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  1. Radiation exposure to the hospital staff from confined patients submitted to nuclear medicine examinations

    International Nuclear Information System (INIS)

    Guidarelli, G.; Rossi, F.; Rossi, A.; Adversi, I.; Abbati, A.; Gaiba, W.; Vianello Vos, C.

    1983-01-01

    Dosimetric measurements were made of the radioactive patients, and, all the data were analyzed, taking into account also the statistical data given by the administration, such as the total number of hospitalized patients in the different departments, the mean duration of hospitalization, the number of staff and the effective presence of them near the patient. Analyzing those data the mean dose absorbed individually by the staff of the hospital and the collective dose in terms of man-rem, were estimated. The annual exposure to the hospital assistants also with the conservative estimates, can reasonably be considered between 5 and 23 mR inclusive. In the actual situation owing to these low levels of exposure, which allow a maximum collective dose of 6.5 manrem (determined on a staff of 242 hospital attendants including the replacements), particular measures of radioprotection for hospital attendants, are not indispensable. However, detailed information about the precautions, which especially refer to correct behaviour in the nursing of the radioactive patients, is necessary

  2. Determination of 99Mo contamination in a nuclear medicine patient submitted to a diagnostic procedure with 99mTc

    Directory of Open Access Journals (Sweden)

    Bernardo Maranhão Dantas

    2005-10-01

    Full Text Available 99mTc is a radionuclide widely used for imaging diagnosis in nuclear medicine. In Brazil it is obtained by elution from 99Mo-99mTc generators supplied by the Nuclear Energy Research Institute (IPEN. The elution is carried out in radiopharmacy laboratories located in hospitals and clinics. Depending of the quality of the generator and conditions of use during the elution process, 99Mo can be extracted from the column of the generator, becoming a radionuclidic impurity of the eluate used for the obtention of the radiopharmaceutical to be administered to the patient. 99Mo emits high-energy photons and beta particles and its presence degrades the quality of the image and unnecessarily increases the radiation dose delivered to the patient. An in-vivo measurement technique was developed to verify the occurrence of internal contamination by 99Mo in nuclear medicine patients. Direct measurements were made in a volunteer who underwent myocardial scintigraphy with 99mTc-sestamibi. The results indicated the presence of internal contamination of the patien by 99Mot. The activity was tracked for several days, and an assessment of the radiation dose from the contaminant 99Mo was made.O 99mTc é um radionuclídeo largamente utilizado em diagnósticos por imagem em medicina nuclear. No Brasil, ele é obtido por eluição de um gerador de 99Mo-99mTc fornecido pelo IPEN. A eluição do gerador é feita nas clínicas onde se realizam os exames. Durante a eluição o 99Mo pode ser carreado da coluna, tornando-se uma impureza radionuclídica do eluato a ser utilizado para a obtenção do radiofármaco administrado ao paciente. O 99Mo emite fótons de alta energia e partículas beta, e sua presença, além de provocar degradação na qualidade da imagem do exame, aumenta desnecessariamente a dose de radiação no paciente. Assim, com o objetivo de verificar a possível ocorrência de contaminação interna por 99Mo em pacientes de medicina nuclear, foi desenvolvida

  3. Automated system of control of radioactive liquid effluents of patients submitted to therapy in hospitals of nuclear medicine (SACEL)

    International Nuclear Information System (INIS)

    Ruiz C, M.A.; Rivero G, T.; Celis del Angel, L.; Sainz M, E.; Molina, G.

    2006-01-01

    Different hospitals of nuclear medicine require of the technical attendance for the design, construction and instrumentation of an effluents retention system coming from the room dedicated to the medical application of iodine 131, with the one object of giving execution to the normative requirements of radiological protection, settled down in the General Regulation of Radiological Safety (RGSR) emitted by the CNSNS in November, 1988 and in the corresponding official standards. An automatic system of flow measurement, the activity concentration of the effluents to the drainage, the discharges control and the automated report it will allow the execution of the national regulations, also the elimination of unhealthy activities as the taking of samples, analysis of those same and the corresponding paperwork, its will allow that the SACEL is capable of to carry out registrations that are to consult in an automated way. The changes in the demands of the National Commission of Nuclear Safety and Safeguards in relation to the liberation of radioactive material in hospitals by medical treatments, it has created the necessity to develop a system that quantifies and dose the liquid effluents of people under thyroid treatment with iodine-131 to the drainage. The Automated System of Control of radioactive liquids effluents generated in Hospitals of Nuclear Medicine (SACEL) developed in the National Institute of Nuclear Research, it fulfills this regulation, besides improving the work conditions for the medical and technical personnel of the hospital in that are installed, since this system has the advantage of to be totally automated and to require of a minimum of attendance. The SACEL is an electro-hydraulic system of effluents control, based in the alternate operation of two decay deposits of the activity of the material contaminated with iodine-131. The system allows to take a registration of those volumes and liberated dose, besides being able to be monitoring in remote

  4. THE CHANGING FACE OF MEDICINE IN THE 21ST CENTURY – THE EXAMPLE OF INFERTILE CLOMID FAILED INSULIN RESISTANT POLYCYSTIC OVARIAN PATIENTS SUBMITTED TO ASSISTED REPRODUCTIVE THERAPY (ART I N PAKISTAN

    Directory of Open Access Journals (Sweden)

    Sarwat Jehan

    2014-12-01

    Full Text Available The outcome of metformin administration in insulin resistant infertile polycystic ovary syndrome (PCOS patients who had failed clomid. The research was conducted at the University Assisted Reproductive Techniques (ART Institute in Pakistan – a developing country with a high prevalence of diabetes. 166 PCOS patients submitted to ART out of 277 referrals (59.9%. Of these 78 (47% achieved pregnancies with 75.6% take home babies and 24.4% reproductive failure prior to ART, Intra Cytoplasmic Sperm Injection (ICSI and In Vitro Fertilization (IVF. The total healthy take home baby rate was 47% of the 166 patients. These seventy eight (78 patients became pregnant prior to ART after starting metformin for insulin resistance. 88 required ART and 19 of these delivered a healthy baby. Metformin (500 to 2500 mg daily was started prior to pregnancy and continued throughout pregnancy. Metformin 1500 mg daily for 3 months resulted in 59 live and well neonates averaging 3.1kg. Metformin <1500 mg daily and / or administration for less than 3 months prior to Pregnancy resulted in 18 abortions and 1 intrauterine death at 30 weeks gestation with no live neonate. Almost 50% became pregnant without ART. When ART was needed 19 out of 88 patients delivered a live baby. Almost 50% of patients with failed ART elsewhere became pregnant on this regime with take home healthy babies and 6 did not require ART. Metformin 1500mg daily administrated for at least 3 months prior to pregnancy and continued throughout pregnancy had an uncomplicated neonatal outcome in 59 patients compared to lower doses or shorter duration of administration in 19 patients who had a uniformly poor pregnancy outcome. The European Society of Human Reproduction and Embryology (ESHRE and American Society for Reproductive Society (ASRM guidelines are biologically and statistically flawed. In South Asia infertile PCOS patients require a long term life cycle approach. Early insulin resistance should be

  5. [Patients with gastric cancer submitted to gastrectomy: an integrative review].

    Science.gov (United States)

    Mello, Bruna Schroeder; Lucena, Amália de Fátima; Echer, Isabel Cristina; Luzia, Melissa de Freitas

    2010-12-01

    This study aims to analyze the scientific production about patients with gastric cancer submitted to gastrectomy and describe important aspects of nursing guidelines for these patients. An integrative review was carried out using Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) and Medical Literature Analysis and Retrieval System Online (MEDLINE) databases; twenty two articles were analyzed. Retrospective cross-sectional studies were the most frequent. The scientific production of nursing is numerically small in relation to the medical area. The results show that approaches related to pre and post-operative in gastrectomy for gastric cancer resection subsidize the knowledge of issues essential for nurses to promote efficient intervention for the recovery of such patients. There is still the need for further research on the practice of nursing in the guidelines of this kind of surgery.

  6. Perioperative fasting time among cancer patients submitted to gastrointestinal surgeries

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    Nayara de Castro Pereira

    Full Text Available Abstract OBJECTIVE To identify the length of perioperative fasting among patients submitted to gastrointestinal cancer surgeries. METHOD Retrospective cohort study, developed by consulting the medical records of 128 patients submitted to gastrointestinal cancer surgeries. RESULTS The mean of total length of fasting was 107.6 hours. The total length of fasting was significantly associated with the number of symptoms presented before (p=0.000 and after the surgery (p=0.007, the length of hospital stay (p=0.000, blood transfusion (p=0.013, nasogastric tube (p=0.001 and nasojejunal tube (p=0,003, postoperative admission at ICU (p=0.002, postoperative death (p=0.000 and length of preoperative fasting (p=0.000. CONCLUSION The length of fasting is associated with complications that affect the quality of the patients’ postoperative recovery and nurses’ work. The nursing team should be alert to this aspect and being responsible for overseeing the patients’ interest, should not permit the unnecessary extension of fasting.

  7. Five-Year Outcome in Stroke Patients Submitted to Thrombolysis.

    Science.gov (United States)

    Machado, Célia; Pinho, João; Alves, José Nuno; Santos, Ana Filipa; Ferreira, Maria do Céu; Abreu, Maria João; Oliveira, Liliana; Mota, João; Fontes, João Ramalho; Ferreira, Carla

    2015-08-01

    Little is known on long-term follow-up after thrombolysis in ischemic stroke patients because the majority of studies evaluated outcome at 3 to 12 months. We aimed to assess 5-year outcome after intravenous thrombolysis (IVT). Cohort study based on the prospective registry of all consecutive ischemic stroke patients submitted to IVT in our Stroke Unit. Five-year outcome, including living settings, functional outcome, stroke recurrence, and mortality, was ascertained by telephonic interviews and additional review of clinical records. Multivariate analyses were performed to identify predictors of outcome and mortality. Excellent outcome was defined as modified Rankin scale 0 to 1. Five-year outcome was available for 155/164 patients submitted to IVT. At 5 years, 32.9% of patients had an excellent outcome (95% confidence interval (CI) =25.5-43.3) and mortality was 43.9% (95%CI=36.1-51.7). Increasing age (odds ratio =0.93, 95% CI =0.90-0.97) and increasing National Institute of Health Stroke Scale (NIHSS) 24 h after thrombolysis (odds ratio =0.81, 95% CI =0.74-0.90) were independently associated with a lower likelihood of an excellent 5-year outcome. Age (hazards ratio =1.07, 95% CI =1.03-1.11) and excellent functional outcome 3 months after thrombolysis (hazards ratio =0.28, 95%CI=0.12-0.66) were independently associated with mortality during follow-up. One third of ischemic stroke patients have excellent 5-year outcome after IVT. Younger age, lower NIHSS 24 h after IVT, and excellent 3-month functional outcome are independent predictors of excellent 5-year outcome. © 2015 American Heart Association, Inc.

  8. Inguinodynia in patients submitted to conventional inguinal hernioplasty.

    Science.gov (United States)

    Dias, Bruno Garcia; Santos, Marcelo Protásio Dos; Chaves, Ana Barbara DE Jesus; Willis, Mariana; Gomes, Marcio Couto; Andrade, Fernandes Tavares; Melo, Valdinaldo Aragão DE; Santos, Paulo Vicente Dos

    2017-01-01

    to evaluate the incidence of chronic pain and its impact on the quality of life of patients submitted to inguinal hernioplasty using the Lichtenstein technique. this was a descriptive, cross-sectional study of patients operated under spinal anesthesia from February 2013 to February 2015 and who had already completed six postoperative months. We questioned patients about the presence of chronic inguinal pain and, if confirmed, invited them to a consultation in which we assessed the pain and its impact on quality of life. out of 158 patients submitted to the procedure, we identified 7.6% as having inguinodynia. Of these, there was an impact on the quality of life in 25%. the incidence of inguinodynia after hernioplasty with repercussion in quality of life was similar to the one of found in the world literature. avaliar a incidência de dor crônica e o seu impacto na qualidade de vida de pacientes submetidos à hernioplastia inguinal pela técnica de Lichtenstein. trata-se de estudo transversal descritivo, de pacientes operados de hérnia inguinal pela técnica de Lichtenstein sob anestesia raquidiana, no período de fevereiro de 2013 a fevereiro de 2015, e que já haviam completado seis meses de pós-operatório. Os pacientes foram questionados sobre a presença de dor inguinal crônica e, caso confirmada, convidados a uma consulta na qual foi feita análise da qualidade da dor e seu impacto na qualidade de vida. do total de 158 pacientes submetidos ao procedimento, 7,6% foram identificados como portadores de inguinodinia. Destes, houve impacto na qualidade de vida em 25%. observou-se incidência de inguinodinia pós-hernioplastia com repercussão na qualidade de vida semelhante à literatura mundial.

  9. Automated system of control of radioactive liquid effluents of patients submitted to therapy in hospitals of nuclear medicine (SACEL); Sistema automatizado de control de efluentes liquidos radiactivos de pacientes sometidos a terapia en hospitales de medicina nuclear (SACEL)

    Energy Technology Data Exchange (ETDEWEB)

    Ruiz C, M.A.; Rivero G, T.; Celis del Angel, L.; Sainz M, E.; Molina, G. [ININ, 52045 Ocoyoacac, Estado de Mexico (Mexico)]. e-mail: marc@nuclear.inin.mx

    2006-07-01

    Different hospitals of nuclear medicine require of the technical attendance for the design, construction and instrumentation of an effluents retention system coming from the room dedicated to the medical application of iodine 131, with the one object of giving execution to the normative requirements of radiological protection, settled down in the General Regulation of Radiological Safety (RGSR) emitted by the CNSNS in November, 1988 and in the corresponding official standards. An automatic system of flow measurement, the activity concentration of the effluents to the drainage, the discharges control and the automated report it will allow the execution of the national regulations, also the elimination of unhealthy activities as the taking of samples, analysis of those same and the corresponding paperwork, its will allow that the SACEL is capable of to carry out registrations that are to consult in an automated way. The changes in the demands of the National Commission of Nuclear Safety and Safeguards in relation to the liberation of radioactive material in hospitals by medical treatments, it has created the necessity to develop a system that quantifies and dose the liquid effluents of people under thyroid treatment with iodine-131 to the drainage. The Automated System of Control of radioactive liquids effluents generated in Hospitals of Nuclear Medicine (SACEL) developed in the National Institute of Nuclear Research, it fulfills this regulation, besides improving the work conditions for the medical and technical personnel of the hospital in that are installed, since this system has the advantage of to be totally automated and to require of a minimum of attendance. The SACEL is an electro-hydraulic system of effluents control, based in the alternate operation of two decay deposits of the activity of the material contaminated with iodine-131. The system allows to take a registration of those volumes and liberated dose, besides being able to be monitoring in remote

  10. Perioperative fasting time among cancer patients submitted to gastrointestinal surgeries.

    Science.gov (United States)

    Pereira, Nayara de Castro; Turrini, Ruth Natalia Teresa; Poveda, Vanessa de Brito

    2017-05-25

    To identify the length of perioperative fasting among patients submitted to gastrointestinal cancer surgeries. Retrospective cohort study, developed by consulting the medical records of 128 patients submitted to gastrointestinal cancer surgeries. The mean of total length of fasting was 107.6 hours. The total length of fasting was significantly associated with the number of symptoms presented before (p=0.000) and after the surgery (p=0.007), the length of hospital stay (p=0.000), blood transfusion (p=0.013), nasogastric tube (p=0.001) and nasojejunal tube (p=0,003), postoperative admission at ICU (p=0.002), postoperative death (p=0.000) and length of preoperative fasting (p=0.000). The length of fasting is associated with complications that affect the quality of the patients' postoperative recovery and nurses' work. The nursing team should be alert to this aspect and being responsible for overseeing the patients' interest, should not permit the unnecessary extension of fasting. Identificar la duración del ayuno perioperatorio entre los pacientes sometidos a cirugías de cáncer gastrointestinal. Estudio de cohorte retrospectivo, por consulta de los registros médicos de 128 pacientes sometidos a cirugías de cáncer gastrointestinal. La media de la duración total del ayuno fue de 107,6 horas. La duración total del ayuno se asoció significativamente con el número de síntomas presentados antes (p=0,000) y después de la cirugía (p=0,007), la duración de la estancia hospitalaria (p=0,000), transfusión de sangre (p=0,013),tubo nasogástrico (P=0,003), ingreso postoperatorio en la UCI (p=0,002), muerte postoperatoria (p=0,000) y duración del ayuno preoperatorio (p=0,000). La duración del ayuno se asocia con complicaciones que afectan la calidad de la recuperación postoperatoria de los pacientes y el trabajo de enfermería. El equipo de enfermería debe estar alerta en relación a este aspecto y ser responsable de supervisar el interés de los pacientes, no

  11. Complementary and Alternative Medicine for Patients

    Science.gov (United States)

    ... Ask about Your Treatment Research Complementary and Alternative Medicine for Patients Complementary and alternative medicine (CAM) is any medical and ... are based on scientific evidence from research studies. Complementary medicine refers to treatments that are used with standard ...

  12. Quality of life in patients submitted to radical prostatectomy

    Directory of Open Access Journals (Sweden)

    Débora Moura Miranda Goluart

    2014-09-01

    Full Text Available A cross-sectional study with a descriptive analysis of 81 patients submitted to radical prostatectomy (RP. Our objective was to correlate quality of life (QL according to the EORTC-QLQ C30 with age group and time after surgery. Mean age was 65.7 years. Most sought the care of urology, asymptomatic. Some referred former smoking (49.9% and high blood pressure (53.1%. Mean preoperative SBP was 8.4 ng/ml. Most participants were in stages T2c to T3, Gleason ?6 and over a year after surgery. Erectile dysfunction presented in 90.1%, and urinary incontinence in 33.3%. Functional and overall health scales presented high QL indexes, and symptomatology, with low ones. Older adults presented higher QL regarding emotional functioning, financial difficulties and overall health, as well as those with over a year after surgery, regarding cognitive functioning and fatigue. Although QL was not greatly affected, there were differences between age groups and time after surgery. doi: 10.5216/ree.v16i3.21589.

  13. Surgical site infection in patients submitted to heart transplantation.

    Science.gov (United States)

    Rodrigues, Jussara Aparecida Souza do Nascimento; Ferretti-Rebustini, Renata Eloah de Lucena; Poveda, Vanessa de Brito

    2016-08-29

    to analyze the occurrence and predisposing factors for surgical site infection in patients submitted to heart transplantation, evaluating the relationship between cases of infections and the variables related to the patient and the surgical procedure. retrospective cohort study, with review of the medical records of patients older than 18 years submitted to heart transplantation. The correlation between variables was evaluated by using Fisher's exact test and Mann-Whitney-Wilcoxon test. the sample consisted of 86 patients, predominantly men, with severe systemic disease, submitted to extensive preoperative hospitalizations. Signs of surgical site infection were observed in 9.3% of transplanted patients, with five (62.5%) superficial incisional, two (25%) deep and one (12.5%) case of organ/space infection. There was no statistically significant association between the variables related to the patient and the surgery. there was no association between the studied variables and the cases of surgical site infection, possibly due to the small number of cases of infection observed in the sample investigated. analisar a ocorrência e os fatores predisponentes para infecção de sítio cirúrgico em pacientes submetidos a transplante cardíaco e verificar a relação entre os casos de infecção e as variáveis referentes ao paciente e ao procedimento cirúrgico. estudo de coorte retrospectivo, com exame dos prontuários médicos de pacientes maiores de 18 anos, submetidos a transplante cardíaco. A correlação entre variáveis foi realizada por meio dos testes exato de Fischer e de Mann-Whitney-Wilcoxon. a amostra foi constituída por 86 pacientes, predominantemente homens, com doença sistêmica grave, submetidos a internações pré-operatórias extensas. Apresentaram sinais de infecção do sítio cirúrgico 9,3% dos transplantados, sendo cinco (62,5%) incisionais superficiais, duas (25%) profundas e um (12,5%) caso de infecção de órgão/espaço. Não houve associa

  14. Computers in medicine: patients' attitudes

    Science.gov (United States)

    Cruickshank, P. J.

    1984-01-01

    Data are presented from two surveys where a 26-item questionnaire was used to measure patients' attitudes to diagnostic computers and to medical computers in general. The first group of respondents were 229 patients who had been given outpatient appointments at a hospital general medical clinic specializing in gastrointestinal problems, where some had experienced a diagnostic computer in use. The second group of respondents were 416 patients attending a group general practice where there was no computer. Patients who had experience of the diagnostic computer or a personal computer had more favourable attitudes to computers in medicine as did younger people and males. The two samples of patients showed broadly similar attitudes, and a notable finding was that over half of each group believed that, with a computer around, the personal touch of the doctor would be lost. PMID:6471021

  15. Socio-demographic, clinical and laboratory profile of patients submitted to hemodialysis

    Directory of Open Access Journals (Sweden)

    Cristina Trevizan Telles

    2014-09-01

    Full Text Available The aim of the study was to characterize the patients with Chronic Kidney Disease submitted to hemodialysis in Rio Grande do Sul, Brazil, regarding the socio-demographic, clinical and laboratory characteristics. It is a cross-sectional study with 90 hemodialysis patients made in July and August 2013, through interviews. The results showed that 77.8% of the patients were male, with average age of 53.52 years and 66.7% were married. The average of schooling was 6.61 years; the Unified Health System assisted 86.7% of the cases. The average time of hemodialysis was 42.99 months. The most frequent etiology of the disease was systemic hypertension, 36.7%. The most used medicine were vitamins and minerals. Most laboratory exams were within the standards of reference. The data of the study can subside discussions among the health professionals involved in order to improve assistance and provide a better quality of life to the patient.

  16. Prona positioning in patients submitted to myocardial perfusion scintigraphy

    International Nuclear Information System (INIS)

    Cunha, C.J.; Ferreira, F.C.L.; Dullius, M.A.; Souza, S.O.; Souza, D.N.

    2011-01-01

    The myocardium perfusion scintigraphy corresponds at the nuclear medicine to one of best diagnostic methods for myocardium diseases. However, artefacts generated by the diaphragmatic tissue can induce to false positive diagnostic when does not occurs association of the image in supine position with the prone position. Images acquired at the two positions were analysed and the evaluation of tomographic images were estimation and consequently, a more completed diagnostic

  17. Dosimetry of patients submitted to cerebral PET/CT for the diagnosis of mild cognitive impairment

    International Nuclear Information System (INIS)

    Santana, Priscila do Carmo; Oliveira, Paulo Marcio Campos de; Bernardes, Felipe Dias; Mamede, Marcelo; Mourao, Arnaldo Prata; Silva, Teogenes Augusto da

    2014-01-01

    Objective: the present study was aimed at evaluating the effective radiation dose in patients submitted to PET/CT for the diagnosis of mild cognitive impairment. Materials and methods: TLD-100 detectors inserted into an Alderson Rando® anthropomorphic phantom were utilized to measure the absorbed dose coming from the CT imaging modality. The anthropomorphic phantoms (male and female adult versions) were submitted to the same technical protocols for patients’ images acquisition. The absorbed dose resulting from the radiopharmaceutical injection was estimated by means of the model proposed by the ICRP publication 106. Results: the effective dose in patients submitted to this diagnostic technique was approximately (5.34 ± 1.99) mSv. Conclusion: optimized protocols for calculation of radioactive activity injected into patients submitted to this diagnostic technique might contribute to reduce the effective radiation dose resulting from PET/CT in the diagnosis of mild cognitive impairment. (author)

  18. Dosimetry of patients submitted to cerebral PET/CT for the diagnosis of mild cognitive impairment

    Energy Technology Data Exchange (ETDEWEB)

    Santana, Priscila do Carmo; Oliveira, Paulo Marcio Campos de; Bernardes, Felipe Dias; Mamede, Marcelo, E-mail: pridili@gmail.com [Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG (Brazil); Mourao, Arnaldo Prata [Centro Federal de Educacao Tecnologica de Minas Gerais (CEFET), Belo Horizonte, MG (Brazil); Silva, Teogenes Augusto da [Centro de Desenvolvimento da Tecnologia Nuclear (CDTN/CNEN-MG), Belo Horizonte, MG (Brazil)

    2014-11-15

    Objective: the present study was aimed at evaluating the effective radiation dose in patients submitted to PET/CT for the diagnosis of mild cognitive impairment. Materials and methods: TLD-100 detectors inserted into an Alderson Rando® anthropomorphic phantom were utilized to measure the absorbed dose coming from the CT imaging modality. The anthropomorphic phantoms (male and female adult versions) were submitted to the same technical protocols for patients’ images acquisition. The absorbed dose resulting from the radiopharmaceutical injection was estimated by means of the model proposed by the ICRP publication 106. Results: the effective dose in patients submitted to this diagnostic technique was approximately (5.34 ± 1.99) mSv. Conclusion: optimized protocols for calculation of radioactive activity injected into patients submitted to this diagnostic technique might contribute to reduce the effective radiation dose resulting from PET/CT in the diagnosis of mild cognitive impairment. (author)

  19. Preparation of patients submitted to thyroidectomy with oral glucose solutions.

    Science.gov (United States)

    Libiszewski, Michał; Drozda, Rafał; Smigielski, Janusz; Kuzdak, Krzysztof; Kołomecki, Krzysztof

    2012-05-01

    The AIM OF THE STUDY was to determine postoperative insulin-resistance in patients subject to total thyroidectomy, the prevalence of subjective feelings of hunger immediately before surgery, and the incidence of nausea/vomiting after surgery in patients prepared for elective operations by means of oral glucose solutions. The study group comprised 115 patients, including 71 patients prepared for surgery by means of oral glucose solutions (12.5% glucose) administered 12 and 3 hours before the procedure, at a dose of 800 and 400 ml. The control group comprised 44 patients prepared for surgery by means of the traditional manner- the last meal was served before 2pm the day before the surgical procedure, while fluids before 10pm. Considering both groups, we evaluated glucose and insulin levels three times, as well as determined the insulin-resistance ratio (HOMA-IR) 24 before, and 12 hours and 7 days after surgery. The incidence of nausea and vomiting after surgery, and the subjective feeling of hunger before surgery were also evaluated. Statistically significant differences considering insulin level and HOMA-IR values were observed during the II and III measurements. The glucose and insulin values, and the HOMA-IR insulin-resistance ratio, showed no statistically significant differences during measurement I. No statistically significant glucose level differences were observed during measurements II and III. A significantly greater subjective feeling of hunger before surgery and nausea/vomiting afterwards were observed in the control group. The preparation of patients with oral glucose solutions decreases the incidence of postoperative (thyroidectomy) insulin-resistance, and occurrence of nausea/vomiting during the postoperative period.

  20. Radiation dose evaluation in patients submitted to conventional radiological examinations

    International Nuclear Information System (INIS)

    Tilly Junior, Joao G.

    1997-01-01

    This work presents the results of the evaluation of radiation dose delivered to the patients undergoing conventional radiological procedures. Based in the realized measurement some indicators are settled to quantitative appraisal of the radiological protection conditions offered to the population. Data assessment was done in the county of Curitiba, in Parana State, Brazil, from 12/95 to 04/96, in ten rooms of three different institutions, under 101 patients, adults with 70 ± 10 kg, during real examinations of chest PA, chest LAT and abdomen AP. (author)

  1. Average glandular dose in patients submitted to mammography exams

    Energy Technology Data Exchange (ETDEWEB)

    Gomes, Danielle S.; Barragan, Carolina V.M.; Costa, Katiane C.; Donato, Sabrina; Castro, William J.; Nogueira, Maria S., E-mail: dsg@cdtn.br, E-mail: kcc@cdtn.br, E-mail: sds@cdtn.br, E-mail: wjc@cdtn.br, E-mail: mnogue@cdtn.br [Centro de Desenvolvimento da Tecnologia Nuclear (CDTN), Belo Horizonte, MG (Brazil); Rezende, Adriana M.L. [Clinica Radiologica Davi Rezende, Belo Horizonte, MG (Brazil); Pinheiro, Luciana J.S. [Centro de Desenvolvimento da Tecnologia Nuclear (CDTN), Belo Horizonte, MG (Brazil). Post-graduation in Sciences and Technology of Radiations, Minerals and Materials; Oliveira, Marcio A. de [Superintendencia Estadual de Vigilancia Sanitaria, Belo Horizonte, MG (Brazil)

    2011-07-01

    Doses in mammography should be maintained as low as possible, however without reducing the standards of image quality necessary for an early detection of breast cancer. As the breast is composed of tissues with very soft composition and densities, detection of small changes in the normal anatomical structures that may be associated with breast cancer becomes more difficult. In order to achieve the standards of resolution and contrast for mammography, quality and intensity of the X- ray beam, breast positioning and compression, film-screen system, and the film processing must be in optimal operational conditions. This study aims at evaluating the average glandular dose in patients undergoing routine tests in a mammography unit in the city of Belo Horizonte. Patient image analysis was done by a radiologist who took into account 10 evaluation criteria for each CC and MLO incidences. The estimation of each patient's glandular dose and the radiographic technique parameters (kV and mA.s) as well as the thickness of the compressed breast were recorded. European image quality criteria were adopted by the radiologist in order to make the image acceptable for diagnostic purposes. For breast densities of 50%/50%, 70%/30%, 30%/70%, adipose and glandular tissues and the incident air-kerma were measured and the glandular dose calculated taking into account the X-ray output during the test. In the study carried out with 63 patients, the mean glandular dose varied from 30% incidence of CC to MLO. (author)

  2. Fasting abbreviation among patients submitted to oncologic surgery: systematic review

    OpenAIRE

    PINTO, Andressa dos Santos; GRIGOLETTI, Shana Souza; MARCADENTI, Aline

    2015-01-01

    INTRODUCTION: The abbreviation of perioperative fasting among candidates to elective surgery have been associated with shorter hospital stay and decreased postoperative complications. OBJECTIVE: To conduct a systematic review from randomized controlled trials to detect whether the abbreviation of fasting is beneficial to patients undergoing cancer surgery compared to traditional fasting protocols. METHOD: A literature search was performed in electronic databases: MEDLINE (PubMed), SciELO...

  3. Evaluation of fungal burden of medicinal plants submitted to gamma radiation process after 30 days

    International Nuclear Information System (INIS)

    Aquino, Simone; Araujo, Michel M.; Villavicencio, A.L.C.H.; Goncalez, Edlayne; Reis, Tatiana A. dos; Correa, Benedito

    2007-01-01

    Forty samples of medicinal plants (Peumus boldus, Camellia sinensis, Maytenus ilicifolia and Cassia angustifolia), purchased from pharmacies and street market in the five cities of Sao Paulo State, were irradiated using a 60 Co gamma ray source (Gammacell) with a dose of 10.0 kGy, delivered at dose rate of 3.0 kGy/h. Nonirradiated samples were used as controls of fungal isolates. For fungal counts and identification in medicinal plants a serial dilutions from 10 -1 to 10 -6 of the samples were seeded in duplicates and plated using the method in Dichloran 18% Glycerol Agar (DG 18) and were counted after five days at 25 deg C. Mycological analysis of control samples revealed the presence of genera Aspergillus and Penicillium, which are known as toxigenic fungi. The process of gamma radiation was effective in reducing the number of colony forming units (cfu/g) in all irradiated samples of medicinal plants after 30 days, using the dose of 10.0 kGy and kept of veiled conditions. (author)

  4. Evaluation of fungal burden of medicinal plants submitted to gamma radiation process after 30 days

    Energy Technology Data Exchange (ETDEWEB)

    Aquino, Simone; Araujo, Michel M.; Villavicencio, A.L.C.H. [Instituto de Pesquisas Energeticas e Nucleares (IPEN/CNEN-SP), Sao Paulo, SP (Brazil). Centro de Tecnologia das Radiacoes]. E-mail: siaq06@hotmail.com; Goncalez, Edlayne; Reis, Tatiana A. dos; Correa, Benedito [Universidade de Sao Paulo, SP (Brazil). Inst. de Ciencias Biomedicas. Dept. de Microbiologia]. E-mail: correabe@usp.br

    2007-07-01

    Forty samples of medicinal plants (Peumus boldus, Camellia sinensis, Maytenus ilicifolia and Cassia angustifolia), purchased from pharmacies and street market in the five cities of Sao Paulo State, were irradiated using a {sup 60}Co gamma ray source (Gammacell) with a dose of 10.0 kGy, delivered at dose rate of 3.0 kGy/h. Nonirradiated samples were used as controls of fungal isolates. For fungal counts and identification in medicinal plants a serial dilutions from 10{sup -1} to 10{sup -6} of the samples were seeded in duplicates and plated using the method in Dichloran 18% Glycerol Agar (DG 18) and were counted after five days at 25 deg C. Mycological analysis of control samples revealed the presence of genera Aspergillus and Penicillium, which are known as toxigenic fungi. The process of gamma radiation was effective in reducing the number of colony forming units (cfu/g) in all irradiated samples of medicinal plants after 30 days, using the dose of 10.0 kGy and kept of veiled conditions. (author)

  5. Guidelines for patient information in nuclear medicine

    International Nuclear Information System (INIS)

    Anon.

    2010-01-01

    This guide for patients information in nuclear medicine is organised in the following manner: what is a medical examination in nuclear medicine, the preparation and the duration of the examination, the possible risks and the radiation doses, pregnancy, delayed menstruation and nursing and what to do after the examination. (N.C.)

  6. Arterial hypertension and associated factors in patients submitted to myocardial revascularization

    Directory of Open Access Journals (Sweden)

    Flávia Cortez Colósimo

    2015-04-01

    Full Text Available OBJECTIVE To identify the prevalence of arterial hypertension and associated factors in patients submitted to myocardial revascularization. METHOD Cross-sectional study using the database of a hospital in São Paulo (SP, Brazil containing 3010 patients with coronary artery disease submitted to myocardial revascularization. A multiple logistic regression was performed to identify variables independently associated with hypertension (statistical significance: p1.3: (OR=1.37;CI:1.09-1.72. CONCLUSION A high prevalence of arterial hypertension and association with both non-modifiable and modifiable factors was observed.

  7. Infection by Cryptosporidium parvum in renal patients submitted to renal transplant or hemodialysis

    Directory of Open Access Journals (Sweden)

    Chieffi Pedro Paulo

    1998-01-01

    Full Text Available The frequency of infection by Cryptosporidium parvum was determined in two groups of renal patients submitted to immunosuppression. One group consisted of 23 renal transplanted individuals, and the other consisted of 32 patients with chronic renal insufficiency, periodically submitted to hemodialysis. A third group of 27 patients with systemic arterial hypertension, not immunosuppressed, was used as control. During a period of 18 months all the patients were submitted to faecal examination to detect C. parvum oocysts, for a total of 1 to 6 tests per patient. The results showed frequencies of C. parvum infection of 34.8%, 25% and 17.4%, respectively, for the renal transplanted group, the patients submitted to hemodialysis and the control group. Statistical analysis showed no significant differences among the three groups even though the frequency of C. parvum infection was higher in the transplanted group. However, when the number of fecal samples containing C. parvum oocysts was taken in account, a significantly higher frequency was found in the renal transplanted group.

  8. The number of articles submitted to the Journal of the Faculty of Medicine experienced a dramatic increase

    Directory of Open Access Journals (Sweden)

    Franklin Escobar-Córdoba

    2017-06-01

    Full Text Available The Journal of the Faculty of Medicine of Universidad Nacional de Colombia has undergone important changes in the past years; the amount of articles submitted for initiating the editorial process has increased, in the same manner as the amount of articles received in English language, and the rejection rate, which is now around 40%. The number of international authors has also grown, thus demonstrating that the publication has achieved greater visibility and recognition. In this context, the following articles have been selected for the first issue of Volume 69 of the Journal of the Faculty of Medicine: “Is parricide a stable phenomenon? An analysis of parricide offenders in a forensic hospital” (1 is a study written by an important group of Brazilian authors, who demonstrate their expertise in one of the crimes that causes most social upheaval due to its broad implications. Parricide immediately attracts attention as it is easily linked to the presence of a mental disorder, which is actually corroborated by this study, since it shows that most parricides are young adult males, who have a low level of education, are single, with no criminal history and schizophrenic; in addition, few cases show antisocial personality disorders.

  9. Obese patients with type 2 diabetes submitted to banded gastric bypass: greater incidence of dumping syndrome.

    Science.gov (United States)

    Padoin, Alexandre Vontobel; Galvão Neto, Manoel; Moretto, Myriam; Barancelli, Fabiano; Schroer, Caroline Eckerdt; Mottin, Cláudio Corá

    2009-11-01

    Dumping syndrome is one of ten most common complications in morbidly obese patients operated. Recent studies in relation to type 2 diabetes mellitus (DM2) in patients submitted to gastric bypass led us to examine the different outcomes in this group of patients. Our objective was to determine the difference in the prevalence of dumping syndrome in patients with DM2 submitted to gastric bypass. In this retrospective study, 49 diabetic and 54 non-diabetic morbidly obese patients were submitted to gastric bypass and followed up at 3, 6, and 12 months after surgery. The occurrence of dumping was determined by the patient's medical chart, where it was considered positive if recorded in at least one of three evaluations. The 103 patients evaluated had a mean BMI of 49.5 +/- 9.3 kg/m(2) and mean age of 38 +/- 9.7 years, with 75.7% being women. The prevalence of dumping syndrome in this population was 24.3%. The prevalence of dumping was greater in patients with DM2 (44.9%) when compared to the control group (5.6%; p DM2 as the only variable associated with dumping syndrome. Dumping syndrome is a common postoperative complication in gastric bypass. Patients with DM2 show a greater postoperative prevalence of dumping.

  10. Fetal dose determination in patients with breast cancer submitted to radiotherapy

    International Nuclear Information System (INIS)

    Melo, H.C.; Roesler, I.C.; Leon, E.

    1985-01-01

    The exposure that the fetus receive during radiotherapy treatment for patients with breast cancer submitted to cobalt 60 and linear accelerator of 6 MV is studied. Measurements with a rando-Alderson Phantom and ionization chamber for each individualized irradiation field, at the body level where the fetus is localized during the several stages of pregnancy, are made. (M.A.C.) [pt

  11. Evaluation of blood glucose in type II diabetic patients submitted to local anesthesia with different vasoconstrictors

    OpenAIRE

    MELLO, Renan Pollettini de; RAMACCIATO, Juliana Cama; PERUZZO, Daiane Cristine; VICENTINI, Carllini Barroso; BERGAMASCHI, Cristiane de Cássia; MOTTA, Rogério Heládio Lopes

    2016-01-01

    ABSTRACT Objective: In the dental clinic, the use of local anesthetics containing vasoconstrictors in diabetic patients are still controversial raising some doubts. Thus, the objective of this randomized crossover clinical trial was to evaluate blood glucose, pulse oximetry and heart rate of type 2 diabetic patients when submitted to local anesthesia using prilocaine 3% associated to felypressin 0,03UI / ml (G1) and 2% lidocaine associated to epinephrine 1: 100,000 (G2). Methods: The sample...

  12. Patient preparation for nuclear medicine studies

    International Nuclear Information System (INIS)

    Stathis, V.J.; Cantrell, D.W.; Cantrell, T.J.

    1987-01-01

    In this chapter are described methods of patient preparation that can favorably affect the outcome of nuclear medicine studies in specific situations. Some of these practices may be considered essential to the success of the nuclear medicine procedure, whereas others may be thought of simply as a means of obtaining more valid or reliable information. Regardless of relative importance, each of the preparatory methods discussed can contribute to the quality of the respective study and can serve as a means of maximizing the value of nuclear medicine procedures. The specific patient preparation techniques discussed in this chapter may not be readily applicable to every practice setting or situation. These or similar procedures can be used or modified as necessary. It is important, however, that when new protocols are developed, the rationale and theoretical basis of each technique be considered

  13. The cost of prescription medicines to patients

    NARCIS (Netherlands)

    Noyce, PR; Huttin, C; Atella, [No Value; Brenner, G; Haaijer-Ruskamp, FM; Hedvall, MB; Mechtler, R

    The study compares the cost-sharing (co-payment) arrangements for prescribed medicines in a sample of EU countries. Through a set of typical prescription scenarios, the cost burden to individual patients of prescriptions are examined, in the context of drug price, and from the perspective of

  14. Anthropometric and clinical profiles of post-bariatric patients submitted to procedures in plastic surgery.

    Science.gov (United States)

    Rosa, Simone Corrêa; Macedo, Jefferson Lessa Soares DE; Casulari, Luiz Augusto; Canedo, Lucas Ribeiro; Marques, João Vitor Almeida

    2018-01-01

    to evaluate the profile of patients submitted to post-bariatric plastic surgery at the North Wing Regional Hospital, Brasília, DF. we conducted a prospective, descriptive and analytical study of patients submitted to Roux-en-Y gastroplasty, and subsequently to plastic surgery, from January 2011 to December 2016. We assessed body mass index before gastroplasty and after surgery plastic surgery, postoperative complications and comorbidities. we studied 139 patients (130 women and nine men), with a mean age of 41 years, who underwent 233 operations. The mean BMI at the time of plastic surgery was 27.44kg/m2. The mean weight loss was 47.02kg and the mean maximum BMI was 45.17kg/m2. The mean time between bariatric surgery and plastic surgery was 42 months. The most important co-morbidities before plastic surgery were arterial hypertension (11.5%), arthropathy (5.4%), diabetes mellitus (5%) and metabolic syndrome (4.3%) (pprofile of post-bariatric patients who underwent plastic surgery was similar to that reported in the literature, except for the low rate of associated surgeries and postoperative complications. Plastic surgery in post-bariatric patients has led to an improvement in the quality of life in most of these patients.

  15. Nutritional assessment methods as predictors of postoperative mortality in gastric cancer patients submitted to gastrectomy

    Directory of Open Access Journals (Sweden)

    Aline Kirjner Poziomyck

    Full Text Available ABSTRACT Objectives: to determine the nutritional evaluation method that best predicts mortality in 90 days of patients submitted to gastrectomy for gastric cancer. Methods: we conducted a prospective study with 44 patients with gastric cancer, stages II to IIIa, of whom nine were submitted to partial gastrectomy, 34 to total gastrectomy, and one to esophago-gastrectomy. All patients were nutritionally evaluated through the same protocol, up to 72h after hospital admission. The parameters used were Patient-Generated Subjective Global Assessment (PGSGA, classical anthropometry, current weight and height, percentage of weight loss (%WL and body mass index (BMI. We also measured the thickness of the thumb adductor muscle (TAM in both hands, dominant hand (TAMD and non-dominant hand (TAMND, as well as the calculated the prognostic nutritional index (PNI. The laboratory profile included serum levels of albumin, erythrocytes, hemoglobin, hematocrit, leukocytes, and total lymphocytes count (TLC. Results: of the 44 patients studied, 29 (66% were malnourished by the subjective method, 15 being grade A, 18 grade B and 11 grade C. Cases with PGSGA grade B and TAMD 10.2±2.9 mm were significantly associated with higher mortality. The ROC curves (95% confidence interval of both PGSGA and TAMD thickness reliably predicted mortality at 30 and 90 days. No laboratory method allowed predicting mortality at 90 days. Conclusion: PGSGA and the TAMD thickness can be used as preoperative parameters for risk of death in patients undergoing gastrectomy for gastric cancer.

  16. New section in journal of translational medicine: patient-targeted molecular therapies.

    Science.gov (United States)

    Bot, Adrian; Chiappelli, Francesco

    2012-05-15

    This Editorial announces a new section in the Journal of Translational Medicine: Patient-Targeted Molecular Therapies. This section is dedicated to the dissemination of targeted molecular therapies in context of patient-centered outcomes research and evidence-based clinical decisions. The focus on patient-targeted molecular therapies - spanning small molecules and biomolecules alike - stems from the unprecedented growth in this arena. This is consonant with the overall objective of the Journal of Translational Medicine, which seeks out to expand firmly to other vast areas of medicine in the domain of translational science, viewed here as the transaction between translational research and translational effectiveness. As we inaugurate this new section in Journal of Translational Medicine, with its mission described in detail in this Editorial, we invite interested scientists to submit their work for publication.

  17. Review of patient safety incidents submitted from Critical Care Units in England & Wales to the UK National Patient Safety Agency.

    Science.gov (United States)

    Thomas, A N; Panchagnula, U; Taylor, R J

    2009-11-01

    We reviewed and classified all patient safety incidents submitted from critical care units in England and Wales to the National Patient Safety Agency for the first quarter of 2008. A total of 6649 incidents were submitted from 141 organisations (median (range) 23 (1-268 incidents)); 786 were unrelated to the critical care episode and 248 were repeat entries. Of the remaining 5615 incidents, 1726 occurred in neonates or babies, 1298 were associated with temporary harm, 15 with permanent harm and 59 required interventions to maintain life or may have contributed to the patient's death. The most common main incident groups were medication (1450 incidents), infrastructure and staffing (1289 incidents) and implementation of care (1047 incidents). There were 2789 incidents classified to more than one main group. The incident analysis highlights ways to improve patient safety and to improve the classification of incidents.

  18. Integrative medicine and patient-centered care.

    Science.gov (United States)

    Maizes, Victoria; Rakel, David; Niemiec, Catherine

    2009-01-01

    Integrative medicine has emerged as a potential solution to the American healthcare crisis. It provides care that is patient centered, healing oriented, emphasizes the therapeutic relationship, and uses therapeutic approaches originating from conventional and alternative medicine. Initially driven by consumer demand, the attention integrative medicine places on understanding whole persons and assisting with lifestyle change is now being recognized as a strategy to address the epidemic of chronic diseases bankrupting our economy. This paper defines integrative medicine and its principles, describes the history of complementary and alternative medicine (CAM) in American healthcare, and discusses the current state and desired future of integrative medical practice. The importance of patient-centered care, patient empowerment, behavior change, continuity of care, outcomes research, and the challenges to successful integration are discussed. The authors suggest a model for an integrative healthcare system grounded in team-based care. A primary health partner who knows the patient well, is able to addresses mind, body, and spiritual needs, and coordinates care with the help of a team of practitioners is at the centerpiece. Collectively, the team can meet all the health needs of the particular patient and forms the patient-centered medical home. The paper culminates with 10 recommendations directed to key actors to facilitate the systemic changes needed for a functional healthcare delivery system. Recommendations include creating financial incentives aligned with health promotion and prevention. Insurers are requested to consider the total costs of care, the potential cost effectiveness of lifestyle approaches and CAM modalities, and the value of longer office visits to develop a therapeutic relationship and stimulate behavioral change. Outcomes research to track the effectiveness of integrative models must be funded, as well as feedback and dissemination strategies

  19. Effect of ionizing radiation on the taste function of patients submitted to head and neck radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Silva, Amaro Ilidio Vespasiano [Universidade Estadual de Campinas (UNICAMP), SP (Brazil); Galante, Celio [Santa Casa de Misericordia de Belo Horizonte, MG (Brazil). Div. de Radioterapia; Manzi, Flavio Ricardo, E-mail: manzi@pucminas.b [Pontificia Universidade Catolica de Minas Gerais (PUC-MG), Belo Horizonte, MG (Brazil)

    2011-09-15

    Objective: to evaluate the effects of ionizing radiation on the taste function in patients submitted to radiotherapy in the head and neck region. Materials and methods: twenty patients diagnosed with head and neck tumors and undergoing treatment in the Division of Radiotherapy at Santa Casa de Misericordia de Belo Horizonte, MG, Brazil, were selected. For their taste function testing, four solutions were manipulated with salt (NaCl), sugar (sucrose), citric acid (for acidity), and urea (for bitterness), at three different (low, medium and high) concentrations. Weekly tests were performed during the first three weeks of radiotherapy, with random administration of the solutions (three drops each) respecting the order of their concentration levels (low, medium and high). After the application of each solution, the patient reported which flavor he/she tasted. Results: a statistically significant difference was observed in the loss of taste function as the results in the 1st and 4th weeks of treatment were compared, with salty solution at the three concentration levels, with the sweet solution at low and medium concentrations, and with the sour and bitter solutions, only at low concentration. Conclusion: ionizing radiation alters the taste function of patients submitted to head and neck radiotherapy. (author)

  20. [Non-verbal communication of patients submitted to heart surgery: from awaking after anesthesia to extubation].

    Science.gov (United States)

    Werlang, Sueli da Cruz; Azzolin, Karina; Moraes, Maria Antonieta; de Souza, Emiliane Nogueira

    2008-12-01

    Preoperative orientation is an essential tool for patient's communication after surgery. This study had the objective of evaluating non-verbal communication of patients submitted to cardiac surgery from the time of awaking from anesthesia until extubation, after having received preoperative orientation by nurses. A quantitative cross-sectional study was developed in a reference hospital of the state of Rio Grande do Sul, Brazil, from March to July 2006. Data were collected in the pre and post operative periods. A questionnaire to evaluate non-verbal communication on awaking from sedation was applied to a sample of 100 patients. Statistical analysis included Student, Wilcoxon, and Mann Whittney tests. Most of the patients responded satisfactorily to non-verbal communication strategies as instructed on the preoperative orientation. Thus, non-verbal communication based on preoperative orientation was helpful during the awaking period.

  1. Patient acceptability of 3D printed medicines.

    Science.gov (United States)

    Goyanes, Alvaro; Scarpa, Mariagiovanna; Kamlow, Michael; Gaisford, Simon; Basit, Abdul W; Orlu, Mine

    2017-09-15

    Patient-centric medicine is a derivative term for personalised medicine, whereby the pharmaceutical product provides the best overall benefit by meeting the comprehensive needs of the individual; considering the end-user from the beginning of the formulation design process right through development to an end product is a must. One way in which to obtain personalised medicines, on-site and on-demand is by three-dimensional printing (3DP). The aim of this study was to investigate the influence of the shape, size and colour of different placebo 3D printed tablets (Printlets™) manufactured by fused deposition modelling (FDM) 3DP on end-user acceptability regarding picking and swallowing. Ten different printlet shapes were prepared by 3DP for an open-label, randomised, exploratory pilot study with 50 participants. Participant-reported outcome (PRO) and researcher reported outcome (RRO) were collected after picking and swallowing of selected printlet geometries including sphere, torus, disc, capsule and tilted diamond shapes. The torus printlet received the highest PRO cores for ease of swallowing and ease of picking. Printlets with a similar appearance to conventional formulations (capsule and disc shape) were also found to be easy to swallow and pick which demonstrates that familiarity is a critical acceptability attribute for end-users. RRO scores were in agreement with the PRO scores. The sphere was not perceived to be an appropriate way of administering an oral solid medicine. Smaller printlet sizes were found to be preferable; however it was found that the perception of size was driven by the type of shape. Printlet colour was also found to affect the perception of the end-user. Our study is the first to guide the pharmaceutical industry towards developing patient-centric medicine in different geometries via 3DP. Overall, the highest acceptability scores for torus printlets indicates that FDM 3DP is a promising fabrication technology towards increasing patient

  2. Diclofenac plasma protein binding: PK-PD modelling in cardiac patients submitted to cardiopulmonary bypass

    Directory of Open Access Journals (Sweden)

    J.O. Auler Jr.

    1997-03-01

    Full Text Available Twenty-four surgical patients of both sexes without cardiac, hepatic, renal or endocrine dysfunctions were divided into two groups: 10 cardiac surgical patients submitted to myocardial revascularization and cardiopulmonary bypass (CPB, 3 females and 7 males aged 65 ± 11 years, 74 ± 16 kg body weight, 166 ± 9 cm height and 1.80 ± 0.21 m2 body surface area (BSA, and control, 14 surgical patients not submitted to CPB, 11 female and 3 males aged 41 ± 14 years, 66 ± 14 kg body weight, 159 ± 9 cm height and 1.65 ± 0.16 m2 BSA (mean ± SD. Sodium diclofenac (1 mg/kg, im Voltaren 75® twice a day was administered to patients in the Recovery Unit 48 h after surgery. Venous blood samples were collected during a period of 0-12 h and analgesia was measured by the visual analogue scale (VAS during the same period. Plasma diclofenac levels were measured by high performance liquid chromatography. A two-compartment open model was applied to obtain the plasma decay curve and to estimate kinetic parameters. Plasma diclofenac protein binding decreased whereas free plasma diclofenac levels were increased five-fold in CPB patients. Data obtained for analgesia reported as the maximum effect (EMAX were: 25% VAS (CPB vs 10% VAS (control, P<0.05, median measured by the visual analogue scale where 100% is equivalent to the highest level of pain. To correlate the effect versus plasma diclofenac levels, the EMAX sigmoid model was applied. A prolongation of the mean residence time for maximum effect (MRTEMAX was observed without any change in lag-time in CPB in spite of the reduced analgesia reported for these patients, during the time-dose interval. In conclusion, the extent of plasma diclofenac protein binding was influenced by CPB with clinically relevant kinetic-dynamic consequences

  3. Considering patient experience and evidence-based choice of medicines in medicines optimisation.

    Science.gov (United States)

    Kaufman, Gerri; Bellerby, Ann; Kitching, Mike

    2017-06-14

    Medicines optimisation can be used by healthcare professionals to support patients to gain maximum benefit from their medicines, with two of the main principles being understanding the patient experience and ensuring medicines choice is evidence-based. Non-adherence is a significant issue in medicines management. Relational aspects of the patient experience, such as empathetic two-way communication between the healthcare professional and patient, the provision of clear information and shared decision-making, can have a positive influence on whether patients take their medicines as intended. In practice, the degree of influence exerted by evidence-based guidelines may result in tensions between the healthcare professional's choice of medicines and the patient's experience, while the prevalence of multimorbidity may mean that some patients are prescribed medicines from several clinical guidelines. This raises issues in relation to patient morbidity and safety, including the potential for issues with polypharmacy and an increased risk of adverse drug reactions. Medication review is an important tool for identifying the patient's medication burden, and deprescribing - the planned reduction of medicines that may no longer be effective - is emerging as a strategy to reduce polypharmacy. Further progress is required to increase patient involvement in the development of guidance for medicines management to enhance the quality of patient care, particularly in relation to their values and preferences. Similarly, further research is necessary to identify how patients make decisions about their medicines use.

  4. Radiological Protection of Patients in Nuclear Medicine

    International Nuclear Information System (INIS)

    Rojo, A.M.

    2011-01-01

    Full text: This lecture aims at presenting the state of the art of radiological protection of patients in nuclear medicine focusing on three aspects of interest where to achieve improvement. The hierarchy of the justification principle of the radiation protection is one of them. There seems for a change to be presented in the paradigm of the radiological protection of patients. The role of the physician who prescribes the medical practice becomes more relevant, together with the nuclear medicine specialist who should be co-responsible for the application of this justification principle. Regarding the doses optimization and the implementation of Dose Reference Level the involvement extends far beyond the physician and radioprotection officer. It is clear that the Medical Physicist is to play a very relevant role in the coordination of actions, as the nuclear medicine technician is to execute them. Another aspect to consider is patient specific dosimetry. It should become a routine practice through calculation of the absorbed dose based on biodistribution data. It should be assessed for each individual patient, as it depends on a number of patient-specific parameters, such as gender, size and the amount of fatty tissue in the body, as well as the extent and nature of the disease. In most cases, dosimetry calculations are not carried out and patients are administered standard levels of activity. There may be situations with a lack of knowledge on internal dosimetry as in many centers either none or only one or two medical physics experts are available. It shows that a formal training for experts in internal dosimetry at national level is required. However up to now, there has been no satisfactory correlation between absorbed dose estimates and patient response. Moreover, the radiation protection for the patient is not assured, as the dose values given are often numbers without connection to radiobiological and/or hematological findings. Pending tasks related to

  5. Radiological protection of patients in nuclear medicine

    International Nuclear Information System (INIS)

    Harding, L.K.

    2001-01-01

    The key factor in medical exposure is justification, that is ensuring that the benefit exceeds the risk. Nuclear medicine studies are comparable in cost to more sophisticated radiological tests such as ultrasound, computed tomography or magnetic resonance. Radiation doses are similar from X ray and nuclear medicine procedures. Having justified exposures the next step is optimization, namely using a radiation dose as low as is reasonably practicable. Diagnostic reference levels may be set nationally or locally such that the balance of diagnostic quality and radiation burden is optimized. In therapy the aim is to achieve a therapeutic dose while keeping the dose to non-target tissues as low as reasonably practicable. Variations in activities may be required for overweight patients, those in severe pain, those with certain conditions and in the case of tomography. Any woman who has missed a period should be assumed to be pregnant; there should be notices to patients emphasizing this. Following the administration of longer lived pharmaceuticals it is important to avoid pregnancy for a time such that the dose to a foetus will not exceed 1 mGy. A similar situation applies to a child who is being breastfed when a mother receives a radiopharmaceutical. In the case of children undergoing investigations the activity needs to be reduced to maintain the same count density as in adults. With the administration of an incorrect pharmaceutical an attempt should be made to enhance excretion, and the referring doctor and the patient should be informed. Extravasation usually requires no action. Positron emission tomography results in higher doses both to staff and patients. Research should use subjects over the age of 50, and avoid anyone who is pregnant or is a child. Nuclear medicine procedures result in a very small loss in life expectancy compared with other common risks. (author)

  6. Peripheral dose measurement in breast cancer patients submitted to Tomotherapy using thermoluminescent dosimeters

    Energy Technology Data Exchange (ETDEWEB)

    Medina A, O.; Medrano S, A. C.; Azorin N, J. [Universidad Autonoma Metropolitana, Unidad Iztapalapa, Av. San Rafael Atlixco 186, Col. Vicentina, 09340 Mexico D. F. (Mexico); Mora G, L. C., E-mail: omedina@xanum.uam.mx [IMSS, Centro Medico Nacional Siglo XXI, Av. Cuauhtemoc 330, 06725 Mexico D. F. (Mexico)

    2015-10-15

    Full text: Thermoluminescence dosimetry (TLD) has been one of the most important techniques in medical radiation applications over many years, creating opportunities of advancing in novel radiotherapy techniques particularly in Tomotherapy with photons. LiF:Mg,Ti TLD is one kind of TLD which can be used in Tomotherapy because of having suitable properties such as good sensitivity, small size and tissue equivalence. Hypo fractionation is a radiotherapeutic technique, widely accepted as an important treatment for breast cancer patients, characterized by high doses at which they are exposed for treatment of cancerous tumors that are irradiated precisely with photons from a helical accelerator and aims to decrease the number of sessions from 3 - 6 weeks to 1 - 3 weeks. Results of measuring the peripheral dose (Pd) in breast cancer patients submitted to Tomotherapy with high-energy photons are presented. (Author)

  7. Transfusion medicine in trauma patients: an update.

    Science.gov (United States)

    Murthi, Sarah B; Stansbury, Lynn G; Dutton, Richard P; Edelman, Bennett B; Scalea, Thomas M; Hess, John R

    2011-10-01

    In 2008, we reviewed the practical interface between transfusion medicine and the surgery and critical care of severely injured patients. Reviewed topics ranged from epidemiology of trauma to patterns of resuscitation to the problems of transfusion reactions. In the interim, trauma specialists have adopted damage control resuscitation and become much more knowledgeable and thoughtful about the use of blood products. This new understanding and the resulting changes in clinical practice have raised new concerns. In this update, we focus on which patients need damage control resuscitation, current views on the optimal form of damage control resuscitation with blood products, the roles of newer blood products, and appropriate transfusion triggers in the postinjury setting. We will also review the role of new technology in patient assessment, therapy and monitoring.

  8. Herbal medicine use among Turkish patients with chronic diseases

    Directory of Open Access Journals (Sweden)

    Munevver Tulunay

    2015-09-01

    Conclusions: In this study herbal medicine use was found to be higher among patients who had been diagnosed with chronic diseases. Therefore physicians should be aware of herbal medicine usage of their patients and inform them about the effectivity and side effects of herbal medicines. [J Intercult Ethnopharmacol 2015; 4(3.000: 217-220

  9. Use Of Chinese Medicine Among Colorectal Cancer Patients: A ...

    African Journals Online (AJOL)

    Use Of Chinese Medicine Among Colorectal Cancer Patients: A Nationwide Population-Based Study. ... African Journal of Traditional, Complementary and Alternative Medicines. Journal Home ... Background: Traditional Chinese medicine (CM) appears to be used worldwide, especially by cancer patients. The aim of the ...

  10. POSTOPERATIVE EFFECT OF PHYSICAL THERAPY RELATED TO FUNCTIONAL CAPACITY AND RESPIRATORY MUSCLE STRENGTH IN PATIENTS SUBMITTED TO BARIATRIC SURGERY

    OpenAIRE

    OLIVEIRA, Josélia Jucirema Jarschel de; FREITAS, Alexandre Coutinho Teixeira de; ALMEIDA, Andréa Adriana de

    2016-01-01

    ABSTRACT Background: Respiratory physiotherapy plays an important role preventing complications in bariatric surgery. Aim: To assess the effects of out-patient physiotherapy during post-operative period through respiratory pressures and functional capacity in individuals submitted to bariatric surgery. Method: A prospective longitudinal and controlled study was done in adults with body mass index (BMI) equal or greater than 40 kg/m², who have been submitted to bariatric surgery. They were ...

  11. [Meiotic abnormalities of oocytes from patients with endometriosis submitted to ovarian stimulation].

    Science.gov (United States)

    Barcelos, Ionara Diniz Evangelista Santos; Vieira, Rodolpho Cruz; Ferreira, Elisa Melo; Araújo, Maria Cristina Picinato Medeiros de; Martins, Wellington de Paula; Ferriani, Rui Alberto; Navarro, Paula Andrea de Albuquerque Salles

    2008-08-01

    to evaluate the meiotic spindle and the chromosome distribution of in vitro mature oocytes from stimulated cycles of infertile women with endometriosis, and with male and/or tubal infertility factors (Control Group), comparing the rates of in vitro maturation (IVM) between the two groups evaluated. fourteen patients with endometriosis and eight with male and/or tubal infertility factors, submitted to ovarian stimulation for intracytoplasmatic sperm injection have been prospectively and consecutively selected, and formed a Study and Control Group, respectively. Immature oocytes (46 and 22, respectively, from the Endometriosis and Control Groups) were submitted to IVM. Oocytes presenting extrusion of the first polar corpuscle were fixed and stained for microtubules and chromatin evaluation through immunofluorescence technique. Statistical analysis has been done by the Fisher's exact test, with statistical significance at pControl Groups, respectively). The chromosome and meiotic spindle organization was observed in 18 and 11 oocytes from the Endometriosis and Control Groups, respectively. In the Endometriosis Group, eight oocytes (44.4%) presented themselves as normal metaphase II (MII), three (16.7%) as abnormal MII, five (27.8%) were in telophase stage I and two (11.1%) underwent parthenogenetic activation. In the Control Group, five oocytes (45.4%) presented themselves as normal MII, three (27.3%) as abnormal MII, one (9.1%) was in telophase stage I and two (18.2%) underwent parthenogenetic activation. There was no significant difference in meiotic anomaly rate between the oocytes in MII from both groups. the present study data did not show significant differences in the IVM or in the meiotic anomalies rate between the IVM oocytes from stimulated cycles of patients with endometriosis, as compared with controls. Nevertheless, they have suggested a delay in the outcome of oocyte meiosis I from patients with endometriosis, shown by the higher proportion of oocytes in

  12. Absorbed Doses to Patients in Nuclear Medicine

    International Nuclear Information System (INIS)

    Leide-Svegborn, Sigrid; Mattsson, Soeren; Nosslin, Bertil; Johansson, Lennart

    2004-09-01

    The work with a Swedish catalogue of radiation absorbed doses to patients undergoing nuclear medicine investigations has continued. After the previous report in 1999, biokinetic data and dose estimates (mean absorbed dose to various organs and tissues and effective dose) have been produced for a number of substances: 11 C- acetate, 11 C- methionine, 18 F-DOPA, whole antibody labelled with either 99m Tc, 111 In, 123 I or 131 I, fragment of antibody, F(ab') 2 labelled with either 99m Tc, 111 In, 123 I or 131 I and fragment of antibody, Fab' labelled with either 99m Tc, 111 In, 123 I or 131 I. The absorbed dose estimates for these substances have been made from published biokinetic information. For other substances of interest, e.g. 14 C-urea (children age 3-6 years), 14 C-glycocholic acid, 14 C-xylose and 14 C-triolein, sufficient literature data have not been available. Therefore, a large number of measurements on patients and volunteers have been carried out, in order to determine the biokinetics and dosimetry for these substances. Samples of breast milk from 50 mothers, who had been subject to nuclear medicine investigations, have been collected at various times after administration of the radiopharmaceutical to the mother. The activity concentration in the breast milk samples has been measured. The absorbed dose to various organs and tissues and the effective dose to the child who ingests the milk have been determined for 17 different radiopharmaceuticals. Based on these results revised recommendations for interruption of breast-feeding after nuclear medicine investigations are suggested

  13. Regenerative Medicine from Protocol to Patient

    Directory of Open Access Journals (Sweden)

    Gustav Steinhoff

    2011-01-01

    (section 12.5 discussed the quality of cells and efficiency of the in vivo viability of transplantation. It would be great to add additional discussions on some other directions, such as improving the integration of the cardiac stem cells with host and combining with tissue engineering to improve transplantation. A new chapter to include the clinical trials of various stem cell therapies: both successful ones and otherwise, as well, the inclusion of the perspectives for some promising cell therapies, which have not been applied in clinic, probably would have done more justice from the perspectives of clinicians and patients. On the whole, this book summarizes the developments and the current trend in regenerative medicine and emphasizes on the stem cell biology and their application. Generally, this book is well-organized and written in lucid style offering a comprehensive review of the advancements in the topics covered. This book is bound to contribute to a thorough understanding of regenerative medicine paving way for great ideas for future research and significant discoveries in the field of Regenerative Medicine.

  14. Financial analysis of diabetic patients hospitalizations submitted to lower limb amputation in a public hospital

    Directory of Open Access Journals (Sweden)

    Renata Santos Silva

    2015-03-01

    Full Text Available This study is a documental descriptive analysis which aimed to verify the cost established in 2006, in relation to the hospitalization of 21 diabetic patients submitted to the lower limb amputation in a public hospital and the value transferred by the Unified Health System (SUS regarding this procedure. Among the studied patients, 57.14% were female and 42.86% male, aged 40 to 90 years. The time of diagnosis varied from 5 to 25 years. The average of hospitalization was 14 days per patient. The cost to the hospital was R$ 99,455.74, average cost per patient was R$ 4,735.98. The total amount transferred by SUS to the hospital was R$ 27,740.15, a cost 3.6 times lower than the hospital costs. The SUS transferring is in accordance with the predetermined values for its table of procedure. Prevention is the only alternative to reduce the rate of amputation and improve survival of diabetes patients. It is necessary an early diagnosis and better control of diabetes mellitus with appropriate government and institutional policies.

  15. Extracranial doses in patients submitted to stereotactic radiosurgery for brain tumors

    Energy Technology Data Exchange (ETDEWEB)

    Lundgren, Maria da Salete Fonseca dos Santos, E-mail: salete@lundgren.med.br [Instituto de Radioterapia Waldemir Miranda, Recife, PE (Brazil); Unit of Radiotherapy, Hospital Universitario Oswaldo Cruz, Recife, PE (Brazil); Khoury, Helen Jamil [Department of Nuclear Energy, Universidade Federal de Pernambuco (UFPE), Recife, PE (Brazil); Azevedo, Sergio [Instituto de Radioterapia Waldemir Miranda, Recife, PE (Brazil)

    2012-03-15

    Objective: To estimate extracranial doses on eyes, thyroid, chest and pelvis in patients submitted to radiosurgery with 6 MV linear accelerator. Materials and Methods: The present study evaluated 11 patients, 7 of them with primary, and 4 with secondary brain tumors. In the latter group, 2 patients had two lesions. Thermoluminescent dosimeters were utilized to estimate the extracranial dose. Radiosurgery cones ranges between 1.50 and 3.75 cm and doses between 1300 and 2000 cGy. Results: Mean patients' age was 52 years, and 63.6% of them were women and 36.4%, men. Lesion locations were the following: right acoustic nerve (1), frontal (2), parietal (5), right occipital (1), cerebellum (2) and parasagittal (2). Mean received doses were the following: 5.1 cGy between the eyes; 4.8 cGy in the right eye; 6.5 cGy in the left eye; 4.2 cGy in the thyroid; 1.65 cGy in the chest; and 0.45 cGy in the pelvis. Conclusion: The results demonstrate that that although the eye doses do not exceed the tolerance limits for occurrence of lens opacity, it is important that the risks associated with radiation doses are taken into consideration by radiotherapists in the planning of cranial radiosurgery procedures. (author)

  16. Uncovering the cathepsin system in heart failure patients submitted to Left Ventricular Assist Device (LVAD) implantation.

    Science.gov (United States)

    D'Amico, Andrea; Ragusa, Rosetta; Caruso, Raffaele; Prescimone, Tommaso; Nonini, Sandra; Cabiati, Manuela; Del Ry, Silvia; Trivella, Maria Giovanna; Giannessi, Daniela; Caselli, Chiara

    2014-12-12

    In end-stage heart failure (HF), the implantation of a left ventricular assist device (LVAD) is able to induce reverse remodeling. Cellular proteases, such as cathepsins, are involved in the progression of HF. The aim of this study was to evaluate the role of cathepsin system in HF patients supported by LVAD, in order to determine their involvement in cardiac remodeling. The expression of cysteine (CatB, CatK, CatL, CatS) and serine cathepsin (CatG), and relative inhibitors (Cystatin B, C and SerpinA3, respectively) was determined in cardiac biopsies of 22 patients submitted to LVAD (pre-LVAD) and compared with: 1) control stable chronic HF patients on medical therapy at the moment of heart transplantation without prior LVAD (HT, n = 7); 2) patients supported by LVAD at the moment of transplantation (post-LVAD, n = 6). The expression of cathepsins and their inhibitors was significantly higher in pre-LVAD compared to the HT group and LVAD induced a further increase in the cathepsin system. Significant positive correlations were observed between cardiac expression of cathepsins and their inhibitors as well as inflammatory cytokines. In the pre-LVAD group, a relationship of cathepsins with dilatative etiology and length of hospitalization was found. A parallel activation of cathepsins and their inhibitors was observed after LVAD support. The possible clinical importance of these modifications is confirmed by their relation with patients' outcome. A better discovery of these pathways could add more insights into the cardiac remodeling during HF.

  17. An Investigation of the Use of Traditional Chinese Medicine and Complementary and Alternative Medicine in Stroke Patients.

