-05-01

Self-care management is becoming an important part of care for chronic patients. However, various kinds of self-management educational materials which government or healthcare institutions provide for patients may not achieve the expected outcome. One of the critical reasons affecting patients' use intention could be patients' perceived information overload regarding the self-management educational materials. This study proposed an extended model of the Theory of Planned Behavior (TPB), which incorporated perceived information overload, to explore if information overload will prevent chronic patients from reading educational materials for self-care management. The independent variables are attitude, subject norm, perceived behavior control and perceived information overload while the dependent variable is behavior intention to use the self-management educational materials. Perceived information overload is also referred to as an antecedent variable which may has impacts on attitude and perceived behavior control. The cross-sectional study interviewed newly diagnosed chronic patients with coronary artery disease, who are the potential users of the self-management educational materials, in a medical center in Taiwan. Data were analyzed using descriptive statistics of the basic information distribution of the respondents, and structural equation modeling to study the reliability and validity for testing hypotheses. A total of 110 respondents were enrolled in this study and successful interview data were collected from 106 respondents. The result indicates that the patients' perceived information overload of self-management educational materials was validated to have impacts on attitude and perceived behavioral control constructs of the TPB as well as contributing a direct impact on patients' intentions to use self-management educational materials. Besides, subjective norm and perceived behavioral control constructs were validated to have significant impacts on

Breast conservation in the setting of contemporary multimodality treatment provides excellent outcomes for patients with occult primary breast cancer.

Science.gov (United States)

Rueth, Natasha M; Black, Dalliah M; Limmer, Angela R; Gabriel, Emmanuel; Huo, Lei; Fornage, Bruno D; Dogan, Basak E; Chavez-MacGregor, Mariana; Yi, Min; Hunt, Kelly K; Strom, Eric A

2015-01-01

To evaluate recurrence and survival for patients with occult (T0N+) breast cancer who underwent contemporary treatment, assessing outcomes for breast conservation and mastectomy. We performed a single-institution review of women with occult breast cancer presenting with axillary metastasis without identifiable breast tumor or distant metastasis. We excluded patients with tumors in the axillary tail or mastectomy specimen, patients with additional nonbreast cancer diagnoses, and patients with a history of breast cancer. Breast conservation was defined as axillary node dissection with radiation therapy, without breast surgery. We evaluated patient, tumor, treatment, and outcome variables. Patients were assessed for local, regional, and distant recurrences. Overall survival was calculated using the Kaplan-Meier method. Thirty-six patients met criteria for occult breast cancer. Most of these patients (77.8 %) had N1 disease. Fifty percent of cancers (n = 18) were estrogen receptor-positive; 12 (33.3 %) were triple-negative. All patients were evaluated with mammography. Thirty-five patients had breast ultrasound (97.2 %) and 33 (91.7 %) had an MRI. Thirty-four patients (94.4 %) were treated with chemotherapy and 33 (91.7 %) with radiotherapy. Twenty-seven patients (75.0 %) were treated with breast conservation. The median follow-up was 64 months. There were no local or regional failures. One distant recurrence occurred >5 years after diagnosis, resulting in a 5-years overall survival rate of 100 %. There were no significant survival differences between patients receiving breast conservation versus mastectomy (p = 0.7). Breast conservation-performed with contemporary imaging and multimodality treatment-provides excellent local control and survival for women with T0N+ breast cancer and can be safely offered instead of mastectomy.

The outcome of stroke: A six month follow-up study

Directory of Open Access Journals (Sweden)

Kameran Hassan Ismail

2018-04-01

Full Text Available Background and objective: Stroke is an increasing problem in developing countries and is the principal cause of disability and dependency in the western world. This study aimed to find out the one- and six-month case fatality, dependency and recurrence rates of stroke in Erbil teaching hospitals. Methods: This hospital-based prospective study included 293 stroke patients hospitalized in Erbil teaching hospitals from January 1st, 2015 through December 31st, 2015. Stroke was diagnosed by a consultant internist or neurologist and confirmed by brain CT-scan and/or MRI. Patients were followed-up for six months, then one- and six-month outcomes were measured including case-fatality, dependency and recurrences rates. Results: The one and six month case fatality rates were 28.3% and 37.5%, respectively. The rates in females (33.3%, 42.6%, respectively were higher than that in males (23.7%, 32.9%, respectively, but there was no significant association between case-fatality rate and gender. A total of 74.3% and 45.4% of patients at one- and six-month were functionally dependent. The majority (88.9% of diabetic patients were functionally dependent. Also, the one and six month recurrence rates of stroke patients were 15.7% and 23.2%, respectively. For both one and six month post stroke more recurrence occurred from ischemic (16.2%, 14.3%, respectively than from hemorrhagic (24.5%, 19.5%, respectively strokes, but there was no significant association between the recurrence and stroke subtype (P = 0.691, P = 0.367, respectively. Conclusion: The reported outcomes are relatively comparable to that reported in other developing countries, although it is still more than the rates of developed countries. Outcome measures can help to give information and develop guidelines for clinical practice and research. Keywords: Stroke; Case fatality; Recurrence; Functional outcome.

Analysis of 2014's Thirty Best Undergraduate Accounting Programs

Science.gov (United States)

Adkins, Darlene A.; Geddie, Mary F.; Moore, Paula Hearn; Griffin, Richard B.

2016-01-01

This paper examines primarily the courses in the accounting major and a portion of the business core of the best thirty accounting programs in the United States as identified by the Accounting Degree Review. A thorough examination of each school's web site has been conducted to gather current (2014) information concerning the requirements for a…

The Instrumentation Program for the Thirty Meter Telescope

OpenAIRE

Simard, Luc; Crampton, David; Ellerbroek, Brent; Boyer, Corinne

2012-01-01

An overview of the current status of the Thirty Meter Telescope (TMT) instrumentation program is presented. Science cases and operational concepts as well as their links to the instruments are continually revisited and updated through a series of workshops and conferences. Work on the three first-light instruments (WFOS IRIS, and IRMS) has made significant progress, and many groups in TMT partner communities are developing future instrument concepts. Other instrument-related subsystems are al...

Readability of patient education materials in ophthalmology: a single-institution study and systematic review.

Science.gov (United States)

Williams, Andrew M; Muir, Kelly W; Rosdahl, Jullia A

2016-08-03

Patient education materials should be written at a level that is understandable for patients with low health literacy. The aims of this study are (1) to review the literature on readability of ophthalmic patient education materials and (2) to evaluate and revise our institution's patient education materials about glaucoma using evidence-based guidelines on writing for patients with low health literacy. A systematic search was conducted on the PubMed/MEDLINE database for studies that have evaluated readability level of ophthalmic patient education materials, and the reported readability scores were assessed. Additionally, we collected evidence-based guidelines for writing easy-to-read patient education materials, and these recommendations were applied to revise 12 patient education handouts on various glaucoma topics at our institution. Readability measures, including Flesch-Kincaid Grade Level (FKGL), and word count were calculated for the original and revised documents. The original and revised versions of the handouts were then scored in random order by two glaucoma specialists using the Suitability Assessment of Materials (SAM) instrument, a grading scale used to evaluate suitability of health information materials for patients. Paired t test was used to analyze changes in readability measures, word count, and SAM score between original and revised handouts. Finally, five glaucoma patients were interviewed to discuss the revised materials, and patient feedback was analyzed qualitatively. Our literature search included 13 studies that evaluated a total of 950 educational materials. Among the mean FKGL readability scores reported in these studies, the median was 11 (representing an eleventh-grade reading level). At our institution, handouts' readability averaged a tenth-grade reading level (FKGL = 10.0 ± 1.6), but revising the handouts improved their readability to a sixth-grade reading level (FKGL = 6.4 ± 1.2) (p readability and suitability of

Results of the patterns of care study for esophageal cancer patients treated with radiotherapy and surgery

International Nuclear Information System (INIS)

Gomi, Kohtaro; Oguchi, Masahiko; Yamashita Takashi

2001-01-01

A Patterns of Care Study examined the records of patients with thoracic esophageal cancer treated with radiotherapy and surgery in 1995 through 1997. Thirty-one percent of patients received preoperative radiotherapy; 61% of these received chemotherapy. Sixty six percent of patients received postoperative radiotherapy. Significant variables for overall survival in multivariate analysis include presence of macroscopic residual tumors (risk ratio=2.66), sex female (0.49), photon energy higher than 4 MV (0.50), Karnofsky performance status greater than 70 (0.55) and the use of chemotherapy (1.64). The value of preoperative concurrent chemotherapy and radiotherapy should be tested in a randomized trial. (author)

Cognitive evolution in hypertensive patients: a six-year follow-up

Directory of Open Access Journals (Sweden)

Vicario A

2011-05-01

Full Text Available Augusto Vicario1,2,3, Mildren A del Sueldo2,3, Judith M Zilberman2,3, Gustavo H Cerezo2,31Department of Internal Medicine, Cardiovascular Division, Hospital Español de Buenos Aires, Argentina; 2Argentine Federation of Cardiology, (AFC, Buenos Aires, Argentina; 3Research Group, Human Health Commission, CERTUS Foundation, Buenos Aires, Argentina Background: Several studies have examined the links between hypertension, vascular damage, and cognitive impairment. The functions most commonly involved seem to be those associated with memory and executive function.Aims: 1 to report the cognitive evolution in a cohort of hypertensive patients, 2 to identify the affected domains, and 3 to correlate the results obtained with blood pressure measurements.Materials and Methods: Observational 6-year follow-up cohort study including both males and females aged ≥65 and ≤80 years, and hypertensive patients under treatment. Patients with a history of any of the following conditions were excluded: stroke, transient ischemic attack, diabetes mellitus, atrial fibrillation, cardiac surgery, dementia, or depression. Four neurocognitive evaluations were performed (at baseline and every 2 years. The tests used evaluated memory and executive function domain. Blood pressure was measured on every cognitive evaluation.Results: Sixty patients were followed for 76.4 ± 2.8 months. The average age at baseline was 72.5 ± 4.2 and 77.9 ± 4.6 at 6 years (65% were women. Two patients were lost to follow up (3.3% and 8 patients died (13.3%.The density incidence for dementia was 0.6% patients per year (pt/y (n = 3 and for depression was 1.6% pt/y (n = 12. No changes were observed in either memory impairment or the Mini Mental State Examination (MMSE results (p = ns during follow-up. A progressive impairment of the executive function was shown regardless of the blood pressure measurements.Conclusion: 1 the incidence of dementia doubled to general population, 2 the initial memory

Acceleration of the direct identification of Staphylococcus aureus versus coagulase-negative staphylococci from blood culture material: a comparison of six bacterial DNA extraction methods.

Science.gov (United States)

Loonen, A J M; Jansz, A R; Kreeftenberg, H; Bruggeman, C A; Wolffs, P F G; van den Brule, A J C

2011-03-01

To accelerate differentiation between Staphylococcus aureus and coagulase-negative staphylococci (CNS), this study aimed to compare six different DNA extraction methods from two commonly used blood culture materials, i.e. BACTEC and BacT/ALERT. Furthermore, we analysed the effect of reduced blood culture incubation for the detection of staphylococci directly from blood culture material. A real-time polymerase chain reaction (PCR) duplex assay was used to compare the six different DNA isolation protocols on two different blood culture systems. Negative blood culture material was spiked with methicillin-resistant S. aureus (MRSA). Bacterial DNA was isolated with automated extractor easyMAG (three protocols), automated extractor MagNA Pure LC (LC Microbiology Kit M(Grade)), a manual kit MolYsis Plus and a combination of MolYsis Plus and the easyMAG. The most optimal isolation method was used to evaluate reduced bacterial incubation times. Bacterial DNA isolation with the MolYsis Plus kit in combination with the specific B protocol on the easyMAG resulted in the most sensitive detection of S. aureus, with a detection limit of 10 CFU/ml, in BacT/ALERT material, whereas using BACTEC resulted in a detection limit of 100 CFU/ml. An initial S. aureus or CNS load of 1 CFU/ml blood can be detected after 5 h of incubation in BacT/ALERT 3D by combining the sensitive isolation method and the tuf LightCycler assay.

Cutaneous tuberculosis after mesotherapy: report of six cases.

Science.gov (United States)

Orjuela, Dora; Puerto, Gloria; Mejía, Graciela; Castro, Claudia; Garzón, María Consuelo; García, Luz Mary; Hernández, Elkin; Ribón, Wellman; Rodríguez, Gerzaín

2010-01-01

Cutaneous tuberculosis as a result of a needle injection is a rare event; it generally occurs among medical and laboratory personnel and among patients receiving percutaneous treatment. Six patients are presented who developed cutaneous tuberculosis after mesotherapy cosmetic treatment. One to four months after injection of an unknown product as treatment for obesity and cellulites, five women and a man developed papules, nodules and drainage of wax like material at the inoculated sites; this was interpreted clinically as a non tuberculous mycobacterium infection. Skin biopsies were taken for a histopathologic study; the biopsy and exudates were cultured to make a phenotypic identification. Polymerase chain reaction and restriction enzyme pattern analyses (PCR-restriction pattern analysis)) procedures were applied to the skin biopsies. Mycobacterium tuberculosis was confirmed in the culture and by PRA analysis in the paraffin-embedded biopsies. The patients had never had tuberculosis. Their thoracic X rays were normal and the size of the tuberculin reaction was 17 to 20 mm. Five patients recovered with antituberculosis treatment and the sixth spontaneously healed after the removal of the largest cutaneous module. No satellite adenopathy or recurrences were observed. A previously undescribed mode of acquisition cutaneous tuberculosis was described. This was the second incident of a demonstrated cutaneous tuberculosis following mesotherapy in Colombia. Skin lesions induced by injections must be tested to detect mycobacterias to include M. tuberculosis.

Infantile fibrosarcoma: Magnetic resonance imaging findings in six cases

Energy Technology Data Exchange (ETDEWEB)

Canale, Sandra [Department of Radiology, Institut Gustave-Roussy, 39 rue Camille Desmoulins, 94805 Villejuif (France)], E-mail: canalesandra@yahoo.com; Vanel, Daniel [Department of Radiology, Institut Gustave-Roussy, 39 rue Camille Desmoulins, 94805 Villejuif (France); Istituti Ortopedici Rizzoli, 1/10 via di Barbiano, 40136 Bologna (Italy); Couanet, Dominique [Department of Radiology, Institut Gustave-Roussy, 39 rue Camille Desmoulins, 94805 Villejuif (France); Patte, Catherine [Department of Pediatrics, Institut Gustave-Roussy, 39 rue Camille Desmoulins, 94805 Villejuif (France); Caramella, Caroline; Dromain, Clarisse [Department of Radiology, Institut Gustave-Roussy, 39 rue Camille Desmoulins, 94805 Villejuif (France)

2009-10-15

Purpose: To retrospectively review magnetic resonance (MR) imaging features in a series of six infantile fibrosarcomas to find out if MR can suggest this unusual diagnosis and to highlight the value of MR during and following treatment. Materials and methods: The records of six cases of histologically proven infantile fibrosarcoma were retrieved from the files of our cancer center. All imaging data available were consensually reviewed by two radiologists. Results: There were five females and one male (age range at diagnosis, 0-12 months; mean, 6 months). The most common finding was a well-circumscribed single mass in five patients (83%). All tumors had arisen on limbs; at their proximal or distal extremity or at the root of the limb. The masses were 9 cm large in mean diameter. The initial tumor signal was isointense to muscle on T1-weighted and hyperintense on T2-weighted sequences. All masses were well circumscribed and half of them contained internal fibrous septa. The internal signal was homogeneous in three patients and heterogeneous in the three others. An intense enhancement was seen in all three contrast-enhanced exams available; heterogeneous in two cases and homogeneous in one. Osseous erosion was observed in only one patient who was the only one with distant metastasis. After treatment (chemotherapy and very limited surgery), tumors had totally disappeared, leaving muscle fat infiltration in two patients and subcutaneous fat hypertrophy in one patient. Conclusion: Although imaging findings are not specific of infantile fibrosarcoma, this diagnosis could be suggested when MR imaging depicts a large well-circumscribed mass arising in a limb at birth or during the neonatal period. This mass is sometimes heterogeneous and septate and exhibits an isointense T1- and hyperintense T2-weighted signals and strong enhancement. MR is also the technique of choice for follow-up during treatment which consists nowadays almost exclusively in chemotherapy.

Assessment of Cardiovascular Fitness of Patients with Pulmonary Tuberculosis Using Six Minute Walk Test

Directory of Open Access Journals (Sweden)

Taofeek Oluwole Awotidebe

2010-04-01

Full Text Available AIM: Patients with pulmonary tuberculosis (TB tends to have limited exercise tolerance and a significant disability affecting their activities of daily living. The importance of exercise in the management of these patients has not been well investigated. This study was designed to assess the cardiovascular fitness of patients with pulmonary TB using the six-minute walk test (6-MWT. METHOD: Sixty five consented patients with Pulmonary TB were consecutively recruited into the study. The patients performed 6-MWT over a 30 meter course on a level walkway at a speed as fast as they could. Data were obtained on participants’ physical characteristics, pre and post exercise blood pressure and heart rate, and maximum oxygen consumption. Data were analyzed using descriptive statistics of mean and standard deviation and paired t-test. RESULTS: The post walk test cardiovascular parameters were significantly higher than the resting cardiovascular parameters. The mean VO2 max and MET of the participants were 11.7±0.97 (ml O2kg -1min-1 and 3.35±0.28 (mL/Kg respectively. The means 6-MWT distance for male and female participants were 502.0±43.0m 481.7±68.3m respectively. CONCLUSION: The result implies that the 6-MWT is capable of evoking a significant cardiovascular change among patients with pulmonary TB. The 6-MWT may be useful in the assessment of functional capacity of patients with pulmonary TB. [TAF Prev Med Bull 2010; 9(2.000: 99-106

[Six-minute walk test in children with neuromuscular disease.

Science.gov (United States)

Cruz-Anleu, Israel Didier; Baños-Mejía, Benjamín Omar; Galicia-Amor, Susana

2013-01-01

Background: neuromuscular diseases affect the motor unit. When they evolve, respiratory complications are common; the six-minute walk test plays an important role in the assessment of functional capacity. Methods: prospective, transversal, descriptive and observational study. We studied seven children with a variety of neuromuscular diseases and spontaneous ambulation. We tested their lung function, and administered a six-minute walk test and a test of respiratory muscle strength to these children. Results: the age was 9.8 ± 2.4 years. All patients were males. Forced vital capacity decreased in three patients (42.8 %), forced expiratory volume during the first second (2.04 ± 1.4 L) and peak expiratory flow (4.33 ± 3.3 L/s) were normal. The maximum strength of respiratory muscles was less than 60 % of predicted values. The distance covered in the six-minute walk test was lower when compared with healthy controls (29.9 %). Conclusions: the six-minute walk test can be a useful tool in early stages of this disease, since it is easy to perform and well tolerated by the patients.

GCSE Assessment Notes: Six GCSE Assessment Assignments.

Science.gov (United States)

Graham, Stephen

1988-01-01

Provided are copy masters, instructions for use, and grading criteria for six problems used as part of the practical assessment for a modular science course. Each problem gives a narrative and a list of materials necessary to complete the problem. (CW)

Genotype-Phenotype Characterization of Novel Variants in Six Italian Patients with Familial Exudative Vitreoretinopathy.

Science.gov (United States)

Iarossi, Giancarlo; Bertelli, Matteo; Maltese, Paolo Enrico; Gusson, Elena; Marchini, Giorgio; Bruson, Alice; Benedetti, Sabrina; Volpetti, Sabrina; Catena, Gino; Buzzonetti, Luca; Ziccardi, Lucia

2017-01-01

Familial exudative vitreoretinopathy (FEVR) is a complex disorder characterized by incomplete development of the retinal vasculature. Here, we report the results obtained on the spectrum of genetic variations and correlated phenotypes found in a cohort of Italian FEVR patients. Eight probands (age range 7-19 years) were assessed by genetic analysis and comprehensive age-appropriate ophthalmic examination. Genetic testing investigated the genes most widely associated in literature with FEVR: FZD4 , LRP5 , TSPAN12 , and NDP . Clinical and genetic evaluations were extended to relatives of probands positive to genetic testing. Six out of eight probands (75%) showed a genetic variation probably related to the phenotype. We identified four novel genetic variants, one variant already described in association with Norrie disease and one previously described linked to autosomal dominant FEVR. Pedigree analysis of patients led to the classification of four autosomal dominant cases of FEVR (caused by FZD4 and TSPAN12 variants) and two X-linked FEVR probands ( NDP variants). None of the patients showed variants in the LRP5 gene. This study represents the largest cohort study in Italian FEVR patients. Our findings are in agreement with the previous literature confirming that FEVR is a clinically and genetically heterogeneous retinal disorder, even when it manifests in the same family.

Genotype-Phenotype Characterization of Novel Variants in Six Italian Patients with Familial Exudative Vitreoretinopathy

Directory of Open Access Journals (Sweden)

Giancarlo Iarossi

2017-01-01

Full Text Available Familial exudative vitreoretinopathy (FEVR is a complex disorder characterized by incomplete development of the retinal vasculature. Here, we report the results obtained on the spectrum of genetic variations and correlated phenotypes found in a cohort of Italian FEVR patients. Eight probands (age range 7–19 years were assessed by genetic analysis and comprehensive age-appropriate ophthalmic examination. Genetic testing investigated the genes most widely associated in literature with FEVR: FZD4, LRP5, TSPAN12, and NDP. Clinical and genetic evaluations were extended to relatives of probands positive to genetic testing. Six out of eight probands (75% showed a genetic variation probably related to the phenotype. We identified four novel genetic variants, one variant already described in association with Norrie disease and one previously described linked to autosomal dominant FEVR. Pedigree analysis of patients led to the classification of four autosomal dominant cases of FEVR (caused by FZD4 and TSPAN12 variants and two X-linked FEVR probands (NDP variants. None of the patients showed variants in the LRP5 gene. This study represents the largest cohort study in Italian FEVR patients. Our findings are in agreement with the previous literature confirming that FEVR is a clinically and genetically heterogeneous retinal disorder, even when it manifests in the same family.

Readability, content, and quality of online patient education materials on preeclampsia.

Science.gov (United States)

Lange, Elizabeth M S; Shah, Anuj M; Braithwaite, Brian A; You, Whitney B; Wong, Cynthia A; Grobman, William A; Toledo, Paloma

2015-01-01

The objective of this study was to evaluate the readability, content, and quality of patient education materials addressing preeclampsia. Websites of U.S. obstetrics and gynecology residency programs were searched for patient education materials. Readability, content, and quality were assessed. A one-sample t-test was used to evaluate mean readability level compared with the recommended 6th grade reading level. Mean readability levels were higher using all indices (p education materials should be improved.

Thirty years of nuclear fission in Yugoslavia

Energy Technology Data Exchange (ETDEWEB)

Pesic, M; Stefanovic, D [Boris Kidric Institute of Nuclear Sciences VINCA, Belgrade (Yugoslavia)

1989-07-01

Experimental nuclear reactor 'RB' in Boris Kidric Institute in Vinca is the first nuclear facility built in Yugoslavia in which the first Yugoslav controlled nuclear fission was achieved thirty years ago on April 26, 1958. Designed by Yugoslav scientist as a bare, natural uranium-heavy water critical assembly, the 'RB' reactor has survived a series of modifications trying to follow directions of contemporary nuclear research. The actual 'RB' reactor technical characteristics and experimental possibilities are described. The modifications are underlined, the experience gained and plans for future are presented. A brief review of reactor operation and experiments performed is shown. (author)

Contribution of hiatal hernia to asthma in patients with gastroesophageal reflux disease.

Science.gov (United States)

Li, Zhi-Tong; Ji, Feng; Han, Xin-Wei; Gu, Lin-Xia; Wang, Li; Yue, Yong-Qiang; Wang, Zhong-Gao

2018-05-01

To determine the correlation between asthma and hiatal hernia (HH) in patients with gastroesophageal reflux disease (GERD)-related asthma requiring laparoscopic anti-reflux surgery. One hundred and thirty-six GERD patients with medically refractory asthma with (80 patients) or without HH (56 patients) were enrolled. Gastroesophageal reflux disease was assessed by endoscopy, esophageal manometry, reflux monitoring and symptom questionnaires, and treated with laparoscopic Nissen fundoplication (LNF) or LNF with concomitant hiatal hernia repair (LNF-HHR). The outcome measures included patients' satisfaction and drug independence. The patients with HH had lower esophageal sphincters (P = .005) and higher DeMeester scores (P = .014) than those without HH. After an average follow-up of 24 months, symptom scores were significantly decreased from the preoperative values (P reflux, but also controlled asthma symptoms. © 2017 John Wiley & Sons Ltd.

Medulloblastoma: Long-term follow-up of patients treated with electron irradiation of the spinal field

International Nuclear Information System (INIS)

Gaspar, L.E.; Dawson, D.J.; Tilley-Gulliford, S.A.; Banerjee, P.

1991-01-01

Thirty-two patients with posterior fossa medulloblastoma underwent treatment with electron irradiation to the spinal field. The 5- and 10-year actuarial survival rates were 57% and 50%, respectively. Late complications observed in the 15 patients followed up for more than 5 years were short stature (six patients), decreased sitting-standing height ratio (four patients), scoliosis (two patients), poor school performance (seven patients), xerostomia (one patient), esophageal stricture (one patient), pituitary dysfunction (four patients), primary hypothyroidism (one patient), bilateral eighth-nerve deafness (one patient), and carcinoma of the thyroid (one patient). Complications following treatment with electrons to a spinal field are compared with reported complications following treatment with photons to the spinal field. Although short-term reactions were minimal, the authors found no difference in late complications. More sophisticated treatment planning may show such a long-term benefit in the future

Localized Ocular Adnexal Mucosa-Associated Lymphoid Tissue Lymphoma Treated With Radiation Therapy: A Long-Term Outcome in 86 Patients With 104 Treated Eyes

Energy Technology Data Exchange (ETDEWEB)

Harada, Ken, E-mail: keharada@ncc.go.jp [Department of Radiation Oncology, National Cancer Center Hospital, Tokyo (Japan); Murakami, Naoya; Kitaguchi, Mayuka; Sekii, Shuhei; Takahashi, Kana; Yoshio, Kotaro; Inaba, Koji; Morota, Madoka; Ito, Yoshinori; Sumi, Minako [Department of Radiation Oncology, National Cancer Center Hospital, Tokyo (Japan); Suzuki, Shigenobu [Department of Ophthalmic Oncology, National Cancer Center Hospital, Tokyo (Japan); Tobinai, Kensei [Department of Hematologic Oncology, National Cancer Center Hospital, Tokyo (Japan); Uno, Takashi [Department of Radiology, Chiba University School of Medicine, Chiba (Japan); Itami, Jun [Department of Radiation Oncology, National Cancer Center Hospital, Tokyo (Japan)

2014-03-01

Purpose: To evaluate the natural history, behavior of progression, prognostic factors, and treatment-related adverse effects of primary ocular adnexal mucosa-associated lymphoid tissue (MALT) lymphoma (POAML). Methods and Materials: Eighty-six patients with histologically proven stage I POAML treated with radiation therapy at National Cancer Center Hospital, Tokyo between 1990 and 2010 were retrospectively reviewed. The median age was 56 years (range, 18-85 years). The median dose administered was 30 Gy (range, 30-46 Gy). Seventy-seven patients (90%) were treated by radiation therapy alone. Results: The median follow-up duration was 9 years (range, 0.9-22 years). The 5- and 10-year overall survival (OS) rates were 97.6% and 93.5%, respectively, and no patients died of lymphoma. Patients with tumor sizes ≥4 cm showed a greater risk of contralateral relapse (P=.012). Six patients with contralateral relapse were seen and treated by radiation therapy alone, and all the lesions were controlled well, with follow-up times of 3 to 12 years. There was 1 case of local relapse after radiation therapy alone, and 3 cases of relapse occurred in a distant site. Cataracts developed in 36 of the 65 eyes treated without lens shielding and in 12 of the 39 patients with lens shielding (P=.037). Conclusions: The majority of patients with POAML showed behavior consistent with that of localized, indolent diseases. Thirty gray of local irradiation seems to be quite effective. The initial bilateral involvement and contralateral orbital relapses can be also controlled with radiation therapy alone. Lens shielding reduces the risk of cataract.

Localized Ocular Adnexal Mucosa-Associated Lymphoid Tissue Lymphoma Treated With Radiation Therapy: A Long-Term Outcome in 86 Patients With 104 Treated Eyes

International Nuclear Information System (INIS)

Harada, Ken; Murakami, Naoya; Kitaguchi, Mayuka; Sekii, Shuhei; Takahashi, Kana; Yoshio, Kotaro; Inaba, Koji; Morota, Madoka; Ito, Yoshinori; Sumi, Minako; Suzuki, Shigenobu; Tobinai, Kensei; Uno, Takashi; Itami, Jun

2014-01-01

Purpose: To evaluate the natural history, behavior of progression, prognostic factors, and treatment-related adverse effects of primary ocular adnexal mucosa-associated lymphoid tissue (MALT) lymphoma (POAML). Methods and Materials: Eighty-six patients with histologically proven stage I POAML treated with radiation therapy at National Cancer Center Hospital, Tokyo between 1990 and 2010 were retrospectively reviewed. The median age was 56 years (range, 18-85 years). The median dose administered was 30 Gy (range, 30-46 Gy). Seventy-seven patients (90%) were treated by radiation therapy alone. Results: The median follow-up duration was 9 years (range, 0.9-22 years). The 5- and 10-year overall survival (OS) rates were 97.6% and 93.5%, respectively, and no patients died of lymphoma. Patients with tumor sizes ≥4 cm showed a greater risk of contralateral relapse (P=.012). Six patients with contralateral relapse were seen and treated by radiation therapy alone, and all the lesions were controlled well, with follow-up times of 3 to 12 years. There was 1 case of local relapse after radiation therapy alone, and 3 cases of relapse occurred in a distant site. Cataracts developed in 36 of the 65 eyes treated without lens shielding and in 12 of the 39 patients with lens shielding (P=.037). Conclusions: The majority of patients with POAML showed behavior consistent with that of localized, indolent diseases. Thirty gray of local irradiation seems to be quite effective. The initial bilateral involvement and contralateral orbital relapses can be also controlled with radiation therapy alone. Lens shielding reduces the risk of cataract

Health-related quality of life of patients six months poststroke living in the Western Cape, South Africa

Directory of Open Access Journals (Sweden)

Anthea J. Rhoda

2014-11-01

Method: An observational, longitudinal study was used to collect data from a conveniently selected sample of first-ever stroke patients. The Rivermead Motor Assessment Scale and the Barthel Index were used to determine functional outcome and the EQ-5D was used to collect information relating to quality of life at two months and six months poststroke. Descriptive and inferential statistics were used to analyse the data. Results: The total sample of 100 participants consisted of 50% men and 50% women with a mean age of 61 and a standard deviation of 10.55 years. Six-month quality of life datawas analysed for 73 of the 100 participants. Of the 27 who were lost to follow-up, nine participants died, four withdrew from the study after baseline data was collected and eleven could not be followed up as they had either moved or no follow-up telephone numbers were available. A further three participants were excluded from the analysis of the EQ-5D as they were aphasic. Of these, approximately 35% had problems with mobility and self-care, whilst 42% had severe problems with everyday activities and 37.8% expressed having anxiety and depression. Quality of life at two months (p = 0.010 and urinary incontinence (p = 0.002 were significant predictors of quality of life at six months. Conclusion: Health-related quality of life was decreased in the South African stroke sample. Functional ability and urinary incontinence were the factors affecting quality of life in the sample. These factors should be considered in the rehabilitation of stroke patients in these settings.

Impact of renal transplantation on erectile dysfunction due to chronic renal failure in male patients

International Nuclear Information System (INIS)

Ahmad, M.; Rafiudding, Q.; Ahmad, A.