    Science.gov (United States)

    Yeh, Mei-Ling; Chiu, Wei-Ling; Wang, Yu-Jen; Lo, Chyi

    This study aimed to investigate the use of traditional Chinese medicine and complementary and alternative medicine in stroke patients in Taiwan. Chinese herbal medicine, massage, acupuncture, natural products, and exercise were widely used among stroke patients. Integrating safe and effective traditional Chinese medicine and complementary and alternative medicine into conventional therapies is suggested.

  18. Validation of an instrument to measure patients' experiences of medicine use: the Living with Medicines Questionnaire.

    Science.gov (United States)

    Krska, Janet; Katusiime, Barbra; Corlett, Sarah A

    2017-01-01

    Medicine-related burden is an increasingly recognized concept, stemming from the rising tide of polypharmacy, which may impact on patient behaviors, including nonadherence. No instruments currently exist which specifically measure medicine-related burden. The Living with Medicines Questionnaire (LMQ) was developed for this purpose. This study validated the LMQ in a sample of adults using regular prescription medicines in the UK. Questionnaires were distributed in community pharmacies and public places in southeast England or online through UK health websites and social media. A total of 1,177 were returned: 507 (43.1%) from pharmacy distribution and 670 (56.9%) online. Construct validity was assessed by principal components analysis and item reduction undertaken on the original 60-item pool. Known-groups analysis assessed differences in mean total scores between participants using different numbers of medicines and between those who did or did not require assistance with medicine use. Internal consistency was assessed by Cronbach's alpha. Free-text comments were analyzed thematically to substantiate underlying dimensions. A 42-item, eight-factor structure comprising intercorrelated dimensions (patient-doctor relationships and communication about medicines, patient-pharmacist communication about medicines, interferences with daily life, practical difficulties, effectiveness, acceptance of medicine use, autonomy/control over medicines and concerns about medicine use) was derived, which explained 57.4% of the total variation. Six of the eight subscales had acceptable internal consistency (α>0.7). More positive experiences were observed among patients using eight or fewer medicines compared to nine or more, and those independent with managing/using their medicines versus those requiring assistance. Free-text comments, provided by almost a third of the respondents, supported the domains identified. The resultant LMQ-2 is a valid and reliable multidimensional measure of

  19. Alternative and complementary medicine in cancer patient

    International Nuclear Information System (INIS)

    Reckova, M.

    2009-01-01

    The use of alternative and complementary medicine (CAM) in cancer patients is widespread and it is not surprising as the results gained by conventional treatments are not sufficient. However, the results from the studies with CAM are not always sufficient according to their testing in appropriate clinical studies. Another problem that is present in the use of CAM is the possibility of drug-drug interactions between conventional therapies and CAM. Thus, it is of utmost importance that the oncologist possess a good knowledge of available CAM and provide a sufficient time for discussion with the patient and his/her family about possible alternative treatments and any downside risks. The cornerstone for pertinent discussion is sufficient knowledge on the part of the oncologist about those alternative treatments that are usually presented in the media with incomplete information about their relevant clinical tests and side effects. The following article presents a review of the current alternative treatment methods with a focus on the alternative drugs that have already been clinically tested, and secondarily on the alternative drugs that have been used even without sufficient testing in clinical trials. (author)

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

    Science.gov (United States)

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

    2016-04-01

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

  1. Why evidence-based medicine failed in patient care and medicine-based evidence will succeed.

    Science.gov (United States)

    Horwitz, Ralph I; Singer, Burton H

    2017-04-01

    Evidence-based medicine (EBM) has succeeded in strengthening the evidence base for population medicine. Where EBM has failed is in answering the practicing doctor's question of what a likely outcome would be when a given treatment is administered to a particular patient with her own distinctive biological and biographical (life experience) profile. We propose Medicine-based evidence (MBE), based on the profiles of individual patients, as the evidence base for individualized or personalized medicine. MBE will build an archive of patient profiles using data from all study types and data sources, and will include both clinical and socio-behavioral information. The clinician seeking guidance for the management of an individual patient will start with the patient's longitudinal profile and find approximate matches in the archive that describes how similar patients responded to a contemplated treatment and alternative treatments. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. [Medicinal plants in cancer patients: current practices and evaluation data].

    Science.gov (United States)

    Huet, Matthieu

    2013-05-01

    Many complementary and alternatives medicines are offered to patients with cancer. Among them, herbal medicines have a substantial place. These plants are mainly used to reduce adverse effects of anticancer treatments and for specific anticancer properties. Our review shows that only few clinical data support medicinal plants effectiveness in cancer patients. Arguments rely mainly on usual indications and pharmacological data for minimization of treatments toxicity while for the anticancer properties, on epidemiological and preclinical data. To inform and counsel patients and people around, healthcare professionals need to evaluate benefit-risk balance on evidence-based information. Because the medical decision should be shared with the patient, his beliefs and preferences have to be considered. When no adverse effect or drug interaction is associated with herbal medicine, we state that their use is acceptable. This paper discuss of potential risk and benefit of the most used medicinal plants by cancer patients.

  3. Clostridium difficile infection in Chilean patients submitted to hematopoietic stem cell transplantation

    Directory of Open Access Journals (Sweden)

    Javier Pilcante

    2015-12-01

    Full Text Available ABSTRACT Introduction: Patients submitted to hematopoietic stem cell transplantation have an increased risk of Clostridium difficile infection and multiple risk factors have been identi- fied. Published reports have indicated an incidence from 9% to 30% of transplant patients however to date there is no information about infection in these patients in Chile. Methods: A retrospective analysis was performed of patients who developed C. difficile infection after hematopoietic stem cell transplantations from 2000 to 2013. Statistical analysis used the Statistical Package for the Social Sciences software. Results: Two hundred and fifty patients were studied (mean age: 39 years; range: 17-69, with 147 (59% receiving allogeneic transplants and 103 (41% receiving autologous trans- plants. One hundred and ninety-two (77% patients had diarrhea, with 25 (10% cases of C. difficile infection being confirmed. Twenty infected patients had undergone allogeneic trans- plants, of which ten had acute lymphoblastic leukemia, three had acute myeloid leukemia and seven had other diseases (myelodysplastic syndrome, chronic myeloid leukemia, severe aplastic anemia. In the autologous transplant group, five patients had C. difficile infection; two had multiple myeloma, one had amyloidosis, one had acute myeloid leukemia and one had germinal carcinoma. The overall incidence of C. difficile infection was 4% within the first week, 6.4% in the first month and 10% in one year, with no difference in overall survival between infected and non-infected groups (72.0% vs. 67.6%, respectively; p-value = 0.56. Patients infected after allogeneic transplants had a slower time to neutrophil engraftment compared to non-infected patients (17.5 vs. 14.9 days, respectively; p-value = 0.008. In the autologous transplant group there was no significant difference in the neutrophil engraftment time between infected and non-infected patients (12.5 days vs. 11.8 days, respectively; p

  4. Three-dimensional dental arch changes of patients submitted to orthodontic-surgical treatment for correction of Class II malocclusion

    OpenAIRE

    Peixoto,Adriano Porto; Pinto,Ary dos Santos; Garib,Daniela Gamba; Gonçalves,João Roberto

    2014-01-01

    INTRODUCTION: This study assessed the three-dimensional changes in the dental arch of patients submitted to orthodontic-surgical treatment for correction of Class II malocclusions at three different periods. METHODS: Landmarks previously identified on upper and lower dental casts were digitized on a three-dimensional digitizer MicroScribe-3DX and stored in Excel worksheets in order to assess the width, length and depth of patient's dental arches. RESULTS: During orthodontic preparation, the m...

  5. Patients with COPD have low adherence to inhaled medicine

    DEFF Research Database (Denmark)

    Lange, Peter; Toettenborg, Sandra; Topp, Marie

    2014-01-01

    describe results of previous studies on prevalence of adherence to inhaled medicine in COPD, and define characteristics of the patients and treatment associated with degree of adherence. We conclude that health professionals should always consider non-adherence, strive to simplify regiments......Medicine adherence in patients with obstructive pulmonary disease (COPD), has not been studied in Denmark. Studies from other countries, however, unequivocally report low prevalence of patients who follow their doctor's advice and have sufficient adherence to inhaled medicine. In this review we......, and that there is an urgent need of studies aiming at improving adherence in patients with COPD....

  6. Validation of an educative manual for patients with head and neck cancer submitted to radiation therapy.

    Science.gov (United States)

    Cruz, Flávia Oliveira de Almeida Marques da; Ferreira, Elaine Barros; Vasques, Christiane Inocêncio; Mata, Luciana Regina Ferreira da; Reis, Paula Elaine Diniz Dos

    2016-06-14

    develop the content and face validation of an educative manual for patients with head and neck cancer submitted to radiation therapy. descriptive methodological research. The Theory of Psychometrics was used for the validation process, developed by 15 experts in the theme area of the educative manual and by two language and publicity professionals. A minimum agreement level of 80% was considered to guarantee the validity of the material. the items addressed in the assessment tool of the educative manual were divided in three blocks: objectives, structure and format, and relevance. Only one item, related to the sociocultural level of the target public, obtained an agreement rate manual proposed were attended to. This can contribute to the understanding of the therapeutic process the head and neck cancer patient is submitted to during the radiation therapy, besides supporting clinical practice through the nursing consultation. validar o conteúdo e a aparência de manual educativo direcionado aos pacientes com câncer de cabeça e pescoço, submetidos à radioterapia. pesquisa metodológica, de caráter descritivo. Utilizou-se a Teoria da Psicometria para o processo de validação, o qual foi realizado por 15 peritos na área temática do manual educativo e por dois profissionais de letras e publicidade. Foi considerado o índice de concordância de, no mínimo, 80% para se garantir a validação do material. os itens abordados no instrumento de avaliação do manual educativo foram divididos em três blocos: objetivos, estrutura e apresentação, e relevância. Apenas um item, relacionado ao nível sociocultural do público-alvo, obteve índice de concordância manual educativo proposto foi considerado válido quanto ao conteúdo e à aparência. Sugere-se que possa contribuir para a compreensão do processo terapêutico ao qual o paciente com câncer de cabeça e pescoço é submetido ao realizar a radioterapia, além de subsidiar a prática clínica por meio da

  7. Application of alternative medicine in gastrointestinal cancer patients

    Directory of Open Access Journals (Sweden)

    Nikolić Ivan

    2012-01-01

    Full Text Available Bacground/Aim. Alternative medicine is a set of therapeutic procedures which are no part of official practice. At present, the use of alternative medicine among cancer patients is significant and the purpose of this study was to get more information on the methods and products of alternative medicine. Thus, the aim of the study was to determine the frequency of the use of alternative medicine among gastrointestinal cancer patients. Methods. The research was conducted using an anonymous questionnaire in writing. We included 205 patients with the diagnosis of gastrointestinal malignancy in the study but the questionnaire was fulfilled by 193 patients and the presented data were based on their answers. The questions were about the sociodemographic characteristics of the patients, the reasons for their use of alternative medicine, and their information sources about alternative medicine. We divided existing alternative therapies into 6 categories: herbal therapy, special diets, psychotherapy, body-mind therapy, spiritual therapy, and other supplements. Results. A total of 48 (24.9% patients did not use any type of alternative therapy; 145 (75.1% patients used at least one product and 124 (64.25% patients used herbal preparations (beetroot juice was consumed by 110 [56.99%] patients; 136 (70.5% patients were informed about alternative therapies by other patients.; 145 (75.1% used alternative medicine to increase the chances for cure; 88 (45.6% of interviewed patients would like to participate in future research in this field. Conclusion. The use of alternative medicine is evidently significant among cancer patients. Further research should be conducted in order to find out interactions of these products with other drugs and potential advantages and disadvantages of this form of treatment.

  8. Herbal medicine use among patients with chronic diseases.

    Science.gov (United States)

    Tulunay, Munevver; Aypak, Cenk; Yikilkan, Hulya; Gorpelioglu, Suleyman

    2015-01-01

    Complementary and alternative medicine (CAM) is commonly used all over the world, and herbal medicines are the most preferred ways of CAM. The aim of this study was to determine the frequency of herbal medicine use among patients with chronic diseases. A cross-sectional descriptive study was conducted from April 2014 to December 2014 among patients who had been diagnosed with diabetes mellitus (DM), hypertension (HT), and hyperlipidemia (HL) in Family Medicine Department of Dışkapı Yıldırım Beyazıt Training and Research Hospital, in Ankara. A questionnaire about herbal drug use was applied by face to face interview to the participants. A total of 217 patients were included in this study. The mean age of the participants was 56.6 ± 9.7 years (55 male and 162 female). The rate of herbal medicine use was 29%. Herbal medicine use among female gender was significantly higher (P = 0.040). Conventional medication use was found to be lower among herbal medicine consumers. There was no relationship between herbal medicine use and type of chronic disease, living area, and occupation or education level. Most frequently used herbs were lemon (39.6%) and garlic (11.1%) for HT, cinnamon (12.7%) for DM, and walnut (6.3%) for HL. In this study, herbal medicine use was found to be higher among patients who had been diagnosed with chronic diseases. Therefore, physicians should be aware of herbal medicine usage of their patients and inform them about the effectivity and side effects of herbal medicines.

  9. Nuclear medicine and the pregnant patient

    International Nuclear Information System (INIS)

    Collins, L.

    1988-01-01

    Estimates of the risks of exposing an embryo or fetus to radiation are discussed. Recommendations are made about the policies a nuclear medicine department should develop for handling cases of accidental irradiation of an embryo or fetus. The choices available where a known pregnancy is involved and diagnostic radiology is required are outlined. Only necessary examinations should be performed and care taken to avoid or minimise irradiation of the fetus. The nuclear medicine physician must be prepared to make (and defend if necessary) an informed decision on whether to proceed with an examination and must also be in a position to discuss the risks with anxious parents

  10. Validation of an educative manual for patients with head and neck cancer submitted to radiation therapy 1

    Science.gov (United States)

    da Cruz, Flávia Oliveira de Almeida Marques; Ferreira, Elaine Barros; Vasques, Christiane Inocêncio; da Mata, Luciana Regina Ferreira; dos Reis, Paula Elaine Diniz

    2016-01-01

    Abstract Objective: develop the content and face validation of an educative manual for patients with head and neck cancer submitted to radiation therapy. Method: descriptive methodological research. The Theory of Psychometrics was used for the validation process, developed by 15 experts in the theme area of the educative manual and by two language and publicity professionals. A minimum agreement level of 80% was considered to guarantee the validity of the material. Results: the items addressed in the assessment tool of the educative manual were divided in three blocks: objectives, structure and format, and relevance. Only one item, related to the sociocultural level of the target public, obtained an agreement rate manual proposed were attended to. This can contribute to the understanding of the therapeutic process the head and neck cancer patient is submitted to during the radiation therapy, besides supporting clinical practice through the nursing consultation. PMID:27305178

  11. Applying the PCXMC software for dose assessment in patients submitted to abdomen and pelvis X-ray examinations

    International Nuclear Information System (INIS)

    Oliveira, V.L.S.; Silva, T.A. da

    2009-01-01

    The PCXMC R computational methodology was applied as a evaluation tool of the organ doses in patients submitted to different X-ray conventional diagnoses examinations. Simulations were made based in x-ray parameters and exposure geometry of three patient of same age group in an Emergency Hospital of the metropolitan area of Belo Horizonte city. Contributions to the effective dose from critical organs were evaluated and analyzed in terms of patient height and weight for the examinations of abdomen and pelvis. (author)

  12. Patients' concern about their medicine after a generic switch

    DEFF Research Database (Denmark)

    Østergaard Rathe, Jette; Søndergaard, Jens; Jarbøl, Dorte E

    2014-01-01

    PURPOSE: This study aims to investigate the possible association between patients' concerns about their medicine and generic switch. METHODS: Cross-sectional survey was carried out comprising responses from 2217 randomly selected persons aged 20 years or older and living in the Region of Southern...... Denmark, who had redeemed generically substitutable drugs in September 2008. For each patient, we focused on the purchase of one generically substitutable drug (index drug). We applied the specific concerns subscale from the Beliefs about Medicine Questionnaire (BMQ) to analyse lack of confidence...... in treatment. We also included general beliefs about medicine (BMQ), views on generic medicine and confidence in the health-care system. The information about the patients' generic switch was obtained from a prescription database and not provided by the patients. Data were analysed using linear regression...

  13. Complementary and Alternative Medicine Usage in Cancer Patients ...

    African Journals Online (AJOL)

    The aim of this study was to investigate the frequency of complementary and alternative medicine (CAM) methods and clinical characteristics in cancer patients in southeast of Turkey. A total of 324 patients (173 female) were enrolled to this study. Questionnaire was applied to all patients individually for approximately 15 ...

  14. Use of complementary/alternative medicine among paediatric patients

    DEFF Research Database (Denmark)

    Madsen, Hanne; Andersen, Susie; Nielsen, Rasmus Gaardskaer

    2003-01-01

    Hospital during a 2 week period in the autumn of 2001 were asked to participate. In total, 622 (92%) patients participated. The data were collected in an interviewer administered questionnaire during a short structured interview with the patient and parents. CAM was divided into herbal medicine (herbal......UNLABELLED: The use of complementary/alternative medicine (CAM) is increasing. The aim was to characterise the use of CAM among patients in a paediatric department. All patients (aged 0-18 years), out-patients or hospitalised, in contact with the Department of Paediatrics, Odense University...... patients suffering from gastrointestinal diseases or hospitalised for observation. More than 50% of the users experienced positive effects and 6% had side-effects from AM. Of the CAM users, 11% or 2% of the total paediatric population used CAM instead of conventional medicines. CONCLUSION...

  15. A Course for Teaching Patient-Centered Medicine to Family Medicine Residents.

    Science.gov (United States)

    Yeheskel, Ayala; Biderman, Aya; Borkan, Jeffrey M.; Herman, Joseph

    2000-01-01

    Describes a three-year course at Ben Gurion University (Israel) to develop attitudes and skills necessary for patient-centered medicine. The course uses directed reading, open discussion, case presentations, role-playing, and Balint groups to develop skills at four levels: doctor-patient communication; family systems theory; family systems…

  16. Evaluation of anatomical and functional changes esophageal stump of patients with advanced megaesophagus submitted to subtotal laparoscopic esophagectomy.

    Science.gov (United States)

    Terra Júnior, Júverson Alves; Terra, Guilherme Azevedo; Silva, Alex Augusto da; Crema, Eduardo

    2012-09-01

    Evaluate anatomical and functional changes of the esophageal stump and gastric fundus of patients with advanced megaesophagus, submitted to laparoscopic subtotal esophagectomy. Twenty patients with advanced megaesophagus, previously submitted to a videolaparoscopic subtotal esophagectomy, were evaluated. Were conducted: radiological evaluation of the stump esophagus with transposed stomach, electromanometric, endoscopic examination and histopathology of the esophageal stump and gastric fundus, without making gastric tube or pyloroplasty. It was observed that the average height and pressure of the anastomosis, in the electromanometric evaluation, were 23.45cm (±1.84cm) and 7.55mmHg (±5.65mmHg). In patients with megaesophagus III, the pressure of the anastomosis was 10.91mmHg (±6.33mmHg), and pressure from the UES, 31.89mmHg (±14.64mm Hg), were significantly higher than those in grade IV. The pathological evaluation detected mild esophagitis in 35% of patients, moderate in 20% and acanthosis glicogenica in 45%. The examination of the gastric fundus showed that 50% of patients were infected with Helicobacter pylori. Chronic gastritis occurred in 95% of the patients. The laparoscopic esophagectomy shown to be effective in the treatment of advanced achalasia. The cervical level anastomosis protects the esophageal stump from the aggression resulted from gastric reflux after the esophagectomy.

  17. Patient's medicines brought to hospital: an overlooked resource?

    Science.gov (United States)

    Ware, G J

    1993-10-27

    To quantify potential cost advantages and identify practical safeguards required for utilising patients own medicines while in hospital, and returning them on discharge. All medicines brought in by patients in two wards of a geriatric assessment and rehabilitation unit at Auckland Hospital were examined by the pharmacist, and their suitability for re-issue assessed. Medicines were regarded as suitable for use where they could be positively identified, had been dispensed within 3 months of admission, or if packed in foil, provided the expiry date and manufacturer identification were on the foil. Medicines (260 items) totalling $2,976, assessed over a 6 month period, were regarded as suitable for use by the patient, with a mean value of $11.36 per patient. Patients own medicines used within the hospital with a unit-of-issue distribution system, and taken home by them on discharge, would provide appreciable savings for the hospital medicine budget and reduction in waste of the overall health dollar.

  18. PEEP-ZEEP technique: cardiorespiratory repercussions in mechanically ventilated patients submitted to a coronary artery bypass graft surgery

    Directory of Open Access Journals (Sweden)

    Auler José

    2011-09-01

    Full Text Available Abstract Background The PEEP-ZEEP technique is previously described as a lung inflation through a positive pressure enhancement at the end of expiration (PEEP, followed by rapid lung deflation with an abrupt reduction in the PEEP to 0 cmH2O (ZEEP, associated to a manual bilateral thoracic compression. Aim To analyze PEEP-ZEEP technique's repercussions on the cardio-respiratory system in immediate postoperative artery graft bypass patients. Methods 15 patients submitted to a coronary artery bypass graft surgery (CABG were enrolled prospectively, before, 10 minutes and 30 minutes after the technique. Patients were curarized, intubated, and mechanically ventilated. To perform PEEP-ZEEP technique, saline solution was instilled into their orotracheal tube than the patient was reconnected to the ventilator. Afterwards, the PEEP was increased to 15 cmH2O throughout 5 ventilatory cycles and than the PEEP was rapidly reduced to 0 cmH2O along with manual bilateral thoracic compression. At the end of the procedure, tracheal suction was accomplished. Results The inspiratory peak and plateau pressures increased during the procedure (p Conclusion The PEEP-ZEEP technique seems to be safe, without alterations on hemodynamic variables, produces elevated expiratory flow and seems to be an alternative technique for the removal of bronchial secretions in patients submitted to a CABG.

  19. Representations of Patients' Experiences of Autonomy in Graphic Medicine.

    Science.gov (United States)

    Tschaepe, Mark

    2018-02-01

    I advocate using graphic medicine in introductory medical ethics courses to help trainees learn about patients' experiences of autonomy. Graphic narratives about this content offer trainees opportunities to gain insights into making diagnoses and recommending treatments. Graphic medicine can also illuminate aspects of patients' experiences of autonomy differently than other genres. Specifically, comics allow readers to consider visual and text-based representations of a patient's actions, speech, thoughts, and emotions. Here, I use Ellen Forney's Marbles: Mania, Depression, Michelangelo, and Me: A Graphic Memoir and Peter Dunlap-Shohl's My Degeneration: A Journey Through Parkinson's as two examples that can serve as pedagogical resources. © 2018 American Medical Association. All Rights Reserved.

  20. 76 FR 71345 - Patient Safety Organizations: Voluntary Relinquishment From Emergency Medicine Patient Safety...

    Science.gov (United States)

    2011-11-17

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Agency for Healthcare Research and Quality Patient Safety Organizations: Voluntary Relinquishment From Emergency Medicine Patient Safety Foundation AGENCY: Agency for... notification of voluntary relinquishment from Emergency Medicine Patient Safety Foundation of its status as a...

  1. [PERSONALIZED MEDICINE: ALL BENEFITS FOR THE PATIENT BUT NEW CHALLENGE IN THE PHYSICIAN-PATIENT RELATIONSHIP].

    Science.gov (United States)

    Scheen, A J; Giet, D

    2015-01-01

    Personalized medicine should lead to major advances for patient care since it contributes to deliver the . In curative medicine, this approach should improve the efficacy of medications by initial selection of "good responders", and should reduce adverse events due to poor tolerance or toxicity by a better pharmacological choice and a more appropriate individualized dose adjustment. Over recent years, considerable technical advances have increasingly linked personalized medicine with predictive and preventive medicine. This progress raises hopes for major advancements in medicine, but may also cause some concern among the lay public. The patient should actively be involved in the decisions related to his/her health, in a true model of participatory medicine. Finally, personalized medicine should leave its strict technical nature and become more interested in the person as a whole, within a holistic approach also integrating psychosocial aspects that are so important in the physician-patient relationship.

  2. Mitral annulus morphologic and functional analysis using real time tridimensional echocardiography in patients submitted to unsupported mitral valve repair.

    Science.gov (United States)

    Guedes, Marco Antônio Vieira; Pomerantzeff, Pablo Maria Alberto; Brandão, Carlos Manuel de Almeida; Vieira, Marcelo Luiz Campos; Tarasoutchi, Flávio; Spinola, Pablo da Cunha; Jatene, Fábio Biscegli

    2015-01-01

    Mitral valve repair is the treatment of choice to correct mitral insufficiency, although the literature related to mitral valve annulus behavior after mitral repair without use of prosthetic rings is scarce. To analyze mitral annulus morphology and function using real time tridimensional echocardiography in individuals submitted to mitral valve repair with Double Teflon technique. Fourteen patients with mitral valve insufficiency secondary to mixomatous degeneration that were submitted to mitral valve repair with the Double Teflon technique were included. Thirteen patients were in FC III/IV. Patients were evaluated in preoperative period, immediate postoperative period, 6 months and 1 year after mitral repair. Statistical analysis was made by repeated measures ANOVA test and was considered statistically significant P<0.05. There were no deaths, reoperation due to valve dysfunction, thromboembolism or endocarditis during the study. Posterior mitral annulus demonstrated a significant reduction in immediate postoperative period (P<0.001), remaining stable during the study, and presents a mean of reduction of 25.8% comparing with preoperative period. There was a significant reduction in anteroposterior and mediolateral diameters in the immediate postoperative period (P<0.001), although there was a significant increase in mediolateral diameter between immediate postoperative period and 1 year. There was no difference in mitral internal area variation over the cardiac cycle during the study. Segmentar annuloplasty reduced the posterior component of mitral annulus, which remained stable in a 1-year-period. The variation in mitral annulus area during cardiac cycle remained stable during the study.

  3. Metrological aspects in estimating of radiation dose in patients of nuclear medicine

    International Nuclear Information System (INIS)

    Ruzzarin, Anelise

    2015-01-01

    In order to investigate the performance of routine measurements in nuclear medicine services, LNMRI/IRD has been conducting, since 1998, a comparison program of activity measurements of radiopharmaceuticals administered to patients in nuclear medicine. Correction factors are determined from the result of performance analysis in order to determine with better accuracy the activity to be administered to the patients. The present study shows how the correction factor is determined by the ratio between the measurement of the activity at the nuclear medicine center and the activity determined by the LNMRI, which is adopted as reference. It is essential that the dose calibrator be calibrated with standards traceable to national metrology laboratories, so that the activity administered to the patient is neither greater nor smaller than the appropriate value. The corrected values of the activities can be used to calculate with greater accuracy the effective doses received by the patients as well as the risk of cancer. Information related to radiopharmaceuticals and administered activities, type of exams and patient data of three Brazilian hospitals were collected for 1496 adults and 134 children submitted to diagnostic exams employing 99m Tc and 131 I. Results showed up to a considerable difference between the administered activity and the corrected activity until 30% and 13% above the reference value, respectively, for the 131 I and 99m Tc was detected. The consequences of these differences were not very critical in this study since the activity measured in dose calibrator before administration was lower than the corrected activity, thus causing a lower effective dose in patients. However, this reduction in activity may result in problems in obtaining the image and consequently, failure diagnosis, delaying correct diagnosis. On the other hand, the overestimation would be worse, mainly in therapeutic applications, because an unnecessarily high absorbed dose would be

  4. Radiological protection of patients in diagnostic and interventional radiology, nuclear medicine and radiotherapy. Contributed papers

    International Nuclear Information System (INIS)

    2001-01-01

    An International Conference on the Radiological Protection of Patients in Diagnostic and Interventional Radiology, Nuclear Medicine and Radiotherapy organized by the International Atomic Energy Agency and co-sponsored by the European Commission, the Pan American Health Organization and the World Health Organization was held in Malaga, Spain, from 26 to 30 March 2001. The Government of Spain hosted this Conference through the Ministerio de Sanidad y Consumo, the Consejo de Seguridad Nuclear, the Junta de Andalucia, the Universidad de Malaga and the Grupo de Investigacion en Proteccion Radiologica de la Universidad de Malaga (PRUMA). The Conference was organized in co-operation with the United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR), the International Commission on Radiological Protection (ICRP) and the following professional societies: International Organization of Medical Physicists (IOMP), International Radiation Protection Association (IRPA), International Society of Radiation Oncology (ISRO), International Society of Radiology (ISR), International Society of Radiographers and Radiological Technologists (ISRRT) and World Federation of Nuclear Medicine and Biology (WFNMB). This publication contains contributed papers submitted to the Conference Programme Committee. The papers are in one of the two working languages of this Conference, English and Spanish. The topics covered by the Conference are as follows: Radiological protection of patients in general diagnostic radiology (radiography), Radiological protection of patients in general diagnostic radiology (fluoroscopy), Radiological protection issues in specific uses of diagnostic radiology, such as mammography and computed tomography (with special consideration of the impact of digital techniques), Radiological protection in interventional radiology, including fluoroscopy not carried out by radiologists, Radiological protection of patients in nuclear medicine, Developing and

  5. Factors Influencing Patient Selection of an Orthopaedic Sports Medicine Physician.

    Science.gov (United States)

    Manning, Blaine T; Bohl, Daniel D; Saltzman, Bryan M; Cotter, Eric J; Wang, Kevin C; Epley, Chad T; Verma, Nikhil N; Cole, Brian J; Bach, Bernard R

    2017-08-01

    The rise in consumer-centric health insurance plans has increased the importance of the patient in choosing a provider. There is a paucity of studies that examine how patients select an orthopaedic sports medicine physician. To evaluate factors that patients consider when choosing an orthopaedic sports medicine physician. Case series; Level of evidence, 4. A total of 1077 patients who sought treatment by 3 sports medicine physicians were administered an anonymous questionnaire. The questionnaire included 19 questions asking respondents to rate the importance of specific factors regarding the selection of orthopaedic sports medicine physicians on a scale of 1 (not important at all) to 10 (very important). The remaining 6 questions were multiple-choice and regarded the following criteria: preferred physician age, appointment availability, clinic waiting room times, travel distance, and medical student/resident involvement. Of the 1077 consecutive patients administered the survey, 382 (35%) responded. Of these, 59% (n = 224) were male, and 41% (n = 158) were female. In ranking the 19 criteria in terms of importance, patients rated board certification (9.12 ± 1.88), being well known for a specific area of expertise (8.27 ± 2.39), and in-network provider status (8.13 ± 2.94) as the 3 most important factors in selecting an orthopaedic sports medicine physician. Radio, television, and Internet advertisements were rated the least important. Regarding physician age, 63% of patients would consider seeking a physician who is ≤65 years old. Approximately 78% of patients would consider seeking a different physician if no appointments were available within 4 weeks. The study results suggest that board certification, being well known for a specific area of expertise, and health insurance in-network providers may be the most important factors influencing patient selection of an orthopaedic sports medicine physician. Advertisements were least important to patients. Patient

  6. Narrative medicine and the personalisation of treatment for elderly patients.

    Science.gov (United States)

    Cenci, C

    2016-07-01

    Healthcare organisations, medical knowledge and clinical practice are among the contexts that have most strongly felt the impact of the over 75 population. This is a population of multimorbidity and polypharmacy patients. They are often seen as a conglomeration of juxtaposed guidelines resulting in the intake of more than 10 drugs a day, with absolutely no certainty of their efficacy. The scientific community is increasingly calling into question the current disease-focused approach. Narrative medicine can provide the tools for a treatment plan which is instead more patient-centred. Narrative medicine can promote the development of a systemic, integrated and multi-disciplinary approach to elderly patients. The stories of patients and caregivers, their representations, perceptions, experiences and preferences can reduce the risk of inappropriate tests and treatments. They can promote deprescribing procedures based on a careful analysis of a specific patient's needs. Narration time is treatment time which does not necessarily create a burden on organisations and caregivers. Quite the contrary since by facilitating adherence and team work, it can significantly reduce time and costs. Given their training and the importance of their relationship with elderly patients, internists, together with geriatricians, can play a key role in promoting and coordinating a narrative medicine approach. Copyright © 2016 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

  7. Painters and patients: how art informs medicine.

    Science.gov (United States)

    Wear, D

    1991-01-01

    This essay describes three movements in art--impressionism, cubism, and abstract expressionism--and how artists within each movement differed in their portrayal of reality. With this background, the author proposes that inquiry into the motives and methods of artists within each movement may help in our understanding of how a person experiences, interprets, and portrays reality. This, in turn, may translate into a recognition of the multiplicity of perspectives and the uniqueness of each patient's lived experience of his or her illness and that the doctor's vantage point on reality may not mesh with that of the patient.

  8. Bariatric surgery influences the number and quality of oocytes in patients submitted to assisted reproduction techniques.

    Science.gov (United States)

    Christofolini, Juliana; Bianco, Bianca; Santos, Gustavo; Adami, Fernando; Christofolini, Denise; Barbosa, Caio Parente

    2014-03-01

    To determine differences in follicle stimulation, oocyte retrieval, maturation, and fertilization among patients who underwent bariatric surgery, obese patients, and patients with 18 assisted reproduction techniques and check that these patients may have some impairment in ovarian response. The study comprised three groups: GI: 29 patients who had undergone restrictive and/or malabsorptive bariatric surgery; GII: 57 obese patients (BMI > 30 kg/m²); and GIII: 94 patients (18 reproductive process can be impaired. Bariatric surgery appears to have an important impact on the formation of follicles and oocytes. © 2013 The Obesity Society.

  9. Quality of life and self-esteem in patients submitted to surgical treatment of skin carcinomas: long-term results.

    Science.gov (United States)

    Maciel, Paula Curitiba; Veiga-Filho, Joel; Carvalho, Marcelo Prado; Fonseca, Fernando Elias Martins; Ferreira, Lydia Masako; Veiga, Daniela Francescato

    2014-01-01

    Cancer is a multifactorial disease and skin carcinomas are the most common type of cancer. Assessing quality of life and self-esteem outcomes in skin cancer patients is important because these are indicators of the results of the treatment, translating how patients face their lives and their personal relationships. To assess the late impact of the surgical treatment of head and/or neck skin carcinomas on quality of life and self-esteem of the patients. Fifty patients with head or neck skin carcinomas were enrolled. Their age ranged between 30 and 75 years, 27 were men and 23 were women. Patients were assessed with regard to quality of life and self-esteem, preoperatively and five years postoperatively. Validated instruments were used: the MOS 36-item Short-form Health Survey (SF-36) and the Rosenberg Self-esteem/EPM-UNIFESP Scale. The Wilcoxon signed-rank test was used for the statistical analysis. Twenty-two patients completed the five-year follow-up, 54.5% women and 45.5% men. Compared to the preoperative assessment, patients had an improvement in mental health (p=0.011) and in self-esteem (p=0.002). There was no statistical difference with regard to the other domains of the SF-36. Patients submitted to surgical treatment of skin carcinoma improved mental health and self-esteem in the late postsurgical testing.

  10. Gross and microscopic findings in patients submitted to nonablative full-face resurfacing using intense pulsed light: a preliminary study.

    Science.gov (United States)

    Hernández-Pérez, Enrique; Ibiett, Erick Valencia

    2002-08-01

    Intense pulsed light (IPL) is a noncoherent, nonlaser, filtered flashlamp emitting a broadband visible light that has been shown to be effective in photoepilation, as well as in a number of vascular and pigmented lesions of the skin. Their efficacy has also been reported recently in the treatment of photodamaged facial skin. In the last condition, however, there are few studies showing the clinical and microscopic changes produced by IPL. To assess the gross and microscopic changes that occur in photodamaged skin submitted to nonablative full-face resurfacing (NAFFR) using IPL. Five women were submitted to five NAFFR sessions using IPL, one every 2 weeks. Skin biopsies and photographs were taken on all of the patients before the first procedure and after the last one, as well as weekly clinical assessment. Data concerning skin features (wrinkles, oiliness, thickness, dilated pores, and general appearance) were all assessed. Microscopic improvement of the aging features in the epidermis and dermis were all assessed. For the statistical analysis a t test for small samples was used. All the patients showed clinical and microscopic improvement in every one of the parameters assessed. The t test for small samples showed a statistically significant difference (P Facial photodamage was clinically and microscopically improved using IPL. Use of IPL as a rejuvenating method seems to be promising, with minimal side effects, a wide safety margin, and minimal downtime.

  11. Complementary medicine use in cancer patients receiving intravenous antineoplastic treatment.

    Science.gov (United States)

    Juanbeltz Zurbano, Regina; Pérez-Fernández, Mª Dolores; Tirapu Nicolás, Bianka; Vera García, Ruth; De la Cruz Sánchez, Susana; Sarobe Carricas, María Teresa

    2017-09-01

    Complementary and alternative medicine (CAM) use has grown considerably, although there is little research on the topic in Spain. The aim of this study was to determine the prevalence of complementary medicine use in adult cancer patients at the same time as they were receiving conventional treatment in a Spanish referral cancer centre. An observational, descriptive, cross-sectional study was conducted in the Ambulatory Treatment Unit during 2 consecutive weeks in March 2015. Adult patients who were receiving intravenous chemotherapy were included. Study variables were obtained from a questionnaire and medical records. 316 patients were included. 32.3% of the patients reported complementary medicine use during this period and 89% were ingesting products by mouth, herbs and natural products being the most commonly used. 81% of patients started to use complementary medicine after diagnosis, and family/friends were the main source of information. 65% of the patients reported improvements, especially in their physical and psychological well-being. Significant predictors of CAM use were female gender (P=0.028), younger age (P<0.001), and secondary education (P=0.009). A large proportion of cancer patients receiving intravenous chemotherapy also use complementary medicine, which they mainly take by mouth. Due to the risk of chemotherapy-CAM interactions, it is important for health-professionals to keep abreast of research on this issue, in order to provide advice on its potential benefit and risks. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

  12. General comments on radiological patient protection in nuclear medicine

    International Nuclear Information System (INIS)

    Tellez de Cepeda, M.; Plaza, R.; Corredoira, E.; Martin Curto, L.M.

    2001-01-01

    In this paper an observation series about different aspects of the radiological protection of the patient in nuclear medicine is provided. It includes: The specific legislation contribution, the justification and, especially, optimization, as a fundamental base of the quality guarantee program, the importance of the fulfillment of the program and the importance of getting done the corresponding internal audits of the pursuit, the communication between the different groups of professionals implicated and between these and the patient, the volunteers who collaborate in the patient's care and the people in the patient's environment, knowing that the patient is a source of external radiation and contamination. (author) [es

  13. Patient Perspectives of Midlevel Providers in Orthopaedic Sports Medicine.

    Science.gov (United States)

    Manning, Blaine T; Bohl, Daniel D; Hannon, Charles P; Redondo, Michael L; Christian, David R; Forsythe, Brian; Nho, Shane J; Bach, Bernard R

    2018-04-01

    Midlevel providers (eg, nurse practitioners and physician assistants) have been integrated into orthopaedic systems of care in response to the increasing demand for musculoskeletal care. Few studies have examined patient perspectives toward midlevel providers in orthopaedic sports medicine. To identify perspectives of orthopaedic sports medicine patients regarding midlevel providers, including optimal scope of practice, reimbursement equity with physicians, and importance of the physician's midlevel provider to patients when initially selecting a physician. Cross-sectional study; Level of evidence, 3. A total of 690 consecutive new patients of 3 orthopaedic sports medicine physicians were prospectively administered an anonymous questionnaire prior to their first visit. Content included patient perspectives regarding midlevel provider importance in physician selection, optimal scope of practice, and reimbursement equity with physicians. Of the 690 consecutive patients who were administered the survey, 605 (87.7%) responded. Of these, 51.9% were men and 48.1% were women, with a mean age of 40.5 ± 15.7 years. More than half (51.2%) perceived no differences in training levels between physician assistants and nurse practitioners. A majority of patients (62.9%) reported that the physician's midlevel provider is an important consideration when choosing a new orthopaedic sports medicine physician. Patients had specific preferences regarding which services should be physician provided. Patients also reported specific preferences regarding those services that could be midlevel provided. There lacked a consensus on reimbursement equity for midlevel practitioners and physicians, despite 71.7% of patients responding that the physician provides a higher-quality consultation. As health care becomes value driven and consumer-centric, understanding patient perspectives on midlevel providers will allow orthopaedic sports medicine physicians to optimize efficiency and patient

  14. Estimated dose from diagnostic nuclear medicine patients to people outside the Nuclear Medicine department.

    Science.gov (United States)

    Bartlett, Marissa L

    2013-11-01

    Patients undergoing nuclear medicine scans can be a source of radiation exposure for staff, family and the public. In this paper, 12 common nuclear medicine scans are considered. Doses are estimated for a range of scenarios, to hospital staff, to the public and to the patients' co-workers and family. Estimates are based on dose rates measured as patients left the Nuclear Medicine department. Radiopharmaceutical clearance is calculated from biokinetic models described in International Commission on Radiological Protection publications 53, 80 and 106. For all scan types, and all scenarios, doses are estimated to be substantially less than the trigger level of 300 µSv. Within the hospital, Intensive Care Unit staff receive the highest dose (up to 80 µSv) from patients who have had a myocardial scan or a positron emission tomography scan. For out-patients, the highest doses (up to 100 µSv) are associated with travel on public transport (for 4 h) on the same day as the scan.

  15. Evaluation of the use of a Business Intelligence system for management of patient radiation dose undergone to nuclear medicine exams

    International Nuclear Information System (INIS)

    Fischer, A.C.F.S.; Capaverde, A.S.; Moreira, M.N.; Moraes, A.L.; Andrade, J.R.M.; Bacelar, A.

    2017-01-01

    The feasibility of using a Business Intelligence (BI) system, IMPAX BI (Agfa), to manage the effective radiation dose of patients undergoing Nuclear Medicine exams was evaluated. The evaluation was divided into four stages, using retrospective data from the activity administered to adult patients in the year 2016. It was possible with the system to create panels to filter the data by date and display them in table and / or graphs, indicating the estimated doses and established limits. The IMPAX BI system proved to be a tool capable of assisting in dose management in Nuclear Medicine since it facilitates the identification of cases in which the patient is submitted to doses higher than those defined in the protocols of exams

  16. Nuclear medicine in patients with prolonged fever

    International Nuclear Information System (INIS)

    Meller, J.

    2007-01-01

    Fever of unknown origin (FUO) was originally defined as recurrent fever of 38.2 C or higher, lasting 2-3 weeks or longer, and undiagnosed after 1 week of hospital evaluation. The last criterion has undergone modification and is now generally interpreted as no diagnosis after appropriate inpatient or outpatient evaluation. The three major categories that account for the majority of fever of unknown origin (FUO) are infections, malignancies and non infectious inflammatory diseases. In this respect FOU in its original definition is clearly separated from nosocomial, post-operative and neutropenic fever, where acute infection is more common. Although in-vitro- or in-vivo-labelled white blood cells (WBCs) have a high diagnostic accuracy in the detection and exclusion of granulocytic pathology, these methods are only of limited value in patients with 'classic' FUO in establishing the final diagnosis due to the low prevalence of acute infection in this group. Labelled WBCs therefore seem to be more useful in patients with nosocomial, post-operative and neutropenic fever. 67 Ga citrate is the only commercially available gamma emitter in imaging acute, chronic, granulomatous and autoimmune inflammation and also various malignant diseases. Therefore 67 Ga citrate was for a long time considered to be the tracer of choice in the diagnostic work-up of FUO. The number of 67 Ga scans contributing to the final diagnosis was found to be higher than it has been reported for labelled WBCs. The positron emitter [ 18 F]-2-fluoro-2'-deoxy-D-glucose (FDG) have been systematically evaluated in the context of classic FUO by several groups within last 5 years. This data, although limited, indicate that FDG-imaging should considered as the most promising procedure in patients with undetermined fever. FDG-PT seems to be more sensitive than other techniques, offers a more rapid diagnosis without an increase of the patients radioactive burden. It is expected that the PET/CT technology will

  17. Pharyngeal Residue and Aspiration and the Relationship with Clinical/Nutritional Status of Patients with Oropharyngeal Dysphagia Submitted to Videofluoroscopy.

    Science.gov (United States)

    Oliveira, D L; Moreira, E A M; de Freitas, M B; Gonçalves, J de A; Furkim, A M; Clavé, P

    2017-01-01

    The aim of this study was to investigate the association between the videofluoroscopic (VFS) signs of impaired efficacy (pharyngeal residue) and safety (aspiration) swallowing and the clinical/nutritional status of patients with suspect of dysphagia. A cross-sectional study was conducted with patients submitted to videofluoroscopy. Data of 76 patients were analyzed between March 2011 and December 2014. The clinical history and VFS exams of patients ≥ 38 years were retrospectively analyzed. 88% patients presented Oropharyngeal Dysphagia (OD), 44.7% presented laryngeal penetration and 32% presented aspiration. 78% patients presented pharyngeal residue. Aspiration was associated with Head Neck Cancer (HNC) [Prevalence Ratio (PR): 2.27, p = 0.028] and cardiovascular disease (PR 1.96, p = 0.027). Underweight [Body Mass Index Underweight patients with OD had a higher prevalence rate of pharyngeal residue than those normally nourished (100% vs. 78%) (PR 1.34, p = 0.011). Pharyngeal residue was associated with male sex (PR 1.32, p = 0.040), neurodegenerative disease (PR 1.57, p = 0.021), stroke (PR 1.62, p = 0.009), cerebral palsy (PR 1.76, p = 0.006) and HNC (PR 1.73, p = 0.002). In the present study, neurologic diseases, HNC, male sex and underweight were associated to impaired swallowing efficacy. Underweight, independently of the other variables, was not associated with impaired swallowing safety.

  18. Herbal Medicine in Primary Healthcare in Germany: The Patient's Perspective

    Directory of Open Access Journals (Sweden)

    Stefanie Joos

    2012-01-01

    Full Text Available Herbal medicine (HM is one of the most widely used Complementary and Alternative Medicine (CAM therapies throughout the world. The WHO has recognized HM as an essential component of primary healthcare. The aim of this study was to explore patients' attitudes towards using HM, their sources of information and the role of costs. Within a qualitative research approach, semi-standardized interviews with 18 patients using HM were conducted and analyzed according to Mayring's content analysis. Patients highlighted their active role and perceived autonomy choosing HM. Most interviewees experienced HM as better, with more sustainable effects and fewer side effects compared to conventional medicine. All media, family, friends, and healthcare professionals were reported as sources of information. Some patients complained that doctors and pharmacists have insufficient knowledge of HM. Most patients expressed their regret that HM is not reimbursed by statutory health insurances but also their general willingness to pay extra for HM. The main challenge for German primary care, besides the reintroduction of reimbursement, is the promotion of knowledge and skill development in HM. This is to ensure patient safety and work in partnership with patients. Appropriate strategies for education must be tailored to the specific needs of health professional groups.

  19. Physician Communication to Enhance Patient Acupuncture Engagement in Family Medicine.

    Science.gov (United States)

    Fisher, Carla L; Ledford, Christy J W; Moss, David A; Crawford, Paul

    2018-04-09

    Integrating complementary therapies (acupuncture) into conventional medicine has garnered recent support. Given the health benefits, low cost, and minimal risks, the military has advocated for acupuncture and begun training family medicine physicians. Little is known about the role of physician communication in patients' acupuncture engagement (uptake and adherence) in conventional medicine settings. We interviewed physicians (N = 15) and patients (N = 17) to capture physician communication they perceived affected treatment engagement. Data for each group were thematically analyzed. Physicians and patients prioritized different communication approaches and associated strategies. Physicians identified four approaches that enhance treatment engagement: (1) using shared decision-making (e.g., treatment options); (2) not being pushy (e.g., in tone); (3) carefully choosing language (e.g., Eastern versus Western terms); and (4) explaining treatment outcomes (e.g., efficacy). Patients also prioritized explaining treatment outcomes but differently (e.g., timing clarity), with two additional approaches: (5) talking with the same physician (e.g., continuity) and (6) being responsive to patient (e.g., flexibility). Findings highlight how physicians and patients prioritize patient-centered communication differently and how it is embedded within a unique, complex therapy. Data showcase authentic narratives that could be translated into physician communication skills training to promote treatment engagement in integrative care.

  20. Use of complementary and alternative medicine by cancer patients ...

    African Journals Online (AJOL)

    Complementary and alternative medicine (CAM) is garnering increasing interest and acceptance among the general population throughout the world. The use of CAM by cancer patients is very common in China. The referenced English literature has no rural community-based study from China on this subject. This study ...

  1. Nuclear medicine procedures for monitoring patient therapy

    International Nuclear Information System (INIS)

    Gobuty, A.H.

    1987-01-01

    The demands of present biomedical technology are not trivial. Such technology has placed unaccustomed demands on clinicians. NM has been no exception. A large number of new tests which have the potential for contributing to patient management in ways unknown until recently are available. This chapter was designed to provide assistance in test assessment with the following temporal sequence: (a) What questions can these test answer? (b) Which test appears to be most appropriate for the question at hand? (c) Is the selected test cost effective? (d) Does the selected test stand on solid experiential and/or factual ground? (e) How can the data obtained best be handled? The widespread acceptance of these monitoring tests indicates that the available rewards are greater than the demands placed on us in using them. Judiciously used, these tests should continue to be important for both the provider and the recipient of health care

  2. Nutritional Advice for Patients with Melasma in Iranian Traditional Medicine

    Directory of Open Access Journals (Sweden)

    Mahdis Mojtabaee

    2016-03-01

    Full Text Available Background Melasma (called Kalaf in Iranian traditional medicine is a common acquired hypermelanosis that affects sun-exposed areas of skin. Several factors including exposure to sunlight, pregnancy, and endocrine diseases increase the risk for Melasma. In traditional medicine, antecedent philosophers and physicians have tried to understand the nature and mechanisms of different systems of the human body for the diagnosis and management of Melasma; they have offered different solutions for it. This study is important since Melasma is a disease causing mental side effects in patients, due to darkness and opacity of the skin; therefore, the treatment of Melasma in terms of its psychological complications is of particular importance. In addition, texts of Iranian traditional medicine contain a wealth of nutritional advice for patients with Melasma. These texts have, until now, not yet been reviewed. The present study has considered the most important references of Iranian traditional medicine texts. Objectives The objective of this study was to extract and categorize the nutritional advice of Iranian traditional medicine texts for the treatment of Melasma. Results Dietary recommendations, not only for treatment but also for prevention of diseases and staying healthy, are very efficient. Conclusions Based on the traditional medicine texts, it is helpful to avoid Soda-producing food as well as to identify appropriate food in order to eliminate the accumulation of Soda or black bile from the blood. This study offers a set of analytical and clinical research on food, which in traditional medicine is called Soda-producing as well as Soda reducing.

  3. Patient-related pitfalls and artifacts in nuclear medicine imaging.

    Science.gov (United States)

    Howarth, D M; Forstrom, L A; O'Connor, M K; Thomas, P A; Cardew, A P

    1996-10-01

    Quality control in nuclear medicine is all important. This applies not only to preparation of the patient and acquisition of the image, but also to interpretation of the study. Although it may seem self-evident, it is important to remain aware of artifacts that are directly related to the patient and need special consideration. Furthermore, at times the distinction between normal variants and artifacts can be difficult. Commonly encountered patient-related artifacts include artifacts caused by attenuation, contamination artifacts, and artifacts caused by intravenous lines, tubes, and catheters. Less commonly, artifacts arise because of the use of multiple isotopes, the presence of fistulas or surgically altered anatomy, and pharmaceuticals and other substances interfering with expected radiopharmaceutical uptake and distribution. The diagnostic accuracy of nuclear medicine reporting can be improved by awareness of these patient-related artifacts. Both awareness and experience are also important when it comes to detecting and identifying normal (and abnormal) variants.

  4. Effect of a hormone-releasing intrauterine system (Mirena® on aromatase and Cox-2 expression in patients with adenomyosis submitted or not, to endometrial resection

    Directory of Open Access Journals (Sweden)

    Maia R

    2012-04-01

    Full Text Available Hugo Maia Jr1,2, Clarice Haddad1, Julio Casoy1, Rebeca Maia1, Nathanael Pinheiro3, Elsimar M Coutinho11Centro de Pesquisa e Assistência em Reprodução Humana (CEPARH, 2Itaigara Memorial Day Hospital, 3IMAGEPAT, Salvador, Bahia, BrazilObjective: To investigate the effect of a levonorgestrel-releasing intrauterine system (Mirena® on aromatase and cyclooxygenase-2 (Cox-2 expression in the endometrium of patients with adenomyosis who were submitted to endometrial resection at the time of insertion, compared to a group not submitted to endometrial resection and a group of controls with adenomyosis not submitted to any previous hormonal treatment.Patients and methods: Patients with adenomyosis (n = 89 were included in this study. Twenty-two patients had been using Mirena® for 5 years but had not been submitted to endometrial resection prior to insertion of the device. Twenty-four patients were submitted to endometrial resection at the time of Mirena® insertion. The remaining 43 patients with adenomyosis had undergone no previous hormonal treatment and served as a control group. Cox-2 and aromatase expression were determined in the endometrium by immunohistochemistry.Results: Use of Mirena® for 5 years reduced aromatase expression in the endometrium; however, this reduction was significantly greater in the uteri previously submitted to endometrial resection. The reduction in Cox-2 expression was significant only in the uteri submitted to endometrial resection followed by the insertion of Mirena®.Conclusion: Endometrial resection followed by the insertion of Mirena® was associated with greater rates of amenorrhea in patients with adenomyosis, which in turn were associated with a more effective inhibition of aromatase and Cox-2 expression in the endometrium.Keywords: aromatase, Mirena®, adenomyosis, Cox-2, endometrium, levonorgestrel

  5. Empowerment of patients in online discussions about medicine use.

    Science.gov (United States)

    van Berkel, Jasper J; Lambooij, Mattijs S; Hegger, Ingrid

    2015-04-08

    Patient empowerment is crucial in the successful self-management of people with chronic diseases. In this study, we investigated whether discussions about medicine use taking place on online message boards contribute to patient empowerment and could subsequently result in the more effective use of medicines. We discuss the extent to which patient empowerment processes occur in discussions on online message boards, focusing on patients with three disorders with different characteristics: diabetes, Amyotrophic Lateral Sclerosis (ALS) and Attention Deficit / Hyperactivity Disorder (ADHD). Because information is an important factor in both patient empowerment and self-management, we also evaluate the quality of the information being exchanged. We used a deductive thematic analysis method based on pre-existing categories. We gathered and analysed 5532 posts related to the conditions ADHD, ALS and diabetes from seven message boards (three for ADHD, three for diabetes, and one for ALS). We coded the posts for empowerment processes and the quality of the information exchanged. We identified patient empowerment processes in posts related to all three disorders. There is some variation in the frequency of these processes, but they show a similar order in the results: patients used the online message boards to exchange information, share personal experiences and for empathy or support. The type of information shared in these processes could contribute to the patient's self-efficacy when it comes to medicine use. The exchanged information was either correct or largely harmless. We also observed a tendency whereby participants correct previously posted incorrect information, and refer people to a healthcare professional following a request for medical advice, e.g. concerning the choice of medicines or dosage. Our findings show that patient empowerment processes occur in posts related to all three disorders. The type of information shared in these processes can contribute to the

  6. Radiation exposure to sonographers from nuclear medicine patients: A review.

    Science.gov (United States)

    Earl, Victoria Jean; Badawy, Mohamed Khaldoun

    2018-02-25

    Following nuclear medicine scans a patient can be a source of radiation exposure to the hospital staff, including sonographers. Sonographers are not routinely monitored for occupational radiation exposure as they do not commonly interact with radioactive patients or other sources of ionizing radiation. This review aims to find evidence relating to the risk and amount of radiation the sonographer is exposed to from nuclear medicine patients. It is established in the literature that the radiation exposure to the sonographer following diagnostic nuclear medicine studies is low and consequently the risk is not significant. Nevertheless, it is paramount that basic radiation safety principles are followed to ensure any exposure to ionizing radiation is kept as low as reasonably achievable. Practical recommendations are given to assist the sonographer in radiation protection. Nuclear medicine therapy procedures may place the sonographer at higher risk and as such consultation with a Radiation Safety Officer or Medical Physicist as to the extent of exposure is recommended. © 2018 The Royal Australian and New Zealand College of Radiologists.

  7. [Evaluation of changes made in the peri-operative care in patients submitted to elective abdominal surgery].

    Science.gov (United States)

    Walczewski, Mayra da Rosa Martins; Justino, Ariane Zanetta; Walczewski, Eduardo André Bracci; Coan, Tatiane

    2012-04-01

    To evaluate the results of the introduction of new measures to accelerate the postoperative recovery of patients undergoing elective abdominal surgery. We observed 162 patients and interviewed them on two distinct periods: the first between October to December 2009 (n = 81) comprised patients who underwent conventional perioperative monitoring (pre-intervention) and the second between March and May 2010 (n = 81), formed by a new group of patients, submitted to the new protocol of perioperative monitoring. Data collection in the two periods occurred without the knowledge of the professionals in the service. The variables were: indication for preoperative nutritional support, duration of fasting, post-operative volume of hydration, use of catheters and drains, length of stay and postoperative morbidity. when comparing the two periods we observed a decrease of 2.5 hours in the time of preoperative fasting (p = 0.0002) in the post-intervention group. As for the reintroduction of oral diet, there was no difference between the two periods (p = 0.0007). When considering the patients without postoperative complications, there was a significantly decreased length of stay (p = 0.001325). There was a reduction of approximately 50% in antibiotic use in the post-intervention group (p = 0.00001). The adoption of multidisciplinary perioperative measures is feasible within our reality, and although there was no statistically significant changes in the present study, it may improve morbidity and reduce length of stay in general surgery.

  8. Anatomical and physiological changes in pelvic diaphragm in patients with chagasic megacolon submitted to Duhamel surgery

    OpenAIRE

    Moreira Júnior,Hélio; Moreira,José P. T.; Isaac,Raniere R.; Almeida,Arminda C. de; Moreira,Hélio; Klug,Wilmar A.

    2013-01-01

    ORIGINAL CONTRIBUTION: understand the reasons why Duhamel surgery results in clinical improvement of constipation in patients with Chagasic colopathy. BACKGROUND: Duhamel surgery is one of the most widespread techniques for the treatment of Chagasic megacolon, with low rates of recurrence of constipation. OBJECTIVE: evaluate the anatomical and physiological changes in the pelvic diaphragm of patients with chagasic colopathy, as well as changes occurring after undergoing Duhamel surgery. DESIG...

  9. Anatomical and physiological changes in pelvic diaphragm in patients with chagasic megacolon submitted to Duhamel surgery

    OpenAIRE

    Hélio Moreira Júnior; José P.T. Moreira; Raniere R. Isaac; Arminda C. de Almeida; Hélio Moreira; Wilmar A. Klug

    2013-01-01

    Original contribution: understand the reasons why Duhamel surgery results in clinical improvement of constipation in patients with Chagasic colopathy. Background: Duhamel surgery is one of the most widespread techniques for the treatment of Chagasic megacolon, with low rates of recurrence of constipation. Objective: evaluate the anatomical and physiological changes in the pelvic diaphragm of patients with chagasic colopathy, as well as changes occurring after undergoing Duhamel surgery. Desig...

  10. Viewpoints of Patients in Qazvin Towards Complementary and Alternative Medicine

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    Barikani

    2016-02-01

    Full Text Available Background We have little information on the degree of individuals’ in Iran and their use of complementary and alternative medicine, its variations and the causes of people’s tendency towards the treatments used in the methods mentioned above. Objectives In 2012, we set out to study the viewpoints of patients in Qazvin, Iran, examining how they feel about complementary and alternative medicine. Patients and Methods In a cross-sectional study, data were collected through the use of a questionnaire. A total of 293 patients who had been referred to the complementary and alternative medicine centers were surveyed. These centers practice methods such as cupping, homeopathy and acupuncture. The questionnaire was divided in two parts, demographic questions and main questions, in this particular study. The data were analyzed using SPSS software version 19 with P < 0.05. Results The mean age of the participants was 37.2 ± 13.3, and 60.8 percent of them were men. In all, 70.6 percent and 24.4 percent of respondents were married and single, respectively. About 58 percent had completed their undergraduate education. The cause of 31.3 percent of the participants’ visits was mental sicknesses, 20.2 percent attended due to rheumatologic diseases, and 8.2 percent applied to the mentioned treatment centers seeking relief from skin-related diseases. Ninety-one percent of the participants reported using alternative and complementary medicine for its efficiency. The levels of high satisfaction they reported gaining from the center’s homeopathy, acupuncture, and phlebotomy services were 17.2%, 16.5%, and 18.2%, respectively. In addition, 70 percent of the patients found the new treatment method to be quite successful, while 27 percent found it to be less effective than other approaches they had tried. Conclusions The people were receptive to the use of alternative and complementary medicine and their satisfaction level was high.

  11. The hateful patient revisited: Relevance for 21st century medicine.

    Science.gov (United States)

    Strous, Rael D; Ulman, Anne-Marie; Kotler, Moshe

    2006-10-01

    While the practice of medicine has changed over the years, including technological advances, access to medical information, and the narrowing of socio-economic and educational gaps between the clinician and his/her patients, the importance of the doctor-patient relationship has not diminished over time. This can be a very rewarding interaction. However, many physicians experience a great deal of anger, inadequacy and frustration, and much of the actual practice of medicine may become a burden rather than a source of satisfaction. Physicians may encounter a subset of patients who engender strong negative feelings, despair and even downright malice. An understanding of the "hateful patient" can therefore be very informative to the physician. Several categories of such patients may be described, and sensitivity to the phenomenon will lead to improved physician well-being, less self-destructive patient behavior and a lower risk of litigation. Several factors may assist the 21st century physician in managing the "hateful patient" in an empathic manner and in making some sense of why the patient has resorted to negative response patterns. Ultimately, a failure to consider these issues will result in poorer medical care and, no less important, reduced satisfaction of both patients and doctors. The intention of this article is to revisit the concept and to place it in the context of contemporary medical practice.

  12. Reliance on medicinal plant therapy among cancer patients in Jamaica.

    Science.gov (United States)

    Foster, Kimberley; Younger, Novie; Aiken, William; Brady-West, Doreen; Delgoda, Rupika

    2017-11-01

    Patients' perspective of their treatment regime plays a vital role in its success. Recognizing the high prevalence of medicinal plant usage among Jamaicans at large, we investigated the engagement of such remedies by cancer patients, with the aim of uncovering self-medicating habits, perceptions and details of utilized plants. A structured, interviewer-based questionnaire was administered to 100 patients attending the oncology and urology clinics at the University Hospital of the West Indies in Kingston, Jamaica. A method of convenience sampling was employed and the data were analyzed using summary statistics and statistical significance tests. A large proportion (n = 80, 80%) of interviewed patients, engaged medicinal plants in their treatment regimes. Such habits were independent of person's education, economic status and were higher among the 55-74 age groups (p Petiveria alliacea L. were the most commonly used plants for treating breast and prostate cancers, respectively. A large proportion of Jamaican cancer patients use medicinal plants in self-medicating practices and their perceptions and habits need to be considered by physicians, in the design of safe and effective care regimes.

  13. Incidence of true short esophagus among patients submitted to laparoscopic Nissen fundoplication.

    Science.gov (United States)

    Migaczewski, Marcin; Zub-Pokrowiecka, Anna; Grzesiak-Kuik, Agata; Pędziwiatr, Michał; Major, Piotr; Rubinkiewicz, Mateusz; Winiarski, Marek; Natkaniec, Michał; Budzyński, Andrzej

    2015-04-01

    The last two decades have observed development of surgical treatment of benign conditions of the gastroesophageal junction (GEJ), including anti-reflux surgery, due to the growing popularity of the laparoscopic approach. Migration of the fundoplication band and recurrent hiatal hernia are a result of the lack of correct diagnosis and appropriate management of the so-called short esophagus. According to various authors, short esophagus is present in up to 60% of patients qualified for anti-reflux surgery. However, some researchers question the existence of this condition. To analyze the prevalence of short esophagus in patients subjected to laparoscopic Nissen fundoplication. The study included 202 patients who were subjected to laparoscopic Nissen fundoplication. As many as 96% of the patients qualified for the surgical treatment showed supradiaphragmatic location of the high pressure zone. The extent of GEJ protrusion ranged from 0 cm to 3 cm (mean: 2 cm). The extent of dissection within the mediastinum was determined by the level of GEJ protrusion, and ranged from 5 cm to 12 cm (mean: 6 cm). Upon complete mobilization of the esophagus within the mediastinum, no cases of significantly shortened esophagus, precluding downward retraction of at least a 2.5-cm segment below the diaphragmatic crura, were documented. Therefore, none of the patients required Collis gastroplasty. The presence of "true" short esophagus is a sporadic finding among patients qualified for anti-reflux surgery. Mediastinal dissection of the esophagus and its mobilization at an appropriate, individually defined level seems a sufficient treatment in the vast majority of these patients.

  14. Red meat intolerance in patients submitted to gastric bypass: a 4-year follow-up study.

    Science.gov (United States)

    Nicoletti, Carolina Ferreira; de Oliveira, Bruno Affonso Parenti; Barbin, Renato; Marchini, Julio Sergio; Salgado Junior, Wilson; Nonino, Carla Barbosa

    2015-01-01

    Bariatric surgery provides significant weight reduction; however, it may result in food intolerance followed by gastrointestinal complications that may lead to nutritional deficiencies. This study evaluated the influence of red meat intolerance on the dietary pattern, biochemical indicators, and clinical symptoms after Roux-en-Y gastric bypass (RYGB). This retrospective study evaluated patients 4 years after RYGB. The patients were divided into 2 groups: patients with and without red meat intolerance, and data for the following were collected: food intake, anthropometric data, biochemical data, and presence of nausea, vomiting, weakness, weak nails, and hair loss. The difference between groups in the times postoperative was determined by ANOVA. Of the 72 patients included in the study, 63 were evaluated during the first postoperative year, 45 during the second, 56 during the third, and 41 during the fourth. Red meat intolerance was observed in 49.2%, 42.2%, 46.4%, and 39% of the patients after 1, 2, 3, and 4 years, respectively. After 1 year, the intolerant group showed lower calorie, carbohydrate, and iron intake. After 3 years, tolerant patients showed weight regain (2.9 ± 5.3 kg), while the intolerant ones remained stable. There was no difference in the presence of clinical symptoms or biochemical indicators between groups. Red meat intolerance is frequent after bariatric surgery and may alter energy, iron intake, and weight loss; however, it is not associated with the presence of clinical symptoms and biochemical profile. Copyright © 2015 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  15. [Diagnostic yield and postoperative management of patients submitted to brain biopsy in a university hospital].

    Science.gov (United States)

    Gracia, Isabel; Perelló, Laura; Valero, Ricard; Hervías, Adriana; Perdomo, Juan; Pujol, Roger; González, Josep; Hurtado, Paola; de Riva, Nicolás; Tercero, Francisco Javier; Carrero, Enrique; Ferrer, Enric; Fàbregas, Neus

    2015-01-01

    To assess the diagnostic yield and the incidence of perioperative complications in patients undergoing an open or closed cerebral biopsy and to determine the length of intensive care monitoring, for early diagnosis and fast management of perioperative complications. This was a retrospective analysis of all the patients that underwent brain biopsy between January 2006 and July 2012. We recorded demographic data, comorbidities, modality of biopsy, intraoperative clinical data, histological results, computed tomography scanning findings and occurrence, and type of perioperative complications and moment of appearance. Seventy-six brain biopsies in 75 consecutive patients (51 closed and 25 open) were analysed. Diagnostic yield was 98% for closed biopsies and 96% for open biopsies. Mortality related to the procedures was 3.9 and 4%, respectively. The incidence of major complications was 3.9% for closed biopsies and 8% for open biopsies; half of these appeared within the first 24 postoperative hours, during patient stay in the Intensive Care Unit. Age was the only risk factor for complications (P=.04) in our study. No differences in morbimortality were found between the studied groups. Diagnostic yield was very high in our series. Because the importance of early diagnosis of complications for preventing long-term sequelae, we recommend overnight hospital stay for observation after open or closed brain biopsy. Copyright © 2014 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.

  16. Is Systemic Inflammation Associated With Elevated PSA Serum Levels In Patients Submitted Chronic Hemodialysis?

    Directory of Open Access Journals (Sweden)

    Gilmar Pereira Silva

    2017-09-01

    Full Text Available Backgroundː whereas that systemic inflammation (SI affects 40–60% of patients on hemodialysis (HD is characterized by serum C-reactive protein (CRP level elevation or proinflammatory interleukin production or both. We evaluated the association between SI and total (tPSA and free PSA (fPSA in patients on HD with tPSA 6 months. Patients were excluded if they had local infections or SI. Hs-CRP was measured using turbidimetry, and tPSA and fPSA levels using immunochemoluminescence. Overall, 27 patients had inflammation (hs-CRP >5 mg/L and 33 had no inflammation (hs-CRP was ≤5 mg/L. In the control group, hs-CRP was ≤ 1 mg/L. Resultsː there was no significant difference in mean levels among groups 3 and 4 for age (p=0,058, tPSA (p=0,74 and fPSA (p=0,30. The SI did not promote differences between groups 1, 2 and 4 for the levels of tPSA (0,71 ± 0,18  vs   0,67 ± 0,15  vs  0,67 ± 0,11; p=0,69 and fPSA (0,34  ±  0,01  vs  0,34  ±  0,01  vs   0,35  ±  0,01, p= 0,59 . As well as maintained no correlation with tPSA and fPSA (p>0,05. Conclusionː The systemic inflammation in hemodialytic patients without clinically detectable cancer (PSA<4ng/ml is no associated with changes fractions of tPSA and fPSA.