2009-01-01

Erectile dysfunction can be defined as the persistent inability of man to achieve penile erection and maintain it sufficient for satisfactory coitus. The objectives of this study were to find out the impact of successful renal transplantation on the degree and frequency of erectile dysfunction. Thirty patients of end stage renal disease that were on regular haemodialysis and candidates of renal transplantation of age range 20-55 years were included in the study after getting informed consent. Erectile functions were assessed by history, examination, investigations and international index of erectile function (IIEF) before and 3 and 6 months after renal transplantation, other information regarding disease and patient were collected in the performa. Out of thirty patients 14 (46.6%) patients had sever erectile dysfunction while 16 (53.3%) patients had moderate erectile dysfunction in the pre renal transplantation period. After three months of renal transplantation 15 (50%) had severe erectile dysfunction, 6 (20%) patients moderate erectile dysfunction and 9 (30%) patients mild erectile dysfunction. After six months 11 (36.6%), 10 (33.3%) and 8 (26.6%) patients had severe, moderate and mild erectile dysfunction respectively. There was improvement in 40%, no change in 53.3% and deterioration in 6.6% patients in the erectile functions after getting renal transplantation for end stage renal disease. (author)

Is outdoor use of the six-minute walk test with a global positioning system in stroke patients' own neighbourhoods reproducible and valid?

NARCIS (Netherlands)

Wevers, L.E.; Kwakkel, G.; van de Port, I.G.

2011-01-01

Objective: To examine the reproducibility, responsiveness and concurrent validity of the six-minute walk test (6MWT) when tested outdoors in patients' own neighbourhoods using a global positioning system (GPS) or a measuring wheel. Methods: A total of 27 chronic stroke patients, discharged to their

Thirty years of transport package development for spent fuels

International Nuclear Information System (INIS)

Cory, A.R.

2005-01-01

By June 2005, when shipments of spent fuel for reprocessing from Germany are concluded, BNFL flask types will have been responsible for transporting more than 2000 tonnes of heavy metal in Europe in the form of spent fuel. Several thousand more tonnes of spent fuel have been transported by sea from Japan over the last thirty years. The design of spent fuel packages has not stood still for that time. In order to anticipate the changing needs of the nuclear power generation industry, advances have been made both in package design and analysis. Thirty years ago spent fuel burnup and initial enrichment were considerably lower, which was reflected in the different demands placed on the shielding design of packages, and in the design of the internal basket to separate the fuel assemblies. Technical development of both 'wet' (water-filled cavity) and 'dry' packages has progressed in parallel, and the relative merits and peculiarities of each type is explored. BNFL has considerable experience in the operation of both types, and is well placed to comment on practical and functional issues associated with both types. While there have been certain evolutionary changes affecting package design, there have also been more significant changes in the Design Safety Case. These have sometimes been necessary to meet changes in IAEA Regulations, or the challenges posed by the regulators themselves. In other cases advantage has been taken of improvements in analytical techniques to demonstrate increased margins of operational safety. Where possible these margins have also been increased by other means, such as taking advantage of commercial trends to reduce package thermal loads. A key factor over the last thirty years has been the increasing influence of the Regulating Authorities and the development of the IAEA Regulations. The various Competent Authorities now tend to have a higher proportion of technical experts, often recruited from the nuclear industry, and are thus more able to

Six-Month Clinical and Angiographic Results of Paclitaxel Eluting Simpax Stent

Directory of Open Access Journals (Sweden)

Mehmet Muhsin Türkmen

2012-08-01

Full Text Available Introduction: We aimed to evaluate the safety and efficacy of the simpax stent in the treatmentof different patient groups.Patients and Methods: Forty-five patients were treated with the simpax stent. Of these patients,23 patients gave consent for six months of follow-up by quantitative coronary angiography (QSAand six patients were evaluated by exercise electrocardiographic test. Only the patients havinglesions with stenosis > 50% of diameter and lengths > 16 mm with reference diameters < 2.75mm were included.Results: The device success rate was 100% and procedure success rate was 97.7%. The meanstent length was 24.6 ± 7.3 mm and stent size was 2.54 ± 0.24 mm. The overall six months incidenceof major adverse cardiac events (MACE was 8.8%. MACE was consisted of two casesof non-Q wave myocardial infarction and two cases of repeated revascularization of the targetlesion. MACE rate was higher in chronic total occlusion (CTO group than non-CTO group (respectively33.3% and 5.1. Also when compared to stent size, MACE rate was 25% in < 2.5 mm,0% ≥ 2.5 mm. The QSA results at six months showed in-stent late lumen loss witha diameter of0.25 ± 0.15 mm in 17 patients.Conclusion: The six month results in this study demonsrated excellent procedural and devicesuccess. Simpax stent was associated with a low in-stent late lumen loss. Also this study showedsimpax stent was a safe and effective device in non-CTO group with stent size ≥ 2.5 mm.

Discriminant cognitive factors in responder and non-responder patients with schizophrenia.

Science.gov (United States)

Stip, E; Lussier, I; Ngan, E; Mendrek, A; Liddle, P

1999-12-01

To identify which improvements in cognitive function are associated with symptom resolution in schizophrenic patients treated with atypical antipsychotics. a prospective open trial with atypical neuroleptics (risperidone, clozapine, quetiapine). Inpatient and outpatient units, Institute of Psychiatry. Thirty-nine patients with schizophrenia according to DSM-IV criteria were included. Clinical and cognitive assessment were done at baseline (T0) and again after six months of treatment (T2). Twenty-five patients completed the trial. New-generation antipsychotics during six months. Patients were considered as responders if their PANSS score decreased at least 20% (n = 15) and non-responders if it did not (n = 10). a computerized cognitive assessment comprised tests of short-term-memory (digit span), explicit long-term memory (word pair learning), divided attention, selective attention and verbal fluency (orthographic and semantic). Clinical assessment included PANSS and ESRS. A discriminant function analysis was performed to determine which changes in cognitive performance predicted symptomatic response status. Semantic fluency and orthographic fluency were significant predictors. Together they correctly predicted responder status in 88% of cases. Memory was not a significant predictor of symptomatic response. Verbal fluency discriminated the responder from the non-responder group during a pharmacological treatment.

Kidney-differentiated cells derived from Lowe Syndrome patient's iPSCs show ciliogenesis defects and Six2 retention at the Golgi complex.

Directory of Open Access Journals (Sweden)

Wen-Chieh Hsieh

Full Text Available Lowe syndrome is an X-linked condition characterized by congenital cataracts, neurological abnormalities and kidney malfunction. This lethal disease is caused by mutations in the OCRL1 gene, which encodes for the phosphatidylinositol 5-phosphatase Ocrl1. While in the past decade we witnessed substantial progress in the identification and characterization of LS patient cellular phenotypes, many of these studies have been performed in knocked-down cell lines or patient's cells from accessible cell types such as skin fibroblasts, and not from the organs affected. This is partially due to the limited accessibility of patient cells from eyes, brain and kidneys. Here we report the preparation of induced pluripotent stem cells (iPSCs from patient skin fibroblasts and their reprogramming into kidney cells. These reprogrammed kidney cells displayed primary cilia assembly defects similar to those described previously in cell lines. Additionally, the transcription factor and cap mesenchyme marker Six2 was substantially retained in the Golgi complex and the functional nuclear-localized fraction was reduced. These results were confirmed using different batches of differentiated cells from different iPSC colonies and by the use of the human proximal tubule kidney cell line HK2. Indeed, OCRL1 KO led to both ciliogenesis defects and Six2 retention in the Golgi complex. In agreement with Six2's role in the suppression of ductal kidney lineages, cells from this pedigree were over-represented among patient kidney-reprogrammed cells. We speculate that this diminished efficacy to produce cap mesenchyme cells would cause LS patients to have difficulties in replenishing senescent or damaged cells derived from this lineage, particularly proximal tubule cells, leading to pathological scenarios such as tubular atrophy.

Retrospective cohort study of prognostic factors in patients with oral cavity and oropharyngeal squamous cell carcinoma.

Science.gov (United States)

Carrillo, José F; Carrillo, Liliana C; Cano, Ana; Ramirez-Ortega, Margarita C; Chanona, Jorge G; Avilés, Alejandro; Herrera-Goepfert, Roberto; Corona-Rivera, Jaime; Ochoa-Carrillo, Francisco J; Oñate-Ocaña, Luis F

2016-04-01

Prognostic factors in oral cavity and oropharyngeal squamous cell carcinoma (SCC) are debated. The purpose of this study was to investigate the association of prognostic factors with oncologic outcomes. Patients with oral cavity and oropharyngeal SCC treated from 1997 to 2012 were included in this retrospective cohort study. Associations of prognostic factors with locoregional recurrence (LRR) or overall survival (OS) were analyzed using the logistic regression and the Cox models. Six hundred thirty-four patients were included in this study; tumor size, surgical margins, and N classification were associated with LRR (p oral cavity and oropharyngeal SCC. © 2015 Wiley Periodicals, Inc.

Readability Assessment of Online Uveitis Patient Education Materials.

Science.gov (United States)

Ayoub, Samantha; Tsui, Edmund; Mohammed, Taariq; Tseng, Joseph

2017-12-29

To evaluate the readability of online uveitis patient education materials. A Google search in November 2016 was completed using search term "uveitis" and "uveitis inflammation." The top 50 websites with patient-centered information were selected and analyzed for readability using the Flesch-Kincaid Grade Level (FKGL), Flesch Reading Ease Score (FRES), Gunning FOG Index (GFI), and Simple Measure of Gobbledygook (SMOG). Statistical analysis was performed with two-tailed t-tests. The mean word count of the top 50 websites was 1162.7 words, and averaged 16.2 words per sentence. For these websites, the mean FRES was 38.0 (range 4-66, SD = 12.0), mean FKGL was 12.3 (range 6.8-19, SD = 2.4), mean SMOG score was 14.4 (range 9.8-19, SD = 1.8), and the mean Gunning FOG index was 14.0 (range 8.6-19, SD = 2.0). The majority of online patient directed uveitis materials are at a higher reading level than that of the average American adult.

Advanced research workshop: nuclear materials safety

International Nuclear Information System (INIS)

Jardine, L J; Moshkov, M M.

1999-01-01

The Advanced Research Workshop (ARW) on Nuclear Materials Safety held June 8-10, 1998, in St. Petersburg, Russia, was attended by 27 Russian experts from 14 different Russian organizations, seven European experts from six different organizations, and 14 U.S. experts from seven different organizations. The ARW was conducted at the State Education Center (SEC), a former Minatom nuclear training center in St. Petersburg. Thirty-three technical presentations were made using simultaneous translations. These presentations are reprinted in this volume as a formal ARW Proceedings in the NATO Science Series. The representative technical papers contained here cover nuclear material safety topics on the storage and disposition of excess plutonium and high enriched uranium (HEU) fissile materials, including vitrification, mixed oxide (MOX) fuel fabrication, plutonium ceramics, reprocessing, geologic disposal, transportation, and Russian regulatory processes. This ARW completed discussions by experts of the nuclear materials safety topics that were not covered in the previous, companion ARW on Nuclear Materials Safety held in Amarillo, Texas, in March 1997. These two workshops, when viewed together as a set, have addressed most nuclear material aspects of the storage and disposition operations required for excess HEU and plutonium. As a result, specific experts in nuclear materials safety have been identified, know each other from their participation in t he two ARW interactions, and have developed a partial consensus and dialogue on the most urgent nuclear materials safety topics to be addressed in a formal bilateral program on t he subject. A strong basis now exists for maintaining and developing a continuing dialogue between Russian, European, and U.S. experts in nuclear materials safety that will improve the safety of future nuclear materials operations in all the countries involved because of t he positive synergistic effects of focusing these diverse backgrounds of

Health-related quality of life of patients six months poststroke living in the Western Cape, South Africa.

Science.gov (United States)

Rhoda, Anthea J

2014-01-01

The majority of individuals report a decline in health-related quality of life following a stroke. Quality of life and factors predicting quality of life could differ in individuals from lower income countries. The aim of this study was therefore to determine the quality of life and factors influencing quality of life of community-dwelling stroke patients living in low-income, peri-urban areas in the Western Cape, South Africa. An observational, longitudinal study was used to collect data from a conveniently selected sample of first-ever stroke patients. The Rivermead Motor Assessment Scale and the Barthel Index were used to determine functional outcome and the EQ-5D was used to collect information relating to quality of life at two months and six months poststroke. Descriptive and inferential statistics were used to analyse the data. The total sample of 100 participants consisted of 50% men and 50% women with a mean age of 61 and a standard deviation of 10.55 years. Six-month quality of life data was analysed for 73 of the 100 participants. Of the 27 who were lost to follow-up, nine participants died, four withdrew from the study after baseline data was collected and eleven could not be followed up as they had either moved or no follow-up telephone numbers were available. A further three participants were excluded from the analysis of the EQ-5D as they were aphasic. Of these, approximately 35% had problems with mobility and self-care, whilst 42% had severe problems with everyday activities and 37.8% expressed having anxiety and depression. Quality of life at two months ( p = 0.010) and urinary incontinence ( p = 0.002) were significant predictors of quality of life at six months. Health-related quality of life was decreased in the South African stroke sample. Functional ability and urinary incontinence were the factors affecting quality of life in the sample. These factors should be considered in the rehabilitation of stroke patients in these settings.

Would you Find Thirty online? Website use in a Western Australian physical activity campaign.

Science.gov (United States)

Leavy, J E; Rosenberg, M; Barnes, R; Bauman, A; Bull, F C

2013-08-01

Mass media campaigns have used a range of traditional media (television, radio and print) to communicate health messages. In the past decade the Internet has added to these traditional methods with Web 2.0, smart phone technology and interactive media. 'Find Thirty every day(®)', a Western Australia population-wide mass media campaign delivered over 2 years, used a combination of traditional mass media, a website, online resources and banner advertising. The aim of the present study is to describe the use of the Find Thirty every day(®) website during the campaign media activities of May 2008-June 2010. Cross-sectional self-reported survey data were collected from a random sample of adults using a computer-assisted telephone interview over the period February-March 2010. Objective online analytical measures of unique visits to the Find Thirty every day(®) website were collected between June 2008 and June 2010. Monthly visitors to the Find Thirty every day(®) website increased from 3193 in 2009 to 4374 in 2010. During the last two media waves (October 2009 and February 2010), site visits were 5388 and 5272 per month, respectively. The impact of the Find Thirty every day(®) website was a positive outcome, considering the minimal online presence. SO WHAT? Health communication campaign planners should maximise the potential synergy of traditional mass media and new social media in future campaigns. Accordingly, a multidisciplinary approach that includes communication researchers, experts in information systems and a creative team experienced in online environments will need to be the way forward.

Effect of intra-hepatic arterial infusion chemotherapy for patients with liver metastasis from breast cancer

International Nuclear Information System (INIS)

Liu Dezhong; Li Huai; Zeng Huiying; Yang Ling

2001-01-01

Objective: To evaluate the efficacy of intra-hepatic arterial infusion chemotherapy for patients with liver metastasis from breast cancer. Methods: 1993-1998 years, Thirty four patients with liver metastasis from breast cancer had received epi-adriamycin, cisplatin, mitomycin and 5-fluorouracil by intrahepatic arterial infusion chemotherapy. Twelve patients had received embolization. Results: Six patients (17.65%) had a complete response, 12 patients (35.29%) had a partial response. The overall response rate was 52.94%. Cumulative survival rates at 1, 2, 3 and 4 years were 56.90%, 25.00%, 5.00% and 5.00% respectively (Kaplan-Meier method). The median overall survival time was 11.5 months. Conclusion: Intra-hepatic arterial infusion chemotherapy is safe and effective for liver metastasis from breast cancer and should be the first choice of treatment for these patients

Thirty-six pulse rectifier scheme based on zigzag auto-connected transformer

Directory of Open Access Journals (Sweden)

Xiao-Qiang Chen

2016-03-01

Full Text Available In this paper, a low kilo-volt-ampere rating zigzag connected autotransformer based 36-pulse rectifier system supplying vector controlled induction motor drives (VCIMD is designed, modeled and simulated. Detailed design procedure and magnetic rating calculation of the proposed autotransformer and interphase reactor is studied. Moreover, the design process of the autotransformer is modified to make it suitable for retrofit applications. Simulation results confirm that the proposed 36-pulse rectifier system is able to suppress less than 35th harmonics in the utility line current. The influence of load variation and load character is also studied to demonstrate the performance and effectiveness of the proposed 36-pulse rectifiers. A set of power quality indices at AC mains and DC link are presented to compare the performance of 6-, 24- and 36-pulse AC-DC converters.

Thirty-six pulse rectifier scheme based on zigzag auto-connected transformer

OpenAIRE

Xiao-Qiang Chen; Chun-Ling Hao; Hao Qiu; Min Li

2016-01-01

In this paper, a low kilo-volt-ampere rating zigzag connected autotransformer based 36-pulse rectifier system supplying vector controlled induction motor drives (VCIMD) is designed, modeled and simulated. Detailed design procedure and magnetic rating calculation of the proposed autotransformer and interphase reactor is studied. Moreover, the design process of the autotransformer is modified to make it suitable for retrofit applications. Simulation results confirm that the proposed 36-pulse re...

The readability of pediatric patient education materials on the World Wide Web.

Science.gov (United States)

D'Alessandro, D M; Kingsley, P; Johnson-West, J

2001-07-01

Literacy is a national and international problem. Studies have shown the readability of adult and pediatric patient education materials to be too high for average adults. Materials should be written at the 8th-grade level or lower. To determine the general readability of pediatric patient education materials designed for adults on the World Wide Web (WWW). GeneralPediatrics.com (http://www.generalpediatrics.com) is a digital library serving the medical information needs of pediatric health care providers, patients, and families. Documents from 100 different authoritative Web sites designed for laypersons were evaluated using a built-in computer software readability formula (Flesch Reading Ease and Flesch-Kincaid reading levels) and hand calculation methods (Fry Formula and SMOG methods). Analysis of variance and paired t tests determined significance. Eighty-nine documents constituted the final sample; they covered a wide spectrum of pediatric topics. The overall Flesch Reading Ease score was 57.0. The overall mean Fry Formula was 12.0 (12th grade, 0 months of schooling) and SMOG was 12.2. The overall Flesch-Kincaid grade level was significantly lower (Peducation materials on the WWW are not written at an appropriate reading level for the average adult. We propose that a practical reading level and how it was determined be included on all patient education materials on the WWW for general guidance in material selection. We discuss suggestions for improved readability of patient education materials.

Evaluation of internet-based patient education materials from internal medicine subspecialty organizations: will patients understand them?

Science.gov (United States)

Hansberry, David R; Agarwal, Nitin; John, Elizabeth S; John, Ann M; Agarwal, Prateek; Reynolds, James C; Baker, Stephen R

2017-06-01

The majority of Americans use the Internet daily, if not more often, and many search online for health information to better understand a diagnosis they have been given or to research treatment options. The average American reads at an eighth-grade level. The purpose of this study is to evaluate the readability of online patient education materials on the websites of 14 professional organizations representing the major internal medicine subspecialties. We used ten well-established quantitative readability scales to assess written text from patient education materials published on the websites of the major professional organizations representing the following subspecialty groups: allergy and immunology, cardiology, endocrinology, gastroenterology, geriatrics, hematology, hospice and palliative care, infectious disease, nephrology, oncology, pulmonology and critical care, rheumatology, sleep medicine, and sports medicine. Collectively the 540 articles analyzed were written at an 11th-grade level (SD 1.4 grade levels). The sleep medicine and nephrology websites had the most readable materials, written at an academic grade level of 8.5 ± 1.5 and 9.0 ± 0.2, respectively. Material at the infectious disease site was written at the most difficult level, with average readability corresponding to grades 13.9 ± 0.3. None of the patient education materials we reviewed conformed to the American Medical Association (AMA) and the National Institutes of Health (NIH) guidelines requiring that patient education articles be written at a third- to seventh-grade reading level. If these online resources were rewritten, it is likely that more patients would derive benefit from reading them.

Laser applications for energy. Fifty years since advent of laser and next thirty years

International Nuclear Information System (INIS)

Nakai, Sadao

2011-01-01

The utilization of light has been changed since the advent of lasers about fifty years ago. Now in the twenty first century, laser science is being applied in every industry as the fundamental technology. In the recent years, remarkable progresses have been made in the semiconductor lasers of high power and wide wavelength region. The amazing developments of ceramics laser materials like YAG and nonlinear optics materials of organic crystals have been achieved as well as the big progress in the fiber lasers. It is also to be pointed out that very high power ultra short laser pulses have become available. In the field of power photonics, which is based on the power semiconductor lasers, fiber lasers and new laser materials, various industrial applications are expected to be constructed further in civil engineering, manufacturing technology, agricultural and biological applications, medical utilization and space sciences. It is expected, by the development of ultra short pulse and ultra high mean power lasers, that particle accelerations, ultra high density sciences, nuclear fusion neutron sources and laser fusion power reactors are to be advanced drastically. Recent development and future prospects of high power lasers are illustrated. Lasers are now regarded as one of the key technologies in line with the national policy toward the creation of innovative industries. Realization of the laser fusion reactor is the most challenging target in the coming thirty years. (S. Funahashi)

Anal carcinoma in HIV-infected patients in the period 1995-2009

DEFF Research Database (Denmark)

Legarth, Rebecca; Helleberg, Marie; Kronborg, Gitte

2013-01-01

Abstract Background: Several studies have demonstrated an increased risk of non-AIDS cancers in HIV patients and, for some cancers, also in relatives of HIV patients. We aimed to estimate (1) the risk of anal carcinoma among HIV patients and their parents, and (2) the mortality after a diagnosis...... 1995-2009, and (2) parents of HIV patients compared with parents of controls for the period 1978-2009. Cancer diagnoses were identified from The Danish Cancer Registry. We further estimated the mortality rate ratios (MRR) of HIV patients compared with controls after the diagnosis of anal carcinoma....... Results: Thirty-six HIV patients versus 8 population controls were diagnosed with anal carcinoma. HIV patients had an increased risk of anal carcinoma (IRR 77.9, 95% CI 36.2-167.7), especially among men who have sex with men (MSM) (IRR 101.4, 95% CI 39.3-261.5). Fathers of HIV patients had an increased...

Six-Position, Frontal View Photography in Blepharoplasty: A Simple Method.

Science.gov (United States)

Zhang, Cheng; Guo, Xiaoshuang; Han, Xuefeng; Tian, Yi; Jin, Xiaolei

2018-02-26

Photography plays a pivotal role in patient education, photo-documentation, preoperative planning and postsurgical evaluation in plastic surgeries. It has long been serving as a bridge that facilitated communication not only between patients and doctors, but also among plastic surgeons from different countries. Although several basic principles and photographic methods have been proposed, there is no internationally accepted photography that could provide both static and dynamic information in blepharoplasty. In this article, we introduced a novel six-position, frontal view photography for thorough assessment in blepharoplasty. From October 2013 to January 2017, 1068 patients who underwent blepharoplasty were enrolled in our clinical research. All patients received six-position, frontal view photography. Pictures were taken of the patients looking up, looking down, squeezing, smiling, looking ahead and with closed eyes. Conventionally, frontal view photography only contained the last two positions. Then, both novel six-position photographs and conventional two-position photographs were used to appraise postsurgical outcomes. Compared to conventional two-position, frontal view photography, six-position, frontal view photography can provide more detailed, thorough information about the eyes. It is of clinical significance in indicating underlying adhesion of skin/muscle/fat according to individual's features and assessing preoperative and postoperative dynamic changes and aesthetic outcomes. Six-position, frontal view photography is technically uncomplicated while exhibiting static, dynamic and detailed information of the eyes. This innovative method is favorable in eye assessment, especially for revision blepharoplasty. We suggest using six-position, frontal view photography to obtain comprehensive photographs. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer

A Report of Six Clinical Cases of Lowered Blood Cholesterol Profile ...

African Journals Online (AJOL)

Purpose: To assess six patients with Diabegard® supplementation with reference to cholesterol profiles. Methods: We report the clinical courses of six individuals taking Diabegard® supplementation at 60 and 120 mg/day for 8 weeks. Results: Patients had a maximum of 52.13 % reduction in low-density lipoprotein (LDL) ...

Nicholas Kaldor after Thirty Years

Directory of Open Access Journals (Sweden)

John Edward King

2016-06-01

Full Text Available The article analyses Kaldor’s ideas on economic policy, his interest in policy issues, and his contribution on specific policies. It underlines Kaldor’s strong and cogent views on three main topics: monetary and fiscal policy, the control of cost inflation, and the stabilisation of commodity prices. The author suggests how Kaldor might have reacted to the most important economic policy questions that still face Britain and the European Union, thirty years after his death. Kaldor was a prominent opponent of Britain’s entry into the then Common Market in the 1970s: not on the basis of any emotive English nationalism, but rather because he believed that the British economy would be damaged by an exposure to unlimited competition from more successful European industries. Perhaps he would have argued that, by 2016, the damage has already been done, and that Britain should now remain in the Union to continue the fight for more sensible macroeconomic policies. He would certainly have been pleased that his adoptive country had refused to join the Eurozone. JEL: B31; E61; E52

Enhanced external counterpulsation in patients with refractory angina pectoris: a pilot study with six months follow-up regarding physical capacity and health-related quality of life.

Science.gov (United States)

Wu, Eline; Mårtensson, Jan; Broström, Anders

2013-10-01

Refractory angina pectoris (AP) is a persistent, painful condition characterized by angina caused by coronary insufficiency in the presence of coronary artery disease. It has been emphasized that there are possible underlying neuropathophysiological mechanisms for refractory AP but chronic ischemia is still considered to be the main problem. These patients suffer from severe AP and cannot be controlled by a combination of pharmacological therapies, angioplasty or coronary bypass surgery. AP has a negative impact on quality of life and daily life. Enhanced external counterpulsation (EECP) is a therapeutic option for these patients. The aim of this study was to evaluate EECP after six months regarding physical capacity and health-related quality of life (HRQoL) in patients with refractory AP. This was a study with single case research experimental design involving 34 patients treated with EECP. Six minute walk test (6MWT), functional class with Canadian Cardiological Society (CCS) classification and self-reported HRQoL questionnaires as Short Form 36 (SF-36) were collected at baseline and after treatment. CCS class and SF-36 were repeated at six months follow-up. Patients enhanced walk distance on average by 29 m after EECP (p<0.01). CCS class also improved (p<0.001) and persisted at six months follow-up (p<0.001). HRQoL improved significantly and the effects were maintained at follow-up after the treatment. Patients with refractory AP receive beneficial effects from EECP both in physical capacity and HRQoL. As other treatment options for this patient group are scarce, EECP should be offered to improve physical health and HRQoL in these patients.

CASE REPORT Thirty years old lady with nephrotic syndrome: a ...

African Journals Online (AJOL)

CASE REPORT. Thirty years old lady with nephrotic syndrome: a case of biopsy proven lupus nephritis in Tanzania. FRANCIS FREDRICK1,2*, PASCHAL J. RUGGAJO2,3,GYAVIIRA MAKANGA3, CHARLES K. SHIJA3, MIKAEL. AMDEMARIAM3, BELSON RUGWIZAGONGA4 and JAMES N. KITINYA4. 1Department of ...

The patient's diagnosis: explanatory models of mental illness.

Science.gov (United States)

Sayre, J

2000-01-01

The purpose of the study was to develop a grounded theory about individuals' perception of the situation of being a psychiatric patient. Thirty-five inpatients (19 males, 16 females), ages 18 to 68, in two psychiatric units of an urban, public facility were interviewed on a biweekly basis from admission to discharge. Data were analyzed using the constant comparative method, and the data indicated that participants used the basic social process of managing self-worth to deal with the stigmatizing social predicament of being a mental patient. Events occurring before admission that shaped their responses were substance abuse, medication noncompliance, and the lack of social capital, which led to norm violations and subsequent hospitalization. Six attribution categories emerged: problem, disease, crisis, punishment, ordination, and violation. Findings support the need for professionals to improve their practice by acknowledging the effects of patients' subjective assessments on their response to hospitalization and by placing more emphasis on assisting patients to deal with the stigmatizing effects of a psychiatric diagnosis.

Dissecting delays in trauma care using corporate lean six sigma methodology.

Science.gov (United States)

Parks, Jennifer K; Klein, Jorie; Frankel, Heidi L; Friese, Randall S; Shafi, Shahid

2008-11-01

The Institute of Medicine has identified trauma center overcrowding as a crisis. We applied corporate Lean Six Sigma methodology to reduce overcrowding by quantifying patient dwell times in trauma resuscitation units (TRU) and to identify opportunities for reducing them. TRU dwell time of all patients treated at a Level I trauma center were measured prospectively during a 3-month period (n = 1,184). Delays were defined as TRU dwell time >6 hours. Using personnel trained in corporate Lean Six Sigma methodology, we created a detailed process map of patient flow through our TRU and measured time spent at each step prospectively during a 24/7 week-long time study (n = 43). Patients with TRU dwell time below the median (3 hours) were compared with those with longer dwell times to identify opportunities for improvement. TRU delays occurred in 183 of 1,184 trauma patients (15%), and peaked on days with >15 patients or with presence of five simultaneous patients. However, 135 delays (74%) occurred on days when Six Sigma mapping identified four processes that were related to TRU delays. Reduction of TRU dwell time by 1 hour per patient using interventions targeting these specific processes has the potential to improve our TRU capacity to care for more patients. Application of corporate Lean Six Sigma methodology identified opportunities for reducing dwell times in our TRU. Such endeavors are vital to maximize operational efficiency and decrease overcrowding in busy trauma centers working at capacity.

Lipid Profile Status in Mustard Lung Patients and its Relation to Severity of Airflow Obstruction

Directory of Open Access Journals (Sweden)

Davood Attaran

2014-02-01

Full Text Available Introduction: Chronic obstructive pulmonary disease (COPD secondary to sulfur mustard gas poisoning, known as mustard lung, is a major late pulmonary complications in chemical warfare patients. Serious comorbidities like dyslipidemia are frequently encountered in COPD. The aim of this study was to measure the serum lipid profile and evaluate the relation of lipid parameters with the severity of airway obstruction in mustard lung patients. Materials and Methods: Thirty-six non-smoker mustard lung patients with no history of cardiovascular disease, diabetes mellitus, and dyslipidemia were entered into this cross-sectional study. Control group consisted of 36 healthy non-smoker men were considered in this study. Serum lipid profile was performed in the patients and the controls. Spirometry was done in mustard lung patients. Results: The mean age of the patients was 47±6.80 SD years. The mean duration of COPD was 18.50±7.75 SD years. There were statistically significant differences in mean serum triglycerides and total cholesterol levels between patients and controls (p=0.04 and p=0.03, respectively.The mean levels of lipid parameters were not statistically significant different among the 4 stages of COPD severity (p>0.05. Conclusion: The current study revealed that the serum levels of triglycerides and cholesterol are elevated in mustard lung patients compared with the healthy controls. Since lipid profile abnormalities are considered as a major risk factor for cardiovascular disease, especial attention to this matter is recommended in mustard lung patients

Assessment of printed patient-educational materials for chronic kidney disease.

Science.gov (United States)

Tuot, Delphine S; Davis, Elizabeth; Velasquez, Alexandra; Banerjee, Tanushree; Powe, Neil R

2013-01-01

Awareness of chronic kidney disease (CKD) is suboptimal among patients with CKD, perhaps due to poor readability of patient education materials (PEMs). We reviewed the suitability and readability of common PEMs that focused on 5 content areas: basics of CKD, risk factors for CKD development, risk factors for CKD progression, complications of CKD and self-management strategies to improve kidney health. Three reviewers (nephrologist, primary care physician, patient) used the Suitability Assessment of Materials to rate PEMs on message content/stimulation of learning, typography, visuals and layout and determined literacy level. Mean ratings were calculated for each PEM by content area and overall (superior = 70-100; adequate = 40-69; inadequate = 6th grade) was associated with an 11.7 point higher mean rating. Most PEMs for kidney disease were adequate. Outstanding PEMs shared characteristics of patient centeredness, a low literacy level, and patient interaction. Providers should be aware of strengths and limitations of PEMs when educating their patients about CKD. Copyright © 2013 S. Karger AG, Basel.