  17. Retrospective analysis of patients submitted to surgical treatment of perianal fistula in Santa Marcelina Hospital, São Paulo

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    Isaac José Felippe Corrêa Neto

    2017-07-01

    Full Text Available Introduction: Perianal fistula is a condition commonly found in surgical practice, with an incidence of approximately 1 in 10,000 individuals, with a predisposition for the male gender, occurring mainly in patients between 30 and 50 years and in 80% of the cases originating from infection in the glandular crypts (cryptoglandular. Objective: To perform a retrospective analysis using electronic medical record data of patients submitted to surgical treatment for perianal fistula in Santa Marcelina Hospital in São Paulo, as well as to verify the incidence of relapse and anal continence disorders, in addition to the complexity and types of fistulas and patient characterization. Results: Two hundred patients were submitted to surgical treatment of perianal fistula were analyzed. Among men, there was a higher incidence of patients with lower educational level (p = 0.02, hypertension (0.03, diabetes (0.05, older age (p = 0.001, whereas among women previous perianal abscess predominated (0.001. There was no statistical difference in anal continence between patients submitted to fistulotomy with or without seton. Conclusion: We observed a predominance of male patients and a low incidence of recurrence and symptoms of anal continence disorders, in addition to a predominance of complex fistulas. Resumo: Introdução: Fístula perianal é uma condição comumente encontrada na prática cirúrgica com incidência de cerca 1 em 10000 indivíduos com predisposição para o sexo masculino, ocorrendo fundamentalmente em pacientes entre 30 e 50 anos e em 80% dos casos tem origem em infecção nas criptas glandulares (criptoglandular. Objetivo: Realizar análise retrospectiva através de dados de prontuário eletrônico de pacientes submetidos a tratamento cirúrgico de fístula perianal no Hospital Santa Marcelina São Paulo, além de verificar a incidência de recidiva e desordens da continência anal, além da complexidade e tipos das fístulas e

  18. Quality of life among morbid obese and patients submitted to bariatric surgery

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    Lívia Moreira Barros

    2015-06-01

    Full Text Available The objective was to assess Quality of Life (QoL among obese waiting for bariatric surgery and post-surgery patients. A cross-sectional quantitative study conducted in a hospital reference in bariatric surgery in Fortaleza-CE. The sample was composed by 64 pre- and 92 post-surgery patients. Data was collected through the QoL questionnaire Moorehead-Ardelt II from the Bariatric Analysis and Reporting Outcome System (BAROS protocol. Most individuals at pre-surgery stage classified their QoL as minimal – 57,8% (37, while the post-surgery group observed a significant change where 75% (69 of participants considered their QoL very good after the procedure (p< 0,001. In both groups, the QoL aspects that presented worse evaluation were: physical activity, sexual interest and eating behavior. Bariatric surgery represents improvement in quality of life of individuals.

  19. ANALYSIS OF FOOD TOLERANCE IN PATIENTS SUBMITTED TO BARIATRIC SURGERY USING THE QUESTIONNAIRE QUALITY OF ALIMENTATION.

    Science.gov (United States)

    Stumpf, Matheo Augusto Morandi; Rodrigues, Marcos Ricardo da Silva; Kluthcovsky, Ana Claudia Garabeli Cavalli; Travalini, Fabiana; Milléo, Fábio Quirillo

    2015-01-01

    Due to the increased prevalence of obesity in many countries, the number of bariatric surgeries is increasing. They are considered the most effective treatment for obesity. In the postoperative there may be difficulties with the quality of alimentation, tolerance to various types of food, as well as vomiting and regurgitation. Few surveys are available to assess these difficulties in the postoperative. To perform a systematic literature review about food tolerance in patients undergoing bariatric surgery using the questionnaire "Quality of Alimentation", and compare the results between different techniques. A descriptive-exploratory study where the portals Medline and Scielo were used. The following headings were used in english, spanish and portuguese: quality of alimentation, bariatric surgery and food tolerance. A total of 88 references were found, 14 used the questionnaire "Quality of Alimentation" and were selected. In total, 2745 patients were interviewed of which 371 underwent to gastric banding, 1006 to sleeve gastrectomy, 1113 to Roux-en-Y gastric bypass, 14 to biliopancreatic diversion associated with duodenal switch, 83 were non-operated obese, and 158 non-obese patients. The questionnaire showed good acceptability. The biliopancreatic diversion with duodenal switch had the best food tolerance in the postoperative when compared to other techniques, but it was evaluated in a single article with a small sample. The longer the time after the operation, the better is the food tolerance. Comparing the sleeve gastrectomy and the Roux-en-Y gastric bypass, there are still controversial results in the literature. The gastric banding had the worst score of food tolerance among all the techniques evaluated. The questionnaire is easy and fast to assess the food tolerance in patients after bariatric surgery. Biliopancreatic diversion with duodenal switch had the best food tolerance in the postoperative when compared to sleeve gastrectomy and the Roux-en-Y gastric

  20. Evaluation of the radiation doses in newborn patients submitted to CT examinations

    Energy Technology Data Exchange (ETDEWEB)

    De Souza Santos, William; Caldas, Linda V.E. [Instituto de Pesquisas Energeticas e Nucleares, Comissao Nacional de Energia Nuclear (IPENCNEN/SP), Av. Prof. Lineu Prestes, 2242, Cidade Universitaria, 05508-000 Sao Paulo, SP, (Brazil); Belinato, Walmir [Departamento de Ensino, Instituto Federal de Educacao, Ciencia e Tecnologia da Bahia, Campus Vitoria da Conquista, Zabele, Av. Amazonas 3150, 45030-220 Vitoria da Conquista, BA, (Brazil); Pereira Neves, Lucio; Perini, Ana Paula [Instituto de Fisica, Universidade Federal de Uberlandia, Caixa Postal 593, 38400-902, Uberlandia, MG, (Brazil)

    2015-07-01

    The number of computed tomography (CT) scans available to the population is increasing, as well as the complexity of such exams. As a result, the radiation doses are increasing as well. Considering the population exposed to CT exams, pediatric patients are considerably more sensitive to radiation than adults. They have a longer life expectancy than adults, and may receive a higher radiation dose than necessary if the CT scan settings are not adjusted for their smaller body size. As a result of these considerations, the risk of developing cancer is of great concern when newborn patients are involved. The objective of this work was to study the radiation doses on radiosensitive organs of newborn patients undergoing a whole body CT examination, utilizing Monte Carlo simulations. The novelty of this work is the use of pediatric virtual anthropomorphic phantoms, developed at the Department of Nuclear Energy at the Federal University of Pernambuco (DEN/UFPE). The CT equipment utilized during the simulations was a Discovery VCT GE PET/CT system, with a tube voltage of 140 kVp. The X-ray spectrum of this CT scanner was generated by the SRS-78 software, which takes into account the X-ray beam energy used in PET/CT procedures. The absorbed organ doses were computed employing the F6 tally (MeV/g). The results were converted to dose coefficients (mGy/100 mA) for all the structures, considering all employed beams. The highest dose coefficients values were obtained for the brain and the thyroid. This work provides useful information regarding the risks involving ionizing radiation in newborn patients, employing a new and reliable technique. (authors)

  1. Study Of Onychomycosis In Submitted Patients To The Pasteur Institute Of Iran 1993 -1999

    Directory of Open Access Journals (Sweden)

    Khaksar A A

    2002-09-01

    Full Text Available Fungal infection of the nail, also known as onychomycosis, is a worldwide problem. It is estimated that onychomycosis constitutes 15-22 percent of all nail disorders. It is also known that 2-5 percent of the adult population in Europe have onychomycosis. This problem is quite common in the dermatology clinic of the countries in the Midle East, India and the Far East. The infection rates and types of fungi involved in onychomycosis vary with conditions such as age, sex, occupation, hygiene, foot wear and several environmental and climatic factors."nMethods and Materials: A retrospective study of nail infection was carried out in the section of Medical Mycology, Pasteur Institute of Iran from April 1993 to March 1999. Nineteen hundreds eighty five cases examined for toe and finger nail infections."nResults: Ranging in age were from 3 months to 84 years old. This study reports the causative agents of onychomycosis in the presented patients in the section of Medical Mycology, Pasteur Institute of Iran. The 1985 patients were examined for onychomycosis. Diagnosis was confirmed by demonstration of fungi in direct (K.OH 20 percent and cultural examination. Onychomycosis were proven in 601 patients. Three hundreds fifty patients were females (59 percent. The fingernails were more commonly positive in females (73.5 percent than males, while the toenail positivity rate in males was 69 percent. Among 601 isolated species, dermatophytes were 308 cases (51 percent mainly from toenail were predominant. Candida SPP. Were isolated in 46 percent of the cases, especially from fingernails. Nondermatophytic molds were isolated only in 3 percent of the patients (18 cases. Most common isolated dermatophytes were Trichophyton rubrum (66.5 percent and T. Mentagrophytes (24.6 percent. Other isolated dermatophytes were: violaceum, T. schoenleinii and Microsporum gypseum. Candida albicans were isolated in 40.9 percent of the yeast onychomycosis. Non- dermatophytyic molds

  2. Nuclear medicine in the management of the aids patient

    International Nuclear Information System (INIS)

    Kramer, E.L.; Sanger, J.J.

    1995-01-01

    For the medical diagnostic imaging specialist in general, and for the nuclear medicine physician specifically, the AIDS epidemic has generated an enormous demand to develop a means of making early diagnoses of the complications of AIDS. For the most part this has meant the early detection, and when possible, the characterization of the opportunistic infections and neoplasms that are a major source of morbidity and mortality for the AIDS patient. Detection of opportunistic infections has been helpful in reclassifying HIV-seropositive patients as having AIDS. This paper reports on nuclear medicine used to evaluate the efficacy and the complications of treatment in human immunodeficiency virus infection. Most recently, functional brain imaging has been used for the diagnosis and follow-up of the AIDS dementia complex. (author). 77 refs., 8 figs

  3. Nuclear medicine in the management of the AIDS patient

    International Nuclear Information System (INIS)

    Kramer, E.L.; Sanger, J.J.

    1990-01-01

    For the medical diagnostic imaging specialist in general, and for the nuclear medicine physician specifically, the AIDS epidemic has generated an enormous demand to develop a means of making early diagnoses of the complications of AIDS. For the most part this has meant the early detection, and when possible, the characterization of the opportunistic infections and neoplasms that are a major source of morbidity and mortality for the AIDS patient. Detection of opportunistic infections has been helpful in reclassifying HIV-seropositive patients as having AIDS. This paper reports on nuclear medicine used to evaluate the efficacy and the complications of treatment in human immunodeficiency virus infection. Most recently, functional brain imaging has been used for the diagnosis and follow-up of the AIDS dementia complex

  4. Evaluation of Oral Mucositis Occurrence in Oncologic Patients under Antineoplastic Therapy Submitted to the Low-Level Laser Coadjuvant Therapy.

    Science.gov (United States)

    Leite Cavalcanti, Alessandro; José de Macêdo, Dário; Suely Barros Dantas, Fernanda; Dos Santos Menezes, Karla; Filipe Bezerra Silva, Diego; Alves de Melo Junior, William; Fabia Cabral Cavalcanti, Alidianne

    2018-04-24

    Low-level laser therapy has been widely used in treating many conditions, including oral mucositis. The purpose of this study was to evaluate the occurrence of oral mucositis in patients undergoing antineoplastic therapy submitted to preventive and therapeutic treatment with low-level laser therapy. This cross-sectional study was carried out with 51 children and adolescents of both sexes with malignant neoplasias who developed oral mucositis and underwent low-level laser therapy. Data were collected on sex, age, type and degree of neoplasia, region affected, and remission time. 64.7% of the patients were male and were between 3 and 6 years of age (39.2%). Acute lymphoid leukemia was the most frequent neoplasm (37.3%). Regarding the maximum oral mucositis, grade 2 (41.2%) was predominant, with jugal mucosa (29.9%) and tongue (17.7%) being the most affected regions. The majority of cases presented lesion remission time between 4 and 7 days (44.0%). Most patients were young, male, and diagnosed with acute lymphoid leukemia. Predominance of grade 2 oral mucositis was observed, with jugal mucosa and tongue being the most affected regions, with the majority of cases presenting lesion remission time between 4 and 7 days. Low-level laser therapy has been shown to be an essential therapy in the prevention and treatment of these lesions, since it is a non-invasive and low-cost method.

  5. Evaluation of Oral Mucositis Occurrence in Oncologic Patients under Antineoplastic Therapy Submitted to the Low-Level Laser Coadjuvant Therapy

    Directory of Open Access Journals (Sweden)

    Alessandro Leite Cavalcanti

    2018-04-01

    Full Text Available Low-level laser therapy has been widely used in treating many conditions, including oral mucositis. The purpose of this study was to evaluate the occurrence of oral mucositis in patients undergoing antineoplastic therapy submitted to preventive and therapeutic treatment with low-level laser therapy. This cross-sectional study was carried out with 51 children and adolescents of both sexes with malignant neoplasias who developed oral mucositis and underwent low-level laser therapy. Data were collected on sex, age, type and degree of neoplasia, region affected, and remission time. 64.7% of the patients were male and were between 3 and 6 years of age (39.2%. Acute lymphoid leukemia was the most frequent neoplasm (37.3%. Regarding the maximum oral mucositis, grade 2 (41.2% was predominant, with jugal mucosa (29.9% and tongue (17.7% being the most affected regions. The majority of cases presented lesion remission time between 4 and 7 days (44.0%. Most patients were young, male, and diagnosed with acute lymphoid leukemia. Predominance of grade 2 oral mucositis was observed, with jugal mucosa and tongue being the most affected regions, with the majority of cases presenting lesion remission time between 4 and 7 days. Low-level laser therapy has been shown to be an essential therapy in the prevention and treatment of these lesions, since it is a non-invasive and low-cost method.

  6. Anatomical and physiological changes in pelvic diaphragm in patients with chagasic megacolon submitted to Duhamel surgery

    Directory of Open Access Journals (Sweden)

    Hélio Moreira Júnior

    2013-04-01

    Full Text Available Original contribution: understand the reasons why Duhamel surgery results in clinical improvement of constipation in patients with Chagasic colopathy. Background: Duhamel surgery is one of the most widespread techniques for the treatment of Chagasic megacolon, with low rates of recurrence of constipation. Objective: evaluate the anatomical and physiological changes in the pelvic diaphragm of patients with chagasic colopathy, as well as changes occurring after undergoing Duhamel surgery. Design: clinical data and results of cinedefecography, electromanometry and anorectal ultrasound of the anal canal were evaluated in patients with Chagasic colopathy, before and after Duhamel surgery. Location: Service of Coloproctology – Departament of Surgery, Faculdade de Medicina da Universidade Federal de Goiás. Patients: patients with positive serology for Chagas Disease, with constipation and radiological megacolon, who presented consecutively to the Chagas outpatient clinic and freely agreed to participate in this study, were prospectively included. Results: a total of 20 patients were included, with a mean age of 53.2 years, of which 16 were women. The following parameters were observed in the postoperative period: change in bowel frequency, of, on average, one evacuation every ten days to daily bowel movement; 16 patients used laxatives preoperatively and only one did, intermittently, in postoperative period. Electromanometry showed, postoperatively, a decrease in anal resting pressure (60.88 to 37.2 mmHg p < 0.001 and anal squeeze pressures (244.3 mL to 161.25 p = 0.01, whereas ultrasound showed that 75% of the patients had abnormalities of the internal anal sphincter in the posterior anal canal juxtaposed to the pulled-through colon. Postoperative rectal emptying observed in cinedefecographic tests occurred more quickly and with less effort when compared with the preoperative findings. There was a change in the anorectal angle postoperatively

  7. Supragingival and subgingival microbiota from patients with poor oral hygiene submitted to radiotherapy for head and neck cancer treatment.

    Science.gov (United States)

    Gaetti-Jardim, Elerson; Jardim, Ellen Cristina Gaetti; Schweitzer, Christiane Marie; da Silva, Júlio Cesar Leite; Oliveira, Murilo Moura; Masocatto, Danilo Chizzolini; Dos Santos, Cauê Monteiro

    2018-01-08

    This case-control study aimed to evaluate the effects of conventional radiotherapy (RT) on the prevalence and populations of oral microorganisms in head and neck cancer patients who did not receive adequate preventive dental care. It was hypothesized that side effects of radiotherapy could be associated with radiation dose, microbiological aspects, and socioeconomic conditions of the patients. Twenty-eight dentate patients with head and neck cancer submitted to RT were included in the study. Radiation dose received varied from 4320 to 7020 cGy. Patients with the same demographic and health conditions, but no history of cancer or antineoplastic treatment were used as controls. Clinical examinations were carried out before RT, 15-22 days after starting RT, immediately after and 6 months after RT. Supra and subgingival biofilms were collected and cultivated onto selective and non-selective media. Isolates were identified by biochemical and physiological characteristics. Stimulated and unstimulated salivary flow rate and saliva buffer capacity were also determined. Mucositis, dermatitis, xerostomia, dysgeusia, dysphagia and candidiasis were common after starting RT and during the treatment period. Xerostomia was followed by a decrease in salivary pH and buffer capacity, which showed association with the increase of cariogenic cocci and yeast populations, which were also associated with deterioration of hygiene. Candida and family Enterobacteriaceae showed increased prevalence with RT, and were associated with the occurrence of mucositis and xerostomia. Modifications in oral biofilms of irradiated patients showed association with xerostomia and hygiene conditions, which reinforces the necessity of improving patient compliance to oral health care programs. Copyright © 2018. Published by Elsevier Ltd.

  8. Cytopathologic evaluation of patients submitted to radiotherapy for uterine cervix cancer.

    Science.gov (United States)

    Padilha, Cátia Martins Leite; Araújo, Mário Lúcio Cordeiro; Souza, Sergio Augusto Lopes de

    2017-04-01

    Cervical cancer is an important public health problem. Pap smear is the leading strategy of screening programs for cervical cancer worldwide. However, delayed diagnosis leads to more aggressive and less effective treatments. Patients with uterine cervix malignancies who are referred for radiotherapy have advanced-stage disease, which results in high rates of locoregional recurrence. The use of radiotherapy as a treatment for cervical cancer causes morphological changes in neoplastic and non-neoplastic epithelial cells, as well as in stromal cells, which make it difficult to diagnose the residual lesion, resulting in a dilemma in cytopathological routine. Based on the difficulties of cytopathologic evaluation for the follow-up of patients treated with radiotherapy for cervical cancer, our objective was to describe the actinic cytopathic effects. Our paper was based on a structured review including the period from June 2015 to April 2016, aiming at an exploratory-descriptive study. Bibliographic investigations were carried out through selection and analysis of articles, list of authors and keywords, selection of new articles focused on the analysis of bibliographic references to previously selected documents, as well as textbooks of recognized merit. The most incident actinic cytopathological alterations as described in the literature are: cellular gigantism, nuclear and cytoplasmic vacuolization, dyskeratosis, bi- and multinucleated (B/M) cells, macro and multiple nucleoli, anisokaryosis, anisonucleolosis and nuclear pyknosis. To date, a protocol has not been established that can precisely differentiate the morphological characteristics between benign cells with actinic effects from recurrent malignant cells on post-radiotherapy smears.

  9. Autonomic activity and baroreflex sensitivity in patients submitted to carotid stenting.

    Science.gov (United States)

    Acampa, Maurizio; Guideri, Francesca; Marotta, Giovanna; Tassi, Rossana; D'Andrea, Paolo; Giudice, Giuseppe Lo; Gistri, Massimo; Rocchi, Raffaele; Bernardi, Alberto; Bracco, Sandra; Venturi, Carlo; Martini, Giuseppe

    2011-03-24

    Arterial baroreflex and cardiac autonomic control play important roles in hemodynamic instability after carotid artery stenting (CAS). Spontaneous baroreflex sensitivity (BRS), heart rate variability (HRV) and blood pressure variability (BPV) are established tools for the assessment of arterial baroreflex and cardiac autonomic activity. Aim of the study was to evaluate cardiac autonomic activity (by means of HRV, BPV and BRS) after CAS and to explore the impact of internal carotid artery stenosis on BRS changes after CAS. 37 patients (68±10.45 years) with internal carotid stenosis underwent CAS. HRV, BPV and BRS were measured in all subjects before and at 1 and 72h after CAS. ANOVA was performed to compare BRS, HRV and BPV parameters before and after CAS. Spearman analysis was performed to determine a possible correlation between carotid stenosis degree (or carotid plaque diameter) and BRS changes (ΔBRS). LF/HF (index of sympatho-vagal balance) decreased during postoperative period, in comparison with baseline (2.32±1.70 vs 1.65±1.40, pBRS does not increase in all the patients, because arterial wall damage and nerve destruction determined by atherosclerotic plaque may reduce ΔBRS. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  10. Characteristics of Homeopathy Users among Internal Medicine Patients in Germany.

    Science.gov (United States)

    Steel, Amie; Cramer, Holger; Leung, Brenda; Lauche, Romy; Adams, Jon; Langhorst, Jost; Dobos, Gustav

    2016-01-01

    Homeopathy use continues to grow in many European countries, and some studies have examined the characteristics of patients using homeopathy within the general population. The aim of this study was to identify predictors for homeopathy use among internal medicine patients. A cross-sectional analysis was conducted among all patients being referred to the Department of Internal and Integrative Medicine at Essen, Germany, over a 3-year period. The analysis examined whether patients had used homeopathy for their primary medical complaint before, the perceived benefit, and the perceived harm of homeopathy use. Odds ratios with 95% confidence intervals were calculated using multiple logistic regression analysis. Of 2,045 respondents, 715 (35.0%) reported having used homeopathy for their primary medical complaint (diagnosis according to the International Statistical Classification of Diseases and Related Health Problems), with 359 (50.2%) reporting perceived benefits and 15 (2.1%) reporting harm. Homeopathy use was positively associated with female gender, high school level education, suffering from fibromyalgia or subthreshold depression, and being fast food abstinent, while patients with osteoarthritis, spinal or other pain, smokers, and patients with a high external-social health locus of control were less likely to use homeopathy. Personal characteristics and health status may impact on the use and the perceived helpfulness of homeopathy. © 2016 S. Karger GmbH, Freiburg.

  11. Quality of care of hospitalized internal medicine patients bedspaced to non-internal medicine inpatient units.

    Directory of Open Access Journals (Sweden)

    Jessica Liu

    Full Text Available When the number of patients requiring hospital admission exceeds the number of available department-allotted beds, patients are often placed on a different specialty's inpatient ward, a practice known as "bedspacing". Whether bedspacing affects quality of patient care has not been previously studied.We reviewed consecutive general internal medicine (GIM admissions for congestive heart failure (CHF, chronic obstructive pulmonary disease (COPD, and pneumonia at St. Michael's Hospital in Toronto, Canada, from 2007 to 2011 and examined whether quality of care differs between bedspaced and nonbedspaced patients. We matched each bedspaced patient with a GIM ward patient admitted on the same call shift with the same diagnosis. The primary outcome was the ratio of the actual to the estimated length of stay (ELOS. General and disease specific measures for CHF, COPD, and pneumonia (e.g. fluid restriction were evaluated, as well as 30-day Emergency Department (ED and hospital readmissions.Overall, 1639 consecutive admissions were reviewed, and 39 matched pairs for CHF, COPD and pneumonia were studied. Differences in both general and disease specific care measures were not detected between groups. For many disease-specific comparisons, ordering and adherence to quality of care indicators was low in both groups.We were unable to detect differences in quality of care between bedspaced and nonbedspaced patients. As high patient volumes and hospital overcrowding remains, bedspacing will likely continue. More research is required in order to determine if quality of care is compromised by this ongoing practice.

  12. [Type 2 Diabetes Mellitus, Depression and Eating Disorders in Patients Submitted to Bariatric Surgery].

    Science.gov (United States)

    Brandão, Isabel; Marques Pinho, Ana; Arrojado, Filipa; Pinto-Bastos, Ana; Maia da Costa, José; Coelho, Rui; Calhau, Conceição; Conceição, Eva

    2016-03-01

    Obesity is associated with a great number of complications, including type 2 diabetes mellitus and psychiatric pathology. Bariatric surgery is the best solution to weight loss and improvement of complications in morbid obese patients. This study aims to analyze the evolution of type 2 diabetes mellitus and psychopathologic variables before and after bariatric surgery and assess the importance of different variables in weight loss. This is a longitudinal study, which evaluates 75 patients before and after bariatric surgery (47 - LAGB - laparoscopic adjustable gastric band; 19 - RYGB - Roux-en-Y gastric bypass; 9 - sleeve) with a follow-up time between 18 and 46 months. A clinical interview and self report questionnaires were applied - Eating Disorder Examination questionnaire - EDE-Q and Beck Depression Inventory - BDI. Results show an improvement in type 2 diabetes mellitus after surgery (X2 (1) = 26.132, p diabetes mellitus, depression and eating disorders in post-operative period are associated with less weight loss. This model explains 27% of weight variance after surgery (R2 = 0.265) and it is significant F (3.33) = 2.981, p = 0.038. Type 2 diabetes mellitus, psychiatric pathology and eating disorders after surgery influenced weight loss. It was not clear in what way this relation was verified, neither the relation that these metabolic and psychological variables may have during the postoperative period. Type 2 diabetes mellitus improved after surgery. Type 2 diabetes mellitus, depression and eating disorders influenced weight loss in the postoperative period. These variables did not influence weight loss in the preoperative period.

  13. Cytopathologic evaluation of patients submitted to radiotherapy for uterine cervix cancer

    Directory of Open Access Journals (Sweden)

    Cátia Martins Leite Padilha

    Full Text Available Summary Cervical cancer is an important public health problem. Pap smear is the leading strategy of screening programs for cervical cancer worldwide. However, delayed diagnosis leads to more aggressive and less effective treatments. Patients with uterine cervix malignancies who are referred for radiotherapy have advanced-stage disease, which results in high rates of locoregional recurrence. The use of radiotherapy as a treatment for cervical cancer causes morphological changes in neoplastic and non-neoplastic epithelial cells, as well as in stromal cells, which make it difficult to diagnose the residual lesion, resulting in a dilemma in cytopathological routine. Based on the difficulties of cytopathologic evaluation for the follow-up of patients treated with radiotherapy for cervical cancer, our objective was to describe the actinic cytopathic effects. Our paper was based on a structured review including the period from June 2015 to April 2016, aiming at an exploratory-descriptive study. Bibliographic investigations were carried out through selection and analysis of articles, list of authors and keywords, selection of new articles focused on the analysis of bibliographic references to previously selected documents, as well as textbooks of recognized merit. The most incident actinic cytopathological alterations as described in the literature are: cellular gigantism, nuclear and cytoplasmic vacuolization, dyskeratosis, bi- and multinucleated (B/M cells, macro and multiple nucleoli, anisokaryosis, anisonucleolosis and nuclear pyknosis. To date, a protocol has not been established that can precisely differentiate the morphological characteristics between benign cells with actinic effects from recurrent malignant cells on post-radiotherapy smears.

  14. Digital radiographic evaluation of the midpalatal suture in patients submitted to rapid maxillary expansion

    Directory of Open Access Journals (Sweden)

    Maria de Fátima Batista de Melo

    2013-01-01

    Full Text Available Aims: To analyze the density of the midpalatal suture by means of digital radiographs three months after retention to evaluate if this period of retention is really sufficient for bone repair. Materials and Methods: This prospective study consisted of 31 patients (11 girls and 20 boys in the mixed or permanent dentition stage, treated using a tooth-tissue borne expanders (Haas. Occlusal digital radiographs were taken at three stages: prior to rapid maxillary expansion (Stage I; immediately after desired maxillary expansion (Stage II; and after three months of retention (Stage III. Radiographs were taken on a dental X-ray machine, set at 70 kVp and 7 mA with an exposure time of 0.04 s. A phosphor storage plate system, imaging plate size n. 2 (35 × 45 × 1.6 mm, was used. Three regions (A, B and C measured 0.02 mm² were selected for optical density analysis. The difference between the measurements was evaluated with the paired t-test. Results: The optical density was reduced at Stages II and III compared with Stage I. Between-stage comparison showed statistically significant changes for all variables (P < 0.05, with the highest mean optical density at Stage I and the lowest at Stage II, in all groups. Actually, there was an increase in optical density between Stages II and III, but they are reduced compared with Stage I. Conclusion: The results strongly suggest that bone formation did not occur as expected, and that a longer retention period for bone repair may be necessary.

  15. Relationship between radiation dose estimation in patients submitted to abdominal tomography examination and the body mass index

    International Nuclear Information System (INIS)

    Capaverde, Alexandre da S.; Pimentel, Juliana; Froner, Ana Paula P.; Silva, Ana Maria Marques da

    2014-01-01

    Because of the radiation dose in computed tomography (CT) is relatively high, it is important to have an estimate of the dose to which the patient is submitted, considering parameters and correction factors, so that the value is closer to the real. The objective of this study is to relate the estimated dose in patients undergoing abdominal CT with BMI (Body Mass Index) groups, considering the specific size of the anatomical region. The work developed in a hospital in Porto Alegre, Brazil, using 16 Siemens Somatom Emotion equipment. We selected 30 adult that underwent to CT of the abdomen in January 2014. Of these, 13 using dose reduction mechanism (Care Dose), (Sample 1) and the rest without this mechanism (Sample 2). Registered weight, height, CTDI vol (Computed Tomography Dose Index) and anteroposterior and lateral diameter at the umbilicus. BMI and the correction factor for the dose estimates were calculated, according to the specific size of the abdomen. It was determined the percentage change between the CTDI vol values provided by CT and the value of CTDI vol after application of the correction factor, plus the average percentage change for each BMI group. The mean percentage change was between 54% and 19% for sample 1 and between 35% and 10% for sample 2, the lowest to highest BMI group. There was a reduction in the medium average percent with the increasing of the BMI groups in both samples. A larger sample of individuals for verification of results is required

  16. Features of patients with comorbid pathology treatment in internal medicine

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    L. F. Kuznetsova

    2015-10-01

    Full Text Available Aim. Nowadays more attention is paid to the comorbid pathologies in the internal medicine as they have important social and medical value. Different combinations of the arterial hypertension, chronic kidney disease, osteoartrosis and anemia influences are now studied. The article underlines the main features of the therapeutic tactics in these patients. Methods and results. The paper presents a case of a patient with mentioned pathology, sets out the main guidelines for the management of patients with such comorbid conditions. Conclusion. Treatment tactics should include: minimum interoperability path of excretion, metabolic neutrality, good tolerability and a positive impact on the affected organ, all of which may contribute not only to improve health and improve the quality of life of patients, but also its extension.

  17. Implantation of a data bank of nuclear medicine patients (DOSIMED)

    International Nuclear Information System (INIS)

    Krempser, Alexandre R.; Oliveira, Silvia M. Velasques de; Silva, Tadeu A.A.

    2009-01-01

    This paper develops a institutional data bank for internal dosimetry and radiological protection of nuclear medicine patents. The data are originating from projects in progress performed by the Group for Research in Internal Dosimetry in Nuclear Medicine of the IRD, Brazil. The DOSIMED data bank was developed on the Linux computer operation system, under PHP and SQL languages, using the Script Case software. Since the investigation is due to medical applications, the data entry is done by projects, after their approval by a committee of local ethics. Projects are associated with equipment used and with studied patients. Patients are associated to and/or appropriated therapeutic protocols. The patient internal dosimetry data are generated by three types of monitoring: image quantification, bio analysis in vitro and external exposure for the patient injected with radioisotope. For the guarantee of data quality, the collected data are imported fro the original documents for the DOSIMED, and the comparison can be done after the final study for data evaluation. Up to the present, the screens for the data entry were developed and the respective consistence data are in progress. The DOSIMED will be available at the IRD intra net for the director and the investigators involved in each project

  18. Patient absorbed dose and radiation risk in nuclear medicine

    International Nuclear Information System (INIS)

    Hetherington, E.; Cochrane, P.

    1992-01-01

    Since the introduction of technetium-99m labelled radiopharmaceuticals used as imaging agents in the nuclear medicine departments of Australian hospitals, patients have voiced concern about the effect of having radioactive materials injected into their bodies. The danger of X-ray exposure is widely known and well accepted, as is exposure to ultrasound, computed tomography scans and other imaging techniques. However, radioactivity is an unknown, and fear of the unknown can occasionally lead to patients refusing to undergo a nuclear medicine procedure. The authors emphasised that the radiation dose to a patient from a typical procedure would depend on the patient's medical history and treatment; the average dose being approximately 50 times the exposure received from the natural environmental background radiation. Furthermore, over an extended period the body can repair most minor damage caused by radiation, just as the body can repair the damage caused by sunburn resulting from too much exposure to sunlight. The risk of genetic effects as a result of a medical radiation dose is than very small

  19. Use of Traditional Indigenous Medicine and Complementary Medicine Among Indigenous Cancer Patients in Queensland, Australia.

    Science.gov (United States)

    Adams, Jon; Valery, Patricia C; Sibbritt, David; Bernardes, Christina M; Broom, Alex; Garvey, Gail

    2015-07-01

    The cancer toll on Indigenous Australians is alarming with overall cancer incidence and mortality rates higher and the 5-year survival rate lower for Indigenous Australians compared with non-Indigenous Australians. Meanwhile, a range of approaches to health and illness-including both complementary and alternative medicine (CAM) and traditional Indigenous medicine (TM)-are used by cancer patients. Little work has focused on Indigenous cancer patients with regard to CAM/TM use. This article reports findings from the first examination of the prevalence and profile of TM/CAM use and users among Indigenous Australians with cancer. A structured questionnaire was administered via face-to-face interviews to 248 Indigenous Australian cancer patients diagnosed with a range of cancer types. All received treatment and were recruited from 1 of 4 large hospitals located in Queensland, Australia. A substantial percentage (18.7%) of Indigenous cancer patients use at least one TM/CAM for support with their care, including traditional Indigenous therapy use (2.8%), visiting a traditional Indigenous practitioner (2.8%), CAM use (10.7%), visiting a CAM practitioner (2.4%), and attending relaxation/meditation classes (4.0%). Having a higher level of educational attainment was positively associated with CAM practitioner consultations (P = .015). Women with breast cancer were more likely to attend relaxation/meditation classes (P = .019). Men with genital organ cancer were more likely to use traditional Indigenous therapies (P = .017) and/or CAM (P = .002). A substantial percentage of Indigenous Australians reported using TM/CAM for their cancer care, and there is a need to expand examination of this area of health care using large-scale studies focusing on in-depth specific cancer(s). © The Author(s) 2015.

  20. Patient dose assessment in different diagnostic procedures in nuclear medicine

    International Nuclear Information System (INIS)

    Sena, E. de; Bejar, M.J.; Berenguer, R.; Ruano, R.; Tamayo, P.

    2001-01-01

    Effective doses have been estimated for 314 patients under diagnostic procedures in a Nuclear Medicine Department using data reported in ICRP-80 and RIDIC (Radiation Internal Dose Information Center). Data on administered activity, radiopharmaceutical and administration route, age and sex of the patients have been collected. Doses in the most exposed critical organ for every protocol, doses in uterus, doses in fetus versus the stage of pregnancy (in case the female patient was pregnant) and doses for nursing infants have been also estimated. Ga-67 studies give the highest effective doses per protocol followed by cardiac SPECT procedures using Tl-201 chloride. Ga-67 studies also give the highest absorbed doses in uterus. Due to not administering different activities, depending on height and weight of adults, women receive doses about 20% higher than men. This would be a practice to modify in the future in order to optimise doses. (author)

  1. SUCCESSFUL TREATMENT OF OSTEOMYELITIS IN LEPROSY PATIENTS BY HOMEOPATHIC MEDICINE

    Directory of Open Access Journals (Sweden)

    D. Chakraborty

    2013-12-01

    Full Text Available Osteomyelitis, a major complication of neuropathic feet in leprosy may occur as a result of infiltration of Mycobacterium leprae in the periosteum of bones or due to secondary bacterial infection of chronic plantar ulcer. There is no effective treatment for healing of planter ulcer and osteomyelitis. Keeping in mind of the limitation of conservative treatment, twenty patients who completed with multi drug therapy but suffering from neuropathic foot with ulcer was treated with Mercurius solubilis, a homoeopathic medicine in 200 potency for one year. All these patients had different degrees of osteomyelitic changes and after treatment showed regeneration and remodeling of bones which may be considered as significant improvement. Based on the radiological finding it may be concluded that Mercurius solubilis found to be effective in the treatment of osteomyelitis in leprosy affected patients.

  2. Radiation dose rates from adult patients undergoing nuclear medicine investigations

    Energy Technology Data Exchange (ETDEWEB)

    Mountford, P.J.; O' Doherty, M.J.; Forge, N.I.; Jeffries, A.; Coakley, A.J. (Kent and Canterbury Hospital (United Kingdom))

    1991-09-01

    Adult patients undergoing nuclear medicine investigations may subsequently come into close contact with members of the public and hospital staff. In order to expand the available dosimetry and derive appropriate recommendations, dose rates were measured at 0.1, 0.5 and 1.0 m from 80 adult patients just before they left the nuclear medicine department after undergoing one of eight {sup 99}Tc{sup m} studies, an {sup 123}I thyroid, an {sup 111}In leucocyte or a {sup 201}Tl cardiac scan. The maximum departure dose rates at these distances of 150, 30 and 7.3 {mu}Sv h{sup -1} were greater than those found in similar published studies of adult and paediatric patients. To limit the dose to an infant to less than 1 mSv, an {sup 111}In leucocyte scan is the only investigation for which it may be necessary to restrict close contact between the infant and a radioactive parent, depending on the dose rate near the surface of the patient, the parent's habits and how fretful is the infant. It is unlikely that a ward nurse will receive a dose of 60 {mu}Sv in a working day if caring for just one radioactive adult patient, unless the patient is classified as totally helpless and had undergone a {sup 99}Tc{sup m} marrow, bone or brain scan. The data and revised calculations of effective exposure times based on a total close contact time of 9 h in every 24 h period should allow worst case estimates of radiation dose to be made and recommendations to be formulated for other circumstances, including any future legislative changes in dose limits or derived levels. (author).

  3. Actual versus recommended storage temperatures of oral anticancer medicines at patients' homes.

    Science.gov (United States)

    Vlieland, N D; van den Bemt, Bjf; van Riet-Nales, D A; Bouvy, M L; Egberts, Acg; Gardarsdottir, H

    2017-01-01

    Background Substantial quantities of unused medicines are returned by patients to the pharmacy each year. Redispensing these medicines would reduce medicinal waste and health care costs. However, it is not known if medicines are stored by patients as recommended in the product label. Inadequate storage may negatively affect the medicine and reduce clinical efficacy whilst increasing the risk for side effects. Objective To investigate the proportion of patients storing oral anticancer medicines according to the temperature instructions in the product label. Methods Consenting adult patients from six Dutch outpatient hospital pharmacies were included in this study if they used an oral anticancer medicine during February 2014 - January 2015. Home storage temperatures were assessed by inclusion of a temperature logger in the original cancer medicines packaging. The primary outcome was the proportion of patients storing oral anticancer medicines as specified in the Summary of Product Characteristics, either by recalculating the observed temperature fluctuations to a single mean kinetic temperature or by following the temperature instructions taking into account a consecutive 24-h tolerance period. Results Ninety (81.1%) of the 111 included patients (47.8% female, mean age 65.2 (SD: 11.1)) returned their temperature loggers to the pharmacy. None of the patients stored oral anticancer medicines at a mean kinetic temperature above 25℃, one patient stored a medicine requiring storage below 25℃ longer than 24 h above 25℃. None of the patients using medicines requiring storage below 30℃ kept their medicine above 30℃ for a consecutive period of 24 h or longer. Conclusion The majority of patients using oral anticancer medicines store their medicines according to the temperature requirements on the product label claim. Based on our results, most oral anticancer medicines will not be negatively affected by temperature conditions at patients' homes for a maximum of

  4. The Role of Patients' Stories in Emergency Medicine Triage.

    Science.gov (United States)

    Roscoe, Lori A; Eisenberg, Eric M; Forde, Colin

    2016-09-01

    Emergency medicine is a communicative activity, and characteristics such as incomplete information, time pressure, and the potentially serious consequences of errors complicate effective communication and decision making. The present study examined the triage process as an interpretive activity driven in part by the patient's story. Of four identified communication processes in the emergency department (ED), the "handoff" of patients between shifts has been identified as especially problematic since missing contextual details from patients' stories increased the probability of errors. The problematic nature of patient handoffs led to our interest in triage, the initial site of interpretation and decision making. Triage distinguishes patients with emergent medical conditions requiring immediate care from those who can more safely wait for medical attention. We report results from 110 hours of observing the triage process and semistructured interviews with 16 triage nurses in a Level I Trauma Center in an urban teaching hospital in the southeastern United States. Field notes and interview transcripts were analyzed and coded to explore decision rules and information sources used in triage decision making. Triage nurses generally discounted patients' stories in favor of information from visual cues and vital signs. Patients' stories tended to influence the triage process only in certain cases when the story contained information that was not readily apparent, such as a recent organ transplant. Triage nurses' reliance on "gut feeling," however, might be a kind of narrative sense-making that combines observable and measurable clinical facts with the narrative competence to utilize intuition and past experience.

  5. Towards personalized medicine: leveraging patient similarity and drug similarity analytics.

    Science.gov (United States)

    Zhang, Ping; Wang, Fei; Hu, Jianying; Sorrentino, Robert

    2014-01-01

    The rapid adoption of electronic health records (EHR) provides a comprehensive source for exploratory and predictive analytic to support clinical decision-making. In this paper, we investigate how to utilize EHR to tailor treatments to individual patients based on their likelihood to respond to a therapy. We construct a heterogeneous graph which includes two domains (patients and drugs) and encodes three relationships (patient similarity, drug similarity, and patient-drug prior associations). We describe a novel approach for performing a label propagation procedure to spread the label information representing the effectiveness of different drugs for different patients over this heterogeneous graph. The proposed method has been applied on a real-world EHR dataset to help identify personalized treatments for hypercholesterolemia. The experimental results demonstrate the effectiveness of the approach and suggest that the combination of appropriate patient similarity and drug similarity analytics could lead to actionable insights for personalized medicine. Particularly, by leveraging drug similarity in combination with patient similarity, our method could perform well even on new or rarely used drugs for which there are few records of known past performance.

  6. Chinese Medicine Patterns in Patients with Post-Stroke Dementia

    Directory of Open Access Journals (Sweden)

    Nou-Ying Tang

    2012-04-01

    Full Text Available A stroke often results in post-stroke dementia, a rapid decline in memory and intelligence causing dysfunctions in daily life. The Chinese medicine doctor uses 4 examinations of inspection, listening, smelling, and feeling to determine the Chinese medicine pattern (CMP. Therefore, the purpose of the present study was to investigate the CMP in patients with post-stroke dementia. A total of 101 stroke patients were examined, consistent with the DSM IV diagnostic criteria of the American Psychiatric Association, as well as the National Institute of Neurological Disorders and Stroke-Association International pour Ia Recherche et I’Enseignement en Neurosciences vascular dementia diagnostic criteria of post-stroke dementia. Results: 100 patients (99.0% were KEDP (kidney essence deficiency pattern, shèn jīng kuī xū zhèng, 腎精虧虛證, 83 patients were AHLYP (ascendant hyperactivity of liver yang pattern, gān yáng shàng kàng zhèng, 肝陽上亢證, 83 patients were QBDP (qi-blood deficiency pattern, qì xuè kuī xū zhèng, 氣血虧虛證, 81 patients were SBOCP (static blood obstructing the collaterals pattern, yū xuè zǔ luò zhèng, 瘀血阻絡證, 72 patients were BSTRP (bowels stagnation turbidity retention pattern, fǔ zhì zhuó liú zhèng, 腑滯濁留證, 50 patients were FHIEP (fire heat interior excess pattern, huǒ rè nèi sheng zhèng, 火熱內盛證, and 39 participants (38.6% were PTOOP (phlegm turbidity obstructing the orifices pattern, tán zhuó zǔ qiào zhèng, 痰濁阻竅證; one to 31 patients have at least 2 CMPs simultaneously. In conclusion, the most CMP is KEDP CMP in the post-stroke dementia patients, and one patient may have one or at least 2 CMPs simultaneously.

  7. Alteration of Complementary and Alternative Medicine Usage in Patients With Cancer in Turkey

    OpenAIRE

    Mutlu, Hasan; Akca, Zeki; Cihan, Yasemin Benderli; Aslan, Tuncay; Erden, Abdülsamet; Büyükçelik, Abdullah

    2013-01-01

    The complementary and alternative medicine (CAM) are commonly encountered by cancer patients. In this study, the methods of CAM used by Turkish cancer patients were documented, and its frequency and the changes in the use of CAM over time were evaluated. Totally of 559 patients were enrolled from Kayseri Training and Research Hospital. Of CAM using patients, 11.8% used alternative medicine products, 60.1% used complementary medicine, and 28% received support from both. Patients with breast ca...

  8. Imunocitomonitorização em pacientes transplantados cardíacos Immunocytomonitorization in patients submitted to cardiac transplantation

    Directory of Open Access Journals (Sweden)

    Ricardo Manrique

    1990-04-01

    we state in terms of a set of active lymphocytes. The technique was applied to follow-up and control of activity of cellular immunology in nine patients submitted to cardiac transplantation, twenty normal volunteers, and five patients candidates to cardiac transplantation. We also submitted to the CIM test, in order to obtain the normal range of lymphocytic activity in the brazilian population. Both groups had not antecedents, either infectious or immunological, chronic or acute pictures. Ten patients with acute bacteriological or viral infection had been tested as a positive control. In normal individuals, we found 1,8% (+/- 1.088 of active lymphocytes and 3,2% (+/0,49 in candidates for cardiac transplantation. In our experience, values above are indicators of an immunological reactivity related to infection or rejection. Out of the 63 tests performed to the cardiac transplanted patients, four of them were positive, three cases related to infectious complications and one was confirmed as a process of acute graft rejection in progress. The mean time for the CIM execution was about two hours. The method was successful for the immunological diagnosis in transplanted cardiacs, due to its sensibility, low costs and promptness of results.

  9. Radiation risk to patients from nuclear medicine procedures in Cuba

    International Nuclear Information System (INIS)

    Brigido, O.; Montalván, A.; Barreras, A.; Hernández, J.

    2015-01-01

    Man-made radiation exposure to the Cuban population predominantly results from the medical use of ionizing radiation. It was therefore the aim of the present study, to provide public health information concerning diagnostic nuclear medicine procedures carried out in Camagüey and Ciego de Ávila provinces between 2000 and 2005. Population radiation dose estimation due to administration of radiopharmaceuticals in Camagüey and Ciego de Ávila provinces was carried out using Medical Internal Radiation Dose scheme (MIRD). Data were gathered on the type of radiopharmaceuticals used, the administered activity, the numbers of each kind of examination, and the age and sex of the patients involved during the period 2000 – 2005. The average annual frequency of examinations was estimated to be 3.34 per 1000 population. The results show that imaging nuclear medicine techniques of thyroid and bone explorations with 13.3 and 12.9%, respectively and iodide uptake with 50% are the main techniques implicated in the relative contribution to the total annual effective collective dose which averaged 95 man⋅Sv for the studied period. Radiation risks for the Camagüey-Ciego de Avila population caused by nuclear medicine examinations in the period studied were calculated: the total number of fatal and non-fatal cancers was 34.2 and the number of serious hereditary disturbance was 7.4 as a result of 24139 nuclear medicine procedures, corresponding a total detriment of 1.72 per 1000 examination. (authors)

  10. Endometrium evaluation with high-field (3-Tesla) magnetic resonance imaging in patients submitted to uterine leiomyoma embolization

    International Nuclear Information System (INIS)

    Jacobs, Monica Amadio Piazza; Nasser, Felipe; Zlotnik, Eduardo; Messina, Marcos de Lorenzo; Baroni, Ronaldo Hueb

    2013-01-01

    To evaluate the endometrial alterations related to embolization of uterine arteries for the treatment of symptomatic uterine leiomyomatosis (pelvic pain and/or uterine bleeding) by means of high-field (3-Tesla) magnetic resonance. This is a longitudinal and prospective study that included 94 patients with a clinical and imaging diagnosis of symptomatic uterine leiomyomatosis, all of them treated by embolization of the uterine arteries. The patients were submitted to evaluations by high-field magnetic resonance of the pelvis before and 6 months after the procedure. Specific evaluations were made of the endometrium on the T2-weighted sequences, and on the T1-weighted sequences before and after the intravenous dynamic infusion of the paramagnetic contrast. In face of these measures, statistical analyses were performed using Student's t test for comparison of the results obtained before and after the procedure. An average increase of 20.9% was noted in the endometrial signal on T2-weighted images obtained after the uterine artery embolization procedure when compared to the pre-procedure evaluation (p=0.0004). In the images obtained with the intravenous infusion of paramagnetic contrast, an average increase of 18.7% was noted in the post-embolization intensity of the endometrial signal, compared to the pre-embolization measure (p<0.035). After embolization of the uterine arteries, there was a significant increase of the endometrial signal on the T2-weighted images and on the post-contrast images, inferring possible edema and increased endometrial flow. Future studies are needed to assess the clinical impact of these findings

  11. Behaviors of providers of traditional korean medicine therapy and complementary and alternative medicine therapy for the treatment of cancer patients.

    Science.gov (United States)

    Yu, Jun-Sang; Kim, Chun-Bae; Kim, Ki-Kyong; Lee, Ji-Eun; Kim, Min-Young

    2015-03-01

    In Korea, cancer is one of the most important causes of death. Cancer patients have sought alternative methods, like complementary and alternative medicine (CAM) together with Western medicine, to treat cancer. Also, there are many kinds of providers of CAM therapy, including providers of Korean oriental medicine therapy. The purpose of this study is to identify the behaviors of Korean oriental medicine therapy and CAM therapy providers who treat cancer patients and to provide background knowledge for establishing a new policy with the management and quality control of CAM. Structured and well organized questionnaires were made, and 350 persons were surveyed concerning the providers of CAM or Korean oriental medicine. The questionnaires were collected and analyzed. The questionnaires (182) were collected. The questionnaires identified a total of 73 known providers, such as medicinal professionals or other providers of CAM suppliers, 35.6% of whom had had experience with treating cancer patients (52.6% vs. 29.6%). The treatment methods were a little different: alternative therapy and nutritional therapy being preferred by medicinal professionals and mind body modulation therapy and alternative therapy being preferred by other CAM providers. Four patients (7.4%) experienced side effects, and 6 patients (12.5%) experienced legal problems. As the method for managing the therapy, CAM providers, medicinal professionals, and other CAM providers had different viewpoints. For example, some CAM providers stated that both legislation and an official education on CAM or a national examination were needed as a first step to establish the provider's qualifications and that as a second step, a license test was needed for quality control. To the contrary, medicinal professionals stated that a license test was needed before legislation. Adequate management and quality control of CAM providers is thought to involve both education and legislation.

  12. Absorbed Doses to Patients in Nuclear Medicine; Doskatalogen foer nukleaermedicin

    Energy Technology Data Exchange (ETDEWEB)

    Leide-Svegborn, Sigrid; Mattsson, Soeren; Nosslin, Bertil [Universitetssjukhuset MAS, Malmoe (Sweden). Avd. foer radiofysik; Johansson, Lennart [Norrlands Universitetssjukhus, Umeaa (Sweden). Avd. foer radiofysik

    2004-09-01

    The work with a Swedish catalogue of radiation absorbed doses to patients undergoing nuclear medicine investigations has continued. After the previous report in 1999, biokinetic data and dose estimates (mean absorbed dose to various organs and tissues and effective dose) have been produced for a number of substances: {sup 11}C- acetate, {sup 11}C- methionine, {sup 18}F-DOPA, whole antibody labelled with either {sup 99m}Tc, {sup 111}In, {sup 123}I or {sup 131}I, fragment of antibody, F(ab'){sub 2} labelled with either {sup 99m}Tc, {sup 111}In, {sup 123}I or {sup 131}I and fragment of antibody, Fab' labelled with either {sup 99m}Tc, {sup 111}In, {sup 123}I or {sup 131}I. The absorbed dose estimates for these substances have been made from published biokinetic information. For other substances of interest, e.g. {sup 14}C-urea (children age 3-6 years), {sup 14}C-glycocholic acid, {sup 14}C-xylose and {sup 14}C-triolein, sufficient literature data have not been available. Therefore, a large number of measurements on patients and volunteers have been carried out, in order to determine the biokinetics and dosimetry for these substances. Samples of breast milk from 50 mothers, who had been subject to nuclear medicine investigations, have been collected at various times after administration of the radiopharmaceutical to the mother. The activity concentration in the breast milk samples has been measured. The absorbed dose to various organs and tissues and the effective dose to the child who ingests the milk have been determined for 17 different radiopharmaceuticals. Based on these results revised recommendations for interruption of breast-feeding after nuclear medicine investigations are suggested.

  13. Using standardized patient encounters to teach longitudinal continuity of care in a family medicine clerkship.

    Science.gov (United States)

    Vest, Bonnie M; Lynch, Abigail; McGuigan, Denise; Servoss, Timothy; Zinnerstrom, Karen; Symons, Andrew B

    2016-08-17

    Despite demonstrated benefits of continuity of care, longitudinal care experiences are difficult to provide to medical students. A series of standardized patient encounters was developed as an innovative curricular element to address this gap in training for medical students in a family medicine clerkship. The objective of this paper is to describe the development and implementation of the curriculum, evaluate the effectiveness of the curriculum for increasing student confidence around continuity of care and chronic disease management, and explore student opinions of the value of the experience. The encounters simulate continuity of care in typical family medicine practice over four standardized patient visits, providing students with experience in longitudinal relationships, ongoing management of chronic and acute conditions, lifestyle counseling, and the use of an electronic medical record. Perceptions of the curriculum were obtained using a pre-post survey asking students to self-rate experience and confidence in continuity relationships, chronic disease management, and lifestyle counseling. Students were also asked about the overall effectiveness of the encounters for simulating family practice and continuity of care. Open-ended comments were gathered through weekly reflection papers submitted by the students. Of 138 third-year medical students, 137 completed the pre-survey, 126 completed the post-survey, and 125 (91%) completed both the pre- and the post-survey. Evaluation results demonstrated that students highly valued the experience. Complete confidence data for 116 students demonstrated increased confidence pre-post (t(115) = 14.92, p continuity of care. This curriculum offers a promising approach to providing students with continuity of care experience. The model addresses a general lack of training in continuity of care in medical schools and provides a standardized method for teaching chronic disease management and continuity relationships.

  14. Estimation of internal exposure to 99Mo in nuclear medicine patients

    International Nuclear Information System (INIS)

    Dantas, B.M.; Silva, C.O.A. da; Dantas, A.L.A.; Lucena, E.A.; Souza, W.O.

    2008-01-01

    99m Tc is the most widely used radionuclide in nuclear medicine. It is obtained by elution of 99 Mo- 99m Tc generators. Depending on the quality of the generator and its integrity, 99 Mo might be extracted from the column during the elution process, becoming a radionuclidic impurity in the 99m Tc eluate. This fact would impart an undesired dose to the patients submitted to diagnostic procedures using 99m Tc. The aims of this work are: to evaluate the incorporation of 99 Mo as a radionuclidic impurity using in vivo and in vitro techniques; to estimate the internal effective doses in nuclear medicine patients and; to provide additional information about the metabolic behavior of molybdenum in humans. A methodology based on in vivo measurements and urine sampling was developed to determine retention and excretion patterns of molybdenum in the human body. In vivo measurements were performed in IRD whole body counter using a NaI(Tl) 8”x4” scintillation detector. The detector is located inside a shielded room with internal dimensions of 2.5 x 2.5 x 2.65 meters. In vitro analysis was based on the collection of urine samples from the patients and was performed in IRD bioassay laboratory using a High Purity Germanium (HPGe) detection system. Four patients have been monitored by in vivo and in vitro measurements showing detectable activities of 99 Mo in whole body and urine samples. Bioassay results were interpreted by using AIDE software version 6. Estimated values of 99 Mo incorporation were compared to predicted values based on the standard metabolic model of molybdenum established by the International Commission of Radiological Protection (ICRP). Internal effective doses were estimated in the order of micro sieverts per examination. Based on the data obtained in this work it is suggested to implement a routine quality control program of radionuclidic impurity of 99 Mo in 99m Tc eluates to be conducted by radiopharmacy laboratories of nuclear medicine centers. (author)

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

    Science.gov (United States)

    Laube, Justin G R; Shapiro, Martin F

    2017-05-01

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

  16. Communication with patients and the duration of family medicine consultations.

    Science.gov (United States)

    Valverde Bolívar, Francisco Javier; Pedregal González, Miguel; Moreno Martos, Herminia; Cózar García, Inmaculada; Torío Durántez, Jesús

    2017-10-17

    To determine the distribution of consultation times, the factors that determine their length, and their relationship with a more participative, patient-centred consulting style. Cross-sectional multicentre study. Primary Healthcare Centres in Andalusia, Spain. A total of 119 tutors and family medicine physician residents. Consultation length and communication with the patient were analysed using the CICCAA scale (Connect, Identify, Understand, Consent, Help) during 436 interviews in Primary Care. The mean duration of consultations was 8.8min (sd: 3.6). The consultation tended to be longer when the physician had a patient-centred approach (10.37±4.19min vs 7.54±2.98min; p=0.001), and when there was joint decision-making (9.79±3.96min vs 7.73±3.42min: p=0.001). In the multivariable model, longer consultations were associated with obtaining higher scores on the CICAA scale, a wider range of reasons for consultation, whether they came accompanied, in urban centres, and a smaller number of daily visits (r 2 =0.32). There was no correlation between physician or patient gender, or problem type. A more patient centred medical profile, increased shared decision-making, a wider range of reasons for consultation, whether they came accompanied, in urban centres, and less professional pressure all seem to be associated with a longer consultation. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  17. [Prevalence of obesity in hospitalized internal medicine patients].

    Science.gov (United States)

    Carrasco Sánchez, F J; Díaz Alcaide, F; Marín Fernández, Y; Chaparro Moreno, I; Pujol de la Llave, E

    2002-09-01

    We describe the weight's distribution in a sample of medical patients in hospital. We estimate the global prevalence and the presence between other different clinical variables. A prevalence cross-sectional study was carried out. We determine weight, stature and several clinical variables in 101 patients admit in the internal medicine department of Juan Ramón Jiménez hospital in Huelva. The patients were admitted from 6th to 7th of june in 2000. The Body Mass Index (BMI) > or = 30 Kg/m2 was used to define the obesity. The prevalence of obesity was 32.2% [0.236-0.416]. In the study we find an association with female (prevalente rate -PR- 3.22), HTA (PR 4.72), dislipemia (RP 4.40) and hyperuricacemia (RP 4.28). The prevalence of obesity in our patients was between 23.41%, it was greater than others estimations in general people. We find association with women and classic cardiovascular risk factors.

  18. Clinical holistic medicine: the patient with multiple diseases.

    Science.gov (United States)

    Ventegodt, Søren; Merrick, Joav

    2005-04-12

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

  19. Applications of patient-specific 3D printing in medicine.

    Science.gov (United States)

    Heller, Martin; Bauer, Heide-Katharina; Goetze, Elisabeth; Gielisch, Matthias; Roth, Klaus E; Drees, Philipp; Maier, Gerrit S; Dorweiler, Bernhard; Ghazy, Ahmed; Neufurth, Meik; Müller, Werner E G; Schröder, Heinz C; Wang, Xiaohong; Vahl, Christian-Friedrich; Al-Nawas, Bilal

    Already three decades ago, the potential of medical 3D printing (3DP) or rapid prototyping for improved patient treatment began to be recognized. Since then, more and more medical indications in different surgical disciplines have been improved by using this new technique. Numerous examples have demonstrated the enormous benefit of 3DP in the medical care of patients by, for example, planning complex surgical interventions preoperatively, reducing implantation steps and anesthesia times, and helping with intraoperative orientation. At the beginning of every individual 3D model, patient-specific data on the basis of computed tomography (CT), magnetic resonance imaging (MRI), or ultrasound data is generated, which is then digitalized and processed using computer-aided design/computer-aided manufacturing (CAD/CAM) software. Finally, the resulting data sets are used to generate 3D-printed models or even implants. There are a variety of different application areas in the various medical fields, eg, drill or positioning templates, or surgical guides in maxillofacial surgery, or patient-specific implants in orthopedics. Furthermore, in vascular surgery it is possible to visualize pathologies such as aortic aneurysms so as to improve the planning of surgical treatment. Although rapid prototyping of individual models and implants is already applied very successfully in regenerative medicine, most of the materials used for 3DP are not yet suitable for implantation in the body. Therefore, it will be necessary in future to develop novel therapy approaches and design new materials in order to completely reconstruct natural tissue.

  20. Nosocomial candidemia in patients admitted to medicine wards compared to other wards: a multicentre study.

    Science.gov (United States)

    Luzzati, Roberto; Merelli, Maria; Ansaldi, Filippo; Rosin, Chiara; Azzini, Annamaria; Cavinato, Silvia; Brugnaro, Pierluigi; Vedovelli, Claudio; Cattelan, Annamaria; Marina, Busetti; Gatti, Giuseppe; Concia, Ercole; Bassetti, Matteo

    2016-12-01

    Risk factors for nosocomial candidemia, severity of sepsis, treatment, and outcome were compared between patients admitted to medicine wards and those to surgical and intensive care units (ICUs). Data were retrospectively collected from patients belonging to six referral hospitals in Italy between January 2011 and December 2013. Risk factors for 30-day mortality were evaluated in the whole patient population. A total of 686 patients (mean age 70 ± 15 years) with candidemia were included. 367 (53.5 %) patients were in medicine wards, and 319 in surgery and ICUs. Host-related risk factors for candidemia were more common in medicine patients whereas healthcare-related factors in surgery/ICU patients. These patients showed severe sepsis and septic shock more commonly (71.7 %) than medicine patients (59.9 %) (p 0.003). The latter underwent central venous catheter (CVC) removal and adequate antifungal therapy less frequently than surgery/ICU patients. 149 (40.6 %) patients died with candidemia in medicine wards and 69 (21.6 %) in other wards (p candidemia was different between medicine patients and those in other wards. Despite the lower severity of candidemia in medicine patients, their mortality turned out to be higher than in surgery or ICU patients. Awareness of the best management of candidemia should be pursued, especially in medicine wards.

  1. Frequency of alcohol use and obesity in community medicine patients

    Directory of Open Access Journals (Sweden)

    Denison Anne

    2005-04-01

    Full Text Available Abstract Background Obesity is an important public health problem. However, the effects of alcohol use on the risk for obesity have not been thoroughly explored. This study focuses on how frequency of alcohol use is related to the risk of obesity in a community medicine clinic population. Methods This study used a cross-sectional survey to test the hypothesis that obesity (BMI > 30 is associated with alcohol use. The convenience sample was drawn from three clinics that primarily serve low-income populations. Independent variables included frequency of alcohol use, frequency of binge drinking, demographic characteristics, health behaviors and health status. Results In comparison to non-drinkers, people who consumed alcohol 3 or more days per month had lower odds of being obese (Adjusted Odds Ratio = .49, p Conclusion More frequent drinking and less television time are independently associated with reduced odds of obesity in this sample of community medicine patients. Additional research is needed to isolate casual mechanisms.

  2. Frequency of alcohol use and obesity in community medicine patients.

    Science.gov (United States)

    Rohrer, James E; Rohland, Barbara M; Denison, Anne; Way, Anthony

    2005-04-22

    Obesity is an important public health problem. However, the effects of alcohol use on the risk for obesity have not been thoroughly explored. This study focuses on how frequency of alcohol use is related to the risk of obesity in a community medicine clinic population. This study used a cross-sectional survey to test the hypothesis that obesity (BMI > 30) is associated with alcohol use. The convenience sample was drawn from three clinics that primarily serve low-income populations. Independent variables included frequency of alcohol use, frequency of binge drinking, demographic characteristics, health behaviors and health status. In comparison to non-drinkers, people who consumed alcohol 3 or more days per month had lower odds of being obese (Adjusted Odds Ratio = .49, p watching eight or more hours of television per day and obesity (AOR = 2.34, p television time are independently associated with reduced odds of obesity in this sample of community medicine patients. Additional research is needed to isolate casual mechanisms.

  3. Manifestações bucais em pacientes submetidos à quimioterapia Buccal manifestations in patients submitted to chemotherapy

    Directory of Open Access Journals (Sweden)

    Fernando Luiz Hespanhol

    2010-06-01

    Full Text Available Em decorrência da quimioterapia, alterações na cavidade oral podem ser observadas e levar a complicações sistêmicas importantes, podendo aumentar o tempo de internação hospitalar, os custos do tratamento e afetar diretamente a qualidade de vida dos pacientes. Este trabalho teve como objetivo realizar uma pesquisa em um hospital de oncologia da cidade de Juiz de Fora (MG, sendo realizado através de coleta de dados nos prontuários de pacientes que estiveram em tratamento oncológico, onde foram avaliadas as prevalências das manifestações orais em relação ao sexo, idade e tipo de tumor. Verificou-se que a mucosite foi a manifestação mais incidente em ambos os sexos em todas as faixas etárias (15,5%. A xerostomia e as demais lesões, como candidíase e lesões aftosas, também estiveram presentes. É possível melhorar a qualidade de vida antes, durante e após as terapias antineoplásicas através de um protocolo de atendimento odontológico que inclua medidas de condicionamento do meio bucal prévia à quimioterapia, como profilaxia, remoção de cáries, tratamento periodontal e de focos periapicais, orientação para higiene oral e dieta, e ainda laserterapia. É importante a inserção do dentista na equipe oncológica para o diagnóstico precoce das manifestações bucais e acompanhamento no período de tratamento.Several changes in the oral cavity due to chemotherapy can be observed and can lead to important systemic complications, increasing the time of the patient in hospital and the costs of the treatment as well as affect the quality of life of the patients. The aim of this study was to assess the oral manifestation in patients treated with chemoterapy according to sex, age and tumor type. Data was collected in an oncology hospital in Juiz de Fora, Minas Gerais State, from patients' records that were submitted to oncologic treatment. It was possible to verify that mucositis, associated or not to other type of lesions

  4. Ethnopharmacological survey of medicinal plants used by patients with psoriasis in the West Bank of Palestine.

    Science.gov (United States)

    Shawahna, Ramzi; Jaradat, Nidal Amin

    2017-01-03

    Psoriasis is a frequent skin inflammatory disorder that inflicts millions of patients around the globe. To meet their healthcare needs, patients with psoriasis often seek treatment outside the allopathic paradigm. Use of medicinal plants has emerged as one of the most common and preferred modalities of complementary and alternative medicine (CAM). The aim of this study was to investigate the use of medicinal plants by patients with psoriasis in the West Bank of Palestine. The current study was a questionnaire based cross-sectional descriptive study on the use of medicinal plants by psoriasis patients in the West Bank of Palestine. A sample of 149 patients with psoriasis who were visiting outpatient clinics responded to the questionnaire in face to face interviews. Medicinal plants were used by 81 (54.4%) patients with psoriasis. Patients used 33 medicinal plants belonging to 26 families. Plants belonging to Lamiaceae and Leguminosae were the most commonly used by the study patients. Aloe vera, Trigonella arabica, Catharanthus roseus and Anthemis cotula were the most frequently used medicinal plants to treat psoriasis. Leaves and fruits were the most commonly used parts by the study patients. Paste was the most commonly used form of preparation. The use of medicinal plants was significantly associated with age and monthly household income of the patients. Enhancement of immunity, improving conventional therapy and reduction of side effects were the most commonly self-reported reasons for using medicinal plants. Patients with psoriasis in Palestine seem to use medicinal plants as a CAM modality to manage their psoriasis. Many medicinal plants were commonly used by patients with psoriasis. More randomized clinical trials are needed to demonstrate safety and efficacy for the majority of these medicinal plants reported to be used by patients with psoriasis in Palestine.

  5. [RESISTANT ARTERIAL HYPERTENSION – APPROACH TO PATIENT IN FAMILY MEDICINE].

    Science.gov (United States)

    Diminić-Lisica, I; Bukmir, L; Lisica, I

    2016-12-01

    Increasing the proportion of patients with controlled hypertension implies understanding and systematic approach to patients with resistant hypertension. In the past decades, an increase in the prevalence of resistant arterial hypertension (RAH) has been observed and the incidence of this problem is becoming greater in the practice of family physicians. Patients with RAH have a higher prevalence of target organ damage as compared with patients having achieved target blood pressure values, and their risk of an adverse cardiovascular event is tripled. RAH is defined as hypertension in which there is no satisfactory control of blood pressure despite compliance to lifestyle changes and taking at least three drugs in full doses, one of which has to be a diuretic. The most important risk factors for resistance to treatment are older age, obesity, smoking, excessive intake of salt and alcohol, the presence of left ventricular hypertrophy, chronic renal failure, diabetes, inadequate baroreflex pathway, chronic stress and associated mental states, use of some drugs, and all forms of secondary hypertension. One-fifth of patients with RAH have primary aldosteronism. Obstructive sleep apnea is a common cause of RAH, and literature reports point to its increasing frequency. Optimal treatment involves a combination of three drugs, one of which is a diuretic. Use of mineralocorticoid antagonist as the fourth drug has shown significant efficacy even in patients who do not have elevated levels of aldosterone. New invasive methods of treatment include renal denervation and permanent electrical stimulation of the carotid sinus. The aim of this paper is to emphasize the importance of RAH as a cardiovascular risk factor, along with early detection and treatment at the family medicine level and timely referral to additional procedures to treat the specific forms of RAH.

  6. Research advances in traditional Chinese medicine syndromes in cancer patients.

    Science.gov (United States)

    Ji, Qing; Luo, Yun-quan; Wang, Wen-hai; Liu, Xuan; Li, Qi; Su, Shi-bing

    2016-01-01

    Traditional Chinese medicine (TCM) syndrome, also known as TCM ZHENG or TCM pattern, is an integral and essential part of TCM theory that helps to guide the design of individualized treatments. A TCM syndrome, in essence, is a characteristic profile of all clinical manifestations in one patient that can be readily identified by a TCM practitioner. In this article, the authors reviewed the presentations of TCM syndromes in seven common malignancies (liver, lung, gastric, breast, colorectal, pancreatic and esophageal cancers), the objectivity and the standardization of TCM syndrome differentiation, the evaluation of TCM syndrome modeling in cancer research, and syndrome differentiation-guided TCM treatment of cancers. A better understanding of TCM syndrome theory, as well as its potential biological basis, may contribute greatly to the clinical TCM diagnosis and the treatment of cancer.

  7. The last mile: improving patient outcomes within modern cardiovascular medicine.

    Science.gov (United States)

    Chew, Derek P

    2008-01-01

    It is now well recognised that, in many areas of medicine, substantial gaps in clinical care exist despite robust clinical trial data and the careful assimilation of this information into clinical practice guidelines. Those at greatest risk are patients presenting with multiple co-morbidities, and those with advanced age in whom the issues of complexity and limited time available for careful assessment, potentially lead to sub-optimal clinical practice and outcomes. Greater efforts are needed to move the acquired knowledge across the "last mile", that is from clinical guidelines and best practice to nationwide routine practice. This article will discuss some of issues faced in operationalizing "clinical effectiveness" in cardiovascular care in Australia.

  8. [Assessment of the patient satisfaction with a Nuclear Medicine Service].

    Science.gov (United States)

    Reyes-Pérez, M; Rodrigo-Rincón, M I; Martínez-Lozano, M E; Goñi-Gironés, E; Camarero-Salazar, A; Serra-Arbeloa, P; Estébanez-Estébanez, C

    2012-01-01

    To know the perceived quality and the levels of patient satisfaction with the Nuclear Medicine Service (MN). A cross-sectional descriptive study was performed. The authors designed a self-applied questionnaire based on a questionnaire from a survey created by the National Health Service of the UK. The answers of 32 items were analyzed, including 4 social-demographic questions and one open question. The authors recoded the variables related to service quality and recorded them as "in accordance" and "not in accordance." The validity of the questionnaire was measured using Cronbach's alpha and determination (R(2)) indexes. The authors used the χ(2), Student's T, ANOVA and linear regression analysis statistical tests. A total of 179 questionnaires were analyzed (response rate: 36.6%, sampling error: 5.8%). Evaluation of general satisfaction and the recommendation of the NM Service obtained a mean score of 8.96 and 9.20 (1-10 scale) points, respectively. The most influential variable regarding general satisfaction was the general impression of the organization of the service. The strong points of the service were courtesy, general organizational image and cleanliness. The main areas for improvement were appointment change process and waiting list. There were no significant differences regarding satisfaction due to the social-demographic variables except for age. This satisfaction survey has shown that patients are satisfied with the Nuclear Medicine Service and that it is a useful tool to detect the strong points and areas for improvement of the Service from the user's perspective. Copyright © 2011 Elsevier España, S.L. y SEMNIM. All rights reserved.

  9. Available Tools to Facilitate Early Patient Access to Medicines in the EU and the USA: Analysis of Conditional Approvals and the Implications for Personalized Medicine.

    Science.gov (United States)

    Leyens, Lada; Richer, Étienne; Melien, Øyvind; Ballensiefen, Wolfgang; Brand, Angela

    2015-01-01

    Scientific knowledge and our understanding of the human body and diseases have limited any possible treatment tailoring to each patient. The technological advances enabling the integration of various data sets (e.g. '-omics', microbiome, epigenetics and environmental exposure) have facilitated a greater understanding of the human body, the molecular basis of disease and all the factors influencing disease onset, progression and response to treatment, thereby ushering in the era of personalized medicine. We evaluate the regulatory approaches available to facilitate early patient access to efficacious and safe compounds in the EU and the USA in order to make more informed recommendations in the future as to the gaps in regulations for early patient access. An in-depth analysis of conditional approvals (EU) and accelerated approvals (USA) is performed based on the publicly available information (European public assessment reports and a summary review of products approved under both programmes). The types of product, indications, time to approval and type of evidence submitted were analysed. Between 2007 and early 2015, 17 products were conditionally approved in the EU and 25 in the USA, most of them in the area of oncology and based on evidence from phase II clinical trial data. Early approval of promising products based on data from early phases of development is already possible in the EU and the USA. Some of the improvements could entail implementing a rolling assessment of evidence in Europe and extending the scope of early dialogues. © 2015 S. Karger AG, Basel.

  10. Integrative Medicine Patients Have High Stress, Pain, and Psychological Symptoms.

    Science.gov (United States)

    Wolever, Ruth Q; Goel, Nikita S; Roberts, Rhonda S; Caldwell, Karen; Kligler, Benjamin; Dusek, Jeffery A; Perlman, Adam; Dolor, Rowena; Abrams, Donald I

    2015-01-01

    Integrative medicine (IM) is a rapidly growing field whose providers report clinical success in treating significant stress, chronic pain, and depressive and anxiety symptoms. While IM therapies have demonstrated efficacy for numerous medical conditions, IM for psychological symptoms has been slower to gain recognition in the medical community. This large, cross-sectional study is the first of its kind to document the psychosocial profiles of 4182 patients at 9 IM clinics that form the BraveNet Practice-Based Research Network (PBRN). IM patients reported higher levels of perceived stress, pain, and depressive symptoms, and lower levels of quality of life compared with national norms. Per provider reports, 60% of patients had at least one of the following: stress (9.3%), fatigue (10.2%), anxiety (7.7%), depression (7.2%), and/or sleep disorders (4.8%). Pain, having both physiological and psychological components, was also included and is the most common condition treated at IM clinics. Those with high stress, psychological conditions, and pain were most frequently treated with acupuncture, IM physician consultation, exercise, chiropractic services, diet/nutrition counseling, and massage. With baseline information on clinical presentation and service utilization, future PBRN studies can examine promising interventions delivered at the clinic to treat stress and psychological conditions. Copyright © 2015 Elsevier Inc. All rights reserved.

  11. Complementary/alternative medicine use among chronic pain clinic patients.

    Science.gov (United States)

    Konvicka, James J; Meyer, Tricia A; McDavid, Andrew J; Roberson, Charles R

    2008-02-01

    Complementary and alternative therapies have enjoyed increasingly widespread use in recent years. Because of this trend, we were eager to obtain a better grasp on the actual number of people in our hospital's pain clinic who have used these modalities. In an effort to explore the use of complementary/alternative medicine (CAM) by patients seen in an anesthesiology chronic pain clinic, we conducted a study using a questionnaire. This questionnaire contained two sections, one covering complementary/alternative modalities and the other dealing with herbals or nutraceuticals. More than 400 patients were surveyed, 41% of whom were male and 59% of whom were female. Comparing alternative therapies by gender revealed no statistical difference in males versus females. The most commonly chosen modalities overall were nutraceuticals, massage therapy, and acupuncture. In terms of age, we found that the patients surveyed who were older than 60 years of age preferred nutraceuticals, and that the younger age group preferred more interactive relaxation techniques, such as meditation and massage.

  12. Correlation of the three-dimensional ultrasound findings with pathology in patients with deep pelvic infiltrating endometriosis submitted to surgery

    Directory of Open Access Journals (Sweden)

    Maria Cecilia Lunardelli da Silva

    2016-04-01

    Full Text Available Objective: This study aims to correlate the findings of the three-dimensional anorectal ultrasonography (3D-AUS with pathological findings in patients with deep pelvic infiltrating endometriosis. Methods: Prospective study of a series of 40 patients with deep pelvic infiltrating endometriosis diagnosed by three-dimensional anorectal ultrasonography and who were submitted to a laparoscopy. The specimens were examined histologically and compared with the results of the three-dimensional anorectal ultrasonography. The research was conducted between March 2008 and March 2011. Results: The results of the examinations were: 72.5% of patients (n = 29 with endometriosis, 12.5% (n = 5 with nonspecific chronic inflammatory reaction, 5% (n = 2 with nonspecific fibrous tissue, 2.5% (n = 1 with adenomyoma, 2.5% (n = 1 with colonic mucosa with foci of recent hemorrhage, edema of lamina propria and superficial erosions, 2.5% (n = 1 with hyperplasia of lymphoid follicles, and the remaining 2.5% (n = 1 with peritoneal tissue within normal limits. Conclusion: We conclude that the use of three-dimensional anorectal ultrasonography in patients with deep pelvic infiltrating endometriosis aid in the diagnosis of rectal lesions, when compared with the pathological findings of surgical specimens. Resumo: Objetivo: Este estudo visa correlacionar os achados da ultrassonografia tridimensional com os achados anatomopatológicos em pacientes com endometriose pélvica infiltrativa profunda submetidos a tratamento cirúrgico. Métodos: Estudo prospectivo de uma série de 40 pacientes com endometriose pélvica infiltrativa profunda diagnosticados pela USR-3D e submetidos à videolaparoscopia. As peças cirúrgicas foram analisadas histologicamente e comparadas com os resultados das USR-3D. A pesquisa foi desenvolvida entre março de 2008 a março de 2011. Resultados: Os resultados dos estudos histopatológicos foram: 72,5% das pacientes (n = 29 com endometriose

  13. Favorable Long-term Outcome in Patients Submitted to Liver Transplantation After Downstaging of Hepatocellular Carcinoma According to a Brazilian Selection Protocol.

    Science.gov (United States)

    Massarollo, P C B; Coppini, A Z; Salzedas-Netto, A A; Coelho, F F; Minami, T; Gonzalez, A M

    2016-09-01

    In October 2008, the Brazilian Ministry of Health authorized listing of downstaged hepatocellular carcinoma (HCC) for liver transplantation, according to a standardized protocol. The aim of this study was to compare the outcome of patients submitted to liver transplantation after downstaging of HCC with the results other standard indications in Brazil. We conducted a retrospective analysis of 2,667 adult 1st elective deceased-donor liver transplantations registered at the database of the Transplant Notification Center of the São Paulo State Health Secretariat. These cases are classified into 3 groups: "cirrhosis," including 1,709 patients transplanted because of end-stage liver disease; "Milan-HCC," including 873 HCC patients initially meeting the Milan criteria; and "downstaging" group, including 85 HCC patients submitted to tumor downstaging to the Milan criteria before liver transplantation. One-, 3-, 5-, and 6-year patients survivals were, respectively, 82.7%, 72.0%, 66.1%, and 66.1%, in the "downstaging" group and 76.7%, 68.4%, 63.9%, and 63.5% in the "Milan-HCC" group (P = .483). At the same time intervals, patient survivals were 67.8%, 62.9%, 60.9%, and 60.2% in the "cirrhosis" group. These probabilities were significantly lower than those of both "downstaging" (P = .047) and "Milan-HCC" (P = .001) groups. Patients submitted to liver transplantation after downstaging of HCC, according to a Brazilian selection protocol, present long-term outcomes similar to HCC patients initially within the Milan criteria and better survival than recipients with end-stage liver disease. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. Absorbed doses received by patients submitted to chest radiographs in hospitals of the city of Sao Paulo, Brazil

    International Nuclear Information System (INIS)

    Freitas, Marcelo Baptista de

    2000-01-01

    Medical irradiation contributes with a significant amount to the dose received by the population. Here, this contribution was evaluated in a survey of absorbed doses received by patients submitted to chest radiological examinations (postero-anterior (PA) and lateral (LAT) projections) in hospitals of the city of Sao Paulo. Due to the variety of equipment and procedures used in radiological examinations, a selection of hospitals was made (12, totalizing 27 X-ray facilities), taking into account their representativeness as medical institutions in the city, in terms of characteristics and number of radiographs carried out. An anthropomorphic phantom, provided with thermoluminescent dosemeters (TLD-1 00), was irradiated simulating the patient, and the radiographic image quality was evaluated. Absorbed doses were determined to the thoracic region (entrance and exit skin and lung doses), and to some important organs from the radiation protection point of view (lens of the eye, thyroid and gonads). The great variation on the exposure parameters (kV, mA.s, beam size) leads to a large interval of entrance skin doses-ESD (coefficients of variation, CV, of 60% and 76%, for PA and LAT projections, respectively, were found) and of organ doses (CV of 60% and 46%. for thyroid and lung respectively). Mean values of ESD for LAT and PA projections were 0.22 and 0.98 mGy, respectively. The average absorbed doses per exam (PA and LAT) to thyroid and lung, 0.15 and 0.24 mGy respectively,showed that the thyroid was irradiated by the primary beam in many cases. Values of lens of the eye and gonad absorbed doses were below 30 μGy. Comparison of the lung doses obtained in this study with values in the literature, calculated by Monte Carlo simulation, showed good agreement. On the other hand, the comparison shows significant differences in the dose values to organs outside the chest region (thyroid, lens of eye and gonads). The effective dose calculated for a chest examination, PA and LAT

  15. POSTOPERATIVE EFFECT OF PHYSICAL THERAPY RELATED TO FUNCTIONAL CAPACITY AND RESPIRATORY MUSCLE STRENGTH IN PATIENTS SUBMITTED TO BARIATRIC SURGERY.

    Science.gov (United States)

    Oliveira, Josélia Jucirema Jarschel de; Freitas, Alexandre Coutinho Teixeira de; Almeida, Andréa Adriana de

    Respiratory physiotherapy plays an important role preventing complications in bariatric surgery. To assess the effects of out-patient physiotherapy during post-operative period through respiratory pressures and functional capacity in individuals submitted to bariatric surgery. A prospective longitudinal and controlled study was done in adults with body mass index (BMI) equal or greater than 40 kg/m², who have been submitted to bariatric surgery. They were divided into two groups: intervention-group, who performed out-patient physiotherapy twice a week, from thirty to sixty days after surgery; and the control-group, who only followed home instructions. Both groups were evaluated before surgery and sixty days after surgery through manovacuometry, six-minute walk test and the Borg Scale of perceived exertion. Twenty participants were included the intervention-group and twenty-three in the control-group. Both groups had significant and similar weight loss after surgery. The manovacuometry presented no differences comparing pre- and post-surgery and in the comparison between the groups. The result of the six-minute walk test for the intervention-group increased by 10.1% in the post-operative period in relation to pre-. The Borg scale of perceived exertion in the intervention-group in pre-surgery decreased by 13.5% in the post-surgery compared to pre-surgery. In the control-group there was no difference comparing pre- and post-operative values, as in the comparison with the intervention-group. The low-intensity exercise program, carried out between the 30th and the 60th day after bariatric surgery provided better functional capacity; did not change respiratory muscle strength; and improved the perceived exertion rate. A fisioterapia respiratória tem papel importante na prevenção das complicações da cirurgia bariátrica. Avaliar os efeitos da fisioterapia ambulatorial no pós-operatório através das pressões respiratórias e da capacidade funcional dos indiv

  16. Clinical Holistic Medicine: The Patient with Multiple Diseases

    Directory of Open Access Journals (Sweden)

    Søren Ventegodt

    2005-01-01

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

  17. Association of oxidative stress and DNA damage with grafting time in patients with multiple myeloma and lymphoma submitted to autologous hematopoietic stem cell transplantation

    Directory of Open Access Journals (Sweden)

    Thayna Nogueira dos Santos

    Full Text Available ABSTRACT The aim of the study was to investigate the association between oxidative stress and DNA damage with grafting time in patients submitted to autologous hematopoietic stem-cell transplantation (HSCT. The study included 37 patients submitted to autologous HSCT diagnosed with Multiple Myeloma (MM and lymphoma (Hodgkin’s and non-Hodgkin’s. Biomarkers of oxidative stress and DNA damage index (DI were performed at baseline (pre-CR of the disease and during the conditioning regimen (CR, one day after the HSCT, ten days after HSCT and twenty days after HSCT, as well as in the control group consisting of 30 healthy individuals. The outcomes showed that both groups of patients had an hyperoxidative state with high DI when compared to baseline and to the control group and that the CR exacerbated this condition. However, after the follow-up period of the study, this picture was re-established to the baseline levels of each pathology. The study patients with MM showed a mean grafting time of 10.75 days (8 to 13 days, with 10.15 days (8 to 15 days for the lymphoma patients. In patients with MM, there was a negative correlation between the grafting time and the basal levels of GPx (r = -0.54; p = 0.034, indicating that lower levels of this important enzyme are associated with a longer grafting time. For the DI, the correlation was a positive one (r = 0.529; p = 0.030. In the group with lymphoma, it was observed that the basal levels of NOx were positively correlated with grafting time (r = 0.4664, p = 0.032. The data indicate the potential of these biomarkers as predictors of toxicity and grafting time in patients with MM and Lymphomas submitted to autologous HSCT.

  18. Use of non-vitamin, non-mineral (NVNM) supplements by hospitalized internal medicine patients and doctor-patient communication.

    Science.gov (United States)

    Samuels, Noah; Zisk-Rony, Rachel Y; Zevin, Shoshana; Becker, Evy L; Yinnon, Amos M; Oberbaum, Menachem

    2012-12-01

    To study non-vitamin, non-mineral (NVNM) supplements use and disclosure of among hospitalized internal medicine patients. A convenience sample of patients completed an interviewer-administered questionnaire examining use of and perceptions regarding NVNM supplements, and disclosure to medical personnel. 280 patients were interviewed (54% female), 15.4% reporting NVNM supplement use. This practice was more prevalent among female patients (p=0.045), more educated (pinternal medicine patients. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  19. Redispensing of medicines unused by patients: a qualitative study among stakeholders.

    Science.gov (United States)

    Bekker, Charlotte L; Gardarsdottir, Helga; Egberts, Toine C G; Bouvy, Marcel L; van den Bemt, Bart J F

    2017-02-01

    Background Medication waste has undesirable economic and environmental consequences. This waste is partly unavoidable, but might be reduced by redispensing medicines unused by patients. However, there is little knowledge of stakeholders' views on the redispensing. Objective To identify the stakeholders' views on the redispensing of medicines unused by patients. Setting Dutch healthcare system. Method Semi-structured interviews were conducted with 19 Dutch stakeholders from September 2014 until April 2015. The interview guide included two themes: medication waste and redispensing of unused medicines. The latter included qualitative-, legal- and financial aspects and stakeholder involvement, with specific attention to the patient. Interview transcripts were subjected to thematic content analysis. Main outcome measure Requirements related to the redispensing of unused medicines. Results All stakeholders considered the redispensing of medicines desirable if the implementation is feasible and the requirements for the safe redispensing are met. All of them pointed out that the product quality of redispensed medicines should be guaranteed and that it should be clear who is responsible for the quality of redispensed medicines. The stakeholders stated that transparent communication to patients is essential to guarantee trust in the redispensing system and that patients should be willing to use redispensed medicines. Moreover, the redispensing system's benefits should outweigh the costs and a minimal economic value of medicines suitable for redispensing should be determined. Conclusion Redispensing unused medicines could decrease medication waste if several requirements are met. For successful implementation of a redispensing system, all relevant stakeholders should be involved and cooperate as a joint-force.

  20. [Analysis of traditional Chinese medicine syndrome, traditional Chinese medicine and western medicine in 84 697 patients with coronary heart disease based on big data].

    Science.gov (United States)

    Li, Gui-hua; Jiang, Hong-yan; Xie, Yan-ming; Jiang, Jun-jie; Yang, Wei; Zhao, Wei; Zhuang, Yan; Wang, Yong-yan

    2014-09-01

    In order to understand the clinical characteristics of patients with coronary heart disease (CHD) in real world and provide reference for clinical prevention and treatment, this study analyzed informations of patient with CHD in hospital information system. Data from 17 national hospitals were collected. Select patients with coronaryheart disease in diagnosis of the first place in 17 hospitals, general informations and traditional Chinese medicine (TCM) syndrome, complications, medicine were analyzed using frequency method and association rules. This study included 84 697 patients with CHD, the majority of men and in the elderly. The average age of patients was 71 years. The proportion of men to women was about 1. 45: 1. Hospital stay time ranged from 8 to 14 d. The most common total hospitalization cost distribution was 5 000-20 000 RMB. Young patients have a rising trend year by year. The death of patients increased with increasing age. Common complications were hypertension, diabetes, cerebral infarction and hyperlipidemia, 57.24 percent of the CHD patient complicated with hypertension, 21.94 percent patients complicated with diabetes. Among TCM syndrome types, Qi-Yin deficiency and qi deficiency blood stasis were the most common syndromes. Blood stasis was the highest syndrome elements, accounted for 79.97%, followed by Qi deficiency, phlegm, Yin deficiency, and so on. The most common western medicine was aspirin, followed with isosorbide dinitrate, clopidogrel. The most common used traditional Chinese medicine was danhong injection, followed by shuxuetong injection. Combined with removing blood stasis drugs has been more common at present clinical treatment, there were 43.46 percent of patients combined with anti-platelet western drug and injection of removing blood stasis.

  1. Principles of Nutrition in Patients with Polycystic Ovary Syndrome in Iranian Traditional Medicine and Comparison with Modern Medicine.

    Science.gov (United States)

    Tansaz, Mojgan; Bahmani, Maryam

    2016-05-01

    Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age with metabolic and gynecological complications. Despite the high prevalence of this disease, many challenges remain regarding its diagnosis and treatment. According to many studies, lifestyle modification especially diet is the first line of the treatment in PCOS patients. The aim of this article was to study the principles of nutrition for PCOS patients in Iranian traditional medicine (ITM) in comparison with modern medicine. This is a descriptive study done using ITM references such as Canon of Medicine, Exir-e-Azam, Tib-e-Akbari, and the keywords feed, nutrition, lifestyle, and PCOS were searched in modern medicine databases. In ITM resources, the symptoms of PCOS were discussed under the topic of several diseases, including "Ehtebase tams", "infertility and uterine inflammation" and "urame rahem". In "Ehtebase tams", like other diseases, the first line of the treatment is diet based on disease etiology. The most common cause of "Ehtebase tams" is dystemperament of the uterus and ovaries especially cold and wet dystemperament. According to ITM, patients with "Ehtebase tams" should limit cold and wet foods in their diet and more hot, dry, and soft foods are most suitable for them. In modern medicine, reducing of carbohydrates and fats is considered. In other studies, there was no preference for different food groups. These differences may be due to the temperament of foods in the food groups. It seems that by combining ITM guidelines with the findings of modern medicine, a proper diet in these patients can be achieved.

  2. [Developing traditional Chinese medicine injection is the need for curing sickness to save patients].

    Science.gov (United States)

    He, Ping; Li, Feng-Jie; Li, Lian-da; Li, Yi-Kui

    2017-03-01

    Safety issues of traditional Chinese medicine injections has been heated debate. There are two diametrically opposed views: it should be used reasonable and developed healthily or be forbidden to use. Some people have many misunderstandings and prejudices about the safety of traditional Chinese medicine injections. Compared with western medicine,traditional Chinese medicine has its own particularity. Traditional Chinese medicine has complex components. Its research and clinical application is different from western medicine. Adverse reactions of traditional Chinese medicine injections are related to many factors,such as a large number of irrational use,blind use of traditional Chinese medicine injections and western medicine injections,counterfeit and substandard drugs,incorrect methods of intravenous infusion,toxicity of supplementary materials,drug ingredients. Developing traditional Chinese medicine injection is the need for curing sickness to save patients. The purposeful, targeted, organized and planned systematic research of traditional Chinese medicine injections should be strengthened,especially the safety of traditional Chinese medicine. Strengthen supervision and control of rational drug use.Strengthen the examination and approval,supervision and management of all aspects to ensure the safety of patients. Copyright© by the Chinese Pharmaceutical Association.

  3. Herbal medicine for hospitalized patients with severe depressive episode: a retrospective controlled study.

    Science.gov (United States)

    Liu, Lan-Ying; Feng, Bin; Chen, Jiong; Tan, Qing-Rong; Chen, Zheng-Xin; Chen, Wen-Song; Wang, Pei-Rong; Zhang, Zhang-Jin

    2015-01-01

    Herbal medicine is increasingly used in depressed patients. The purpose of this retrospective controlled study was to evaluate the efficacy and safety of herbal medicine treatment of severe depressive episode. A total of 146 severely depressed subjects were selected from patients who were admitted to the Department of Psychosomatics of Tongde Hospital at Hangzhou, China between 1st September 2009 and 30th November 2013. While all were medicated with psychotropic drugs, 78 received additional individualized herbal medicine. The severity of depressive symptoms was measured using 24-item Hamilton Rating Scale for Depression (HAMD-24) at admission and thereafter once weekly during hospital stay. The proportion of patients achieving clinical response and remission and incidence of adverse events were compared. The two groups had similar average length of hospital stay for approximately 28 days and were not different in the use of psychotropic medications. Survival analysis revealed that patients with herbal medicine had significantly higher chance of achieving clinical response [relative risk (RR)=2.179, Pherbal medicine. Patients with herbal medicine experienced remarkably fewer incidences of physical tiredness, headache, palpitation, dry mouth and constipation, but had a significantly higher incidence of digestive discomfort compared to patients without herbal medicine. These results indicate that additional treatment with individualized herbal medicine enhances antidepressant response and reduces certain side effects associated with psychotropic medications. Herbal medicine is an effective and relatively safe therapy for severe depressive episode (Trial Registration: ChiCTR-OCH-13003864). Copyright © 2014 Elsevier B.V. All rights reserved.

  4. Late follow-up of patients submitted to subtotal splenectomy: late clinical, laboratory, imaging and functional with preservation of the upper splenic pole

    Directory of Open Access Journals (Sweden)

    Andy Petroianu

    2008-09-01

    Full Text Available objective: To evaluate the follow-up of patients submitted to splenectomy with preservation of the upper splenic pole. Methods: All patients undergoing subtotal splenectomy were invited to be reviewed. A total of 86 patients submitted to this surgery were studied. The procedure was performed due to one of the following conditions: portal hypertension due to schistosomiasis (n = 43, trauma (n = 31, Gaucher’s disease (n = 4, myeloid hepatosplenomegaly due to myelofibrosis (n = 3, splenomegalic retarded growth and sexual development (n = 2, severe pain due to splenic ischemia (n = 2 and pancreatic cystadenoma (n = 1. All patients underwent hematologic tests, immunological assessment, abdominal ultrasonography, computed tomography (CT, scintigraphy and endoscopy. Rresults: Increased white blood cell and platelet counts were the only hematological abnormalities. No immune deficit was found. Esophageal varices were still present in patients who underwent surgery because of portal hypertension, but none had a re-bleeding event. The ultrasonography, tomography and scintigraphy confirmed the presence of functional splenic remnants without significant size alteration. Conclusions: Subtotal splenectomy seems to be a safe procedure that can be useful to treat conditions involving the spleen. The functions of the splenic remnants are preserved during long periods of time.

  5. Trashepatic left gastric vein embolization in the treatment of recurrent hemorrhaging in patients with schistosomiasis previously submitted to non-derivative surgery

    Directory of Open Access Journals (Sweden)

    Paulo Fernandes Saad

    2012-12-01

    Full Text Available CONTEXT: Non-derivative surgical techniques are the treatment of choice for the control of upper digestive tract hemorrhages after schistosomotic portal hypertension. However, recurrent hemorrhaging due to gastroesophagic varices is frequent. OBJECTIVE: To evaluate the outcome of treatment based on embolization of the left gastric vein to control the reoccurrence of hemorrhages caused by gastroesophagic varices in patients with schistosomiasis previously submitted to non-derivative surgery. METHODS: Rates of reoccurrence of hemorrhages and the qualitative and quantitative reduction of gastroesophagic varices in patients undergoing transhepatic embolization of the left gastric vein between December 1999 and January 2009 were studied based on medical charts and follow-up reports. RESULTS: Seven patients with a mean age of 39.3 years underwent percutaneous transhepatic embolization of the left gastric vein. The mean time between azigoportal disconnections employed in combination with splenectomy and the percutaneous approach was 8.4 ± 7.3 years, and the number of episodes of digestive hemorrhaging ranged from 1 to 7 years. No episodes of reoccurrence of hemorrhaging were found during a follow-up period which ranged from 6 months to 7 years. Endoscopic postembolization studies revealed reductions in gastroesophagic varices in all patients compared to preembolization endoscopy. CONCLUSIONS: Percutaneous transhepatic embolization of the left gastric vein in patients with schistosomiasis previously submitted to surgery resulted in a decrease in gastroesophagic varices and was shown to be effective in controlling hemorrhage reoccurrence.

  6. Measuring medicine-related experiences from the patient perspective: a systematic review.

    Science.gov (United States)

    Katusiime, Barbra; Corlett, Sarah; Reeve, Joanne; Krska, Janet

    2016-01-01

    There is an increasing drive to measure and so improve patients' experiences and outcomes of health care. This also applies to medicines, given their ubiquity as health care interventions. Patients' experiences of using medicines vary, and instruments which measure these are seen as an essential component to improve care. We aimed to identify generic measures of patients' experiences of using prescription medicines and to examine their properties and suitability for use in research or practice. Multiple electronic databases were searched: MEDLINE, Embase, PsycINFO, PsycARTICLES, CINHAL Plus, PROQOLID ® , and Google Scholar. We identified, critically appraised, and summarized generic questionnaires assessing one or more aspects of the medicine use experience among adult patients using prescription medicines for chronic conditions, and the process of questionnaire development, degree of patient involvement, and/or validation processes. Fifteen questionnaires were included. Of these, nine measures were multidimensional, covering various aspects of medicine use. Six instruments covered only a single domain, assessing a specific facet of using medicines. Domains covered were the following: effectiveness; convenience, practicalities, and/or managing medicines; information, knowledge, and/or understanding; side effects; relationships and/or communication with health professionals; impact on daily living and/or social life; general satisfaction; attitudes; beliefs, concerns, and/or perceptions; medical follow-up and/or adherence-related issues; treatment- and/or medicine-related burden, perceived control, or autonomy; self-confidence about medicine use; availability and accessibility; and medicine-related quality of life. None of the identified questionnaires covered all domains. Instruments varied in the extent of patient involvement in both their development and validation. There is a scarcity of psychometrically sound, comprehensive, and generic measures of experiences

  7. Personalized vascular medicine: tailoring cardiovascular disease management to the individual patient

    NARCIS (Netherlands)

    Dorresteijn, J.A.N.

    2013-01-01

    Applying group-level findings to individual patients is an absolute requisite for practicing evidence-based cardiovascular medicine. Yet, because individual patient characteristics may influence the pathophysiology and prognosis of disease and the likelihood of response to therapy, such

  8. Number of patients studied prior to approval of new medicines: a database analysis.

    Directory of Open Access Journals (Sweden)

    Ruben G Duijnhoven

    Full Text Available BACKGROUND: At the time of approval of a new medicine, there are few long-term data on the medicine's benefit-risk balance. Clinical trials are designed to demonstrate efficacy, but have major limitations with regard to safety in terms of patient exposure and length of follow-up. This study of the number of patients who had been administered medicines at the time of medicine approval by the European Medicines Agency aimed to determine the total number of patients studied, as well as the number of patients studied long term for chronic medication use, compared with the International Conference on Harmonisation's E1 guideline recommendations. METHODS AND FINDINGS: All medicines containing new molecular entities approved between 2000 and 2010 were included in the study, including orphan medicines as a separate category. The total number of patients studied before approval was extracted (main outcome. In addition, the number of patients with long-term use (6 or 12 mo was determined for chronic medication. 200 unique new medicines were identified: 161 standard and 39 orphan medicines. The median total number of patients studied before approval was 1,708 (interquartile range [IQR] 968-3,195 for standard medicines and 438 (IQR 132-915 for orphan medicines. On average, chronic medication was studied in a larger number of patients (median 2,338, IQR 1,462-4,135 than medication for intermediate (878, IQR 513-1,559 or short-term use (1,315, IQR 609-2,420. Safety and efficacy of chronic use was studied in fewer than 1,000 patients for at least 6 and 12 mo in 46.4% and 58.3% of new medicines, respectively. Among the 84 medicines intended for chronic use, 68 (82.1% met the guideline recommendations for 6-mo use (at least 300 participants studied for 6 mo and at least 1,000 participants studied for any length of time, whereas 67 (79.8% of the medicines met the criteria for 12-mo patient exposure (at least 100 participants studied for 12 mo. CONCLUSIONS: For

  9. Absorbed Doses to Patients in Nuclear Medicine; Doskatalogen foer nukleaermedicin

    Energy Technology Data Exchange (ETDEWEB)

    Leide-Svegborn, Sigrid; Mattsson, Soeren; Johansson, Lennart; Fernlund, Per; Nosslin, Bertil

    2007-04-15

    The Swedish radiation protection authority, (SSI), has supported work on estimates of radiation doses to patients from nuclear medicine examinations since more than 20 years. A number of projects have been reported. The results are put together and published under the name 'Doskatalogen' which contains data on doses to different organs and tissues from radiopharmaceuticals used for diagnostics and research. This new report contains data on: {sup 11}C-labelled substances (realistic maximum model), amino acids labelled with {sup 11}C, {sup 18}F or {sup 75}Se, {sup 99m}Tc-apcitide, {sup 123}I-labelled fatty acids ({sup 123}I- BMIPP and {sup 123}I-IPPA) and revised models for previously reported {sup 15}O-labelled water, {sup 99m}Tc-tetrofosmin (rest as well as exercise) and {sup 201}Tl-ion Data for almost 200 substances and radionuclides are included in the 'Doskatalogen' today. Since the year 2001 the 'Doskatalogen' is available on the authority's home page (www.ssi.se)

  10. Use of medicinal plants among Ethiopian patients with diabetes: A ...

    African Journals Online (AJOL)

    unhcc

    J. Health Dev. 2017;31(1):18-26]. Key words: medicinal plants, type 2 diabetes, Ethiopia, qualitative research. Introduction. Self-care practice using medicinal plants comprises one of the common ..... This should be followed with 2 eggs or one cup of butter as .... for buda (evil eye) sold in Merkato, which had a very repulsive ...

  11. Complementary medicine use among Moroccan patients with cancer

    African Journals Online (AJOL)

    Background: Complementary and alternative medicine (CAM) is a group of diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine. As cancer incidence rates and survival time increase, use of CAM will likely increase. However, little is known about ...

  12. Child Friendly Medicines : Availability, Pharmaceutical design, Usability and patient outcomes

    NARCIS (Netherlands)

    Nales, D.A.

    2014-01-01

    Introduction Child and maternal health are key to overall human life expectancy, implying an urgent need for medicines that keep (unborn) children and mothers healthy and alive. Unfortunately, medicines may bring harm as well. For example, limb malformation due to the use of thalidomide by pregnant

  13. [PERSONALIZED APPROACH TO PATIENT WITH CHRONIC WOUND IN FAMILY MEDICINE].

    Science.gov (United States)

    Sinožić, T; Katić, M; Kovačević, J

    2016-01-01

    satisfaction with the results achieved. Family doctors are involved in the care of chronic wound patients as part of the multidisciplinary team of experts. Additional specific knowledge and skills are required for such care in order to ensure overall quality care as a supplement of the existing knowledge, skills and working experience in family medicine.

  14. Factors affecting nebulised medicine adherence in adult patients with cystic fibrosis: a qualitative study.

    Science.gov (United States)

    Hogan, Alice; Bonney, Mary-Ann; Brien, Jo-Anne; Karamy, Rita; Aslani, Parisa

    2015-02-01

    Nebulised medicines contribute to the high treatment burden experienced by patients with cystic fibrosis (CF). This study explored experiences of adult patients with CF when using nebulised medicines, factors impacting on their adherence to nebulised therapy and strategies they used to facilitate adherence. Community setting, in Sydney, Australia. Ten patients with CF were recruited through a CF patient organisation. Semi-structured face-to-face interviews were conducted, addressing the study objectives. Interviews were audio-recorded, transcribed verbatim and content analysed for anticipated and emergent themes. Experiences with using nebulised medicines; and barriers and facilitators of adherence to nebulised medicines. Participants' age ranged from 22 to 45 years, with half being male. Four broad themes (with more specific sub-themes) were identified from the interviews: experiences with using nebulised medicines (cleaning nebuliser, time taken to use nebuliser medicine, flexibility in use of nebuliser); feelings about using nebulised medicines (necessary/important, dislike, part of life); factors impacting non-adherence (time consuming therapy, side effects/effects of medicine, work/social demands, lack of perceived importance); factors and strategies facilitating adherence (perceived medicine importance, habit/routine, support, health benefits, technology/medicine dose form, timetabling). Nebulised therapy for cystic fibrosis patients takes a substantial amount of time, with patients trying to alter their routine to incorporate nebulising into their daily lives. However there are still many factors that lead to low adherence, including work/social demands and travelling. Patients balance the necessity for nebulised therapy against the barriers, and engage in intentional non-adherence at times. Future strategies and resources should target and address specific factors identified by patients with CF as being important and impacting their adherence to nebulised

  15. Patient knowledge, perceptions, and acceptance of generic medicines: a comprehensive review of the current literature

    Directory of Open Access Journals (Sweden)

    Alrasheedy AA

    2014-04-01

    Full Text Available Alian A Alrasheedy,1 Mohamed Azmi Hassali,1 Kay Stewart,2 David CM Kong,2 Hisham Aljadhey,3 Mohamed Izham Mohamed Ibrahim,4 Saleh Karamah Al-Tamimi1 1Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia; 2Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia; 3Medication Safety Research Chair, Clinical Pharmacy Department, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia; 4College of Pharmacy, Qatar University, Doha, Qatar Background: Generic medicines have the same quality, safety, and efficacy as their counterpart original brand medicines. Generic medicines provide the same therapeutic outcomes but at a much cheaper cost, so are promoted in many countries to contain pharmaceutical expenditure and sustain the health care system. Thus, the perspective of patients and medicine consumers as end users of these medicines is an important factor to enhance the use and utilization of generic medicines. The objective of this paper is to review patients’ and consumers’ knowledge, perceptions, acceptance, and views of generic medicines in the current literature. Methods: An extensive literature search was performed in several databases, namely Scopus, PubMed, ISI Web of Knowledge, Proquest, and the Wiley online library, to identify relevant studies published in the English literature for the period 1990–2013. Results: A total of 53 studies were included in the review, comprising 24 studies from Europe, ten from North America, six from Asia, five from Australia and New Zealand, five from the Middle East, one from Africa, one from Latin America, and one from the Caribbean region. A large body of literature has reported misconceptions and negative perceptions about generic medicines on the part of patients and medicine consumers. Moreover, although it is reported in almost all countries, the percentage of consumers who had

  16. Medicine administration errors in patients with dysphagia in secondary care: a multi-centre observational study.

    Science.gov (United States)

    Kelly, Jennifer; Wright, David; Wood, John

    2011-12-01

    The aim of this study was to describe the interventions used by nurses when administering oral medicines to patients with and without dysphagia, to quantify the appropriateness of these interventions and the medicine administration error rate. The administration of medicines to patients with dysphagia is complex and potentially more error prone because of the need to match the medication's formulation to the swallowing ability of the patient. Data was collected on the preparation and administration of oral medicines to patients with and without dysphagia, including those with enteral feeding tubes, using undisguised direct observation of 65 nurse-led medicine administration rounds on stroke and care-of-the-elderly wards at four acute general hospitals in East of England between 1 March and 30 June 2008. Of the 2129 medicine administrations observed, 817 involved an error, and of these 313 involved patients with dysphagia. Excluding time errors, the normalized frequency of medicine administration errors for patients with dysphagia was 21.1% compared with 5.9% for patients without. Using a mixed effects model and excluding time errors, there is a higher risk of errors for patients with dysphagia (excluding patients with enteral tubes) compared with those without (P < 0.001) and a further increase in risk of error for patients with enteral tubes compared with dysphagic patients without tubes (P < 0.001). The increased medicine administration error rate in patients with dysphagia requires healthcare professionals to take extra care when prescribing, dispensing and administering medicines to this group. © 2011 The Authors. Journal of Advanced Nursing © 2011 Blackwell Publishing Ltd.

  17. Radiation doses to patients from nuclear medicine examinations

    International Nuclear Information System (INIS)

    Boehm, K.; Boehmova, I.

    2014-01-01

    Public Health Authority of the Slovak Republic, Bratislava The exposure of the population to ionizing radiation is rising rapidly, nearly exclusively due to increasing medical use of radiation, including diagnostic methods of nuclear medicine. In 2012 Public health authority of the Slovak republic (PHA SR) performed a survey about the population exposure from nuclear medicine procedures. The primary objectives of this survey were to assess the frequency of different nuclear medicine procedures, determine the average activities administered by nuclear medicine procedures and compare them with the national diagnostic reference levels and determine the annual collective effective dose to the Slovak population from nuclear medicine. The effective dose calculation was based on the methodology of the ICRP32, ICRP80 and ICRP106. In Slovak republic are 11 nuclear medicine departments. The collected data of activities administered by different procedures correspond to 100 % of nuclear medicine departments. The total number of procedures included in the study was 36 250. The most commonly performed procedure was bone scintigraphy (35.9%), followed by lung perfusion and ventilation scintigraphy (17.0%), static and dynamic renal scintigraphy (13.0%), whole-body positron emission tomography of tumors with PET radiopharmaceuticals (11.6%), myocardial perfusion (8.8%), thyroid scintigraphy (6.2%), parathyroid scintigraphy (2.1%), scintigraphy of tumors (2.1%), scintigraphy of the liver and spleen (0.8%), brain perfusion (0.7%) and examination of the gastrointestinal system (0.3%). (authors)

  18. Biomedicine or Holistic Medicine for Treating Mentally Ill Patients? A Philosophical and Economical Analysis

    Directory of Open Access Journals (Sweden)

    Søren Ventegodt

    2007-01-01

    Full Text Available Today we have two scientific medical traditions, two schools or treatment systems: holistic medicine and biomedicine. The two traditions are based on two very different philosophical positions: subjectivistic and objectivistic. The philosopher Buber taught us that you can say I-Thou or I-It, holding the other person as a subject or an object. These two fundamentally different attitudes seem to characterize the difference in world view and patient approach in the two schools, one coming from psychoanalysis and the old, holistic tradition of Hippocratic medicine. Holistic medicine during the last decade has developed its philosophical positions and is today an independent, medical system seemingly capable of curing mentally ill patients at the cost of a few thousand Euros with no side effects and with lasting value for the patient. The problem is that very few studies have tested the effect of holistic medicine on mentally ill patients. Another problem is that the effect of holistic medicine must be documented in a way that respects this school's philosophical integrity, allowing for subjective assessment of patient benefit and using the patient as his/her own control, as placebo control cannot be used in placebo-only treatment. As the existing data are strongly in favor of using holistic medicine, which seems to be safer, more efficient, and cheaper, it is recommended that clinical holistic medicine also be used as treatment for mental illness. More research and funding is needed to develop scientific holistic medicine.

  19. Biomedicine or holistic medicine for treating mentally ill patients? A philosophical and economical analysis.

    Science.gov (United States)

    Ventegodt, Søren; Kandel, Isack; Merrick, Joav

    2007-12-18

    Today we have two scientific medical traditions, two schools or treatment systems: holistic medicine and biomedicine. The two traditions are based on two very different philosophical positions: subjectivistic and objectivistic. The philosopher Buber taught us that you can say I-Thou or I-It, holding the other person as a subject or an object. These two fundamentally different attitudes seem to characterize the difference in world view and patient approach in the two schools, one coming from psychoanalysis and the old, holistic tradition of Hippocratic medicine. Holistic medicine during the last decade has developed its philosophical positions and is today an independent, medical system seemingly capable of curing mentally ill patients at the cost of a few thousand Euros with no side effects and with lasting value for the patient. The problem is that very few studies have tested the effect of holistic medicine on mentally ill patients. Another problem is that the effect of holistic medicine must be documented in a way that respects this school's philosophical integrity, allowing for subjective assessment of patient benefit and using the patient as his/her own control, as placebo control cannot be used in placebo-only treatment. As the existing data are strongly in favor of using holistic medicine, which seems to be safer, more efficient, and cheaper, it is recommended that clinical holistic medicine also be used as treatment for mental illness. More research and funding is needed to develop scientific holistic medicine.

  20. Study of accessibility and quality of the patient information about medicines in Latvia

    Directory of Open Access Journals (Sweden)

    Ozolina V.

    2012-10-01

    Full Text Available Receipt of adequate amount of accurate patient information on medicines before their use is one of the main cornerstones of the treatment. Without the information medicines cannot be used safely and effectively. Basically, it can be argued that the information is converting the pharmacologically active substance into the medicinal product. Main source of information for patients in Latvia is Package leaflets. Label of medicines and patient information leaflet are drawn up in compliance with regulatory requirements, but for people it is often difficult to understand information contained in the package leaflets due to the complex language. The readability test – introduced as a mandatory requirement for marketing authorization and renewal of marketing authorization of medicines – improves the quality of package leaflets making them more patient “friendly”.

  1. Opinion: redefining the role of the physician in laboratory medicine in the context of emerging technologies, personalised medicine and patient autonomy ('4P medicine').

    Science.gov (United States)

    Orth, Matthias; Averina, Maria; Chatzipanagiotou, Stylianos; Faure, Gilbert; Haushofer, Alexander; Kusec, Vesna; Machado, Augusto; Misbah, Siraj A; Oosterhuis, Wytze; Pulkki, Kari; Twomey, Patrick J; Wieland, Eberhard

    2017-12-22

    The role of clinical pathologists or laboratory-based physicians is being challenged on several fronts-exponential advances in technology, increasing patient autonomy exercised in the right to directly request tests and the use of non-medical specialists as substitutes. In response, clinical pathologists have focused their energies on the pre-analytical and postanalytical phases of Laboratory Medicine thus emphasising their essential role in individualised medical interpretation of complex laboratory results. Across the European Union, the role of medical doctors is enshrined in the Medical Act. This paper highlights the relevance of this act to patient welfare and the need to strengthen training programmes to prevent an erosion in the quality of Laboratory Medicine provided to patients and their physicians. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  2. Specimen rejection in laboratory medicine: Necessary for patient safety?

    Science.gov (United States)

    Dikmen, Zeliha Gunnur; Pinar, Asli; Akbiyik, Filiz

    2015-01-01

    The emergency laboratory in Hacettepe University Hospitals receives specimens from emergency departments (EDs), inpatient services and intensive care units (ICUs). The samples are accepted according to the rejection criteria of the laboratory. In this study, we aimed to evaluate the sample rejection ratios according to the types of pre-preanalytical errors and collection areas. The samples sent to the emergency laboratory were recorded during 12 months between January to December, 2013 in which 453,171 samples were received and 27,067 specimens were rejected. Rejection ratios was 2.5% for biochemistry tests, 3.2% for complete blood count (CBC), 9.8% for blood gases, 9.2% for urine analysis, 13.3% for coagulation tests, 12.8% for therapeutic drug monitoring, 3.5% for cardiac markers and 12% for hormone tests. The most frequent rejection reasons were fibrin clots (28%) and inadequate volume (9%) for biochemical tests. Clotted samples (35%) and inadequate volume (13%) were the major causes for coagulation tests, blood gas analyses and CBC. The ratio of rejected specimens was higher in the EDs (40%) compared to ICUs (30%) and inpatient services (28%). The highest rejection ratio was observed in neurology ICU (14%) among the ICUs and internal medicine inpatient service (10%) within inpatient clinics. We detected an overall specimen rejection rate of 6% in emergency laboratory. By documentation of rejected samples and periodic training of healthcare personnel, we expect to decrease sample rejection ratios below 2%, improve total quality management of the emergency laboratory and promote patient safety.

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

    Science.gov (United States)

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

    2016-05-01

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

  4. Medicinal plants consumption by patients under psychological treatment in a municipality in Chile

    Directory of Open Access Journals (Sweden)

    Rodrigo Ramírez-Tagle

    2018-04-01

    Full Text Available Context: High levels of mental illness are found today in the population of Chile and the consumption of medicinal herbs could be included in the scope of complementary therapies for the treatment of mental illnesses. In Chile there is no information respect to consumption of medicinal herbs in patients under psychological treatment. Aims: To characterize the consumption of medicinal herbs by patients treated in a mental health clinic. Methods: In this quantitative cross-sectional study (n = 100, patients were administered a closed-response survey to determine the frequency of medicinal plant consumption as complementary treatment and subsequently to characterize such consumption. Results: Among the patients surveyed, 36% consumed medicinal herbs to treat a psychological pathology as a complementary treatment. Among those who consumed medicinal herbs, 65% consumed Cannabis sativa (marijuana either exclusively (42% or in conjunction with other plants (23%, 80% reported that their therapist was aware of this behavior, and 35% consumed medicinal herbs once or twice a day. Conclusions: In the present study, there was significant use of medicinal plants by patients treated at the mental health clinic, especially marijuana consuming. This demonstrates the importance of recognizing citizens´ right to free and equal access to healthcare and acknowledging the responsibility of the state to ensure the safety and quality of the services offered to the population.

  5. Use of complementary and alternative medicine by pediatric patients with functional and organic gastrointestinal diseases: results from a multicenter survey

    NARCIS (Netherlands)

    Vlieger, Arine M.; Blink, Marjolein; Tromp, Ellen; Benninga, Marc A.

    2008-01-01

    OBJECTIVES: Many pediatric patients use complementary and alternative medicine, especially when facing a chronic illness for which treatment options are limited. So far, research on the use of complementary and alternative medicine in patients with functional gastrointestinal disease has been

  6. Traditional Chinese medicine as adjunctive therapy improves the long-term survival of lung cancer patients.

    Science.gov (United States)

    Liao, Yueh-Hsiang; Li, Chia-Ing; Lin, Cheng-Chieh; Lin, Jaung-Geng; Chiang, Jen-Huai; Li, Tsai-Chung

    2017-12-01

    Traditional Chinese medicine is one of the popular alternative treatments for cancer, mainly enhancing host immune response and reducing adverse effect of chemotherapy. This study first explored traditional Chinese medicine treatment effect on long-term survival of lung cancer patients. This study evaluated whether traditional Chinese medicine combined with conventional cancer treatment improved overall survival of lung cancer patients. We had conducted a retrospective cohort study on 111,564 newly diagnosed lung cancer patients in 2000-2009 from National Health Insurance Program database. A total of 23,803 (21.31%) patients used traditional Chinese medicine for lung cancer care. Eligible participants were followed up until 2011 with a mean follow-up period of 1.96 years (standard deviation 2.55) for non-TCM users and 3.04 years (2.85) for traditional Chinese medicine users. Patients with traditional Chinese medicine utilization were significantly more likely to have a 32% decreased risk of death [hazard ratio = 0.62; 95% confidence interval = 0.61-0.63], compared with patients without traditional Chinese medicine utilization after multivariate adjustment. We also observed a similar significant reduction risk across various subgroups of chronic lung diseases. Qing Zao Jiu Fei Tang was the most effective traditional Chinese medicine agent for mortality reduction both in the entire lung cancer (0.81; 0.72-0.91) and matched populations (0.86; 0.78-0.95). This study demonstrated adjunctive therapy with traditional Chinese medicine may improve overall survival of lung cancer patients. This study also suggested traditional Chinese medicine may be used as an adjunctive therapy for cancer treatment. These observational findings need being validated by future randomized controlled trials to rule out the possibility of effect due to holistic care.

  7. Prona positioning in patients submitted to myocardial perfusion scintigraphy; Posicao prona em pacientes submetidos a cintilografia de perfusao miocardica

    Energy Technology Data Exchange (ETDEWEB)

    Cunha, C.J.; Ferreira, F.C.L.; Dullius, M.A.; Souza, S.O.; Souza, D.N. [Universidade Federal de Sergipe (UFS), Sao Cristovao, SE (Brazil). Dept. de Fisica; Carvalho, C.R.A. [Clinica de Medicina Nuclear Endocrinologia e Diabetes, Aracaju, SE (Brazil)

    2011-10-26

    The myocardium perfusion scintigraphy corresponds at the nuclear medicine to one of best diagnostic methods for myocardium diseases. However, artefacts generated by the diaphragmatic tissue can induce to false positive diagnostic when does not occurs association of the image in supine position with the prone position. Images acquired at the two positions were analysed and the evaluation of tomographic images were estimation and consequently, a more completed diagnostic

  8. Mapping of medicine data with k-means and apriori combinations based on patient diagnosis

    Science.gov (United States)

    Dharshinni, N. P.; Mawengkang, H.; Nasution, M. K. M.

    2018-03-01

    Medicine is one of the items needed by sick society, the high influence of medicine on service and the economy in hospitals, requires mapping and planning the optimal need for medicines according to the conditions, because 50% -60% of hospital income is sourced from medicine sales. The purpose of this study was to find patterns of doctor’s prescription medicine association with sales data using an apriori algorithm based on data grouping using a k-means algorithm. The results of the experiments show that medicine prescription data with medicine sales have significant differences so that the data can not be used as materials for medicine planning, this is due to some indication of one of the unavailability of medicine caused by mapping inaccuracy so that the planning of medicine requirements is not optimal. The results of this analysis can be used as input materials in decision making, so the planning needs of medicines can be in accordance with the development of patient disease patterns.

  9. Students letters to patients as a part of education in family medicine.

    Science.gov (United States)

    Mrduljaš-Đjujic, Nataša; Pavličević, Ivančica; Marušic, Ana; Marušic, Matko

    2012-01-01

    Family medicine fosters holistic approach to patient-centered practice. Current medical curriculum in Croatia does not have well-structured courses or tools to prepare medicals students for successful communication with the patient and for building lasting and beneficial doctor- patient relationship. We explored the value of students practice in writing letters to patients about their illness as a way of building personal and compassionate relationship with patients. Sixth year students at the School of Medicine in Split wrote letters to the patients from consultations under the supervision of the supervisor in a family medicine practice. Structured teaching of communication with the patient brings family medicine back to what has actually always been its main part- communication and doctor-patient relationship. Our future aim is to develop students letters to patients as a new tool in the family medicine course examination. Moreover, we will investigate how they can be used in everyday practice of family medicine. Copyright 2012 by Academy of Sciences and Arts of Bosnia and Herzegovina.

  10. Complementary and alternative medicine in inflammatory bowel disease patients: frequency and risk factors.

    Science.gov (United States)

    Fernández, Alberto; Barreiro-de Acosta, Manuel; Vallejo, Nicolau; Iglesias, Marta; Carmona, Amalia; González-Portela, Carlos; Lorenzo, Aurelio; Domínguez-Muñoz, J Enrique

    2012-11-01

    The use of complementary and alternative medicine in inflammatory bowel disease patients is progressively increased. To evaluate the use of complementary and alternative medicine in inflammatory bowel disease patients and to know potential risk factors for their use. The subjective response of these therapies and the impact on treatment adherence were also evaluated. Prospective, descriptive and transversal study. Inflammatory bowel disease patients were classified according to demographic and clinical characteristics. A questionnaire about the use of complementary and alternative medicine was collected. 705 patients were included. 126 patients (23%) had used complementary and alternative medicine. The most commonly used was herbal remedies (n=61), homoeopathy (n=36), acupuncture (n=31), kefir (n=31) and aloe vera (n=25). Factors associated with its use were extraintestinal manifestations (OR 1.69, CI 95% 1.11-2.57) and long-term evolution of the disease (OR 2.08, CI 95% 1.44-2.99). Most patients (74%) had the subjective feeling that use of complementary and alternative medicine had not improved their condition, 11 had adverse events related to its use and 11% of patients discontinued their conventional drugs. Use of complementary and alternative medicine in inflammatory bowel disease patients is frequent, especially in those with extraintestinal manifestations and long-term evolution. The use of these therapies was not perceived as a benefit for patients. Copyright © 2012 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

  11. Use of traditional Mi'kmaq medicine among patients at a First Nations community health centre.

    Science.gov (United States)

    Cook, Sarah Jane

    2005-01-01

    The provision of complete, effective, and culturally sensitive health care to First Nations communities requires a familiarity with and respect for patients' healing beliefs and practices. This study addresses one aspect of cross-cultural care by attempting to understand the use of Mi'kmaq medicine among patients at a community health centre and their attitudes toward both Mi'kmaq and Western medicine. A questionnaire was completed by 100 patients (14 men, 86 women) at the clinic. The majority (66%) of respondents had used Mi'kmaq medicine, and 92.4% of these respondents had not discussed this with their physician. Of those who had used Mi'kmaq medicine, 24.3% use it as first-line treatment when they are ill, and 31.8% believe that Mi'kmaq medicine is better overall than Western. Even among patients who have not used Mi'kmaq medicine, 5.9% believe that it is more effective than Western medicine in treating illness. These results have implications for the delivery of health care to First Nations patients, especially in terms of understanding patients' health care values and in meeting the need to provide effective cross-cultural care.

  12. ePatient Conference Explores Future of Personalized Medicine | NIH MedlinePlus the Magazine

    Science.gov (United States)

    ... page please turn Javascript on. ePatient Conference Explores Future of Personalized Medicine Past Issues / Spring - Summer 2010 Table of Contents ... your healthcare provider communicate better in the digital future? What is personalized medicine? Some of the nation's top health researchers, computer ...

  13. Identifying Facilitators and Barriers for Patient Safety in a Medicine Label Design System Using Patient Simulation and Interviews

    DEFF Research Database (Denmark)

    Dieckmann, Peter; Clemmensen, Marianne Hald; Sørensen, Trine Kart

    2016-01-01

    Objectives Medicine label design plays an important role in improving patient safety. This study aimed at identifying facilitators and barriers in a medicine label system to prevent medication errors in clinical use by health care professionals. Methods The study design is qualitative and explora...

  14. Concomitant Use of Dietary Supplements and Medicines in Patients due to Miscommunication with Physicians in Japan

    Science.gov (United States)

    Chiba, Tsuyoshi; Sato, Yoko; Suzuki, Sachina; Umegaki, Keizo

    2015-01-01

    We previously reported that some patients used dietary supplements with their medication without consulting with physicians. Dietary supplements and medicines may interact with each other when used concomitantly, resulting in health problems. An Internet survey was conducted on 2109 people who concomitantly took dietary supplements and medicines in order to address dietary supplement usage in people who regularly take medicines in Japan. A total of 1508 patients (two admitted patients and 1506 ambulatory patients) and 601 non-patients, who were not consulting with physicians, participated in this study. Purpose for dietary supplement use was different among ages. Dietary supplements were used to treat diseases in 4.0% of non-patients and 11.9% of patients, while 10.8% of patients used dietary supplements to treat the same diseases as their medication. However, 70.3% of patients did not declare dietary supplement use to their physicians or pharmacists because they considered the concomitant use of dietary supplements and medicines to be safe. A total of 8.4% of all subjects realized the potential for adverse effects associated with dietary supplements. The incidence of adverse events was higher in patients who used dietary supplements to treat their disease. Communication between patients and physicians is important for avoiding the adverse effects associated with the concomitant use of dietary supplements and medicines. PMID:25894658

  15. Patients' knowledge of new medicines after discharge from hospital: What are the effects of hospital-based discharge counseling and community-based medicines use reviews (MURs)?

    Science.gov (United States)

    Elson, Rachel; Cook, Helen; Blenkinsopp, Alison

    Interventions to reduce medicines discontinuity at transitions during and reinforced after discharge are effective. However, few studies have linked hospital-based counseling with onward referral for community pharmacy-based follow-up to support patients' medicines use. To determine the effects of targeted hospital pharmacist counseling on discharge or targeted community pharmacy medicines reviews post-discharge on patients' knowledge of newly started medication. The study was a controlled trial of targeted medicines discharge counseling provided by hospital pharmacists or follow-up post-discharge medicines review provided by community pharmacists compared with usual care (nurse counseling). Outcomes measured using a structured telephone survey conducted at two and four weeks after patients were discharged from hospital. Patients who received hospital pharmacist counseling were significantly more likely to report being told the purpose of their new medicine and how to take it versus those receiving usual care. Fewer than half of the patients who were allocated to receive a community pharmacy medicines review received one. Patient knowledge of medicines newly prescribed in the hospital was increased by targeted counseling of hospital pharmacists. The findings suggest the need to improve the consistency of the information covered when providing counseling, perhaps by the implementation of a counseling checklist for use by all disciplines of staff involved in patient counseling. The potential of community pharmacy follow-up medicines review is currently undermined by several barriers to uptake. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. Use of medicines by patients of the primary health care of the Brazilian Unified Health System.

    Science.gov (United States)

    Costa, Clarisse Melo Franco Neves; Silveira, Micheline Rosa; Acurcio, Francisco de Assis; Guerra, Augusto Afonso; Guibu, Ione Aquemi; Costa, Karen Sarmento; Karnikowski, Margô Gomes de Oliveira; Soeiro, Orlando Mario; Leite, Silvana Nair; Costa, Ediná Alves; Nascimento, Renata Cristina Rezende Macedo do; Araújo, Vânia Eloísa de; Álvares, Juliana

    2017-11-13

    To characterize the use of medicines by patients of the primary health care of the Brazilian Unified Health System (SUS). This is a cross-sectional, exploratory, and descriptive study, part of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos - Serviços, 2015 (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines - Services, 2015). Interviews were carried out with patients present in the services by semi-structured questionnaires. Sociodemographic, clinical, and use of medicines variables were assessed and the use of medicines in the 30 days prior to the interview was also verified. The population was stratified into three age groups: 18 to 44, 45 to 64, and 65 years or more. The differences between the age groups were verified using the Student's t-test for continuous variables and chi-square test for the categorical ones. The complex samples analysis plan was employed. The medicines were classified according to the Anatomical Therapeutic Chemical Classification System. Of the 8,803 patients interviewed, 6,511 (76.2%) reported to have used medicines in the 30 days prior to the interview. On average, each patient used 2.32 medicines, without difference between the sexes. Among medicine users, 18.2% were aged 65 years or more. Compared to the other age groups, older adults presented more comorbidities, used more medicines, and self-reported worse health conditions. They were also less educated, reported worse economic situation, and lived alone. The medicines that were mostly used were "other analgesics and antipyretics" (3rd ATC level) and Losartan (5th ATC level). Most medicine users had lower education level and presented comorbidities. The most used medicines were the antihypertensive ones. Self-medication was higher among young people. Most patients reported to use generic medicines. The average number of medicines and the prevalence of use increased with age. Due to the characteristics

  17. Complementary and alternative medicine use in Iranian patients with diabetes mellitus.

    Science.gov (United States)

    Hashempur, Mohammad Hashem; Heydari, Mojtaba; Mosavat, Seyed Hamdollah; Heydari, Seyyed Taghi; Shams, Mesbah

    2015-09-01

    There is increasing interest in complementary and alternative medicine generally, and especially by those affected by chronic diseases, such as diabetes mellitus. We aimed to determine the prevalence and pattern of complementary and alternative medicine use among patients suffering from diabetes mellitus in Shiraz, southern Iran. Another objective was to explore associated factors for use of complementary and alternative medicine among patients with diabetes mellitus. A 19-item semi-structured questionnaire (open- and close-ended) was administered to 239 patients with diabetes mellitus in this cross-sectional study. It was carried out in two outpatient diabetes clinics affiliated with the Shiraz University of Medical Sciences, Shiraz, Iran. One hundred and eighty patients (75.3%) used at least one type of complementary and alternative medicine in the last year prior to the interview. Patients with diabetes mellitus who were living in a large family (≥5 members), not taking insulin, and believed that complementary and alternative medicine have synergistic effects with conventional medicine, were independently and significantly (P values: 0.02, 0.04, and 0.01, respectively) more likely to use complementary and alternative medicine. Most of the users (97.7%) reported use of herbal preparations, and 89.4% of users did not change their medication, neither in medication schedule nor its dosage. The use of complementary and alternative medicine, especially herbal remedies, is popular among diabetes patients in Shiraz, Iran. This use is associated with patients' family size, type of conventional medications and their view about concomitant use of complementary and conventional medicine.

  18. Patient Throughput in a Sports Medicine Clinic With the Implementation of an Athletic Trainer

    Science.gov (United States)

    Nicolello, Timothy S.; Pecha, Forrest Q.; Omdal, Reed L.; Nilsson, Kurt J.; Homaechevarria, Alejandro A.

    2016-01-01

    Background: Orthopaedic clinics have acquired a multitude of health professionals to improve clinic efficiency. More recently, athletic trainers (ATs) have been utilized to improve clinical efficiency and patient care because of their extensive background in musculoskeletal injuries and anatomy. Improved clinical efficiency allows for increased patient visits, potentially enhancing patient access and downstream revenue via relative value units (RVUs). Hypothesis: The addition of an AT into a sports medicine physician’s clinic will increase total patient throughput and overall RVU production. Study Design: Retrospective analysis. Level of Evidence: Level 4. Methods: Patients seen by each of the 2 primary care sports medicine physicians at St Luke’s Sports Medicine for a 2-year period were retrospectively evaluated. The initial clinic model included the physician and a medical assistant; during the second year of analysis an AT was added to the clinic staffing model. Two-tailed t tests were used to determine significant differences in patient volume between the 2 periods of data collection. Results: Through the implementation of an AT, patient throughput increased by 0.7 patients per hour over 2 half-day clinics, a 25% increase (P sports medicine clinic may improve clinical productivity and financial stability, thereby validating the incorporation of ATs into the established clinical model. Clinical Relevance: Limited research exists measuring patient throughput with an AT in a sports medicine clinic. This study investigates patient throughput and the subsequent increase in work-based RVUs. PMID:27799568

  19. Stem cells in reproductive medicine: ready for the patient?

    NARCIS (Netherlands)

    Vassena, R.; Eguizabal, C.; Heindryckx, B.; Sermon, K.; Simon, C.; van Pelt, A. M. M.; Veiga, A.; Zambelli, F.

    2015-01-01

    Are there effective and clinically validated stem cell-based therapies for reproductive diseases? At the moment, clinically validated stem cell treatments for reproductive diseases and alterations are not available. Research in stem cells and regenerative medicine is growing in scope, and its

  20. Analysis of the numbers of B, T and subpopulation lymphocytes in patients with breast cancer submitted to a different radiotherapy schedules

    International Nuclear Information System (INIS)

    Andrade, J.M. de.

    1989-01-01

    The behaviour of T and B lymphocytes subpopulations was evaluated in patients with breast cancer submitted to 3 different schedules of radiotherapy. The assays were carried out before and immediately after the end of treatment. T lymphocytes and the helper/inducer (CD 4 ) and suppressor/cytotoxic (CD 8 ) subpopulations were counted by indirect immunofluorescence with monoclonal antibodies of the OKT series. The number of B lymphocytes was obtained by direct immunofluorescence with fluorescein-conjugated anti-human Ig antibodies. The patients were divided into 3 groups: irradiation of the breast only; irradiation of the lymph-draining areas; irradiation of the breast, of the lymph-draining area and of the sternal area. (author)

  1. Patient and consumer organisations at the European Medicines Agency : Financial disclosure and transparency

    NARCIS (Netherlands)

    Perehudoff, Katrina; Alves, Teresa Leonardo

    Background: The transparency criteria adopted by the European Medicines Agency require eligible patient and consumer organisations to disclose the names and contributions of their public and private revenue sources. Despite various transparency initiatives, the exact funding sources of, and amounts

  2. Omega-3 and omega-6 content of medicinal foods for depressed patients: implications from the Iranian Traditional Medicine.

    Science.gov (United States)

    Tavakkoli-Kakhki, Mandana; Motavasselian, Malihe; Mosaddegh, Mahmoud; Esfahani, Mohammad Mahdi; Kamalinejad, Mohammad; Nematy, Mohsen; Eslami, Saeid

    2014-07-01

    Considering the increasing prevalence of depression in modern societies and the positive effects of omega-3 polyunsaturated fatty acids on depression, this study aims to investigate the omega-3 and omega-6 content of various foodstuffs, prescribed or prohibited by Iranian Traditional Medicine (ITM). Firstly, reliable sources of Iranian Traditional Medicine were reviewed in order to identify the prescribed and prohibited foodstuffs for depressed patients. Afterwards, according to the online database of United States Department of Agriculture (URL: http://ndb.nal.usda.gov/ndb/search/list), the ratio of linoleic acid to alpha linolenic acid (as representatives of omega-6 and omega-3, respectively) was identified in each foodstuff. Finally, the ratios of omega-6 to omega-3 were compared between seven food groups of vegetables, fruits, dry goods, high protein products, dairies, breads, and spices. Based on the resources of Iranian Traditional Medicine, the following foods are prescribed for depressed patients: basil, coriander, spinach, lettuce, squash, peppermint, dill, chicory, celery, beet, quince, cucumber, watermelon, grape, peach, pomegranate, banana, apple, currant, pistachio, dried fig, almond, egg, chicken, lamb, trout, milk, bread without bran, saffron, oregano, and coriander seeds. On the other hand, cabbage, eggplant, onion, garlic, broad beans, lentils, beef, whole wheat bread, and mustard are prohibited. It should be noted that omega-3 content in some prescribed foods is more than that of the prohibited ones. The present study showed that mint, basil, spinach, lettuce, squash, lamb, saffron, oregano, cucumber, pistachio, milk, and also wild trout can be considered as medicinal foods for depressed patients.

  3. Omega-3 and omega-6 content of medicinal foods for depressed patients: implications from the Iranian Traditional Medicine

    Directory of Open Access Journals (Sweden)

    Mandana Tavakkoli-Kakhki

    2014-06-01

    Full Text Available Objectives: Considering the increasing prevalence of depression in modern societies and the positive effects of omega-3 polyunsaturated fatty acids on depression, this study aims to investigate the omega-3 and omega-6 content of various foodstuffs, prescribed or prohibited by Iranian Traditional Medicine (ITM. Materials and Methods: Firstly, reliable sources of Iranian Traditional Medicine were reviewed in order to identify the prescribed and prohibited foodstuffs for depressed patients. Afterwards, according to the online database of United States Department of Agriculture (URL: http://ndb.nal.usda.gov/ndb/search/list, the ratio of linoleic acid to alpha linolenic acid (as representatives of omega-6 and omega-3, respectively was identified in each foodstuff. Finally, the ratios of omega-6 to omega-3 were compared between seven food groups of vegetables, fruits, dry goods, high protein products, dairies, breads, and spices. Results: Based on the resources of Iranian Traditional Medicine, the following foods are prescribed for depressed patients: basil, coriander, spinach, lettuce, squash, peppermint, dill, chicory, celery, beet, quince, cucumber, watermelon, grape, peach, pomegranate, banana, apple, currant, pistachio, dried fig, almond, egg, chicken, lamb, trout, milk, bread without bran,saffron, oregano, and coriander seeds. On the other hand, cabbage, eggplant, onion, garlic, broad beans, lentils, beef, whole wheat bread, and mustard are prohibited. It should be noted that omega-3 content in some prescribed foods is more than that of the prohibited ones. Conclusion: The present study showed that mint, basil, spinach, lettuce, squash, lamb, saffron, oregano, cucumber, pistachio, milk, and also wild trout can be considered as medicinal foods for depressed patients.