Monday-Morning Quarterbacking: A Senior Analyst Uses His Early Work to Discuss Contemporary Child and Adolescent Psychoanalytic Technique.

Science.gov (United States)

Sugarman, Alan

2015-01-01

Contemporary child and adolescent psychoanalytic technique has evolved and changed a great deal in the last thirty years. This paper will describe the analysis of an adolescent girl from early in the author's career to demonstrate the ways in which technique has changed. The clinical material presented highlights six areas in which contemporary child and adolescent analysts practice and/or understand material and the clinical process differently than they did thirty years ago: (1) the contemporary perspective on mutative action, (2) the contemporary emphasis on mental organization, (3) the developmental lag in integrating the structural model, (4) the child analyst's multiple functions, (5) the child analyst's use of countertransference, and (6) the child analyst's work with parents. The author discusses how he would work differently with the patient now using his contemporary perspective. But he also wonders what might have been lost by not working in a more traditional manner, in particular the opportunity to analyze the patient's hypersensitivity to feeling hurt and mistreated so directly in the transference.

Assessment of a six gene panel for the molecular detection of circulating tumor cells in the blood of female cancer patients

International Nuclear Information System (INIS)

Obermayr, Eva; Heinze, Georg; Tong, Dan; Zeillinger, Robert; Sanchez-Cabo, Fatima; Tea, Muy-Kheng M; Singer, Christian F; Krainer, Michael; Fischer, Michael B; Sehouli, Jalid; Reinthaller, Alexander; Horvat, Reinhard

2010-01-01

The presence of circulating tumor cells (CTC) in the peripheral blood of cancer patients has been described for various solid tumors and their clinical relevance has been shown. CTC detection based on the analysis of epithelial antigens might be hampered by the genetic heterogeneity of the primary tumor and loss of epithelial antigens. Therefore, we aimed to identify new gene markers for the PCR-based detection of CTC in female cancer patients. Gene expression of 38 cancer cell lines (breast, ovarian, cervical and endometrial) and of 10 peripheral blood mononuclear cell (PBMC) samples from healthy female donors was measured using microarray technology (Applied Biosystems). Differentially expressed genes were identified using the maxT test and the 50% one-sided trimmed maxT-test. Confirmatory RT-qPCR was performed for 380 gene targets using the AB TaqMan ® Low Density Arrays. Then, 93 gene targets were analyzed using the same RT-qPCR platform in tumor tissues of 126 patients with primary breast, ovarian or endometrial cancer. Finally, blood samples from 26 healthy women and from 125 patients (primary breast, ovarian, cervical, or endometrial cancer, and advanced breast cancer) were analyzed following OncoQuick enrichment and RNA pre-amplification. Likewise, hMAM and EpCAM gene expression was analyzed in the blood of breast and ovarian cancer patients. For each gene, a cut-off threshold value was set at three standard deviations from the mean expression level of the healthy controls to identify potential markers for CTC detection. Six genes were over-expressed in blood samples from 81% of patients with advanced and 29% of patients with primary breast cancer. EpCAM gene expression was detected in 19% and 5% of patients, respectively, whereas hMAM gene expression was observed in the advanced group (39%) only. Multimarker analysis using the new six gene panel positively identified 44% of the cervical, 64% of the endometrial and 19% of the ovarian cancer patients. The

Thirty ways to temporize on waste

International Nuclear Information System (INIS)

Marshall, E.

1987-01-01

Congress must decide in the coming weeks whether it should try to revive the civil nuclear waste program or yield to politics and apply an anesthetic for a couple of years. The program is in such poor shape that Congress may have to do something. Thirty proposals have been introduced; most would derail or postpone the present plan for disposing of nuclear waste. About 50 members of Congress would like to call a moratorium on field research at potential waste repository sites. They see this as the best way out of the present impasse-if a moratorium is a way out. But this decision would come as a blow to the nuclear utilities, already hard-pressed on several fronts. The last thing they want is a general review of the waste program. The options available for dispersing of nuclear wastes are discussed

Predictors of Better Self-Care in Patients with Heart Failure after Six Months of Follow-Up Home Visits

Science.gov (United States)

Trojahn, Melina Maria; Ruschel, Karen Brasil; Nogueira de Souza, Emiliane; Mussi, Cláudia Motta; Naomi Hirakata, Vânia; Nogueira Mello Lopes, Alexandra; Rabelo-Silva, Eneida Rejane

2013-01-01

This study aimed to examine the predictors of better self-care behavior in patients with heart failure (HF) in a home visiting program. This is a longitudinal study nested in a randomized controlled trial (ISRCTN01213862) in which the home-based educational intervention consisted of a six-month followup that included four home visits by a nurse, interspersed with four telephone calls. The self-care score was measured at baseline and at six months using the Brazilian version of the European Heart Failure Self-Care Behaviour Scale. The associations included eight variables: age, sex, schooling, having received the intervention, social support, income, comorbidities, and symptom severity. A simple linear regression model was developed using significant variables (P ≤ 0.20), followed by a multivariate model to determine the predictors of better self-care. One hundred eighty-eight patients completed the study. A better self-care behavior was associated with patients who received intervention (P < 0.001), had more years of schooling (P = 0.016), and had more comorbidities (P = 0.008). Having received the intervention (P < 0.001) and having a greater number of comorbidities (P = 0.038) were predictors of better self-care. In the multivariate regression model, being in the intervention group and having more comorbidities were a predictor of better self-care. PMID:24083023

Immune reconstitution inflammatory syndrome in HIV-infected patients with Pneumocystis jirovecii pneumonia.

Science.gov (United States)

Roade Tato, Luisa; Burgos Cibrian, Joaquín; Curran Fábregas, Adrià; Navarro Mercadé, Jordi; Willekens, Rein; Martín Gómez, María Teresa; Ribera Pascuet, Esteban; Falcó Ferrer, Vicenç

2017-11-26

The incidence of immune reconstitution inflammatory syndrome (IRIS) in HIV-infected patients after an episode of Pneumocystis jirovecii pneumonia (PJP) seems to be lower than with other opportunistic infections. We conducted an observational study in order to determine the incidence, clinical characteristics and outcome of patients diagnosed with PJP-related IRIS. We conducted an observational study of HIV patients diagnosed with PJP-related IRIS from January 2000 to November 2015. We analyzed epidemiological and clinical characteristics as well as laboratory findings. We also carried out a systematic review of published cases. Six cases of IRIS out of 123 (4.9%) HIV-infected patients with PJP who started ART were diagnosed. All six cases were men with a median age of 34 (IQR: 8) years. The six patients developed paradoxical IRIS. Subjects younger than 40 years old (p=0.084) and with an HIV-RNA viral load >100000 copies/ml (p=0.081) at diagnosis showed a tendency to develop IRIS. Thirty-seven published cases of PJP-related IRIS were identified. Although 51% of cases involved respiratory failure, no deaths were reported. PJP-related IRIS is rare condition compared to other opportunistic infections. It can lead to a severe respiratory failure in a significant proportion of cases, although no deaths have been reported. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

The Thirty Years War as a prototype of hybrid wars

OpenAIRE

A. V. Bagaeva

2015-01-01

The idea of the article is to show that the phenomenon of hybrid war, which confidently entered the scientific and official discourse, has a long history. In author’s opinion, the Thirty Years’ War in Central Europe can be characterized as one of the first historical examples of hybrid war.

Effect of radiation therapy on lipid peroxidation and total antioxidant capacity of blood and saliva in oral cancer patients

International Nuclear Information System (INIS)

Lobo, Aswin D.A.

2012-01-01

Radiation therapy is reported to induce oxidative stress in oral cancer patients. Saliva as a diagnostic tool has received increasing attention in recent years. Saliva analysis is proposed to be a noninvasive, sensitive tool for the evaluation of biological effects of radiation therapy in oral cancer. We aimed to assess the effect of radiation therapy on malondialdehyde, the marker of lipid peroxidation, and total antioxidant capacity in blood and saliva of oral cancer patients. We also aimed to assess the correlation between blood and saliva with respect to malonaldehyde (MDA) level and total antioxidant capacity (TAC). Thirty, clinically diagnosed oral cancer patients visiting the Oncology Department were the subjects. Thirty age- and sex-matched normal, healthy controls were included. Blood and saliva samples were collected from controls, and from oral cancer patients before and after radiation therapy. The samples were analyzed for MDA and TAC by standard spectrophotometric methods. Oral cancer patients showed significantly higher MDA level and lower TAC in blood and saliva when compared to controls. One week after radiation therapy, there was significant increase in MDA and decrease in TAC in oral cancer patients. After the completion of radiation therapy of six weeks, MDA level decreased and TAC increased, restoring the values near-to-controls. The pattern of change in MDA and TAC was similar between blood and saliva. There was significant correlation between blood and saliva with respect to MDA and TAC in oral cancer patients. Oral cancer patients showed increased oxidative stress and impaired antioxidant capacity. After radiation therapy of one week, oxidative stress increased further, and after six weeks of radiation therapy there was amelioration of antioxidant status. Saliva could be a sensitive and convenient laboratory tool for diagnosis of oral cancer and evaluation of biological effects of radiation therapy. (author)

Studi Implementasi Six Sigma dalam Sistem Inventori Galangan Kapal

Directory of Open Access Journals (Sweden)

Elwin Elwin

2012-09-01

Full Text Available Dalam industri galangan kapal terdapat bahan baku, barang dalam proses dan barang jadi yang merupakan macam-macam bentuk dari persediaan dan berhubungan dengan stok, ketika persediaan tidak dikelola dengan benar maka akan terjadi pembengkakkan biaya/pengeluaran biaya yang tidak dibutuhkan. Tugas akhir ini bertujuan untuk mengetahui kondisi inventori di PT. Dok dan Perkapalan Surbaya, untuk mengetahui faktor-faktor yang menjadi penyebab terjadinya variabilitas output six sigma dan mengurangi defect pada sistem inventori dengan menggunakan metode six sigma DMAIC (Define, Measure, Analyze, Improve dan Control,. Berdasarkan perhitungan Material Pipa mengalami defect sebesar 50.98% dengan nilai sigma 1.48, Material Elbow mengalami defect sebesar 89.80% dengan nilai sigma 0.33, Material Flange mengalami defect sebesar 71.99% dengan nilai sigma 0.90, Material Paking mengalami defect sebesar 13.12% dengan nilai sigma 2.74 dan Material Mur mengalami defect sebesar 17.26% dengan nilai sigma 2.57. Sesuai dengan perhitungan reorder point for the inventory untuk masing-masing material, maka dapat diketahui bahwa material Pipa reoder point adalah 58 lonjor, elbow 100 buah, flange 168 buah, paking 24 buah dan mur 946 buah. Nilai sigma yang diperoleh dalam perhitungan tingkat persediaan masih jauh dari nilai yang seharusnya dapat dicapai oleh suatu perusahaan (6σ, sehingga dilakukan tahap Improve dengan metode Failure Mode and Effect Analysis (FMEA, pembuat SOP Pengendalian persediaan material dengan format baru serta galangan perlu melakukan perhitungan reorder point.  

Constructing osteoarthritis through discourse – a qualitative analysis of six patient information leaflets on osteoarthritis

Directory of Open Access Journals (Sweden)

Ong Bie

2007-04-01

Full Text Available Abstract Background Health service policy in the United Kingdom emphasises the importance of self-care by patients with chronic conditions. Written information for patients about their condition is seen as an important aid to help patients look after themselves. From a discourse analysis perspective written texts such as patient information leaflets do not simply describe the reality of a medical condition and its management but by drawing on some sorts of knowledge and evidence rather than others help construct the reality of that condition. This study explored patient information leaflets on osteoarthritis (OA to see how OA was constructed and to consider the implications for self-care. Methods Systematic and repeated readings of six patient information leaflets on osteoarthritis to look for similarities and differences across leaflets, contradictions within leaflets and the resources called on to make claims about the nature of OA and its management. Results Biomedical discourse of OA as a joint disease dominated. Only one leaflet included an illness discourse albeit limited, and was also the only one to feature patient experiences of living with OA. The leaflets had different views on the causes of OA including the role of lifestyle and ageing. Most emphasised patient responsibility for preventing the progression of OA. Advice about changing behaviour such as diet and exercise was not grounded in lived experience. There were inconsistent messages about using painkillers, exercise and the need to involve professionals when making changes to lifestyle. Conclusion The nature of the discourse impacted on how OA and the respective roles of patients and professionals were depicted. Limited discourse on illness meant that the complexity of living with OA and its consequences was underestimated. Written information needs to shift from joint biology to helping patients live with osteoarthritis. Written information should incorporate patient

An application of Lean Six Sigma in a hospital

NARCIS (Netherlands)

van den Heuvel, J.; Does, R.J.M.M.; de Koning, H.; Anthony, J.; Kumar, M.

2007-01-01

Abstract Healthcare today faces major challenges. Patients demand quality of care to be improved continuously. Insurance companies demand the lowest possible prices. Lean Six Sigma is a tool that can help healthcare providers to achieve these at least partly conflicting goals. Lean Six Sigma is an

Synergism between hydrogen peroxide and seventeen acids against six bacterial strains.

Science.gov (United States)

Martin, H; Maris, P

2012-09-01

The objective of this study was to evaluate the bactericidal efficacy of hydrogen peroxide administered in combination with 17 mineral and organic acids authorized for use in the food industry. The assays were performed on a 96-well microplate using a microdilution technique based on the checkerboard titration method. The six selected strains were reference strains and strains representative of contaminating bacteria in the food industry. Each synergistic hydrogen peroxide/acid combination found after 5-min contact time at 20°C in distilled water was then tested in conditions simulating four different use conditions. Thirty-two combinations were synergistic in distilled water; twenty-five of these remained synergistic with one or more of the four mineral and organic interfering substances selected. Hydrogen peroxide/formic acid combination was synergistic for all six bacterial strains in distilled water and remained synergistic with interfering substances. Six other combinations maintained their synergistic effect in the presence of an organic load but only for one or two bacterial strains. Synergistic combinations of disinfectants were revealed, among them the promising hydrogen peroxide/formic acid combination. A rapid screening method was proposed and used to reveal the synergistic potential of disinfectant and/or sanitizer combinations. © 2012 ANSES Fougères Laboratory Journal of Applied Microbiology © 2012 The Society for Applied Microbiology.

Which benefits and harms of preoperative radiotherapy should be addressed? A Delphi consensus study among rectal cancer patients and radiation oncologists

International Nuclear Information System (INIS)

Kunneman, Marleen; Pieterse, Arwen H.; Stiggelbout, Anne M.; Marijnen, Corrie A.M.

2015-01-01

Background and purpose: We previously found considerable variation in information provision on preoperative radiotherapy (PRT) in rectal cancer. Our aims were to reach consensus among patients and oncologists on which benefits/harms of PRT should be addressed during the consultation, and to assess congruence with daily clinical practice. Materials and methods: A four-round Delphi-study was conducted with two expert panels: (1) 31 treated rectal cancer patients and (2) 35 radiation oncologists. Thirty-seven possible benefits/harms were shown. Participants indicated whether addressing the benefit/harm was (1) essential, (2) desired, (3) not necessary, or (4) to be avoided. Consensus was assumed when ⩾80% of the panel agreed. Results were compared to 81 audio-taped consultations. Results: The panels reached consensus that six topics should be addressed in all patients (local control, survival, long term altered defecation pattern and faecal incontinence, perineal wound healing problems, advice to avoid pregnancy), three in male patients (erectile dysfunction, ejaculation disorder, infertility), and four in female patients (vaginal dryness, pain during intercourse, menopause, infertility). On average, less than half of these topics were addressed in daily clinical practice. Conclusions: This study showed substantial overlap between benefits/harms that patients and oncologists consider important to address during the consultation, and at the same time poor congruence with daily clinical practice

Risk Factors of Pulmonary Hypertension in Brazilian Patients with Sickle Cell Anemia.

Science.gov (United States)

Lobo, Clarisse Lopes de Castro; do Nascimento, Emilia Matos; Abelha, Renato; Queiroz, Ana Maria Mach; Connes, Philippe; Cardoso, Gilberto Perez; Ballas, Samir K

2015-01-01

This study was a prospective cross-sectional cohort study of 125 patients with sickle cell anemia (SS) between the ages of 16 to 60 years. Enrolled patients were followed-up prospectively for 15 months. Demographic, clinical, hematological and routine biochemical data were obtained on all patients. Six-minute walk test and Doppler Echocardiography were performed on all patients. A tricuspid regurgitant jet velocity (TRJV) 3.0 m/sec, severe. Patients with abnormal TRJV were significantly older and more anemic, had significantly higher lactate dehydrogenase (LDH) levels, reticulocyte count and incidence of death. The logistic multimodal model implemented for the 125 patients indicated that age was the covariate that influenced the outcome of normal or abnormal TRJV with a cutoff age of thirty-two years. The survival rate for the group of patients with creatinine (Cr) > 1.0 mg/dL was lower than the group with Cr ≤ 1 and normal TRJV. A coefficient matrix showed that the LDH values were weakly correlated with the reticulocyte count but strongly correlated with hemoglobin suggesting that the TRJV values were not correlated with the hemolytic rate but with anemia. Ten patients died during the follow-up of whom 7 had TRJV > 2.5 m/sec. Acute chest syndrome was the most common cause of death followed by sepsis. In conclusion, this study shows that patients with SS older than thirty-two years with high LDH, elevated TRJV, severe anemia and Cr > 1 have poor prognosis and may be at risk of having pulmonary hypertension and should undergo RHC.

Risk Factors of Pulmonary Hypertension in Brazilian Patients with Sickle Cell Anemia.

Directory of Open Access Journals (Sweden)

Clarisse Lopes de Castro Lobo

Full Text Available This study was a prospective cross-sectional cohort study of 125 patients with sickle cell anemia (SS between the ages of 16 to 60 years. Enrolled patients were followed-up prospectively for 15 months. Demographic, clinical, hematological and routine biochemical data were obtained on all patients. Six-minute walk test and Doppler Echocardiography were performed on all patients. A tricuspid regurgitant jet velocity (TRJV 3.0 m/sec, severe. Patients with abnormal TRJV were significantly older and more anemic, had significantly higher lactate dehydrogenase (LDH levels, reticulocyte count and incidence of death. The logistic multimodal model implemented for the 125 patients indicated that age was the covariate that influenced the outcome of normal or abnormal TRJV with a cutoff age of thirty-two years. The survival rate for the group of patients with creatinine (Cr > 1.0 mg/dL was lower than the group with Cr ≤ 1 and normal TRJV. A coefficient matrix showed that the LDH values were weakly correlated with the reticulocyte count but strongly correlated with hemoglobin suggesting that the TRJV values were not correlated with the hemolytic rate but with anemia. Ten patients died during the follow-up of whom 7 had TRJV > 2.5 m/sec. Acute chest syndrome was the most common cause of death followed by sepsis. In conclusion, this study shows that patients with SS older than thirty-two years with high LDH, elevated TRJV, severe anemia and Cr > 1 have poor prognosis and may be at risk of having pulmonary hypertension and should undergo RHC.

The Thirty Years War as a prototype of hybrid wars

Directory of Open Access Journals (Sweden)

A. V. Bagaeva

2015-01-01

Full Text Available The idea of the article is to show that the phenomenon of hybrid war, which confidently entered the scientific and official discourse, has a long history. In author’s opinion, the Thirty Years’ War in Central Europe can be characterized as one of the first historical examples of hybrid war.

Anterior six arms prolene mesh for high stage vaginal prolapse: five years follow-up

Directory of Open Access Journals (Sweden)

Luis Gustavo M. de Toledo

Full Text Available ABSTRACT Introduction In high stage vaginal prolapse, recurrence risk patients, anterior and apical defects need to be addressed in the same procedure. The pre-molded commercial mesh kits are expensive and not always available. Alternative effective and safe treatment ways, with lower costs are desirable. Objective To present long term follow-up of patients treated with a homemade mesh shape to correct high stage prolapses. Materials and Methods We describe prospectively 18 patients with anterior and apical vaginal prolapses, stages III and IV, repaired using this specific design of mesh. All patients were submitted to pre-operative clinical evaluation and urodynamics. Prolapse was classified using the pelvic organ prolapse quantification (POP-Q. Intervention Prolapse surgery, using a six arms prolene mesh, through a single anterior vaginal incision. Outcome Measurements: POP-Q, patients satisfaction, descriptive statistical analysis. Results Between February 2009 and Oct 2010, 18 consecutive women underwent the above-mentioned surgery. Mean age was 68 years. At a mean follow-up of .,4 years (5 to 5.8 years, 16 (89% patients were continent, mean Ba point came from +4.7cm to - 2.5cm, mean C point from +2.8cm to -6.6cm and mean Bp point from +1.3 to -1.7cm. There were two (11% objective failures, but all the patients were considered success subjectively. There were two cases of mesh vaginal extrusion. Conclusions The homemade six arms prolene mesh allows concomitant correction of anterior and apical prolapses, through a single anterior vaginal incision, being an effective, safe and affordable treatment option when mesh is needed.

Clinical and sociodemographic correlates of suicidality in patients with major depressive disorder from six Asian countries

Science.gov (United States)

2014-01-01

Background East Asian countries have high suicide rates. However, little is known about clinical and sociodemographic factors associated with suicidality in Asian populations. The aim of this study was to evaluate the factors associated with suicidality in patients with major depressive disorder (MDD) from six Asian countries. Methods The study cohort consisted of 547 outpatients with MDD. Patients presented to study sites in China (n = 114), South Korea (n = 101), Malaysia (n = 90), Singapore (n = 40), Thailand (n = 103), and Taiwan (n = 99). All patients completed the Mini-International Neuropsychiatric Interview (MINI), the Montgomery–Asberg Depression Rating Scale (MADRS), the Global Severity Index(SCL-90R), the Fatigue Severity Scale, the 36-item short-form health survey, the Sheehan Disability Scale, and the Multidimensional Scale of Perceived Social Support (MSPSS). Patients were classified as showing high suicidality if they scored ≥6 on the MINI suicidality module. Multivariate logistic regression analysis was used to examine sociodemographic and clinical factors related to high suicidality. Results One hundred and twenty-five patients were classed as high suicidality. Unemployed status (adjusted odds ratio [OR] 2.43, p suicidality. Hindu (adjusted OR 0.09, p suicidality. Conclusions A variety of sociodemographic and clinical factors were associated with high suicidality in Asian patients with MDD. These factors may facilitate the identification of MDD patients at risk of suicide. PMID:24524225

Correlation of six minute walk test with spirometric indices in chronic obstructive pulmonary disease patients: A tertiary care hospital experience

Directory of Open Access Journals (Sweden)

Abhijit Kundu

2015-01-01

Full Text Available Background: Six-minute walk test (6MWT is a simple, objective, reproducible test which correlated well with different spirometric indices, and thus able to predict severity of chronic obstructive pulmonary disease (COPD and can replace spirometry in resource poor set-up. Aims and Objectives: To find out correlation between spirometric indices (forced expiratory volume in 1 s (FEV 1 , forced vital capacity (FVC, and peak expiratory flow rate (PEFR and 6-minute walk distance (6MWD in COPD patients, and thus to assess whether 6MWT can replace spirometry. Settings and Design: Institution based cross-sectional observational study. Materials and Methods: Eighty patients of COPD (diagnosis confirmed by Global Initiative for Chronic Obstructive Lung Disease (GOLD 2010 criteria were enrolled for the study after applying exclusion criteria. All patients underwent spirometric measurement of FEV 1 , FVC, PEFR, and ratio of FEV 1 and FVC and test repeated after bronchodilation by 200-400 μg of salbutamol. 6MWT was performed following American Thoracic Society (ATS protocol of 6MWT and distance was measured in meters. Results: We found significant linear correlation of 6MWT with post-FEV 1 (r = 0.478, P < 0.001, post-FVC (r = 0.454, P < 0.001, and post-PEFR (r = 0.408, P < 0.001, but no correlation with FEV 1 /FVC (r = 0.250, P = 0.025. We also found significant correlation of 6MWT with BODE (body mass index (BMI, airway obstruction, dyspnea, and exercise capacity index (r = −0.419, P < 0.001. Conclusions: 6MWT can be a useful replacement of spirometry in assessment of severity of COPD.

Abutment Material Effect on Peri-implant Soft Tissue Color and Perceived Esthetics.

Science.gov (United States)

Kim, Aram; Campbell, Stephen D; Viana, Marlos A G; Knoernschild, Kent L

2016-12-01

The purpose of this study was to evaluate the effect of implant abutment material on peri-implant soft tissue color using intraoral spectrophotometric analysis and to compare the clinical outcomes with patient and clinician perception and satisfaction. Thirty patients and four prosthodontic faculty members participated. Abutments were zirconia, gold-hued titanium, and titanium. Peri-implant mucosa color of a single anterior implant restoration was compared to the patient's control tooth. Spectrophotometric analysis using SpectroShade TM Micro data determined the color difference (ΔE, ΔL*, Δa*, Δb*) between the midfacial peri-implant soft tissue for each abutment material and the marginal gingiva of the control tooth. Color difference values of the abutment groups were compared using ANOVA (α = 0.05). Patient and clinician satisfaction surveys were also conducted using a color-correcting light source. The results of each patient and clinician survey question were compared using chi-square analysis (α = 0.05). Pearson correlation analyses identified the relationship between the total color difference (ΔE) and the patient/clinician perception and satisfaction, as well as between ΔE and tissue thickness. Zirconia abutments displayed significantly smaller spectrophotometric gingival color difference (ΔE) compared to titanium and gold-hued titanium abutments (respectively, 3.98 ± 0.99; 7.22 ± 3.31; 5.65 ± 2.11; p abutment materials, and no correlation between ΔE and the patient and clinician satisfaction. Patient satisfaction was significantly higher than clinician, and patient-perceived differences were lower than clinicians' (p abutments demonstrated significantly lower mean color difference compared to titanium or gold-hued titanium abutments as measured spectrophotometrically; however, no statistical difference in patient or clinician perception/satisfaction among abutment materials was demonstrated. Patients were significantly more satisfied than

The radiology of IRIS (immune reconstitution inflammatory syndrome) in patients with mycobacterial tuberculosis and HIV co-infection: appearances in 11 patients

International Nuclear Information System (INIS)

Rajeswaran, G.; Becker, J.L.; Michailidis, C.; Pozniak, A.L.; Padley, S.P.G.

2006-01-01

Aim: To determine the radiological manifestations of IRIS (immune reconstitution inflammatory syndrome) in patients with HIV and mycobacterium tuberculosis co-infection, in the context of their demographic and clinical data. Materials and methods: The radiological imaging, demographic and clinical data of 11 patients diagnosed with IRIS associated with HIV and mycobacterial tuberculosis co-infection were studied retrospectively. Where available, follow-up imaging studies were also reviewed. Results: The most common radiological feature of IRIS was lymph node enlargement (73%), with central low attenuation centres, in keeping with necrosis, present in most of these cases (88%). Most commonly affected were intra-abdominal nodes (70%), followed by axillary (40%) and mediastinal lymph nodes (36%). Within the lung parenchyma, diffuse, bilateral pulmonary nodules were seen in 55% of cases. Unilateral small volume pleural effusions were seen in two cases with associated parenchymal changes seen in only one. Small volume ascites was seen in two cases. Thirty-six percent of cases presented with new or worsening abscesses despite treatment. In this context, image-guided radiological drainage proved a useful adjunct to the conventional medical therapy for IRIS. The most common clinical signs of IRIS included fever (64%), abdominal pain (36%) and cough (27%). Conclusion: We have described the radiological features that are characteristic in IRIS and the importance of putting these into context with the clinical and pathological findings as part of a multidisciplinary approach in making the diagnosis. The role of the radiologist is central in diagnosis, monitoring of disease progression and management of complications in patients with IRIS

Agressive osteoblastoma in a seven-year-old girl's mandible: Treatment and six-year monitoring.

Science.gov (United States)

Castro, Paulo Henrique Souza; Molinari, Danielle Lima; Stateri, Hiran Queiroz; Borges, Alvaro Henrique; Volpato, Luiz Evaristo Ricci

2016-01-01

Osteoblastoma is a rare benign bone tumor with locally aggressive behavior in some cases; however, with rare malignant transformations. A case of osteoblastoma in a seven-year-old patient's mandible is presented. After the diagnosis, the patient underwent two stages of treatment. In the first intervention, an intralesional curettage was performed as well as a marsupialization of the lesion, in order to reduce its volume and allow a second and more conservative surgical period. In the second surgery, after reducing the lesion, enucleation and rigid internal fixation of the mandible were performed. The treatment has proven to be satisfactory, without recurrence of the injury for two years, when the patient suffered a car accident that caused the synthetic material to fracture. The internal fixation was surgically replaced and the patient is being monitored after six years of the initial intervention, without presenting further changes. Copyright © 2016 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Comparison of chest-CT findings of Influenza virus-associated pneumonia in immunocompetent vs. immunocompromised patients

Energy Technology Data Exchange (ETDEWEB)

Kloth, C., E-mail: christopher.kloth@med.uni-tuebingen.de [Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str. 3, 72076 Tübingen (Germany); Forler, S.; Gatidis, S. [Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str. 3, 72076 Tübingen (Germany); Beck, R. [Institute of Medical Virology and Epidemiology of Viral Diseases, Eberhard-Karls-University, Elfriede-Aulhorn-Straße 6, 72076 Tübingen (Germany); Spira, D.; Nikolaou, K.; Horger, M. [Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str. 3, 72076 Tübingen (Germany)

2015-06-15

Highlights: • Patterns of pulmonary infiltration caused by Influenza viruses do not significantly differ between immunocompetent and immunocompromised patients or between different types and subtypes of Influenza virus. • Patterns of pulmonary infiltration caused by Influenza viruses seem to be interchangeable which might in part explain the great overlap in CT-imaging findings that has been reported in the past. • Interestingly, pattern transition from interstitial into airway-centric pattern seems to be frequent in immunocompromised patients receiving specific antiviral therapy, whereas the conversion of the airway-centric pattern into an interstitial pattern was observed more frequent in immunocompetent patients developing ARDS. - Abstract: Purpose: To retrospectively compare CT-patterns of pulmonary infiltration caused by different Influenza virus types and subtypes in immunocompetent and immunocompromised patients for possible discrimination. Materials and methods: Retrospective database search at our institution yielded 237 patients who were tested positive for Influenza virus type A or type B by bronchoalveolar lavage between January 2009 and April 2014. Fifty-six of these patients (female 26; male 30; median age 55.8 y, range 17–86 y; SD ± 14.4 y) underwent chest-HRCT due to a more severe clinical course of pulmonary infection. We registered all CT-findings compatible with pulmonary infection classifying them as airway predominant (tree-in-bud, centrilobular nodules, bronchial wall thickening ± peribronchial ground-glass opacity and consolidation) vs. interstitial-parenchymal predominant (bilateral, symmetrical GGO, consolidation, crazy paving and/or interlobular septal thickening). Twenty-six patients (46.4%) had follow-up CT-studies (0.78 mean, SD ± 5.8 scans). Results: Thirty-six patients were immunocompromised (group I) whereas 20 patients were immunocompetent (group II). An airway-centric pattern of infection was found in 15 patients (group

Thirty years of the new astronomy

International Nuclear Information System (INIS)

Rowan-Robinson, M.

1990-01-01

In an overview of advances in astrophysics over the last thirty years, the author expounds some of the important discoveries and how they have contributed to our understanding of star formation and evolution. The starting point for these new ideas has been exploring the non-visible radiations of the universe. Telescopes and observatories have been tuned to receive infrared, ultraviolet, x-ray, gamma ray and radiowave emissions. Radio astronomy revealed the existence of interstellar molecular clouds where stars are born. The discovery of the uniform microwave background radiation has suggested that the Universe started as a hot big bang. The inflationary model of cosmology provides answers to some problems of the big bang theory and predicts the existence of dark, nonluminous, matter which some infrared observations have confirmed. The author ends by providing a modern, astrophysical, description of the constellations so familiar to mediaeval astrologers. (UK)

Wythenshawe boiler rig. Thirty years of support to the UK nuclear power industry

International Nuclear Information System (INIS)

Rudge, Andy; Woolsey, Ian S.; Moore, Andrew

2010-01-01

The Wythenshawe Boiler Rig in Manchester, UK, recently celebrated thirty years of operation in support of the UK nuclear power industry. The Boiler Rig, owned by EDF Energy and operated on EDF Energy's behalf by Serco plc, is a full scale once-through boiler test facility for the investigation of chemistry and corrosion related topics. This paper presents an overview of the design and operation of the Boiler Rig together with some of the technical highlights from its thirty years of operation, many of which have relevance to power plant operations beyond those plants for which the work was performed. (orig.)

Recruiting newly referred lung cancer patients to a patient navigator intervention (PACO)

DEFF Research Database (Denmark)

Kjær, Trille Kristina; Mellemgaard, Anders; Stensøe Oksen, Marianne

2017-01-01

OBJECTIVES: The incidence of and survival from lung cancer are associated with socioeconomic position, and disparities have been observed in both curative and palliative treatment for lung cancer. 'Patient navigation' is valuable in addressing health disparity, with timely treatment and transitio...... of internal and external obstacles to patients' recruitment. The study provides insight into the barriers to recruitment of socially disadvantaged cancer patients to clinical trials and will inform future trial designs....... to care. We conducted a pilot study to test the feasibility of a patient navigator program (PAtient COach) for newly diagnosed lung cancer. We present the trial, the findings from the pilot study and discuss factors that might have affected recruitment rates. MATERIAL AND METHODS: We invited 24 lung...... of 1 or 2 or be over 65 years of age. The patient navigators targeted four phases of treatment: planning, initiation, compliance and end of treatment. RESULTS: Six months after the start of the study, we had recruited only six patients, due mainly to inherent patient resistance and because only 50...

[Improving inpatient pharmacoterapeutic process by Lean Six Sigma methodology].

Science.gov (United States)

Font Noguera, I; Fernández Megía, M J; Ferrer Riquelme, A J; Balasch I Parisi, S; Edo Solsona, M D; Poveda Andres, J L

2013-01-01

Lean Six Sigma methodology has been used to improve care processes, eliminate waste, reduce costs, and increase patient satisfaction. To analyse the results obtained with Lean Six Sigma methodology in the diagnosis and improvement of the inpatient pharmacotherapy process during structural and organisational changes in a tertiary hospital. 1.000 beds tertiary hospital. prospective observational study. The define, measure, analyse, improve and control (DMAIC), were deployed from March to September 2011. An Initial Project Charter was updated as results were obtained. 131 patients with treatments prescribed within 24h after admission and with 4 drugs. safety indicators (medication errors), and efficiency indicators (complaints and time delays). Proportion of patients with a medication error was reduced from 61.0% (25/41 patients) to 55.7% (39/70 patients) in four months. Percentage of errors (regarding the opportunities for error) decreased in the different phases of the process: Prescription: from 5.1% (19/372 opportunities) to 3.3% (19/572 opportunities); Preparation: from 2.7% (14/525 opportunities) to 1.3% (11/847 opportunities); and administration: from 4.9% (16/329 opportunities) to 3.0% (13/433 opportunities). Nursing complaints decreased from 10.0% (2119/21038 patients) to 5.7% (1779/31097 patients). The estimated economic impact was 76,800 euros saved. An improvement in the pharmacotherapeutic process and a positive economic impact was observed, as well as enhancing patient safety and efficiency of the organization. Standardisation and professional training are future Lean Six Sigma candidate projects. Copyright © 2012 SECA. Published by Elsevier Espana. All rights reserved.

Prevalence of Peri-Implant Mucositis and Peri-Implantitis in Patients Treated with a Combination of Axial and Tilted Implants Supporting a Complete Fixed Denture

Directory of Open Access Journals (Sweden)

Nicolò Cavalli

2015-01-01

Full Text Available Objectives. The aim of this retrospective study was to assess the incidence and prevalence of peri-implant mucositis and peri-implantitis in patients with a fixed full-arch prosthesis supported by two axial and two tilted implants. Materials and Methods. Sixty-nine patients were included in the study. Each patient received a fixed full-arch prosthesis supported by two mesial axial and two distal tilted implants to rehabilitate the upper arch, the lower arch, or both. Three hundred thirty-six implants for 84 restorations were delivered. Patients were scheduled for follow-up visits every 6 months in the first 2 years and yearly after. At each follow-up visit peri-implant mucositis and peri-implantitis were diagnosed if present. Results. The overall follow-up range was from 12 to 130 months (mean 63,2 months. Three patients presented peri-implantitis. The prevalence of peri-implant mucositis ranged between 0 and 7,14% of patients (5,06% of implants while the prevalence of peri-implantitis varied from 0 to 4,55% of patients (3,81% of implants. Conclusions. The prevalence and incidence of peri-implant mucositis and peri-implantitis are lower than most of the studies in literature. Therefore this kind of rehabilitation could be considered a feasible option, on the condition of adopting a systematic hygienic protocol.

A Status Report on the Thirty Meter Telescope Adaptive Optics

Indian Academy of Sciences (India)

2016-01-27

Jan 27, 2016 ... We provide an update on the recent development of the adaptive optics (AO) systems for the Thirty Meter Telescope (TMT) since mid-2011. The first light AO facility for TMT consists of the Narrow Field Infra-Red AO System (NFIRAOS) and the associated Laser Guide Star Facility (LGSF). This order 60 × 60 ...

ACDA Thirty Years of Popularization of Astronomy in Colombia

Science.gov (United States)

Ocampo, W.; Higuera-G., Mario A.

2017-07-01

The Colombian Association of Astronomical Studies (ACDA) is a Non Profit Organization with thirty years of permanent efforts for the popularization of astronomy and related sciences in Colombia. ACDA put together amateur and profesional astronomers, as well as interested people. We surely had left a footprint on uncountable number of attending people to our activities, members and former members, and have supported the process of building a new society, with more awareness on the importance of science. We devote our efforts to our members and general people, to keep them motivated, support them and follow each member own interests in order to expand and spread their knowledge. In order to achieve our goals we have develop several strategies as: acquire of didactic material and optical instruments, video projections and discussion, astronomical observations, visits to observatories and planetariums, attending conferences and events, and mainly a weekly Saturday morning talk at the Bogotá Planetarium. ACDA has had different study teams on several fields including: Planetary Systems, Astrobiology, Space Exploration, Cosmology, History of Astronomy and Radioastronomy. ACDA has a national brandname on Astronomy due to seriousness and quality of its projects. A good list of members have become profesional astronomers. From our experience we can say: astronomy is a fertile field to teach science, in general there is an absence of astronomy culture in the public, our best communication experience are astronomical observations, explained astronomy movies and colloquiums, our best public are kids and aged people and finally, social networks gave dynamics to our astronomy spreading initiative.

Readability, suitability, and health content assessment of web-based patient education materials on colorectal cancer screening.

Science.gov (United States)

Tian, Chenlu; Champlin, Sara; Mackert, Michael; Lazard, Allison; Agrawal, Deepak

2014-08-01

Colorectal cancer (CRC) screening rates in the Unites States are still below target level. Web-based patient education materials are used by patients and providers to provide supplemental information on CRC screening. Low literacy levels and patient perceptions are significant barriers to screening. There are little data on the quality of these online materials from a health literacy standpoint or whether they address patients' perceptions. To evaluate the readability, suitability, and health content of web-based patient education materials on colon cancer screening. Descriptive study. Web-based patient materials. Twelve reputable and popular online patient education materials were evaluated. Readability was measured by using the Flesch-Kincaid Reading Grade Level, and suitability was determined by the Suitability Assessment of Materials, a scale that considers characteristics such as content, graphics, layout/typography, and learning stimulation. Health content was evaluated within the framework of the Health Belief Model, a behavioral model that relates patients' perceptions of susceptibility to disease, severity, and benefits and barriers to their medical decisions. Each material was scored independently by 3 reviewers. Flesch-Kincaid Reading Grade Level score, Suitability Assessment of Materials score, health content score. Readability for 10 of 12 materials surpassed the maximum recommended sixth-grade reading level. Five were 10th grade level and above. Only 1 of 12 materials received a superior suitability score; 3 materials received inadequate scores. Health content analysis revealed that only 50% of the resources discussed CRC risk in the general population and <25% specifically addressed patients at high risk, such as African Americans, smokers, patients with diabetes, and obese patients. For perceived barriers to screening, only 8.3% of resources discussed embarrassment, 25% discussed pain with colonoscopy, 25% addressed cost of colonoscopy, and none

Prescription History of Emergency Department Patients Prescribed Opioids

Directory of Open Access Journals (Sweden)

Jason A Hoppe

2013-05-01

Full Text Available Introduction: To use Colorado’s prescription drug monitoring program (PDMP to describe the recent opioid prescription history of patients discharged from our emergency department (ED with a prescription for opioid pain medications.Methods: Retrospective cohort study of 300 adult ED patients who received an opioid prescription. We abstracted prescription histories for the six months prior to the ED visit from the PDMP, and abstracted clinical and demographic variables from the chart.Results: There were 5,379 ED visits during the study month, 3,732 of which were discharged. Providers wrote 1,165 prescriptions for opioid analgesics to 1,124/3,732 (30% of the patients. Median age was 36 years. Thirty-nine percent were male. Patients were 46% Caucasian, 26% African American, 22% Hispanic, 2% Asian and 4% other. These were similar to our overall ED population. There was substantial variability in the number of prescriptions, prescribers and total number of pills. A majority (205/296 of patients had zero or one prescription. The 90th percentile for number of prescriptions was seven, while the 10th percentile was zero. Patients in the highest decile tended to be older, with a higher proportion of Caucasians and females. Patients in the lowest decile resembled the general ED population. The most common diagnoses associated with opioid prescriptions were abdominal pain (11.5%, cold/flu symptoms (9.5%, back pain (5.4%, flank pain (5.0% and motor vehicle crash (4.7%.Conclusion: Substantial variability exists in the opioid prescription histories of ED patients, but a majority received zero or one prescription in the preceding six months. The top decile of patients averaged more than two prescriptions per month over the six months prior to ED visit, written by more than 6 different prescribers. There was a trend toward these patients being older, Caucasian and female. [West J Emerg Med. 2013;14(3:247–252.

Portland cement versus MTA as a root-end filling material. A pilot study.

Science.gov (United States)

da Silva, Sérgio Ribeiro; da Silva Neto, José Dias; Veiga, Daniela Francescato; Schnaider, Taylor Brandão; Ferreira, Lydia Masako

2015-02-01

To assess periradicular lesions clinically and by computed tomography (CT) after endodontic surgery using either Portland cement or mineral trioxide aggregate (MTA) as a root-end filling material. Three patients diagnosed with periradicular lesions by cone-beam CT underwent endodontic surgery with root-end filling. Patient A was treated with MTA as the root-end filling material, patient B was treated with Portland cement and patient C had two teeth treated, one with MTA and the other with Portland cement. Six months after surgery, the patients were assessed clinically and by CT scan and the obtained results were compared. Periradicular tissue regeneration was observed in all cases, with no significant differences in bone formation when comparing the use of MTA and Portland cement as root-end filling materials. Both mineral trioxide aggregate and Portland cement were successful in the treatment of periradicular lesions.

Clinical Manifestations and Outcomes of Rickettsia australis Infection: A 15-Year Retrospective Study of Hospitalized Patients

Directory of Open Access Journals (Sweden)

Adam Stewart

2017-06-01

Full Text Available Queensland tick typhus (QTT; Rickettsia australis is an important cause of community-acquired acute febrile illness in eastern Australia. Cases of QTT were identified retrospectively from 2000 to 2015 at five sites in Northern Brisbane through a pathology database. Those included had a fourfold rise in spotted fever group (SFG-specific serology, a single SFG-specific serology ≥ 256 or SFG-specific serology ≥ 128 with a clinically consistent illness. Cases were excluded on the basis of clinical unlikelihood of QTT infection. Thirty-six cases were included. Fever was found in 34/36 (94% patients. Rash occurred in 83% of patients with maculopapular being the dominant morphology (70%. Thrombocytopenia, lymphopenia, and raised transaminases were common and occurred in 58%, 69%, and 89% of patients, respectively. Thirty-one of 36 (86% patients received antibiotic therapy (usually doxycycline and the time to correct antibiotic (from admission ranged from 3 to 120 h (mean 45.5 h. Four of 36 (11% required intensive care unit (ICU admission for severe sepsis and end-organ support. There were no deaths. QTT has a wide range of clinical and laboratory features. Early and appropriate antimicrobial therapy is important and may prevent severe disease. Further prospective studies are required to identify factors associated with severe infection and sepsis.

Prognostic Factors and Outcome in Askin-Rosai Tumor: A Review of 104 Patients

International Nuclear Information System (INIS)

Laskar, Siddhartha; Nair, Chandrika; Mallik, Suman; Bahl, Gaurav; Pai, Suresh; Shet, Tanuja; Gupta, Tejpal; Arora, Brijesh; Bakshi, Ashish; Pramesh, C.S.; Mistry, Rajesh; Qureshi, Sajid; Medhi, Seema; Jambhekar, Nirmala; Kurkure, Purna; Banavali, Shripad; Muckaden, Mary Ann

2011-01-01

Purpose: To evaluate the prognostic factors and treatment outcome of patients with Askin-Rosai tumor of the chest wall treated at a single institution. Methods and Materials: Treatment comprised multiagent chemotherapy and local therapy, which was either in the form of surgery alone, radical external-beam radiotherapy (EBRT) alone, or a combination of surgery and EBRT. Thirty-two patients (40%) were treated with all three modalities, 21 (27%) received chemotherapy and radical EBRT, and 19 (24%) underwent chemotherapy followed by surgery only. Results: One hundred four consecutive patients aged 3-60 years were treated at the Tata Memorial Hospital from January 1995 to October 2003. Most (70%) were male (male/female ratio, 2.3:1). Asymptomatic swelling (43%) was the most common presenting symptom, and 25% of patients presented with distant metastasis. After a median follow-up of 28 months, local control, disease-free survival, and overall survival rates were 67%, 36%, and 45%, respectively. Median time to relapse was 25 months, and the median survival was 76 months. Multivariate analysis revealed age ≥18 years, poor response to induction chemotherapy, and presence of pleural effusion as indicators of inferior survival. Fifty-six percent of patients with metastatic disease at presentation died within 1 month of diagnosis, with 6-month and 5-year actuarial survival of 14% and 4%, respectively. Conclusion: Primary tumor size, pleural effusion, response to chemotherapy, and optimal radiotherapy were important prognostic factors influencing outcome. The combination of neoadjuvant chemotherapy, surgery, and radiotherapy resulted in optimal outcome.

Variant Philadelphia translocations with different breakpoints in six chronic myeloid leukemia patients

Directory of Open Access Journals (Sweden)

Dilhan Kuru

2011-09-01

Full Text Available Objective: The Philadelphia (Ph chromosome, consisting of the t(9;22(q34;q11 translocation, is observed in ~90% of patients with chronic myeloid leukemia (CML. Variant Ph translocations are observed in 5%-10% of CML patients. In variant translocations 3 and possibly more chromosomes are involved. Herein we report 6 CML patients with variant Ph translocations.Materials and Methods: Bone marrow samples were examined using conventional cytogenetic meth ods. Fluorescence in situ hybridization (FISH with whole-chromosome paints and BCR-ABL 1D probes were used to confirm and/or complement the findings, and identify rearrangements beyond the resolution of conventional cytogenetic methods. Results: Variant Ph translocations in the 6 patients were as follows: t(7;22(p22;q11, t(9;22;15(q34;q11;q22, t(15;22(p11;q11, t(1;9;22;3(q24;q34;q11;q21, t(12;22(p13;q11, and t(4;8;9;22(q11;q13;q34;q11.Conclusion: Among the patients, 3 had simple and 3 had complex variant Ph translocations. Two of the presented cases had variant Ph chromosomes not previously described, 1 of which had a new complex Ph translocation involving chromosomes 1, 3, 9, 22, and t(1;9;22;3(q24;q34;q11;q21 apart from a clone with a classical Ph, and the other case had variant Ph translocation with chromosomes 4, 8, 9, and 22, and t(4;8;9;22(q11;q13;q34;q11 full complex translocation. Number of studies reported that some patients with variant Ph translocation were poor responders to imatinib. All of our patients with variant Ph translocations had suboptimal responses to imatinib, denoting a poor prognosis also. Variant Ph translocations may be important as they are associated with prognosis and therapy for CML patients.

Esophageal Manometry with Provocative Testing in Patients with Noncardiac Angina-Like Chest Pain

Directory of Open Access Journals (Sweden)

William G Paterson

1991-01-01

Full Text Available In a five year period 238 of 594 esophageal manometric studies performed in the authors’ laboratory were done on patients whose major reason for referral was noncardiac angina-like chest pain. Standard eophageal manometry was performed followed by an acid-antacid perfusion period (Bernstein test and then subcutaneous bethanechol (80 μg/kg to a maximum of 5 mg was adminstered. Baseline manometry was normal in 38% of patients and was diagnostic of ‘nutcracker’ esophagus, nonspecific esophageal motility disorder, diffuse esophageal spasm and isolated hypertensive lower esophageal sphincter in 24%, 19%, 16% and 3% of patients, respectively. Ninety-six of 238 patients (40% experienced reproduction of their presenting angina-like chest pain during acid perfusion. In 80% of these patients there were associated esophageal motor abnormal ilies induced by the acid perfusion. Thirty-six of 212 (17% experienced pain reproduction following the injection of bethanechol; however, 16 of these had already had their presenting chest pain reproduced during the acid perfusion study. In two-thirds of the patients with pain reproduction following bechanechol there was an associated bethanechol-induced esophageal motility disorder. Overall 49% of patients had their pain reproduced during provocative testing. The acid perfusion test reproduced the pain much more frequently than bethanechol simulation. This study reaffirms the value of esophageal manometry and provocative testing in this group of patients.

Three-dimensional analysis of maxillary development in patients with unilateral cleft lip and palate during the first six years of life.

Science.gov (United States)

Stancheva, Nadezhda; Dannhauer, Karl-Heinz; Hemprich, Alexander; Krey, Karl-Friedrich

2015-09-01

The purpose of this work was to analyse early upper-jaw development in patients with unilateral cleft lip and palate (UCLP) treated using two different concepts and to compare shape and size developments between these two groups and a group of noncleft patients. A total of 204 maxillary casts available for this study from 50 UCLP patients were analyzed for upper-jaw development based on three-dimensional measurements performed with a Reflex Microscope from birth up to 71 months of age. Thirty-five of these 50 patients were part of an early treatment group (two-stage cleft closure with single-stage palatoplasty at an age of 10-14 months) and 15 were part of a late treatment group (two-stage cleft closure with palatoplasty at an age of 4-7 years). The control group included 39 casts of 17 noncleft patients. Analysis of shape and size between the patients in the three groups yielded statistically significant differences between the cleft and the noncleft patients. In both treatment groups, we made observations typically associated with cleft formation like lateralization, asymmetry of the greater and lesser cleft segments, and pronounced vertical deviations of the segments. Viewed in all dimensions, however, the patients in the early treatment group approached the control group more closely, although a statistically significant difference was still observed. Our results suggest that the timing of hard-palate closure is not a decisive factor for upper-jaw development. Intrinsic factors (initial cleft width, presence of tooth buds) and the surgeon's skills appear to have a much more defining role.

Readability of Patient Education Materials From the Web Sites of Orthopedic Implant Manufacturers.

Science.gov (United States)

Yi, Meghan M; Yi, Paul H; Hussein, Khalil I; Cross, Michael B; Della Valle, Craig J

2017-12-01

Prior studies indicate that orthopedic patient education materials are written at a level that is too high for the average patient. The purpose of this study was to assess the readability of online patient education materials provided by orthopedic implant manufacturers. All patient education articles available in 2013 from the web sites of the 5 largest orthopedic implant manufacturers were identified. Each article was evaluated with the Flesch-Kincaid (FK) readability test. The number of articles with readability ≤ the eighth-grade level (average reading ability of US adults) and the sixth-grade level (recommended level for patient education materials) was determined. Mean readability levels of each company's articles were compared using analysis of variance (significance set at P articles were reviewed from the 5 largest implant manufacturers. The mean overall FK grade level was 10.9 (range, 3.8-16.1). Only 58 articles (10%) were written ≤ the eighth-grade level, and only 13 (2.2%) were ≤ the sixth-grade level. The mean FK grade level was significantly different among groups (Smith & Nephew = 12.0, Stryker = 11.6, Biomet = 11.3, DePuy = 10.6, Zimmer = 10.1; P education materials from implant manufacturers are written at a level too high to be comprehended by the average patient. Future efforts should be made to improve the readability of orthopedic patient education materials. Copyright © 2017 Elsevier Inc. All rights reserved.

The East Irish Sea Basin - from caterpillar to butterfly, a thirty-year metamorphosis

Energy Technology Data Exchange (ETDEWEB)

Colter, V.S.

1997-12-31

In the thirty years since the award of the first licenses, the East Irish Sea Basin has emerged as a significant hydrocarbon province. This paper first lists some of the occasionally almost arbitrary events that led to the first success in the basin, the discovery of the Morecambe Field, in 1974. An attempt is made to review progress over those thirty years in certain topics, namely (1) stratigraphy, (2) structure, (3) sedimentology, (4) diagenesis `The `Platy Illite problem`; and others, (5) uplift and inversion, (6) hydrocarbon sources and types, (7) East Irish Sea Basin analogues. The paper concludes by summarizing the current state of knowledge. (author)

Investigation of contact allergy to dental materials by patch testing

Directory of Open Access Journals (Sweden)

Reena Rai

2014-01-01

Full Text Available Background: Dental products are widely used by patients and dental personnel alike and may cause problems for both. Dental materials could cause contact allergy with varying manifestations such as burning, pain, stomatitis, cheilitis, ulcers, lichenoid reactions localized to the oral mucosa in patients, and hand dermatitis in dental personnel. Patch testing with the dental series comprising commonly used materials can be used to detect contact allergies to dental materials. Aim: This study aimed to identify contact allergy among patients who have oral mucosal lesions after dental treatment and among dental personnel who came in contact with these materials. Materials and Methods: Twenty patients who had undergone dental procedures with symptoms of oral lichen planus, oral stomatitis, burning mouth, and recurrent aphthosis, were included in the study. Dental personnel with history of hand dermatitis were also included in the study. Patch testing was performed using Chemotechnique Dental Series and results interpreted as recommended by the International Contact Dermatitis Research Group (ICDRG. Results: Out of 13 patients who had undergone dental treatment/with oral symptoms, six patients with stomatitis, lichenoid lesions, and oral ulcers showed positive patch tests to a variety of dental materials, seven patients with ulcers had negative patch tests, seven dental personnel with hand dermatitis showed multiple allergies to various dental materials, and most had multiple positivities. Conclusion: The patch test is a useful, simple, noninvasive method to detect contact allergies among patients and among dental personnel dealing with these products. Long term studies are necessary to establish the relevance of these positive patch tests by eliminating the allergic substances, identifying clinical improvement, and substituting with nonallergenic materials.

Hemodynamic factors as a cause of vascular surgery failures in diabetics

DEFF Research Database (Denmark)

Tønnesen, K H; Agerskov, K; Faris, I

1983-01-01

Thirty-six legs in thirty-three diabetic patients with ischemia at rest and multiple level arterial disease were studied preoperatively. Direct intraarterial femoral and popliteal artery blood pressures were measured together with indirect arm and foot blood pressures. Based on the systolic...

Outcome of wide local excision in dermatofibrosarcoma protuberans and use of radiotherapy for margin-positive disease

Directory of Open Access Journals (Sweden)

Raashid Hamid

2013-01-01

Full Text Available Purpose: Wide local excision (WLE is the preferred treatment of dermatofibrosarcoma protuberans (DFSP. The aim is to achieve negtive margins. We followed the impact of radiotherapy used postoperatively for both margin-negative and margin-positive DFSP tumors. Materials and Methods: Outcome of treatment of 36 patients of DFSP treated at our hospital was assessed. Thirty patients received radiotherapy postoperatively and six patients received radiotherapy alone. The maximum dimension of the lesion was 15 cm 2 . Patients were followed up for varying periods of time for any recurrence. Results: 10-year actuarial local control rate was determined. Local control was realized in six patients who were treated with radiotherapy alone. 30 patients were treated by radiotherapy and surgery. Out of these 30 patients, there were 6 local failures (failure rate 10%. Actuarial control rate was 82%. The failures were among patients who had positive margins. Conclusion: Radiotherapy is effective, and it decreases the recurrence rate in the treatment of DFSP. It is especially helpful in margin-positive disease. This appears true for patients treated with radiotherapy alone or radiotherapy used postoperatively.

Scintigraphy of sacroiliac joints in acute anterior uveitis. A study of thirty patients.

Science.gov (United States)

Russell, A S; Lentle, B C; Percy, J S; Jackson, F I

1976-11-01

HLA-B27 is a transplantation antigen found in a high proportion of patients with ankylosing spondylitis. Recently, an association has been shown to exist between HLA-B27 and acute uveitis, even in the absence of ankylosing spondylitis. We have examined the HLA antigen profile of 45 patients with acute nongranulomatous anterior uveitis and have confirmed this relation. In addition, using 90mtechnetium stannous pyrophosphate we have been able to demonstrate abnormal bone scan in 19 of 30 patients studied. Such abnormalities are limited to the sacroiliac joints but are otherwise the same as those seen in overt ankylosing spondylitis. Seven of the 19 patients did not have HLA-B27. These factors suggest that acute anterior uveitis may often represent a manifestation of a spondylitic diathesis even in the complete absence of any suggestive symptomatic or radiologic change and, in some cases, even though the antigenic marker HLA-B27 may be absent.

Scintigraphy of sacroliac joints in acute anterior uveitis. A study of thirty patients

International Nuclear Information System (INIS)

Russell, A.S.; Lentle, B.C.; Percy, J.S.; Jackson, F.I.

1976-01-01

HLA-B27 is a transplantation antigen found in a high proportion of patients with ankylosing spondylitis. Recently, an association has been shown to exist between HLA-B27 and acute uveitis, even in the absence of ankylosing spondylitis. We have examined the HLA antigen profile of 45 patients with acute nongranulomatous anterior uveitis and have confirmed this relation. In addition, using 90m technetium stannous pyrophosphate we have been able to demonstrate abnormal bone scan in 19 of 30 patients studied. Such abnormalities are limited to the sacroiliac joints but are otherwise the same as those seen in overt ankylosing spondylitis. Seven of the 19 patients did not have HLA-B27. These factors suggest that acute anterior uveitis may often represent a manifestation of a spondylitic diathesis even in the complete absence of any suggestive symptomatic or radiologic change and, in some cases, even through the antigenic marker HLA-B27 may be absent

Patients' preferences when comparing analogue implant impressions using a polyether impression material versus digital impressions (Intraoral Scan) of dental implants.

Science.gov (United States)

Wismeijer, Daniel; Mans, Ronny; van Genuchten, Michiel; Reijers, Hajo A

2014-10-01

The primary objective of this clinical study was to assess the patients' perception of the difference between an analogue impression approach on the one hand and an intra-oral scan (IO scan) on the other when restoring implants in the non-aesthetic zone. A second objective was to analyse the difference in time needed to perform these two procedures. Thirty consecutive patients who had received 41 implants (Straumann tissue level) in the non-aesthetic zone in an implant-based referral practice setting in the Netherlands. As they were to receive crown and or bridge work on the implants, in one session, the final impressions were taken with both an analogue technique and with an intraoral scan. Patients were also asked if, directly after the treatment was carried out, they would be prepared to fill out a questionnaire on their perception of both techniques. The time involved following these two procedures was also recorded. The preparatory activities of the treatment, the taste of the impression material and the overall preference of the patients were significantly in favour of the IO scan. The bite registration, the scan head and gag reflex positively tended to the IO scan, but none of these effects were significant. The overall time involved with the IO scan was more negatively perceived than the analogue impression. Overall less time was involved when following the analogue impression technique than with the IO scan. The overall preference of the patients in our sample is significantly in favour of the approach using the IO scan. This preference relates mainly to the differences between the compared approaches with respect to taste effects and their preparatory activities. The patients did perceive the duration of IO scan more negatively than the analogue impression approach. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Juego de rol Lean Six Sigma para empresas

OpenAIRE

Moldon Garrido, David; Porqueras Vila, Olga

2015-01-01

El objetivo del presente trabajo es la creación de un juego de rol que sirva a las empresas como formación. El fin de este juego es concienciar y formar a los trabajadores en la metodología Lean Six Sigma. Lean Six Sigma es una metodología centrada en la mejora continua para reducir los costes de la no calidad. Estos costes son aquellos generados por la producción de material o servicios que no cumplen los requerimientos del cliente. Creamos un juego de rol en el que los participantes form...

First trainer six practice tests with answers

CERN Document Server

May, Peter

2014-01-01

Six full practice tests with tips and training for the 2015 revised Cambridge English: First (FCE). First Trainer Second edition offers six practice tests for the revised Cambridge English: First (FCE) exam combined with easy-to-follow guidance and exam tips. The first two tests are fully guided with advice on how to tackle each paper. Extra practice activities, informed by the Cambridge Learner Corpus, a bank of real candidates' exam papers, focus on areas where students typically need the most help. This version contains a full answer key. Audio for the listening and speaking test activities is available online for download. Audio CDs featuring the listening material are also available, separately.

Mathematical omnibus thirty lectures on classic mathematics

CERN Document Server

Fuchs, Dmitry; Fuchs, Dmitry

2007-01-01

The book consists of thirty lectures on diverse topics, covering much of the mathematical landscape rather than focusing on one area. The reader will learn numerous results that often belong to neither the standard undergraduate nor graduate curriculum and will discover connections between classical and contemporary ideas in algebra, combinatorics, geometry, and topology. The reader's effort will be rewarded in seeing the harmony of each subject. The common thread in the selected subjects is their illustration of the unity and beauty of mathematics. Most lectures contain exercises, and solutions or answers are given to selected exercises. A special feature of the book is an abundance of drawings (more than four hundred), artwork by an accomplished artist, and about a hundred portraits of mathematicians. Almost every lecture contains surprises for even the seasoned researcher.

[The safety and efficacy of alimemazine (teraligen) in relieving anxiety in patients with alcohol addiction].

Science.gov (United States)

Asadullin, A R; Yuldashev, V L; Asadullina, G M; Akhmetova, E A; Ishchenko, K A

2018-01-01

To assess the efficacy of monotherapy of anxiety in alcoholism with alimemazine (teraligen). Thirty-six patients with alcohol addiction were treated with alimemazine in dose 15 mg during 9 month. In control group (11 patients) teraligen was no used. A significant positive effect of treatment with teraligen was observed. There were the improvement in alcohol addiction course, decrease in scores on the Addiction Severity Index (ASI) from severe to mild level and decrease in trait and state anxiety measured with the Spielberger-Khanin scale from high to low levels. The reduction on symptoms of depression from moderate (at baseline) to subdepressive levels on the Beck Depression Inventory was noted in the end of treatment.

Readability of online patient education materials on adult reconstruction Web sites.

Science.gov (United States)

Polishchuk, Daniil L; Hashem, Jenifer; Sabharwal, Sanjeev

2012-05-01

Recommended readability of patient education materials is sixth-grade level or lower. Readability of 212 patient education materials pertaining to adult reconstruction topics available from the American Academy of Orthopaedic Surgeons, American Association of Hip and Knee Surgeons, and 3 other specialty and private practitioner Web sites was assessed using the Flesch-Kincaid grade formula. The mean Flesch-Kincaid score was 11.1 (range, 3-26.5). Only 5 (2%) articles had a readability level of sixth grade or lower. Readability of most of the articles for patient education on adult reconstruction Web sites evaluated may be too advanced for a substantial portion of patients. Further studies are needed to assess the optimal readability level of health information on the Internet. Copyright © 2012 Elsevier Inc. All rights reserved.

Indications for Elective Tracheostomy in Reconstructive Surgery in Patients With Oral Cancer.