  4. Research studies on patients' illness experience using the Narrative Medicine approach: a systematic review.

    Science.gov (United States)

    Fioretti, Chiara; Mazzocco, Ketti; Riva, Silvia; Oliveri, Serena; Masiero, Marianna; Pravettoni, Gabriella

    2016-07-14

    Since its birth about 30 years ago, Narrative Medicine approach has increased in popularity in the medical context as well as in other disciplines. This paper aims to review Narrative Medicine research studies on patients' and their caregivers' illness experience. MEDLINE, Psycinfo, EBSCO Psychological and Behavioural Science, The Cochrane Library and CINAHL databases were searched to identify all the research studies which focused on the Narrative Medicine approach reported in the title, in the abstract and in the keywords the words 'Narrative Medicine' or 'Narrative-based Medicine'. number of participants, type of disease, race and age of participants, type of study, dependent variables, intervention methods, assessment. Of the 325 titles screened, we identified 10 research articles fitting the inclusion criteria. Our systematic review showed that research on Narrative Medicine has no common specific methodology: narrative in Medicine is used as an intervention protocol as well as an assessment tool. Patients' characteristics, types of disease and data analysis procedures differ among the screened studies. Narrative Medicine research in medical practice needs to find clear and specific protocols to deepen the impact of narrative on medical practice and on patients' lives. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  5. Use of Chinese medicine by cancer patients: a review of surveys

    Directory of Open Access Journals (Sweden)

    Smith Caroline A

    2011-06-01

    Full Text Available Abstract Chinese medicine has been used to treat a variety of cancer-related conditions. This study aims to examine the prevalence and patterns of Chinese medicine usage by cancer patients. We reviewed articles written in English and found only the Chinese medicine usage from the studies on complementary and alternative medicine (CAM. Seventy four (74 out of 81 articles reported rates of CAM usage ranging from 2.6 to 100%. Acupuncture was reported in 71 out of 81 studies. Other less commonly reported modalities included Qigong (n = 17, Chinese herbal medicine (n = 11, Taichi (n = 10, acupressure (n = 6, moxibustion (n = 2, Chinese dietary therapy (n = 1, Chinese massage (n = 1, cupping (n = 1 and other Chinese medicine modalities (n = 19. This review also found important limitations of the English language articles on CAM usage in cancer patients. Our results show that Chinese medicine, in particular Chinese herbal medicine, is commonly used by cancer patients. Further research is warranted to include studies not written in English.

  6. Integration of naturopathic medicine into acute inpatient care: An approach for patient-centred medicine under diagnosis-related groups.

    Science.gov (United States)

    Romeyke, Tobias; Nöhammer, Elisabeth; Scheuer, Hans Christoph; Stummer, Harald

    2017-08-01

    The integration of naturopathic methods into acute inpatient care has been the subject of very few scientific studies. Patient expectations of the service received in hospital are increasing, and the integration of naturopathy into clinical practice can serve as Unique Selling Proposition. The present study was conducted over a period of two years. In total, over 1700 patients were included in the study. The setting is an acute hospital specialising in a multimodal, patient-centred approach to treatment. Patient satisfaction with the use of holistic care, patient perception of adherence to treatment and the amount of time care staff spend with patients were all investigated. The patients' principal diagnoses were also recorded using the DRG classification system, as were the number of concomitant diseases and the length of their stay in hospital. The majority of patients rate the integration of complementary care in the acute hospital very positively. The effects on patient perception of adherence to treatment and the amount of time care staff spend with patients are also assessed positively. At the same time, we can see that patients who receive patient-centred care in this study predominantly suffer from diseases and disorders of the musculoskeletal system and connective tissue, diseases of the nervous system and mental diseases and disorders. They also have numerous concomitant diseases. It could be shown that patients are very satisfied with the combination of naturopathy and academic medicine and with approaches that take patient preferences into account. Integrating naturopathy can be considered for multimorbid patients, in particular. Moreover, patient-centred care can improve staff satisfaction levels. Copyright © 2017 Elsevier Ltd. All rights reserved.

  7. Metrological aspects in the estimate of the administered activity in nuclear medicine patients

    International Nuclear Information System (INIS)

    Ruzzarin, A.; Iwahara, A.; Tahuata, L.; Xavier, A.M.

    2014-01-01

    In order to investigate the performance quality of routine measurements of Nuclear Medicine Services (NMS), the National Metrology Laboratory of Ionizing Radiation/Institute of Radiation Protection and Dosimetry (LNMRI/IRD) has been conducting, since 1998, a program of comparison for activity measurements of radiopharmaceuticals administered to patients in nuclear medicine. Correction factors are determined from the result of performance analysis in order to determine with better accuracy the activity to be administered to the patients. (author)

  8. Communication between physicians and cancer patients about complementary and alternative medicine: exploring patients' perspectives.

    Science.gov (United States)

    Tasaki, Katsuya; Maskarinec, Gertraud; Shumay, Dianne M; Tatsumura, Yvonne; Kakai, Hisako

    2002-01-01

    The aim of this paper is to identify barriers to communication between physicians and cancer patients regarding complementary and alternative medicine (CAM) by exploring the perspectives of patients. In face of the recent popularity of CAM use among cancer patients, the lack of communication is a serious problem. A number of CAM therapies may interfere with conventional treatments and thus impact patients' well-being and chances of survival. In addition, lack of communication is problematic in the health care context because the development of openness and trust between health care providers and clients is contingent upon effective interpersonal communication. We conducted semi-structured interviews with 143 cancer patients to explore their experiences with CAM use. Using a qualitative research method, we examined interview data from 93 CAM users who provided sufficient information about communication issues. As a result, three themes emerged describing barriers to unsuccessful communication as perceived from the patient's point of view: physicians' indifference or opposition toward CAM use, physicians' emphasis on scientific evidence, and patients' anticipation of a negative response from their physician. Increasing education about CAM and regular assessment of CAM use may help physicians to be more aware of their patients' CAM use. As a result, physicians may provide patients with information on risks and benefits of CAM use and refer patients to other services that may address unmet needs. Given a difference in epistemiologic beliefs about cancer and its treatment, the challenge is to find a common ground for an open discussion in which physicians consider that scientific evidence is not all that counts in the life of an individual facing a serious disease. Copyright 2002 John Wiley & Sons, Ltd.

  9. Active Student Participation May Enhance Patient Centeredness: Patients' Assessments of the Clinical Education Ward for Integrative Medicine

    Directory of Open Access Journals (Sweden)

    Christian Scheffer

    2013-01-01

    Full Text Available Objectives. To examine the impact of active student participation on quality of care in an integrative inpatient setting. Methods. Over a two-year period, we surveyed all patients treated on the Clinical Education Ward for Integrative Medicine (CEWIM, where final-year medical students are integrated into an internal medicine ward complementing conventional medicine with anthroposophic medicine. Patients treated on the regular wards of the same internal medicine department served as the control group (CG. General quality of care was studied with the Picker Inpatient Questionnaire, physician empathy with the Consultation and Relational Empathy measure, and patient enablement with the Patient Enablement Index. ANCOVA was used to control for covariates while examining significant differences between both patient groups. Results. Comparison of the CG wards and the CEWIM revealed no significant differences in medical treatment success. The CEWIM, however, achieved better results for physician-patient interaction, physician empathy, and patient enablement. Eighty Percent of the CEWIM patients rated student participation as positively impacting quality of care. Conclusion. Our results indicate that incorporating students in an integrative healthcare setting may result in greater patient centeredness. Further studies are needed to determine whether this is due to organizational advantages, students' empathic activity, the impact of teaching, or learner-teacher interaction.

  10. An exploration of health professionals' experiences of medicines management in elderly, hospitalised patients in Abu Dhabi.

    Science.gov (United States)

    Al Shemeili, Saeed; Klein, Susan; Strath, Alison; Fares, Saleh; Stewart, Derek

    2016-02-01

    Given the multiplicity of issues relating to medicines in the elderly, the structures and processes of medicines management should be clearly defined and described to optimise patient outcomes. There is a paucity of research which provides an in-depth exploration of these elements of medicines management for elderly patients. This study explored health professionals’ experiences of medicines management for elderly, hospitalised patients in Abu Dhabi. Setting The research was conducted in five major hospitals in Abu Dhabi, the United Arab Emirates. Responses to an online sampling questionnaire were used to purposively select nurses, pharmacists and physicians for interview. A semi-structured interview schedule was developed with reference to normalization process theory (NPT) and the theoretical domains framework (TDF) to explore issues of medicines management structures, processes and outcomes. Face-to-face interviews of 20–30 min were audio-recorded, transcribed verbatim and analysed using the Framework Approach. Health professionals’ in-depth experiences of structures, processes and outcomes relating to medicines management. Results Saturation of themes was deemed to occur at interview 27 (7 nurses, 13 pharmacists, 7 physicians). Six key themes and several subthemes emerged from the qualitative analysis, which pertained to the need for: appropriate polypharmacy; a systematic approach to medicines history taking; improved communication and documentation; improved patients’ adherence to medicines; guidelines and policies to support medicines selection, and an educated and trained multidisciplinary team. The most dominant TDF behavioural determinants were issues around: professional role and identity; beliefs about capabilities; beliefs about consequences; environmental context and resources; knowledge, and goals. NPT construct identified little evidence of coherence, cognitive participation, collective action and reflexive monitoring. The key themes

  11. Follow-Up of Peripheral IL-1β and IL-6 and Relation with Apoptotic Death in Drug-Resistant Temporal Lobe Epilepsy Patients Submitted to Surgery

    Directory of Open Access Journals (Sweden)

    Lourdes Lorigados Pedre

    2018-02-01

    Full Text Available Increasing amounts of evidence support the role of inflammation in epilepsy. This study was done to evaluate serum follow-up of IL-1β and IL-6 levels, as well as their concentration in the neocortex, and the relationship of central inflammation with NF-κB and annexin V in drug-resistant temporal lobe epileptic (DRTLE patients submitted to surgical treatment. Peripheral and central levels of IL-1β and IL-6were measured by ELISA in 10 DRTLE patients. The sera from patients were taken before surgery, and 12 and 24 months after surgical treatment. The neocortical expression of NF-κB was evaluated by western blotting and annexin V co-localization with synaptophysin by immunohistochemistry. The neocortical tissues from five patients who died by non-neurological causes were used as control. Decreased serum levels of IL-1 and IL-6 were observed after surgery; at this time, 70% of patients were seizure-free. No values of IL-1 and IL-6 were detected in neocortical control tissue, whereas cytokine levels were evidenced in DRTLE. Increased NF-κB neocortex expression was found and the positive annexin V neurons were more obvious in the DRTLE tissue, correlating with IL-6 levels. The follow-up study confirmed that the inflammatory alterations disappeared one year after surgery, when the majority of patients were seizure-free, and the apoptotic death process correlated with inflammation.

  12. Perioperative oral nutritional supplements in normally or mildly undernourished geriatric patients submitted to surgery for hip fracture: a randomized clinical trial.

    Science.gov (United States)

    Botella-Carretero, José I; Iglesias, Borja; Balsa, José A; Arrieta, Francisco; Zamarrón, Isabel; Vázquez, Clotilde

    2010-10-01

    Oral nutritional supplements have been recommended after orthopedic surgery in geriatric patients. This has been shown to be effective even in normally nourished or mildly undernourished geriatric patients. Whether perioperative administration of these products is also effective and suitable is not known. Randomized, controlled, open, paralleled two-arms clinical trial, comparing energy-protein supplements (40 g of protein and 400 kcal per day), with no intervention in normally nourished or mildly undernourished patients. Outcomes were serum proteins, body mass index, postoperative complications among others. 60 Elderly patients were included. Patients in the intervention group (n = 30) ingested 52.2 ± 12.1% of the prescribed supplements per day for 5.8 ± 1.8 days before surgery and until hospital discharge. There was a significant change in serum albumin at follow-up (F = 22.536, P supplemented proteins per day (OR[95%CI] = 0.925[0.869-0.985]) were associated with less postoperative complications (R(2) = 0.323, χ(2) = 11.541, P = 0.003). Perioperative supplements in geriatric patients with hip fracture submitted to surgery showed better recovery of plasma proteins. Higher daily protein intakes were associated with less postoperative complications. Copyright © 2010 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

  13. Investigation into the use of complementary and alternative medicine and affecting factors in Turkish asthmatic patients.

    Science.gov (United States)

    Tokem, Yasemin; Aytemur, Zeynep Ayfer; Yildirim, Yasemin; Fadiloglu, Cicek

    2012-03-01

    The purpose of this study was to examine the frequency of complementary and alternative medicine usage in asthmatic patients living in the west of Turkey, the most frequently used complementary and alternative medicine methods and socio-demographic factors affecting this and factors related to the disease. While the rate of complementary and alternative medicine usage in asthmatic patients and the reasons for using it vary, practices specific to different countries and regions are of interest. Differing cultural and social factors even in geographically similar regions can affect the type of complementary and alternative medicine used. Two hundred asthmatic patients registered in the asthma outpatient clinic of a large hospital in Turkey and who had undergone pulmonary function tests within the previous six months were included in this study, which was planned according to a descriptive design. The patients filled out a questionnaire on their demographic characteristics and complementary and alternative medicine usage. The proportion of patients who reported using one or more of the complementary and alternative medicine methods was 63·0%. Of these patients, 61·9% were using plants and herbal treatments, 53·2% were doing exercises and 36·5% said that they prayed. The objectives of their use of complementary and alternative medicine were to reduce asthma-related complaints (58%) and to feel better (37·8%). The proportion of people experiencing adverse effects was 3·3% (n = 4). Factors motivating asthmatic patients to use complementary and alternative medicine were the existence of comorbid diseases and a long period since diagnosis (p complementary and alternative medicine and the severity of the disease, pulmonary function test parameters, the number of asthma attacks or hospitalisations because of asthma within the last year (p > 0·05). Understanding by nurses of the causes and patterns of the use of complementary and alternative medicine in asthmatic

  14. Pediatrics Education in an AHEC Setting: Preparing Students to Provide Patient Centered Medicine

    Science.gov (United States)

    Evans, Steven Owens

    2012-01-01

    Patient centered medicine is a paradigm of health care that seeks to treat the whole person, rather than only the illness. The physician must understand the patient as a whole by considering the patient's individual needs, social structure, socioeconomic status, and educational background. Medical education includes ways to train students in this…

  15. Measuring medicine-related experiences from the patient perspective: a systematic review

    Directory of Open Access Journals (Sweden)

    Katusiime B

    2016-10-01

    Full Text Available Barbra Katusiime,1 Sarah Corlett,1 Joanne Reeve,2 Janet Krska1 1Medway School of Pharmacy, The Universities of Kent and Greenwich, Chatham, Maritime, Kent, UK; 2Warwick Medical School, University of Warwick, Coventry, UK Background: There is an increasing drive to measure and so improve patients’ experiences and outcomes of health care. This also applies to medicines, given their ubiquity as health care interventions. Patients’ experiences of using medicines vary, and instruments which measure these are seen as an essential component to improve care. We aimed to identify generic measures of patients’ experiences of using prescription medicines and to examine their properties and suitability for use in research or practice. Methods: Multiple electronic databases were searched: MEDLINE, Embase, PsycINFO, PsycARTICLES, CINHAL Plus, PROQOLID®, and Google Scholar. We identified, critically appraised, and summarized generic questionnaires assessing one or more aspects of the medicine use experience among adult patients using prescription medicines for chronic conditions, and the process of questionnaire development, degree of patient involvement, and/or validation processes. Results: Fifteen questionnaires were included. Of these, nine measures were multidimensional, covering various aspects of medicine use. Six instruments covered only a single domain, assessing a specific facet of using medicines. Domains covered were the following: effectiveness; convenience, practicalities, and/or managing medicines; information, knowledge, and/or understanding; side effects; relationships and/or communication with health professionals; impact on daily living and/or social life; general satisfaction; attitudes; beliefs, concerns, and/or perceptions; medical follow-up and/or adherence-related issues; treatment- and/or medicine-related burden, perceived control, or autonomy; self-confidence about medicine use; availability and accessibility; and medicine

  16. Distinction by radioisotope technique of a subgroup with increased thrombophilic potential among patients submitted to major abdominal surgery

    DEFF Research Database (Denmark)

    Rasmussen, A; Toftdahl, D; Lindholt, J

    1986-01-01

    Deep vein thrombosis (DVT) detectable by the 99mTechnetium-labeled plasmin test developed in 13 (37%) of 35 sequentially studied patients, all above 40 years, undergoing elective major abdominal surgery. Ten of the 13 patients with DVT had an abnormal pulmonary perfusion scintigram, suggesting pu...

  17. Getting personal: can systems medicine integrate scientific and humanistic conceptions of the patient?

    Science.gov (United States)

    Vogt, Henrik; Ulvestad, Elling; Eriksen, Thor Eirik; Getz, Linn

    2014-12-01

    The practicing doctor, and most obviously the primary care clinician who encounters the full complexity of patients, faces several fundamental but intrinsically related theoretical and practical challenges - strongly actualized by so-called medically unexplained symptoms (MUS) and multi-morbidity. Systems medicine, which is the emerging application of systems biology to medicine and a merger of molecular biomedicine, systems theory and mathematical modelling, has recently been proposed as a primary care-centered strategy for medicine that promises to meet these challenges. Significantly, it has been proposed to do so in a way that at first glance may seem compatible with humanistic medicine. More specifically, it is promoted as an integrative, holistic, personalized and patient-centered approach. In this article, we ask whether and to what extent systems medicine can provide a comprehensive conceptual account of and approach to the patient and the root causes of health problems that can be reconciled with the concept of the patient as a person, which is an essential theoretical element in humanistic medicine. We answer this question through a comparative analysis of the theories of primary care doctor Eric Cassell and systems biologist Denis Noble. We argue that, although systems biological concepts, notably Noble's theory of biological relativity and downward causation, are highly relevant for understanding human beings and health problems, they are nevertheless insufficient in fully bridging the gap to humanistic medicine. Systems biologists are currently unable to conceptualize living wholes, and seem unable to account for meaning, value and symbolic interaction, which are central concepts in humanistic medicine, as constraints on human health. Accordingly, systems medicine as currently envisioned cannot be said to be integrative, holistic, personalized or patient-centered in a humanistic medical sense. © 2014 The Authors. Journal of Evaluation in Clinical

  18. Herbal medicine use among hypertensive patients attending public and private health facilities in Freetown Sierra Leone.

    Science.gov (United States)

    James, Peter Bai; Kamara, Halimatu; Bah, Abdulai Jawo; Steel, Amie; Wardle, Jon

    2018-05-01

    This study aimed to determine the prevalence, determinants and pattern of herbal medicine use among hypertensive patients in Freetown. We conducted a cross-sectional study among hypertensive patients attending public and private health facilities in Freetown, Sierra Leone between August and October 2016. We analyzed the data using SPSS version 24. We used Chi-square, Fisher exact two-tailed test and regression analysis for data analysis. A p-value less than 0.05 was considered statistically significant. Out of 260 study participants, over half (n = 148, 56.9%) reported using herbal medicine for the treatment of hypertension alone or together with comorbid condition(s). The most commonly used herbal medicine among users were honey (n = 89, 33.3%), moringa (n = 80, 30.0%) and garlic (n = 73, 27.3%). No significant difference existed between users and non-users of herbal medicine with regards to socio-demographic and health-related factors. The majority (n = 241, 92.7%) of respondents considered herbal medicine beneficial if it was recommended by a healthcare provider yet 85.1% (n = 126) did not disclose their herbal medicine use to their health care provider. There is a high use of herbal medicines among hypertensive patients in Freetown, Sierra Leone. It is essential for healthcare providers to take heed of the findings of this study and routinely ask their patients about their herbal medicine use status. Such practice will provide the opportunity to discuss the benefits and risks of herbal medicine use with the aim of maximizing patient desired therapeutic outcomes. Copyright © 2018 Elsevier Ltd. All rights reserved.

  19. American Orthopaedic Society for Sports Medicine

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    ... Upcoming Meetings Online Education Archived Meetings Faculty Resources Sports Medicine Fellowships Traveling Fellowship Submit an Abstract Submit ... Support AOSSM Research Publications Toggle American Journal of Sports Medicine Sports Health: A Multidisciplinary Approach Orthopaedic Journal ...

  20. Implementing standardized, inter-unit communication in an international setting: handoff of patients from emergency medicine to internal medicine.

    Science.gov (United States)

    Balhara, Kamna S; Peterson, Susan M; Elabd, Mohamed Moheb; Regan, Linda; Anton, Xavier; Al-Natour, Basil Ali; Hsieh, Yu-Hsiang; Scheulen, James; Stewart de Ramirez, Sarah A

    2017-02-03

    Standardized handoffs may reduce communication errors, but research on handoff in community and international settings is lacking. Our study at a community hospital in the United Arab Emirates characterizes existing handoff practices for admitted patients from emergency medicine (EM) to internal medicine (IM), develops a standardized handoff tool, and assesses its impact on communication and physician perceptions. EM physicians completed a survey regarding handoff practices and expectations. Trained observers utilized a checklist based on the Systems Engineering Initiative for Patient Safety model to observe 40 handoffs. EM and IM physicians collaboratively developed a written tool encouraging bedside handoff of admitted patients. After the intervention, surveys of EM physicians and 40 observations were subsequently repeated. 77.5% of initial observed handoffs occurred face-to-face, with 42.5% at bedside, and in four different languages. Most survey respondents considered face-to-face handoff ideal. Respondents noted 9-13 patients suffering harm due to handoff in the prior month. After handoff tool implementation, 97.5% of observed handoffs occurred face-to-face (versus 77.5%, p = 0.014), with 82.5% at bedside (versus 42.5%, p international, non-academic setting. Our three-step approach can be applied towards developing standardized, context-specific inter-specialty handoff in a variety of settings.

  1. Intensive perioperative glucose control does not improve outcomes of patients submitted to open-heart surgery: a randomized controlled trial

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    Raquel Pei Chen Chan

    2009-01-01

    Full Text Available BACKGROUND: The objective of this study was to investigate the relationship between different target levels of glucose and the clinical outcomes of patients undergoing cardiac surgery with cardiopulmonary bypass. METHODS: We designed a prospective study in a university hospital where 109 consecutive patients were enrolled during a six-month period. All patients were scheduled for open-heart surgery requiring cardiopulmonary bypass. Patients were randomly allocated into two groups. One group consisted of 55 patients and had a target glucose level of 80-130 mg/dl, while the other contained 54 patients and had a target glucose level of 160-200 mg/dl. These parameters were controlled during surgery and for 36 hours after surgery in the intensive care unit. Primary outcomes were clinical outcomes, including time of mechanical ventilation, length of stay in the intensive care unit, infection, hypoglycemia, renal or neurological dysfunction, blood transfusion and length of stay in the hospital. The secondary outcome was a combined end-point (mortality at 30 days, infection or length of stay in the intensive care unit of more than 3 days. A p-value of 0.05. CONCLUSIONS: In 109 patients undergoing cardiac surgery with cardiopulmonary bypass, both protocols of glycemic control in an intraoperative setting and in the intensive care unit were found to be safe, easily achieved and not to differentially affect clinical outcomes.

  2. Quality of life in the late follow-up of ulcerative colitis patients submitted to restorative proctocolectomy with sphincter preservation over ten years ago

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    Alberto Luiz Monteiro Meyer

    2009-01-01

    Full Text Available OBJECTIVE: To evaluate, by means of the Inflammatory Bowel Disease Questionnaire (IBDQ, the quality of life of ulcerative colitis patients submitted to proctocolectomy with sphincter preservation using J-pouch reconstruction over ten years ago. METHODS: The study consisted of 36 patients interviewed using the Inflammatory Bowel Disease Questionnaire. The score scale, resulting from the addition of each answer, ranged from 32 to 224, where the highest score indicates the best quality of life. The chi square test was used to verify the existence of meaningful differences between the results of the questionnaire and age, and gender proportion. For each section, as well as for all of them combined, the Kruskal-Wallis test was used to verify if there were differences in the Inflammatory Bowel Disease Questionnaire scores among the groups in relation to the proportions. RESULTS: After applying the Inflammatory Bowel Disease Questionnaire, it was determined that quality of life was considered excellent for 9 (25%, good for 11 (30.6%, regular for 13 (36.1%, and bad for 3 (8.3% patients. In our study, we determined that 85% of the patients were pleased with and thankful for the surgery that they underwent. CONCLUSION: We can conclude that the possibility of sphincter preservation should always be taken into account, since patients remain clinically stable and have a high quality of life even after long periods.

  3. Chronotropic response to vasodilator-stress in patients submitted to myocardial perfusion imaging: impact on the accuracy in detecting coronary stenosis

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    Gimelli, Alessia; Coceani, Michele; Quaranta, Angela; Emdin, Michele [Fondazione Toscana Gabriele Monasterio, Pisa (Italy); Liga, Riccardo [University Hospital of Pisa, Cardio-Thoracic and Vascular Department, Pisa (Italy); Marzullo, Paolo [Fondazione Toscana Gabriele Monasterio, Pisa (Italy); CNR, Institute of Clinical Physiology, Pisa (Italy)

    2015-11-15

    A lower heart rate response (HRR) during vasodilator MPI has been shown to have a relevant adverse prognostic impact. We sought to evaluate the interaction among individual HRR to vasodilator stress and myocardial perfusion imaging (MPI) accuracy in patients with suspected ischemic heart disease (IHD). One hundred and sixty-five consecutive patients were submitted to vasodilator-stress MPI on a cardiac camera equipped with cadmium-zinc-thelluride detectors and coronary angiography. A coronary stenosis >70 % was considered significant. In every patient, the summed difference score (SDS) was computed from MPI images. Patients were categorized according to the tertiles of the distribution of individual HRR during dipyridamole: ''Group 1'' (HRR < 8 bpm; lowest tertile); ''Group 2'' (8 ≤ HRR ≤ 12 bpm; middle tertile); ''Group 3'' (HRR >12 bpm; highest tertile). Significant coronary artery disease (CAD) was present in 102 (62 %) patients. In the overall population, MPI showed a significant accuracy (AUC: 0.81, 95 % CI 0.74-0.86; p < 0.001) in unmasking the presence of significant coronary stenosis. Interestingly, in patients with a blunted HRR during dipyridamole (''Group 1'') MPI showed a significantly lower sensitivity (68 %) in detecting CAD than in those with a higher HRR (''Group 3'') (91 %, p = 0.007), despite a preserved specificity (76 % vs 77 %, P=NS). Similarly, the correlation among CAD extent and post-stress LV functional stunning was limited to ''Group 3'' patients, while it disappeared in those with blunted HRR. In patients with suspected IHD, MPI sensitivity is strongly influenced by the magnitude of patient heart rate increase to the pharmacologic stressor, suggesting an interaction among blunted HRR and lower accuracy in unmasking CAD. (orig.)

  4. Comparison of methods for detection of Blastocystis infection in routinely submitted stool samples, and also in IBS/IBD Patients in Ankara, Turkey.

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    Funda Dogruman-Al

    Full Text Available BACKGROUND: This study compared diagnostic methods for identifying Blastocystis in stool samples, and evaluated the frequency of detection of Blastocystis in patients with irritable bowel syndrome (IBS and inflammatory bowel disease (IBD. RESULTS AND DISCUSSION: From a set of 105 stool specimens submitted for routine parasitological analysis, 30 were identified as positive for Blastocystis by the culture method. From that group of 30 positives, Lugol's stain, trichrome staining, and an immunofluorescence assay identified 11, 15, and 26 samples as positive respectively. Using culture as a standard, the sensitivity of Lugol's stain was 36.7%, trichrome staining was 50%, and the IFA stain was 86.7%. The specificity of Lugol's stain was 91%, trichrome staining was 100%, and the IFA stain was 97.3%. In the group of 27 IBS and IBD patients, using all methods combined, we detected Blastocystis in 67% (18/27 of the patients. Blastocystis was detected in 33% (2/6 of IBD patients and 76% (16/21 of IBS patients. For comparison, trichrome staining alone, the method most frequently used in many countries, would have only identified Blastocystis infection in 29% (6/21 of the IBS patients. No parasitic co-infections were identified in the IBS/IBD patients. Most Blastocystis-positive IBS/IBD patients were over 36 with an average length of illness of 4.9 years. CONCLUSIONS: Most IBS patients in this study were infected with Blastocystis. IFA staining may be a useful alternative to stool culture, especially if stool specimens have been chemically preserved.

  5. Pilocarpina no tratamento de xerostomia em pacientes submetidos à iodoterapia: estudo piloto Pilocarpine used to treat xerostomia in patients submitted to radioactive iodine therapy: a pilot study

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    Juliana Pereira Almeida

    2010-10-01

    Full Text Available Xerostomia é uma queixa tardia frequente associada à iodoterapia. Terapias para o tratamento desta morbidade podem proporcionar melhora na qualidade de vida dos pacientes com câncer de tireoide submetidos à iodoterapia adjuvante. OBJETIVOS: Relatar a experiência com o uso da pilocarpina no tratamento de xerostomia em pacientes com câncer de tireoide submetidos à iodoterapia adjuvante. MATERIAL E MÉTODOS: Cinco pacientes preencheram os critérios de inclusão e receberam 5mg de pilocarpina, 3 vezes ao dia, por uma semana. Os efeitos colaterais do medicamento e a resposta subjetiva à queixa de xerostomia após o tratamento foram avaliados. DESENHO DO ESTUDO: Trata-se de um estudo prospectivo, não-randomizado. RESULTADOS: Sudorese foi o efeito colateral mais comum com o uso da pilocarpina, seguido por cansaço e dor de cabeça. Dois pacientes relataram alívio da xerostomia com o uso da medicação, mas somente um paciente foi capaz de tolerar os efeitos colaterais. CONCLUSÕES: Pilocarpina parece aliviar os sintomas de xerostomia em pacientes submetidos à iodoterapia, já que o medicamento é capaz de estimular o fluxo salivar. No entanto, os efeitos colaterais observados inviabilizam seu uso por recusa por parte dos pacientes em continuar a terapia por períodos mais longos.Xerostomia complaint is very commonly associated to radioactive iodine therapy. Alternatives to treat this morbidity can offer better quality of life to patients with thyroid cancer submitted to adjuvant iodine therapy. AIM: to report on the experience with pilocarpine on the treatment of xerostomia in thyroid cancer patients submitted to adjuvant radioactive iodine therapy (RIT. MATERIALS AND METHODS: The five patients who met the inclusion criteria received 5mg of pilocarpine, 3 tid for one week. Side effects of the drug and subjective response to xerostomia complaints after treatment were evaluated. DESIGN: it is a prospective, non-randomized study. RESULTS

  6. Unmonitored use of herbal medicine by patients with breast cancer: reframing expectations.

    Science.gov (United States)

    Samuels, Noah; Ben-Arye, Eran; Maimon, Yair; Berger, Raanan

    2017-11-01

    To identify the unmonitored use of herbal medicine by female patients with breast cancer, examining the impact of an integrative physician (IP) consultation on this practice. The files of 269 female patients with breast cancer following an IP consultation were surveyed retrospectively for use of herbal medicine for cancer-related goals. Expectations from the IP consultation and adherence to the IP-guided treatments were examined as well. Among the cohort, 111 (41.3%) reported using herbal medicine for cancer-related goals, unmonitored by their oncology healthcare professional. Factors predicting herbal medicine use were the adoption of dietary changes (odds ratio = 13.6, p herbal medicine than non-users (34.5 vs. 22.8%; p = 0.088), as were those who had consulted with a complementary/alternative medicine practitioner (54.9 vs. 20.8%; p = 0.005). The IP advised 17 patients (15.3%) to stop taking specific herbal products due to safety-related concerns; and 10 patients to take dietary supplements for relief of specific symptoms. Herbal medicine users were less likely than non-users to adhere to the IP-recommended treatment program (34.7 vs. 48.3%; p = 0.037). Unmonitored use of herbal medicine by patients with breast cancer is more frequent among those adopting dietary changes for cancer-related goals. Integrative physicians provide evidence-based guidance on the safe and effective use of herbal products, and reframe patient expectations from cancer-related goals to reducing symptoms and improving quality of life.

  7. Study Gaps Relevant to Use of Complementary Medicine in Patients With Leukemia: A Review Study

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    Miladinia

    2016-04-01

    Full Text Available Context A review of the literature of recent decades has shown that few studies have been conducted on the effects of various types of complementary medicine on patients with leukemia. Therefore, the present study aimed to find research gaps in the use of different types of complementary medicine in patients with leukemia to be applied in future studies. Evidence Acquisition The present study was a review-type design based on a review of the literature on different types of complementary medicine in patients with leukemia, up to 2015. The search was conducted through electronic databases and search engines. According to the inclusion and exclusion criteria, 8 studies which had been conducted on the use of complementary medicine in patients with leukemia were selected for the identification of gaps. Results The overall results showed that few studies have been conducted on the use of exercise, massage therapy, music therapy, acupressure, and healing touch in patients with leukemia, and these subjects are potential research areas for many different studies. However, no studies have been carried out on the effects of acupuncture, relaxation, and yoga on these patients. Conclusions The results of this review showed that the number of studies on the use of complementary medicine in leukemia patients is very limited (especially in Iran, and it can be the subject of numerous studies in the future.

  8. Complementary medicine for cancer patients in general practice: qualitative interviews with german general practitioners.

    Science.gov (United States)

    Dahlhaus, Anne; Siebenhofer, Andrea; Guethlin, Corina

    2015-01-01

    The aim of this study was to investigate how general practitioners react when their cancer patients show interest in complementary medicine, and how their reaction is related to their knowledge in the field. We conducted semi-structured interviews with 10 German general practitioners. Interviewees came from 5 different federal states and varied in terms of urban/rural setting, single/joint practice, additional certifications, gender and length of professional experience. Interviews were electronically recorded, transcribed and then analysed using qualitative content analysis according to Mayring. General practitioners feel largely responsible for providing information on complementary medicine to their cancer patients. However, uncertainty and a lack of knowledge concerning CAM lead mainly to reactive responses to patients' needs, and the general practitioners base their recommendations on personal experiences and attitudes. They wish to support their cancer patients and thus, in order to keep their patients' hopes up and maintain a trusting relationship, sometimes support complementary medicine, regardless of their own convictions. Although general practitioners see themselves as an important source of information on complementary medicine for their cancer patients, they also speak of their uncertainties and lack of knowledge. General practitioners would profit from training in complementary medicine enabling them to discuss this topic with their cancer patients in a proactive, open and honest manner. © 2015 S. Karger GmbH, Freiburg

  9. A Paradigm Shift Towards Patient Involvement in Medicines Development and Regulatory Science

    DEFF Research Database (Denmark)

    Borup, Gitte; Bach, Karin Friis; Schmiegelow, Merete

    2016-01-01

    The Copenhagen Centre for Regulatory Science (CORS) and Biopeople at the University of Copenhagen held a workshop in May 2015 titled “Patient Involvement in Medicines Development and Approvals: A Paradigm Shift Towards True Patient Impact in Medicines Development and Regulatory Science......” that acknowledged the importance of having patients more involved in the entire process of medicines research and development (R&D) and life cycle management. Four key stakeholders, representing patients, academia, industry, and regulatory authorities, each gave their view and perspective on the status...... access to patient experience was proposed. A research and educational center such as CORS, which was founded on cross-sectorial and cross-disciplinary cooperation, is an example of an institution that could be a good starting point for hosting such a platform....

  10. [Comparative study on the usefulness of antibacterial prophylaxis with levofloxacin in patients submitted to hematopoietic stem cell transplantation].

    Science.gov (United States)

    Fernandez Sojo, Jesús; Batlle Massana, Montserrat; Morgades, Mireia; Vives Polo, Susana; Quesada, María Dolores; Ribera Santasusana, Josep María

    2016-01-01

    Bacterial infection remains a frequent complication in patients receiving a hematopoietic stem cell transplantation (HSCT). However, the impact of the antibacterial prophylaxis mortality in these patients is controversial. Retrospective comparison of 2 consecutive groups of patients undergoing HSCT receiving (n=132) or not (n=107) antibacterial prophylaxis with levofloxacin. 41% of patients receiving prophylaxis with levofloxacin had microbiologically documented infection (MDI) with bacteremia, compared with 40% of those not receiving levofloxacin. The frequency of gram-negative bacteremia was 11 and 38%, the resistance to levofloxacin was 39 and 14%, and the mortality was 8 and 7%, respectively. In our experience, the use of levofloxacin as prophylaxis in HSCT was associated with a lower frequency of gram-negative bacteremia but was not associated with a decreased rate of MDI and did not influence their outcome. In contrast, there was an increase in quinolone resistance in patients treated with levofloxacin. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

  11. Antioxidant enzyme profile and lipid peroxidation products in semen samples of testicular germ cell tumor patients submitted to orchiectomy.

    Science.gov (United States)

    Sposito, Camila; Camargo, Mariana; Tibaldi, Danielle Spinola; Barradas, Valéria; Cedenho, Agnaldo Pereira; Nichi, Marcílio; Bertolla, Ricardo Pimenta; Spaine, Deborah Montagnini

    2017-01-01

    To determine enzymatic antioxidant and lipid peroxidation levels in seminal plasma of patients orchiectomized for testicular tumors. The study included 52 patients: 26 control men and 26 orchiectomized patients for testicular tumor, of which 12 men had seminoma tumor and 14 men non-seminoma tumor. After semen analysis performed according to the WHO guidelines, an aliquot of semen was centrifuged and the seminal plasma was collected. Lipid peroxidation was performed by thiobarbituric acid reactive substances(TBARS) assay and antioxidant profile was assessed by analyzing catalase, glutathione per-oxidase (GPx) and superoxide anion (SOD) activities using colorimetric assays with a standard spectrophotometer. Data were tested for normality and compared using one-way ANOVA (p<0.05). Seminoma and non-seminoma groups presented lower sperm concentration and morphology when compared to control group (p=0.0001). Both study groups (seminoma and non-seminoma) presented higher TBARS levels when compared to control group (p=0.0000013). No differences were observed for SOD (p=0.646) and GPx (p=0.328). It was not possible to access the enzymatic activity of catalase in any group. Patients with testicular tumor present increased semen oxidative stress, but no differences were observed in antioxidant levels, even after orchiectomy. This indicates that most likely an increased generation of oxidative products takes place in these patients. Copyright® by the International Brazilian Journal of Urology.

  12. Avaliação isocinética em pacientes submetidos à artroplastia total de joelho Isokinetic evaluation of patients submitted to total knee arthroplasty

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    Marco Kawamura Demange

    2009-01-01

    Full Text Available OBJETIVOS: Tem-se afirmado que a via de acesso minimamente invasiva na artroplastia total de joelho (ATJ por não agredir o músculo quadríceps femoral permite reabilitação mais precoce. A fim de verificar a influência da preservação do aparelho extensor no ato cirúrgico, avaliou-se a força da musculatura extensora e flexora do joelho em pacientes submetidos à ATJ por duas vias de acesso diferentes. MATERIAIS E MÉTODOS: Este estudo comparou, no período de janeiro de 2005 a julho de 2006, os valores de torque máximo e de trabalho total obtidos por dinamometria isocinética aos seis meses de pós-operatório. Foram avaliados 12 indivíduos submetidos a ATJ por via de acesso minimamente invasiva e 8 indivíduos submetidos a ATJ por via de acesso transquadricipital. RESULTADOS: A análise estatística dos valores de torque máximo e de trabalho total absolutos e corrigidos pelo peso corporal não demonstrou diferença entre os dois grupos. CONCLUSÃO: Não há diferença de força da musculatura extensora e flexora do joelho aos seis meses de cirurgia.OBJECTIVE: In total knee arthroplasty, the minimally-invasive approach has been claimed to enable earlier rehabilitation because it spares the femoral quadriceps muscle. To check the influence of preserving the extensor apparatus during surgery, the strength of knee extension and flexion muscles was evaluated in patients submitted to total knee arthroplasty with different approaches. MATERIALS AND METHODS: The values of maximum torque and total work obtained by isokinetic dynamometry six months after surgery were compared for the Minimally invasive surgery group constituted of 12 individuals submitted to total knee arthroplasty by the minimally invasive surgical approach and the Control group, constituted of eight patients submitted to total knee arthroplasty by the transquadricipital approach, between January 2005 and July 2006. RESULTS: Statistical analysis of the absolute values for

  13. Incidence of vitamin B12 deficiency in patients submitted to Fobi-Capella Roux-en-Y bariatric surgery.

    Science.gov (United States)

    Carvalho, Iara Ribeiro; Loscalzo, Izabella Tesoto; Freitas, Mayteé Fernandes Borges de; Jordão, Regina Esteves; Friano, Tatiane de Cássia

    2012-01-01

    Patients undergoing bariatric surgery may develop over time, some complications and anemia is an important one due to gastric resection, leading to iron, folic acid or vitamin B12 deficiency. To determine the incidence of deficiency of vitamin B12 and other anthropometric and biochemical data comparing the preoperative and postoperative (six months) period in patients who underwent bariatric surgery with Fobi-Capella (Roux-en-Y) technique. Retrospective and descriptive analysis of 91 charts of patients who underwent surgery. It was collected personal information, date of surgery and pre-and postoperative (six months) values, weight loss, comorbidities, serum analysis of total cholesterol, triglycerides, glucose, vitamin B12, hemoglobin and hematocrit. For statistical analysis, it was considered significance level of 5% (pdeficiency of vitamin B12 after six months of surgery could not be observed; this fact can be attributed to the use of nutritional supplements or to the short follow-up time after surgery.

  14. Patient Partnerships Transforming Sleep Medicine Research and Clinical Care: Perspectives from the Sleep Apnea Patient-Centered Outcomes Network.

    Science.gov (United States)

    Redline, Susan; Baker-Goodwin, Si; Bakker, Jessie P; Epstein, Matthew; Hanes, Sherry; Hanson, Mark; Harrington, Zinta; Johnston, James C; Kapur, Vishesh K; Keepnews, David; Kontos, Emily; Lowe, Andy; Owens, Judith; Page, Kathy; Rothstein, Nancy

    2016-07-15

    Due to an ongoing recent evolution in practice, sleep medicine as a discipline has been compelled to respond to the converging pressures to reduce costs, improve outcomes, and demonstrate value. Patient "researchers" are uniquely placed to participate in initiatives that address the specific needs and priorities of patients and facilitate the identification of interventions with high likelihood of acceptance by the "customer." To date, however, the "patient voice" largely has been lacking in processes affecting relevant policies and practice guidelines. In this Special Report, patient and research leaders of the Sleep Apnea Patient-Centered Outcomes Network (SAPCON), a national collaborative group of patients, researchers and clinicians working together to promote patient-centered comparative effectiveness research, discuss these interrelated challenges in the context of sleep apnea, and the role patients and patient-centered networks may play in informing evidence-based research designed to meet patient's needs. We first briefly discuss the challenges facing sleep medicine associated with costs, outcomes, and value. We then discuss the key role patients and patient-centered networks can play in efforts to design research to guide better sleep health care, and national support for such initiatives. Finally, we summarize some of the challenges in moving to a new paradigm of patient-researcher-clinician partnerships. By forging strong partnerships among patients, clinicians and researchers, networks such as SAPCON can serve as a living demonstration of how to achieve value in health care. © 2016 American Academy of Sleep Medicine.

  15. Neuropsychological and quality of life assessment in patients with Parkinson's disease submitted to bilateral deep brain stimulation in the subthalamic nucleus

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    Alessandra Shenandoa Heluani

    Full Text Available ABSTRACT Deep brain stimulation (DBS has been widely used to control motor symptoms and improve quality of life in patients with Parkinsons disease (PD. Recently, DBS in the subthalamic nucleus (STN has become the preferred target for patients with mixed motor symptoms. Despite resultant motor and quality of life improvements, the procedure has been associated with cognitive decline, mainly in language skills, and also with psychiatric symptoms. Objective: To evaluate the influence of DBS in the STN on cognition, mood and quality of life. Methods: We studied 20 patients with PD submitted to DBS in the STN from May 2008 to June 2012 with an extensive battery of cognitive tests including memory, language, praxis, executive functions and attention assessments; the Parkinson's Disease Quality of Life Questionnaire (PDQ-39; and the Hospital Anxiety and Depression Scale (HAD, were applied both before and after the surgery. Data was analyzed using SPSS version 17.0 and results compared using the paired Student's t test. Results: A total of 20 patients with pre and post-operative assessments were included. A statistically significant improvement was found in total score and on subscales of mobility, activities of daily living and emotional well-being from the PDQ-39 (P=0.009, 0.025, 0.001 and 0.034, respectively. No significant difference was found on the cognitive battery or mood scale. Conclusion: DBS in the SNT improved quality of life in PD with no negative impact on cognitive skills and mood.

  16. Decreased Bone Mineral Density in Patients Submitted to Kidney Transplantation Is Related to Age, Body Mass Index, Time on Dialysis, and Hyperparathyroidism

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    Miguel Madeira

    2014-01-01

    Full Text Available Background. Renal transplantation (Tx influences bone mineral density (BMD by several mechanisms. The main objective of this study was to correlate BMD and risk factors associated with bone loss in patients submitted to kidney Tx. Methods. We evaluated 88 individuals after renal Tx (median time = 31.5 months since Tx. All of them sustained glomerular filtration rate ≥60 mL/min/1.73 m2. BMD was measured by dual-energy X-ray absorptiometry (DXA, Prodigy-GE. Calcium, phosphate, albumin, creatinine, and intact parathormone (PTH were measured at the same time. All statistical tests were two-sided and P value less than 0.05 were accepted as significant for all analyses in this study. Results. Serum PTH was raised in 42% patients, but corrected calcium was normal in 83 patients. No fragility fracture was reported, but the overall prevalence of osteoporosis was 27.6% and lower than expected BMD (Z-score ≤ −2.0 SD was observed in 28.4%. Patients with lower than expected BMD had higher PTH levels. Conclusions. Older age, lower body mass index (BMI, longer time on dialysis, and elevated PTH levels were identified as the main factors associated with lower BMD.

  17. The Electronic Health Record and Patient Portals in HIV Medicine.

    Science.gov (United States)

    Daskalakis, Demetre C

    2017-04-01

    The electronic medical record provides an exciting opportunity to support the coordination of care by medical and social providers. Many of these systems include patient portals that allow providers to share clinical information with patients in real time. These "patient portals" provide a unique opportunity for clients and patients to access and use HIV and sexually transmitted infection information for communication with healthcare providers, with potential or actual sex partners, and for tracking their own clinical course and progress. A concerted effort to develop these should include a high level of transparency and adequate support for both patient and provider.

  18. Prevalence of simple liver cysts and hemangiomas in cirrhotic and non-cirrhotic patients submitted to magnetic resonance imaging

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    Breno Victor Tomaz Galvao

    2013-07-01

    Full Text Available Objective To determine the prevalence of liver cysts and hemangiomas in the general population and in cirrhotic patients. Materials and Methods Retrospective, observational, and cross-sectional study selecting consecutive magnetic resonance imaging studies performed in the period from February to July 2011. A total of 303 patients (187 women and 116 men with mean age of 53.3 years were included in the present study. Patients with previously known liver lesions were excluded. The images were consensually analyzed by two observers in the search for simple liver cysts and typical liver hemangiomas, according to universally accepted imaging criteria. Lesions prevalence, diameters and location were determined in both cirrhotic and non-cirrhotic individuals. Results The authors observed prevalence of 8.6% for hemangiomas and 14.5% for simple cysts. No statistically significant difference was observed in relation to prevalence of hemangiomas and cysts among cirrhotic and non-cirrhotic patients (p = 0.954; p = 0.472. Conclusion In the present study, the prevalence of cysts and hemangiomas was higher than the prevalence reported by autopsy series. No influence of cirrhosis was observed on the prevalence and appearance of such incidental lesions.

  19. Analysis of autonomic modulation of heart rate in patients with Parkinson's disease and elderly individuals submitted to game therapy training.

    Science.gov (United States)

    Rocha, Rodrigo Santiago Barbosa; De Oliveira Rocha, Larissa Salgado; Pena, Elza Sara Maués; Caldas, Laiz Cristinna Ponce; Moreno, Marlene Aparecida

    2018-01-01

    Elderly patients and individuals with Parkinson's disease have a reduction in autonomic heart rate modulation, which may influence the survival of these patients, and rehabilitation can minimize this event. We tested the hypothesis that rehabilitation protocol with game console would influence the cardiac autonomic modulation of patients with Parkinson's Disease. Eight-seven volunteers were divided into two groups, control (n = 45) and Parkinson's (n = 42), they completed the study 40 volunteers in the control group (CG) and 31 patients in the Parkinson group (PG), and subjected to 24 sessions of game therapy physiotherapy, thrice a week. Analysis of autonomic HR modulation was conducted before and after the rehabilitation program using a Polar RS800CX HR sensor. For the analysis of heart rate variability the data were transferred to the Kubios HRV 2.2 program. Statistical analysis was performed in the Biostat 5.2 program, the comparison of the data by ANOVA followed by Tukey test, and the general characteristics by the chi-square test. The critical value for rejecting the null hypothesis was set at P modulation of HR values. Subjects with PD exhibit less autonomic modulation of HR and the rehabilitation protocol with game therapy improved autonomic modulation of HR. Geriatr Gerontol Int 2018; 18: 20-25. © 2017 Japan Geriatrics Society.

  20. Medication information seeking behavior of patients who use multiple medicines: how does it affect adherence?

    Science.gov (United States)

    Carter, Stephen R; Moles, Rebekah; White, Lesley; Chen, Timothy F

    2013-07-01

    This article explores medication information seeking behavior (MISB). We aimed to develop a scale for measuring MISB and use it to explore the relationships between MISB, adherence and factors, which drive information seeking. Patients (N=910) using multiple medicines completed questionnaires. Exploratory and confirmatory factor analyses were performed. Correlations and multivariate analyses were used to investigate the relationships between variables. Respondents sought medication information mainly from health professionals and written medicines information. The medication information seeking behavior scale (MISB) had acceptable reliability and validity. Information seeking was most intense among respondents who had recent changes in their medicine regimen and worries about their medicines. Those who sought medication information from autonomous sources were more likely to be non-adherent than those who never did (OR=2.00 [1.48, 2.70]). Seeking information from health professionals had no influence on adherence. Health practitioners should carefully attend to patients' questions about medicines information. When patients mention that they are worried about their medicines and have sought medication information from television, magazines, brochures or family and friends, this could be a sign that they tend towards non-adherent behavior. The MISB scale could be used to learn more about patients' use of medication information. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  1. Prevalence and pattern of use of indigenous medicines in diabetic patients attending a tertiary care centre.

    Science.gov (United States)

    Sethi, Ankur; Srivastava, Saurabh; Madhu, S V

    2011-07-01

    The aim of the study was to see the pattern of use of indigenous medicines in diabetic patients and to find out its correlation with various demographic variables in patients of type 2 diabetes. A sample of 113 patients with diabetes (type 1 and type 2) was interviewed using a structured questionnaire by trained medical personnel about the intake of indigenous medicines. Correlation of intake of indigenous medicines with various demographic variables was assessed using appropriate statistical tests. Male to female ratio in the present study was 1:3. Mean duration of diabetes was 5.2 +/- 2 years. It was found that majority of patients 101/113 (89.4%) attending diabetic clinic were using indigenous medicines in one form or the other. Most common drugs used were karela (78.8%), jamun (65.5%), methi (38.9%) and neem (28.3%). Majority were taking on advice from fellow diabetics (41.6%) and were not sure (39.8%) about the effect. No significant correlation was found with their intake and demographic variables as age, sex, per capita income, duration of diabtes, occupation, cultural background and antidiabetic medicine used. There is a high percentage of indigenous drug use in patients with diabetes which is often not reported. Treating physicians need to be alert to this possibility while managing diabetic patients in order to correctly interpret glycaemic control, hypoglycaemic episodes and other unexplained comorbidities that might arise in them.

  2. Development and utilization of the Medicines Use Review patient satisfaction questionnaire

    Directory of Open Access Journals (Sweden)

    Hindi A

    2017-10-01

    Full Text Available Ali Hindi,1 Caroline Parkhurst,1,2 Yasamin Rashidi,1 Shun Yan Ho,1 Nilesh Patel,1 Parastou Donyai11Department of Pharmacy, University of Reading, Berkshire, UK; 2Professional Services Department, Day Lewis Pharmacy Group, Croydon, London, UK Abstract: The Medicines Use Review is a community pharmacy service funded in the United Kingdom to improve patients’ adherence to medication and reduce medicines waste. The objective was to develop, pilot, and utilize a new Medicines Use Review patient satisfaction questionnaire. A questionnaire for patient self-completion was developed using a published framework of patient satisfaction with the Medicines Use Review service. The questions were validated using the content validity index and the questionnaire piloted through three pharmacies (February–April 2016. The revised questionnaire contained 12 questions with responses on a 5-point Likert scale, and a comments box. The questionnaire was distributed to patients following a Medicines Use Review consultation via community pharmacies (June–October 2016. Exploratory factor analysis and Cronbach’s α were performed to investigate the relationships between the items and to examine structural validity. The survey results were examined for patients’ reported satisfaction with Medicines Use Reviews, while the handwritten comments were thematically analyzed and mapped against the questionnaire items. An estimated 2,151 questionnaires were handed out, and a total of 505 responses were received indicating a 24% response rate. Exploratory factor analysis revealed two factors with a cumulative variance of 68.8%, and Cronbach’s α showed high internal consistency for each factor (α=0.90 and α=0.89, respectively. The survey results demonstrated that patients could show a high degree of overall satisfaction with the service, even if initially reluctant to take part in a Medicines Use Review. The results support the Medicines Use Review patient satisfaction

  3. Assessing Patients' Preference for Integrating Herbal Medicine Within Primary Care Services in Saudi Arabia.

    Science.gov (United States)

    Allam, Safaa; Moharam, Maha; Alarfaj, Gada

    2014-07-01

    Family physician advice and follow-up may be important to reduce the negative aspects of locally marketed herbal remedies and improve the patient outcome. There is a lack of studies assessing the preference of Saudi patients for the integration of herbal medicine into primary care services. To examine the knowledge, attitudes, and practice of Saudi patients toward herbal medicine and its integration into primary care services. A cross-sectional study was conducted between February and March 2013 among adult patients attending the family medicine clinics at a primary care center in Riyadh, Saudi Arabia. A self-administered questionnaire (27 items) was developed and administered to all patients. A total of 240 patients were included in the current analysis. The average age was 33.5 ± 9.9 years, and 61% of the patients were women. Approximately 60% of the patients were aware of herbal medicine use and its possible side effects. More than 85% of the patients believed that herbal containers should be labeled with safety information. Approximately 71% of the patients had a favorable attitude toward integrated services. Approximately 65% of the patients used herbal remedies for themselves, and 42% used them for their children. Preference for integrated services was significantly associated with female sex, better knowledge, positive attitudes toward safety and regulations, and higher level of practice. A good knowledge and a very favorable attitude toward integrating herbal medicine into primary care services were found among a group of patients attending a primary care center in Saudi Arabia. © The Author(s) 2014.

  4. Analysis of the motor behavior of a patient submitted to radical mastectomy - doi:10.5020/18061230.2009.p61

    Directory of Open Access Journals (Sweden)

    Lucas Flocke Hack

    2012-01-01

    Full Text Available Objective: To analyze the motor behavior of a patient in late postoperative of radical mastectomy during the accomplishment of some daily life activities, her gait and her body posture. Methods: This was an observational and descriptive case report study developed in an academic institution at Novo Hamburgo/RS, Brazil. By means of video recording, the accomplishment of daily life activities, the gait and body posture of a mastectomy patient were evaluated. Results: The most important alterations found were: increased base of support, torso swinging on gait, “S” shape scoliosis, accentuation of the spine physiologic curves and compensatory attitudes for reaching greater amplitudes of arm elevation at the same side of the surgery. Conclusion: We conclude that motor behavior alterations after surgery of radical mastectomy can be reasonably minimized, remaining a small reduction of movement amplitude and of muscular strength on upper limb and torso.

  5. Effectiveness of standardized approach versus usual care on physiotherapy treatment for patients submitted to alveolar bone graft: a pilot study.

    Science.gov (United States)

    Vidotto, Laís Silva; Bigliassi, Marcelo; Alencar, Tatiane Romanini Rodrigues; Silva, Thaísa Maria Santos; Probst, Vanessa Suziane

    2015-07-01

    To compare the acute effects of a standardized physiotherapy protocol versus a typical non-standardized physiotherapy protocol on pain and performance of patients undergoing alveolar bone graft (ABG). Sixteen patients (9 males; 12 [11-13] years) with cleft lip and palate undergoing ABG were allocated into two groups: (1) experimental group--EG (standardized physiotherapy protocol); and (2) control group--CG (typical, non-standardized physiotherapy treatment). Range of motion, muscle strength, gait speed, and pain level were assessed prior to surgical intervention (PRE), as well as on the first, second, and third post-operative days (1st, 2nd, and 3rd PO, respectively). Recovery with respect to range of motion of hip flexion was more pronounced in the EG (64.6 ± 11.0°) in comparison to the CG (48.5 ± 17.7° on the 3rd PO; p physiotherapy protocol appears to be better than a non-standardized physiotherapy protocol for acute improvement of range of motion of hip flexion and for reducing pain in patients undergoing ABG.

  6. Communication in dental medicine: importance in motivating elderly dental patients.

    Science.gov (United States)

    Scutariu, Mihaela Monica; Forna, Norina

    2013-01-01

    Dental services for elderly patients are characterized by a series of particularities related to the vulnerability of this age group, which is affected by various co morbidities, and the diminished physical, cognitive and financial capacities. Finding ways to keep elderly patients coming to a dental office is possible by improving the dentist-patient relationship and implicitly the quality of care by increasing the self-esteem of the elderly and their place in society, by increasing the role of oral health in the quality of life, and here we refer to the pleasure of eating, the pleasant physical aspect and normal diction. The present paper presents the psychological aspects that interfere in the communication process between the dentist and the elderly patient and the changes motivation undergoes when people are in pain. These data can sometimes change the reticent attitude of the dentist towards the elderly patient which is often considered to be a risk patient.

  7. Morbidity and medicine prescriptions in a nationwide Danish population of patients diagnosed with polycystic ovary syndrome

    DEFF Research Database (Denmark)

    Glintborg, Dorte; Hass Rubin, Katrine; Nybo, Mads

    2015-01-01

    OBJECTIVE: The prevalence of type 2 diabetes is increased in polycystic ovary syndrome (PCOS), but the prevalence of other diseases is not clarified. We aimed to investigate morbidity and medicine prescriptions in PCOS. DESIGN: A National Register-based study. METHODS: Patients with PCOS (PCOS....... Infertility was increased in patients compared with controls, but the mean number of births was higher in PCOS. Medicine prescriptions within all diagnosis areas were significantly higher in PCOS patients than in controls.In PCOS OUH, polycystic ovaries (PCO) and irregular menses were associated with a more...

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

    NARCIS (Netherlands)

    Kampen, D.A. van

    2013-01-01

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

  9. Medicine use among HIV/Aids patients in public hospitals, Kwara State

    African Journals Online (AJOL)

    Method: This study was conducted in seven public hospitals in six local government areas, Kwara State. Exit interviews of 780 eligible HIV/AIDS patients were conducted through use of structured questionnaire. Additionally, there were exit observational checks of medicines dispensed to these patients. Descriptive statistics ...

  10. Coordinating the norms and values of medical research, medical practice and patient worlds-the ethics of evidence based medicine in orphaned fields of medicine

    NARCIS (Netherlands)

    Vos, R.; Willems, D.; Houtepen, R.

    2004-01-01

    Evidence based medicine is rightly at the core of current medicine. If patients and society put trust in medical professional competency, and on the basis of that competency delegate all kinds of responsibilities to the medical profession, medical professionals had better make sure their competency

  11. Exposure of ionizing radiation to non-radiation workers from nuclear medicine patients

    International Nuclear Information System (INIS)

    Janssen, J.; Smart, R.C.; McKay, E.

    1999-01-01

    Full text: Occasionally, patients are required to have several tests in one day. They may be injected with radio-isotopes in the morning, have other investigations during the absorption period and then return to nuclear medicine for imaging later in the day. Recently, the NSW Department of Health issued a circular concerning exposure to sonographers from ionizing radiation emitted from nuclear medicine patients. The object of this study is to establish a model of emissions from nuclear medicine patients and to measure the exposure to other health workers who may be in close contact with these patients. Dose rate measurements were acquired for patients injected with 99 Tc m and 67 Ga for the following studies: heart, thyroid, lung, bone, biliary and lymphoma. Measurements were taken at 10 cm increments to 1 m and at time intervals of 0,1,2 and 24 h post-injection. In addition, 5 sonographers were issued with TLDs to be worn on the waist and fingers for a period of 3 months. The dose limit for a non-radiation worker is 1000 μSv (ICRP 60). The external dose rate measurements indicate that, assuming a sonographer is seated approximately 30 cm from a patient injected with 800 MBq 99 Tc m -HDP for a bone scan, 1 h post-injection, the sonographer would receive a dose of 11 μSv for a 30 min ultrasound scan. In practice, only 4 nuclear medicine patients were scanned in the ultrasound department during the 5 week monitoring period and the sonographers' TLDs recorded no radiation dose. In conclusion, the average exposure to sonographers from nuclear medicine patients is well within the limits recommended by the ICRP. However, in accordance with the ALARA principle where practicable, any ultrasound examination should be performed prior to nuclear medicine studies

  12. Valeriana officinalis L. for conscious sedation of patients submitted to impacted lower third molar surgery: A randomized, double-blind, placebo-controlled split-mouth study

    Science.gov (United States)

    Pinheiro, Marcos Luciano Pimenta; Alcântara, Carlos Eduardo Pinto; de Moraes, Márcio; de Andrade, Eduardo Dias

    2014-01-01

    Introduction: Anxiety is one of the components of patient stress in the dental office and is recognized as one of the main factors that negatively affect treatment. The control of anxiety can be performed through conscious sedation, for which benzodiazepine is the drug of choice in dental practice, however present side-effects. Objective: The objective of the following study is to evaluate the efficacy of Valeriana officinalis L. (Valerian) for control of anxiety during the third molar surgery. Materials and Methods: A single oral dose of either Valerian (100 mg) or placebo was randomly administered 1 h before each surgical procedure to 20 volunteers between 17 and 31 years of age. Anxiety level was assessed by physiological parameters (blood pressure and heart rate [HR]) and the observation of signs. Descriptive analysis, Chi-square test, Friedman test, Wilcoxon test and effect size test were performed (P < 0.05). Results: According to the researcher's (80%) and surgeon's (75%) evaluations, the patients treated with Valerian were calmer and more relaxed during surgery. Valerian had a greater effect on the maintenance of systolic blood pressure and HR after surgery. Conclusion: Valerian was more effective at controlling anxiety than a placebo when used for the conscious sedation of adult patients submitted to impacted lower third molar surgery. PMID:24741279

  13. Valeriana officinalis L. for conscious sedation of patients submitted to impacted lower third molar surgery: A randomized, double-blind, placebo-controlled split-mouth study

    Directory of Open Access Journals (Sweden)

    Marcos Luciano Pimenta Pinheiro

    2014-01-01

    Full Text Available Introduction: Anxiety is one of the components of patient stress in the dental office and is recognized as one of the main factors that negatively affect treatment. The control of anxiety can be performed through conscious sedation, for which benzodiazepine is the drug of choice in dental practice, however present side-effects. Objective: The objective of the following study is to evaluate the efficacy of Valeriana officinalis L. (Valerian for control of anxiety during the third molar surgery. Materials and Methods: A single oral dose of either Valerian (100 mg or placebo was randomly administered 1 h before each surgical procedure to 20 volunteers between 17 and 31 years of age. Anxiety level was assessed by physiological parameters (blood pressure and heart rate [HR] and the observation of signs. Descriptive analysis, Chi-square test, Friedman test, Wilcoxon test and effect size test were performed (P < 0.05. Results: According to the researcher′s (80% and surgeon′s (75% evaluations, the patients treated with Valerian were calmer and more relaxed during surgery. Valerian had a greater effect on the maintenance of systolic blood pressure and HR after surgery. Conclusion: Valerian was more effective at controlling anxiety than a placebo when used for the conscious sedation of adult patients submitted to impacted lower third molar surgery.

  14. Computed tomography (CT), nuclear medicine (NM), and ultrasound (US) in oncology patients

    International Nuclear Information System (INIS)

    McNeil, B.J.

    1982-01-01

    This review will summarize the effectiveness of computed tomography, ultrasound, and nuclear medicine imaging procedures in several different disease processes. The results indicate: (1) CT is clearly better than ultrasound for diseases of the adrenal gland and pancreas; (2) for patients with gynecologic malignancies, CT and ultrasound are approximately equivalent in their ability to define treatment options effectively; (3) in the liver, the differences among the three modalities are less marked and are disease specific. For example, for patients with colon cancer the increased effectiveness of CT relative to ultrasound or nuclear medicine is small. For patients with breast cancer, the difference is greater; (4) for patients suspected to have a focal source of sepsis, CT is slightly better than ultrasound or nuclear medicine. In these patients, however, when nuclear medicine images are obtained on a rectilinear scanner, the results are significantly worse compared to nuclear medicine images on a LFOV gamma camera or to ultrasound. As a result of the above studies and concommitant statistical analyses, several conclusions can be drawn about optimum experimental design and statistical approaches for comparing imaging modalities

  15. Herbal Medicine for Xerostomia in Cancer Patients: A Systematic Review of Randomized Controlled Trials.

    Science.gov (United States)

    Park, Bongki; Noh, Hyeonseok; Choi, Dong-Jun

    2017-09-01

    Xerostomia (dry mouth) causes many clinical problems, including oral infections, speech difficulties, and impaired chewing and swallowing of food. Many cancer patients have complained of xerostomia induced by cancer therapy. The aim of this systematic review is to assess the efficacy of herbal medicine for the treatment of xerostomia in cancer patients. Randomized controlled trials investigating the use of herbal medicines to treat xerostomia in cancer patients were included. We searched the following 12 databases without restrictions on time or language. The risk of bias was assessed using the Cochrane Risk of Bias Tool. Twenty-five randomized controlled trials involving 1586 patients met the inclusion criteria. A total of 24 formulas were examined in the included trials. Most of the included trials were insufficiently reported in the methodology section. Five formulas were shown to significantly improve the salivary flow rate compared to comparators. Regarding the grade of xerostomia, all formulas with the exception of a Dark Plum gargle solution with normal saline were significantly effective in reducing the severity of dry mouth. Adverse events were reported in 4 trials, and adverse effects of herbal medicine were reported in 3 trials. We found herbal medicines had potential benefits for improving salivary function and reducing the severity of dry mouth in cancer patients. However, methodological limitations and a relatively small sample size reduced the strength of the evidence. More high-quality trials reporting sufficient methodological data are warranted to enforce the strength of evidence regarding the effectiveness of herbal medicines.

  16. Usefulness of patient studies in learning family medicine at ...

    African Journals Online (AJOL)

    These problems arise from difficult student-facilitator relations and from the logistics of doing patient studies, such as a lack of orientation and difficulty in obtaining literature. Conclusion: Patient studies are appropriate assignments for the M Fam Med programme at Medunsa. The problems, such as strained facilitator-student ...

  17. Quality management in nuclear medicine for better patient care: the IAEA program.

    Science.gov (United States)

    Dondi, Maurizio; Kashyap, Ravi; Pascual, Thomas; Paez, Diana; Nunez-Miller, Rodolfo

    2013-05-01

    The International Atomic Energy Agency promotes the practice of nuclear medicine among its Member States with a focus on quality and safety. It considers quality culture as a part of the educational process and as a tool to reduce heterogeneity in the practice of nuclear medicine, and in turn, patient care. Sensitization about quality is incorporated in all its delivery mechanisms. The Agency has developed a structured peer-review process called quality management (QM) audits in nuclear medicine practices to help nuclear medicine facilities improve their quality through this voluntary comprehensive audit process. The process is multidisciplinary, covering all aspects of nuclear medicine practice with a focus on the patient. It complements other QM and accreditation approaches developed by professional societies or accreditation agencies. The Agency is committed to propagate its utility and assist in the implementation process. Similar auditing programs for practice in diagnostic radiology and radiotherapy, called QUADRIL and QUATRO, respectively, are also in place. Necessary amendments in the auditing process and content are incorporated based on technological and practice changes with time. The reader will become familiar with the approach of the Agency on QM in nuclear medicine and its implementation process to improve patient care. Copyright © 2013 Elsevier Inc. All rights reserved.

  18. Outcomes of Music Therapy Interventions on Symptom Management in Palliative Medicine Patients.

    Science.gov (United States)

    Gallagher, Lisa M; Lagman, Ruth; Rybicki, Lisa

    2018-02-01

    Evidence has demonstrated the positive effects of music therapy on symptom management for palliative medicine patients. Previous studies have addressed patient needs, with limited discussion involving the relationship between interventions utilized to improve symptoms. The purpose of this study was to understand the impact of music therapy sessions; identify common music therapy goals and interventions and assess their effect; and investigate the effects of gender, age, and type of cancer on symptoms in patients who experienced music therapy. This was a retrospective study of data collected during music therapy sessions. Patients scored their symptoms (pain, anxiety, depression, shortness of breath, and mood) before and after sessions. Data collected from over 1500 patients included symptom evaluation, goals, interventions, music used, patient/family reactions, and narratives. Among 293 patients who met all study inclusion criteria, significant improvement in pain, anxiety, depression, shortness of breath, mood, facial expression, and vocalization scores was noted. In addition, 96% of patients had positive responses to participating in music therapy. Vocal and emotional were the 2 most effective interventions in improving symptoms. All 5 patient-reported symptoms improved when the therapist focused on these symptoms as goals. Age, gender, and diagnosis had no impact on symptom improvement. This study demonstrated the importance of music therapy for addressing symptoms and behaviors of palliative medicine patients. Statistically and clinically significant effects were noted. The most effective interventions were identified. More research needs to be conducted to better understand the benefits of music therapy for palliative medicine patients.

  19. Comparative evaluation of ventilatory function through pre and postoperative peak expiratory flow in patients submitted to elective upper abdominal surgery.