Science.gov (United States)

Leiser, Yoav; Barak, Michal; Ghantous, Yasmine; Yehudai, Noam; Abu El-Naaj, Imad

2017-01-01

Oral cancer surgery carries a high risk of upper airway obstruction; yet optimal airway management approach remains controversial. The purpose of the present study was to evaluate the use of tracheostomy in oncological patients undergoing oral cancer surgery with intra oral flap reconstruction. The study cohort included 75 patients with oral cancer, who underwent major intraoral resections and reconstruction with vascularized flaps. Thirty-six percent of the patients received elective tracheostomy (27 patients). Mean hospital stay of the patients with tracheostomy was 28.4 ± 12.5 days compared with 9.7 ± 2.1 days in the nontracheostomy patients. A scoring system rendered from this study suggests that patients with a total scoring at or above 8 should be considered for elective tracheostomy. With appropriate postoperative monitoring, selected patients can be managed without routine elective tracheostomy, yet, patients with comorbidities, mostly elderly patients, which undergo surgical resection and reconstruction in high-risk areas that can result in a bulky flap that pose danger to the postoperative airway, should receive elective tracheostomy.

Mucinous tubular and spindle cell carcinoma of kidney: A clinicopathologic study of six cases

Directory of Open Access Journals (Sweden)

Mudassar Hussain

2012-01-01

Full Text Available Background: Mucinous tubular and spindle carcinoma (MTSCC of kidney is a rare, low-grade polymorphic tumor. Recent studies have described a wide morphology spectrum of this tumor. Aim: To report the clinico-pathologic features of six cases of MTSCC of kidney. Materials and Methods: Six cases of MTSCC of kidney were studied and literature was reviewed. Immunohistochemistry was done by Envision method. Results: The age of the patients ranged from 44 to 84 years (mean 58.5 years. Four patients were males and two were females. The tumor was located in the left kidney in four cases and in the right kidney in two cases. The tumor size ranged from 4.5 to 15 cm (mean 6.4 cm. All tumors exhibited an admixture of tubules, spindle cells, and mucinous stroma in variable proportions. Tubules were predominant in five cases and spindle cells in one case. Psammomatous calcifications, papillations, and necrosis were seen in two cases. Collections of foamy histiocytes were noted in four cases. Cytoplasmic vacuoles and osseous metaplasia were seen in one case each. All cases were Fuhrman′s nuclear grade II. Five cases were of stage pT1, and one was pT3. All cases stained positive for alcian blue at pH 2.5. Immunohistochemical stain CK7 was positive in all cases and CD10 was positive in 1/1 case. All patients were alive and well at follow-up of 12-59 months (mean 33.5 months. No metastases were detected. Conclusions: We report six cases of MTSCC of kidney, a rare distinct variant of RCC, with a favorable prognosis. A male predominance was seen in our cases. MTSCC shares histologic and immunohistochemical overlap with papillary renal cell carcinoma (PRCC and cytogenetic analysis should be performed in difficult cases to avoid a misdiagnosis.

Joint Coal Board. Thirty-eighth annual report 1984/1985. [New South Wales

Energy Technology Data Exchange (ETDEWEB)

1986-01-01

The thirty-eighth annual report of the Joint Coal Board is presented. Included are the major activities of the Board, general statistics of the New South Wales coal industry, an industry review and the Board's financial statements.

Increased risk of breast cancer in splenectomized patients undergoing radiation therapy for Hodgkin's disease

International Nuclear Information System (INIS)

Chung, Chung T.; Bogart, Jeffrey A.; Adams, James F.; Sagerman, Robert H.; Numann, Patricia J.; Tassiopoulos, Apostolos; Duggan, David B.

1997-01-01

Purpose: Second malignancies have been reported among patients who were treated by radiation therapy or chemotherapy alone or in combination. Studies have implied an increased risk of breast cancer in women who received radiotherapy as part of their treatment for Hodgkin's disease. This review was performed to determine if there is an association between splenectomy and subsequent breast cancer. Methods and Materials: One hundred and thirty-six female patients with histologically proven Hodgkin's disease were seen in the Division of Radiation Oncology between 1962 and 1985. All patients received mantle or mediastinal irradiation as part of their therapy. The risk of breast cancer was assessed and multiple linear regression analysis was performed on the following variables: patient age, stage, dose and extent of radiation field, time after completing radiation therapy, splenectomy, and chemotheraphy. Results: Breast cancer was observed in 11 of 74 splenectomized patients and in none of 62 patients not splenectomized. The mean follow-up was 13 years in splenectomized patients and 16 years, 7 months in nonsplenectomized patients. Nine patients developed invasive breast cancer and two developed ductal carcinoma in situ. Splenectomy was the only variable independently associated with an increased risk of breast cancer (p < 0.005) in multiple linear regression analysis; age, latency, and splenectomy considered together were also associated with an increased risk of breast cancer (p < 0.01). Conclusion: Our data show an increased risk of breast cancer in splenectomized patients who had treatment for Hodgkin's disease. A multiinstitutional survey may better define the influence of splenectomy relative to developing breast cancer in patients treated for Hodgkin's disease. The risk of breast cancer should be considered when recommending staging laparotomy, and we recommend close follow-up examination including routine mammograms for female patients successfully treated for

Risk factors associated with default among new pulmonary TB patients and social support in six Russian regions.

Science.gov (United States)

Jakubowiak, W M; Bogorodskaya, E M; Borisov, S E; Borisov, E S; Danilova, I D; Danilova, D I; Kourbatova, E V; Kourbatova, E K

2007-01-01

Tuberculosis (TB) services in six Russian regions in which social support programmes for TB patients were implemented. To identify risk factors for default and to evaluate possible impact of social support. Retrospective study of new pulmonary smear-positive and smear-negative TB patients registered during the second and third quarters of the 2003. Data were analysed in a case-control study including default patients as cases and successfully treated patients as controls, using multivariate logistic regression modelling. A total of 1805 cases of pulmonary TB were enrolled. Default rates in the regions were 2.3-6.3%. On multivariate analysis, risk factors independently associated with default outcome included: unemployment (OR 4.44; 95%CI 2.23-8.86), alcohol abuse (OR 1.99; 95%CI 1.04-3.81), and homelessness (OR 3.49; 95%CI 1.25-9.77). Social support reduced the default outcome (OR 0.13; 95%CI 0.06-0.28), controlling for age, sex, region, residence and acid-fast bacilli (AFB) smear of sputum. Unemployment, alcohol abuse and homelessness were associated with increased default outcome among new TB patients, while social support for TB patients reduced default. Further prospective randomised studies are necessary to evaluate the impact and to determine the most cost-effective social support for improving treatment outcomes of TB in patients in Russia, especially among populations at risk of default.

Clinical Outcome in Posthysterectomy Cervical Cancer Patients Treated With Concurrent Cisplatin and Intensity-Modulated Pelvic Radiotherapy: Comparison With Conventional Radiotherapy

International Nuclear Information System (INIS)

Chen, M.-F.; Tseng, C.-J.; Tseng, C.-C.; Kuo, Y.-C.; Yu, C.-Y.; Chen, W.-C.

2007-01-01

Purpose: To assess local control and acute and chronic toxicity with intensity-modulated radiation therapy (IMRT) as adjuvant treatment of cervical cancer. Methods and Materials: Between April 2002 and February 2006, 68 patients at high risk of cervical cancer after hysterectomy were treated with adjuvant pelvic radiotherapy and concurrent chemotherapy. Adjuvant chemotherapy consisted of cisplatin (50 mg/m 2 ) for six cycles every week. Thirty-three patients received adjuvant radiotherapy by IMRT. Before the IMRT series was initiated, 35 other patients underwent conventional four-field radiotherapy (Box-RT). The two groups did not differ significantly in respect of clinicopathologic and treatment factors. Results: IMRT provided compatible local tumor control compared with Box-RT. The actuarial 1-year locoregional control for patients in the IMRT and Box-RT groups was 93% and 94%, respectively. IMRT was well tolerated, with significant reduction in acute gastrointestinal (GI) and genitourinary (GU) toxicities compared with the Box-RT group (GI 36 vs. 80%, p = 0.00012; GU 30 vs. 60%, p = 0.022). Furthermore, the IMRT group had lower rates of chronic GI and GU toxicities than the Box-RT patients (GI 6 vs. 34%, p = 0.002; GU 9 vs. 23%, p = 0.231). Conclusion: Our results suggest that IMRT significantly improved the tolerance to adjuvant chemoradiotherapy with compatible locoregional control compared with conventional Box-RT. However, longer follow-up and more patients are needed to confirm the benefits of IMRT

Analysis of the efficiency of different materials used as cervical barrier in endogenous bleaching

Directory of Open Access Journals (Sweden)

Joel de Brito Gonçalves

2008-01-01

Full Text Available Objective: Evaluate the efficiency of three materials used for making the cervical buffer on the bleaching procedure. Methods: Thirty-six, recently extracted human canines were used, and divided into four experimental groups of nine replicas in each group. Group I was the control group, in which no sealing was done in the cervical region; Group II corresponded to the cervical buffer made by chemically activated glass ionomer cement (Vidrion R; in Group III resin-modified glass ionomer cement (Vitremer, 3M, Sumaré, Brazil was used as the cervical buffer; and in Group IV Coltosol temporary restorative cement was used. A paste of sodium perborateand 30% hydrogen peroxide was placed in the pulp chamber for seven days, followed by placement of a dye to evaluate microleakageafterwards. Results: The results obtained among the experimental groups were statistically significant. Conclusion: That Coltosol was the most effective material against leakage in the apical direction. Vitremer (3M, Sumaré, Brazil occupied the intermediate position among the groups, and Vidrion behave better than the control group only, therefore, with precarious sealing properties.

The Six Minute Walk Test Revisited

Science.gov (United States)

Mazumder, M.

2017-12-01

Background and Purpose: Heart failure is the leading cause of death and often alters or severely restricts human mobility, an essential life function. Motion capture is an emerging tool for analyzing human movement and extremity articulation, providing quantitative information on gait and range of motion. This study uses BioStamp mechanosensors to identify differences in motion for the duration of the Six Minute Walk Test and signature patterns of muscle contraction and posture in patients with advanced heart failure compared to healthy subjects. Identification and close follow up of these patterns may allow enhanced diagnosis and the possibility for early intervention before disease worsening. Additionally, movement parameters represent a new family of potential biomarkers to track heart failure onset, progression and therapy. Methods: Prior to the Six Minute Walk Test, BioStamps (MC10) were applied to the chest, upper and lower extremities of heart failure and healthy patients and data were streamed and recorded revealing the pattern of movement in three separate axes. Conjointly, before and after the Six Minute Walk Test, the following vitals were measured per subject: heart rate, respiratory rate, blood pressure, oxygen saturation, dyspnea and leg fatigue (self-reported with Borg scale). During the test, patients were encouraged to walk as far as they can in 6 minutes on a 30m course, as we recorded the number of laps completed and oxygen saturation every minute. Results and Conclusions: The sensors captured and quantified whole body and regional motion parameters including: a. motion extent, position, acceleration and angle via incorporated accelerometers and gyroscopes; b. muscle contraction via incorporated electromyogram (EMG). Accelerometry and gyroscopic data for the last five steps of a healthy and heart failure patient are shown. While significant differences in motion for the duration of the test were not found, each category of patients had a distinct

Patient cloth with motion recognition sensors based on flexible piezoelectric materials.

Science.gov (United States)

Youngsu Cha; Kihyuk Nam; Doik Kim

2017-07-01

In this paper, we introduce a patient cloth for position monitoring using motion recognition sensors based on flexible piezoelectric materials. The motion recognition sensors are embedded in three parts, which are the knee, hip and back, in the patient cloth. We use polyvinylidene fluoride (PVDF) as the flexible piezoelectric material for the sensors. By using the piezoelectric effect of the PVDF, we detect electrical signals when the cloth is bent or extended. We analyze the sensing values for our human motions by processing the sensor outputs in a custom-made program. Specifically, we focus on the transitions between standing and sitting, and sitting knee extension and supine position, which are important motions for patient monitoring.

Cerebral perfusion changes in schizophrenia patients evaluated with Tc-99 HMPAO

International Nuclear Information System (INIS)

Sehweil, A.; El-Hilu, S.; Jahan, S.; Higazi, E.; Salhat, M.; Al-Mohannadi, S.; Abdel-Dayem, H.M.

1989-01-01

Tc-99m HMPAO has been used to image cerebral perfusion changes in 20 chronic schizophrenia patients (19 men and 1 woman), with an average age of 29 years (range, 22-48 years). All were receiving neuroleptic drugs. Twelve had received electroconvulsive therapy. All patients had abnormal studies (except one, which was normal) and poor response to treatment. Ventricular dilation and cerebral atrophy were seen in 11 patients. Seventy-seven focal lesions were detected. Forty-two lesions showed increased HMPAO retention: 26 in the basal ganglia in 14 patients (12, bilateral, two unilateral), 10 along the sylvian fissure in the parietotemporal region, three in the frontal region, and one in each of the temporal, parietal, and occipital regions. Thirty-five focal lesions showed decreased perfusion: 10 parietal, eight frontal, seven temporal, six cerebellar, and four occipital. This study demonstrates the potential value of Tc-99m HMPAO in the study of schizophrenia and other psychiatric disorders

Squamous cell carcinoma of the external auditory canal: computed tomography findings in six cases

International Nuclear Information System (INIS)

Gonzalez, Fabio Mota; Paes Junior, Ademar Jose de Oliveira; Tornin, Olger de Souza; Souza, Ricardo Pires de

2005-01-01

Objective: to evaluate the role of computed tomography in the assessment of deep extension of squamous cell carcinoma of the external auditory canal. Materials and methods: in the period between May 1995 and December 2003 six patients with squamous cell carcinoma of the external auditory canal were submitted to computed tomography scan at 'Hospital Heliopolis', Sao Paulo, SP, Brazil, including axial and coronal slices with soft tissue and bone algorithms. Results: thickening of the soft tissue of the external auditory canal was seen in all patients, bone erosion and invasion of the middle ear in five (83.3%), invasion of the mastoid and parotid gland in four (66.7%), invasion of the temporomandibular joint in three (50%), and invasion of the middle cranial fossa, carotid canal and cervical lymph node enlargement in two (33.3%) patients. Conclusion: assessment of deep extension of squamous cell carcinoma of the external auditory canal using computed tomography is useful for clinical staging of the disease allowing better therapeutic planning for these patients. (author)

Clinico-radiological profile and risk factors in patients with anthracosis

Directory of Open Access Journals (Sweden)

Virendra Singh

2015-01-01

Full Text Available Background: Anthracosis is the black pigmentation of the mucosal lining of the tracheo-bronchial tree. The significance of this finding is not known and often ignored. The aim of the present study is to find the association of anthracosis with demographic variables, biomass fuel and occupational exposure, respiratory diseases, radiological pattern and functional morbidity. Materials and Methods: Enrolment of the subjects for the study was done at SMS hospital, Jaipur. Patients with anthracosis evident on bronchoscopy were included as the cases. Patients without anthracosis on bronchoscopy, matched according to age, gender and smoking habits, were included in the control group. Subjects in both the arms completed a questionnaire and also underwent computed tomography (CT of the chest and six minute walk test (6MWT. Results: Thirty cases and 53 controls were included in the study. The patients with anthracosis presented with symptoms ranging from cough (76.65%, hemoptysis (46.6%, fever (26.6%, dyspnea (90% and malaise (73.3%. Biomass fuel exposure for the cases was 35.13 ± 55.86 hours in a year and for the controls was 28.15 ± 40.09 hours in a year (P > 0.05. Stone mining was significantly associated with anthracosis (P < 0.05. CT chest revealed fibrosis (43.3%, consolidation (33.3%, cavitation (16.6% and mass (46.6% in the cases. Sixty percent of cases and 15% of controls were diagnosed to have either old or active pulmonary tuberculosis (P < 0.05. Conclusions: Anthracosis is associated with pulmonary tuberculosis. Biomass exposure is not significantly associated with anthracosis. Post tubercular fibrosis is more common on CT chest of patients with anthracosis.

STUDY ON NONALCOHOLIC STEATOHEPATITIS (NASH IN PATIENTS OF OBESE, TYPE 2 DIABETES MELLITUS

Directory of Open Access Journals (Sweden)

Uma Shankar Mishra

2018-02-01

Full Text Available BACKGROUND Nonalcoholic steatohepatitis (NASH represents only a part of a wide spectrum of non-alcoholic fatty liver disease (NAFLD and its prevalence is only 2-3% in the general population. Diabetes mellitus increases the risk for severe necroinflammation. The diagnosis rests on the hallmark histological features. Liver biopsy is essential for positive diagnosis and prognostication of NASH. The aim of this study was to evaluate the correlation between NASH and risk factor like diabetes, BMI and other risk factors. MATERIALS AND METHODS 36 patients with histologically confirmed NASH with elevated liver aminotransferase and negative markers for other diseases admitted to our institution from Sept-2012 to August-2014, were included in the study, meeting our inclusion & exclusion criteria. Investigations were done & data was collected. Data were pooled & interpreted using standard statistical methods. RESULTS Twenty out of thirty-six patients had diabetes in our study i.e. 55.6% were diabetes. 22 out of 36 patients i.e. 61.1% had BMI >28 kg/m2 . the mean waist circumference in our study was 93.13 Cm. 15 out of 24 female patients i.e. 62.5% females had WC>88 cm and 8 out of 12 male patients i.e. 66.7% males had WC >102 cm., 20 out of 36 patients i.e. 55.6% patients fulfilled at least 3 out of 5 criteria and therefore had insulin resistance syndrome or metabolic syndrome. CONCLUSION Patients with NASH are typically asymptomatic unless cirrhosis develops. 97.22% patients were dyslipidaemics. NASH may be considered an additional features of insulin resistance & metabolic syndrome. Age, gender, waist circumference, BMI, ALT, AST: ALT ratio, serum triglyceride levels, HTN & BAAT score are independent predictors of NASH.

A novel prognostic six-CpG signature in glioblastomas.

Science.gov (United States)

Yin, An-An; Lu, Nan; Etcheverry, Amandine; Aubry, Marc; Barnholtz-Sloan, Jill; Zhang, Lu-Hua; Mosser, Jean; Zhang, Wei; Zhang, Xiang; Liu, Yu-He; He, Ya-Long

2018-03-01

We aimed to identify a clinically useful biomarker using DNA methylation-based information to optimize individual treatment of patients with glioblastoma (GBM). A six-CpG panel was identified by incorporating genome-wide DNA methylation data and clinical information of three distinct discovery sets and was combined using a risk-score model. Different validation sets of GBMs and lower-grade gliomas and different statistical methods were implemented for prognostic evaluation. An integrative analysis of multidimensional TCGA data was performed to molecularly characterize different risk tumors. The six-CpG risk-score signature robustly predicted overall survival (OS) in all discovery and validation cohorts and in a treatment-independent manner. It also predicted progression-free survival (PFS) in available patients. The multimarker epigenetic signature was demonstrated as an independent prognosticator and had better performance than known molecular indicators such as glioma-CpG island methylator phenotype (G-CIMP) and proneural subtype. The defined risk subgroups were molecularly distinct; high-risk tumors were biologically more aggressive with concordant activation of proangiogenic signaling at multimolecular levels. Accordingly, we observed better OS benefits of bevacizumab-contained therapy to high-risk patients in independent sets, supporting its implication in guiding usage of antiangiogenic therapy. Finally, the six-CpG signature refined the risk classification based on G-CIMP and MGMT methylation status. The novel six-CpG signature is a robust and independent prognostic indicator for GBMs and is of promising value to improve personalized management. © 2018 John Wiley & Sons Ltd.

Eroded dentin does not jeopardize the bond strength of adhesive restorative materials

Directory of Open Access Journals (Sweden)

Janaina Barros Cruz

2012-08-01

Full Text Available This in vitro study evaluated the bond strength of adhesive restorative materials to sound and eroded dentin. Thirty-six bovine incisors were embedded in acrylic resin and ground to obtain flat buccal dentin surfaces. Specimens were randomly allocated in 2 groups: sound dentin (immersion in artificial saliva and eroded dentin (pH cycling model - 3× / cola drink for 7 days. Specimens were then reassigned according to restorative material: glass ionomer cement (KetacTM Molar Easy Mix, resin-modified glass ionomer cement (VitremerTM or adhesive system with resin composite (Adper Single Bond 2 + Filtek Z250. Polyethylene tubes with an internal diameter of 0.76 mm were placed over the dentin and filled with the material. The microshear bond test was performed after 24 h of water storage at 37ºC. The failure mode was evaluated using a stereomicroscope (400×. Bond strength data were analyzed with two-way ANOVA and Tukey's post hoc tests (α = 0.05. Eroded dentin showed bond strength values similar to those for sound dentin for all materials. The adhesive system showed the highest bond strength values, regardless of the substrate (p < 0.0001. For all groups, the adhesive/mixed failure prevailed. In conclusion, adhesive materials may be used in eroded dentin without jeopardizing the bonding quality. It is preferable to use an etch-and-rinse adhesive system because it shows the highest bond strength values compared with the glass ionomer cements tested.

Developing and evaluating rare disease educational materials co-created by expert clinicians and patients

DEFF Research Database (Denmark)

Badiu, Corin; Bonomi, Marco; Borshchevsky, Ivan

2017-01-01

were conducted by clinicians and patients who are native speakers. RESULTS: Co-created patient education materials reached the target 6th grade reading level according to 2/6 (33%) algorithms (range: grade 5.9-9.7). The online survey received 164 hits in 2 months and 63/159 (40%) of eligible patients...... disease patients. Combining dissemination via traditional healthcare professional platforms as well as patient-centric sites can facilitate broad uptake of culturally adapted translations. This process may serve as a roadmap for creating patient education materials for other rare diseases....

A healthcare Lean Six Sigma System for postanesthesia care unit workflow improvement.

Science.gov (United States)

Kuo, Alex Mu-Hsing; Borycki, Elizabeth; Kushniruk, Andre; Lee, Te-Shu

2011-01-01

The aim of this article is to propose a new model called Healthcare Lean Six Sigma System that integrates Lean and Six Sigma methodologies to improve workflow in a postanesthesia care unit. The methodology of the proposed model is fully described. A postanesthesia care unit case study is also used to demonstrate the benefits of using the Healthcare Lean Six Sigma System model by combining Lean and Six Sigma methodologies together. The new model bridges the service gaps between health care providers and patients, balances the requirements of health care managers, and delivers health care services to patients by taking the benefits of the Lean speed and Six Sigma high-quality principles. The full benefits of the new model will be realized when applied at both strategic and operational levels. For further research, we will examine how the proposed model is used in different real-world case studies.

Percutaneous Image-Guided Screw Fixation of Bone Lesions in Cancer Patients: Double-Centre Analysis of Outcomes including Local Evolution of the Treated Focus

Energy Technology Data Exchange (ETDEWEB)

Cazzato, Roberto Luigi, E-mail: gigicazzato@hotmail.it; Koch, Guillaume, E-mail: guillaume.koch@chru-strasbourg.fr [Hôpitaux Universitaires de Strasbourg, HUS, Department of Interventional Radiology, Nouvel Hôpital Civil (France); Buy, Xavier, E-mail: x.buy@bordeaux.unicancer.fr [Institut Bergonié, Department of Radiology (France); Ramamurthy, Nitin, E-mail: nitin-ramamurthy@hotmail.com [Norfolk and Norwich University Hospital, Department of Radiology (United Kingdom); Tsoumakidou, Georgia, E-mail: georgia.tsoumakidou@chru-strasbourg.fr; Caudrelier, Jean, E-mail: jean.caudrelier@chru-strasbourg.fr [Hôpitaux Universitaires de Strasbourg, HUS, Department of Interventional Radiology, Nouvel Hôpital Civil (France); Catena, Vittorio, E-mail: v.catena@bordeaux.unicancer.fr [Institut Bergonié, Department of Radiology (France); Garnon, Julien, E-mail: juleiengarnon@gmail.com [Hôpitaux Universitaires de Strasbourg, HUS, Department of Interventional Radiology, Nouvel Hôpital Civil (France); Palussiere, Jean, E-mail: j.palussiere@bordeaux.unicancer.fr [Institut Bergonié, Department of Radiology (France); Gangi, Afshin, E-mail: gangi@unistra.fr [Hôpitaux Universitaires de Strasbourg, HUS, Department of Interventional Radiology, Nouvel Hôpital Civil (France)

2016-10-15

AimTo review outcomes and local evolution of treated lesions following percutaneous image-guided screw fixation (PIGSF) of pathological/insufficiency fractures (PF/InF) and impeding fractures (ImF) in cancer patients at two tertiary centres.Materials and methodsThirty-two consecutive patients (mean age 67.5 years; range 33–86 years) with a range of tumours and prognoses underwent PIGSF for non/minimally displaced PF/InF and ImF. Screws were placed under CT/fluoroscopy or cone-beam CT guidance, with or without cementoplasty. Clinical outcomes were assessed using a simple 4-point scale (1 = worse; 2 = stable; 3 = improved; 4 = significantly improved). Local evolution was reviewed on most recent follow-up imaging. Technical success, complications, and overall survival were evaluated.ResultsThirty-six lesions were treated with 74 screws mainly in the pelvis and femoral neck (58.2 %); including 47.2 % PF, 13.9 % InF, and 38.9 % ImF. Cementoplasty was performed in 63.9 % of the cases. Technical success was 91.6 %. Hospital stay was ≤3 days; 87.1 % of lesions were improved at 1-month follow-up; three major complications (early screw-impingement radiculopathy; accelerated coxarthrosis; late coxofemoral septic arthritis) and one minor complication were observed. Unfavourable local evolution at imaging occurred in 3/24 lesions (12.5 %) at mean 8.7-month follow-up, including poor consolidation (one case) and screw loosening (two cases, at least 1 symptomatic). There were no cases of secondary fractures.ConclusionsPIGSF is feasible for a wide range of oncologic patients, offering good short-term efficacy, acceptable complication rates, and rapid recovery. Unfavourable local evolution at imaging may be relatively frequent, and requires close clinico-radiological surveillance.

Clinical outcome in measles patients hospitalized with complications

International Nuclear Information System (INIS)

Rehman, A.U.; Saeed, T.

2008-01-01

Measles is a highly communicable viral illness and is common cause of childhood mortality and morbidity. Keeping in view the high prevalence of measles in the developing world, we carried out this study to look into the complicated measles cases and clinical outcome in patients admitted in children ward of Ayub Teaching Hospital. Detailed history and physical examination of all the hospitalized patients with complication of measles were recorded in a proforma. Immunization and nutritional status of each admitted patient was assessed and the clinical outcome of measles was compared with demographic profile. one hundred thirty six hospitalized patients with complications of measles were studied. There was 60.3% male and 57.3% of patients were vaccinated against measles. Malnourished patients were 71.35% and had longer hospital stay (>5 days). Pneumonia (39.7%) and diarrhoea (38.2%) were the commonest complications. Seven children died and encephalitis (57.1%) was the commonest cause of death. The most common complications of measles are pneumonia and diarrhoea with dehydration requiring admission. Malnutrition results in more complications and longer hospital stay. Mortality is significantly associated with encephalitis. (author)

Six Lessons We Learned Applying Six Sigma

Science.gov (United States)

Carroll, Napoleon; Casleton, Christa H.

2005-01-01

As Chief Financial Officer of Kennedy Space Center (KSC), I'm not only responsible for financial planning and accounting but also for building strong partnerships with the CFO customers, who include Space Shuttle and International Space Station operations as well all who manage the KSC Spaceport. My never ending goal is to design, manage and continuously improve our core business processes so that they deliver world class products and services to the CFO's customers. I became interested in Six Sigma as Christa Casleton (KSC's first Six Sigma Black belt) applied Six Sigma tools and methods to our Plan and Account for Travel Costs Process. Her analysis was fresh, innovative and thorough but, even more impressive, was her approach to ensure ongoing, continuous process improvement. Encouraged by the results, I launched two more process improvement initiatives aimed at applying Six Sigma principles to CFO processes that not only touch most of my employees but also have direct customer impact. As many of you know, Six Sigma is a measurement scale that compares the output of a process with customer requirements. That's straight forward, but demands that you not only understand your processes but also know your products and the critical customer requirements. The objective is to isolate and eliminate the causes of process variation so that the customer sees consistently high quality.

Effects of simulated space environmental parameters on six commercially available composite materials

International Nuclear Information System (INIS)

Funk, J.G.; Sykes, G.F. Jr.

1989-04-01

The effects of simulated space environmental parameters on microdamage induced by the environment in a series of commercially available graphite-fiber-reinforced composite materials were determined. Composites with both thermoset and thermoplastic resin systems were studied. Low-Earth-Orbit (LEO) exposures were simulated by thermal cycling; geosynchronous-orbit (GEO) exposures were simulated by electron irradiation plus thermal cycling. The thermal cycling temperature range was -250 F to either 200 F or 150 F. The upper limits of the thermal cycles were different to ensure that an individual composite material was not cycled above its glass transition temperature. Material response was characterized through assessment of the induced microcracking and its influence on mechanical property changes at both room temperature and -250 F. Microdamage was induced in both thermoset and thermoplastic advanced composite materials exposed to the simulated LEO environment. However, a 350 F cure single-phase toughened epoxy composite was not damaged during exposure to the LEO environment. The simuated GEO environment produced microdamage in all materials tested

The Readability of AAOS Patient Education Materials: Evaluating the Progress Since 2008.

Science.gov (United States)

Roberts, Heather; Zhang, Dafang; Dyer, George S M

2016-09-07

The Internet has become a major resource for patients; however, patient education materials are frequently written at relatively high levels of reading ability. The purpose of this study was to evaluate the readability of patient education materials on the American Academy of Orthopaedic Surgeons (AAOS) web site. Readability scores were calculated for all patient education articles on the AAOS web site using 5 algorithms: Flesch Reading Ease, Flesch-Kincaid Grade Level, SMOG (Simple Measure of Gobbledygook) Grade, Coleman-Liau Index, and Gunning-Fog Index. The mean readability scores were compared across the anatomic categories to which they pertained. Using a liberal measure of readability, the Flesch-Kincaid Grade Level, 3.9% of articles were written at or below the recommended sixth-grade reading level, and 84% of the articles were written above the eighth-grade reading level. Articles in the present study had a lower mean Flesch-Kincaid Grade Level than those available in 2008 (p readability levels of AAOS articles are higher than generally recommended. Although the mean Flesch-Kincaid Grade Level was lower in the present study than it was in 2008, a need remains to improve the readability of AAOS patient education articles. Ensuring that online patient education materials are written at an appropriate reading grade level would be expected to improve physician-patient communication. Copyright © 2016 by The Journal of Bone and Joint Surgery, Incorporated.

Readability of Orthopaedic Oncology-related Patient Education Materials Available on the Internet.

Science.gov (United States)

Shah, Akash K; Yi, Paul H; Stein, Andrew

2015-12-01

A person's health literacy is one of the most important indicators of a patient's health status. According to national recommendations, patient education materials should be written at no higher than the sixth- to eighth-grade reading level. The purpose of our study was to assess the readability of online patient education materials related to orthopaedic oncology on the websites of the American Academy of Orthopaedic Surgeons (AAOS), American Cancer Society (ACS), Bone and Cancer Foundation (BCF), and National Cancer Institute (NCI). We searched the online patient education libraries of the AAOS, ACS, BCF, and NCI for all articles related to orthopaedic oncology. The Flesch-Kincaid (FK) readability score was calculated for each article and compared between sources. A total of 227 articles were identified with an overall mean FK grade level of 9.8. Stratified by source, the mean FK grade levels were 10.1, 9.6, 11.1, and 9.5 for the AAOS, ACS, BCF, and NCI, respectively (P education materials related to orthopaedic oncology appear to be written at a level above the comprehension ability of the average patient. Copyright 2015 by the American Academy of Orthopaedic Surgeons.

A comparative analysis of neurosurgical online education materials to assess patient comprehension.

Science.gov (United States)

Agarwal, Nitin; Chaudhari, Amit; Hansberry, David R; Tomei, Krystal L; Prestigiacomo, Charles J

2013-10-01

Americans have increasingly utilized the internet as a first-line resource for a variety of information, including healthcare-oriented materials. Therefore, these online resources should be written at a level the average American can understand. Patient education resources specifically written for and available to the public were downloaded from the American Association of Neurological Surgeons website and assessed for their level of readability using the Flesch Reading Ease, Flesch-Kincaid Grade Level, Simple Measure of Gobbledygook Grading, Coleman-Liau Index, and Gunning-Fog Index. A total of 71 subsections from different neurosurgical specialties were reviewed, including Cerebrovascular, Spine and Peripheral Nerves, Neurotrauma and Critical Care, Pain, Pediatric, Stereotactic and Functional, and Tumor material. All neurosurgical subspecialty education material provided on the American Association of Neurological Surgeons website was uniformly written at a level that was too high, as assessed by all modalities. In order to reach a larger patient population, patient education materials on the American Association of Neurological Surgeons website should be revised with the goal of simplifying readability. Copyright © 2013 Elsevier Ltd. All rights reserved.

Diversity of halophilic archaea from six hypersaline environments in Turkey.

Science.gov (United States)

Ozcan, Birgul; Ozcengiz, Gulay; Coleri, Arzu; Cokmus, Cumhur

2007-06-01

The diversity of archaeal strains from six hypersaline environments in Turkey was analyzed by comparing their phenotypic characteristics and 16S rDNA sequences. Thirty-three isolates were characterized in terms of their phenotypic properties including morphological and biochemical characteristics, susceptibility to different antibiotics, and total lipid and plasmid contents, and finally compared by 16S rDNA gene sequences. The results showed that all isolates belong to the family Halobacteriaceae. Phylogenetic analyses using approximately 1,388 bp comparisions of 16S rDNA sequences demonstrated that all isolates clustered closely to species belonging to 9 genera, namely Halorubrum (8 isolates), Natrinema (5 isolates), Haloarcula (4 isolates), Natronococcus (4 isolates), Natrialba (4 isolates), Haloferax (3 isolates), Haloterrigena (3 isolates), Halalkalicoccus (1 isolate), and Halomicrobium (1 isolate). The results revealed a high diversity among the isolated halophilic strains and indicated that some of these strains constitute new taxa of extremely halophilic archaea.

Applying Lean Six Sigma to improve medication management.

Science.gov (United States)

Nayar, Preethy; Ojha, Diptee; Fetrick, Ann; Nguyen, Anh T

2016-01-01

A significant proportion of veterans use dual care or health care services within and outside the Veterans Health Administration (VHA). In this study conducted at a VHA medical center in the USA, the authors used Lean Six Sigma principles to develop recommendations to eliminate wasteful processes and implement a more efficient and effective process to manage medications for dual care veteran patients. The purpose of this study is to: assess compliance with the VHA's dual care policy; collect data and describe the current process for co-management of dual care veterans' medications; and draft recommendations to improve the current process for dual care medications co-management. Input was obtained from the VHA patient care team members to draw a process map to describe the current process for filling a non-VHA prescription at a VHA facility. Data were collected through surveys and direct observation to measure the current process and to develop recommendations to redesign and improve the process. A key bottleneck in the process that was identified was the receipt of the non-VHA medical record which resulted in delays in filling prescriptions. The recommendations of this project focus on the four domains of: documentation of dual care; veteran education; process redesign; and outreach to community providers. This case study describes the application of Lean Six Sigma principles in one urban Veterans Affairs Medical Center (VAMC) in the Mid-Western USA to solve a specific organizational quality problem. Therefore, the findings may not be generalizable to other organizations. The Lean Six Sigma general principles applied in this project to develop recommendations to improve medication management for dual care veterans are applicable to any process improvement or redesign project and has valuable lessons for other VAMCs seeking to improve care for their dual care veteran patients. The findings of this project will be of value to VA providers and policy makers and health

Fall risk screening protocol for older hearing clinic patients.

Science.gov (United States)

Criter, Robin E; Honaker, Julie A

2017-10-01

The primary purposes of this study were (1) to describe measures that may contrast audiology patients who fall from those who do not fall and (2) to evaluate the clinical performance of measures that could be easily used for fall risk screening in a mainstream audiology hearing clinic. Cross-sectional study Study sample: Thirty-six community-dwelling audiology patient participants and 27 community-dwelling non-audiology patients over 60 years of age. The Hearing Handicap Inventory for the Elderly (HHIE) most accurately identified patients with a recent fall (sensitivity: 76.0%), while the Dizziness Handicap Inventory (DHI) most accurately identified patients without a recent fall (specificity: 90.9%). A combination of measures used in a protocol-including HHIE, DHI, number of medications, and the Timed Up and Go test-resulted in good, accurate identification of patients with or without a recent history of falls (92.0% sensitivity, 100% specificity). This study reports good sensitivity and excellent specificity for identifying patients with and without a recent history of falls when measures were combined into a screening protocol. Despite previously reported barriers, effective fall risk screenings may be performed in hearing clinic settings with measures often readily accessible to audiologists.

Discovery and functional annotation of SIX6 variants in primary open-angle glaucoma.

Directory of Open Access Journals (Sweden)

Megan Ulmer Carnes

Full Text Available Glaucoma is a leading cause of blindness worldwide. Primary open-angle glaucoma (POAG is the most common subtype and is a complex trait with multigenic inheritance. Genome-wide association studies have previously identified a significant association between POAG and the SIX6 locus (rs10483727, odds ratio (OR = 1.32, p = 3.87×10(-11. SIX6 plays a role in ocular development and has been associated with the morphology of the optic nerve. We sequenced the SIX6 coding and regulatory regions in 262 POAG cases and 256 controls and identified six nonsynonymous coding variants, including five rare and one common variant, Asn141His (rs33912345, which was associated significantly with POAG (OR = 1.27, p = 4.2×10(-10 in the NEIGHBOR/GLAUGEN datasets. These variants were tested in an in vivo Danio rerio (zebrafish complementation assay to evaluate ocular metrics such as eye size and optic nerve structure. Five variants, found primarily in POAG cases, were hypomorphic or null, while the sixth variant, found only in controls, was benign. One variant in the SIX6 enhancer increased expression of SIX6 and disrupted its regulation. Finally, to our knowledge for the first time, we have identified a clinical feature in POAG patients that appears to be dependent upon SIX6 genotype: patients who are homozygous for the SIX6 risk allele (His141 have a statistically thinner retinal nerve fiber layer than patients homozygous for the SIX6 non-risk allele (Asn141. Our results, in combination with previous SIX6 work, lead us to hypothesize that SIX6 risk variants disrupt the development of the neural retina, leading to a reduced number of retinal ganglion cells, thereby increasing the risk of glaucoma-associated vision loss.

LEAN SIX SIGMA TECHNIQUES TO IMPROVE OPHTHALMOLOGY CLINIC EFFICIENCY.

Science.gov (United States)

Ciulla, Thomas A; Tatikonda, Mohan V; ElMaraghi, Yehya A; Hussain, Rehan M; Hill, Amanda L; Clary, Julie M; Hattab, Eyas

2017-07-18

Ophthalmologists serve an increasing volume of a growing elderly population undergoing increasingly complex outpatient medical care, including extensive diagnostic testing and treatment. The resulting prolonged patient visit times ("patient flow times") limit quality, patient and employee satisfaction, and represent waste. Lean Six Sigma process improvement was used in a vitreoretinal practice to decrease patient flow time, demonstrating that this approach can yield significant improvement in health care. Process flow maps were created to determine the most common care pathways within clinic. Three months' visits from the electronic medical record system, which tracks patient task times at each process step in the office were collected. Care tasks and care pathways consuming the greatest time and variation were identified and modified. Follow-up analysis from 6 weeks' visits was conducted to assess improvement. Nearly all patients took one of five paths through the office. Patient flow was redesigned to reduce waiting room time by having staff members immediately start patients into one of those five paths; staffing was adjusted to address high demand tasks, and scheduling was optimized around derived predictors of patient flow times. Follow-up analysis revealed a statistically significant decline in mean patient flow time by 18% and inpatient flow time SD by 4.6%. Patient and employee satisfaction scores improved. Manufacturing industry techniques, such as Lean and Six Sigma, can be used to improve patient care, minimize waste, and enhance patient and staff satisfaction in outpatient clinics.

A Comparison of the Effects of Pilates and McKenzie Training on Pain and General Health in Men with Chronic Low Back Pain: A Randomized Trial

OpenAIRE

Hasanpour-Dehkordi, Ali; Dehghani, Arman; Solati, Kamal

2017-01-01

Background: Today, chronic low back pain is one of the special challenges in healthcare. There is no unique approach to treat chronic low back pain. A variety of methods are used for the treatment of low back pain, but the effects of these methods have not yet been investigated adequately. Aim: The aim of this study was to compare the effects of Pilates and McKenzie training on pain and general health of men with chronic low back pain. Materials and Methods: Thirty-six patients with chronic l...

Six Sigma and Lean concepts, a case study: patient centered care model for a mammography center.

Science.gov (United States)

Viau, Mark; Southern, Becky

2007-01-01

Boca Raton Community Hospital in South Florida decided to increase return while enhancing patient experience and increasing staff morale. They implemented a program to pursue "enterprise excellence" through Six Sigma methodologies. In order to ensure the root causes to delays and rework were addressed, a multigenerational project plan with 3 major components was developed. Step 1: Stabilize; Step 2: Optimize; Step 3: Innovate. By including staff and process owners in the process, they are empowered to think differently about what they do and how they do it. A team that works collaboratively to identify problems and develop solutions can only be a positive to any organization.

Clinical and sociodemographic correlates of suicidality in patients with major depressive disorder from six Asian countries.

Science.gov (United States)

Lim, Ah-Young; Lee, Ah-Rong; Hatim, Ahmad; Tian-Mei, Si; Liu, Chia-Yih; Jeon, Hong Jin; Udomratn, Pichet; Bautista, Dianne; Chan, Edwin; Liu, Shen-Ing; Chua, Hong Choon; Hong, Jin Pyo

2014-02-13

East Asian countries have high suicide rates. However, little is known about clinical and sociodemographic factors associated with suicidality in Asian populations. The aim of this study was to evaluate the factors associated with suicidality in patients with major depressive disorder (MDD) from six Asian countries. The study cohort consisted of 547 outpatients with MDD. Patients presented to study sites in China (n = 114), South Korea (n = 101), Malaysia (n = 90), Singapore (n = 40), Thailand (n = 103), and Taiwan (n = 99). All patients completed the Mini-International Neuropsychiatric Interview (MINI), the Montgomery-Asberg Depression Rating Scale (MADRS), the Global Severity Index(SCL-90R), the Fatigue Severity Scale, the 36-item short-form health survey, the Sheehan Disability Scale, and the Multidimensional Scale of Perceived Social Support (MSPSS). Patients were classified as showing high suicidality if they scored ≥ 6 on the MINI suicidality module. Multivariate logistic regression analysis was used to examine sociodemographic and clinical factors related to high suicidality. One hundred and twenty-five patients were classed as high suicidality. Unemployed status (adjusted odds ratio [OR] 2.43, p < 0.01), MADRS score (adjusted OR 1.08), p < 0.001, and GSI (SCL-90R) score (adjusted OR 1.06, p < 0.01) were positively related to high suicidality. Hindu (adjusted OR 0.09, p < 0.05) or Muslim (adjusted OR 0.21, p < 0.001) religion and MSPSS score (adjusted OR 0.82, p < 0.05) were protective against high suicidality. A variety of sociodemographic and clinical factors were associated with high suicidality in Asian patients with MDD. These factors may facilitate the identification of MDD patients at risk of suicide.

Examining the online approaches used by hospitals in Sydney, Australia to inform patients about healthcare associated infections and infection prevention strategies.

Science.gov (United States)

Park, J; Seale, H

2017-12-21

Provision of information plays a critical role in supporting patients to be engaged or empowered to be involved with infection prevention measures in hospitals. This explorative study evaluated the suitability, readability and accessibility of information on healthcare associated infections (HCAIs) and infection prevention strategies targeted at patients from the websites of 19 acute care public hospitals in Sydney, Australia. We included hospitals with greater than 200 beds in the sample. We examined online information targeted at patients on HCAIs and infection prevention and compared it using the Suitability Assessment of Material (SAM) and Simple Measure of Gobbledygook (SMOG) readability formulas for suitability, readability and accessibility. Thirty-six webpages were identified as being relevant and containing information about HCAIs or infection prevention. Based on the SAM/SMOG scores, only three webpages were found to be 'superior'. Many of the webpages scored poorly in content, literacy, graphics, learning stimulation and cultural appropriateness. In comparison, most of the webpages scored well in the layout and typography. The majority (97%) of the materials were written at a level higher than the recommended reading grade level. Lastly, the websites scored poorly on the ability to locate the information easily, as messages about HCAIs/infection prevention were usually embedded into other topics. While providing information online is only one approach to delivering messages about infection prevention, it is becoming increasingly important in today's technology society. Hospitals are neglecting to use best practices when designing their online resources and current websites are difficult to navigate. The findings point to the need to review patient information on HCAIs regarding suitability, readability and accessibility.

A patient's view on the location of the temporomandibular joint.

Science.gov (United States)

Koole, Paul; Zonnenberg, Adriaan J J; Mulder, Jan

2018-03-25

Objective A survey was held to establish whether laypeople knew the location of their temporomandibular joint. Methods A sample of 61 participants, visiting their dental office for a routine check-up, was given a three-question survey of whether they knew the location of their temporomandibular joint and could point to this location. Results Thirty-eight participants answered the question affirmatively. Only 13 pointed to the correct location. Of these, six participants received consultation for TMD in the past, three participants were healthcare providers, and four participants actually had knowledge of the exact location. Out of 23 participants who did not know the location, one accidently designated the correct position. Conclusion The location of the temporomandibular joint is not a well-known site for many patients. In the presence of orofacial pain, it seems advisable to let the patient designate and record the site of the pain on a drawing on the patient chart.

Comparative Analysis between Lean, Six Sigma and Lean Six Sigma Concepts

Directory of Open Access Journals (Sweden)

Alexandra Mirela Cristina MUNTEANU

2017-06-01

Full Text Available This paper analyzes the benefits of Lean Six Sigma in comparison with Lean and Six Sigma, traditional improvement methodologies. The introduction highlights the appearance of Lean Six Sigma, early 2000s, as well as the benefits brought by the integrated approach. The following parts of the study emphasize the main differences between methodologies and their commonalities based on their synergy. Finally the advantages of Lean Six Sigma versus Lean and Six Sigma are analyzed and systematized by author in order to reveal Lean Six Sigma’s benefits.

Game-Based Virtual Reality Canoe Paddling Training to Improve Postural Balance and Upper Extremity Function: A Preliminary Randomized Controlled Study of 30 Patients with Subacute Stroke.

Science.gov (United States)

Lee, Myung Mo; Lee, Kyeong Jin; Song, Chang Ho

2018-04-27

BACKGROUND Virtual reality (VR) training with motion-controlled console games can be incorporated into stroke rehabilitation programs. The use of a variety of gaming software can provide the patient with an opportunity to perform activities that are exciting, entertaining, and that may not be feasible in clinical environments. The aim of this preliminary randomized controlled study was to investigate the effects of game-based VR canoe paddling training, when combined with conventional physical rehabilitation programs, on postural balance and upper extremity function in 30 patients with subacute stroke. MATERIAL AND METHODS Thirty patients, who were within six months following the diagnosis of stroke, were randomly allocated to either the experimental group (n=15) or the control group (n=15). All participants participated in a conventional rehabilitation program. Also, the experimental group (n=15) performed the VR canoe paddling training for 30 minutes each day, three times per week, for five weeks. After five weeks, outcomes of changes in postural balance and upper extremity function were evaluated and compared between the two groups. RESULTS At five weeks, postural balance and upper extremity function showed significant improvements in both patients groups when compared with the baseline measurements (pGame-based VR canoe paddling training is an effective rehabilitation therapy that enhances postural balance and upper extremity function in patients with subacute stroke when combined with conventional physical rehabilitation programs.

Quality of life and fatigue of patients with spinal bone metastases under combined treatment with resistance training and radiation therapy- a randomized pilot trial

International Nuclear Information System (INIS)

Rief, Harald; Gioules, Alexandros; Debus, Jürgen; Akbar, Michael; Keller, Monika; Omlor, Georg; Welzel, Thomas; Bruckner, Thomas; Rieken, Stefan; Häfner, Matthias F; Schlampp, Ingmar

2014-01-01

The aim of this trial was to compare the effects of resistance training versus passive physical therapy on quality of life (QoL), fatigue, and emotional distress outcomes during radiation therapy in patients with spinal bone metastases under radiotherapy (RT). In this randomized trial, 60 patients were treated from September 2011 until March 2013 into one of the two groups: isometric resistance training or physical therapy with thirty patients in each group during RT. EORTC QLQ-BM22, EORTC QLQ-FA13, and FBK-R10 were assessed at baseline, three months, and six months after RT. Psychosocial aspects in resistance training group (Arm A) were significantly improved after three (p = 0.001) and six months (p = 0.010). Other rated items of the QLQ-BM22 painful site, and pain characteristics were without significant differences. Functional interference showed a positive trend after six months (p = 0.081). After six months, physical fatigue (p = 0.013), and interference with daily life (p = 0.006) according to the QLQ-FA13 assessment improved in Arm A significantly. Emotional distress was in Arm A lower after six months (p = 0.016). The Cohen’s effect size confirmed the clinically significant improvement of these findings. In this group of patients we were able to show that guided isometric resistance training of the paravertebral muscles can improve functional capacity, reduce fatigue and thereby enhance QoL over a 6-months period in patients with stable spinal metastases. The results offer a rationale for future large controlled investigations to confirm these findings

Safety and efficacy of ranirestat in patients with mild-to-moderate diabetic sensorimotor polyneuropathy.

Science.gov (United States)

Polydefkis, Michael; Arezzo, Joseph; Nash, Marshall; Bril, Vera; Shaibani, Aziz; Gordon, Robert J; Bradshaw, Kate L; Junor, Roderick W J

2015-12-01

We examined the efficacy and safety of ranirestat in patients with diabetic sensorimotor polyneuropathy (DSPN). Patients (18-75 years) with stable type 1/2 diabetes mellitus and DSPN were eligible for this global, double-blind, phase II/III study (ClinicalTrials.gov NCT00927914). Patients (n = 800) were randomized 1 : 1 : 1 to placebo, ranirestat 40 mg/day or 80 mg/day (265 : 264 : 271). Change in peroneal motor nerve conduction velocity (PMNCV) from baseline to 24 months was the primary endpoint with a goal improvement vs. placebo ≥1.2 m/s. Other endpoints included symptoms, quality-of-life, and safety. Six hundred thirty-three patients completed the study. The PMNCV difference from placebo was significant at 6, 12, and 18 months in both ranirestat groups, but diabetes. © 2015 Peripheral Nerve Society.

Quality of patient education materials for rehabilitation after neurological surgery.

Science.gov (United States)

Agarwal, Nitin; Sarris, Christina; Hansberry, David R; Lin, Matthew J; Barrese, James C; Prestigiacomo, Charles J

2013-01-01

To evaluate the quality of online patient education materials for rehabilitation following neurological surgery. Materials were obtained from the National Institute of Neurological Disorders and Stroke (NINDS), U.S. National Library of Medicine (NLM), American Occupational Therapy Association (AOTA), and the American Academy of Orthopaedic Surgeons (AAOS). After removing unnecessary formatting, the readability of each site was assessed using the Flesch Reading Ease and Flesch-Kincaid Grade Level evaluations with Microsoft Office Word software. The average values of the Flesch Reading Ease and Flesch-Kincaid Grade Level were 41.5 and 11.8, respectively, which are well outside the recommended reading levels for the average American. Moreover, no online section was written below a ninth grade reading level. Evaluations of several websites from the NINDS, NLM, AOTA, and AAOS demonstrated that their reading levels were higher than that of the average American. Improved readability might be beneficial for patient education. Ultimately, increased patient comprehension may correlate to positive clinical outcomes.

Modeling Glaucoma: Retinal Ganglion Cells Generated from Induced Pluripotent Stem Cells of Patients with SIX6 Risk Allele Show Developmental Abnormalities.

Science.gov (United States)

Teotia, Pooja; Van Hook, Matthew J; Wichman, Christopher S; Allingham, R Rand; Hauser, Michael A; Ahmad, Iqbal

2017-11-01

Glaucoma represents a group of multifactorial diseases with a unifying pathology of progressive retinal ganglion cell (RGC) degeneration, causing irreversible vision loss. To test the hypothesis that RGCs are intrinsically vulnerable in glaucoma, we have developed an in vitro model using the SIX6 risk allele carrying glaucoma patient-specific induced pluripotent stem cells (iPSCs) for generating functional RGCs. Here, we demonstrate that the efficiency of RGC generation by SIX6 risk allele iPSCs is significantly lower than iPSCs-derived from healthy, age- and sex-matched controls. The decrease in the number of RGC generation is accompanied by repressed developmental expression of RGC regulatory genes. The SIX6 risk allele RGCs display short and simple neurites, reduced expression of guidance molecules, and immature electrophysiological signature. In addition, these cells have higher expression of glaucoma-associated genes, CDKN2A and CDKN2B, suggesting an early onset of the disease phenotype. Consistent with the developmental abnormalities, the SIX6 risk allele RGCs display global dysregulation of genes which map on developmentally relevant biological processes for RGC differentiation and signaling pathways such as mammalian target of rapamycin that integrate diverse functions for differentiation, metabolism, and survival. The results suggest that SIX6 influences different stages of RGC differentiation and their survival; therefore, alteration in SIX6 function due to the risk allele may lead to cellular and molecular abnormalities. These abnormalities, if carried into adulthood, may make RGCs vulnerable in glaucoma. Stem Cells 2017;35:2239-2252. © 2017 AlphaMed Press.

A qualitative exploration of patients' attitudes towards the 'Participate Inform Notice Know' (PINK) patient safety video.

Science.gov (United States)

Pinto, Anna; Vincent, Charles; Darzi, Ara; Davis, Rachel

2013-02-01

To explore patients' attitudes towards the PINK video, a patient education video aimed at encouraging hospital patients' involvement in safety-relevant behaviours. Qualitative semi-structured interviews. Detailed field notes were taken during the interviews which were analysed using content analysis. One National Health System (NHS) teaching hospital based in London, UK. Thirty-six in-patients aged between 20 and 79 years, 18 of them males. The PINK video is a short animated educational video aimed at encouraging patients to be involved in the safety of their care during hospitalization. Patients' perceptions of how informative, relevant and acceptable the video is; attitudes towards participating in the recommended safety-related behaviours and; potential negative side effects of watching the video. Overall the video was received favourably among the interviewees. Commonly cited benefits included raising awareness and facilitating patients to be involved in their care during their hospital stay. More variability was found in participants' views with regard to the video's role as a patient safety enhancement tool. A number of suggestions for improvement of the video were provided relating to tailoring its content and design to meet the needs of individual patients and their circumstances. Educational videos such as PINK have significant potential to empower patients in the safety and quality of their care. However, efforts to implement patient safety educational videos in practice need to consider different patient groups' needs and characteristics instead of trying to adopt 'a one size fits all' approach.

ACL status in arthroplasty patients, why not to preserve?

Directory of Open Access Journals (Sweden)

Abdelbadie Ahmed

2018-01-01

Full Text Available Introduction: Only 70–85% of patients that had total knee arthroplasty (TKA are satisfied with their knees. The need for a near to normal knee kinematics is crucial and maybe the solution to their needs. Addressing the cruciate ligaments during surgery along with the extent of arthrosis may give a solution to this problem. Material and methods: One hundred consecutive patients in whom a total knee arthroplasty was indicated and performed were prospectively documented. During the knee replacement surgery, the condition of the anterior and posterior cruciate ligaments and the degree of osteoarthritis (OA in the medial and lateral compartments as well as in the patello-femoral joint were documented using the Outerbridge classification. The patients’ average age was 72.3 years, with the majority being female. In all patients, a total bi-compartmental knee replacement was indicated. Results: Our results showed that in 78% of all patients the anterior, and in 98% the posterior cruciate ligament was still intact. Seventy-one percent of cases suffered from grade 4 medial osteoarthritis, 19% from grade 3 and 10% from grade 2. Thirty-six of patients suffered from grade 4 lateral osteoarthritis, 36% from grade 3, 24% from grade 2 and 4% from grade 1. Grade 4 patello-femoral osteoarthritis was present in 32% of all patients, grade 3 in 60% and grade 2 in 8% of all patients. Discussion: The goal of arthroplasty is to approximate the function of a normal knee. The retention of the anterior cruciate ligament (ACL allows for better knee, kinematics, improved proprioception, increased flexion and an overall improvement in knee function. The decreased constraint that is possible with retention of both cruciates may decrease implant stresses and improve the implant survivorship. The distribution of OA shows that the medial and patello-femoral compartments of the joint are primarily affected. This could also allow for a more conservative and patient

Is outdoor use of the six-minute walk test with a global positioning system in stroke patients' own neighbourhoods reproducible and valid?

OpenAIRE

Wevers, L.E.; Kwakkel, G.; Port, van de, I.G.

2011-01-01

Objective: To examine the reproducibility, responsiveness and concurrent validity of the six-minute walk test (6MWT) when tested outdoors in patients' own neighbourhoods using a global positioning system (GPS) or a measuring wheel. Methods: A total of 27 chronic stroke patients, discharged to their own homes, were tested twice, within 5 consecutive days. The 6MWT was conducted using a GPS and an measuring wheel simultaneously to determine walking distance. Reproducibility was determined as te...

Epileptic seizures in Neuro-Behcet disease: why some patients develop seizure and others not?

Science.gov (United States)

Kutlu, Gulnihal; Semercioglu, Sencer; Ucler, Serap; Erdal, Abidin; Inan, Levent E

2015-03-01

Behcet disease (BD) is a chronic relapsing inflammatory disorder. Neuro BD (NBD) is seen in approximately 5% of all patients. The aim of this study is to investigate the frequency, type and prognosis of epileptic seizures in different forms of NBD. All files of 42 patients with NBD were evaluated between 2006 and 2012, retrospectively. The demographic data, the presentation of NBD, clinical findings including seizures, EEG and neuroimaging findings were reviewed. The mean age of patients was 35.02±8.43 years. Thirty (71.4%) patients were male; the remaining 12 of them were female. Twenty-four patients had brainstem lesions; 16 patients had cerebral venous thrombosis. Spinal cord involvement was seen in two patients. Seven patients had epileptic seizures (six partial onset seizures with or without secondary generalization). Six of them had cerebral sinus thrombosis (CVT). Four patients had a seizure as the first symptom of the thrombosis. One patient had late onset seizure due to chronic venous infarct. The other patient with seizure had brainstem involvement. The remaining was diagnosed as epilepsy before the determination of NBD. CVT seen in BD seems to be the main risk factor for epileptic seizures in patients with NBD. The prognosis is usually good especially in patients with CVT. Epileptic seizures in patients with brainstem involvement may be an indicator for poor prognosis. Superior sagittal thrombosis or cortical infarct would be predictor of seizures occurrence because of the high ratio in patients with seizures. Copyright © 2015 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

Six-channel instantaneous optical pyrometer

International Nuclear Information System (INIS)

Wang Guichao

2001-01-01

An instantaneous optical pyrometer to measure the spectral radiance of the materials shocked to high pressure has been developed. Thermal radiation emitted by the source is sampled at six wavelength bands from visible to near infrared spectrum. And the signal for each channel is separately transited through the optical fiber and then detected by photomultipliers and oscilloscopes with a time resolution of 20 ns. Shock temperatures ranging from 2400 to 9000 K could been reliably measured with an error less than 3%. The results of some experiments on air and NaI crystals are also given

Intraarterial digital subtraction angiography of peripheral arteries with isotonic contrast material

International Nuclear Information System (INIS)

Yashiro, Naobumi; Itai, Yuji; Ohtomo, Kuni; Furui, Shigeru; Iio, Masahiro

1984-01-01

Intraarterial digital subtraction angiography (IADSA) of peripheral arteries with isotonic contrast material, which was prepared by diluting meglumine amidotrizoate (65% Angiografin), was performed in ten patients. In six, both IADSA and conventional screen-film arteriography were performed for comparison. Painless peripheral arteriography was achieved by IADSA with isotonic contrast material. Five IADSAs were safely done on an outpatient basis. Visualization of arteries by IADSA was satisfactory, but the details of smaller arteries were better shown by screen-film arteriography. Visualization of faint stains was better in IADSA. The authors believe that IADSA with isotonic contrast material is a method of choice for the diagnosis of vascular diseases and tumorous conditions of extremities, as well as for the purpose of preoperative vascular mapping. It is safely performed with smaller dose of contrast material on outpatient basis, and with less discomfort and cost for the patient. (author)

Presence of left atrial diverticula, accessory appendages, and normal variant pulmonary venous anatomy diagnosed using MDCT and adverse outcomes following radiofrequency catheter ablation therapy in patients with drug-refractory atrial fibrillation: An exploratory study

International Nuclear Information System (INIS)

Patel, S.N.; French, A.; Mathias, H.; Lyen, S.; Hamilton, M.C.K.; Manghat, N.E.

2013-01-01

Aim: To determine the frequency of normal variation left atrial anatomy (NVLAA) (diverticula, accessory appendages) and normal variation pulmonary venous anatomy (NVPVA) in patients with atrial fibrillation (AF), and to determine whether the presence of these entities is associated with an increased recurrence of atrial arrhythmias following radiofrequency catheter ablation (RFCA). Materials and methods: All cardiac MDCT images performed prior to RFCA between November 2009 and May 2011 in patients with drug-refractory AF were retrospectively evaluated. The presence, type, and location of NVLAA and NVPVA, and outcome of RFCA were recorded. Success was defined as restoration of sinus rhythm. Results: Forty-six consecutive patients with a mean age of 59.8 (±9.7) years (76.1% male) underwent cardiac MDCT for anatomical planning prior to RFCA procedures. Fourteen (30.4%) patients had NVLAA, 35% of patients had NVPVA. Thirty (65%) patients had successful RFCA: 57% of these had a NVLAA, 67% had NVPVA. Sixteen (35%) patients had unsuccessful RFCA: 63% of these had a NVLAA, 56% had NVPVA. There was no significant association between the presence of NVLAA (p = 0.699), NVPVA (p = 0.197), or “NVLAA in the presence of normal pulmonary venous anatomy” (p = 0.589) and the outcome of RFCA. Conclusion: The presence of NVLAA and NVPVA appears unrelated to adverse outcome in patients undergoing RFCA for the treatment of drug-refractory AF

Using Six Sigma and Lean methodologies to improve OR throughput.

Science.gov (United States)

Fairbanks, Catharine B

2007-07-01

Improving patient flow in the perioperative environment is challenging, but it has positive implications for both staff members and for the facility. One facility in vermont improved patient throughput by incorporating Six Sigma and Lean methodologies for patients undergoing elective procedures. The results of the project were significantly improved patient flow and increased teamwork and pride among perioperative staff members. (c) AORN, Inc, 2007.

Availability of cosmetic treatment using novel cosmetics-based material on patients with craniofacial concavity.

Science.gov (United States)

Koyama, Shigeto; Kanetaka, Hiroyasu; Sagehashi, Yoshinori; Sasaki, Keiichi; Sato, Naoko

2018-03-08

Patients treated with maxillofacial prosthetics often experience emotional problems because of the remaining facial skin concavity such as a surgical scar. In such cases, cosmetic treatment can potentially correct their skin tone imperfections and deformities. This study aimed to evaluate the clinical availability of novel cosmetics-based material for craniofacial small concavity by initiating a cosmetic treatment in a preliminary case. Eighteen patients with aesthetic problems such as craniofacial deformities, small defects, and concavities on their faces underwent cosmetic treatment that was performed by makeup practitioners. Data were collected from the patient's charts and a survey questionnaire. A visual analog scale was used to conduct a survey regarding the satisfaction levels of the patients following cosmetic treatment with a novel cosmetics-based material. The cosmetic treatment was performed for a concavity on the left midface of a 67-year-old woman with partial maxillectomy. The novel cosmetics-based material was manufactured from a semi-translucent oil base. The satisfaction level of the patient increased after undergoing the cosmetic treatment. Regarding clinical applications, the novel cosmetics-based material can help reduce their cosmetic disturbance and restore the small deformity. These results suggest that the cosmetic treatment with the novel cosmetics-based material can be used as a subsidiary method for facial prostheses or an independent new method for correcting patients' small craniofacial concavity and for reducing visible deformity. Copyright © 2018 Japan Prosthodontic Society. Published by Elsevier Ltd. All rights reserved.