    Science.gov (United States)

    Scheeren, Caio Fernando Cavanus; Gonçalves, José Júlio Saraiva

    2016-01-01

    to evaluate the ventilatory function by Peak Expiratory Flow (PEF) in the immediate pre and postoperative periods of patients undergoing elective surgical procedures in the upper abdomen. we conducted a prospective cohort study including 47 patients admitted to the Hospital Regional de Mato Grosso do Sul from July to December 2014, who underwent elective surgeries of the upper abdomen, and submiited to spirometric evaluation and measurement of PEF immediately before and after surgery. of the 47 patients, 22 (46.8%) were male and 25 (53.20%) female. The mean preoperative PEF was 412.1±91.7, and postoperative, 331.0±87.8, indicating significant differences between the two variables. Men had higher PEF values than women, both in the pre and postoperative periods. There was a reasonable inverse correlation between age and decreased PEF. Both situations showed statistical significance (pvalores de PFE do que o feminino, tanto no pré-cirúrgico quanto no pós-cirúrgico. Observou-se razoável correlação inversamente proporcional entre as variáveis idade e diminuição do PFE. Ambas as situações mostraram significância estatística (pvalores de PFE tanto no pré como no pós-operatório. O grupo composto por portadores de co-morbidades (HAS e/ou DM) apresentou menores valores de PFE tanto no pré como no pós-operatório (p=0,005). Em ambos os grupos, o pós-operatório determinou uma diminuição significativa do PFE (p<0,001). O tipo de cirurgia realizada e o tipo de anestesia não mostraram diferenças significantes em relação ao PFE. as variáveis mais implicadas na diminuição da função ventilatória, avaliadas através da PFE, foram: idade avançada, tabagismo e presença de comorbidades.

  20. Basal levels of triiodotironine, thyroxine, thyrotropin, free thyroxine and reverse triiodotyronine in patients with chronic renal failure submitted to hemodialysis

    International Nuclear Information System (INIS)

    Knobel, H.; Mendonca, B.B. de; Mendes, V.; Rocha Junior, J.E.; Medeiros Neto, G.

    1987-01-01

    Serum triiodotironine (T3), thyroxine (T4), thyrotropin (TSH), free thyroxine (FT4) and reverse triiodothyronine (rT3) concentrations were determined by radioimmunoassay in 21 uremic patients on regular hemodialysis therapy (sera were collected immediately before dialysis) and 11 normal controls. In advanced chronic renal failure serum T3 and T4 were frequently decreased (86% and 57%, respectively). and serum rT3 was normal (81%) or subnormal (14%). The serum TSH and FT4 values were normal in all cases even when serum T3 and T4 concentrations were decreased below the normal range. The findings suggest that the measurement of serum TSH probably represents the most reliable differentiation between this disease with low T4 levels and primary hypothyroidism. (author)

  1. Quantitative evaluation of Streptococcus mutans and Candida sp and salivary factors in the oral cavity of patients submitted to radiotherapy

    International Nuclear Information System (INIS)

    Spolidorio, Denise Madalena Palomari; Spolidorio, Luis Carlos; Barbeiro, Roberto Henrique; Bernardo, Wagner Luis Carvalho; Pavan, Sabrina; Hoefling, Jose Francisco

    2001-01-01

    The aim of this study was to quantify the microorganisms Streptococcus mutans and Candida sp in the oral cavity of patients with oropharynx carcinoma, before, during and after radiotherapy, and to correlate the results with salivary factors such as pH, buffer capacity and flow rate. Saliva samples were collected, diluted and inoculated in SB-20 agar and in Sabouraud agar, for Streptococcus mutans and Candida sp, respectively. Previously to dilution, the concentrated saliva was analyzed, and the salivary factors were determined. After the growth of colonies, the number of microorganisms was determined in CFU/ml. The analysis of the results allowed to conclude that the salivary factors are related to the presence of microorganisms, and that the number of CFU/ml increased as salivary flow rate decreased. The effects of radiation compromised salivary homeostasis and favored the increase of infection by yeasts and bacteria. (author)

  2. Vancomycin-induced thrombocytopenia: a rare adverse effect in a patient -submitted to bone graft in the jaw.

    Science.gov (United States)

    Danieletto, Carolina Ferrairo; Ferreira, Gustavo Zanna; Farah, Gustavo Jacobucci; Cuman, Roberto Kenji Nakamura

    2017-01-01

    Thrombocytopenia is the reduction in the number of blood -platelets, which may be caused by -several different conditions such as sepsis, disseminated intravascular -clotting, and large blood losses. Additionally, in rare situations, thrombocytopenia may also be induced by the use of medicaments. One of these drugs is the vancomycin, a glycopeptide presently used against -serious infections involving Gram-positive bacteria such as the methicillin-resistant Staphylococcus aureus and penicillin-resistant Streptococcus. The objective of this study is to report on a case of serious vancomycin-induced thrombocytopenia in a patient infected with methicillin-resistant S. aureus after mandibular reconstruction with autogenous bone graft, and to draw attention to the importance of this clinically rare adverse effect. Vancomycin-induced thrombocytopenia is a rare condition, which is also a significant disorder that demands attention and the rapid identification and replacement of the antimicrobial agent. © 2016 Special Care Dentistry Association and Wiley Periodicals, Inc.

  3. Metabolic syndrome in Internal Medicine patients: the pilot NIMEC study (National Internal Medicine Equivalent/Complex C-V-@Risk

    Directory of Open Access Journals (Sweden)

    R. Nardi

    2013-05-01

    Full Text Available BACKGROUND Metabolic Syndrome (MetS, currently defined as slight differences in the criteria of diagnosis – depending on which authority is quoted [i.e.: NCEP-ATP III (National Cholesterol Education Program/Adult Treatment Panel III; WHO (World Health Organization; IDF (International Diabetes Federation; AACE (American Association of Clinical Endocrinologists], designates a cluster of metabolic risk factors that come together in a single individual, leading to cardiovascular disease. MetS is quite common, approximately 20-30% of the population in industrialized countries being affected. However, most of epidemiological data regarding MetS are derived from populations consisting mostly of middle-aged and younger subjects. AIM OF THE STUDY To assess the prevalence of the MetS in Internal Medicine wards and to determine its related comorbidities, including other clinical forms of atherosclerotic disease such as CHD risk equivalents. METHODS Our study was performed in patients admitted in Internal Medicine wards and selected as a randomization list in 12 Emilia Romagna-Marche FADOI centers. 1.316 patients were registered. According to explicit inclusion/exclusion criteria, we studied overall 902 participants (50.6% men, mean of age: 71-73 years. RESULTS According to NCEP-ATP III and IDF criteria the prevalence of MetS was 45.3% (IC 95%: 41.6-49.1 and 38.6% (IC 95%: 34.9-42.3, respectively. Patients with MetS presented a higher significant rate of ALT increase, syncope, atrial fibrillation, COPD, unstable angina, chronic kidney disease, cancer, valvular heart disease, peripheral arterial disease and carotid plaques. A strong association between IDF-MetS and congestive heart failure was observed, suggesting a role of central obesity as an independent risk factor in the elderly. DISCUSSION World-wide populations are becoming older. Aging and MetS are two conditions that represent an important part of health-care spending. Trunkal fatness increases in

  4. Disfagia orofaríngea em pacientes submetidos à entubação orotraqueal Oropharyngeal dysphagia in patients submitted to orotracheal intubation

    Directory of Open Access Journals (Sweden)

    Michele Ramos Grigio Kunigk

    2007-12-01

    Full Text Available OBJETIVO: Detectar e caracterizar as alterações da fase oral e faríngea da deglutição, bem como verificar a ocorrência de penetração e aspiração laríngeas em pacientes submetidos à entubação orotraqueal. MÉTODOS: O estudo incluiu 30 adultos internados na unidade de tratamento intensivo do Hospital Estadual Mário Covas, que receberam entubação orotraqueal no período de 40 horas a 15 dias. Todos foram submetidos, por duas vezes, à avaliação endoscópica da deglutição, na primeira e segunda semanas, após a extubação, sendo observadas as alterações da fase oral e faríngea da deglutição e a presença de penetração e aspiração laríngeas. RESULTADOS: Na primeira avaliação, as alterações da fase oral estiveram presentes em 19(63,3% pacientes e, na segunda, em 12(40%.As alterações da fase faríngea ocorreram na primeira avaliação em 27(90% pacientes e, na segunda, em 8(26,7%. A penetração e a aspiração laríngeas foram detectadas nas duas avaliações, sendo diferentes para cada consistência e volume testados. CONCLUSÃO: A população submetida à entubação orotraqueal após a extubação apresenta alterações das fases oral e faríngea da deglutição caracterizadas por uma variedade de comprometimentos e acompanhadas de penetração e aspiração laríngeas.PURPOSE: To detect and characterize alterations in the oropharyngeal phase of swallowing as well as to verify the occurrence of laryngeal penetration and aspiration in patients submitted to invasive mechanical ventilation. METHODS: The study consisted of 30 individuals hospitalized in the intensive care unit of the Mario Covas State Hospital, who received invasive mechanical ventilation. They were all submitted twice to endoscopic evaluation for swallowing disorders in the first and second week after extubation. Alterations were observed in the oro-pharyngeal phase of swallowing and also the presence of penetration and laryngeal aspiration

  5. Use of complementary and alternative medicine by patients with cancer in northern Turkey: analysis of cost and satisfaction.

    Science.gov (United States)

    Aydin Avci, Ilknur; Koç, Zeliha; Sağlam, Zeynep

    2012-03-01

    The aims of this study were to determine (1) the prevalence of complementary and alternative medicine use among patients with cancer, (2) the method of use of the particular therapy, (3) the reasons for using complementary and alternative medicine therapies, (4) the benefits experienced by the use of complementary and alternative medicine, (5) the source of information about complementary and alternative medicine therapies and, (6) the satisfaction and cost of complementary and alternative medicine. Complementary and alternative medicine consists of diverse medical and healthcare systems, practices and products that are not considered at present to be a part of conventional medicine. The majority of patients who use complementary and alternative medicine use more than one method. Complementary and alternative medicine use is more common in cases of advanced disease or poor prognosis. This is a descriptive study of complementary and alternative medicine. This study was conducted in the Chemotherapy Unit at Ondokuz Mayıs University, Faculty of Medicine, Samsun, Turkey, between 18 March 2008-30 June 2008. Two hundred fifty-three patients with cancer, among 281 patients who applied to the chemotherapy clinic between these dates, agreed to take part in the study with whom contact could be made were included. A questionnaire including descriptive characteristics in collecting data, characteristics about diseases and their treatments, complementary and alternative medicine information and implementation situations and a control list about complementary and alternative medicine implementations were given. The collected data were evaluated by computer using descriptive statistics, the chi-square test and Student's t-test. In this study, 94·1% of the patients were content with medical treatment, 58·9% of them used complementary and alternative medicine treatments, 41·1% did not use any complementary and alternative medicine treatments. The satisfaction level of the

  6. Medicines Optimisation Assessment Tool (MOAT): a prognostic model to target hospital pharmacists' input to improve patient outcomes. Protocol for an observational study.

    Science.gov (United States)

    Geeson, Cathy; Wei, Li; Franklin, Bryony Dean

    2017-06-14

    Medicines optimisation is a key role for hospital pharmacists, but with ever-increasing demands on services there is a need to increase efficiency while maintaining patient safety. The aim of this study is to develop a prognostic model, the Medicines Optimisation Assessment Tool (MOAT), which can be used to target patients most in need of pharmacists' input while in hospital. The MOAT will be developed following recommendations of the Prognosis Research Strategy partnership. Using a cohort study we will prospectively include 1500 adult patients from the medical wards of two UK hospitals. Data on medication-related problems (MRPs) experienced by study patients will be collected by pharmacists at the study sites as part of their routine daily clinical assessment of patients. Data on potential risk factors such as polypharmacy, renal impairment and the use of 'high risk' medicines will be collected retrospectively from the information departments at the study sites, laboratory reporting systems and patient medical records. Multivariable logistic regression models will then be used to determine the relationship between potential risk factors and the study outcome of preventable MRPs that are at least moderate in severity. Bootstrapping will be used to adjust the MOAT for optimism, and predictive performance will be assessed using calibration and discrimination. A simplified scoring system will also be developed, which will be assessed for sensitivity and specificity. This study has been approved by the Proportionate Review Service Sub-Committee of the National Health Service Research Ethics Committee Wales REC 7 (16/WA/0016) and the Health Research Authority (project ID 197298). We plan to disseminate the results via presentations at relevant patient/public, professional, academic and scientific meetings and conferences, and will submit findings for publication in peer-reviewed journals. NCT02582463. © Article author(s) (or their employer(s) unless otherwise stated in

  7. Metrological aspects in estimating of radiation dose in patients of nuclear medicine; Aspectos metrologicos na estimativa da dose efetiva de pacientes em medicina nuclear

    Energy Technology Data Exchange (ETDEWEB)

    Ruzzarin, Anelise

    2015-06-01

    In order to investigate the performance of routine measurements in nuclear medicine services, LNMRI/IRD has been conducting, since 1998, a comparison program of activity measurements of radiopharmaceuticals administered to patients in nuclear medicine. Correction factors are determined from the result of performance analysis in order to determine with better accuracy the activity to be administered to the patients. The present study shows how the correction factor is determined by the ratio between the measurement of the activity at the nuclear medicine center and the activity determined by the LNMRI, which is adopted as reference. It is essential that the dose calibrator be calibrated with standards traceable to national metrology laboratories, so that the activity administered to the patient is neither greater nor smaller than the appropriate value. The corrected values of the activities can be used to calculate with greater accuracy the effective doses received by the patients as well as the risk of cancer. Information related to radiopharmaceuticals and administered activities, type of exams and patient data of three Brazilian hospitals were collected for 1496 adults and 134 children submitted to diagnostic exams employing {sup 99m}Tc and {sup 131}I. Results showed up to a considerable difference between the administered activity and the corrected activity until 30% and 13% above the reference value, respectively, for the {sup 131}I and {sup 99m}Tc was detected. The consequences of these differences were not very critical in this study since the activity measured in dose calibrator before administration was lower than the corrected activity, thus causing a lower effective dose in patients. However, this reduction in activity may result in problems in obtaining the image and consequently, failure diagnosis, delaying correct diagnosis. On the other hand, the overestimation would be worse, mainly in therapeutic applications, because an unnecessarily high absorbed

  8. Triggering radiation alarm at security checks. Patients should be informed even after diagnostic nuclear medicine procedures.

    Science.gov (United States)

    Palumbo, Barbara; Neumann, Irmgard; Havlik, Ernst; Palumbo, Renato; Sinzinger, Helmut

    2009-01-01

    During the last few years an increasing number of nuclear medicine patients in various countries evoked a radiation alarm after therapeutic or diagnostic procedures, and even after passive exposure. A prospective calculation of activity retention in the patient's body is difficult due to extremely high variation of uptake and kinetics. Furthermore, different sensitivities and distances of the detectors make a prospective calculation even more difficult. In this article a number of cases are being reported, related problems are discussed and the surprisingly very limited literature reviewed. In order to minimize problems after eventually triggering alarms, we strongly recommend that each patient receives a certificate providing personal data, tracer, dose, half-life of the radionuclide, type and date of procedure applied as well as the nuclear medicine unit to contact for further information. Furthermore, a closer cooperation and exchange of information between the authorities and local nuclear medicine societies, would be welcome.

  9. Individualised medicine from the perspectives of patients using complementary therapies: a meta-ethnography approach

    Science.gov (United States)

    2013-01-01

    Background Personalised (or individualised) medicine in the days of genetic research refers to molecular biologic specifications in individuals and not to a response to individual patient needs in the sense of person-centred medicine. Studies suggest that patients often wish for authentically person-centred care and personal physician-patient interactions, and that they therefore choose Complementary and Alternative medicine (CAM) as a possibility to complement standard care and ensure a patient-centred approach. Therefore, to build on the findings documented in these qualitative studies, we investigated the various concepts of individualised medicine inherent in patients’ reasons for using CAM. Methods We used the technique of meta-ethnography, following a three-stage approach: (1) A comprehensive systematic literature search of 67 electronic databases and appraisal of eligible qualitative studies related to patients’ reasons for seeking CAM was carried out. Eligibility for inclusion was determined using defined criteria. (2) A meta-ethnographic study was conducted according to Noblit and Hare's method for translating key themes in patients’ reasons for using CAM. (3) A line-of-argument approach was used to synthesize and interpret key concepts associated with patients’ reasoning regarding individualized medicine. Results (1) Of a total of 9,578 citations screened, 38 studies were appraised with a quality assessment checklist and a total of 30 publications were included in the study. (2) Reasons for CAM use evolved following a reciprocal translation. (3) The line-of-argument interpretations of patients’ concepts of individualised medicine that emerged based on the findings of our multidisciplinary research team were “personal growth”, “holism”, “alliance”, “integrative care”, “self-activation” and “wellbeing”. Conclusions The results of this meta-ethnographic study demonstrate that patients’ notions of individualised medicine

  10. Impact of patients' access to medical records in occupational medicine.

    Science.gov (United States)

    Krakov, A; Kabaha, N; Azuri, J; Moshe, S

    2018-04-14

    Information technologies offer new ways to engage with patients regarding their health, but no studies have been done in occupational health services (OHS). To examine the advantages and disadvantages of providing written and oral medical information to patients in OHS. In this cross-sectional study, data were retrieved from patients visiting four different OHS during 2014-15 for a fitness for work evaluation. We built a semi-quantitative satisfaction questionnaire, with responses ranging on a Likert scale of 1-5 from very dissatisfied (1) to very satisfied (5). There were 287 questionnaires available for analysis. The number of patients who received detailed oral and written information, which included an explanation of their health condition and of the occupational physician's (OP's) decision, was higher in clinics 1 and 3 compared to clinics 2 and 4 (48 and 38% compared to 21 and 31% respectively, P < 0.05). When patients were provided with detailed oral and written information, they declared having a better understanding (4.3 and 4.4 compared to 3.8 respectively, P < 0.001), a higher level of confidence in their OP (4.4 and 4.3 compared to 3.7 and 4 respectively, P < 0.001), a higher level of satisfaction (4.3 and 4.4 compared to 3.8 respectively, P < 0.001) and a higher sense of control and ability to correct the record (1.8 compared to 1.4 respectively, P < 0.01), compared to patients who received partial information. We recommend sharing detailed oral and written medical information with patients in OHS.

  11. Influence of Prescribed Herbal and Western Medicine on Patients with Abnormal Liver Function Tests: A Retrospective Quasi-Experimental Study

    Science.gov (United States)

    Lee, Ah-Ram; Yim, Je-Min; Kim, Won-Il

    2012-01-01

    Objectives: The aim of this study was to investigate the safety and the efficacy of Korean herbal, western and combination medicine use in patients with abnormal liver function tests. Methods: We investigated nerve disease patients with abnormal liver function tests who were treated with Korean herbal, western and combination medicine at Dong-Eui University Oriental Hospital from January 2011 to August 2011. We compared aspartic aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP) and total bilirubin (T-bil) levels before and after taking medicine and excluded patients who had liver-related disease when admitted. Results: AST and ALT were decreased significantly in patients who had taken herbal, western medicine. AST, ALT and ALP were decreased significantly in patients who had taken combination medicine. Compare to herbal medicine, AST, ALT and ALP were decreased significantly in patients who had taken western medicine, and ALT and ALP were decreased significantly in patients who had taken combination medicine. There were no significant differences between western and combination medicine. Conclusions: This study suggests that prescribed Korean herbal medicine, at least, does not injure liver function for patients’, moreover, it was shown to be effective in patients with abnormal liver function tests. PMID:25780634

  12. Unconventional therapists and their patients in Polish traditional folk medicine

    Directory of Open Access Journals (Sweden)

    Piątkowski Włodzimierz

    2015-12-01

    Full Text Available Folk medicine is a clearly distinct, comparatively homogeneous and closed system which has arisen from many centuries of isolation and self-sufficiency of the people of the Polish countryside. A feature of this special system involved tradition and relatively consistent illness behaviors, resistant to broader influences of the global society, despite the gradually growing role of modernization factors. An inherent feature of folk culture that impacted behaviors and attitudes of the rural population towards illness was the co-occurrence and overlapping of mystical-magical and religious elements. These applied both to the views on etiology, prevention, diagnosis and therapeutic treatment. Special functions in healing activities in the countryside were performed by the elderly. The matters related to health and illness were the province of the elderly as they were respected and revered for their life’s wisdom and life experience. The purpose of the article is to show the specificity of non-medical treatment in the context of social and cultural determinants, placing special emphasis on the role and importance of the elderly in exercising treatment roles.

  13. From patients to providers: changing the culture in medicine toward sexual and gender minorities.

    Science.gov (United States)

    Mansh, Matthew; Garcia, Gabriel; Lunn, Mitchell R

    2015-05-01

    Equality for sexual and gender minorities (SGMs)-including members of the lesbian, gay, bisexual, and transgender communities-has become an integral part of the national conversation in the United States. Although SGM civil rights have expanded in recent years, these populations continue to experience unique health and health care disparities, including poor access to health care, stigmatization, and discrimination. SGM trainees and physicians also face challenges, including derogatory comments, humiliation, harassment, fear of being ostracized, and residency/job placement discrimination. These inequities are not mutually exclusive to either patients or providers; instead, they are intertwined parts of a persistent, negative culture in medicine toward SGM individuals.In this Perspective, the authors argue that SGM physicians must lead this charge for equality by fostering diversity and inclusion in medicine. They posit that academic medicine can accomplish this goal by (1) modernizing research on the physician workforce, (2) implementing new policies and programs to promote safe and supportive training and practice environments, and (3) developing recruitment practices to ensure a diverse, competent physician workforce that includes SGM individuals.These efforts will have an immediate impact by identifying and empowering new leaders to address SGM health care reform, creating diverse training environments that promote cultural competency, and aligning medicine with other professional fields (e.g., business, law) that already are working toward these goals. By tackling the inequities that SGM providers face, academic medicine can normalize sexual and gender identity disclosure and promote a welcoming, supportive environment for everyone in medicine, including patients.

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

    Science.gov (United States)

    2011-01-01

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

  15. Potentially inappropriate prescribing in elderly population: A study in medicine out-patient department

    Directory of Open Access Journals (Sweden)

    Ajit Kumar Sah

    2017-03-01

    Full Text Available Background & Objectives: Older individuals often suffer from multiple systemic diseases and are particularly more vulnerable to potentially inappropriate medicine prescribing. Inappropriate medication can cause serious medical problem for the elderly. The study was conducted with objectives to determine the prevalence of potentially inappropriate medicine (PIM prescribing in older Nepalese patients in a medicine outpatient department.Materials & Methods: A prospective observational analysis of drugs prescribed in medicine out-patient department (OPD of a tertiary hospital of central Nepal was conducted during November 2012 to October 2013 among 869 older adults aged 65 years and above. The use of potentially inappropriate medications (PIM in elderly patients was analysed using Beer’s Criteria updated to 2013. Results: In the 869 patients included, the average number of drugs prescribed per prescription was 5.56. The most commonly used drugs were atenolol (24.3%, amlodipine (23.16%, paracetamol (17.6%, salbutamol (15.72% and vitamin B complex (13.26%. The total number of medications prescribed was 4833. At least one instance of PIM was experienced by approximately 26.3% of patients when evaluated using the Beers criteria. Conclusion: Potentially inappropriate medications are highly prevalent among older patients attending medical OPD and are associated with number of medications prescribed. Further research is warranted to study the impact of PIMs towards health related outcomes in these elderly.

  16. Influence of Electroacupuncture and Laser-Acupuncture on Treating Paresthesia in Patients Submitted to Combined Orthognathic Surgery and Genioplasty.

    Science.gov (United States)

    de Oliveira, Renata F; Goldman, Ricardo S; Mendes, Fausto Medeiros; de Freitas, Patricia Moreira

    2017-10-01

    Objective: The goal of this research was to observe the influence of electroacupuncture (EA) and laser-acupuncture on the return of tactile/pain sensitivity in patients who underwent orthognathic surgery. Materials and Methods: Thirty volunteers subjected to orthognathic surgery were evaluated and randomly divided into 2 groups, in which 3 treatments were evaluated: control ( n  = 30) (G0, medication + placebo laser treatment) and 2 experimental treatments ( n  = 15) (G1, medication + EA) or G2 (medication + laser-acupuncture). The control group had n  = 30 because for each experimental treatment conducted on a volunteer's hemi-face, there was a control treatment on the other hemi-face. In G1, medication was given with EA, with needles placed at predetermined points (ST 4 [ Dicang ], M-HN-18 [ Jiachengjiang ], CV 24 [ Chengjiang ], ST 5 [ Daying ], ST 6 [ Jiache ], and point A1 [YNSA]). For electrostimulation, the device used delivered transcutaneous electrical nerve stimulation of a burst type, with intensity and frequency variations of T = 220 ms and F = 4 Hz (30 minutes, 2 × /week). In G2, in addition to the medication, laser irradiation (at 780 nm) was applied on acupuncture points (at 0.04 cm 2 , 70 mW, 6 s/point, 0.42 J/point, 10 J/cm 2 , 2 × /week). All volunteers were evaluated before and during the 4 months following the surgery. Tactile sensitivity was assessed by mechanical brushing (brush #s 2 and 12) and by a 2-point discrimination test, using a bow compass. A pain test was performed with a pulp electrical test that stimulates intact nerves of the dentin-pulp complex. A Kaplan-Meier test was performed, and survival curves were plotted for comparison between groups. Cox regression analysis was also conducted (α = 0.05). Results: There were no statistically significant differences among the groups for the 2-point discrimination test (brushes #2 and #12) on the buccal mucosa region and for the pulp test

  17. Influence of Electroacupuncture and Laser-Acupuncture on Treating Paresthesia in Patients Submitted to Combined Orthognathic Surgery and Genioplasty

    Science.gov (United States)

    de Oliveira, Renata F.; Goldman, Ricardo S.; Mendes, Fausto Medeiros

    2017-01-01

    Abstract Objective: The goal of this research was to observe the influence of electroacupuncture (EA) and laser-acupuncture on the return of tactile/pain sensitivity in patients who underwent orthognathic surgery. Materials and Methods: Thirty volunteers subjected to orthognathic surgery were evaluated and randomly divided into 2 groups, in which 3 treatments were evaluated: control (n = 30) (G0, medication + placebo laser treatment) and 2 experimental treatments (n = 15) (G1, medication + EA) or G2 (medication + laser-acupuncture). The control group had n = 30 because for each experimental treatment conducted on a volunteer's hemi-face, there was a control treatment on the other hemi-face. In G1, medication was given with EA, with needles placed at predetermined points (ST 4 [Dicang], M-HN-18 [Jiachengjiang], CV 24 [Chengjiang], ST 5 [Daying], ST 6 [Jiache], and point A1 [YNSA]). For electrostimulation, the device used delivered transcutaneous electrical nerve stimulation of a burst type, with intensity and frequency variations of T = 220 ms and F = 4 Hz (30 minutes, 2 × /week). In G2, in addition to the medication, laser irradiation (at 780 nm) was applied on acupuncture points (at 0.04 cm2, 70 mW, 6 s/point, 0.42 J/point, 10 J/cm2, 2 × /week). All volunteers were evaluated before and during the 4 months following the surgery. Tactile sensitivity was assessed by mechanical brushing (brush #s 2 and 12) and by a 2-point discrimination test, using a bow compass. A pain test was performed with a pulp electrical test that stimulates intact nerves of the dentin-pulp complex. A Kaplan–Meier test was performed, and survival curves were plotted for comparison between groups. Cox regression analysis was also conducted (α = 0.05). Results: There were no statistically significant differences among the groups for the 2-point discrimination test (brushes #2 and #12) on the buccal mucosa region and for the pulp test on all

  18. Access to medicines by patients of the primary health care in the Brazilian Unified Health System.

    Science.gov (United States)

    Álvares, Juliana; Guerra, Augusto Afonso; Araújo, Vânia Eloisa de; Almeida, Alessandra Maciel; Dias, Carolina Zampirolli; Ascef, Bruna de Oliveira; Costa, Ediná Alves; Guibu, Ione Aquemi; Soeiro, Orlando Mario; Leite, Silvana Nair; Karnikowski, Margô Gomes de Oliveira; Costa, Karen Sarmento; Acurcio, Francisco de Assis

    2017-11-13

    To evaluate the access to medicines in primary health care of the Brazilian Unified Health System (SUS), from the patients' perspective. This is a cross-sectional study that used data from the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos - Services, 2015 (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines), conducted by interviews with 8,591 patients in cities of the five regions of Brazil. Evaluation of access to medicines used concepts proposed by Penshansky and Thomas (1981), according to the dimensions: availability, accessibility, accommodation, acceptability, and affordability. Each dimension was evaluated by its own indicators. For the "availability" dimension, 59.8% of patients reported having full access to medicines, without significant difference between regions. For "accessibility," 60% of patients declared that the basic health unit (UBS) was not far from their house, 83% said it was very easy/easy to get to the UBS, and most patients reported that they go walking (64.5%). For "accommodation," UBS was evaluated as very good/good for the items "comfort" (74.2%) and "cleanliness" (90.9%), and 70.8% of patients reported that they do not wait to receive their medicines, although the average waiting time was 32.9 minutes. For "acceptability," 93.1% of patients reported to be served with respect and courtesy by the staff of the dispensing units and 90.5% declared that the units' service was very good/good. For "affordability," 13% of patients reported not being able to buy something important to cover expenses with health problems, and 41.8% of participants pointed out the expense with medicines. Results show 70%-90% compliance, which is compatible with developed countries. However, access to medicines remains a challenge, because it is still heavily compromised by the low availability of essential medicines in public health units, showing that it does not occur universally, equally

  19. Computational biomechanics for medicine fundamental science and patient-specific applications

    CERN Document Server

    Miller, Karol; Wittek, Adam; Nielsen, Poul

    2014-01-01

    One of the greatest challenges facing the computational engineering community is to extend the success of computational mechanics to fields outside traditional engineering, in particular to biology, the biomedical sciences, and medicine. The Computational Biomechanics for Medicine titles provide an opportunity for specialists in computational biomechanics to present their latest methodologies and advancements. This latest installment comprises nine of the latest developments in both fundamental science and patient-specific applications, from researchers in Australia, New Zealand, USA, UK, France, Ireland, and China. Some of the interesting topics discussed are: cellular mechanics; tumor growth and modeling; medical image analysis; and both patient-specific fluid dynamics and solid mechanics simulations.

  20. Predictors for patient knowledge and reported behaviour regarding driving under the influence of medicines: a multi-country survey.

    NARCIS (Netherlands)

    Monteiro, S.P.; Dijk, L. van; Verstraete, A.G.; Alvarez, F.J.; Heissing, M.; Gier, J.J. de

    2012-01-01

    Background: Reports on the state of knowledge about medicines and driving showed an increased concern about the role that the use of medicines might play in car crashes. Much of patient knowledge regarding medicines comes from communications with healthcare professionals. This study, part of the

  1. Predictors for patient knowledge and reported behaviour regarding driving under the influence of medicines : a multi-country survey

    NARCIS (Netherlands)

    Monteiro, Susana P.; van Dijk, Liset; Verstraete, Alain G.; Alvarez, F. Javier; Heissing, Michael; de Gier, Johan J.

    2012-01-01

    Background: Reports on the state of knowledge about medicines and driving showed an increased concern about the role that the use of medicines might play in car crashes. Much of patient knowledge regarding medicines comes from communications with healthcare professionals. This study, part of the

  2. Number of patients studied prior to approval of new medicines

    DEFF Research Database (Denmark)

    Duijnhoven, Ruben G; Straus, Sabine M J M; Raine, June M

    2013-01-01

    . Both safety and efficacy require continued study after approval. New epidemiologic tools and legislative actions necessitate a review of the requirements for the number of patients studied prior to approval, particularly for chronic use, and adequate use of post-marketing studies. Please see later...

  3. Brand loyalty, patients and limited generic medicines uptake.

    Science.gov (United States)

    Costa-Font, Joan; Rudisill, Caroline; Tan, Stefanie

    2014-06-01

    The sluggish development of European generic drug markets depends heavily on demand side factors, and more specifically, patients' and doctors' loyalty to branded products. Loyalty to originator drugs, to the point where originator prices rise upon generic entry has been described as the 'generics paradox'. Originator loyalty can emerge for a plethora of reasons; including costs, perceptions about quality and physician advice. We know very little about the behavioural underpinnings of brand loyalty from the consumer or patient standpoint. This paper attempts to test the extent to which patients are brand loyal by drawing upon Spain's 2002 Health Barometer survey as it includes questions about consumer acceptance of generics in a country with exceptionally low generic uptake and substitution at the time of the study. Our findings suggest that at least 13% of the population would not accept generics as substitutes to the originator. These results confirm evidence of brand loyalty for a minority. Alongside high levels of awareness of generics, we find that low cost-sharing levels explain consumer brand loyalty but their impact on acceptance of generic substitution is very small. Higher cost-sharing and exempting fewer patients from cost-sharing have the potential to encourage generic acceptance. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  4. Usefulness of patient studies in learning family medicine at ...

    African Journals Online (AJOL)

    first-hand experience of the learner as a major source of learning.2 .... possible bias. Ethical approval of the research was obtained in ad- vance from the Research, Ethics and. Publication Committee of Medunsa. Analysis. All the interviews were .... tions about patient studies. The general impression gained by this research ...

  5. Potential of regenerative medicine for treatment of vitiligo patients

    Directory of Open Access Journals (Sweden)

    A. A. Kubanova

    2014-01-01

    Full Text Available The article presents a review of publishes sources on the efficacy of methods such as tissue engineering and cellular transplantation of autologous melanocytes for treatment of vitiligo patients. The article describes general principles of treatment and particular features of current melanocyte transplantation methods.

  6. Family Medicine Education with Virtual Patients: a Qualitative Study.

    Science.gov (United States)

    Sobocan, Monika; Klemenc-Ketis, Zalika

    2015-08-01

    Virtual patients (VP) have been present within the medical education process for some time. Although they are assumed to be of great benefit for student learning, very little is know about student perception and outcomes of learning, especially during the pre-clerkship years. Therefore we have decided to investigate the use of VPs during lectures, which has never been analyzed before, but could present an opportunity for more effective and holistic learning. This was a qualitative study among the 4th year undergraduate medical students at the Medical Faculty, University of Maribor, Slovenia. Students, after completing 4 virtual patient cases during the semester, were asked to participate in focus groups. Using these focus groups we asked students to provide information about their perceptions of VP cases, their learning, and suggestions for educational improvements. Data was transcribed and analyzed using the grounded theory-based coding method (open coding). Medical students reported having a positive attitude towards virtual patient learning. They perceived them as helpful for filling in knowledge gaps, learning appropriate patient care and clinical reasoning. However, especially within the setting of early clinical learning, students felt the need to discuss their questions with their tutors in order to achieve better learning outcomes. Students on teaching courses feel the need for structured instructor sessions and the integration of VPs in the course planning in order to maximize their learning outcomes.

  7. In-Patient Treatment of Fibromyalgia: A Controlled Nonrandomized Comparison of Conventional Medicine versus Integrative Medicine including Fasting Therapy

    Directory of Open Access Journals (Sweden)

    Andreas Michalsen

    2013-01-01

    Full Text Available Fibromyalgia poses a challenge for therapy. Recent guidelines suggest that fibromyalgia should be treated within a multidisciplinary therapy approach. No data are available that evaluated multimodal treatment strategies of Integrative Medicine (IM. We conducted a controlled, nonrandomized pilot study that compared two inpatient treatment strategies, an IM approach that included fasting therapy and a conventional rheumatology (CM approach. IM used fasting cure and Mind-Body-Medicine as specific methods. Of 48 included consecutive patients, 28 were treated with IM, 20 with CM. Primary outcome was change in the Fibromyalgia Impact Questionnaire (FIQ score after the 2-week hospital stay. Secondary outcomes included scores of pain, depression, anxiety, and well being. Assessments were repeated after 12 weeks. At 2 weeks, there were significant improvements in the FIQ (P<0.014 and for most of secondary outcomes for the IM group compared to the CM group. The beneficial effects for the IM approach were reduced after 12 weeks and no longer statistically significant with the exception of anxiety. Findings indicate that a multimodal IM treatment with fasting therapy might be superior to CM in the short term and not inferior in the mid term. Longer-term studies are warranted to assess the clinical impact of integrative multimodal treatment in fibromyalgia.

  8. A survey of sports medicine physicians regarding psychological issues in patient-athletes.

    Science.gov (United States)

    Mann, Barton J; Grana, William A; Indelicato, Peter A; O'Neill, Daniel F; George, Steven Z

    2007-12-01

    To determine the extent to which sports medicine physicians encounter and discuss psychological issues among athletes they treat and to evaluate physicians' perceptions of the availability and efficacy of sport psychologists and other mental health resources. Cross-sectional study. A survey was sent via e-mail to all physician members of 4 prominent sports medicine professional associations: the American Orthopaedic Society for Sports Medicine, American College of Sports Medicine, American Medical Society for Sports Medicine, and American Osteopathic Academy of Sports Medicine. The extent to which respondents discuss psychological issues with athletes varied by subspecialty and by specific issues assessed. Fears about reinjury, fears related to surgery, and lack of patience with recovery/rehabilitation were the 3 most common injury-related topics discussed with patient-athletes. The 3 most common non-injury-related topics discussed were stress/pressure, anxiety, and burnout. Family practitioners were more likely to discuss injury-related psychological issues than were orthopaedic surgeons. Orthopaedic surgeons reported the lowest frequencies of discussing non-injury-related psychological issues. Only 19% of all respondents indicated there were adequate numbers of sport psychologists and other mental health professionals in their geographical area to treat the needs of athletes. Three quarters of respondents reported they rarely or never referred athletes to sport psychologists for injury-related issues, and two thirds indicated they rarely or never referred athletes to sport psychologists for non-injury-related problems. Respondents rated sport psychologists and athletic trainers/physical therapists to be moderately effective in working with athletes regarding psychological problems. Sports medicine physicians frequently encounter psychological issues with patient-athletes. There is a need for tools to facilitate assessment of these problems as well as greater

  9. The impact of the "business" of pain medicine on patient care.

    Science.gov (United States)

    Taylor, Mary Lou

    2011-05-01

    The objective of this article was to examine the impact on patient care of the growing economic forces in pain medicine. Chronic pain is a growing problem in the United States, as more people seek treatment than ever before. The practice of pain medicine is influenced by many market forces, including industry relationships with pain providers, lawmakers and insurance companies, direct-to-consumer advertising, insurance reimbursement patterns, and competition among health care systems and pain management providers. These economic factors can encourage innovation and efficiency and may increase access to pain treatment. However, they have also resulted in unrealistic expectations for pain relief, increased reliance on medications, widespread use of inadequately tested or unnecessary pain management diagnostic and treatment techniques, decreased use of some effective treatments, and lack of adequate pain education. Patients are undergoing more treatments, but there is little evidence of overall improved function. Following guidelines set out by the industry and pain medicine organizations, safeguarding against false or incomplete advertising, establishing easier methods for questioning advertising content, increasing the practice of evidence-based medicine, increasing government-sponsored research of definitive studies, and improving communication of efficacious treatment will facilitate the practice of ethical pain medicine and improve patient care. Wiley Periodicals, Inc.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1999-03-01

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

  11. Radiation exposure and dosimetry in transplant patients due to Nuclear Medicine studies

    International Nuclear Information System (INIS)

    El-Maghraby, T. A. F.; Cairo Univ., Cairo; Camps, J. A. J.; Geleyns, J.; Pauwels, E. K. J.

    2000-01-01

    Organ transplantation is now an accepted method of therapy for treating patients with end stage failure of kidneys, liver, heart or lung. Nuclear Medicine may provide functional data and semi-quantitative parameters. However, one serious factor that hampers the use of nuclear medicine procedures in transplant patients is the general clinical concern about radiation exposure to the patient. This lead the researcher to discuss the effective doses and radiation dosimetry associated with radionuclide procedures used in the management and follow-up of transplant patients. A simple way to place the risk associated with Nuclear Medicine studies in an appropriate context is to compare the dose with that received from more familiar source of exposure such as from a diagnostic X-ray procedure. The radiation dose for the different radiopharmaceuticals used to study transplant organ function ranges between 0.1 and 5.3 mSv which is comparable to X-ray procedures with the exception of 201 Tl and 111 In-antimyosin. Thus Nuclear Medicine studies do not bear a higher radiation risk than the often used X-ray studies in transplant patients

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

    Science.gov (United States)

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

    2015-12-01

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

  13. [The doctor-patient relationship against the backdrop of patient-centered medicine. The conclusions of dialogical ethics].

    Science.gov (United States)

    Kreß, H

    2012-09-01

    "Health" and "illness" are multilayered terms. The understanding of human health depends, apart from scientific aspects, on people's individual perceptions as well as on aspects of culture and world view. The ideal of patient-centered medicine requires that a physician does not merely have to establish an objectifiable diagnosis. Rather, a physician should also respect the patients' right to self-determination, their personal values, and their subjective view of health and illness. The philosophy of dialogue, which developed in the twentieth century, offers a conceptual background for this ideal. On an empirical basis, the successful communication between doctor and patient can be interpreted as a useful placebo phenomenon. Alternative medicine puts great emphasis on the doctor's attentive care. This also explains why the alternative branch of medicine has appealed to many patients. Therefore, science-oriented medicine should review methods in which the doctor's empathy and dialogue ability are crucial to treatment success. It is part of the physician's responsibility to appreciate the personal perspectives of patients, to respect them and, if necessary, to engage with them critically.

  14. Narrative Medicine perspectives on patient identity and integrative care in neuro-oncology.

    Science.gov (United States)

    Slocum, Robert B; Howard, Tracy A; Villano, John L

    2017-09-01

    Narrative Medicine sessions can encourage patients to rediscover personal identity and meaning by telling or writing their stories. We explored this process to improve care and quality of life for brain cancer patients in an academic neuro-oncology program. Brain cancer and its treatments may threaten a patient's quality of life and sense of self in many ways, including impaired cognitive skills, loss of memory, reduced coordination, and limited capacity for self-expression. The impact of symptoms and side effects on quality of life must be evaluated in terms of each patient's identity and may be understood in terms of each patient's story. Insights from Narrative Medicine visits may also be helpful for the treatment team as they seek to assess patient needs, attitudes, and abilities. We provide case-based histories demonstrating applications of Narrative Medicine in the care of patients with brain tumors whose sense of self and quality of life are challenged. The cases include managing frontal lobe syndrome of loss of initiative and pervasive emotional apathy with his wife and young children, regaining a meaningful activity in a patient, re-establishing self-identity in a young woman with ependymoma, and improving spells with coexistent epilepsy and psychogenic non-epileptic seizures (PNES).

  15. Patient satisfaction and side effects in primary care: An observational study comparing homeopathy and conventional medicine

    Directory of Open Access Journals (Sweden)

    Thurneysen André

    2008-09-01

    Full Text Available Abstract Background This study is part of a nationwide evaluation of complementary medicine in Switzerland (Programme Evaluation of Complementary Medicine PEK and was funded by the Swiss Federal Office of Public Health. The main objective of this study is to investigate patient satisfaction and perception of side effects in homeopathy compared with conventional care in a primary care setting. Methods We examined data from two cross-sectional studies conducted in 2002–2003. The first study was a physician questionnaire assessing structural characteristics of practices. The second study was conducted on four given days during a 12-month period in 2002/2003 using a physician and patient questionnaire at consultation and a patient questionnaire mailed to the patient one month later (including Europep questionnaire. The participating physicians were all trained and licensed in conventional medicine. An additional qualification was required for medical doctors providing homeopathy (membership in the Swiss association of homeopathic physicians SVHA. Results A total of 6778 adult patients received the questionnaire and 3126 responded (46.1%. Statistically significant differences were found with respect to health status (higher percentage of chronic and severe conditions in the homeopathic group, perception of side effects (higher percentage of reported side effects in the conventional group and patient satisfaction (higher percentage of satisfied patients in the homeopathic group. Conclusion Overall patient satisfaction was significantly higher in homeopathic than in conventional care. Homeopathic treatments were perceived as a low-risk therapy with two to three times fewer side effects than conventional care

  16. Complex decision making in patients with dementia in an internal medicine department.

    Science.gov (United States)

    Kabelka, Ladislav

    2017-10-01

    With the increase of polymorbidity, extending life expectancy and improving treatment options for chronic diseases, the care for dementia is moving into other areas of medicine. The length and quality of life with advanced dementia is directly dependent on the quality of medical and nursing care, early detection and treatment of complications, nutritional support and palliative care plan. Significant is also the support for family carers. The key coordinators of care for patients with dementia are general practitioners (GPs), geriatricians, psychiatrists, and an increasingly important role play internists. Case reports of patients admitted to an internal medicine department. Description of clinical experiences with caring on patients with dementia. In the internal departments of regional hospitals, there is a room for adjustment of the care plan, for comprehensive assessment of the patient and for making crucial decisions regarding nutrition, treatment of chronic diseases, consideration of previously expressed wishes in the context of the patient condition, and potential prognostic indicators. This assessment must result in a comprehensive documentation and communication with patients, and in the case of advanced dementia with their family members. The general internal medicine is very often the first place where the patient has a chance to hear about indication for palliative care. Without the availability of a multidisciplinary assessment, good communication and documentation, it is unrealistic to expect that the hospital would provide comprehensive care for patients with dementia.

  17. Analgesia in Patients with Trauma in Emergency Medicine.

    Science.gov (United States)

    Häske, David; Böttiger, Bernd W; Bouillon, Bertil; Fischer, Matthias; Gaier, Gernot; Gliwitzky, Bernhard; Helm, Matthias; Hilbert-Carius, Peter; Hossfeld, Björn; Meisner, Christoph; Schempf, Benjamin; Wafaisade, Arasch; Bernhard, Michael

    2017-11-17

    Suitable analgesic drugs and techniques are needed for the acute care of the approximately 18 200-18 400 seriously injured patients in Germany each year. This systematic review and meta-analysis of analgesia in trauma patients was carried out on the basis of randomized, controlled trials and observational studies. A systematic search of the literature over the 10-year period ending in February 2016 was carried out in the PubMed, Google Scholar, and Springer Link Library databases. Some of the considered trials and studies were included in a meta-analysis. Mean differences (MD) of pain reduction or pain outcome as measured on the Numeric Rating Scale were taken as a summarizing measure of treatment efficacy. Out of 685 studies, 41 studies were considered and 10 studies were included in the meta-analysis. Among the drugs and drug combinations studied, none was clearly superior to another with respect to pain relief. Neither fentanyl versus morphine (MD -0.10 with a 95% confidence interval of [-0.58; 0.39], p = 0.70) nor ketamine versus morphine (MD -1.27 [-3.71; 1.16], p = 0.31), or the combination of ketamine and morphine versus morphine alone (MD -1.23 [-2.29; -0.18], p = 0.02) showed clear superiority regarding analgesia. Ketamine, fentanyl, and morphine are suitable for analgesia in spontaneously breathing trauma patients. Fentanyl and ketamine have a rapid onset of action and a strong analgesic effect. Our quantitative meta-analysis revealed no evidence for the superiority of any of the three substances over the others. Suitable monitoring equipment, and expertise in emergency procedures are prerequisites for safe and effective analgesia by healthcare professionals..

  18. Influence of patient medication on diagnostic accuracy in nuclear medicine

    Energy Technology Data Exchange (ETDEWEB)

    Sampson, C.B. [Addenbrooke`s Hospital, Cambridge (United Kingdom). Dept. of Nuclear Medicine

    1997-12-31

    Full text. In recently years many reports have published of unusual or unexpected changes in the biodistribution of radiopharmaceuticals which do not correlate with normality or disease. Whilst many extraneous factors can alter tracer kinetics it has become apparent that concomitant patient medication can be such a factor. If the clinician is unaware that patient is on drug therapy difficulties arise in making a accurate diagnosis. Most drug/radio pharmaceutical effects are those in which the functional status of the organ is altered as a result of the pharmacological action of the drug. Examples here are narcotic analgesics such as methadone, pethidine and morphine which cause spasm of the biliary tract due to contraction of the sphincter of Oddi and an altered transit time of the technetium labelled tracer. Cytotoxic drugs such as cyclophosphamide and vincristine can markedly affect tumour uptake of 67-gallium so that litter or no activity is taken up by the tumour. Nifedipine, because of its powerful calcium channel blocking activity is known to affect the radiolabelling of white cells and red cells and to affect uptake of Tc-99 m MDP into bones. Other important and confusing effects are caused by phenothiazines, cimetidine and oral contraceptives. In recent years it has been reported that drugs such as cyclosporin, azathioprine and heparin and derivatives of heparin can markedly interfere with cell labelling procedures. This review will consider some of the clinical effects of drugs and will also address the reporting of instances of drug/radio pharmaceutical interactions

  19. Implementation strategies of Systems Medicine in clinical research and home care for cardiovascular disease patients.

    Science.gov (United States)

    Montecucco, Fabrizio; Carbone, Federico; Dini, Frank Lloyd; Fiuza, Manuela; Pinto, Fausto J; Martelli, Antonietta; Palombo, Domenico; Sambuceti, Gianmario; Mach, François; De Caterina, Raffaele

    2014-11-01

    Insights from the "-omics" science have recently emphasized the need to implement an overall strategy in medical research. Here, the development of Systems Medicine has been indicated as a potential tool for clinical translation of basic research discoveries. Systems Medicine also gives the opportunity of improving different steps in medical practice, from diagnosis to healthcare management, including clinical research. The development of Systems Medicine is still hampered however by several challenges, the main one being the development of computational tools adequate to record, analyze and share a large amount of disparate data. In addition, available informatics tools appear not yet fully suitable for the challenge because they are not standardized, not universally available, or with ethical/legal concerns. Cardiovascular diseases (CVD) are a very promising area for translating Systems Medicine into clinical practice. By developing clinically applied technologies, the collection and analysis of data may improve CV risk stratification and prediction. Standardized models for data recording and analysis can also greatly broaden data exchange, thus promoting a uniform management of CVD patients also useful for clinical research. This advance however requires a great organizational effort by both physicians and health institutions, as well as the overcoming of ethical problems. This narrative review aims at providing an update on the state-of-art knowledge in the area of Systems Medicine as applied to CVD, focusing on current critical issues, providing a road map for its practical implementation. Copyright © 2014 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

  20. Perceptions of family members of palliative medicine and hospice patients who experienced music therapy.

    Science.gov (United States)

    Gallagher, Lisa M; Lagman, Ruth; Bates, Debbie; Edsall, Melissa; Eden, Patricia; Janaitis, Jessica; Rybicki, Lisa

    2017-06-01

    Evidence shows that music therapy aids in symptom management and improves quality of life for palliative medicine and hospice patients. The majority of previous studies have addressed patient needs, while only a few addressed the needs of family members. The primary purpose of this study was to understand family members' perceptions of music therapy experienced by a relative in palliative medicine or hospice. Patient self-reported scales and music therapist assessment of change were also investigated. Patients scored their symptoms (pain, anxiety, depression, shortness of breath, and mood) before and after music therapy sessions. One family member present during the session assessed perceived effect on the patient's pain, anxiety, depression, shortness of breath, stress level, restlessness, comfort level, mood, and quality of life. The effect on family member's stress level, quality of life, and mood and helpfulness of the music therapy session for the patient and self were studied. Recommendations about future patient participation in music therapy and qualitative comments were also solicited. Fifty family member/patient dyads participated in the study. Family member perceptions were positive, with 82% of responders indicating improvement for self and patient in stress, mood, and quality of life; 80% rating the session as extremely helpful; and 100% of 49 recommending further music therapy sessions for the patient. Patients reported statistically significant improvement in pain, depression, distress, and mood scores. Family members of patients in palliative medicine and hospice settings reported an immediate positive impact of music therapy on the patient and on themselves. More research needs to be conducted to better understand the benefits of music therapy for family members.

  1. Evaluation of prognosis and quality of life in patients with myocardial infarction by cardiac nuclear medicine

    International Nuclear Information System (INIS)

    Nakamura, Mototoshi; Kondo, Takesi; Tachiki, Syuichi

    1994-01-01

    The present study was designed to evaluate the value of cardiac nuclear medicine in the evaluation of prognosis and quality of life (QOL) in chronic stage in patients with myocardial infarction (MI). The subjects were 909 MI patients who were admitted to CCU and underwent Tl-201 myocardial imaging (n=593), Tc-99m PYP myocardial imaging (n=582) and gated blood pool imaging (n=577) and whose records were available concerning life or death as of January 23, 1992. On Tl-201 and Tc-99m PYP images, Tl-201 defect and abnormal uptake of Tc-99m PYP were visually interpreted as large, middle and small; and on gated blood pool images, less than 30% of ejection fraction (EF) was defined as severe, 30-50% of EF as moderate and 50% or more of EF as normal. Survival rate was low in the group of patients having large Tl-201 defect and Tc-99m PYP uptake. In addition, patients in this group tended to be resigned. The presence or absence of right ventricular infarction on PYP images and the severity of Parkey's classification were independent upon survival rate. Survival rate was significantly lower in the group of patients unable to receive cardiac nuclear medicine than in the group of patients receiving it. Cardiac nuclear medicine performed in the subacute phase was considered useful in evaluating prognosis of MI patients and QOL in the chronic phase. (N.K.)

  2. Traditional Chinese Medicine Use among Patients with Psoriasis in Taiwan: A Nationwide Population-Based Study

    Directory of Open Access Journals (Sweden)

    Shu-Wen Weng

    2016-01-01

    Full Text Available Traditional Chinese medicine (TCM has long been used for patients with psoriasis. This study aimed to investigate TCM usage in patients with psoriasis. We analyzed a cohort of one million individuals representing the 23 million enrollees randomly selected from the National Health Insurance Research Database in Taiwan. We identified 28,510 patients newly diagnosed with psoriasis between 2000 and 2010. Among them, 20,084 (70.4% patients were TCM users. Patients who were female, younger, white-collar workers and lived in urbanized area tended to be TCM users. The median interval between the initial diagnosis of psoriasis to the first TCM consultation was 12 months. More than half (N=11,609; 57.8% of the TCM users received only Chinese herbal medicine. Win-qing-yin and Bai-xian-pi were the most commonly prescribed Chinese herbal formula and single herb, respectively. The core prescription pattern comprised Mu-dan-pi, Wen-qing-yin, Zi-cao, Bai-xian-pi, and Di-fu-zi. Patients preferred TCM than Western medicine consultations when they had metabolic syndrome, hepatitis, rheumatoid arthritis, alopecia areata, Crohn’s disease, cancer, depression, fatty liver, chronic airway obstruction, sleep disorder, and allergic rhinitis. In conclusion, TCM use is popular among patients with psoriasis in Taiwan. Future clinical trials to investigate its efficacy are warranted.

  3. Modes of Embodiment in Breast Cancer Patients Using Complementary and Alternative Medicine

    DEFF Research Database (Denmark)

    Salamonsen, Anita; Kruse, Tove Elisabeth; Eriksen, Sissel H.

    2012-01-01

    Breast cancer patients are frequent users of complementary and alternative medicine (CAM). They often have complex reasons for, and experiences from, their use of CAM. Bodily experiences are important and almost unexplored elements in CAM use. Our aim was to explore the meaning and importance...

  4. Systems biology guided by Chinese medicine reveals new markers for sub-typing rheumatoid arthritis patients

    NARCIS (Netherlands)

    Wietmarschen, H. van; Yuan, K.; Lu, C.; Gao, P.; Wang, J.; Xiao, C.; Yan, X.; Wang, M.; Schroën, J.; Lu, A.; Xu, G.; Greef, J. van der

    2009-01-01

    BACKGROUND: Complex chronic diseases such as rheumatoid arthritis have become a major challenge in medicine and for the pharmaceutical industry. New impulses for drug development are needed. OBJECTIVE: A systems biology approach is explored to find subtypes of rheumatoid arthritis patients enabling

  5. The value of an information leaflet for patients having nuclear medicine investigations

    International Nuclear Information System (INIS)

    Ahmed, Susan Mohamed; Mohammed, Nada Yousif; Elhasseen, Amna Elnour

    2001-01-01

    This research aimed at design an information leaflet about nuclear medicine investigations usually done at the radiation and isotopes centre of Khartoum (RICK). The objectives are: to confirm lack of knowledge among patients attending hospital, to find out kind of information required and to improve service quality

  6. Traditional herbal medicine use among hypertensive patients in sub-Saharan Africa: a systematic review.

    Science.gov (United States)

    Liwa, Anthony C; Smart, Luke R; Frumkin, Amara; Epstein, Helen-Ann B; Fitzgerald, Daniel W; Peck, Robert N

    2014-06-01

    Hypertension is increasingly common in sub-Saharan Africa, and rates of hypertension control are low. Use of traditional herbal medicines (THM) is common among adults in sub-Saharan Africa and may affect hypertension therapy. We searched Ovid MEDLINE, Ovid EMBASE, and Web of Knowledge in June 2013 to find studies about THM use among hypertensive patients living in sub-Saharan Africa. Two independent reviewers evaluated titles and abstracts. Qualifying references were reviewed in full text. Data were extracted using a standardized questionnaire. Four hundred and eighty-one references were retrieved, and four articles from two countries met criteria for inclusion. The prevalence of THM use was 25-65% (average 38.6%). THM was the most common type of complementary and alternative medicines used by patients (86.7-96.6%). Among THM users, 47.5% concomitantly used both allopathic medicine and THM. Increased age (phistory of hypertension (OR 1.78) were positively associated with THM use, while belief that hypertension is preventable was negatively associated with THM use (OR 0.57). More than one-third of adults with hypertension in sub-Saharan Africa use THM. Half of these patients use THM concurrently with allopathic medicine. Healthcare workers in sub-Saharan Africa must discuss THM use with their hypertensive patients. More research is urgently needed to define the impact of THM use on hypertension control and outcomes in sub-Saharan Africa.

  7. The ethics of bringing Regenerative Medicine to patients: the example of orthopedics

    NARCIS (Netherlands)

    Niemansburg, S.L.

    2015-01-01

    The translation of Regenerative medicine (RM) technologies, such as cell-based interventions, biomaterials, and tissue engineering, to patients is increasingly considered. RM is an umbrella term for the research and clinical applications that share the scientific aspiration to restore the original

  8. Patients Whose GP Knows Complementary Medicine Have Lower Costs and Live Longer

    NARCIS (Netherlands)

    Kooreman, P.; Baars, E.

    2010-01-01

    A small fraction of general practitioners (GPs) in the Netherlands has completed additional training in complementary medicine after obtaining their conventional medical degree. Using a data set from a health insurer, this paper documents that patients whose GP has additional training in

  9. Emergency department patient characteristics: Potential impact on emergency medicine residency programs in the Netherlands.

    NARCIS (Netherlands)

    Elshove-Bolk, J.; Mencl, F.; Rijswijck, B.T. van; Weiss, I.M.; Simons, M.P.; Vugt, A.B. van

    2006-01-01

    OBJECTIVES: We set out to study emergency department patient characteristics at a busy level-2 trauma center, to gain insight into the practise of emergency medicine, which is not yet recognized as a specialty in the Netherlands. METHODS: From May 27 to July 4 2001, the following data were recorded

  10. Elderly patient refractory to multiple pain medications successfully treated with integrative East–West medicine

    Directory of Open Access Journals (Sweden)

    Bill Tu

    2008-07-01

    Full Text Available Bill Tu, Michael Johnston, Ka-Kit HuiUCLA Center for East–West Medicine, Department of Internal Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA, USABackground: Polypharmacy is a common and serious problem in the elderly today. Few solutions have been effective in reducing its incidence.Case summary: An 87-year-old female with a history of osteoarthritis and spinal stenosis presented with a five month history of severe right hip pain. She had been seen by multiple specialists and hospitalized many times. During these encounters, she was prescribed a long list of pain medications. However, these medications did not improve her pain and added to her risk of adverse drug events. After exhausting traditional Western medical therapies, she received a referral to the UCLA Center for East–West Medicine. There, clinicians treated her with a nonpharmacological integrative East-West medicine approach that included acupuncture, dry needling of trigger points, and education on self-acupressure. Her pain began improving and she was able to cut back on analgesic use under physician supervision. Ultimately, she improved to the point where she was able to discontinue all of her pain medications. Symptomatic relief was evidenced by improvement in health-related quality of life (HRQOL.Conclusions: This case study suggests that integrative East–West medicine may have the potential to reduce the incidence of polypharmacy in elderly patients presenting with pain conditions and improve their quality of life.Keywords: polypharmacy, pain, osteoarthritis, acupuncture, complementary and alternative medicine, integrative medicine, adverse drug reaction, elderly

  11. Complementary and Alternative Medicine Use Among Patients With Chronic Kidney Disease and Kidney Transplant Recipients.

    Science.gov (United States)

    Osman, Noha A; Hassanein, Safaa M; Leil, Marwa M; NasrAllah, Mohamed M

    2015-11-01

    To explore and compare complementary and alternative medicine (CAM) practice among subsets of patients with chronic kidney disease (CKD) and renal allograft recipients. Cross-sectional survey questionnaire. Three outpatient nephrology clinics and dialysis centers in Egypt. A total of 1005 subjects were included in the study (560 predialyis patients with CKD 3-4, 245 patients on hemodialysis, and 200 transplant recipients). Face to face interview with CKD patients. The survey inquired about epidemiological data, types, sources, and patterns of CAM used as well as the effect of CAM use on the patients' interaction with modern medicine and clinical caregivers. (1) Prevalence and types of CAM used by CKD patients; (2) Associations and correlates of CAM use including epidemiological features, impact of CAM use on adherence to conventional treatment and interaction of the users with modern medical systems; (3) Differences in CAM practice between subsets of CKD patients viz. hemodialysis patients, CKD 3-4, and transplant recipients. Overall, 522 patients (52%) were using CAM (64% of predialyis patients, 33% of dialysis patients, and 40.5% of transplant recipients, P transplant recipients were more likely to report P Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

  12. [Pharmacotherapy follow-up for patients admitted to the Internal Medicine Department of Hospital Infanta Margarita].

    Science.gov (United States)

    Campos Vieira, N; Bicas Rocha, K; Calleja Hernández, M A; Faus Dáder, M J

    2004-01-01

    In pharmacotherapeutic follow-up a pharmacist is responsible for drug-related patient needs (DRPN) by detecting, preventing and solving medication-related problems aiming at specific results to improve patient quality of life. Drug-related problems are pharmacotherapy failures leading to failed therapeutic goals or undesirable events. In this study, Daders methodology for pharmacotherapeutic follow-up was used in patients admitted to the Internal Medicine Department of Hospital Infanta Margarita, Cabra-Córdoba, Spain. In all, 85 DRPNs (2.7 DRPNs per patient) were identified, and 36 pharmaceutical procedures were performed, with physicians accepting 92% of said procedures. Forty-nine percent of drug-related problems were related to need, 40% to effectiveness, and 11% to safety. The presence of a pharmacist at the Internal Medicine Department allows the detection of DRPNs that are mostly related to need and effectiveness. Pharmaceutical procedures are widely accepted by medical teams.

  13. Health Anxiety Levels in Patients Admitted to Internal Medicine Outpatient Clinic for Several Times

    Directory of Open Access Journals (Sweden)

    Ali Gul

    2014-12-01

    Full Text Available Aim: Health anxiety (HA in patients consist of incorrect reference to normal bodily sensations as a signs of a serious disease. The aim of this study is to investigate the HA in patients admitted to internal medicine outpatient clinic for several times within one year. Material and Method: 60 patients who admitted more than one time to internal medicine outpatient clinic within one year and the control group consisted of 60 people were enrolled in this study. Short-form of health anxiety inventory (SAE-KF was given to these groups, The results were compared statistically. Results: SAE-KF scores were significantly higher in the patient group (11.17 ± 6.07 than the control group (10.71±4.44 (Z=-5.96, P

  14. How often do patients in primary care use the methods of traditional medicine

    Directory of Open Access Journals (Sweden)

    Petrov-Kiurski Miloranka

    2014-01-01

    Full Text Available Introduction: Traditional medicine is a comprehensive system of theory and practice, implemented in the prevention, diagnostics and treatment of diseases, which utilizes preparations of vegetable, animal and mineral origin, as well as methods of spiritual therapy Objective: 1. To estimate how many patients in primary care use traditional medicine for diagnostics, treatment and prevention of diseases, and to establish possible differences regarding gender, age and urban or rural location. 2. What methods of traditional medicine are the most often used, and for which diseases and conditions? 3. Why did the subjects opted for this type of treatment, and what was the effect of the therapy? Method: Multicentric research based on interviewing patients in five outpatient health centers in Serbia. As a survey instrument was used a questionnaire with 10 questions. Results: The study included 1157 subjects, 683 women and 474 men, mean age 60.22±14.54, The traditional medicine was used by 83.66% (79.96% males and 86.245% females. Information about the methods of traditional medicine subjects usually received from their friends and acquaintances (54.9% and the media (39.3%. There is no significant difference in the way of obtaining information in relation to gender. Information on the internet was obtained more often in subjects younger than 65 (p=0.000 and in urban population (p=0.000. The same is true for information obtained from doctor or pharmacist (p=0.003. They opted for this method because in their opinion it is less harmful and have less adverse effects (72.8%. This type of treatment patients used for treatment of muscles, bone and joint diseases - 28.5%, diseases of the heart and blood vessels -21,1 %, and for the treatment of pain 19.7%. Patients from rural areas more often used traditional medicine for treatment of cardiovascular diseases (p=0.000. Outcome of treatment was good or satisfactory in 45.3%, moderate in 32%, and in 15.8% effect was

  15. Readability of sports medicine-related patient education materials from the American Academy of Orthopaedic Surgeons and the American Orthopaedic Society for Sports Medicine.

    Science.gov (United States)

    Ganta, Abhishek; Yi, Paul H; Hussein, Khalil; Frank, Rachel M

    2014-04-01

    Although studies have revealed high readability levels of orthopedic patient education materials, no study has evaluated sports medicine-related patient education materials. We conducted a study to assess the readability of sports medicine-related patient education materials from the American Academy of Orthopaedic Surgeons (AAOS) and the American Orthopaedic Society for Sports Medicine (AOSSM). All sports medicine patient education articles available online in 2012 from the AAOS and the AOSSM, including the Stop Sports Injuries Campaign (STOP), were identified, and their readability was assessed with the Flesch-Kinkaid (FK) readability test. Mean overall FK grade level of the 170 articles reviewed (104 from AAOS, 36 from AOSSM, 30 from STOP) was 10.2. Mean FK levels for the 3 sources were 9.5 (AAOS), 11.0 (AOSSM), and 11.5 (STOP) (P = .16). Fifteen (8.8%) of the 170 articles had a readability level at or below eighth grade (average reading level of US adults); only 2 (1.2%) of the 170 articles were at or below the recommended sixth-grade level. The majority of sports medicine-related patient education materials from AAOS and AOSSM had reading levels higher than recommended, indicating that the majority of the patient population may find it difficult to comprehend these articles.

  16. Moving towards patient-centered medicine for COPD management: multidimensional approaches versus phenotype-based medicine--a critical view.

    Science.gov (United States)

    Lopez-Campos, Jose Luis; Bustamante, Víctor; Muñoz, Xavier; Barreiro, Esther

    2014-09-01

    For decades, chronic obstructive pulmonary disease (COPD) has been considered a relentlessly progressive disease in which the deterioration of lung function is associated with an increase in symptoms, interrupted only by periods of exacerbation. However, this paradigm of COPD severity based on FEV1 has been challenged by currently available evidence. So far, three main approaches, though with contradictory aspects, have been proposed in order to address the complexity of COPD as well as to develop appropriate diagnostic, prognostic and therapeutic strategies for the disease: 1) the use of independent, clinically relevant variables, 2) the use of multidimensional indices, and 3) disease approaches based on clinical phenotypes. Multivariable systems seem superior to FEV1 in predicting prognosis and defining disease severity. However, selection of variables available from current literature must be confronted with issues of medical practice. Future evidence will be needed to reveal their effective relationship with disease long-term prognosis and to demonstrate the most adequate cutoff values to be used in clinical settings. Multidimensional scores provide a good prognostic instrument for the identification of patients with a particular degree of disease severity. Clinical phenotyping can help clinicians identify the patients who respond to specific pharmacological interventions; however, there is some controversy about the phenotypes to select and their long-term implications. Although these approaches are not perfect, they represent the first step towards patient-centered medicine for COPD. In the near-future, these different approaches should converge towards one new field to focus on the better management of COPD patients.

  17. [Personalized molecular medicine: new paradigms in the treatment of cochlear implant and cancer patients].

    Science.gov (United States)

    Zenner, H P; Pfister, M; Friese, N; Zrenner, E; Röcken, M

    2014-07-01

    To evaluate present options for the indication of cochlear implants (CI) and new forms of treatment for head and neck cancer, melanomas and basal cell carcinomas, with emphasis on future perspectives. A literature search was performed in the PubMed database. Search parameters were "personalized medicine", "individualized medicine" and "molecular medicine". Personalized medicine based on molecular-genetic evaluation of functional proteins such as otoferlin, connexin 26 and KCNQ4 or the Usher gene is becoming increasingly important for the indication of CI in the context of infant deafness. Determination of HER2/EGFR mutations in the epithelial growth factor receptor (EGFR) gene may be an important prognostic parameter for therapeutic decisions in head and neck cancer patients. In basal cell carcinoma therapy, mutations in the Hedgehog (PCTH1) and Smoothened (SMO) pathways strongly influence the indication of therapeutic Hedgehog inhibition, e.g. using small molecules. Analyses of c-Kit receptor, BRAF-600E and NRAS mutations are required for specific molecular therapy of metastasizing melanomas. The significant advances in the field of specific molecular therapy are best illustrated by the availability of the first gene therapeutic procedures for treatment of RPE65-induced infantile retinal degradation. The aim of personalized molecular medicine is to identify patients who will respond particularly positively or negatively (e.g. in terms of adverse side effects) to a therapy using the methods of molecular medicine. This should allow a specific therapy to be successfully applied or preclude its indication in order to avoid serious adverse side effects. This approach serves to stratify patients for adequate treatment.

  18. Estimated Organ Doses to Patients from Diagnostic Nuclear Medicine Examinations over Five Decades: 1960-2010.

    Science.gov (United States)

    Villoing, Daphnée; Drozdovitch, Vladimir; Simon, Steven L; Kitahara, Cari M; Linet, Martha S; Melo, Dunstana R

    2017-12-01

    Ionizing radiation exposure to the general U.S. population nearly doubled between 1980 and 2006, due almost entirely to the significant increase in the number of radiologic and nuclear medicine procedures performed. Significant changes in the types of procedures and radionuclides used in nuclear medicine, as well as in detection technology, have led to notable changes over time in absorbed doses to specific organs. This study is the first to estimate per-procedure organ doses to nuclear medicine patients and trends in doses over five decades. Weighted average organ doses per examination to 14 organs of interest were calculated for 17 examination types over 10 5-y time periods (1960-2010) as the product of the percentage of use of each radiopharmaceutical in those diagnostic procedures based on comprehensive literature review, the administered activity, and ICRP dose coefficients; doses per radiopharmaceutical were also provided for each organ, procedure, and time period. The weighted doses to adult nuclear medicine patients from cardiac procedures increased to all organs of interest between 1960 and 2010 except for the urinary bladder wall. From high radiation doses for most other procedures in the 1960s, with up to 0.7 Gy in the specific case of radioiodinated thyroid scans, organ-absorbed doses generally decreased from 1960 to 1990. In contrast, during the 1990s and 2000s, the weighted doses were gradually increased for some procedures, such as brain and skeleton scans. The increasing number of nuclear medicine procedures, specifically cardiac scans and changes in weighted doses, underscore the need to monitor exposure levels and radiation-related disease risks in nuclear medicine patients.