Comparative Analysis between Lean, Six Sigma and Lean Six Sigma Concepts

OpenAIRE

Alexandra Mirela Cristina MUNTEANU

2017-01-01

This paper analyzes the benefits of Lean Six Sigma in comparison with Lean and Six Sigma, traditional improvement methodologies. The introduction highlights the appearance of Lean Six Sigma, early 2000s, as well as the benefits brought by the integrated approach. The following parts of the study emphasize the main differences between methodologies and their commonalities based on their synergy. Finally the advantages of Lean Six Sigma versus Lean and Six Sigma are analyzed and systematized by...

State-Independent Proof of Kochen—Specker Theorem with Thirty Rank-Two Projectors

International Nuclear Information System (INIS)

Toh, S. P.

2013-01-01

The Kochen—Specker theorem states that noncontextual hidden variable theories are incompatible with quantum mechanics. We provide a state-independent proof of the Kochen—Specker theorem using the smallest number of projectors, i.e., thirty rank-2 projectors, associated with the Mermin pentagram for a three-qubit system

Structure - materials - production

DEFF Research Database (Denmark)

Gammelgaard Nielsen, Anders; Gammel, Peder; Busch, Jens

2002-01-01

For the last six years th Aarhus School of Architecture has introduced the first year students (there are about 200 students admitted each year) to structure, materials, design and production through a five week course in collaboration with a group of local companies.......For the last six years th Aarhus School of Architecture has introduced the first year students (there are about 200 students admitted each year) to structure, materials, design and production through a five week course in collaboration with a group of local companies....

Readability of online patient education materials for velopharyngeal insufficiency.

Science.gov (United States)

Xie, Deborah X; Wang, Ray Y; Chinnadurai, Sivakumar

2018-01-01

Evaluate the readability of online and mobile application health information about velopharyngeal insufficiency (VPI). Top website and mobile application results for search terms "velopharyngeal insufficiency", "velopharyngeal dysfunction", "VPI", and "VPD" were analyzed. Readability was determined using 10 algorithms with Readability Studio Professional Edition (Oleander Software Ltd; Vandalia, OH). Subgroup analysis was performed based on search term and article source - academic hospital, general online resource, peer-reviewed journal, or professional organization. 18 unique articles were identified. Overall mean reading grade level was a 12.89 ± 2.9. The highest reading level among these articles was 15.47-approximately the level of a college senior. Articles from "velopharyngeal dysfunction" had the highest mean reading level (13.73 ± 2.11), above "velopharyngeal insufficiency" (12.30 ± 1.56) and "VPI" (11.66 ± 1.70). Articles from peer-reviewed journals had the highest mean reading level (15.35 ± 2.79), while articles from academic hospitals had the lowest (12.81 ± 1.66). There were statistically significant differences in reading levels between the different search terms (P reading level guidelines, online patient education materials for VPI are disseminated with language too complex for most readers. There is also a lack of VPI-related mobile application data available for patients. Patients will benefit if future updates to websites and disseminated patient information are undertaken with health literacy in mind. Future studies will investigate patient comprehension of these materials. Copyright © 2017 Elsevier B.V. All rights reserved.

Readability assessment of online patient education materials from academic otolaryngology-head and neck surgery departments.

Science.gov (United States)

Svider, Peter F; Agarwal, Nitin; Choudhry, Osamah J; Hajart, Aaron F; Baredes, Soly; Liu, James K; Eloy, Jean Anderson

2013-01-01

The aim of this study was to compare the readability of online patient education materials among academic otolaryngology departments in the mid-Atlantic region, with the purpose of determining whether these commonly used online resources were written at a level readily understood by the average American. A readability analysis of online patient education materials was performed using several commonly used readability assessments including the Flesch Reading Ease Score, the Flesch-Kincaid Grade Level, Simple Measure of Gobbledygook, Gunning Frequency of Gobbledygook, the New Dale-Chall Test, the Coleman-Liau Index, the New Fog Count, the Raygor Readability Estimate, the FORCAST test, and the Fry Graph. Most patient education materials from these programs were written at or above an 11th grade reading level, considerably above National Institutes of Health guidelines for recommended difficulty. Patient educational materials from academic otolaryngology Web sites are written at too difficult a reading level for a significant portion of patients and can be simplified. Copyright © 2013 Elsevier Inc. All rights reserved.

Different effect of psyllium and guar dietary supplementation on blood pressure control in hypertensive overweight patients: a six-month, randomized clinical trial.

Science.gov (United States)

Cicero, Arrigo F G; Derosa, Giuseppe; Manca, Marco; Bove, Marilisa; Borghi, Claudio; Gaddi, Antonio V

2007-08-01

In the setting of a six-month, open-label clinical trial, 141 consecutively enrolled, hypertensive, overweight patients were randomized to the oral ingestion of psyllium powder or guar gum 3.5 gr t.i.d., to be taken 20 min before the main two meals, or to standard diet. Both fibers improved significantly BMI, FPG, FPI, HOMA Index, HbA1c, LDL-C, and ApoB. Psyllium supplementation only exerted a significant improvement in plasma TG concentration, in SBP and DBP. In our study, six-month supplementation with psyllium fiber, but not with guar fiber nor standard diet, appears to significantly reduce both SBP and DBP in hypertensive overweight subjects.

A thirty million year-old inherited heteroplasmy.

Directory of Open Access Journals (Sweden)

Vincent Doublet

Full Text Available Due to essentially maternal inheritance and a bottleneck effect during early oogenesis, newly arising mitochondrial DNA (mtDNA mutations segregate rapidly in metazoan female germlines. Consequently, heteroplasmy (i.e. the mixture of mtDNA genotypes within an organism is generally resolved to homoplasmy within a few generations. Here, we report an exceptional transpecific heteroplasmy (predicting an alanine/valine alloacceptor tRNA change that has been stably inherited in oniscid crustaceans for at least thirty million years. Our results suggest that this heteroplasmy is stably transmitted across generations because it occurs within mitochondria and therefore escapes the mtDNA bottleneck that usually erases heteroplasmy. Consistently, at least two oniscid species possess an atypical trimeric mitochondrial genome, which provides an adequate substrate for the emergence of a constitutive intra-mitochondrial heteroplasmy. Persistence of a mitochondrial polymorphism on such a deep evolutionary timescale suggests that balancing selection may be shaping mitochondrial sequence evolution in oniscid crustaceans.

Health Literacy: Readability of ACC/AHA Online Patient Education Material.

Science.gov (United States)

Kapoor, Karan; George, Praveen; Evans, Matthew C; Miller, Weldon J; Liu, Stanley S

To determine whether the online patient education material offered by the American College of Cardiology (ACC) and the American Heart Association (AHA) is written at a higher level than the 6th-7th grade level recommended by the National Institute of Health (NIH). Online patient education material from each website was subjected to reading grade level (RGL) analysis using the Readability Studio Professional Edition. One-sample t testing was used to compare the mean RGLs obtained from 8 formulas to the NIH-recommended 6.5 grade level and 8th grade national mean. In total, 372 articles from the ACC website and 82 from the AHA were studied. Mean (±SD) RGLs for the 454 articles were 9.6 ± 2.1, 11.2 ± 2.1, 11.9 ± 1.6, 10.8 ± 1.6, 9.7 ± 2.1, 10.8 ± 0.8, 10.5 ± 2.6, and 11.7 ± 3.5 according to the Flesch-Kincaid grade level (FKGL), Simple Measure of Gobbledygook (SMOG Index), Coleman-Liau Index (CLI), Gunning-Fog Index (GFI), New Dale-Chall reading level formula (NDC), FORCAST, Raygor Readability Estimate (RRE), and Fry Graph (Fry), respectively. All analyzed articles had significantly higher RGLs than both the NIH-recommended grade level of 6.5 and the national mean grade level of 8 (p education material provided on the ACC and AHA websites is written above the NIH-recommended 6.5 grade level and 8th grade national mean reading level. Additional studies are required to demonstrate whether lowering the RGL of this material improves outcomes among patients with cardiovascular disease. © 2017 S. Karger AG, Basel.

Quality Assessment of Diabetes Online Patient Education Materials from Academic Institutions

Science.gov (United States)

Dorcely, Brenda; Agarwal, Nitin; Raghuwanshi, Maya

2015-01-01

Objective: The purpose of this study was to assess and compare the readability of type 2 diabetes online patient education materials from academic institutions in the northeast USA and the American Diabetes Association. Many US residents utilise the Internet to obtain health information. Studies have shown that online patient education materials…

Personal and Parents’ Life Stories in Patients with Borderline Personality Disorder

DEFF Research Database (Denmark)

Lind, Majse; Thomsen, Dorthe Kirkegaard; Bøye, Rikke

. Thirty patients with BPD and thirty matched control participants described and answered questions about their personal life stories and their parents’ life stories and completed measures of identity disturbance, alexithymia, empathy, and emotional intelligence. Compared to the control group, patients...

Thirty-two years of Acta Neophilologica - with gratitude to its founder and editor Professor Janez Stanonik

Directory of Open Access Journals (Sweden)

Mirko Jurak

2000-12-01

Full Text Available In spring this year Professor Janez Stanonik decided to retire as the Editor of the scholarly journal Acta Neophilologica, which he founded in 1968 and edited for thirty-two years. I endeavoured to help him with the material side of the journal from the very beginning until1995; since then this task has been performed by the present Associate Editor. At the time when Janez Stanonik began publishing this journal, his main aim was to make our research work in Western European and American literature better known to scholars all over the world. However, in a few years' time the journal also became open to scholars from other countries and other fields, particularly in areas connected with Slovene literature and culture, Slovene immigrant literature, and linguistics. I believe that this approach gave the journal a new openness and that it enriched its quality, therefore I intend to follow this policy in the future too.

Efficacy of postal communication with patients who have cryopreserved pre-embryos.

Science.gov (United States)

Brzyski, R G

1998-11-01

To compare the characteristics of patients who did and did not respond to a request for information regarding their cryopreserved pre-embryos. Mail survey. Academic-assisted reproductive technology program. One hundred thirty-six patients with cryopreserved pre-embryos. Patients were surveyed by first-class mail regarding their plans for their cryopreserved pre-embryos and their interest in embryo donation. Age, number of stored pre-embryos, and duration of storage of responders and nonresponders at 6 weeks after mailing. Eighty-three patients (62%) did not respond to the survey. Compared with responders, nonresponders were significantly older at the time of embryo cryopreservation, had fewer pre-embryos cryopreserved, and had the pre-embryos cryopreserved for a longer duration. Five responders (9%) expressed an interest in embryo donation. Three patients requested disposal of pre-embryos. Sixteen surveys (12%) were returned as undeliverable. As a group, these patients had the fewest pre-embryos cryopreserved and had the longest duration of storage. A disturbing number of patients with cryopreserved pre-embryos ignored efforts by our program to maintain contact. Older patients with few cryopreserved pre-embryos may require special attention to avoid abandonment.

The digital divide in Internet-based patient education materials.

Science.gov (United States)

Sun, Gordon H

2012-11-01

The ubiquity of the Internet has led to the widespread availability of health-related information to the public, and the subsequent empowerment of patients has fundamentally altered the patient-physician relationship. Among several concerns of physicians is the possibility that patients may be misinformed by information obtained from the Internet. One opportunity for health care providers to address this problem exists within Internet-based patient education materials (IPEMs). According to recent research in Otolaryngology-Head and Neck Surgery, IPEMs found within professional otolaryngology websites are written at the 8th- to 18th-grade reading comprehension level, essentially unchanged over the past 3 years. This greatly exceeds the fourth- to sixth-grade reading level recommended by the National Institutes of Health. Benefits, strategies, and challenges to improving the readability of IPEMs are discussed.

Opioid Usage During Admission in Hip Fracture Patients-The Effect of the Continuous Femoral Nerve Block

DEFF Research Database (Denmark)

Helsø, Ida; Jantzen, Christopher; Lauritzen, Jes Bruun

2016-01-01

INTRODUCTION: The aim of this study was to investigate whether there was a difference in opioid usage during admission for hip fracture patients with continuous femoral nerve block (cFNB) when compared to patients nonfemoral nerve block (nFNB). METHODS AND MATERIALS: Patients were identified from...... the local database on all hip fracture patients admitted to Bispebjerg University Hospital, Denmark. Four hundred fifty-six hip fracture patients were included during the period September 2008 to October 2010. RESULTS: Three hundred sixty-six hip fracture patients had cFNB. The mean time with cFNB was 3...

The six-spot-step test - a new method for monitoring walking ability in patients with chronic inflammatory polyneuropathy

DEFF Research Database (Denmark)

Kreutzfeldt, Melissa; Jensen, Henrik B; Ravnborg, Mads

2017-01-01

OBJECTIVE: To evaluate whether the Six-Spot-Step-Test (SSST) is more suitable for monitoring walking ability in patients with chronic inflammatory polyneuropathy than the Timed-25-Foot-Walking test (T25FW). METHOD: In the SSST, participants have to walk as quickly as possible across a field...... of effect size, standardized response means and relative efficiency. Both ambulation tests correlated moderately to PGIC. CONCLUSION: The SSST may be superior to the T25FW in terms of dynamic range, floor effect and responsiveness which makes the SSST a possible alternative for monitoring walking ability...

Assessment of patients' awareness and factors influencing patients' demands for sedation in endodontics.

Science.gov (United States)

Huh, Yoo Kyeom; Montagnese, Thomas A; Harding, Jarrod; Aminoshariae, Anita; Mickel, Andre

2015-02-01

Endodontic therapy is perceived by many as a procedure to be feared. Many studies have reported that fear and anxiety are major deterrents to seeking dental care in general, but only a few deal with the use of sedation in endodontic therapies. The purpose of this study was to assess patients' awareness of and factors influencing the potential demand for sedation in endodontics. We hypothesized that there is an association between demographic factors and the demand for sedation in endodontics. A survey consisting of 24 questions was given to patients 18 years and older who presented to the graduate endodontic clinic. Results were collected and statistically analyzed. Thirty-six percent of patients reported that their perception of sedation was being put to sleep, and 27% perceived it as related to or reducing pain. Concerns associated with endodontic therapy were the fear of pain (35%), fear of needles (16%), difficulty getting numb (10%), and anxiety (7%). The 2 major demographic factors that influenced the demand for sedation were cost and the level of anxiety (P endodontic therapy if the option of sedation was available. The demand for sedation in endodontics is high. Patients' understanding of sedation varies. More patients would consider having endodontic procedures if sedation was available. The provision of sedation by endodontists could result in more patients accepting endodontic therapies. Copyright © 2015 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

The clinical features, laboratory findings, treatment and follow-up results of patients with morphea

Directory of Open Access Journals (Sweden)

Nehir Parlak

2013-12-01

Full Text Available Objective: Morphea, also known as localized scleroderma, is a rare skin disease of unknown pathogenesis, characterized by fibrosis in the skin and subcutaneous tissue. In this study, we aim to evaluate the demographic features, clinical characteristics, laboratory findings, and response to treatment in patients diagnosed with morphea. Materials and Methods: The findings of fifty eight patients diagnosed with morphea were retrospectively evaluated between 1995-2011. All patients' clinical symptoms, concomitant diseases, symptoms, immunological features and presence of peripheral eosinophilia were investigated. Treatment methods, response to therapy of 40 patients whose treatment continued for 2-12 months were examined. Fourty nine patients (84.5% were female and 9 patients (15.5% were male of 58 patients who were diagnosed with morphea. The mean age of patients was 42.33±18.44 years (range: 7-75 years. Diagnosis was made histopathologically in all cases. Borrelia antibodies were negative in all patients enrolling the study. Thirty six patients (62.1% had plaque type, 17 patients (29.3% had generalized type, 3 patients (5.2% had mixed type (linear + plaque and 2 patients (3.4% had linear type of morphea. ANA was found to be positive in 12 (26.2% of 46 patients. Considering the relationship between the clinical types of morphea with ANA, 38.5% of plaque type, 53.8% of generalized type, 7.7% of mixed type patients showed ANA positivity. ANA positivity was statistically significant in patients with generalized morphea (p=0.027. Peripheral eosinophilia was detected in one case in whom lesions were generalized (2.1%. Colchicine therapy was given to 23 cases. Complete and partial response rates are 47.8% and 26.1%, respectively. However, 17.4% of patients remained stable and progression was noted in 8.7% of the cases. Conclusion: In conclusion, plaque type morphea is the most common type of morphea. ANA positivity was statistically significant in

Readability of the Most Commonly Accessed Arthroscopy-Related Online Patient Education Materials.

Science.gov (United States)

Akinleye, Sheriff D; Krochak, Ryan; Richardson, Nicholas; Garofolo, Garret; Culbertson, Maya Deza; Erez, Orry

2018-04-01

To assess the readability and comprehension of written text by the most commonly visited websites containing patient education materials on common conditions that can be treated arthroscopically. We examined 50 websites, assessed independently by 2 orthopaedic surgery residents (S.A. and G.G.), with educational materials on 5 common conditions treated by arthroscopic surgeons: anterior cruciate ligament (ACL) tear, meniscus tear, hip labral tear, shoulder labral tear, and rotator cuff tear. Following a Google search for each condition, we analyzed the 10 most visited websites for each disorder using a widely used and validated tool for assessing the reading levels of written materials (Flesch-Kincaid formula). The average grade reading level of the 50 websites studied was 9.90 with a reading ease of 52.14 ("fairly difficult, high school"). Only 26% of the websites were at or below the national average of an eighth-grade reading level. Of the 5 conditions treated by arthroscopic surgery, ACL tear had the highest average grade reading level at 10.73 ± 1.54, whereas meniscus tear had the lowest at 9.31 ± 1.81. Every condition in this study had an average readability at or above the ninth-grade reading level. The most frequently accessed materials for patients with injuries requiring arthroscopic surgery exceeds the readability recommendations of the American Medical Association and National Institutes of Health, as well as the average reading ability of US adults. Given the fact that these are the most commonly visited websites by the lay public, there needs to be a greater emphasis on tailoring written information to the literacy levels of the patient population. This study emphasizes the discrepancy between the recommended versus the measured reading levels of online patient education materials related to conditions treated by arthroscopic surgeons. The subject matter of these conditions is inherently complex; thus, relying solely on text to inform patients

Evaluating the complexity of online patient education materials about brain aneurysms published by major academic institutions.

Science.gov (United States)

Gupta, Raghav; Adeeb, Nimer; Griessenauer, Christoph J; Moore, Justin M; Patel, Apar S; Kim, Christopher; Thomas, Ajith J; Ogilvy, Christopher S

2017-08-01

OBJECTIVE Health care education resources are increasingly available on the Internet. A majority of people reference these resources at one point or another. A threshold literacy level is needed to comprehend the information presented within these materials. A key component of health literacy is the readability of educational resources. The National Institutes of Health (NIH) and the American Medical Association have recommended that patient education materials be written between a 4th- and a 6th-grade education level. The authors assessed the readability of online patient education materials about brain aneurysms that have been published by several academic institutions across the US. METHODS Online patient education materials about brain aneurysms were downloaded from the websites of 20 academic institutions. The materials were assessed via 8 readability scales using Readability Studio software (Oleander Software Solutions), and then were statistically analyzed. RESULTS None of the patient education materials were written at or below the NIH's recommended 6th-grade reading level. The average educational level required to comprehend the texts across all institutions, as assessed by 7 of the readability scales, was 12.4 ± 2.5 (mean ± SD). The Flesch Reading Ease Scale classified the materials as "difficult" to understand, correlating with a college-level education or higher. An ANOVA test found that there were no significant differences in readability among the materials from the institutions (p = 0.215). CONCLUSIONS Brain aneurysms affect 3.2% of adults 50 years or older across the world and can cause significant patient anxiety and uncertainty. Current patient education materials are not written at or below the NIH's recommended 4th- to 6th-grade education level.

Sixteen-slice multidetector computed tomographic virtual cystoscopy in the evaluation of a patient with suspected bladder tumor and history of bladder carcinoma operation.

Science.gov (United States)

Basak, Muzaffer; Ozkurt, Huseyin; Tanriverdi, Orhan; Cay, Esra; Aydin, Mustafa; Miroglu, Cengiz

2009-01-01

The purpose of this study was to evaluate the use of virtual cystoscopy performed with multidetector computed tomography (CT) in patients with suspected bladder tumors and histories of bladder carcinoma operation. Thirty-six patients (29 men and 7 women) with a mean age of 66 years (range, 24-88 years) with suspected bladder tumors and histories of bladder carcinoma operation were included in this prospective study. Virtual cystoscopy was performed by 16-slice multidetector CT scanner. The bladder was filled with diluted contrast material solution through a Foley catheter. Then, all patients underwent conventional cystoscopy examination. Two reviewers found 18 lesions detected by virtual cystoscopy by consensus, whereas 19 lesions were depicted by conventional cystoscopy. At virtual and conventional cystoscopies, the conditions of 3 patients, 2 with chronic inflammations and 1 with foreign body reaction, were wrongly diagnosed as tumors. At conventional cystoscopy, one patient's result was wrongly interpreted as normal. In pathologic evaluation, all tumors were diagnosed as transitional cell carcinoma. Bladder tumor can be noninvasively diagnosed using virtual cystoscopy. Use of virtual cystoscopy should be considered inpatients who present with hematuria or have histories of bladder carcinoma operation and are for follow-up because of its lesser complication risk and its being a less invasive, easily applied procedure without need of anesthesia. In the future, owing to the development of the CT technology and image processing technique, virtual cystoscopy may have a part in the detection of bladder cancer.

Noninvasive Coronary Angiography using 64-Detector-Row Computed Tomography in Patients with a Low to Moderate Pretest Probability of Significant Coronary Artery Disease

International Nuclear Information System (INIS)

Schlosser, T.; Mohrs, O.K.; Magedanz, A.; Nowak, B.; Voigtlaender, T.; Barkhausen, J.; Schmermund, A.

2007-01-01

Purpose: To evaluate the value of 64-detector-row computed tomography for ruling out high-grade coronary stenoses in patients with a low to moderate pretest probability of significant coronary artery disease. Material and Methods: The study included 61 patients with a suspicion of coronary artery disease on the basis of atypical angina or ambiguous findings in noninvasive stress testing and a class II indication for invasive coronary angiography (ICA). All patients were examined by 64-detector-row computed tomography angiography (CTA) and ICA. On a coronary segmental level, the presence of significant (>50% diameter) stenoses was examined. Results: In a total of 915 segments, CTA detected 62 significant stenoses. Thirty-four significant stenoses were confirmed by ICA, whereas 28 stenoses could not be confirmed by ICA. Twenty-two of them showed wall irregularities on ICA, and six were angiographically normal. Accordingly, on a coronary segmental basis, 28 false-positive and 0 false-negative findings resulted in a sensitivity of 100%, a specificity of 96.8%, a positive predictive value of 54.8%, and a negative predictive value of 100%. The diagnostic accuracy was 96.9%. Conclusion: Sixty-four-detector-row computed tomography reliably detects significant coronary stenoses in patients with suspected coronary artery disease and appears to be helpful in the selection of patients who need to undergo ICA. Calcified and non-calcified plaques are detected. Grading of stenoses in areas with calcification is difficult. Frequently, stenosis severity is overestimated by 64-detector-row computed tomography

Noninvasive Coronary Angiography using 64-Detector-Row Computed Tomography in Patients with a Low to Moderate Pretest Probability of Significant Coronary Artery Disease

Energy Technology Data Exchange (ETDEWEB)

Schlosser, T.; Mohrs, O.K.; Magedanz, A.; Nowak, B.; Voigtlaender, T.; Barkhausen, J.; Schmermund, A. [Dept. of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen (Germany)

2007-04-15

Purpose: To evaluate the value of 64-detector-row computed tomography for ruling out high-grade coronary stenoses in patients with a low to moderate pretest probability of significant coronary artery disease. Material and Methods: The study included 61 patients with a suspicion of coronary artery disease on the basis of atypical angina or ambiguous findings in noninvasive stress testing and a class II indication for invasive coronary angiography (ICA). All patients were examined by 64-detector-row computed tomography angiography (CTA) and ICA. On a coronary segmental level, the presence of significant (>50% diameter) stenoses was examined. Results: In a total of 915 segments, CTA detected 62 significant stenoses. Thirty-four significant stenoses were confirmed by ICA, whereas 28 stenoses could not be confirmed by ICA. Twenty-two of them showed wall irregularities on ICA, and six were angiographically normal. Accordingly, on a coronary segmental basis, 28 false-positive and 0 false-negative findings resulted in a sensitivity of 100%, a specificity of 96.8%, a positive predictive value of 54.8%, and a negative predictive value of 100%. The diagnostic accuracy was 96.9%. Conclusion: Sixty-four-detector-row computed tomography reliably detects significant coronary stenoses in patients with suspected coronary artery disease and appears to be helpful in the selection of patients who need to undergo ICA. Calcified and non-calcified plaques are detected. Grading of stenoses in areas with calcification is difficult. Frequently, stenosis severity is overestimated by 64-detector-row computed tomography.

Effective doses to family members of patients treated with radioiodine 131

International Nuclear Information System (INIS)

Kocovska, Marina Zdravevska; Ristevska, Svetlana Micevska; Nikolovski, Sasho; Jokic, Vesna Spasic

2010-01-01

The purpose of this study was to evaluate the effective dose to family members of thyroid cancer and hyperthyroid patients treated with radioiodine 131; also to compare the results with dose constraints proposed by International Commission of Radiological Protection (ICRP) and Basic Safety Standards (BSS) of the International Atomic Energy Agency (IAEA). Material and methods: for estimation of effective doses at sixty family members of thirty thyroid cancer and thirty hyperthyroid patients treated with radioiodine 131, the thermoluminescent dosimeters, Model TLD 100, were used. Thyroid cancer patients were hospitalized for three days, while hyperthyroid patients were treated on out-patient basis. The family members wore thermoluminescent dosimeter in front of the torso for seven days. Results: The radiation doses to family members of thyroid cancer patients were well below recommended dose constraint of 1 mSv. The mean value of effective dose was 0.21 mSv (min 0.02 - max 0.51 mSv). Effective doses, higher than 1 mSv, were detected at 11 family members of hyperthyroid patients.. The mean value of effective dose at family members of hyperthyroid patients was 0.87 mSv (min 0.12 - max 6.79) Conclusion: After three days of hospitalization and detailed given oral and written instruction, thyroid carcinoma patients maintain not to exceed the proposed dose limits. Hyperthyroid patients present a greater radiation hazard than thyroid carcinoma patients. The estimated effective doses were higher than the effective doses at family members of thyroid carcinoma patients. These findings may be considered when establishing new national guidelines concerning radiation protection and release of patients after a treatment with radioiodine therapy.(Author)

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.

Treatment of acromegaly patients at the Federal University of Triângulo Mineiro (UFTM: Experience Report

Directory of Open Access Journals (Sweden)

Maria de Fátima Borges

Full Text Available OBJECTIVE: To evaluate the effectiveness of the treatment of acromegaly patients at the Federal University of Triangulo Mineiro. METHODS: Cross-sectional and retrospective study of thirty cases treated over a period of two decades. RESULTS: 17 men (56.7% aged 14-67 years and 13 women aged 14-86 years were analyzed. Twenty-one patients underwent transphenoidal surgery, whichwas associated with somatostatin receptor ligands in 11 patients (39.3%, somatostatin receptor ligands + radiotherapyin 5 patients (17.8%, radiotherapy in 3 patients (10.7%, and radiotherapy + somatostatin receptorligands + cabergoline in 1 patient (3.6%. Additionally, 2 patients underwent radiotherapy and surgeryalone. Six patients received somatostatin receptor ligands before surgery, and 2 were not treated due to refusal and death. Nine patients have died, and 20 are being followed; 13 (65% have growth hormonelevels o1 ng/mL, and 11 have normal insulin-like growth factor 1 levels. CONCLUSION: The current treatment options enable patients seen in regional reference centers to achieve strict control parameters, which allows them to be treated close to their homes.

Treatment of acromegaly patients at the Federal University of Triângulo Mineiro (UFTM): Experience Report

Science.gov (United States)

de Fátima Borges, Maria; Lara, Beatriz Hallal Jorge; Tomé, Janaíne Machado; de Araújo, Leopoldo Prezia; Bugiga, Flávio Cesar Lucas; Sousa, Júlio Cláudio; Soares, Jacqueline Mendes Fonseca; Dezena, Roberto Alexandre; Ferreira, Beatriz Pires

2017-01-01

OBJECTIVE: To evaluate the effectiveness of the treatment of acromegaly patients at the Federal University of Triangulo Mineiro. METHODS: Cross-sectional and retrospective study of thirty cases treated over a period of two decades. RESULTS: 17 men (56.7%) aged 14-67 years and 13 women aged 14-86 years were analyzed. Twenty-one patients underwent transphenoidal surgery, whichwas associated with somatostatin receptor ligands in 11 patients (39.3%), somatostatin receptor ligands + radiotherapyin 5 patients (17.8%), radiotherapy in 3 patients (10.7%), and radiotherapy + somatostatin receptorligands + cabergoline in 1 patient (3.6%). Additionally, 2 patients underwent radiotherapy and surgeryalone. Six patients received somatostatin receptor ligands before surgery, and 2 were not treated due to refusal and death. Nine patients have died, and 20 are being followed; 13 (65%) have growth hormonelevels o1 ng/mL, and 11 have normal insulin-like growth factor 1 levels. CONCLUSION: The current treatment options enable patients seen in regional reference centers to achieve strict control parameters, which allows them to be treated close to their homes. PMID:28492721

Oat cell carcinoma of esophagus: a report of six British patients with a review of the literature

International Nuclear Information System (INIS)

Doherty, M.A.; McIntyre, M.; Arnott, S.J.

1984-01-01

This paper presents 6 British patients with a diagnosis of oat cell carcinoma of the esophagus. Sixty-six patients have previously been reported in the literature, the majority (30) being British. Approximately two-thirds of these tumors have been reported as pure oat cell carcinoma of the esophagus. Four other histological patterns have been described: oat cell carcinoma with squamous carcinoma in situ; oat cell carcinoma with squamous carcinoma; oat cell carcinoma with adenocarcinoma; and oat cell carcinoma with carcinoid differentiation. A preponderance of males has also been noted, although this series shows a 2:1 female:male ratio. The tumor arises most commonly in the mid or lower esophagus. The cell of origin of these tumors is considered to be the Kulchitsky or APUD cell of neuroectodermal derivation. They may show neurosecretory granules on electron microsopy. Polypeptides have been identified within the tumor cells. One previous report describes a patient with primary oat cell carcinoma of the esophagus and hypercalcemia. A patient with the syndrome of inappropriate anti-diuretic hormone secretion is described in this paper. Survival is poor following radiotherapy, with a median survival of 3 months in this series. On reviewing the records of the Radiation Oncology Unit in Edinburgh, no patient with oat cell carcinoma of the esophagus was reported before 1972. This suggests that awareness of this tumor is increasing and, although rare, its incidence is greater than previously reported

Effects of Material And Non-Material Reinforcers On Academic ...

African Journals Online (AJOL)

This study examined effects of material and non-material reinforcers on academic performance of Abia State Senior Secondary Schools girls on health science. As a quasi-experimental study, 120 SS II students were selected from six secondary schools located in the three Educational zones of the state. From each zone ...

Improving a newly developed patient-reported outcome for thyroid patients, using cognitive interviewing

DEFF Research Database (Denmark)

Watt, Torquil; Rasmussen, Ase Krogh; Groenvold, Mogens

2008-01-01

Objective To improve a newly developed patient-reported outcome measure for thyroid patients using cognitive interviewing. Methods Thirty-one interviews using immediate retrospective and expansive probing were conducted among patients with non-toxic goiter (n = 4), nodular toxic goiter (n = 5) Gr...

Quality of life and mortality assessment in patients with major cardiac events in the postoperative period.

Science.gov (United States)

Abelha, Fernando José; Botelho, Miguela; Fernandes, Vera; Barros, Henrique

2010-01-01

Cardiovascular complications in the postoperative period are associated with high mortality and morbidity. Few studies have assessed the degree of dependence in these patients and their perception of health. The objective of this study was to assess the mortality and the quality of life in patients who developed major cardiac events (MCE) in the postoperative period. Retrospective study carried out in a Surgical Intensive Care Unit (SICU), between March 2006 and March 2008. The patients were assessed regarding the occurrence of CE. Six months after the hospital discharge, the Short-Form-36 (SF-36) questionnaire was filled out and dependence was assessed in relation to activities of daily living (ADL). The comparisons between independent groups of patients were carried out using Student's t test. The comparison between each variable and the occurrence of CE was carried out by logistic regression and included all patients. Of the 1,280 patients that met the inclusion criteria, 26 (2%) developed MCE. The univariate analysis identified as independent determinants for the development of major cardiac events: ASA physical status, hypertension, ischemic heart disease, congestive heart disease and score of the Revised Cardiac Risk Index (RCRI). The six-month mortality after the SICU discharge was 35%. Of the 17 surviving patients, 13 completed the questionnaires. Thirty-one percent of them reported that their general health was better on the day they answered the questionnaire, when compared to 12 months before. Sixty-nine percent of the patients were dependent in instrumental ADL e 15% in personal ADL. The development of MCE has a significant impact on the duration of hospital stay and mortality rates. Six months after the discharge from the SICU, more than 50% of the patients were dependent in at least one instrumental ADL. Copyright 2010 Elsevier Editora Ltda. All rights reserved.

Extracolonic findings (ECF) on CT colonography (CTC) in patients presenting with colorectal symptoms

Energy Technology Data Exchange (ETDEWEB)

Sarit Badiani, Sarit; Karandikar, Sharad [Dept. of General Surgery, Heart of England Foundation Trust, Birmingham (United Kingdom); Tomas-Hernandez, Silvia; Roy-Choudhury; Shuvro [Dept. of Radiology, Heart of England Foundation Trust, Birmingham (United Kingdom)], e-mail: shurvrorc@googlemail.com

2013-10-15

Background: Computed tomographic colonography (CTC) is now an established method for imaging the colon and rectum in the screening and symptomatic setting. Additional benefit of CTC is the ability to assess for extracolonic findings especially in patients presenting with colorectal symptoms. Purpose: To determine prevalence of extracolonic findings (ECF) in symptomatic patients undergoing CTC and determine accuracy of CTC for exclusion of significant abdominal disease and extracolonic malignancy (ECM). Material and Methods: A total of 1359 unenhanced prone and postcontrast supine CTC studies were performed between March 2002 and December 2007. ECF were retrospectively classified according to C-RADS criteria into E1 to E4 findings. For ECM, a gold standard of clinical and/or radiological follow-up supplemented with data from the regional cancer registry with a median follow-up of 42 months was created. Sensitivity and negative predictive values for ECM was calculated. Results: Following exclusions, 1177 CTCs were analyzed. Of 1423 extracolonic findings reported, 328/1423 (23%) E3 and 100/1423 (7%) E4 (including six eventual FP studies) findings were identified. Thirty-two ECMs were confirmed following further investigations. Seven further small ECMs were detected during the entire follow-up, of which two were potentially visible in retrospect (false-negative studies). Additional tests were generated from 55/1177 (4.7%) studies. Sensitivity and negative predictive value for ECM was 94.1% (95% CI 78.9 - 98.9%) and 99.8% (95% CI 99.3 - 99.9%), respectively. Conclusion: One in 37 patients were found to have an ECM. Two potentially detectable cancers were missed. Only a small proportion of patients underwent additional work-up.

Thirty-day outcomes of direct carotid artery stenting with cerebral protection in high-risk patients

International Nuclear Information System (INIS)

Veselka, J.; Cerna, D.; Zimolova, P.; Blasko, P.; Fiedler, J.; Hajek, P.; Maly, M.; Zemanek, D.; Duchonova, R.

2007-01-01

Implantation of a carotid artery stent after predilation is a standard approach in the endovascular treatment of carotid artery stenoses. Stenting without predilation may be an alternative approach in a certain subset of patients. The present prospective, single-center registry was designed to evaluate the feasibility and safety of direct carotid artery stenting (DCAS) in high-risk patients. Symptomatic patients with stenosis >50% and asymptomatic patients with stenosis >70% were eligible for enrolment. Criteria for high-risk patients included: need or history of open heart surgery, history of myocardial infarction, multivessel coronary artery disease, left ventricular dysfunction (ejection fraction ≤40%), severe pulmonary or renal disease, significant contralateral carotid disease, previous endarterectomy, and age ≥80 years. All procedures were performed using a filter protection device. Patients underwent complete clinical examination before and after DCAS and at 30-day follow-up. A total of 83 consecutive patients (45 males, 68±9 years, 33% symptomatic) underwent 100 procedures and 103 stents were deployed successfully. The technical success rate of stenting was 100%. Predilation of carotid stenosis was necessary in 1 (1%) procedure. Carotid-artery stenoses before and after DCAS were 80±9% and 7±9%, respectively. The median fluoroscopic time for DCAS was 7 min. The overall rate of in-hospital major adverse cerebrovascular events (death, stroke, myocardial infarction) was 5% (2 minor strokes, 3 transient attacks). There was 1 (1%) minor stroke within the 30-day follow-up. DCAS is feasible and can be performed with an acceptable risk in high-risk patients. (author)

Three-dimensional dose accumulation in pseudo-split-field IMRT and brachytherapy for locally advanced cervical cancer

DEFF Research Database (Denmark)

Sun, Baozhou; Yang, Deshan; Esthappan, Jackie

2015-01-01

-field intensity-modulated radiation therapy (IMRT) and image-guided BT in locally advanced cervical cancer. METHODS AND MATERIALS: Thirty-three patients treated with split-field-IMRT to 45.0-51.2 Gy in 1.6-1.8 Gy per fraction to the elective pelvic lymph nodes and to 20 Gy to the central pelvis region were...... included in this study. Patients received six weekly fractions of high-dose rate BT to 6.5-7.3 Gy per fraction. A dose tracker software was developed to compute the equivalent dose in 2-Gy fractions (EQD2) to gross tumor volume (GTV), organs-at-risk and point A. Total dose-volume histogram parameters were...

Neuromuscular electrical stimulation improves exercise tolerance in chronic obstructive pulmonary disease patients with better preserved fat-free mass

Directory of Open Access Journals (Sweden)

Lara Maris Nápolis

2011-01-01

Full Text Available BACKGROUND: High-frequency neuromuscular electrical stimulation increases exercise tolerance in patients with advanced chronic obstructive pulmonary disease (COPD patients. However, it is conceivable that its benefits are more prominent in patients with better-preserved peripheral muscle function and structure. OBJECTIVE: To investigate the effects of high-frequency neuromuscular electrical stimulation in COPD patients with better-preserved peripheral muscle function. Design: Prospective and cross-over study. METHODS: Thirty COPD patients were randomly assigned to either home-based, high-frequency neuromuscular electrical stimulation or sham stimulation for six weeks. The training intensity was adjusted according to each subject's tolerance. Fat-free mass, isometric strength, six-minute walking distance and time to exercise intolerance (Tlim were assessed. RESULTS: Thirteen (46.4% patients responded to high-frequency neuromuscular electrical stimulation; that is, they had a post/pre Δ Tlim >10% after stimulation (unimproved after sham stimulation. Responders had a higher baseline fat-free mass and six-minute walking distance than their seventeen (53.6% non-responding counterparts. Responders trained at higher stimulation intensities; their mean amplitude of stimulation during training was significantly related to their fat-free mass (r = 0.65; p<0.01. Logistic regression revealed that fat-free mass was the single independent predictor of Tlim improvement (odds ratio [95% CI] = 1.15 [1.04-1.26]; p<0.05. CONCLUSIONS: We conclude that high-frequency neuromuscular electrical stimulation improved the exercise capacity of COPD patients with better-preserved fat-free mass because they tolerated higher training stimulus levels. These data suggest that early training with high-frequency neuromuscular electrical stimulation before tissue wasting begins might enhance exercise tolerance in patients with less advanced COPD.

Patient safety competency and educational needs of nursing educators in South Korea

Science.gov (United States)

2017-01-01

Background Nursing educators must be qualified to teach patient safety to nursing students to ensure patient safety in the clinical field. The purpose of this study was to assess nursing educators’ competencies and educational needs for patient safety in hospitals and nursing schools. Method A mixed-methods sequential explanatory design employed a survey and focus group interview with nursing educators (school clinical instructors and hospital nurse preceptors). Thirty-eight questionnaires filled out by clinical instructors from six four-year nursing universities and 106 questionnaires from nurse preceptors from three high-level general hospitals in the Seoul metropolitan area were analyzed to obtain quantitative data. Focus group interviews were conducted among six clinical instructors from one nursing school and four nurse preceptors from one high-level general hospital in Seoul. Results Nursing educators had higher levels of attitude compared with relatively lower levels of skill and knowledge regarding patient safety. They reported educational needs of “medication” and “infection prevention” as being higher and “human factors” and “complexity of systems” as being lower. Nursing educators desired different types of education for patient safety. Conclusion It is necessary to enhance nursing educators’ patient safety skills and knowledge by developing and providing an integrated program of patient safety, with various teaching methods to meet their educational needs. The findings of this study provide the basic information needed to reform patient safety education programs appropriately to fit nursing educators' needs and their patient safety competencies in both clinical practice and academia. Furthermore, the findings have revealed the importance of effective communication between clinical and academic settings in making patient safety education seamless. PMID:28873099

Patient safety competency and educational needs of nursing educators in South Korea.

Directory of Open Access Journals (Sweden)

Haena Jang

Full Text Available Nursing educators must be qualified to teach patient safety to nursing students to ensure patient safety in the clinical field. The purpose of this study was to assess nursing educators' competencies and educational needs for patient safety in hospitals and nursing schools.A mixed-methods sequential explanatory design employed a survey and focus group interview with nursing educators (school clinical instructors and hospital nurse preceptors. Thirty-eight questionnaires filled out by clinical instructors from six four-year nursing universities and 106 questionnaires from nurse preceptors from three high-level general hospitals in the Seoul metropolitan area were analyzed to obtain quantitative data. Focus group interviews were conducted among six clinical instructors from one nursing school and four nurse preceptors from one high-level general hospital in Seoul.Nursing educators had higher levels of attitude compared with relatively lower levels of skill and knowledge regarding patient safety. They reported educational needs of "medication" and "infection prevention" as being higher and "human factors" and "complexity of systems" as being lower. Nursing educators desired different types of education for patient safety.It is necessary to enhance nursing educators' patient safety skills and knowledge by developing and providing an integrated program of patient safety, with various teaching methods to meet their educational needs. The findings of this study provide the basic information needed to reform patient safety education programs appropriately to fit nursing educators' needs and their patient safety competencies in both clinical practice and academia. Furthermore, the findings have revealed the importance of effective communication between clinical and academic settings in making patient safety education seamless.

Transfusion practice in hip arthroplasty - a nationwide study

DEFF Research Database (Denmark)

Jans, Øivind; Kehlet, H; Hussain, Zubair Butt

2011-01-01

) in Denmark. Materials and Methods We performed a retrospective cohort study of all patients undergoing THA or RTHA in Denmark in 2008. Primary outcomes were intercentre variation in red blood cell (RBC) transfusion rates and the timing of transfusion related to surgery. Results Six thousand nine hundred......Background and Objectives The optimal transfusion strategy in hip arthroplasty remains controversial despite existing guidelines. The aim of this study was to evaluate the transfusion practice in patients undergoing primary total hip arthroplasty (THA) or revision total hip arthroplasty (RTHA...... thirty-two THA patients and 1132 RTHA patients were included for analysis of which 1674 (24%) THA and 689 (61%) RTHA patients received RBC transfusion. Of these, 47% of THA and 73% of RTHA patients received transfusion on the day of surgery. Transfusion rates between centres varied from 7 to 71...

Clinical, electrophysiological, genetic, and imaging features of six Chinese Han patients with hereditary neuropathy with liability to pressure palsies (HNPP).

Science.gov (United States)

Chen, Bin; Niu, Songtao; Wang, Xingao; Li, Wei; Chen, Na; Zhang, Zaiqiang

2018-02-01

Hereditary neuropathy with liability to pressure palsies (HNPP) is an autosomal dominant peripheral neuropathy caused by mutations in the peripheral myelin protein 22 (PMP22) gene. This study summarizes the clinical, electrophysiological, genetic, and imaging features of six unrelated Chinese Han patients with HNPP. Age of onset was within the second decade in five patients, and 46 years of age in one patient. Weakness or numbness in a unilateral lower extremity was the most common symptom in 5 patients, and bilateral sensorineural hearing loss was also detected in one patient. Electrophysiological presentations suggested demyelinating sensory-motor polyneuropathy in the group. Magnetic resonance imaging (MRI) of the cervical and lumbar spine revealed varying degrees of degeneration in five patients, and mild kyphosis of cervical vertebral bodies in 2 teen-aged patients. In addition, cranial MRI of one patient showed scattered demyelination in the frontal lobes. Targeted next-generation-sequencing (NGS) revealed a PMP22 deletion in five patients and a heterozygous c.199G>A mutation in exon 4 of PMP22 in one patient. The I92V variant of lipopolysaccharide-induced tumor necrosis factor (LITAF) gene was found in one patient. There was no relationship between the Ile92Val variant of LITAF and age of onset in this group, albeit the sample size was very small. Copyright © 2017 Elsevier Ltd. All rights reserved.

Cell mediated immunity in patients with osteosarcoma

International Nuclear Information System (INIS)

Lloyd, E.L.; Henning, C.B.

1975-01-01

Because of the difficulty of obtaining suitable material, earlier studies on cell mediated immunity in the radium patients failed to include positive controls. Recently we were fortunate in obtaining samples of lymphocytes from two suitable patients who had had amputations for spontaneous osteosarcoma six months previously. Lymphocytes from both of these patients showed cytotoxicity to cultured cells derived from a human osteogenic sarcoma but not to normal fibroblasts. These results help to validate our test for early detection of osteosarcoma in the radium patients using measurements of cytotoxicity

Childhood Trauma and Alexithymia in Patients with Conversion Disorder.

Science.gov (United States)

Farooq, Anum; Yousaf, Aasma

2016-07-01

To determine the relationship between childhood trauma (physical, sexual, emotional abuse and neglect) and alexithymia in patients with conversion disorder, and to identify it as a predictor of alexithymia in conversion disorder. An analytical study. Multiple public sector hospitals in Lahore, from September 2012 to July 2013. Eighty women with conversion disorder were recruited on the basis of DSM IV-TR diagnostic criteria checklist to screen conversion disorder. Childhood abuse interview to measure childhood trauma and Bermond Vorst Alexithymia Questionnaire, DSM-IV TR Dianostic Criteria Checklist, and Childhood Abuse Interview to assess alexithymia were used, respectively. The mean age of the sample was 18 ±2.2 years. Thirty-six cases had a history of childhood trauma, physical abuse was the most reported trauma (f = 19, 23.8%) in their childhood. Patients with conversion disorder has a significant association with alexithymia (p conversion disorder. Strategies should be devised to reduce this disorder among women in Pakistani society.

Tolerance and efficacy of a low dose of the calcimimetic agent cinacalcet in controlling moderate to severe secondary hyperparathyroidism in hemodialysis patients.

Science.gov (United States)

Bashir, Salah O; Omer, Hayder A; Aamer, Mahmoud A; Somialy, Rashid; Morsy, Mohamed D

2015-11-01

Secondary hyperparathyroidism is almost a constant feature in chronic kidney disease (CKD) patients maintained on hemodialysis (HD). Calcimimetic agents appear to offer an alternative to surgery in controlling secondary hyperparathyroidism in these patients. Recent studies provide conflicting data on the benefits, efficacy and tolerance of cinacalcet as first-line therapy for the treatment of secondary hyperparathyroidism in CKD. This study was designed to investigate the efficacy and tolerance of a low dose of the calcimimetic agent cinacalcet in patients on long-term HD having moderate to severe secondary hyperparathyroidism. Twenty five adult male patients on HD for more than three years were included in the study. All had moderate to severe secondary hyperparathyroidism with serum intact parathyroid hormone (iPTH) >50 pmol/L, resistant to conventional treatment. We used the targets of Chronic Kidney Disease: Outcomes Quality Initiative (K/DOQI) clinical guidelines as optimal target of serum iPTH, calcium and phosphate. Patients were administered cinacalcet as a single oral daily dose of 30 mg and were followed-up for six months. Cinacalcet treatment for six months resulted in a significant reduction in the serum phosphate and iPTH levels while the serum calcium levels remained unchanged. Thirty-six percent of the patients attained the recommended serum iPTH levels, 40% achieved significant reduction of the serum iPTH levels and 24% showed no favorable response. Only one patient dropped out because of severe gastrointestinal symptoms. Our results suggest that treatment of CKD patients, having moderate to severe secondary hyperparathyroidism, with low-dose cinacalcet is effective and well tolerated.

Perseveration Found in a Human Drawing Task: Six-Fingered Hands Drawn by Patients with Right Anterior Insula and Operculum Damage

Directory of Open Access Journals (Sweden)

Chiharu Niki

2014-01-01

Full Text Available Background. Perseveration has been observed in a number of behavioural contexts, including speaking, writing, and drawing. However, no previous report describes patients who show perseveration only for drawing a human figure. Objective. The present report describes a group of patients who show body awareness-related cognitive impairment during a human figure drawing task, a different presentation from previously described neuropsychological cases. Methods. Participants were 15 patients who had a frontal lobe brain tumour around the insula cortex of the right hemisphere and had subsequently undergone a neurosurgical resective operation. Participants were asked to draw a human figure in both “hands-down” and “hands-up” configurations. Results. Eight of the 15 patients drew a human figure with six fingers during the “hands-up” and the “hands-down” human figure drawing tasks (one patient drew eight fingers. A statistical analysis of potential lesion areas revealed damage to the right anterior frontal insula and operculum in this group of patients relative to the five-finger drawing group. Conclusions. Our findings reveal a newly described neuropsychological phenomenon that could reflect impairment in attention directed towards body representations.

Perseveration Found in a Human Drawing Task: Six-Fingered Hands Drawn by Patients with Right Anterior Insula and Operculum Damage

Science.gov (United States)

Niki, Chiharu; Maruyama, Takashi; Muragaki, Yoshihiro; Kumada, Takatsune

2014-01-01

Background. Perseveration has been observed in a number of behavioural contexts, including speaking, writing, and drawing. However, no previous report describes patients who show perseveration only for drawing a human figure. Objective. The present report describes a group of patients who show body awareness-related cognitive impairment during a human figure drawing task, a different presentation from previously described neuropsychological cases. Methods. Participants were 15 patients who had a frontal lobe brain tumour around the insula cortex of the right hemisphere and had subsequently undergone a neurosurgical resective operation. Participants were asked to draw a human figure in both “hands-down” and “hands-up” configurations. Results. Eight of the 15 patients drew a human figure with six fingers during the “hands-up” and the “hands-down” human figure drawing tasks (one patient drew eight fingers). A statistical analysis of potential lesion areas revealed damage to the right anterior frontal insula and operculum in this group of patients relative to the five-finger drawing group. Conclusions. Our findings reveal a newly described neuropsychological phenomenon that could reflect impairment in attention directed towards body representations. PMID:24876665

Impact of Mézières Rehabilitative Method in Patients with Parkinson’s Disease: A Randomized Controlled Trial

Directory of Open Access Journals (Sweden)

Teresa Paolucci

2017-01-01

Full Text Available The aim of this study was to assess the efficacy of Mézières method in improving trunk flexibility of the back muscles and balance in patients with Parkinson’s disease (PD. Materials and Methods. Thirty-six patients were randomized into 2 groups: the Mézières treatment group and the control group (home exercise group. The primary outcome was the improvement in balance per the Berg Balance Scale (BBS and the trunk flexibility of the back for the anterior flexion trunk test. Also, we evaluated pain, gait balance for the Functional Gait Assessment (FGA, disease-related disability for the Modified Parkinson’s Activity Scale and the Unified Parkinson’s Disease Rating Scale (UPDRS, the quality of life, and the functional exercise capacity. All the measures were evaluated at baseline (T0, at the end of the rehabilitative program (T1, and at the 12-week follow-up (T2. Results. In the Mézières group, the BBS (p<.001 and trunk flexion test (p<.001 improved significantly at T1 and remained the same at T2. Between groups, significant changes were reported in FGA (p=.027 and UPDRS Total (p=.007 at T1 and in FGA (p=.03 at T2. Conclusion. The Mézières approach is efficacious in improving the flexibility of the trunk and balance in PD patients.

Comparison of six-minute walking tests conducted with and without supplemental oxygen in patients with chronic obstructive pulmonary disease and exercise-induced oxygen desaturation

International Nuclear Information System (INIS)

Ozalevli, S.; Ozden, A.; Gocen, Z.; Cimrin, Arif Hikmet

2007-01-01

There are contradictory reports in the literature on the supplemental oxygen administered before or after exercise tests. In light of this, we compared the results of 6-minute walking tests performed in room-air conditions (A6MWT) in patients with supplemental oxygen (O6MWT) in patients with chronic obstructive pulmonary disease (COPD) and exercise-induced oxygen desaturation. Thirty-one patients with COPD were included in the study. The A6MWT and O6MWT were performed in randomized order on each patient. During the tests, severity dyspenia and tiring of the leg were evaluated by the Modified Borg Scale. Heart rate and pulsed oxygen saturation and blood pressure were measured by pulse oximeter. Walking distance was longer with the O6MWT than with the A6MWT (P=0.001). The O6MWT resulted in a smaller increase in dyspnea, leg fatigue and heart rate and a smaller drop in pulsed saturation than the A6MWT (P<0.05). The walking distance with O6MWT correlated with respiratory function and hemodynamic parameters (P<0.05). The O6MWT, which produced less hemodynamic stress and was safer than the A6MWT, might provide more accurate information on exercise limitations for patients with COPD. These results suggest that the O6MWT can be used as a standard walking exercise test for patients with COPd and exercise-induced oxygen desaturation. (author)

The use of Lean and Six Sigma methodologies in surgery: a systematic review.

Science.gov (United States)

Mason, S E; Nicolay, C R; Darzi, A

2015-04-01

Lean and Six Sigma are improvement methodologies developed in the manufacturing industry and have been applied to healthcare settings since the 1990 s. They use a systematic and reproducible approach to provide Quality Improvement (QI), with a flexible process that can be applied to a range of outcomes across different patient groups. This review assesses the literature with regard to the use and utility of Lean and Six Sigma methodologies in surgery. MEDLINE, Embase, PsycINFO, Allied and Complementary Medicine Database, British Nursing Index, Cumulative Index to Nursing and Allied Health Literature, Health Business Elite and the Health Management Information Consortium were searched in January 2014. Experimental studies were included if they assessed the use of Lean or Six Sigma on the ability to improve specified outcomes in surgical patients. Of the 124 studies returned, 23 were suitable for inclusion with 11 assessing Lean, 6 Six Sigma and 6 Lean Six Sigma. The broad range of outcomes can be collated into six common aims: to optimise outpatient efficiency, to improve operating theatre efficiency, to decrease operative complications, to reduce ward-based harms, to reduce mortality and to limit unnecessary cost and length of stay. The majority of studies (88%) demonstrate improvement; however high levels of systematic bias and imprecision were evident. Lean and Six Sigma QI methodologies have the potential to produce clinically significant improvement for surgical patients. However there is a need to conduct high-quality studies with low risk of systematic bias in order to further understand their role. Copyright © 2014 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

Quality of reporting of randomised controlled trials of herbal interventions in ASEAN Plus Six Countries: a systematic review.

Science.gov (United States)

Pratoomsoot, Chayanin; Sruamsiri, Rosarin; Dilokthornsakul, Piyameth; Chaiyakunapruk, Nathorn

2015-01-01

Many randomised controlled trials (RCTs) of herbal interventions have been conducted in the ASEAN Communities. Good quality reporting of RCTs is essential for assessing clinical significance. Given the importance ASEAN placed on herbal medicines, the reporting quality of RCTs of herbal interventions among the ASEAN Communities deserved a special attention. To systematically review the quality of reporting of RCTs of herbal interventions conducted in the ASEAN Plus Six Countries. Searches were performed using PubMed, EMBASE, The Cochrane Library, and Allied and Complementary Medicine (AMED), from inception through October 2013. These were limited to studies specific to humans and RCTs. Herbal species search terms were based on those listed in the National List of Essential Medicines [NLEM (Thailand, 2011)]. Studies conducted in the ASEAN Plus Six Countries, published in English were included. Seventy-one articles were identified. Thirty (42.25%) RCTs were from ASEAN Countries, whereas 41 RCTs (57.75%) were from Plus Six Group. Adherence to the recommended CONSORT checklist items for reporting of RCTs of herbal interventions among ASEAN Plus Six Countries ranged from 0% to 97.18%. Less than a quarter of the RCTs (18.31%) reported information on standardisation of the herbal products. However, the scope of our interventions of interest was limited to those developed from 20 herbal species listed in the NLEM of Thailand. The present study highlights the need to improve reporting quality of RCTs of herbal interventions across ASEAN Plus Six Communities.

Evaluation of best corrected visual acuity and central macular thickness after intravitreal dexamethasone implant injections in patients with Irvine-Gass syndrome: A retrospective study of six cases.

Science.gov (United States)

Keilani, Chafik; Halalchi, Aziz; Wakpi Djeugue, Désiré; Regis, Anne; Abada, Samir

2016-10-01

Irvine-Gass syndrome is a macular edema (ME) that specifically occurs after cataract surgery. Its incidence varies from 0.2-2%. The purpose of this study is to evaluate the effectiveness of intravitreal dexamethasone implant injections in patients with Irvine-Gass syndrome. Patients with ME secondary to cataract surgery who underwent intravitreal injections of dexamethasone implant between December 2011 to October 2014 at François-Quesnay hospital (Mantes-la-Jolie, France) were retrospectively reviewed. The patients were followed for at least 10 months. All the patients were handled by intravitreal injection of dexamethasone in the eye of study among which some resisted to a preliminary treatment by non-steroidal anti-inflammatory drug (NSAID) and acetazolamide. The patients were examined each month. The patients were again handled by intravitreal injection of dexamethasone if they presented a recurrence. The primary endpoint of the study was determined on best corrected visual acuity (BCVA) using early diabetic retinopathy study (ETDRS) scale and central macular thickness (CMT) [μm] using optical coherence tomography (OCT) 3 and 6 months after the first injection. Secondary endpoints were the number of recurrences, the number of injections, the duration average before the first recurrence, the BCVA 10 months after the first injection and the tolerance. Six eyes of six patients were studied. At baseline, the mean (standard deviation [SD]) of the BCVA was 59.8±11. Three months after the first injection, the mean (SD) of the BCVA showed a statistically significant increase to 72.2±8.6 (P=0.03). Six months after the first injection, the mean (SD) of the BCVA showed a statistically significant increase to 72±11.8 (P=0.03). Concerning the CMT, the mean (SD) was 495.6±135.2 before treatment. Three months after the first injection, the mean (SD) of the CMT showed a statistically significant decrease to 268.6±57.8 (P=0.03). Six months after the first injection, the

Small-bowel capsule endoscopy in patients with suspected Crohn's disease-diagnostic value and complications.

Science.gov (United States)

Figueiredo, Pedro; Almeida, Nuno; Lopes, Sandra; Duque, Gabriela; Freire, Paulo; Lérias, Clotilde; Gouveia, Hermano; Sofia, Carlos

2010-01-01

The aim of this work was to assess the value of capsule enteroscopy in the diagnosis of patients with suspected Crohn's Disease (CD). Methods. This was a retrospective study in a single tertiary care centre involving patients undergoing capsule enteroscopy for suspected CD. Patients taking nonsteroidal anti inflammatory drugs during the thirty preceding days or with a follow-up period of less than six months were excluded. Results. Seventy eight patients were included. The endoscopic findings included mucosal breaks in 50%, ulcerated stenosis in 5%, and villous atrophy in 4%. The diagnosis of CD was established in 31 patients. The sensitivity, specificity, positive and negative predictive value of the endoscopic findings were 93%, 80%, 77%, and 94%, respectively. Capsule retention occurred in four patients (5%). The presence of ulcerated stenosis was significantly more frequent in patients with positive inflammatory markers. The diagnostic yield of capsule enteroscopy in patients with negative ileoscopy was 56%, with a diagnostic acuity of 93%. Small bowel capsule endoscopy is a safe and valid technique for assessing patients with suspected CD. Capsule retention is more frequent in patients with positive inflammatory markers. Patients with negative ileoscopy and suspected CD should be submitted to capsule enteroscopy.

Anthropometric, biochemical and clinical assessment of malnutrition in Malaysian patients with advanced cirrhosis

Directory of Open Access Journals (Sweden)

Rampal Sanjay

2010-06-01

Full Text Available Abstract Background There is limited data on the nutritional status of Asian patients with various aetiologies of cirrhosis. This study aimed to determine the prevalence of malnutrition and to compare nutritional differences between various aetiologies. Methodology A cross-sectional study of adult patients with decompensated cirrhosis was conducted. Nutritional status was assessed using standard anthropometry, serum visceral proteins and subjective global assessment (SGA. Results Thirty six patients (mean age 59.8 ± 12.8 years; 66.7% males; 41.6% viral hepatitis; Child-Pugh C 55.6% with decompensated cirrhosis were recruited. Malnutrition was prevalent in 18 (50% patients and the mean caloric intake was low at 15.2 kcal/kg/day. SGA grade C, as compared to SGA grade B, demonstrated significantly lower anthropometric values in males (BMI 18.1 ± 1.6 vs 26.3 ± 3.5 kg/m2, p Conclusion Significant malnutrition in Malaysian patients with advanced cirrhosis is common. Alcoholic cirrhosis may have more malnutrition compared to other aetiologies of cirrhosis.

Auckland City Hospital's Ortho-Geriatric Service: an audit of patients aged over 65 with fractured neck of femur.

Science.gov (United States)

Wimalasena, Bodhi; Harris, Roger

2016-07-01

The aims of this audit were to collect the Minimum Data Set outlined by the Australia New Zealand Hip Fracture Registry (ANZHFR), assess patient characteristics, analyse process of care, and evaluate how this compares to NICE guidelines for hip fracture care, as well as to Auckland Hospital data from 2007. Retrospective case record audit of patients with fractured neck of femur aged 65 years and over admitted under Orthopaedics over a 4-month period in 2013. Ninety-one patients were audited; mean age was 83 years, 68% were female. Both inpatient and 30-day mortality was 5%. 120-day mortality was 15%. Seventy-six percent of patients were admitted from ED within the national health target prescribed period of 6 hours. Only one patient was treated non-surgically. Eighty-six percent had surgery within 48 hours of admission. Eighty-two percent of patients had rehabilitation and treatment by Older People's Health. Of those living at home pre-fracture, 76% returned home on discharge. Thirty-seven percent of patients were able to walk unaided prior to hip fracture, but only 1% on discharge. Average overall length of stay was 22 days. Bisphosphonates were prescribed for 56% of patients. Compared to 2007, Auckland City Hospital has demonstrated a significant improvement in the rate of provision of timely surgery for hip fracture patients. Most patients are receiving the guideline recommended fracture-specific surgical interventions. The assessment and treatment of osteoporosis needs further attention.