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

    Science.gov (United States)

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

    2015-01-01

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

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

    Science.gov (United States)

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

    2015-01-01

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

  1. A qualitative study of patient involvement in medicines management after hospital discharge: an under-recognised source of systems resilience.

    Science.gov (United States)

    Fylan, Beth; Armitage, Gerry; Naylor, Deirdre; Blenkinsopp, Alison

    2017-11-16

    There are risks to the safety of medicines management when patient care is transferred between healthcare organisations, for example, when a patient is discharged from hospital. Using the theoretical concept of resilience in healthcare, this study aimed to better understand the proactive role that patients can play in creating safer, resilient medicines management at a common transition of care. Qualitative interviews with 60 cardiology patients 6 weeks after their discharge from 2 UK hospitals explored patients' experiences with their discharge medicines. Data were initially subjected to an inductive thematic analysis and a subsequent theory-guided deductive analysis. During interviews 23 patients described medicines management resilience strategies in two main themes: identifying system vulnerabilities; and establishing self-management strategies. Patients could anticipate problems in the system that supplied them with medicines and took specific actions to prevent them. They also identified when errors had occurred both before and after medicines had been supplied and took corrective action to avoid harm. Some reported how they had not foreseen problems or experienced patient safety incidents. Patients recounted how they ensured information about medicines changes was correctly communicated and acted upon, and described their strategies to enhance their own reliability in adherence and resource management. Patients experience the impact of vulnerabilities in the medicines management system across the secondary-primary care transition but many are able to enhance system resilience through developing strategies to reduce the risk of medicines errors occurring. Consequently, there are opportunities-with caveats-to elicit, develop and formalise patients' capabilities which would contribute to safer patient care and more effective medicines management. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights

  2. An Investigation of the Use of Traditional Chinese Medicine in Stroke Patients in Taiwan

    Directory of Open Access Journals (Sweden)

    Chien-Chang Liao

    2012-01-01

    Full Text Available Background. The use of complementary and alternative medicine in critical illness is increasing worldwide. This study investigates how traditional Chinese medicine (TCM is used in stroke patients. Methods. Using Taiwan National Health Insurance reimbursement claims, we compared the annual use of TCM between stroke patients and general population, identifying 15,330 patients with a new onset of stroke in 2000–2009. The sociodemographic status and medical comorbidities between stroke patients receiving TCM services and those without using the service were compared. Results. The use of TCM was higher in stroke patients than in the general population, 27.9% versus 25.4% in 2000 and 32.7% versus 27.8% in 2009, respectively, and grew consistently from 2000 to 2009. Among stroke patients, women, younger patients, white-collar employees, higher-income residents, and those living in areas with more TCM physicians were more likely to use TCM. Stroke patients using rehabilitation services were more likely to have more TCM visits (OR = 2.28, 95% CI = 1.96–2.66 and higher expenditure on TCM (OR = 2.67, 95% CI = 2.29–3.12 compared with stroke patients without rehabilitation. Conclusion. TCM is popular and well accepted in Taiwan. Patients with stroke have a higher TCM utilization rate than people without stroke.

  3. A question-answer pair (QAP) database integrated with websites to answer complex questions submitted to the Regional Medicines Information and Pharmacovigilance Centres in Norway (RELIS): a descriptive study.

    Science.gov (United States)

    Schjøtt, Jan; Reppe, Linda A; Roland, Pål-Didrik H; Westergren, Tone

    2012-01-01

    To assess a question-answer pair (QAP) database integrated with websites developed for drug information centres to answer complex questions effectively. Descriptive study with comparison of two subsequent 6-year periods (1995-2000 and 2001-2006). The Regional Medicines Information and Pharmacovigilance Centres in Norway (RELIS). A randomised sample of QAPs from the RELIS database. Answer time in days compared with Mann-Whitney U test. Number of drugs involved (one, two, three or more), complexity (judgemental and/or patient-related or not) and literature search (none, simple or advanced) compared with χ(2) tests. 842 QAPs (312 from 1995 to 2000 and 530 from 2001 to 2006) were compared. The fraction of judgemental and patient-related questions increased (66%-75% and 54%-72%, respectively, p50% advanced) was similar in the two periods, but the fraction of answers referring to the RELIS database increased (13%-31%, p<0.01). Median answer time was reduced from 2 days to 1 (p<0.01), although the fraction of complex questions increased from the first to the second period. Furthermore, the mean number of questions per employee per year increased from 66 to 89 from the first to the second period. The authors conclude that RELIS has a potential to efficiently answer complex questions. The model is of relevance for organisation of drug information centres.

  4. A question–answer pair (QAP) database integrated with websites to answer complex questions submitted to the Regional Medicines Information and Pharmacovigilance Centres in Norway (RELIS): a descriptive study

    Science.gov (United States)

    Reppe, Linda A; Roland, Pål-Didrik H; Westergren, Tone

    2012-01-01

    Objective To assess a question–answer pair (QAP) database integrated with websites developed for drug information centres to answer complex questions effectively. Design Descriptive study with comparison of two subsequent 6-year periods (1995–2000 and 2001–2006). Setting The Regional Medicines Information and Pharmacovigilance Centres in Norway (RELIS). Participants A randomised sample of QAPs from the RELIS database. Primary outcome measure Answer time in days compared with Mann–Whitney U test. Secondary outcome measure Number of drugs involved (one, two, three or more), complexity (judgemental and/or patient-related or not) and literature search (none, simple or advanced) compared with χ2 tests. Results 842 QAPs (312 from 1995 to 2000 and 530 from 2001 to 2006) were compared. The fraction of judgemental and patient-related questions increased (66%–75% and 54%–72%, respectively, p50% advanced) was similar in the two periods, but the fraction of answers referring to the RELIS database increased (13%–31%, p<0.01). Median answer time was reduced from 2 days to 1 (p<0.01), although the fraction of complex questions increased from the first to the second period. Furthermore, the mean number of questions per employee per year increased from 66 to 89 from the first to the second period. Conclusions The authors conclude that RELIS has a potential to efficiently answer complex questions. The model is of relevance for organisation of drug information centres. PMID:22422916

  5. Interest in Integrative Medicine Among Postmenopausal Hormone Receptor-Positive Breast Cancer Patients in the EvAluate-TM Study.

    Science.gov (United States)

    Hack, Carolin C; Fasching, Peter A; Fehm, Tanja; de Waal, Johann; Rezai, Mahdi; Baier, Bernd; Baake, Gerold; Kolberg, Hans-Christian; Guggenberger, Martin; Warm, Mathias; Harbeck, Nadia; Wuerstlein, Rachel; Deuker, Jörg-Uwe; Dall, Peter; Richter, Barbara; Wachsmann, Grischa; Brucker, Cosima; Siebers, Jan W; Fersis, Nikos; Kuhn, Thomas; Wolf, Christopher; Vollert, Hans-Walter; Breitbach, Georg-Peter; Janni, Wolfgang; Landthaler, Robert; Kohls, Andreas; Rezek, Daniela; Noesslet, Thomas; Fischer, Gunnar; Henschen, Stefan; Praetz, Thomas; Heyl, Volker; Kühn, Thorsten; Krauss, Thomas; Thomssen, Christoph; Hohn, Andre; Tesch, Hans; Mundhenke, Christoph; Hein, Alexander; Rauh, Claudia; Bayer, Christian M; Jacob, Adib; Schmidt, Katja; Belleville, Erik; Hadji, Peyman; Brucker, Sara Y; Wallwiener, Diethelm; Kümmel, Sherko; Beckmann, Matthias W; Paepke, Daniela

    2017-06-01

    Breast cancer patients often use complementary and alternative medicine, but few prospectively collected data on the topic are available specifically for postmenopausal breast cancer patients. A large prospective study was therefore conducted within a noninterventional study in order to identify the characteristics of patients interested in integrative medicine. The EvAluate-TM study is a prospective, multicenter noninterventional study in which treatment with the aromatase inhibitor letrozole was evaluated in postmenopausal women with hormone receptor-positive primary breast cancer. Between 2008 and 2009, 5045 postmenopausal patients were enrolled at 339 certified breast centers in Germany. As part of the data collection process, patients were asked at the baseline about their interest in and information needs relating to integrative medicine. Of the 5045 patients recruited, 3411 responded to the questionnaire on integrative medicine and took part in the analysis, 1583 patients expressed an interest in integrative medicine, and 1828 patients declared no interest. Relevant predictors of interest in integrative medicine were age, body mass index, tumor size, previous chemotherapy, and use of concomitant medications for other medical conditions. Interest in integrative medicine declined highly significantly ( P 65 years, 38.0%). Patients in favor of integrative medicine were significantly less satisfied with the information received about individual treatments and antihormonal therapy. Patients with interest in integrative medicine were more often interested in rehabilitation and fitness, nutritional counseling, and additional support from self-help organizations. These women were mostly interested in receiving information about their disease and integrative medicine from a physician, rather than from other sources. This study shows that a considerable proportion of postmenopausal breast cancer patients are interested in integrative medicine. Information about

  6. Interest in Integrative Medicine Among Postmenopausal Hormone Receptor–Positive Breast Cancer Patients in the EvAluate-TM Study

    Science.gov (United States)

    Hack, Carolin C.; Fasching, Peter A.; Fehm, Tanja; de Waal, Johann; Rezai, Mahdi; Baier, Bernd; Baake, Gerold; Kolberg, Hans-Christian; Guggenberger, Martin; Warm, Mathias; Harbeck, Nadia; Wuerstlein, Rachel; Deuker, Jörg-Uwe; Dall, Peter; Richter, Barbara; Wachsmann, Grischa; Brucker, Cosima; Siebers, Jan W.; Fersis, Nikos; Kuhn, Thomas; Wolf, Christopher; Vollert, Hans-Walter; Breitbach, Georg-Peter; Janni, Wolfgang; Landthaler, Robert; Kohls, Andreas; Rezek, Daniela; Noesslet, Thomas; Fischer, Gunnar; Henschen, Stefan; Praetz, Thomas; Heyl, Volker; Kühn, Thorsten; Krauss, Thomas; Thomssen, Christoph; Hohn, Andre; Tesch, Hans; Mundhenke, Christoph; Hein, Alexander; Rauh, Claudia; Bayer, Christian M.; Jacob, Adib; Schmidt, Katja; Belleville, Erik; Hadji, Peyman; Brucker, Sara Y.; Wallwiener, Diethelm; Kümmel, Sherko; Beckmann, Matthias W.; Paepke, Daniela

    2016-01-01

    Background. Breast cancer patients often use complementary and alternative medicine, but few prospectively collected data on the topic are available specifically for postmenopausal breast cancer patients. A large prospective study was therefore conducted within a noninterventional study in order to identify the characteristics of patients interested in integrative medicine. Methods. The EvAluate-TM study is a prospective, multicenter noninterventional study in which treatment with the aromatase inhibitor letrozole was evaluated in postmenopausal women with hormone receptor–positive primary breast cancer. Between 2008 and 2009, 5045 postmenopausal patients were enrolled at 339 certified breast centers in Germany. As part of the data collection process, patients were asked at the baseline about their interest in and information needs relating to integrative medicine. Results. Of the 5045 patients recruited, 3411 responded to the questionnaire on integrative medicine and took part in the analysis, 1583 patients expressed an interest in integrative medicine, and 1828 patients declared no interest. Relevant predictors of interest in integrative medicine were age, body mass index, tumor size, previous chemotherapy, and use of concomitant medications for other medical conditions. Interest in integrative medicine declined highly significantly (P 65 years, 38.0%). Patients in favor of integrative medicine were significantly less satisfied with the information received about individual treatments and antihormonal therapy. Patients with interest in integrative medicine were more often interested in rehabilitation and fitness, nutritional counseling, and additional support from self-help organizations. These women were mostly interested in receiving information about their disease and integrative medicine from a physician, rather than from other sources. Conclusions. This study shows that a considerable proportion of postmenopausal breast cancer patients are interested in

  7. Views of new internal medicine faculty of their preparedness and competence in physician-patient communication.

    Science.gov (United States)

    Mueller, Paul S; Barrier, Patricia A; Call, Timothy G; Duncan, Alan K; Hurley, Daniel L; Multari, Adamarie; Rabatin, Jeffrey T; Li, James T C

    2006-05-26

    We sought to assess self-rated importance of the medical interview to clinical practice and competence in physician-patient communication among new internal medicine faculty at an academic medical center. Since 2001, new internal medicine faculty at the Mayo Clinic College of Medicine (Rochester, Minnesota) have completed a survey on physician-patient communication. The survey asks the new faculty to rate their overall competence in medical interviewing, the importance of the medical interview to their practice, their confidence and adequacy of previous training in handling eight frequently encountered challenging communication scenarios, and whether they would benefit from additional communication training. Between 2001 and 2004, 75 general internists and internal medicine subspecialists were appointed to the faculty, and of these, 58 (77%) completed the survey. The faculty rated (on a 10-point scale) the importance of the medical interview higher than their competence in interviewing; this difference was significant (average +/- SD, 9.4 +/- 1.0 vs 7.7 +/- 1.2, P communication scenario, the new faculty rated the adequacy of their previous training in handling the scenario relatively low. A majority (57%) said they would benefit from additional communication training. Although new internal medicine faculty rate high the importance of the medical interview, they rate their competence and adequacy of previous training in medical interviewing relatively low, and many indicate that they would benefit from additional communication training. These results should encourage academic medical centers to make curricula in physician-patient communication available to their faculty members because many of them not only care for patients, but also teach clinical skills, including communication skills, to trainees.

  8. The use of complementary and alternative medicine for patients with traumatic brain injury in Taiwan

    Directory of Open Access Journals (Sweden)

    Gau Bih-Shya

    2012-11-01

    Full Text Available Abstract Background The use of complementary and alternative medicine (CAM continues to increase in Taiwan. This study examined the use of CAM and beliefs about CAM as expressed by patients with traumatic brain injury (TBI in Taiwan. Methods TBI patients and their accompanying relatives were interviewed by using a structured questionnaire at an outpatient clinic in a medical center in northern Taiwan. Results A total of 101 patients with TBI participated in the study. Sixty-four (63% patients had used at least one form of CAM after sustaining TBI. CAM users had used an average of 2.72 forms of CAM after sustaining TBI. The most frequently used CAM category was traditional Chinese medicine (37; 57.8%, followed by folk and religious therapies (30; 46.9%, and dietary supplements (30; 46.9%. The majority of the patients (45; 70.3% did not report CAM use because they felt it was unnecessary to do so. Patients who used CAM had a significantly stronger positive belief in CAM than those who did not (t = −2.72; P = .008. After using CAM, most of the patients (54; 85% perceived moderate satisfaction (2.89 ± 0.44, according to a 4-point Likert scale. Conclusion Although the use of CAM is common for TBI patients receiving conventional medical health care in Taiwan, most patients did not inform health care personnel about their CAM use. TBI patients perceive combined use of CAM and conventional medicine as beneficial for their overall health.

  9. Use of complementary and alternative medicine by Korean patients with Parkinson's disease.

    Science.gov (United States)

    Kim, Sung R; Lee, Tai Y; Kim, Mi S; Lee, Myoung C; Chung, Sun J

    2009-02-01

    Many patients with Parkinson's disease (PD) often utilize complementary and alternative medicine (CAM). We aimed to survey the prevalence, spectrum of use, and factors related to utilization of CAM in patients with PD in Korea. Between 15 December 2005 and 30 April 2006, we studied 123 patients with PD who volunteered to be interviewed using semi-structured questionnaires. Ninety-four (76%) patients had used CAM. The mean cost of CAM paid by patients (out-of-pocket costs) was 102.3 US Dollars (USD) per month, while medical costs of treatment for PD paid by patients (out-of-pocket costs) averaged 72.8 USD per month. Patients using CAM sought to improve motor symptoms (57.6%), fatigue (19.6%), pain (4.3%), constipation (5.4%) or specified no single reason (13.0%). The spectrum of CAM use included oriental medicines (76.6%), traditional food (44.7%), non-prescribed drugs (31.9%), traditional therapies (7.4%), massage (7.4%) and behavioral therapy (7.4%). Factors related to current use of CAM were disease duration, degree of education, and daily levodopa equivalent dose. In a logistic regression analysis, the duration of PD was a significant factor for CAM use. These results suggest that a high proportion of Korean PD patients employed CAM, associated with high costs and serious side effects in some patients.

  10. Emergency department patient characteristics: Potential impact on emergency medicine residency programs in the Netherlands.

    Science.gov (United States)

    Elshove-Bolk, Jolande; Mencl, Francis; van Rijswijck, Bas T F; Weiss, Ilanit M; Simons, Maarten P; van Vugt, Arie B

    2006-12-01

    We set out to study emergency department patient characteristics at a busy level-2 trauma center, to gain insight into the practise of emergency medicine, which is not yet recognized as a specialty in the Netherlands. From May 27 to July 4 2001, the following data were recorded from the charts of all patients presenting to the emergency department: age, time and form of presentation, diagnostics, treatment, disposition and the single best diagnosis (International Classification of Disease-10 classification). The majority (84%) of the 5234 patients (134/day) patients seen were self-referred and treated by the emergency department physician. The remaining 16% were referred, usually by their general practitioner, directly to a specialty service, which saw them in the emergency department. Self-referred patients tended to be younger (average 33 years), with minor trauma, and infrequently required diagnostics (37%), treatment (49%) or admission (4%). The referred patients were older (average 50 years), with 41% needing admission. Only 16% of all patients were under 16 years of age. In all, there were five deaths (referred patients), 12 resuscitations, seven intubations, seven chest tube insertions and no lumbar punctures performed during the study period. The acuity of self-referred patients seen by the emergency physicians is low, with little diagnostic testing and few interventions and resuscitations, even in a busy center. This has both training and practise implications and it may be inappropriate to take an emergency medicine practise model or curriculum from another country based on its emergency department population.

  11. Characteristics and status of Korean medicine use in whiplash-associated disorder patients.

    Science.gov (United States)

    Kim, Nohyeon; Shin, Byung-Cheul; Shin, Joon-Shik; Lee, Jinho; Lee, Yoon Jae; Kim, Me-Riong; Hwang, Eui-Hyoung; Jung, Chan Yung; Ruan, Diana; Ha, In-Hyuk

    2018-04-06

    Patients are free to choose conventional or Korean medicine treatment under the dual medical system in Korea, and the prevalence of patients who choose Korean medicine treatment for whiplash-associated disorders (WADs) is high. This study analyzed the sociodemographic characteristics and medical service use in this population to provide healthcare providers with basic usage information of complementary and alternative medicine for WAD. A total of 8291 outpatients who registered under automobile insurance coverage and visited the main branch of Jaseng Hospital of Korean Medicine from April 1, 2014 to August 10, 2016 were included. Data on sociodemographic characteristics, symptoms, and accident and treatment-related details were collected from electronic medical records. Univariate and multivariate regression analyses were performed to identify baseline factors predictive of total treatment duration. The most prevalent demographic of patients who chose Korean medicine for WAD treatment was males in their thirties whose initial visit to the hospital was 16.1 ± 94.1 days from the accident. Neck pain accompanied by low back pain (57.0%) was the most common complaint, and for singular pain, neck pain (13.5%) was the most prevalent. Baseline numeric rating scale (NRS) pain levels were generally moderate (4-6) regardless of area. Patients received 7.2 ± 10.2 sessions of treatment for 32.6 ± 55.3 days. The most commonly prescribed treatment modalities in order of highest frequency were acupuncture, cupping, pharmacopuncture, and herbal medicine, which collectively accounted for > 90% of treatments. Acupuncture was administered 29.0 ± 40.8 times, and cupping 14.0 ± 18.7 times as the two highest frequency treatments. In multivariate regression analysis, longer treatment periods were found to be associated with higher NRS, older age, and delayed initial visits at baseline. This study highlights the characteristics and Korean medicine use of WAD

  12. [Personalized medicine in otology. The role of genetic diagnostics in patients with hearing impairment].

    Science.gov (United States)

    Friese, N; Braun, K; Müller, M; Tropitzsch, A

    2015-06-01

    Classification of diseases on the molecular level is the basis for personalized medicine. Personalized medicine proposes to improve efficiency and quality of care, to reduce side effects and to increase long-term cost-effectiveness. This paper is concerned with the role of genetic diagnostics in patients with a cochlear implant. A selective literature search in PubMed was performed. Genetic diagnosis allows ruling out syndromic hearing loss and thus prevents follow-up studies. It allows genetic counseling, prognosis and advice on family planning and targeted prevention. Due to its minimal invasiveness, it is suitable for evaluation of factors accounting for hearing loss in children. Molecular medicine plays a major role in the treatment of sensorineural hearings loss with cochlear implants.

  13. Complementary and alternative medicine use in patients with mental disorders in Turkey.

    Science.gov (United States)

    Bahceci, Bulent; Bagcioglu, Erman; Ozturk, Ahmet; Bulbul, Feridun; Sahiner, Ismail Volkan; Tuncer, Buket Eryonucu; Guzel, Halil İbrahim; Hocaoglu, Cicek

    2013-11-01

    The aim of this study was to determine the prevalence of complementary and alternative medicine (CAM) use and the associated socio-demographic factors among patients with mental disorders in the Turkish community. One thousand and twenty-seven patients with a diagnosis of mental disorders who were attending psychiatric outpatient clinics in five Turkish cities were interviewed. A survey questionnaire, which included questions on socio-demographic characteristics and CAM use, was administered face-to-face by psychiatrists. 22.2% of patients with mental disorders were using some form of CAM in the Turkish community. CAM and medication concurrent users had a higher level of education and income compared to CAM users only or medicine users only (p mental disorders should be investigated and taken into account by psychiatrists. Copyright © 2013 Elsevier Ltd. All rights reserved.

  14. [Nuclear medicine in radiotherapy planning for patients with malignant neoplasms of different locations].

    Science.gov (United States)

    Kanaev, S V; Novikov, S N; Girshovich, M M; Krivorot'ko, P V; Beĭnusov, D S; Krzhivitskiĭ, P I

    2012-01-01

    The performance of nuclear medicine methods in radiation therapy tactics determination was analyzed in patients receiving therapy for Hodgkin lymphoma (HL, n=556), breast cancer (BC, n=230), treatment-naive patients with non-small cell lung cancer (NSCLC, n=86). In HL patients the nuclear medicine methods were used to determine the irradiation fields for spleen irradiation (67%) and abdominal lymph nodes (27%). The bone marrow scan data had significant influence on radiation therapy tactics in 10-27% of cases. The visualization of primary tumor lymphatic drainage lead to changing the irradiation field topography in 75% cases of external BC and 85% of internal BC localization. Tumorotropic isotope mammal scan data lead to the changes in planned irradiation volume in 16% of BC patietns. In NSLC patients the results of "positive" scintigraphy with lipophilic 99mTc-marked cations lead to the change in irradiation tactics in 16% of cases. Therefore, the results of diagnostic investigations suggest the important role of nuclear medicine diagnostic methods in patients with various tumors of different localizations.

  15. What is it about homeopathy that patients value? and what can family medicine learn from this?

    Science.gov (United States)

    Schmacke, Norbert; Müller, Veronika; Stamer, Maren

    2014-01-01

    Homeopathy is one of the most frequently used areas of complementary and alternative medicine (CAM). Previous research has focused in particular on the pharmacological effectiveness of homeopathy. There is intense discussion among German family medical practitioners as to whether family medicine should adopt elements of homeopathy because of the popularity of this treatment method. For the first time in Germany, patients with chronic conditions were asked about their views on the medical care provided by homeopathic medical practitioners. The survey used questionnaire-based, semi-structured expert interviews, the contents of which were then analysed and summarised. A total of 21 women and five men aged from 29 to 75 years were surveyed. The 'fit' between therapist and patient proved to be particularly important. Both the initial homeopathic consultation and the process of searching for the appropriate medication were seen by patients as confidence-inspiring confirmations of the validity of homeopathic therapy which they considered desirable in this personalised form. The possible adoption by family medicine of elements of homeopathy may be seen as controversial, but this study again indicates the vital importance of successful communication to ensure a sustainable doctor-patient relationship. Advances in this sector not only require continuous efforts in the areas of medical training and professional development, but also touch on basic questions relating to the development of effective medical care, such as those currently being discussed in the context of the 'patient-centred medical home'.

  16. THE EFFECT OF HOMOEOPATHIC MEDICINES ON ANXIETY, DEPRESSION, WELL BEING AND PHYSICAL SIGNS AMONG PATIENTS WITH LOW BACK PAIN

    OpenAIRE

    Subhadra KT; Razeena Padmam

    2017-01-01

    To study whether there is any difference in the effect of homoeopathic medicines, placebo, homoeopathic medicines in combination with placebo on anxiety, depression, well being and physical signs among patients with pathological low back pain and somatoform low back pain. The sample consisted of 439 patients including patients with pathological low back pain and somatoform low back pain. The patients in these two category were further classified into three groups based on the type of interven...

  17. Internet availability and interest in patients at a family medicine residency clinic.

    Science.gov (United States)

    Fashner, Julia; Drye, Stephen T

    2011-02-01

    The Internet has affected the day-to-day lives of physicians, hospitals, and patients. The medical information for each is available at a moment's notice. We surveyed patients to see how many have access to the Internet and whether they are interested in using the Internet to communicate about their medical care. An anonymous one-page survey was given to patients over the age of 18 who had an office visit at the Family Medicine Center. A total of 258 of 300 surveys were returned. A majority of these patients have access to the Internet (80.6%). Patients were most interested in being able to receive appointment reminders by e-mail (44.6%), get answers to medical questions (41.9%), and schedule appointments online (41.5%). Patients would like to be active participants in their medical care electronically. We encourage other physicians to investigate what patients in their practice would consider a service to provide electronically.

  18. A clinical study of integrating acupuncture and Western medicine in treating patients with Parkinson's disease.

    Science.gov (United States)

    Chen, Fang-Pey; Chang, Ching-Mao; Shiu, Jing-Huei; Chiu, Jen-Hwey; Wu, Ta-Peng; Yang, Jen-Lin; Kung, Yen-Ying; Chen, Fun-Jou; Chern, Chang-Ming; Hwang, Shinn-Jang

    2015-01-01

    Complementary therapy with acupuncture for Parkinson's disease (PD) has been studied for quite a long time, but the effectiveness of the treatment still remains unclear. The aim of this study is to evaluate the integrated effects of acupuncture treatment in PD patients who received western medicine. In the short-term acupuncture treatment study, 20 patients received acupuncture therapy twice a week in acupoints DU 20, GB 20, LI 11, LI 10, LI 4, GB 31, ST 32, GB 34 and GB 38 along with western medicine for 18 weeks, and 20 controlled patients received western medicine only. In the long-term acupuncture treatment, 13 patients received acupuncture treatment twice a week for 36 weeks. The outcome parameters include Unified Parkinson's disease rating scale (UPDRS), Beck Anxiety Inventory (BAI), Beck Depression Inventory-Version 2 (BDI-II), and WHO quality of life (WHOQOL). In the short-term clinical trial, a higher percentage of patients in the acupuncture group had score improvement in UPDRS total scores (55% vs. 15%, p = 0.019), sub-score of mind, behavior and mood (85% vs. 25%, p vs. 15%, p = 0.003), mobility (40% vs. 15%, p = 0.155) and complication of treatment (75% vs. 15%, p vs. 35%, p = 0.003), and WHOQOL score (65% vs. 15%, p = 0.003) when compared to control group at the end of the 18 weeks' follow up. After 36 weeks of long-term acupuncture treatment, the mean UPDRS total scores and sub-score of mentation, behavior and mood, sub-score of complications of therapy and BDI-II score decreased significantly when compared to the pretreatment baseline. In conclusion, acupuncture treatment had integrated effects in reducing symptoms and signs of mind, behavior, mood, complications of therapy and depression in PD patients who received Western medicine.

  19. Conjunctival endogenous microbiota in patients submitted to cataract surgery Microbiota endógena conjuntival em pacientes submetidos à cirurgia de catarata

    Directory of Open Access Journals (Sweden)

    Claudete I. Locatelli

    2003-07-01

    Full Text Available Bacterial isolation, identification and antimicrobial susceptibility tests were carried out in ocular material collected with swab and polimethylmethacrylate (PMMA or silicone intraocular lenses (IOL from forty six patients submitted to cataract surgery. Seventy six isolates and seven different microorganisms were identified. Coagulase-negative staphylococci (CNS were the predominant microorganisms isolated from swabs (71.4% of cases, PMMA lenses (81.3% and silicon lenses (77.8%. Coagulase-negative staphylococci isolates revealed high resistance to penicillin G followed by tetracycline, chloramphenicol and aminoglicosides. However, these isolates displayed great susceptibility to vancomycin, cephalothin and ofloxacin. Except for penicillin G, Staphylococcus aureus was very sensitive to the antimicrobial agents including oxacillin. Among Gram-negatives, Proteus mirabilis was prevalent and presented high resistance to tetracycline and chloramphenicol. Enterococcus isolates were vancomycin sensitive.A partir de material ocular coletado de 46 pacientes submetidos à cirurgia de catarata foram realizados isolamento, identificação e teste de susceptibilidade de microrganismos frente a antimicrobianos, utilizando-se suabes e lentes intraoculares (LIO. Foram obtidos 76 isolados e identificados 7 tipos de microrganismos. Estafilococos coagulase-negativos (CNS foram os microrganismos mais freqüentemente detectados de suabes (71,4% dos casos, lentes de PMMA (81,3% e lentes de silicone (77,8%. Isolados de CNS apresentaram elevada resistência à penicilina G, seguida por tetraciclina, cloranfenicol e aminoglicosídeos. No entanto, estes isolados mostraram grande sensibilidade à vancomicina, cefalotina e ofloxacina. Com exceção da penicilina G, os isolados de Staphylococcus aureus foram bastante sensíveis aos agentes antimicrobianos, incluindo a oxacilina. Entre as gram-negativas, Proteus mirabilis foi a bactéria mais freqüente e também se mostrou

  20. Complementary medicine use in patients with head and neck cancer in Ireland.

    LENUS (Irish Health Repository)

    Amin, Mohamed

    2010-08-01

    The objectives of the study were: first, to determine the prevalence of traditional medicine (TM) and complementary and alternative medicine (CAM) use in head and neck cancer patients in Ireland; second, to educate ourselves on the plethora of CAM\\/TM options available to patients outside the dominion of conventional medicine. The study design consisted of a cross-sectional survey carried out in three head and neck cancer centres. Self-administered questionnaires were distributed to 110 head and neck cancer patients attending the three cancer centres and data were collected for statistical analysis. A total of 106 patients completed the questionnaire; 21.7% of the participants used CAM\\/TM since their diagnosis with head and neck cancer. CAM\\/TM usage was higher in female (34.3%) than in male patients (16.2%). CAM\\/TM use was more common in the 41-50-year age group, in patients with higher educational levels and those holding strong religious beliefs, and also in married than single patients. The most common types of CAM\\/TM used were spiritual and laying on of hands. The most common reasons reported for using CAM\\/TM were to counteract the ill effects of treatment and increase the body\\'s ability to fight cancer. Sources of information on CAM\\/TM were friends (65%), family (48%) and media (21%). This survey reveals a high prevalence of CAM\\/TM use in head and neck cancer patients, hence emphasising the need for otolaryngologists to educate themselves on the various therapies available to be able to provide informative advice. There is an urgent need for evidence-based investigation of various CAM\\/TM therapies currently offered to patients.

  1. Assessment of adherence to cardiovascular medicines in rural population: An observational study in patients attending a tertiary care hospital.

    Science.gov (United States)

    Santra, Gouranga

    2015-01-01

    Nonadherence to cardiovascular medicines is a major concern. It increases the morbidity and mortality of cardiovascular patients. The work was conducted to evaluate the adherence to cardiovascular medicines in patients of rural India. The study was conducted in the Department of Medicine involving rural patients with essential hypertension (HTN), congestive cardiac failure (CCF), and ischemic heart disease (IHD) over 12 months period. Patients were prescribed with cardiovascular medicines at the initial visit and adherence to medicines was assessed in the subsequent visit. Four items Morisky's Medication Adherence Scale (MMAS-4) was used for assessing medication adherence. Patients were considered adherent to medication if they answered negatively to all four questions. Overall adherence to medication was 20.83%, 28.37% and 32% in HTN, CCF, and IHD patients, respectively. Nonadherence was highest in patients of HTN. Among the four reasons of nonadherence assessed by MMAS-4, carelessness was the most common and forgetfulness was the least common cause of nonadherence in all the three groups of patients. Patients of rural India adhere poorly to cardiovascular medicines. Nonadherence should be considered as a public health problem. Strategies for detecting the level of adherence of cardiovascular medicines, its barriers, and subsequent interventions should be developed by policy-makers to reduce morbidity and mortality due to cardiovascular disorders.

  2. Treinamento muscular respiratório na revascularização do miocárdio Respiratory muscle training in patients submitted to coronary arterial bypass graft

    Directory of Open Access Journals (Sweden)

    Graziella Ferreira Barros

    2010-12-01

    Full Text Available OBJETIVOS: 1 Evidenciar a perda de capacidade ventilatória no período de pós-operatório, em pacientes submetidos à revascularização do miocárdio. 2 Testar a hipótese de que o treinamento muscular respiratório (TMR, realizado após a cirurgia, pode melhorar a capacidade ventilatória nessa população. MÉTODOS: Estudo randomizado, onde 38 pacientes (idade: 65 ± 7 anos, 29 masculinos, submetidos à revascularização miocárdica com circulação extracorpórea, foram divididos em dois grupos: 23 pacientes no grupo TMR e 15 no grupo controle (CO. O grupo TMR realizou fisioterapia convencional + TMR, o grupo CO realizou apenas fisioterapia convencional. Avaliaram-se, em três momentos (pré-operatório, primeiro dia de pós-operatório e alta hospitalar, as variáveis: pressões inspiratória e expiratória máximas (Pimáx e Pemáx, dor, dispneia (Borg, pico de fluxo expiratório (PFE, volume corrente e dias de internação. RESULTADOS: A Pimáx do grupo TMR foi maior no momento da alta (90 ± 26 vs. 55 ± 38 cmH2O, P=0,01, assim como a Pemáx (99 ± 30 vs. 53 ± 26 cmH2O, P=0,02. O PFE do grupo TMR foi maior após a internação (237 ± 93 vs. 157 ± 102 lpm, P=0,02. O volume corrente dos grupos foi também diferente no momento da alta (TMR: 0,71 ± 0,21 vs. CO: 0,44 ± 0,12 litros, P=0,00. Não houve diferenças entre os grupos com relação aos dias de internação, dispneia ou dor. CONCLUSÕES: Ocorre perda de força muscular respiratória em pacientes submetidos à revascularização miocárdica. O TMR, realizado no período pós-operatório, foi eficaz em restaurar os seguintes parâmetros: Pimáx, Pemáx, PFE e volume corrente, nessa população.OBJECTIVES: 1 To demonstrate the impaired ventilatory capacity during the post operatory period, in patients submitted to coronary arterial bypass graft surgery (CABG. 2 To test the hypothesis that the respiratory muscle training (RMT, performed after the surgery, may increase the

  3. Association of face-to-face handoffs and outcomes of hospitalized internal medicine patients.

    Science.gov (United States)

    Schouten, Will M; Burton, M Caroline; Jones, LaKisha D; Newman, James; Kashiwagi, Deanne T

    2015-03-01

    Failures in communication at the time of patient handoff have been implicated as contributing factors to preventable adverse events. Examine the relationship between face-to-face handoffs and the rate of patient outcomes, including adverse events. Retrospective cohort. A 1157-bed academic tertiary referral hospital. There were 805 adult patients admitted to general internal medicine services. Retrospective comparison of clinical outcomes, including the rate of adverse events, of patients whose care was transitioned with and without face-to-face handoffs. Rapid response team calls, code team calls, transfers to a higher level of care, death in hospital, 30-day readmission rate, length of stay, and adverse events (as identified using the Global Trigger Tool). There was no significant difference with respect to the frequency of rapid response team calls, code team calls, transfers to a higher level of care, deaths in hospital, length of stay, 30-day readmission rate, or adverse events between patients whose care was transitioned with or without a face-to-face handoff. Face-to-face handoff of patients admitted to general medical services at a large academic tertiary referral hospital was not associated with a significant difference in measured patient outcomes, including the rate of adverse events, compared to a non-face-to-face handoff. Additional study is needed to determine the qualities of patient handoff that optimize efficiency and safety. © 2015 Society of Hospital Medicine.

  4. Online Physician Reviews in Female Pelvic Medicine and Reconstructive Surgery: What Do Patients Really Want?

    Science.gov (United States)

    Asanad, Kian; Parameshwar, Pooja S; Houman, Justin; Spiegel, Brennan M; Daskivich, Timothy J; Anger, Jennifer T

    This study aimed to qualitatively analyze online reviews of Female Pelvic Medicine and Reconstructive Surgery (FPMRS) specialists to better understand patients' experiences and improve patient satisfaction. Fifty urologists and urogynecologists were randomly sampled from the Society of Urodynamics, Female Pelvic Medicine, and Urogenital Reconstruction membership website. We evaluated patient ratings and reviews of physicians from 4 websites: Yelp, Healthgrades, Vitals, and UCompareHealthCare. Qualitative data analysis was performed using grounded theory methodology, as described by Charmaz (Constructing Grounded Theory, 2014). Across the four websites, the mean number of stars per physician ranged from 3.6 to 4.1 and the mean number of reviews per physician ranged from 1.3 to 7.6. Qualitative analysis revealed several preliminary themes: patient-physician experience, medical and surgical treatment, office staff, and analysis of worth. Physicians who developed strong connections with patients through empathetic communication were likely to receive a positive review, regardless of wait times. Bedside manner was found to be multidimensional and included physician competence and understanding patients' concerns. Failure to meet several expectations led to dissatisfaction of care and negative patient reviews. Patients' perspectives of quality of care in FPMRS are weighted heavily toward establishing personal connections with physicians. Accurate diagnosis and effective management of urological conditions, especially after negative experiences with previous providers, were associated with satisfaction of care. It seems that the concept of good bedside manner is multifactorial and requires the provider to demonstrate not one but several different sets of communication skills.

  5. Patients' experience of Chinese Medicine Primary Care Services: Implications on Improving Coordination and Continuity of Care.

    Science.gov (United States)

    Chung, Vincent Ch; Yip, Benjamin Hk; Griffiths, Sian M; Yu, Ellen Lm; Liu, Siya; Ho, Robin St; Wu, Xinyin; Leung, Albert Wn; Sit, Regina Ws; Wu, Justin Cy; Wong, Samuel Ys

    2015-12-21

    Chinese medicine (CM) is major form of traditional and complementary medicine used by Chinese populations. Evaluation on patients' experience on CM service is essential for improving service quality. This cross sectional study aims (i) to assess how CM clinics with different administrative model differ in terms of quality from patients' perspective; and (ii) to investigate how quality varies with patients' demographic and health characteristics. Five hundred and sixteen patients were sampled from charity and semi-public CM clinics in Hong Kong, and were invited to assess their experience using the Primary Care Assessment Tool (PCAT). Results indicated that overall mean PCAT scoring is satisfactory, achieving 70.7% (91.26/129) of total score. Ratings were lower in areas of "coordination of patient information", "continuity of care", and "range of service provided". Impact of administrative models, including involvement of tax-funded healthcare system and outreach delivery, were minimal after adjusting for patient characteristics. Demographic and health characteristics of patients did not contribute to substantial variations in scoring. To improve patient experience, policy makers should consider strengthening care coordination, continuity and comprehensiveness in CM primary care services. Sharing of electronic records and establishing referral system are potential solutions for linking CM and conventional healthcare services.

  6. Prevalence, patterns, and perceived value of complementary and alternative medicine among HIV patients: a descriptive study.

    Science.gov (United States)

    Bahall, Mandreker

    2017-08-23

    Use of complementary and alternative medicine (CAM) is widespread among different patient populations despite the availability of evidence-based conventional medicine and lack of supporting evidence for the claims of most CAM types. This study explored the prevalence, patterns, and perceived value of CAM among human immunodeficiency virus (HIV) patients. This quantitative descriptive study was conducted between November 1, 2014 and March 31, 2015 among a cross-sectional, convenience sample of attendees of the HIV clinic of a public tertiary health care institution. Face-to-face interviews using a 34-item questionnaire were conducted. Data analysis included descriptive statistics, chi-square tests, and binary logistic regression analysis. CAM was used by 113 (32.8%) of a total of 343 HIV patients, but Medicinal herbs were the most common type of CAM used (n = 110, 97.3%) followed by spiritual therapy (n = 56, 49.6%), including faith healing/prayer and meditation. The most used medicinal herbs were Aloe vera (n = 54, 49.1%), ginger (n = 33, 30.0%), and garlic (n = 23, 20.9%). The most used vitamins were complex B vitamins (n = 70, 61.9%), followed by vitamin A (n = 58, 51.3%), vitamin E (n = 51, 45.1%), and vitamin D (n = 42, 37.1%). Most CAM users continued using conventional medicine in addition to CAM and were willing to use CAM without supervision and without informing their health care provider. Patients were generally satisfied with CAM therapy (n = 91, 80.5%). The main reasons for CAM use were the desire to take control of their treatment (8.8%) or just trying anything that could help (18.8%). Main influences were the mass media (32.7%) and non-hospital health personnel (19.5%). Predictors of CAM use were being 30-50 years, married and having a secondary school education. About one-third of HIV patients used CAM, but virtually none informed their healthcare provider. Medicinal herbs were the most common type of CAM, followed by spiritual

  7. [The SIAARTI consensus document on the management of patients with end-stage chronic organ failure. From evidence-based medicine to knowledge-based medicine].

    Science.gov (United States)

    Bertolini, Guido

    2014-01-01

    The management of patients with end-stage chronic organ failure is an increasingly important topic, since the extraordinary medical and technological advances have significantly reduced mortality and improved quality of life with prolonged survival of end-stage diseases. What should be the plan of care for these patients? Who should bear the responsibility for care? With what targets? These are crucial questions, to which modern medicine should provide convincing answers. The authors of the document explicitly resisted the temptation to draw up guidelines, showing that it is possible to customize medical intervention on the individual patient, keeping it tightly linked to the available knowledge. This is the most relevant aspect of the document: it goes beyond the classical concept of evidence-based medicine choosing to refer to the most dynamic knowledge-based medicine approach.

  8. The influence of patient's consciousness regarding high blood pressure and patient's attitude in face of disease controlling medicine intake.

    Science.gov (United States)

    Strelec, Maria Aparecida A Moura; Pierin, Angela M G; Mion, Décio

    2003-10-01

    To assess the relation between blood pressure control and the following: the Morisky-Green test, the patient's consciousness regarding high blood pressure, the patient's attitude in face of medicine intake, the patient's attendance at medical consultations, and the subjective physician's judgment. We studied 130 hypertensive patients with the following characteristics: 73% females, 60 +/- 11 years, 58% married, 70% white, 45% retired, 45% with incomplete elementary schooling, 64% had a familial income of 1 to 3 minimum wages, body mass index of 30 +/- 7 kg/m , consciousness regarding the disease for a mean period of 11 +/- 9.5 years, and mean treatment duration of 8 +/- 7 years. Only 35% of the hypertensive individuals had blood pressure under control and a longer duration of treatment (10 +/- 7 vs 7 +/- 6.5 years; Pface of medicine intake, the controlled patients achieved significantly higher scores than did the noncontrolled patients (8 +/- 1.9 vs 7 +/- 2, Pconsciousness regarding their disease and its treatment, and most (70%) patients attended 3 or 4 medical consultations, which did not influence blood pressure control. The physicians attributed significantly higher scores regarding adherence to treatment to controlled patients (6 +/- 0.8 vs 5 +/- 1.2; PConsciousness regarding the disease, the Morisky-Green test, and attendance to medical consultations did not influence blood pressure control.

  9. High prevalence of complementary and alternative medicine use in patients with genetically proven mitochondrial disorders.

    Science.gov (United States)

    Franik, Sebastian; Huidekoper, Hidde H; Visser, Gepke; de Vries, Maaike; de Boer, Lonneke; Hermans-Peters, Marion; Rodenburg, Richard; Verhaak, Chris; Vlieger, Arine M; Smeitink, Jan A M; Janssen, Mirian C H; Wortmann, Saskia B

    2015-05-01

    Despite major advances in understanding the pathophysiology of mitochondrial diseases, clinical management of these conditions remains largely supportive, and no effective treatment is available. We therefore assumed that the burden of disease combined with the lack of adequate treatment leaves open a big market for complementary and alternative medicine use. The objective of this study was to evaluate the use and perceived effectiveness of complementary and alternative medicine in children and adults with genetically proven mitochondrial disease. The reported use was surprisingly high, with 88% of children and 91% of adults having used some kind of complementary and alternative medicine in the last 2 years. Also, the mean cost of these treatments was impressive, being 489/year for children and 359/year for adult patients. Over-the-counter remedies (e.g., food supplements, homeopathy) and self-help techniques (e.g., Reiki, yoga) were the most frequently used complementary and alternative therapies in our cohort: 54% of children and 60% of adults reported the various complementary and alternative medicine therapies to be effective. Given the fact that currently no effective treatment exists, further research toward the different therapies is needed, as our study clearly demonstrates that such therapies are highly sought after by affected patients.

  10. Rectal dose assessment in patients submitted to high-dose-rate brachytherapy for uterine cervix cancer; Avaliacao da dose no reto em pacientes submetidas a braquiterapia de alta taxa de dose para o tratamento do cancer do colo uterino

    Energy Technology Data Exchange (ETDEWEB)

    Oliveira, Jetro Pereira de [Universidade Federal do Rio de Janeiro (UFRJ), RJ (Brazil). Faculdade de Medicina; Rosa, Luiz Antonio Ribeiro da [Instituto de Radioprotecao e Dosimetria (IRD/CNEN-RJ), Rio de Janeiro, RJ (Brazil)], e-mail: lrosa@ird.gov.br; Batista, Delano Valdivino Santos; Bardella, Lucia Helena [Instituto Nacional de Cancer (INCA), Rio de Janeiro, RJ (Brazil). Unit of Medical Physics; Carvalho, Arnaldo Rangel [Instituto de Radioprotecao e Dosimetria (IRD/CNEN-RJ), Rio de Janeiro, RJ (Brazil). Lab. of Thermoluminescent Dosimetry

    2009-03-15

    Objective: The present study was aimed at developing a thermoluminescent dosimetric system capable of assessing the doses delivered to the rectum of patients submitted to high-dose-rate brachytherapy for uterine cervix cancer. Materials and methods: LiF:Mg,Ti,Na powder was the thermoluminescent material utilized for evaluating the rectal dose. The powder was divided into small portions (34 mg) which were accommodated in a capillary tube. This tube was placed into a rectal probe that was introduced into the patient's rectum. Results: The doses delivered to the rectum of six patients submitted to high-dose-rate brachytherapy for uterine cervix cancer evaluated by means of thermoluminescent dosimeters presented a good agreement with the planned values based on two orthogonal (anteroposterior and lateral) radiographic images of the patients. Conclusion: The thermoluminescent dosimetric system developed in the present study is simple and easy to be utilized as compared to other rectal dosimetry methods. The system has shown to be effective in the evaluation of rectal doses in patients submitted to high-dose-rate brachytherapy for uterine cervix cancer. (author)

  11. Acupuncture and Traditional Herbal Medicine Therapy Prevent Deliriumin Patients with Cardiovascular Disease in Intensive Care Units.

    Science.gov (United States)

    Matsumoto-Miyazaki, Jun; Ushikoshi, Hiroaki; Miyata, Shusaku; Miyazaki, Nagisa; Nawa, Takahide; Okada, Hideshi; Ojio, Shinsuke; Ogura, Shinji; Minatoguchi, Shinya

    2017-01-01

    The aim of this study was to determine the effect of combination therapy consisting of acupuncture and traditional herbal medicine (Kampo medicine) for reducing the incidence rate of delirium in patients with cardiovascular (CV) disease in ICUs. Twenty-nine patients who had been urgently admitted to the ICU in the control period were treated with conventional intensive care. Thirty patients in the treatment period received conventional therapy plus a combination therapy consisting of acupuncture and herbal medicine. Acupuncture treatment was performed once a day, and the herbal formula was administered orally three times a day during the first week of the ICU stay. The standard acupuncture points were GV20, Ex-HN3, HT7, LI4, Liv3, and KI3, and the main herbal preparation was Kamikihito. The incident rates of delirium, assessed using the confusion assessment method for ICU, in the treatment and control period were compared. The incidence rate of delirium was significantly lower in the treatment group than in the control group (6.6% vs. 37.9%, [Formula: see text]). Moreover, sedative drugs and non-pharmacological approaches against aggressive behavior of patients who were delirious were used less in the treatment group than in the control group. No serious adverse events were observed in the treatment group. Combination therapy consisting of acupuncture and herbal medicine was found to be effective in lowering the incidence of delirium in patients with CV disease in ICUs. Further studies with a large sample size and parallel randomized controlled design would be required to establish the effects of this therapy.

  12. 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.

  13. Mental disorders frequency alternative and complementary medicine usage among patients with hypertension and type 2 diabetes mellitus.

    Science.gov (United States)

    Keskin, Ahmet; BIlge, Ugur

    2014-01-01

    Diabetes mellitus (DM) and hypertension (HT) are chronic disorders with which mental disorders may coexist and for which patients may resort to alternative medicine use. Alternative and complementary medicine is a treatment option that patients tend to use. This study is to determine the prevalence of mental disorders among patients diagnosed with DM and HT and their use of alternative medicine methods. Materials and Methods The study was conducted in a primary care setting. The data were collected from the Family Health Center No. 4 at Ηankaya, Ankara, Turkey. It involved patients aged between 18 and 65, who were on follow-up treatment for DM and HT. Patients accepted to participate in the study were administered the sociodemographic data form, the Primary Care Evaluation of Mental Disorders (PRIME-MD) questionnaire and the alternative medicine inquiry form. One hundred and sixteen patients with HT and 119 patients with DM (type 2) were recruited for the study. In this study, 47.4% of HT patients and 53.8% of the DM patients were diagnosed with a PRIME-MD. The most commonly encountered disorder was mood disorders, in 37.1% of the HT patients and 45.4% of the DM patients. In this study, four HT patients (0.3%) and no DM patients stated that they resorted to complimentary medicine, which can use be used alongside conventional medical treatment and may help to feel better and cope better with any chronic condition. All four HT patients were using multivitamin combinations to support the treatment. As the alternative medicine usage was described as treatment used instead of conventional medical treatment we did not find any patient using alternative medicine. Mental disorders may coexist with HT and DM. Some of the HT and DM patients suffering from a mental disorder seek psychiatric support, while others do not. We believe that it is important to examine patients for mental disorders, while being followed-up for a chronic disease.

  14. Predictors for patient knowledge and reported behaviour regarding driving under the influence of medicines: a multi-country survey

    Science.gov (United States)

    2012-01-01

    Background Reports on the state of knowledge about medicines and driving showed an increased concern about the role that the use of medicines might play in car crashes. Much of patient knowledge regarding medicines comes from communications with healthcare professionals. This study, part of the DRUID (Driving Under the Influence of Drugs, alcohol and medicines) project, was carried out in four European countries and attempts to define predictors for knowledge of patients who use driving-impairing medicines. The influence of socio-demographic variables on patient knowledge was investigated as well as the influence of socio-demographic factors, knowledge and attitudes on patients' reported behaviour regarding driving under the influence of medicines. Methods Pharmacists handed out questionnaires to patients who met the inclusion criteria: 1) prevalent user of benzodiazepines, antidepressants or first generation antihistamines for systemic use; 2) age between 18 and 75 years old and 3) actual driver of a motorised vehicle. Factors affecting knowledge and reported behaviour towards driving-impairing medicines were analysed by means of multiple linear regression analysis and multiple logistic regression analysis, respectively. Results A total of 633 questionnaires (out of 3.607 that were distributed to patients) were analysed. Patient knowledge regarding driving under the influence of medicines is better in younger and higher educated patients. Information provided to or accessed by patients does not influence knowledge. Patients who experienced side effects and who have a negative attitude towards driving under the influence of impairing medicines are more prone to change their driving frequency behaviour than those who use their motorised vehicles on a daily basis or those who use anti-allergic medicines. Conclusions Changes in driving behaviour can be predicted by negative attitudes towards driving under the influence of medicines but not by patients' knowledge

  15. Early Patient Access to Medicines: Health Technology Assessment Bodies Need to Catch Up with New Marketing Authorization Methods.

    Science.gov (United States)

    Leyens, Lada; Brand, Angela

    National and international medicines agencies have developed innovative methods to expedite promising new medicines to the market and facilitate early patient access. Some of these approval pathways are the conditional approval and the adaptive pathways by the European Medicines Agency (EMA); the Promising Innovative Medicine (PIM) designation and the Early Access to Medicines Scheme (EAMS) by the Medicines and Healthcare Products Regulatory Agency (MHRA), as well as the Fast Track, Breakthrough or Accelerated Approval methods by the Food and Drug Administration (FDA). However, at least in Europe, these methods cannot achieve the goal of improving timely access for patients to new medicines on their own; the reimbursement process also has to become adaptive and flexible. In the past 2 years, the effective access (national patient access) to newly approved oncology drugs ranged from 1 to 30 months, with an extremely high variability between European countries. The goal of early patient access in Europe can only be achieved if the national health technology assessment bodies, such as NICE (ENG), HAS (FR), G-BA (DE) or AIFA (IT), provide harmonized, transparent, flexible, conditional and adaptive methods that adopt the level of evidence accepted by the medicines agencies. The efforts from medicines agencies are welcome but will be in vain if health technology assessments do not follow with similar initiatives, and the European 'postcode' lottery will continue. © 2016 S. Karger AG, Basel.

  16. Labor unions in medicine: the intersection of patient advocacy and self-advocacy.

    Science.gov (United States)

    Manthous, Constantine A

    2014-05-01

    Labor unions have been a weak force in the medical marketplace. To briefly review the history of physicians' and nurses' labor unions, explore the ethics of unions in medicine, and offer a solution that simultaneously serves patients and professionals. A selective review of the literature. Labor unions of medical professionals pose an ethical quandary, that is a tension between selfless patient advocacy versus self-advocacy. The primary role of labor unions has been to extract from management benefits for employees. The threat of work actions is the primary tool that labor unions can apply to encourage management to negotiate mutually acceptable conditions of employment. Work actions-namely slow-downs and strikes-may harm patients and may therefore run afoul of professionals' primary duty to the primacy of patients' welfare. An alternative model is offered wherein medical unions align self-centered and patient-centered interests and leverage the Public Good, in the form of public opinion, to encourage good-faith bargaining with management. As medicine becomes increasingly corporatized, physicians will join nurses in "at-will employment" arrangements whereby self-advocacy and patient advocacy may be impacted. Although labor unions have been a means of counterbalancing unchecked discretion of corporate management, conventional labor unions may run afoul of medical ethical principles. Reconsideration and innovation, to address this ethical dilemma, could provide a solution that aligns both clinicians' and patients' welfare.

  17. Bronchopulmonary complications associated to enteral nutrition devices in patients admitted to internal medicine departments.

    Science.gov (United States)

    Marco, J; Barba, R; Lázaro, M; Matía, P; Plaza, S; Canora, J; Zapatero, A

    2013-01-01

    Enteral nutrition using feeding devices such as nasogastric (NG) tube or percutaneous endoscopic gastrostomy (PEG) is an effective feeding method subject that may give rise to complications. We have studied the relationship between enteral nutrition feeding devices in patients admitted to the Internal Medicine Departments and the development of pulmonary complications (bronchial aspiration and aspiration pneumonia). All of the patients discharge between 2005 and 2009 from the Internal Medicine (IM) Departments of the public hospitals of the National Health System in Spain were analyzed. The data of patients with bronchial aspiration or aspiration pneumonia who also were carriers of NG tubes or PEG, were obtained from the Minimum Basic Data Set (MBDS). From a total of 2,767,259 discharges, 26,066 (0.92%) patients with nasogastric tube (NG tube) or percutaneous gastrostomy (PEG) were identified. A total of 21.5% of patients with NG tube and 25.9% of patients with PEG had coding for a bronchopulmonary aspiration on their discharge report versus 1.2% of patients without an enteral feeding tube. In the multivariate analysis, the likelihood of suffering bronchoaspiration was 9 times greater in patients with SNG (OR: 9.1; 95% CI: 8.7-9.4) and 15 greater in subjects with PEG (OR: 15.2; 95% CI: 14.5-15.9) than in subjects without SNG or PEG. Mean stay (9.2 and 12.7 more days), diagnostic complexity and costs were much higher in patients with SNG or PEG compared to patients in hospital who did not require these devices. An association was found between SNG and PEG for enteral feeding and pulmonary complications. Mean stay, diagnostic complexity and cost per admission of these patients was higher in patients who did not require enteral nutrition. Copyright © 2012 Elsevier España, S.L. All rights reserved.

  18. [Study on medical pattern of traditional Chinese medicine and western medicine diagnosis and treatment of hypertension patients in 30 034 cases in real world].

    Science.gov (United States)

    Ma, Jin-hui; Wang, Zhi-fei; Xie, Yan-ming; Yang, Wei; Yang, Zhi-xin; Zhuang, Yan; Wang, Yong-yan

    2014-09-01

    Select patients diagnosed of hypertension in the first place in 16 hospitals and the patients were described by association rules analysis and distribution for the analysis in the study,in order to understand the information of diagnosis and treatment in hypertension patients in real world. The information include age, gender, admission condition, inpatient department, hospitalization expenses, western medicine comorbidities, the traditional Chinese medicine (TCM) syndrome and the medicine. The average age of patients was 64 years in the study. The proportion of men to women about 1. 10: 1. Admission condition is critical for about 10.12% of the total and more concentrated in the cardiovascular department. Hospital stay ranged from 8 to 14 d. Inpatients with medical insurance is 62.93%. Total hospitalization cost distribution most is the 5 000-10 000 RMB. Hypertension complicated with coronary heart disease, blood lipoprotein disorder disease; phlegm and blood stasis and Yin deficiency of liver and kidney are the most in TCM syndrome type. Promoting blood circulation and removing blood stasis is the major in Chinese medicine treatment. Western medicine treatment basically conforms to the guidelines. The most antihypertensive drugs is calcium antagonistst, accounting for about 81.2% of the total number. Class ACEI, class ARB, beta blockers, diuretics class are accounted for 43.0%, 43.4%, 42.4%, 42.4%, fixed compound is only 2 393, accounting for about 8%. the total frequency of five classes of antihypertensive drugs is 78 206 times. The principal conclusions of this analysis are as follows: the elderly people is the most in hypertension, more men than women; medical insurance is the majority type in hospitalization cost; nearly half of the population is combined with coronary heart disease; phlegm and blood stasis and yin deficiency of liver and kidney are the most in TCM syndrome type; western medicine treatment basically conforms to the guidelines. Combination

  19. Patient access to health care and medicines across low-income countries.

    Science.gov (United States)

    Srivastava, Divya; McGuire, Alistair

    2015-05-01

    This study explores the issue of demand for health care and medicines in low-income country settings. Using the World Health Survey, multivariate analysis of cross-sectional household data from 35 low-income countries found that when ill, patient demand for health care to visit a clinic or hospital is inelastic ranging from -0.19 to 0.11. The main determinants of health seeking behaviour include having insurance, having a chronic condition, high household expenditure, and marital status. Women, the educated and those living in urban settings are more likely to seek care in a clinic. These findings suggest low-income patients will experience access problems, raising important policy implications to improve access to health care and medicines in these settings. Copyright © 2015 Elsevier Ltd. All rights reserved.

  20. [Geriatric intensive care patients : Perspectives and limits of geriatric intensive care medicine].

    Science.gov (United States)

    Müller-Werdan, U; Heppner, H-J; Michels, G

    2018-04-18

    Critically ill geriatric patients are vitally endangered due to the aging processes of organs, the frequently existing multimorbidity with subsequent polypharmacy and the typical geriatric syndrome of functional impairments. Aging processes in organs lower the clinical threshold for organ dysfunction and organ failure. Physiological organ aging processes with practical consequences for intensive care medicine are atypical manifestion of sepsis in immunosenescence, altered pharmacokinetics, reduced tolerance to hypovolemia due to proportionally reduced water compartment of the body in old age, the frequently only apparently normal function of the kidneys and the continuous reduction in pulmonary function in old age. The main reasons for changes in therapeutic targets are the will of the patient and risk-benefit considerations. The guidelines of the ethics section of the German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI) provide assistance and suggestions for a structured decision-making process.

  1. Comparative study of the prevalence of sepsis in patients admitted to dermatology and internal medicine wards*

    Science.gov (United States)

    Almeida, Luiz Maurício Costa; Diniz, Michelle dos Santos; Diniz, Lorena dos Santos; Machado-Pinto, Jackson; Silva, Francisco Chagas Lima

    2013-01-01

    BACKGROUND Sepsis is a common cause of morbidity and mortality among hospitalized patients. The prevalence of this condition has increased significantly in different parts of the world. Patients admitted to dermatology wards often have severe loss of skin barrier and use systemic corticosteroids, which favor the development of sepsis. OBJECTIVES To evaluate the prevalence of sepsis among patients admitted to a dermatology ward compared to that among patients admitted to an internal medicine ward. METHODS It is a cross-sectional, observational, comparative study that was conducted at Hospital Santa Casa de Belo Horizonte. Data were collected from all patients admitted to four hospital beds at the dermatology and internal medicine wards between July 2008 and July 2009. Medical records were analyzed for the occurrence of sepsis, dermatologic diagnoses, comorbidities, types of pathogens and most commonly used antibiotics. RESULTS We analyzed 185 medical records. The prevalence of sepsis was 7.6% among patients admitted to the dermatology ward and 2.2% (p = 0.10) among those admitted to the internal medicine ward. Patients with comorbidities, diabetes mellitus and cancer did not show a higher incidence of sepsis. The main agent found was Staphylococcus aureus, and the most commonly used antibiotics were ciprofloxacin and oxacillin. There was a significant association between sepsis and the use of systemic corticosteroids (p <0.001). CONCLUSION It becomes clear that epidemiological studies on sepsis should be performed more extensively and accurately in Brazil so that efforts to prevent and treat this serious disease can be made more effectively. PMID:24173179

  2. Estado nutricional de pacientes pediátricos ostomizados Estado nutricional de niños portadores de ostomía Nutritional status of pediatric patients submitted to ostomy procedures

    Directory of Open Access Journals (Sweden)

    Emanuelle Tenório B. N. do Egito

    2013-03-01

    ón corporal, así como los perímetros torácico y cefálico en niños con menos de cinco años. Se utilizó la prueba t de Student para comparar dos grupos independientes, siendo significante pOBJECTIVE: To assess the nutritional status of children submitted to ostomy for intestinal discharge. METHODS: A descriptive case series was carried out including 30 children aged up to ten years old submitted to colostomy or ileostomy at the pediatric surgery unit of Institute of Medicine Professor Fernando Figueira, Recife, Pernambuco. Socioeconomic, clinical, anthropometric, and laboratorial (hemoglobin and hematocrit data were collected using a structured questionnaire. Nutritional status was determined based on anthropometric indicators (height/age, weight/age, and body mass index/age, which were stratified by gender, with World Health Organization standards as reference. Arm circumference and triceps skinfold were measured for the evaluation of body composition. Chest and head perimeters were measured on children aged up to five years-old. The Student's t-test was applied to compare two independent groups, considering p<0.05 as significant. RESULTS: All anthropometric indicators revealed nutritional deficit, especially in the height/age index, which revealed a frequency of 24.1% of short statue. Patients submitted to ileostomy presented lower mean Z score of anthropometric indicators, hemoglobin, hematocrit and ostomy time in comparison to those submitted to colostomy, with significant differences only for the Z score of body mass index/age (p=0.016, hemoglobin (p=0.025, and hematocrit (p=0.023. CONCLUSIONS: There is a substantial frequency of nutritional deficit in the analyzed sample, especially based on the height/age index. Although ileostomized patients had less time of ostomy, they had higher nutritional deficit compared to the colostomized ones, likely due to greater risk of postoperative complications, with consequent nutritional impairment.

  3. Biomedicine or Holistic Medicine for Treating Mentally Ill Patients? A Philosophical and Economical Analysis

    OpenAIRE

    Ventegodt, Søren; Kandel, Isack; Merrick, Joav

    2007-01-01

    Today we have two scientific medical traditions, two schools or treatment systems: holistic medicine and biomedicine. The two traditions are based on two very different philosophical positions: subjectivistic and objectivistic. The philosopher Buber taught us that you can say I-Thou or I-It, holding the other person as a subject or an object. These two fundamentally different attitudes seem to characterize the difference in world view and patient approach in the two schools, one coming from p...

  4. [Simulator training in medicine and health care. A new pedagogic model for good patient safety].

    Science.gov (United States)

    Felländer-Tsai, L; Stahre, C; Anderberg, B; Barle, H; Bringman, S; Kjellin, A; Ramel, S; Strinnlund, B; Carlsson, C; Wredmark, T

    2001-09-05

    Advanced simulation within medicine and health care is a rapidly growing field. Simulator based training can be applied in minimal invasive surgery, in endoscopic procedures as well as in anaesthesia and critical care management. At Huddinge University Hospital a center for advanced simulation of both endoscopic surgery and anaesthesia/critical care management is currently being set up. The objective is to focus on improved medical and health care training and thus improving patient safety by reducing medical errors.

  5. Translation and cross-cultural adaptation into Brazilian Portuguese of the Vanderbilt Head and Neck Symptom Survey version 2.0 (VHNSS 2.0 for the assessment of oral symptoms in head and neck cancer patients submitted to radiotherapy

    Directory of Open Access Journals (Sweden)

    Eliane Marçon Barroso

    2015-12-01

    Full Text Available ABSTRACT INTRODUCTION: Patients submitted to radiotherapy for the treatment of head and neck cancer have several symptoms, predominantly oral. The Vanderbilt Head and Neck Symptom Survey version 2.0 is an American tool developed to evaluate oral symptoms in head and neck cancer patients submitted to radiotherapy. OBJECTIVE: The aim of the present study was to translate the Vanderbilt Head and Neck Symptom Survey version 2.0 into Brazilian Portuguese and cross-culturally adapt this tool for subsequent validation and application in Brazil. METHODS: A method used for the translation and cultural adaptation of tools, which included independent translations, synthesis of the translations, back-translations, expert committee, and pre-test, was used. The pre-test was performed with 37 head and neck cancer patients, who were divided into four groups, to assess the relevance and understanding of the assessed items. Data were submitted to descriptive statistical analysis. RESULTS: The overall mean of the content validity index was 0.79 for semantic and idiomatic equivalence, and it was higher than 0.8 for cultural and conceptual equivalence. The cognitive interview showed that patients were able to paraphrase the items, and considered them relevant and easily understood. CONCLUSION: The tool was translated and cross-culturally adapted to be used in Brazil. The authors believe this translation is suited for validation.

  6. Translation and cross-cultural adaptation into Brazilian Portuguese of the Vanderbilt Head and Neck Symptom Survey version 2.0 (VHNSS 2.0) for the assessment of oral symptoms in head and neck cancer patients submitted to radiotherapy.

    Science.gov (United States)

    Barroso, Eliane Marçon; Carvalho, André Lopes; Paiva, Carlos Eduardo; Nunes, João Soares; Paiva, Bianca Sakamoto Ribeiro

    2015-01-01

    Patients submitted to radiotherapy for the treatment of head and neck cancer have several symptoms, predominantly oral. The Vanderbilt Head and Neck Symptom Survey version 2.0 is an American tool developed to evaluate oral symptoms in head and neck cancer patients submitted to radiotherapy. The aim of the present study was to translate the Vanderbilt Head and Neck Symptom Survey version 2.0 into Brazilian Portuguese and cross-culturally adapt this tool for subsequent validation and application in Brazil. A method used for the translation and cultural adaptation of tools, which included independent translations, synthesis of the translations, back-translations, expert committee, and pre-test, was used. The pre-test was performed with 37 head and neck cancer patients, who were divided into four groups, to assess the relevance and understanding of the assessed items. Data were submitted to descriptive statistical analysis. The overall mean of the content validity index was 0.79 for semantic and idiomatic equivalence, and it was higher than 0.8 for cultural and conceptual equivalence. The cognitive interview showed that patients were able to paraphrase the items, and considered them relevant and easily understood. The tool was translated and cross-culturally adapted to be used in Brazil. The authors believe this translation is suited for validation. Copyright © 2015 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

  7. Physician and patient attitudes towards complementary and alternative medicine in obstetrics and gynecology

    Directory of Open Access Journals (Sweden)

    Sen Ananda

    2008-06-01

    Full Text Available Abstract Background In the U.S., complementary and alternative medicine (CAM use is most prevalent among reproductive age, educated women. We sought to determine general attitudes and approaches to CAM among obstetric and gynecology patients and physicians. Methods Obstetrician-gynecologist members of the American Medical Association in the state of Michigan and obstetric-gynecology patients at the University of Michigan were surveyed. Physician and patient attitudes and practices regarding CAM were characterized. Results Surveys were obtained from 401 physicians and 483 patients. Physicians appeared to have a more positive attitude towards CAM as compared to patients, and most reported routinely endorsing, providing or referring patients for at least one CAM modality. The most commonly used CAM interventions by patients were divergent from those rated highest among physicians, and most patients did not consult with a health care provider prior to starting CAM. Conclusion Although obstetrics/gynecology physicians and patients have a positive attitude towards CAM, physician and patients' view of the most effective CAM therapies were incongruent. Obstetrician/gynecologists should routinely ask their patients about their use of CAM with the goal of providing responsible, evidence-based advice to optimize patient care.

  8. Patients' and physicians' satisfaction with a pharmacist managed anticoagulation program in a family medicine clinic.

    Science.gov (United States)

    Bishop, Lisa; Young, Stephanie; Twells, Laurie; Dillon, Carla; Hawboldt, John

    2015-06-09

    A pharmacist managed anticoagulation service was initiated in a multi-physician family medicine clinic in December 2006. In order to determine the patient and physician satisfaction with the service, a study was designed to describe the patients' satisfaction with the warfarin education and management they received from the pharmacist, and to describe the physicians' satisfaction with the level of care provided by the pharmacist for patients taking warfarin. A self-administered survey was completed by both eligible patients receiving warfarin and physicians prescribing warfarin between December 2006 and May 2008. The patient survey collected information on patient demographics, satisfaction with warfarin education and daily warfarin management. The physician survey collected data about the satisfaction with patient education and daily anticoagulation management by the pharmacist. Seventy-six of 94 (81%) patients completed the survey. Fifty-nine percent were male with a mean age of 65 years (range 24-90). Ninety-six percent agreed/strongly agreed the pharmacist did a good job teaching the importance of warfarin adherence, the necessity of INR testing and the risks of bleeding. Eighty-five percent agreed/strongly agreed the risk of blood clots was well explained, 79% felt the pharmacist did a good job teaching about dietary considerations and 77% agreed/strongly agreed the pharmacist explained when to see a doctor. All patients felt the pharmacist gave clear instructions on warfarin dosing and INR testing. Four of nine physicians (44%) completed the survey. All agreed/strongly agreed the pharmacist was competent in the care provided, were confident in the care their patients received, would like the pharmacist to continue the service, and would recommend this program to other clinics. Patients and family physicians were satisfied with the pharmacist managed anticoagulation program and recommended continuation of the program. These results support the role of the

  9. Introduction of Virtual Patient Software to Enhance Physician Assistant Student Knowledge in Palliative Medicine.

    Science.gov (United States)

    Prazak, Kristine A

    2017-01-01

    The purpose of this project was to infuse palliative medicine and end-of-life care creatively into physician assistant (PA) education. Nine second-year PA students volunteered to participate in this quasi-experimental, pretest-posttest pilot study. Students initially completed an anonymous survey evaluating seven domains of knowledge in palliative medicine coupled with a self-assessment in competence. Virtual patient software was then used to simulate clinical encounters that addressed major palliative care domains. Upon completion of these cases, the same survey, with the addition of three questions about their own personal feelings, was administered. Overall response was positive in regard to improved knowledge and the virtual patient experience. After completion of the cases, students rated their self-assessed skills higher in all domains than prior to completing the cases. Factual knowledge scores showed a slight but not significant improvement, with an average pre-survey score of 4.56 and post-survey score of 4.67. Using virtual patient software can be a way of infusing palliative medicine and end-of-life care into PA education. These encounters can then be modified to include interprofessional encounters within the health professions.

  10. Transforming patient experience: health web science meets medicine 2.0.

    Science.gov (United States)

    McHattie, Lynn-Sayers; Cumming, Grant; French, Tara

    2014-01-01

    Until recently, the Western biomedical paradigm has been effective in delivering health care, however this model is not positioned to tackle complex societal challenges or solve the current problems facing health care and delivery. The future of medicine requires a shift to a patient-centric model and in so doing the Internet has a significant role to play. The disciplines of Health Web Science and Medicine 2.0 are pivotal to this approach. This viewpoint paper argues that these disciplines, together with the field of design, can tackle these challenges. Drawing together ideas from design practice and research, complexity theory, and participatory action research we depict design as an approach that is fundamentally social and linked to concepts of person-centered care. We discuss the role of design, specifically co-design, in understanding the social, psychological, and behavioral dimensions of illness and the implications for the design of future care towards transforming the patient experience. This paper builds on the presentations and subsequent interdisciplinary dialogue that developed from the panel session "Transforming Patient Experience: Health Web Science Meets Web 2.0" at the 2013 Medicine 2.0 conference in London.

  11. Patients' general satisfaction with telephone counseling by pharmacists and effects on satisfaction with information and beliefs about medicines : Results from a cluster randomized trial

    NARCIS (Netherlands)

    Kooy, Marcel Jan; Van Geffen, Erica C G; Heerdink, Eibert R.; Van Dijk, Liset; Bouvy, Marcel L.

    2015-01-01

    Assess effects of pharmacists' counseling by telephone on patients' satisfaction with counseling, satisfaction with information and beliefs about medicines for newly prescribed medicines. Methods: A cluster randomized trial in Dutch community pharmacies. Patients ≥18 years were included when

  12. The Effectiveness of Traditional Chinese Medicine in Treating Patients with Leukemia

    Directory of Open Access Journals (Sweden)

    Yu-Jun Wang

    2016-01-01

    Full Text Available Leukemia is the most common malignancy among all childhood cancers and is associated with a low survival rate in adult patients. Since 1995, the National Health Insurance (NHI program in Taiwan has been offering insurance coverage for Traditional Chinese Medicine (TCM, along with conventional Western medicine (WM. This study analyzes the status of TCM utilization in Taiwan, in both pediatric and adult patients with leukemia. A retrospective cohort study was conducted using population-based National Health Insurance Research Database of Registry of Catastrophic Illness, involving patient data from 2001 to 2010 and follow-up data through 2011. The effectiveness of TCM use was evaluated. Relevant sociodemographic data showed that both pediatric and adult patients who were TCM users one year prior to leukemia diagnosis were more likely to utilize TCM services for cancer therapy. A greater part of medical expenditure of TCM users was lower than that of TCM nonusers, except little discrepancy in drug fee of adult patients. The survival rate is also higher in TCM users. Altogether, these data show that TCM has the potential to serve as an adjuvant therapy when combined with conventional WM in the treatment of patients with leukemia.

  13. Current trends on internal dosimetry for patient protection in nuclear medicine

    International Nuclear Information System (INIS)

    Rojo, A.M.; Gisone, P.A.; Kunst, J.J.

    2001-01-01

    The associated risk-benefit analyses in nuclear medicine implicitly performed by the clinician have been straightforward. Relatively low administered activity activities yield important diagnostic information, the benefit of which far outweigh any potential risk associated with the attendant normal tissue radiation doses. Such small risk to benefit ratios have been very forgiving of possible inaccuracies in dose estimates. With the ongoing development of new radiopharmaceutical and the increasing therapeutic application of internal radionuclides, radiation dosimetry in nuclear medicine continues to evolve from population- and organ-average to patient-specific dose estimation. Patient-specific dosimetry refers to the estimation of radiation dose to tissues of a specific-patients based on their individual body and measured biokinetics rather than an average anthropomorphic model and hypothetic kinetic. The importance of dosimetry specific-patient considers to avoid the risk of an unsuitable treatment and/or with probability of damage to the patient. This is illustrated by the dosimetric approaches to radioiodine treatment of hyperthyroidism. The most common prescription algorithm to fix the activity administered to a hyperthyroid patient does not consider individual parameters that are highly variable (thyroid uptake, biological half-life, thyroid mass). Its arbitrary approach doesn't permit individually optimized therapy and it may be inappropriate and even hazardous. (author)

  14. Use of Chinese Herb Medicine in Cancer Patients: A Survey in Southwestern China

    Directory of Open Access Journals (Sweden)

    Tai-Guo Liu

    2012-01-01

    Full Text Available Chinese herb medicine (CHM is the most commonly reported traditional Chinese medicine (TCM modality. This study aimed to assess the prevalence and associated factors of CHM use in cancer patients in southwestern China. Cancer patients from eleven comprehensive cancer centers were asked to complete a structured questionnaire. Of 587 available replies, 53.0% used CHM. Multiple logistic regression analysis showed that educational level, stage of disease, duration of cancer since diagnosis, marital status, and previous use of CHM were strongly associated with CHM use after cancer diagnosis. The source of information about CHM was mainly from media and friends/family. CHM products were used without any consultation with a TCM practitioner by 67.5% of users. The majority used CHM to improve their physical and emotional well-beings and to reduce cancer therapy-induced toxicities. About 4.5% patients reported side effects of CHM. This survey revealed a high prevalence of CHM use among cancer patients. However, these patients did not get sufficient consultation about the indications and contradictions of these drugs. It is imperative for oncologists to communicate with their cancer patients about the usage of CHM so as to avoid the potential side effects.

  15. Complementary and Alternative Medicine Usage by Multiple Sclerosis Patients: Results from a Prospective Clinical Study.

    Science.gov (United States)

    Kim, Soohyun; Chang, Lawrence; Weinstock-Guttman, Bianca; Gandhi, Sirin; Jakimovski, Dejan; Carl, Ellen; Zivadinov, Robert; Ramanathan, Murali

    2018-03-02

    To investigate the factors associated with complementary and alternative medicine (CAM) usage by multiple sclerosis (MS) patients. Design, Setting/Location: Single-center, prospective clinical study at an academic MS center in the northeastern United States. This study included CAM data from 524 MS patients and 304 healthy controls (HC) enrolled in a prospective study of clinical, neuroimaging, and environmental risk factors in MS at an academic MS Center. Clinical, neuroimaging, and disease-modifying treatment data were obtained. In addition, data on usage of CAM modalities, including acupuncture, aromatherapy, Ayurveda, Chinese herbal medicine, chiropractor, electromagnetic therapy, homeopathy, hypnosis, massage, naturopathy, Qi gong, Reiki, therapeutic touch, and bee stings were collected in an in-person interview. The percentages of HC reporting usage of any CAM (32%) was similar to that in MS patients after diagnosis (30.5%). The usage of any CAM was higher in MS patients after MS diagnosis compared to before MS diagnosis (p usage. Gender, education level, DMT treatment status, and MS disease course are associated with CAM usage in MS patients. Ever-CAM usage patterns in MS patients are similar to those in HC.

  16. Limitation of therapeutic effort in patients hospitalised in departments of internal medicine.

    Science.gov (United States)

    García Caballero, R; Herreros, B; Real de Asúa, D; Gámez, S; Vega, G; García Olmos, L

    There is little information on the limitation of therapeutic effort (LTE) in patients admitted to hospital internal medicine units. To describe the indicated LTE regimens in the departments of internal medicine and the characteristics of the patients who undergo them. An observational, descriptive retrospective study was conducted on 4 hospitals of the Community of Madrid. The study collected demographic and comorbidity data and the LTE orders prescribed for all patients who died during a period of 6 months. The study included 382 patients with a mean age of 85±10 years; 204 were women (53.4%) and 222 (58.1%) came from their homes. Some 51.1% of the patients were terminal, 43.2% had moderate to severe dementia, and 95.5% presented at least moderate comorbidity. Some type of LTE was performed in 318 patients (83.7%); the most common orders were "No cardiopulmonary resuscitation" (292 patients, 76.4%; 95% CI 72.1-80.8), "Do not use aggressive measures" (113 patients, 16.4%; 95% CI 13.7-19.4) and "Do not transfer to an intensive care unit" (102 cases, 14.8%, 95% CI 12.3-17.7). Some type of LTE was performed in 318 patients (83.7%); the most common orders were "No cardiopulmonary resuscitation" (292 patients, 76.4%; 95% CI 72.1-80.8), "Do not use aggressive measures" (113 patients, 16.4%; 95% CI 13.7-19.4) and "Do not transfer to an intensive care unit" (102 cases, 14.8%, 95% CI 12.3-17.7). LTE is common among patients who die in Internal Medicine. The most widely used regimens were "No CPR" and the unspecific statement "Do not use aggressive measures". The patients were elderly and had significant comorbidity, terminal illness and advanced dementia. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  17. Acompanhamento psicológico tardio em pacientes submetidos à cirurgia bariátrica Late psychological follow-up on patients submitted to bariatric surgery

    Directory of Open Access Journals (Sweden)

    Simone Dallegrave Marchesini

    2010-06-01

    a prevenção às recaídas possa ser foco terapêutico.BACKGROUND: The human being is not alone; he is always compared to their peers and the environment. Every change corresponds to a social reaction and a response issued in the form of behavior. AIM: To evaluate some of the postoperative psychological conditions and life style in a short and in a long term follow-up. METHOD: A 26 item evaluation questionnaire was sent to post bariatric patients concerning to motivation and compliance to the treatment, behavioral changes, humor alterations, reaching of expectancies among others. RESULTS: The majority of this group of patients felt prepared for surgery during the first office interview, but didn't know the method of treatment that they were about to be submitted to. The majority also had not been treated for their psychological and/or psychiatric conditions and didn't change their life style after the operation. Compliance to nutrition orientation was partial and there were evident emotional manifestations. The weight regain complaint was small compared with the satisfaction of the weight loss. Most of these patients would be submitted again to the operation, and half of them stated the need for support groups. Patients wanted the operation, but didn't realize the need of better preparation and didn't change the behavioral patterns necessary to reach the success in a long term follow-up. They usually abandon the postoperative treatment. CONCLUSION: It can be inferred that the motivations that lead individuals to seek bariatric surgery are predicated on social returns, in the aesthetic standards and the psychological desire for life change. Once implemented the change of life, motivation is over, but does not guarantee the existential satisfaction. It is also possible to infer that the preparation for the care of spouses and family claims a space in training professionals in the area of surgical treatment of obesity, for the prevention of relapses can be therapeutic

  18. From Patient-Specific Mathematical Neuro-Oncology to Precision Medicine

    Directory of Open Access Journals (Sweden)

    Anne eBaldock

    2013-04-01

    Full Text Available Gliomas are notoriously aggressive, malignant brain tumors that have variable response to treatment. These patients often have poor prognosis, informed primarily by histopathology. Mathematical neuro-oncology (MNO is a young and burgeoning field that leverages mathematical models to predict and quantify response to therapies. These mathematical models can form the basis of modern precision medicine approaches to tailor therapy in a patient-specific manner. Patient specific models (PSMs can be used to overcome imaging limitations, improve prognostic predictions, stratify patients and assess treatment response in silico. The information gleaned from such models can aid in the construction and efficacy of clinical trials and treatment protocols, accelerating the pace of clinical research in the war on cancer. This review focuses on the growing translation of PSM to clinical neuro-oncology. It will also provide a forward-looking view on a new era of patient-specific mathematical neuro-oncology.

  19. Complementary and alternative medicine in radiation oncology. Survey of patients' attitudes

    International Nuclear Information System (INIS)

    Lettner, Sabrina; Kessel, Kerstin A.; Combs, Stephanie E.

    2017-01-01

    Complementary and alternative medicine (CAM) are gaining in importance, but objective data are mostly missing. However, in previous trials, methods such as acupuncture showed significant advantages compared to standard therapies. Thus, the aim was to evaluate most frequently used methods, their significance and the general acceptance amongst cancer patients undergoing radiotherapy (RT). A questionnaire of 18 questions based on the categorical classification released by the National Centre for Complementary and Integrative Health was developed. From April to September 2015, all patients undergoing RT at the Department of Radiation Oncology, Technical University of Munich, completed the survey. Changes in attitude towards CAM were evaluated using the questionnaire after RT during the first follow-up visit (n = 31). Of 634 patients, 333 answered the questionnaire (52.5%). Of all participants, 26.4% used CAM parallel to RT. Before RT, a total of 39.3% had already used complementary medicine. The most frequently applied methods during therapy were vitamins/minerals, food supplements, physiotherapy/manual medicine, and homeopathy. The majority (71.5%) did not use any complementary treatment, mostly stating that CAM was not offered to them (73.5%). The most common reasons for use were to improve the immune system (48%), to reduce side effects (43.8%), and to not miss an opportunity (37.8%). Treatment integrated into the individual therapy concept, e.g. regular acupuncture, would be used by 63.7% of RT patients. In comparison to other studies, usage of CAM parallel to RT in our department is considered to be low. Acceptance amongst patients is present, as treatment integrated into the individual oncology therapy would be used by about two-third of patients. (orig.) [de

  20. Complementary and alternative medicine in radiation oncology : Survey of patients' attitudes.

    Science.gov (United States)

    Lettner, Sabrina; Kessel, Kerstin A; Combs, Stephanie E

    2017-05-01

    Complementary and alternative medicine (CAM) are gaining in importance, but objective data are mostly missing. However, in previous trials, methods such as acupuncture showed significant advantages compared to standard therapies. Thus, the aim was to evaluate most frequently used methods, their significance and the general acceptance amongst cancer patients undergoing radiotherapy (RT). A questionnaire of 18 questions based on the categorical classification released by the National Centre for Complementary and Integrative Health was developed. From April to September 2015, all patients undergoing RT at the Department of Radiation Oncology, Technical University of Munich, completed the survey. Changes in attitude towards CAM were evaluated using the questionnaire after RT during the first follow-up visit (n = 31). Of 634 patients, 333 answered the questionnaire (52.5%). Of all participants, 26.4% used CAM parallel to RT. Before RT, a total of 39.3% had already used complementary medicine. The most frequently applied methods during therapy were vitamins/minerals, food supplements, physiotherapy/manual medicine, and homeopathy. The majority (71.5%) did not use any complementary treatment, mostly stating that CAM was not offered to them (73.5%). The most common reasons for use were to improve the immune system (48%), to reduce side effects (43.8%), and to not miss an opportunity (37.8%). Treatment integrated into the individual therapy concept, e.g. regular acupuncture, would be used by 63.7% of RT patients. In comparison to other studies, usage of CAM parallel to RT in our department is considered to be low. Acceptance amongst patients is present, as treatment integrated into the individual oncology therapy would be used by about two-third of patients.

  1. The Swiss Master in Chiropractic Medicine Curriculum: Preparing Graduates to Work Together With Medicine to Improve Patient Care.

    Science.gov (United States)

    Humphreys, B Kim; Peterson, Cynthia K

    2016-12-01

    In 2007, chiropractic became 1 of the 5 medical professions in Switzerland. This required a new chiropractic program that was fully integrated within a Swiss medical school. The purpose of this article was to discuss the Master in Chiropractic Medicine (MChiroMed) program at the University of Zürich, including advantages, opportunities, and challenges. In 2008, the MChiroMed program began with its first student cohort. The MChiroMed program is a 6-year Bologna model 2-cycle (bachelor and master) "spiral curriculum," with the first 4 years being fully integrated within the medical curriculum. A review of the main features of the curriculum revealed the advantages, opportunities, and challenges of this program in comparison with other contemporary chiropractic educational programs. Advantages and opportunities include an integrated curriculum within a university, medical school, and musculoskeletal hospital, with their associated human and physical resources. Many opportunities exist for high-level research collaborations. The rigorous entrance qualifications and small student cohorts result in bright, motivated, and enthusiastic students; appropriate assessments; and timely feedback on academic and clinical subjects. Early patient contact in hospitals and clinical facilities encourages the integration of academic theory and clinical practice. The main challenges faced by this program include difficulty recruiting a sufficient number of students because of the rigorous entrance requirements and curriculum overload resulting from undertaking a full medical curriculum and chiropractic modules. The MChiroMed program is a unique chiropractic curriculum that integrates medical and chiropractic education within a spiral curriculum at a world-class Swiss university medical school. The expectation is that graduates, with their expanded diagnostic and therapeutic knowledge, skills, and experience, will become future experts in primary spine care in Switzerland. It is hoped

  2. Students do not reduce patient satisfaction in a family medicine clinic as measured by a nationally used patient satisfaction instrument.

    Science.gov (United States)

    Speicher, Mark R; Sterrenberg, Timothy R

    2015-03-01

    Patient satisfaction surveys are widely used to give physicians feedback on their treatment of patients, included in physician performance evaluation and payment, and correlated with better health outcomes. Our research uses industry-standard satisfaction measures to gauge the impact on patient satisfaction of having students involved in a patient's medical care at the family medicine clinic of a large southwestern osteopathic medical school. A retrospective cohort study was conducted using the Press-Ganey Survey, a national survey commonly used by hospitals and clinics. The survey was modified to indicate the presence of a learner in the patient's treatment room. The survey provided data on patient satisfaction with the office, the visit, and the care received. Overall, 730 survey responses were used in the study, 434 from patients with whose visit included a student. There were no statistically significant differences in patient satisfaction scores, including overall satisfaction with the visit. Our findings indicate that student doctors do not decrease patient satisfaction and that satisfaction scores may be useful in student evaluations. This finding should encourage outpatient physicians who teach medical students that their patient satisfaction scores on the most widely used patient satisfaction survey will not be impacted by teaching students.

  3. Medical teleconsultation to general practitioners reduces the medical error vulnerability of internal medicine patients.

    Science.gov (United States)

    Campanella, Nando; Morosini, Pierpaolo; Sampaolo, Guido; Catozzo, Vania; Caso, Andrea; Ferretti, Maurizio; Giovagnoli, Moreno; Torniai, Mariangela; Antico, Ettore

    2015-11-01

    e-Health strategies are supposed to improve the performance of national health systems. Medical teleconsultation (MT) is an important component of such e-Health strategies. The outcome of MT was evaluated with regard to the impact on the medical error vulnerability (MEV) of internal medicine patients. A team of internal medicine doctors plus a network of forty specialists was set-up in one health district belonging to a unified and universal national health system of a country of Western Europe, in order to provide free-of-charge MT to support general practitioners in solving internal medicine cases. In this observational study, the case series of 2013 is reviewed. a) Only 21% of the MT fell short to the general practitioner's expectations about the case solving focus; b) throughout the medical care process of the patient, 49% of the cases met with one or more of the five MEVs, namely: 1) clinical test mishandling; 2) inaccurate differential diagnosis; 3) inadequate information flow between health providers at different levels of care (transition care); 4) poor coordination between health providers; and 5) poor reconciliation of medications or hazardous therapies. c) MT canceled or prevented MEVs in 56% and mitigate MEVs in 15% of the cases; d) MT canceled or prevented 85% of MEV caused by poor information exchange in transition care, therefore improving patient referral and counter-referral. MT reduces MEV and therefore, whenever implemented to a large extent, may improve the quality of health care delivery and the performance of national health systems. Copyright © 2015 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

  4. Review on pharmacological pain management in trauma patients in (pre-hospital) emergency medicine in the Netherlands

    NARCIS (Netherlands)

    Dijkstra, B.M.; Berben, S.A.A.; Dongen, R.T.M. van; Schoonhoven, L.

    2014-01-01

    Pain is one of the main complaints of trauma patients in (pre-hospital) emergency medicine. Significant deficiencies in pain management in emergency medicine have been identified. No evidence-based protocols or guidelines have been developed so far, addressing effectiveness and safety issues, taking

  5. Complementary and alternative medicine (CAM) use among Jordanian patients with chronic diseases.

    Science.gov (United States)

    Wazaify, Mayyada; Alawwa, Izzat; Yasein, Nada; Al-Saleh, Akram; Afifi, Fatma U

    2013-08-01

    This study explores the prevalence of herbal medicine use in a cohort of patients with chronic kidney disease (CKD), dyslipidemia and hypertension (HTN) in Jordan. The study took the form of a cross-sectional survey of patients attending the outpatient departments at The Jordan University Hospital (JUH), in Amman. The method was based on semi-structured questionnaire. A total of 700 CKD, dyslipidemia and hypertension patients were interviewed. Of the participants, 7.6% (n = 53) reported using herbs. Most of complementary and alternative medicine (CAM) users were older than 50 years of age (n = 42; 79.3%) and predominantly female (54.1%, n = 29). The majority of patients in this group had hypertension (n = 44, 83.0%), followed by dyslipidemia (n = 32, 60.4%). The most common herbal product to be used was Hibiscus sabdariffa (22.5%). This study confirmed that there is an appreciable prevalence of herbal use among patients with CKD, dyslipidemia and hypertension in Jordan. Copyright © 2013 Elsevier Ltd. All rights reserved.

  6. [Patient safety culture in family and community medicine residents in Aragon].

    Science.gov (United States)

    Rodríguez-Cogollo, R; Paredes-Alvarado, I R; Galicia-Flores, T; Barrasa-Villar, J I; Castán-Ruiz, S

    2014-01-01

    having an appropriate patient safety culture is the first recommendation to improve it. The aim of this article is to determine the safety culture in family medicine residents and then to identify improvement strategies. an online cross-sectional survey of residents in family medicine teaching units of Aragon using the translated, validated and adapted to Spanish, Medical Office Survey on Patient Safety Culture (MOSPS) questionnaire. The results were grouped in 12-dimensional responses for analysis, and the mean value of each dimension was calculated. Perceptions were described by Percentages of Positive (PRP) and Negative Responses (PRN) to each dimension. positive results were seen in «the Patient Care Tracking/Follow-up». There were significant differences in the «Information Exchange With Other Settings», «Staff Training» and «Overall Perceptions of Patient Safety and Quality». Study participants viewed «Work Pressure and Pace» negatively. the institutions providing health services, as well as their staff, are increasingly aware of the importance of improving Patient Safety, and the results of this study allowed us to present information that helps identify weaknesses, and to design initiatives and strategies to improve care practices. Copyright © 2013 SECA. Published by Elsevier Espana. All rights reserved.

  7. Puntaje de riesgo para morbilidad y mortalidad en pacientes sometidos a intervencionismo coronario percutáneo Morbimortality risk score in patients submitted to percutaneous coronary intervention

    Directory of Open Access Journals (Sweden)

    Andrés Fernández

    2008-04-01

    Full Text Available El objetivo principal de este estudio observacional, fue establecer un puntaje de riesgo para morbilidad y mortalidad intrahospitalaria en pacientes sometidos a intervención coronaria percutánea luego de sufrir alguno de los siguientes síndromes coronarios agudos: angina inestable, infarto agudo del miocardio sin elevación del segmento ST o infarto agudo del miocardio con elevación del segmento ST. Se realizó una recolección de datos clínicos y demográficos a partir de 1.310 pacientes atendidos en la clínica, entre 2003 a 2006, de manera retro-prospectiva, con el fin de elaborar un puntaje válido para la población colombiana. Esto se realizó mediante una base de datos de múltiples variables pre-procedimiento (antecedentes personales, variables intra-procedimiento (tiempo transcurrido desde la hora de la consulta al servicio de urgencias hasta el momento del cateterismo, número de vasos enfermos entre otros y variables post-procedimientos (complicaciones de morbi-mortalidad. Luego, el análisis de los datos se llevó a cabo mediante un modelo de regresión logística, para determinar cuáles de los factores de riesgo fueron estadísticamente significativos para causar alguno de los resultados evaluados. Los principales resultados evaluados fueron: muerte, eventos hematológicos adversos y estancia hospitalaria. Luego del análisis se encontró que los principales factores relacionados con la morbi-mortalidad de los pacientes fueron el tipo de paciente (o tipo de síndrome coronario sufrido, su edad y su estado hemodinámico al ingreso (presencia de shock cardiogénico. A partir de estos resultados, se desarrolló el puntaje de riesgo a través de las variables pre-operatorias e intra-operatorias.The main objective of this observational study was to establish a mortality risk score for intra-hospital morbidity and mortality in patients submitted to percutaneous coronary intervention (PCI after having suffered one of the following

  8. Infecções hospitalares em 46 pacientes submetidos a artroplastia total do quadril Hospital infections in 46 patients submitted to total hip replacement

    Directory of Open Access Journals (Sweden)

    Ana Lúcia Lei Munhoz Lima

    2001-03-01

    Full Text Available Foram estudados 46 pacientes submetidos a artroplastia total do quadril em um Instituto de Ortopedia de São Paulo, Brasil, no período de 1993 a 1995, com o objetivo de obter a real frequência das infecções hospitalares da ferida operatória superficial e profunda que ocorrem nessa cirurgia. O estudo baseou-se no acompanhamento pré-operatório, trans-operatório e pós-operatório com seguimento mínimo de três meses de todos os pacientes, no sentido de caracterizar os agentes etiológicos das infecções e os fatores de risco que contribuem para o seu desenvolvimento. Foi observada uma freqüência total de 15.1% de infecções hospitalares, sendo 6.5% de infecção superficial da ferida operatória, 6.5% de infecção profunda e 2.1% de infecção do trato urinário. Os agentes etiológicos encontrados foram Pseudomonas aeruginosa (2 casos, Staphylococcus coagulase negativo (2 casos, Morganella morgani (1 caso e associação de Acinetobacter calcoaceticus (2 casos. O fator de risco com significância estatística observado nesta casuística foi o tempo cirúrgico aumentado. Concluiu-se que a frequência de infecção da ferida cirúrgica superficial e profunda nas artroplastias totais de quadril foi maior, nesta casuística, do que a relatada na literatura internacional, com elevada participação de bacilos Gram-negativos como agentes etiológicos e tendo como principal fator de risco o tempo cirúrgico aumentado.We studied 46 patients submitted to total hip replacement at an Orthopaedics Institute in the city of São Paulo, Brazil, from 1993 to 1995, in order to determine the real frequency of hospital infections of the superficial and deep surgical wounds occurring in this operation. The study consisted of preoperative, transoperative and postoperative monitoring and a minimum follow-up period of three months for all patients in order to characterise the etiologic agents of the infections and risk factors contributing to the

  9. Is the level of patient co-payment for medicines associated with refill adherence in Sweden?

    Science.gov (United States)

    Lesén, Eva; Andersson Sundell, Karolina; Carlsten, Anders; Mårdby, Ann-Charlotte; Jönsson, Anna K

    2014-02-01

    In the Swedish reimbursement scheme, the co-payment is based on the price of the product and decreases in a stepwise manner as the total accumulated co-payment increases. The aim of this study was to analyse how refill adherence in Sweden varies according to patient's co-payment level for medicines, with antiepileptic drug (AED) use as an example. Prevalent AED users aged 18-85 years who purchased an AED between 1 January and 30 June 2007 were identified in the Swedish Prescribed Drug Register and followed for a maximum of 2 years. Patient time was categorized based on patient's accumulated co-payment for all drugs per reimbursement period. The continuous measure of medication acquisition (CMA) was used to estimate refill adherence in relation to the patients' co-payment level. Associations between patients' co-payment for all medicines and refill adherence were assessed with multilevel mixed-effects linear regression, accounting for clustering within patients. The study population included 2210 patients (mean age: 56 years; 54% men). CMA for AED was 91% for patients where the co-payment corresponded to 100% of the price. Compared with these patients, refill adherence for AED was 2-4% higher (P co-payment (co-payment of ≤50% of the price). Higher age, higher income and fenytoin use were also associated with a higher refill adherence for AED. Using AED as an example, a higher level of reimbursement was associated with a higher refill adherence compared with full co-payment in Sweden.

  10. Risco nutricional e complicações em obesos hospitalizados submetidos à cirurgia Nutritional risk and complications in hospitalized obese patient submitted to surgery

    Directory of Open Access Journals (Sweden)

    Mariana Raslan

    2007-12-01

    nutritional state. Obesity represents a nutritional disorder frequently in general hospital in nowadays and it may be associated with nutritional alteration, presenting prejudicial consequences to patient clinical outcome, besides being a factor related to postoperatory complications and death. AIM: To identify nutritional risk using Malnutrition Universal Screening Tool and verify the results from postoperatory complications, correlating nutritional risks and obesity. METHODS: Total of 433 adults patients hospitalized in general surgical ward were evaluated. At admission, patients were measured on body weight and height. Nutritional screening was applied after obesity definition using Body Mass Index as parameter (Kg/m², classified in grade I (30-34,99 Kg/m²; grade II (35-39,99 Kg/m²; grade III (>40,00 Kg/m². Follow-up patients were conducted until patient's discharge or eventual death. RESULTS: Among patients submitted to the study, 17,1% were considered obese. Nutritional risk in obese patients was verified in 23%. Complications presented during hospital staying were related to esophagus, biliary tract, vascular, head, and neck. Infections complications were pulmonary, abdominal wall, and urinary tract. Complications due to fistulas were located in gastrointestinal tract, biliary tract, and pancreas. Others complications consisted of respiratory insufficiency, lobar atelectasis, and postoperatory bleeding. CONCLUSION: Hospitalized obese patients might present nutritional risk, being obesity grade I the more frequently one in general hospital. Positive association between nutritional risk and complication frequency was verified in the present study, justifying by the nutritional screening at the hospital admission as routinely, including overweight and obese patients.

  11. Perspectives from the Patient and the Healthcare Professional in Multiple Sclerosis: Social Media and Participatory Medicine.

    Science.gov (United States)

    Kantor, Daniel; Bright, Jeremy R; Burtchell, Jeri

    2017-12-08

    When faced with a diagnosis of multiple sclerosis (MS), patients often turn to the Internet and social media to find support groups, read about the experiences of other people affected by MS and seek their advice, and research their condition and treatment options to discuss with their healthcare professionals (HCPs). Here, we examine the use of social media and the Internet among patients with MS, considering its impact on patient empowerment and patient participation in treatment decision-making and MS research. These themes are exemplified with first-hand experiences of the patient author. We also explore the impact of the Internet and social media on the management of patients from the perspective of HCPs, including new opportunities for HCPs to engage in participatory medicine and to improve communication with and among patients. We consider both the benefits afforded to and the potential pitfalls faced by HCPs when interacting with their patients via these routes, and discuss potential concerns around privacy and confidentiality in the use of the Internet and social media in the clinical context. Communication online is driving the evolution of the patient-HCP relationship, and is empowering patients to participate more actively in the decision-making process relating to the provision of their health care. Funding Novartis Pharmaceuticals Corporation.

  12. The influence of patient's consciousness regarding high blood pressure and patient's attitude in face of disease controlling medicine intake

    Directory of Open Access Journals (Sweden)

    Maria Aparecida A Moura Strelec

    2003-10-01

    Full Text Available OBJECTIVE: To assess the relation between blood pressure control and the following: the Morisky-Green test, the patient's consciousness regarding high blood pressure, the patient's attitude in face of medicine intake, the patient's attendance at medical consultations, and the subjective physician's judgment. METHODS: We studied 130 hypertensive patients with the following characteristics: 73% females, 60±11 years, 58% married, 70% white, 45% retired, 45% with incomplete elementary schooling, 64% had a familial income of 1 to 3 minimum wages, body mass index of 30±7 kg/m², consciousness regarding the disease for a mean period of 11±9.5 years, and mean treatment duration of 8 ±7 years. RESULTS: Only 35% of the hypertensive individuals had blood pressure under control and a longer duration of treatment (10±7 vs 7±6.5 years; P<0.05. The retiree predominated. The result of the Morisky-Green test did not relate to blood pressure control. In evaluating the attitude in face of medicine intake, the controlled patients achieved significantly higher scores than did the noncontrolled patients (8±1.9 vs 7 ±2, P<0.05. The hypertensive patients had higher levels of consciousness regarding their disease and its treatment, and most (70% patients attended 3 or 4 medical consultations, which did not influence blood pressure control. The physicians attributed significantly higher scores regarding adherence to treatment to controlled patients (6±0.8 vs 5±1.2; P<0.05. CONCLUSION: Consciousness regarding the disease, the Morisky-Green test, and attendance to medical consultations did not influence blood pressure control.

  13. [Changes in knowledge and carrying out the advance directives of patients admitted to internal medicine].

    Science.gov (United States)

    Pérez, M; Herreros, B; Martín, M D; Molina, J; Guijarro, C; Velasco, M

    2013-01-01

    Advance directives (ADs), are documents in which patients express in advance that their wishes are fulfilled when they are unable to communicate them. It is unknown whether patients admitted to internal medicine are more aware of and make ADs. To study the changes in the level of knowledge and implementation of AD among patients admitted to an internal medicine department of a hospital in Madrid since a specific regulation to implement them was introduced. A survey was conducted among patients admitted to internal medicine in two periods: 2008 and 2010. A total of 206 surveys were analysed (84 in 2008 and 122 in 2010). The mean age of the patients was 76.8 years, and 51.5% were women. More than two-thirds (69.4%) had a co-morbidity. and 4.4% had a terminal illness, with no statistical differences between the periods. Only 5.3% knew what ADs are, 1 had implemented ADs, and 46.1%, once informed, would like to implement them. There were no differences between 2008 and 2010 as regards knowledge and implementation of AD. In 2010 there was a greater interest to implement them (would like to implement them: 52.5 vs 36.9%), although in 2010 less respondents believe that AD would change the attitude of the doctor (not change the attitude: 92.6 vs. 69%, P<.001). Knowledge and implementation of AD did not change significantly in the years following the regulation (from 2008-2010). In both periods, their knowledge and implementation are scarce. Copyright © 2012 SECA. Published by Elsevier Espana. All rights reserved.

  14. Complementary and alternative medicine usage among cardiac patients: a descriptive study.

    Science.gov (United States)

    Bahall, Mandreker

    2015-03-31

    The use of complementary and alternative medicine (CAM) persists, despite the availability of conventional medicine (CM), modernisation, globalisation, technological advancement, and limited scientific evidence supporting CAM. People with cardiovascular diseases often use CAM, despite possible major adverse effects and lack of evidence supporting CAM claims. This study explored CAM use among cardiac patients, the types of CAM used, reasons and factors that influence its use, and the association between patient demographics and CAM use. This cross-sectional quantitative study was conducted using quota sampling to survey 329 public clinic adult cardiac patients within the South-West Regional Health Authority (SWRHA) of Trinidad and Tobago. From 1 July 2012 to 31August 2012, each participant completed questionnaires, after consenting to participate. Data analysis included χ(2) tests and binary logistic regression. One hundred eighty-five (56.2%; standard error [SE] = 2.74%) patients used CAM. Herbal medicine was the most common CAM (85.9%; SE = 2.56%), followed by spiritual therapy/mind-body systems (61.6%; SE = 3.58%), physical therapy/body manipulation (13.5%; SE = 2.51%), alternative systems (8.1%; SE = 2.01%), and other methods (3.8%; SE = 1. 41%). The patients believed that CAM promotes health and wellness (79.5%; SE = 2.97%), assists in fighting illness (78.9%; SE = 3.00%), addresses the limitations of CM (69.2%; SE = 3.56%), alleviates symptoms (21.6%; SE = 6.51%), costs less than CM (21.6 %, SE = 3.03), and has fewer adverse/damaging effects than CM (29.7, SE =3.36), or they were disappointed with CM (12.4%, SE = 2.42). Ethnicity and religion were associated with CAM usage, but only ethnicity was a useful predictor of CAM use. Complementary and alternative medicine use was high among cardiac patients (56.2%, SE = 2.74%), and associated with ethnicity and religion. Friends, family, and perceived mode of

  15. Patient preparation for intravenous urography: are we practising evidence-based medicine?

    International Nuclear Information System (INIS)

    Singh, S.; Reddicliffe, N.; Parker, D.A.

    2008-01-01

    Aim: To identify the current practice of patient preparation prior to intravenous urography (IVU) in England and Wales. Methods: Seventy-two hospitals were contacted to request details regarding the duration of fluid restriction, adherence to a low-residue diet, or use of laxatives for patient preparation before IVU examinations. Results: Results showed that out of 45 hospitals that still use IVU, only six (13.3%) did not follow a patient-preparation regime. The vast majority of the hospitals contacted (87.6%), implemented either fluid and/or food restriction, or prescribed laxatives. The duration of fluid and food restriction varied from 2-12 h duration, and some departments advocated 48 h of laxatives. Conclusion: A large proportion of hospitals are not practising evidence-based medicine in relation to IVU, and we suggest that the practice of patient preparation should be abandoned

  16. Physical and rehabilitation medicine (PRM) care pathways: "patients after total hip arthroplasty".

    Science.gov (United States)

    Ribinik, P; Le Moine, F; de Korvin, G; Coudeyre, E; Genty, M; Rannou, F; Yelnik, A; Calmels, P

    2012-11-01

    This document is part of a series of documents designed by the French Physical and Rehabilitation Medicine Society (SOFMER) and the French Federation of PRM (FEDMER). These documents describe the needs for or a specific type of patients; PRM care objectives, human and material resources to be implemented, chronology as well as expected outcomes. "Care pathways in PRM" is a short document designed to enable the reader (physicians, decision-maker, administrator, lawyer or finance manager) to quickly apprehend the needs of these patients and the available therapeutic care structures for proper organization and pricing of these activities. Patients after total hip arthroplasty are classified into three care sequences and two clinical categories, each one being treated with the same six parameters according to the International Classification of Functioning, Disability and Health (WHO), while taking into account personal and environmental factors that could influence the needs of these patients. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

  17. Physical and rehabilitation medicine (PRM) care pathways: "patients after total knee arthroplasty".

    Science.gov (United States)

    Ribinik, P; Le Moine, F; de Korvin, G; Coudeyre, E; Genty, M; Rannou, F; Yelnik, A; Calmels, P

    2012-11-01

    This document is part of a series of documents designed by the French Physical and Rehabilitation Medicine Society (SOFMER) and the French Federation of PRM (FEDMER). These documents describe the needs for or a specific type of patients; PRM care objectives, human and material resources to be implemented, chronology as well as expected outcomes. "Care pathways in PRM" is a short document designed to enable the reader (physicians, decision-maker, administrator, lawyer or finance manager) to quickly apprehend the needs of these patients and the available therapeutic care structures for proper organization and pricing of these activities. Patients after total knee arthroplasty are classified into three care sequences and two clinical categories, each one being treated with the same six parameters according to the International Classification of Functioning, Disability and Health (WHO), while taking into account personal and environmental factors that could influence the needs of these patients. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

  18. Patient preparation for intravenous urography: are we practising evidence-based medicine?

    Science.gov (United States)

    Singh, S; Reddicliffe, N; Parker, D A

    2008-02-01

    To identify the current practice of patient preparation prior to intravenous urography (IVU) in England and Wales. Seventy-two hospitals were contacted to request details regarding the duration of fluid restriction, adherence to a low-residue diet, or use of laxatives for patient preparation before IVU examinations. Results showed that out of 45 hospitals that still use IVU, only six (13.3%) did not follow a patient-preparation regime. The vast majority of the hospitals contacted (87.6%), implemented either fluid and/or food restriction, or prescribed laxatives. The duration of fluid and food restriction varied from 2-12 h duration, and some departments advocated 48 h of laxatives. A large proportion of hospitals are not practising evidence-based medicine in relation to IVU, and we suggest that the practice of patient preparation should be abandoned.

  19. Experience of an eating disorders out-patient program in an internal medicine hospital.

    Science.gov (United States)

    García-García, Eduardo; Rocha-Velis, Ingrid; Vázquez-Velázquez, Verónica; Kaufer-Horwitz, Martha; Reynoso, Ricardo; Méndez, Juan Pablo

    2013-12-01

    The aim of this study was to develop a successful low budget out-patient program, in an internal medicine hospital, for patients presenting eating disorders in an emerging nation. A total of 144 patients were included in a 6 month intervention centered in medical support, with fortnightly medical consultations, monthly counseling by a nutritionist and by a psychiatrist and three psycho-educational courses. The Three Factor Eating Questionnaire and the Eating Disorders Inventory-2 were performed at the beginning and at the end of the study. After 6 months, more than half of the patients who completed the intervention were on remission. Substantial improvement was observed regarding the scores of both instruments after completion of the program. The outcome of this study compares favorably to previous published data of more intensive programs. These results were obtained having little infrastructure, a low budget and limited human resources, making this a suitable eating disorders program for emerging nations.

  20. Modern medicine is losing its humanistic essence: 'Patients no more, but diseases' is the new motto now.

    Directory of Open Access Journals (Sweden)

    Filiz Bulut

    2016-12-01

    Full Text Available For medicine, which is as old as history of humanity, the virtue of helping has always been a priority. However, the way medicine see diseases and human being changed from time to time, and the treatment approaches were shaped accordingly. Ancient Greek's Knidos and Kos Schools of Medicine reflecting one of the earliest schools of systematic medical education show us two distinct perspectives. School of Kos carries the characteristics of Hippocratic medicine and reach a diagnosis not considering the disease symptoms but through the disease itself, and the prognosis of the patient is taken into consideration as well. The disease and the patient are handled with a holistic view without focusing on an organ and the treatment is planned accordingly, while the School of Knidos focuses mainly on the disease not to the patient and reach a clinical diagnosis based on the specifications presented from the symptoms. Today's modern medicine mentality has significant similarities with the School of Knidos approach. This model ignores the cases specific to the patient while diagnosing and applying treatment methods. The physicians who get more specialised every day are becoming implementers of an alienated medicine in contrast to Hippocrates's 'There is no disease, but the patient' aphorism. Nowadays, with the rapidly developing technology and ever-growing accumulation of knowledge, it is possible to say that we moved away from the 'humanistic' medicine concept. In addition, in today's medicine, embedding the business concepts into medicine and commercialization of medicine have significant effects on this phenomenon. The establishment and assessment of the relationship of patient-physician on the basis of ‘customer satisfaction' is changing physicians' opinions on their profession and patients, which leads to a worrisome transformation such as moving away from traditional medical virtues. In this process, respect and trust for the physician are shaken and

  1. Liver enzyme abnormalities in taking traditional herbal medicine in Korea: A retrospective large sample cohort study of musculoskeletal disorder patients.

    Science.gov (United States)

    Lee, Jinho; Shin, Joon-Shik; Kim, Me-Riong; Byun, Jang-Hoon; Lee, Seung-Yeol; Shin, Ye-Sle; Kim, Hyejin; Byung Park, Ki; Shin, Byung-Cheul; Lee, Myeong Soo; Ha, In-Hyuk

    2015-07-01

    The objective of this study is to report the incidence of liver injury from herbal medicine in musculoskeletal disease patients as large-scale studies are scarce. Considering that herbal medicine is frequently used in patients irrespective of liver function in Korea, we investigated the prevalence of liver injury by liver function test results in musculoskeletal disease patients. Of 32675 inpatients taking herbal medicine at 7 locations of a Korean medicine hospital between 2005 and 2013, we screened for liver injury in 6894 patients with liver function tests (LFTs) at admission and discharge. LFTs included t-bilirubin, AST, ALT, and ALP. Liver injury at discharge was assessed by LFT result classifications at admission (liver injury, liver function abnormality, and normal liver function). In analyses for risk factors of liver injury at discharge, we adjusted for age, sex, length of stay, conventional medicine intake, HBs antigen/antibody, and liver function at admission. A total 354 patients (prevalence 5.1%) had liver injury at admission, and 217 (3.1%) at discharge. Of the 354 patients with liver injury at admission, only 9 showed a clinically significant increase after herbal medicine intake, and 225 returned to within normal range or showed significant liver function recovery. Out of 4769 patients with normal liver function at admission, 27 (0.6%) had liver injury at discharge. In multivariate analyses for risk factors, younger age, liver function abnormality at admission, and HBs antigen positive were associated with injury at discharge. The prevalence of liver injury in patients with normal liver function taking herbal medicine for musculoskeletal disease was low, and herbal medicine did not exacerbate liver injury in most patients with injury prior to intake. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  2. Data collection of patients with diabetes in family medicine: a study in north-eastern Italy.

    Science.gov (United States)

    Vaona, Alberto; Del Zotti, Franco; Girotto, Sandro; Marafetti, Claudio; Rigon, Giulio; Marcon, Alessandro

    2017-08-16

    Studies on data collection and quality of care in Italian family medicine are lacking. The aim of this study was to assess the completeness of data collection of patients with diabetes in a large sample of family physicians in the province of Verona, Veneto region, a benchmark for the Italian National Health System. We extracted the data on all the patients with diabetes from the electronic health records of 270 family physicians in 2006 and 2009. We reported the percentage of patients with data recorded for 12 indicators of performance derived from the National Institute for Clinical Excellence diabetes guidelines. Secondarily, we assessed quality of care using the Q-score (the lower the score, the greater the risk of cardiovascular events). Patients with diabetes were 18,507 in 2006 and 20,744 in 2009, and the percentage of patients registered as having diabetes was 4.9% and 5.4% of the total population, respectively (p collection improved for all the indicators between 2006 and 2009 but the performance was still low at the end of the study period: patients with no data recorded were 42% in 2006 and 32% in 2009, while patients with data recorded for ≥5 indicators were 9% in 2006 and 17% in 2009. The Q-score improved (mean ± SD, 20.7 ± 3.0 in 2006 vs 21.3 ± 3.6 in 2009, p collection and quality of care for patients with diabetes during the study period. Nonetheless, data collection was still unsatisfactory in comparison with international benchmarks in 2009. Structural interventions in the organization of family medicine, which have not been implemented since the study period, should be prioritised in Italy.

  3. Cost of Treatment of Hospitalized Patients with Diabetes in Prenda Hospital Medicine Service, Angola

    Directory of Open Access Journals (Sweden)

    António Zangulo

    2017-07-01

    Full Text Available Introduction: Diabetes has a major impact on morbidity and mortality today. It is estimated that by 2040, about 642 million people are affected worldwide, of which, 34.2 million are from sub-Saharan countries. The direct annual cost of diabetes health care worldwide is estimated at about 153 billion dollars. These patients represent 30% to 40% of all admissions to emergency services, leading to high values of hospital expenditure. We aim to evaluate the cost of treatment of patients with diabetes admitted to Prenda Hospital Medicine Service in 2012. Methods: Retrospective analytical observational study, with data collected from the clinical processes of medical service (age and gender, length of hospitalization, resources consumed, cost of treatment per patient and discharge. Results: Out of 121 patients, the majority was female (n = 70, 57.9%. The age group of 36 to 45 years old was the most frequent among these patients (n = 26, 21.5%. November was the month that recorded the largest number of admissions (n = 17, 14%. About 45.5% were hospitalized during five to eight days, on average for nine days. The majority (76.9% was discharged due to health condition improvement. The price of materials used for treatment of the disease had high variation, and 31 550.15 kwanzas was spent to acquire them. The direct cost per patient per day was 4170.11 kwanzas and the estimated annual cost of care of diabetic patients admitted to Prenda Hospital was 45 525 490.9 kwanzas in 2012. Discussion and Conclusion: These results are in accordance with other studies, indicating a relevant cost of treatment of diabetic patients admitted to Prenda Hospital Medicine Service in 2012.

  4. Nuclear Medicine Imaging of Infection in Cancer Patients (With Emphasis on FDG-PET)

    Science.gov (United States)

    Vos, Fidel J.; van der Graaf, Winette T.A.; Oyen, Wim J.G.

    2011-01-01

    Infections are a common cause of death and an even more common cause of morbidity in cancer patients. Timely and adequate diagnosis of infection is very important. This article provides clinicians as well as nuclear medicine specialists with a concise summary of the most important and widely available nuclear medicine imaging techniques for infectious and inflammatory diseases in cancer patients with an emphasis on fluorodeoxyglucose positron emission tomography (FDG-PET). 67Ga-citrate has many unfavorable characteristics, and the development of newer radiopharmaceuticals has resulted in the replacement of 67Ga-citrate scintigraphy by scintigraphy with labeled leukocytes or FDG-PET for the majority of conditions. The sensitivity of labeled leukocyte scintigraphy in non-neutropenic cancer patients is comparable with that in patients without malignancy. The specificity, however, is lower because of the uptake of labeled leukocytes in many primary tumors and metastases, most probably as a result of their inflammatory component. In addition, labeled leukocyte scintigraphy cannot be used for febrile neutropenia because of the inability to harvest sufficient peripheral leukocytes for in vitro labeling. FDG-PET has several advantages over these conventional scintigraphic techniques. FDG-PET has shown its usefulness in diagnosing septic thrombophlebitis in cancer patients. It has also been shown that imaging of infectious processes using FDG-PET is possible in patients with severe neutropenia. Although larger prospective studies examining the value of FDG-PET in cancer patients suspected of infection, especially in those with febrile neutropenia, are needed, FDG-PET appears to be the most promising scintigraphic technique for the diagnosis of infection in this patient group. PMID:21680576

  5. A Department of Medicine Infrastructure for Patient Safety and Clinical Quality Improvement.

    Science.gov (United States)

    Mathews, Simon C; Pronovost, Peter J; Daugherty Biddison, E Lee; Petty, Brent G; Anderson, Mark E; Nelson, Terry S; Outten, Katie; Langlotz, Ronald; Duda, Denice; Herzke, Carrie A; Peairs, Kimberly S; Golden, Sherita H; Lautzenheiser, Matthew B; James, Hailey J; Desai, Sanjay V; Keller, Sara C; Feldman, Leonard S; Pahwa, Amit K; Berry, Stephen A

    2017-11-01

    Payers, providers, and patients increasingly recognize the importance of quality and safety in health care. Academic Departments of Medicine can advance quality and safety given the large populations they serve and the broad spectrum of diseases they treat. However, there are only few detailed examples of how quality and safety can be organized. This article describes a practical model at The Johns Hopkins Hospital Department of Medicine and details its structure and operation within a large academic health system. It is based on a fractal model that integrates multiple smaller units similar in structure (composition of faculty/staff), process (use of similar tools), and approach (using a common framework to address issues). This organization stresses local, multidisciplinary leadership, facilitates horizontal connections for peer learning, and maintains vertical connections for broader accountability.

  6. Using text-mining techniques in electronic patient records to identify ADRs from medicine use

    DEFF Research Database (Denmark)

    Warrer, Pernille; Hansen, Ebba Holme; Jensen, Lars Juhl

    2012-01-01

    included empirically based studies on text mining of electronic patient records (EPRs) that focused on detecting ADRs, excluding those that investigated adverse events not related to medicine use. We extracted information on study populations, EPR data sources, frequencies and types of the identified ADRs......, medicines associated with ADRs, text-mining algorithms used and their performance. Seven studies, all from the United States, were eligible for inclusion in the review. Studies were published from 2001, the majority between 2009 and 2010. Text-mining techniques varied over time from simple free text...... searching of outpatient visit notes and inpatient discharge summaries to more advanced techniques involving natural language processing (NLP) of inpatient discharge summaries. Performance appeared to increase with the use of NLP, although many ADRs were still missed. Due to differences in study design...

  7. Negotiating complementary and alternative medicine use in primary care visits with older patients.

    Science.gov (United States)

    Koenig, Christopher J; Ho, Evelyn Y; Yadegar, Vivien; Tarn, Derjung M

    2012-12-01

    To empirically investigate the ways in which patients and providers discuss Complementary and Alternative Medicine (CAM) treatment in primary care visits. Audio recordings from visits between 256 adult patients aged 50 years and older and 28 primary care physicians were transcribed and analyzed using discourse analysis, an empirical sociolinguistic methodology focusing on how language is used to negotiate meaning. Discussion about CAM occurred 128 times in 82 of 256 visits (32.0%). The most frequently discussed CAM modalities were non-vitamin, non-mineral supplements and massage. Three physician-patient interactions were analyzed turn-by-turn to demonstrate negotiations about CAM use. Patients raised CAM discussions to seek physician expertise about treatments, and physicians adopted a range of responses along a continuum that included encouragement, neutrality, and discouragement. Despite differential knowledge about CAM treatments, physicians helped patients assess the risks and benefits of CAM treatments and made recommendations based on patient preferences for treatment. Regardless of a physician's stance or knowledge about CAM, she or he can help patients negotiate CAM treatment decisions. Providers do not have to possess extensive knowledge about specific CAM treatments to have meaningful discussions with patients and to give patients a framework for evaluating CAM treatment use. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  8. Complementary and alternative medicine use in patients with hematological cancers in Malaysia.

    Science.gov (United States)

    Gan, G G; Leong, Y C; Bee, P C; Chin, E; Teh, A K H

    2015-08-01

    Complementary and alternative medicine (CAM) is often used by cancer patients, but not many studies had been published on the prevalence of CAM use in patients with hematological cancers. This study aims to determine the prevalence of CAM and type of CAM used in this group of patients in a multiracial and multicultural country. This is a cross-sectional survey carried out in two hospitals in Malaysia. Patients with underlying hematological cancers were asked to complete the questionnaires on CAM and the Hospital Anxiety and Depression Scale. A total of 245 patients participated. The prevalence of CAM use was 70.2 %. The most common types of CAM used are biological-based therapies (90.2 %) and mind-body interventions (42 %). Vitamin and diet supplements (68.6 %) and folk/herb remedies (58 %) are the most common biological-based therapies used. There is no significant association of CAM use with age, gender, education level, and household income. Female patients are more likely to use more than one CAM therapies. The most common reason reported for CAM use was to boost immunity (57 %) and cure (24 %). Majority of patients (65 %) felt CAM was effective, and 60 % did not inform their physicians regarding CAM usage. In view of the high prevalence of CAM use in patients with hematological cancers, it is important that the physicians play an active role in seeking information from patients and to monitor possible drug-vitamin-herbal interactions.

  9. Utilization and perceived effectiveness of complementary and alternative medicine in patients with dystonia.

    Science.gov (United States)

    Junker, Judith; Oberwittler, Christoph; Jackson, Didi; Berger, Klaus

    2004-02-01

    The use of complementary and alternative medicine (CAM) is increasing worldwide, especially by patients with chronic diseases. To date, no data are available about utilization and perceived effectiveness of CAM in patients with dystonia. A questionnaire survey on utilization and costs of CAM was completed by 180 members of the German Dystonia Society, a patient advocate group. In total, 131 dystonia patients (73%) were current or former users of CAM, 55 patients used CAM in addition to botulinum toxin A injections, and 86 patients had experience with three or more CAM methods. The options used most widely were acupuncture (56%), relaxation techniques (44%), homeopathy (27%), and massages (26%). Among users of specific CAM methods, breathing therapy, Feldenkrais, massages, and relaxation techniques were perceived as most effective. On average, patients spent 1,513 Euro on CAM without reimbursement. There was no correlation between costs and perceived effectiveness of different methods. In line with other studies on chronically ill patients, our results show that dystonia patients frequently utilize CAM methods, often in addition to conventional treatment. There is a growing need to evaluate scientifically the effect of CAM methods on symptom severity and quality of life in dystonia, to prevent utilization of costly and ineffective CAM treatments.

  10. Características psicológicas de pacientes submetidos a cirurgia bariátrica Psychological characteristics of patients submitted to bariatric surgery

    Directory of Open Access Journals (Sweden)

    Ronis Magdaleno Jr.

    2009-01-01

    terapêutico específico.INTRODUCTION: The great number of patients submitted bariatric surgery who have psychological and psychiatric complications during the postoperative period require a thorough preoperative investigation and a categorization with the purpose of predicting possible complications and personalizing psychological care that might favor patient compliance. Psychodynamic assessment may provide data for such categorization and, thus, suggest effective pre- and postoperative approach strategies. Therefore, the objective of this study was to identify personality structures that may be useful in the postoperative follow-up, as well as additional inclusion and exclusion criteria for the surgical procedure. METHOD: Report of empirical survey conducted during psychotherapy sessions with an open group of patients who underwent bariatric surgery. DISCUSSION: After surgery, patients may experience phases of emotional restructuring, such as an initial phase of feeling triumphant, followed by a phase when there is risk of melancholic behavior and new addictions. We identified three categories of psychological structures: melancholic structure (patients seem to be more likely to develop other postoperative addictive behaviors, mainly eating disorders, since they cannot tolerate the frustration of the loss; dementalized structure (due to the lack of elaborative capacity, patients are unable to reorganize themselves in face of the challenge of keeping their weight under control; and perverse structure (patients comply with the scheduled weight loss; however, their behavior makes the health team experience uncomfortable situations. Establishing psychological categories may be crucial in order to suggest postoperative management strategies, including referral to a psychotherapist with the purpose of providing personalized care, thus increasing specific therapeutic success.

  11. Disposition of Patients Before and After Establishment of Emergency Medicine Specialists

    Directory of Open Access Journals (Sweden)

    Payman Asadi

    2014-09-01

    Full Text Available Introduction: Emergency department (ED as the fundamental part of hospital has a specific importance due to admitting the most various and sensitive group of patients. The aim of the ED is presenting services with highest quality in the least time. To reach this goal establishment of an emergency medicine specialist who performs assessment, resuscitation, stabilization, detection, and maintenance of emergency patients is noteworthy. The aim of this study was evaluating the effect of establishing the emergency medicine specialists on the performance of ED in Poursina Hospital, Rasht, Iran.  Methods: In this cross-sectional study files of all patients hospitalized in the ED of Poursina, Rasht, Iran, through 2005-2012 were evaluated. Variables such as age, gender, cause of refer and number of hospitalization, number of discharging from department, percentage of bed occupation and daily bed occupation, time of hospitalization, number of discharging under six hours, number of transportation to other wards or hospitals, and the rate of bed circulation in the ED were assessed, too. Data was gathered through hospital information system and analyzed using SPSS 20. Results: Through 2005 to 2012 number of admitted patients in the ED has increased so that the most admitted number was related to 2012 (p=0.0001. The present of discharged patients under six hours and the rate of direct discharging before the presence of emergency medicine specialists have increased from 15.5% and 58.9% to 23.4% and 61.2% in after their presence, respectively(p=0.001. Transporting to other wards and hospitals were also decreased from 41.1% to 38.8% (p=0.0001. The occupied beds percentage after presenting of emergency medicine specialists has noticeably decreased compared to the past, while bed turnover rate increased. In other words, the bed turnover mean has increased from 354.5±108.4 during 2005-2008 to 637.7±30.8 through 2009-2012 (p=0.002. Also, during 2005-2008 the

  12. Patient satisfaction of primary care for musculoskeletal diseases: A comparison between Neural Therapy and conventional medicine

    Directory of Open Access Journals (Sweden)

    Staub Lukas

    2008-06-01

    Full Text Available Abstract Background The main objective of this study was to assess and compare patient satisfaction with Neural Therapy (NT and conventional medicine (COM in primary care for musculoskeletal diseases. Methods A cross-sectional study in primary care for musculoskeletal disorders covering 77 conventional primary care providers and 18 physicians certified in NT with 241 and 164 patients respectively. Patients and physicians documented consultations and patients completed questionnaires at a one-month follow-up. Physicians documented duration and severity of symptoms, diagnosis, and procedures. The main outcomes in the evaluation of patients were: fulfillment of expectations, perceived treatment effects, and patient satisfaction. Results The most frequent diagnoses belonged to the group of dorsopathies (39% in COM, 46% in NT. We found significant differences between NT and COM with regard to patient evaluations. NT patients documented better fulfilment of treatment expectations and higher overall treatment satisfaction. More patients in NT reported positive side effects and less frequent negative effects than patients in COM. Also, significant differences between NT and COM patients were seen in the quality of the patient-physician interaction (relation and communication, medical care, information and support, continuity and cooperation, facilities availability, and accessibility, where NT patients showed higher satisfaction. Differences were also found with regard to the physicians' management of disease, with fewer work incapacity attestations issued and longer consultation times in NT. Conclusion Our findings show a significantly higher treatment and care-related patient satisfaction with primary care for musculoskeletal diseases provided by physicians practising Neural Therapy.

  13. Nutrient-rich versus nutrient-poor foods for depressed patients based on Iranian Traditional Medicine resources

    NARCIS (Netherlands)

    Tavakkoli-Kakhki, Mandana; Eslami, Saeid; Motavasselian, Malihe

    2015-01-01

    Objectives: Considering the positive effects of certain nutrients on depression, increasingly prevalent in the contemporary societies, we investigated the nutritional content of prescribed and prohibited foodstuffs for depressed patients in Iranian Traditional Medicine resources. Materials and

  14. Clinical Complexity in Medicine: A Measurement Model of Task and Patient Complexity.

    Science.gov (United States)

    Islam, R; Weir, C; Del Fiol, G

    2016-01-01

    Complexity in medicine needs to be reduced to simple components in a way that is comprehensible to researchers and clinicians. Few studies in the current literature propose a measurement model that addresses both task and patient complexity in medicine. The objective of this paper is to develop an integrated approach to understand and measure clinical complexity by incorporating both task and patient complexity components focusing on the infectious disease domain. The measurement model was adapted and modified for the healthcare domain. Three clinical infectious disease teams were observed, audio-recorded and transcribed. Each team included an infectious diseases expert, one infectious diseases fellow, one physician assistant and one pharmacy resident fellow. The transcripts were parsed and the authors independently coded complexity attributes. This baseline measurement model of clinical complexity was modified in an initial set of coding processes and further validated in a consensus-based iterative process that included several meetings and email discussions by three clinical experts from diverse backgrounds from the Department of Biomedical Informatics at the University of Utah. Inter-rater reliability was calculated using Cohen's kappa. The proposed clinical complexity model consists of two separate components. The first is a clinical task complexity model with 13 clinical complexity-contributing factors and 7 dimensions. The second is the patient complexity model with 11 complexity-contributing factors and 5 dimensions. The measurement model for complexity encompassing both task and patient complexity will be a valuable resource for future researchers and industry to measure and understand complexity in healthcare.

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

    Science.gov (United States)

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

    2014-01-01

    Over 20 states now approve medical marijuana for a long list of "indications," and more states may well offer access in the near future. Surveys have demonstrated that pain is the most common indication for medical use of cannabis. As more individuals gain access to this botanical product through state ballot initiatives and legislative mandate, the pain specialist is likely to be confronted by patients either seeking such treatment where permitted, or otherwise inquiring about its potential benefits and harms, and alternative pharmaceuticals containing cannabinoids. Whether or not they are in the position to prescribe medical cannabis, pain physicians would seem to have an obligation to understand and inform their patients on key issues of the evidence base on cannabinoid therapeutics. One way to fulfill this obligation might be to borrow from concepts developed in the prescription of opioids: the use of a written agreement to describe and minimize risks. Regrettably, the widespread adoption of opioids was undertaken while harmful effects were minimized; obviously, no one wants to repeat this misstep. This article describes a method of educating patients in a manner analogous to other treatment agreements. Undoubtedly, the knowledge base concerning risks will be an iterative process as we learn more about the long-term use of medicinal cannabis. But we should start the process now so that patients may be instructed about our current conception of what the use of medicinal cannabis entails. PMID:25370134

  16. [Prescription errors in patients admitted to an internal medicine department from the emergency room].

    Science.gov (United States)

    Gutiérrez Paúls, L; González Alvarez, I; Requena Caturla, T; Fernández Capitán, M C

    2006-01-01

    To identify and quantify emergency room prescription errors upon patient admission in an internal medicine unit, assess their severity and causes, and evaluate their potential clinical impact. Discrepancies found between emergency room and internal medicine unit prescriptions were analyzed by 4th-year resident pharmacists. Prescription errors were collected and classified according to their severity and potential morbidity, and a medical analysis of service value was performed according to Overhage's method. Furthermore, pharmacist actions regarding therapeutic regimen optimization are described. Of 177 patients, 50 had prescription errors, for a total of 141 errors. Seven percent of prescriptions had an error. Mean errors per patient amounted to 0.8 (SD 1.51). Most commonly involved medications included anti-asthmatic and anti-infectious agents, and fluid therapy agents. On severity assessment 12.8% were considered severe, and 57.4% were considered significant. The main cause was omission of a needed therapy. Potential pharmacotherapeutic morbidity is related to adverse effects and cardiovascular disease. Medical assessment considered 12% very significant, and 52% significant. Pharmacist actions were directed towards effectiveness improvement in 57% of cases, and safety in 43.2% of cases. Emergency departments, as main entry points for patient admission to hospital, should be considered a priority in prescription quality improvement programs.

  17. Complementary and alternative medicine for patients with chronic fatigue syndrome: A systematic review

    Directory of Open Access Journals (Sweden)

    Cao Huijuan

    2011-10-01

    Full Text Available Abstract Background Throughout the world, patients with chronic diseases/illnesses use complementary and alternative medicines (CAM. The use of CAM is also substantial among patients with diseases/illnesses of unknown aetiology. Chronic fatigue syndrome (CFS, also termed myalgic encephalomyelitis (ME, is no exception. Hence, a systematic review of randomised controlled trials of CAM treatments in patients with CFS/ME was undertaken to summarise the existing evidence from RCTs of CAM treatments in this patient population. Methods Seventeen data sources were searched up to 13th August 2011. All randomised controlled trials (RCTs of any type of CAM therapy used for treating CFS were included, with the exception of acupuncture and complex herbal medicines; studies were included regardless of blinding. Controlled clinical trials, uncontrolled observational studies, and case studies were excluded. Results A total of 26 RCTs, which included 3,273 participants, met our inclusion criteria. The CAM therapy from the RCTs included the following: mind-body medicine, distant healing, massage, tuina and tai chi, homeopathy, ginseng, and dietary supplementation. Studies of qigong, massage and tuina were demonstrated to have positive effects, whereas distant healing failed to do so. Compared with placebo, homeopathy also had insufficient evidence of symptom improvement in CFS. Seventeen studies tested supplements for CFS. Most of the supplements failed to show beneficial effects for CFS, with the exception of NADH and magnesium. Conclusions The results of our systematic review provide limited evidence for the effectiveness of CAM therapy in relieving symptoms of CFS. However, we are not able to draw firm conclusions concerning CAM therapy for CFS due to the limited number of RCTs for each therapy, the small sample size of each study and the high risk of bias in these trials. Further rigorous RCTs that focus on promising CAM therapies are warranted.

  18. Analysis of radiation doses to patients from diagnostic department of nuclear medicine

    International Nuclear Information System (INIS)

    Lepej, L.; Messingerova, M.

    1995-01-01

    In this paper the values of mean effective dose equivalents per unit activity (H E/1Bq ) were used for the calculation of mean effective dose equivalents for one examination (H E ). The collective effective dose equivalents for each radiopharmaceutical and type of examination (S ER ) and global collective effective dose equivalent for department for all radiopharmaceuticals (S E ) during evaluated period were defined. The data for years from 1992 to 1994 were evaluated and compared with results in literature. The evaluation of radiation doses in nuclear medicine department is useful parameter for internal quality control. Using this method, the radiation dose in this laboratory was changed to minimum (under mean value of Slovak Republic). Unfortunately, the real data of patients radiation doses are different from the calculated one. Due to different kinetic of radiopharmaceuticals in individual patients (influenced by pathology, age, etc.) the evaluation of radiation burden to nuclear medicine patients is problematic. But this approach enable the relative comparison of the changes in values of H E and S E during the observed period. The evaluation of individual (minimal) effective dose equivalent - (H min ) which represents dose calculated under physiologic conditions can be useful for indication of diagnostic examination by physicians. Therefore the systematic registration of H min from all examinations - patient's radiation history. This is specially important in the case of children and young people. The importance of the proposed method, is in regulation of radiation dose from nuclear medicine diagnostic examinations, not only be the control of number and type of examinations, but also by selection of used radiopharmaceuticals and by the way how to use them. (J.K.) 1 fig., 2 refs

  19. Complementary and alternative medicine for patients with chronic fatigue syndrome: A systematic review

    Science.gov (United States)

    2011-01-01

    Background Throughout the world, patients with chronic diseases/illnesses use complementary and alternative medicines (CAM). The use of CAM is also substantial among patients with diseases/illnesses of